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Kids Doctor Checkup

MY PRACTICE

As a responsible Doctor, I make sure patients have time to get to know me and my professional background so they’ll feel comfortable with their care choice. Through a holistic approach I view each patient as a whole rather than a single symptom to be treated. I’m dedicated to building long-lasting relationships based on trust and medical integrity with every single patient.

ADHD ASSESSMENT & DIAGNOSIS (Identification)

Referral

The service age criteria is 6 years up to 18th birthday.

If 18th birthday is coming up soon it may be advisable to see an adult specialist. 

As well as ADHD, if you are very concerned regarding a mental health problem such as depression or your child has expressed suicidal or self-harm thoughts, then it would be advisable to see a Psychiatrist. Please let me know and I can recommend. 

I only accepts referrals from the ADHD Foundation in Liverpool or Ghosh Medical Group

 

By accepting an appointment to see me, you have agreed that the focus of the consultation will be to decide if ADHD is the cause or contributing factor to your child's difficulties. Formal assessment for any conditions other than ADHD will require a separate appointment. 

I will apply a holistic approach to a detailed neuro-developmental assessment that will consider other medical problems and conditions that can be confused with ADHD but also other co-existing conditions (co-morbid) such as autism, dyspraxia, dyslexia, sensory processing difficulties as well as emotional/mental health difficulties such as emotional dysregulation, anxiety and depression. As such, an ADHD assessment is not a simple exercise.​

Assessment

I follow NICE guidance as a minimum standard.

The first appointment is 90 minutes and F2F. I do not offer video consultation for the first appointment.

This will involve taking a detailed history, examination and informal observation. This will include talking to your child about their life, experiences and difficulties. 

I will also review the ADHD screening assessment completed by the ADHD Foundation (they will have sent me all the reports including QbTest result) prior to your appointment) and the health-development questionnaire you completed pre-clinic, this will help to focus on areas of concern for you and your child.​

As a large part of your child's day is spent in school, for my assessment, I will always require feedback from your child's teacher/s. Even if you feel the school do not share your concerns, their opinion is still an important part of my holistic approach. School feedback is one of many pieces of the jigsaw I will consider. The ADHD Foundation will have requested school feedback. 

If this has not been completed then please contact me and I will send the relevant forms to be completed by the school (teacher/SENCO).

If school feedback isn’t readily available for the first appointment (has left school or summer holidays) it will still be helpful if you can bring any school reports, learning plans etc.

Also, please bring any letters or reports from any therapists (e.g speech) or specialists your child has seen in the past.

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Diagnosis

Depending on evidence gathered and complexity, I aim to give my opinion on diagnosis i.e., does your child have ADHD or not,  at the first appointment. 

However, in some cases, if your child's difficulties are complex that cannot be covered during the appointment or if I need to request further information (school, other professionals) a 2nd or 3rd  appointment will be required. This will also apply if following the initial assessment, I feel your child may need additional assessments/tests to help me to diagnose or deal with your child’s condition. Examples include psychology, psychiatry, speech/language therapist and occupational therapist. 

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Once assessment is completed, with your consent, I will email a Summary Assessment and Diagnostic Report outlining my findings/opinion/recommendations for parent/child/teacher. I will send a copy to your GP. You should expect to receive this report, in most cases, within 14 working days. The cost of this summary clinical report is included in your appointment fee. I keep this report brief and to the point, to minimise overall cost to you. One or two queries regarding the report I am more than happy to discuss via email, otherwise may require a further appointment (F2F or Video). 

Support, Therapy, Treatment including Medication

Through a holistic approach, I view each patient as a whole rather than a single symptom to be treated. 

I will discuss support/therapy options at the first or second appointment. 

Not all children with ADHD require medication. If medication is the right choice for your child then it is important to note that medication is more likely to be effective if part of a multi-modal psycho-educational approach with school and home-based ADHD specific support and behavioural strategies. I will discuss some of these strategies during the first few appointments but for more detailed practical support I would recommend discussion with the school SENCO and the ADHD Foundation.

Further reading: LINK1  LINK2 

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ADHD Medication

Please note that I only prescribe if I believe it is clinically indicated and not on demand.

Before starting medication, I will complete a risk assessment (see FAQ's) and a full physical examination that will include weight, height, and blood pressure. 

There are a number of different medications available. See Resources

My practice is to start on the lowest dose and then slowly increase depending on response and any complications. This sometimes requires changing medication. As such, this will require a number of review appointments to find the right medication and dose and monitor your child's health. All appointments to be book via website.

Read more about medication: LINK1  LINK2

Standard medication titration plan:​​

  1. Prescription issued. I do not charge for issuing the first prescription. Each prescription is for 28 days supply.

  2. Day1. Start medication. Every day. Roughly same time every morning. Methylphenidate Information leaflet. Elvanse Information leaflet.

  3. If worried about severe side effects then please book a medication review appointment (Video) or stop medication pending further discussion.

  4. Every 2-3 weeks please book a medication review appointment - includes issuing a new prescription. 20 mins max. These consultations are focused only on medication titration.

  5. On average it takes around 3-6 appointments to stabilise medication. Sometimes longer.

  6. Once on a stable dose, I can then write to your GP to carry on prescribing on a shared care basis. 

  7. Any prescriptions required in between appointments will cost £25 and posted via special delivery

I follow NICE guidelines regarding first and second line medications and titration.  ​

ADHD medications are controlled drugs. A new prescription will need to be issued monthly or more frequently depending on any changes to treatment. 

Presently, I am unable to send the prescription to your local pharmacy. See FAQ regarding likely costs.  

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Long Term 

Once on a stable medication dose, I can then request shared care and on-going prescribing by your GP including referral to your local NHS ADHD care provider for on-going specialist care. Alternatively, I would be very pleased to provide on-going specialist review, typically 6 monthly. 

 

Please note some GP's will not provide shared care from a private clinician. I would recommend discussing this with your GP prior to your first appointment with me.

I only see young people up to their 18th birthday, although, if I’ve initiated treatment before then, I would be happy to provide on going care for a short time till care has been transferred and accepted by an adult specialist. 

OTHER NEURODEVELOPMENT ASSESSMENTS

1. For autism, I can certainly do an assessment/autism screen and advice on whether it is likely but for a formal diagnosis this usually requires a team approach using standardised autism diagnostic tools. A young person may have autism and ADHD together. For appointment and likely costs please contact me. 

2. For 'motor dyspraxia' (Developmental Coordination Disorder) I recommend an initial assessment by a Paediatric Occupational Therapist followed by a medical assessment by a Paediatrician. If the former is done then please contact me regarding likely costs.

3. For sensory processing difficulties ( I do not use the term disorder) you will need an assessment by a specialist paediatric occupational therapist.

4. General concerns regarding development and behaviour

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