Neurodevelopmental conditions are present in at least 15% of the population and are part of natural differences in brain development, often influenced by genetics or an infant’s environment. Neurodivergence is a part of a person’s brain development and is not something to cure. Some environments or situations may create challenges, and strategies can help.  These conditions can occur on their own or alongside each other. For example, sometimes people can have both autism and ADHD.

A neurodevelopmental condition may impact:

• Motor skills
• Social skills
• Learning and cognition
• Sensory processing and interaction
• Speech, language and communication
• Activity and impulsivity
• Attention, memory and concentration
• Emotional wellbeing
• Mental Health
• Attachment and relationships
• Sleep
• Eating and feeding

Neurodevelopmental conditions include the following:

• Intellectual Disabilities
• Autism
• Attention Deficit Hyperactivity Disorder (ADHD)
• Fetal Alcohol Spectrum Disorder (FASD)
• Developmental Coordination Disorder (DCD)
• Developmental Language Disorder (DLD)

Babies, children and young people develop at different rates and in different ways but tend to follow a similar path when meeting milestones in their development. Learn more about developmental milestones from UNICEF.

Sometimes families have concerns about their child’s development. As a parent or carer, you may have noticed your child experiences challenges or differences in areas like eating, sleeping, learning or carrying out everyday tasks like using the toilet. In some cases, families might be worried about behaviour, emotional wellbeing or sensory needs, such as reactions to bright lights or loud noises. These things can have a big impact on your family life.

If you are worried about your child’s development, you can speak to:

• Family doctor (GP)
• Health visitor
• School nurse
• School or nursery teacher
• Social worker
• Another professional involved in their life, e.g. paediatrician (a doctor that specialises in children and young people)

Learn more about child development and support through NHS Lothian here.

In Scotland, children and young people do not need a formal diagnosis of a particular condition to get the help and support at school or nursery. This is set out in the Education (Additional Support for Learning) (Scotland) Act 2004.

Support usually begins with:

• Classroom and learning adjustments
• Social and emotional support
• Wellbeing and family support
• Targeted programmes and services like Speech and Language Therapy for communication differences
• Assessment and planning through GIRFEC*

These supports often meet a child or young person’s needs. Find out more about available supports.

*Health services, schools, and local authorities all follow a framework called ‘Getting It Right for Every Child’, also known as GIRFEC, to support the wellbeing of all children in Scotland. Learn more about GIRFEC.

Your child has a right to support based on need. Learn more about how to access support in school in your area:

NHS Lothian can help support you and your child through different health services, depending on your child’s age and circumstance.

• Health Visitors offer support and advice regarding the wellbeing of children until the school years. Learn more
• School Nurses work with education staff and other services to oversee the health and wellbeing needs of the school aged children and young people. Learn more
• Speech and Language Therapy work with children and young people who experience communication differences or who need support with communication. Learn more
• Occupational Therapy helps people to participate in daily life and activities to improve their health and wellbeing. Learn more

Getting It Right For Every Child (GIRFEC)

Getting it right for every child (GIRFEC) is the national approach to improving outcomes and supporting the wellbeing of children and young people by offering the right help at the right time from the right people. Learn more about GIRFEC.

East Lothian

Edinburgh

Midlothian

West Lothian

For independent advice and information, contact Enquire. Enquire is a Scotland’s national advice service for additional support for learning.

Identification of Need →  Support → Review → Targeted support → Clinical assessment (if needed) → Post assessment support (if appropriate)

Assessment is part of a wider support system – not the starting point. Support and resources are available when a need is identified.

A diagnosis may:

• Help explain a child’s needs
• Support access to some specialist services
• Help with some benefits and entitlements
• Guide long-term planning

A diagnosis does not automatically:

• Change waiting times
• Provide additional school support
• Guarantee access to specialist services
• Replace the need for ongoing support planning

Support is based on need, no diagnosis or label.

Many children benefit fully from community and school-based supports without needing clinical assessment. This can include children who:

• Are making progress with the right supports
• Have mild or situational support needs
• Need adjustments rather than diagnosis

Clinical ND assessment is usually for children and young people whose needs:

• Would benefit from specialist understanding to guide long-term support
• Significantly impacts daily life, learning, relationships or safety
• Continues to need high levels of support despite consistent support over time

Information will be gathered from different professionals in different settings. This might take some time, depending on what needs to be done. The assessments may take place in different places, such as at home, school, nursery, clinics, or using telephone or video calls.

We appreciate this can be an uncertain time for families and sometimes feel overwhelming.

Gathering information helps build a full picture of strengths, needs to put the best help and support in place. An important part of the assessment is when NHS professionals have a conversation with you about your child. During this conversation we will ask you about:

• Your child’s early development
• How your child joins in and learns in different settings and with different people
• Their understanding of language, communication, social interaction, movement and activity, play, free time, and imaginative or flexible thinking.

A neurodevelopmental clinical assessment looks broadly at how your child learns, communicates, interacts, and manages everyday tasks. It usually involves gathering developmental history, observing behaviour, and using standardised tools to understand areas like social communication, attention, language, thinking skills, motor skills, and emotional or behavioural patterns. It may also include input from several professionals to build a clear picture of your child’s strengths and needs.

The NHS can diagnose the following neurodevelopmental conditions:

• Foetal Alcohol Spectrum Disorder (FASD)
• Autism
• Attention Deficit Hyperactivity Disorder (ADHD)
• Intellectual Disability / Global Developmental Delay
• Developmental Coordination Disorder (DCD)
• Developmental Language Disorder (DLD)

The NHS service does not diagnose:

• Dyslexia or dyscalculia (identified by schools)
• Auditory Processing Disorder
• Pathological Demand Avoidance (PDA) as a separate diagnosis
• Dysgraphia

If you have concerns about your child’s hearing, our Audiology service can provide support. Learn more.

If you have concerns about underlying language challenges, then consider making a request for assistance to Speech & Language Therapy. Find contact details here.

Support for differences in these areas is still available without a diagnosis. Visit our Support and Resources page to find supports available for a variety of difficulties and differences.

There may be several professionals that aid in the clinical assessment depending on the needs of your child. Those might include:

• Community Paediatricians specialise in children and young people and childhood neurodevelopmental conditions, childhood disability and other complex medical conditions. They assess a child’s health and development and determine if there are any tests or care that might help. Learn more
• Psychiatrists work with children and young people to understand their neurodevelopmental, emotional, behavioural, and mental health needs. They work with others to understand the whole picture. They can prescribe medication to help where appropriate. Learn more about CAMHS
• Nurses are trained in supporting neurodevelopmental, emotional, behavioural, and mental health needs.
• Speech and Language Therapists support children and young people who may have speech, language, and communication difficulties. They support at home, school, or nursery and in the community, to enable children to communicate, understand, engage, and participate in everyday life. Learn more
• Occupational Therapists work out how movement and sensory differences affect a child’s confidence and ability to join in everyday activities. This might include eating, dressing, going to the toilet, school, work, and play. Learn more
• Clinical Psychologists assess children and young people to understand the links between early experiences, how they think, feel, learn, and behave, and how this may affect their health, wellbeing, and development. Sometimes they offer psychological therapies, such as art, play or group therapies, where these might be helpful. Learn more about CAMHS
• Educational Psychologists work with schools to help support pupils, teachers and parents. They make school feel enjoyable and positive and help people understand how children and young people learn, behave, and develop.

Who you and your child will see will depend on the type of differences you have noticed. Other professionals who see your child now, or who have seen them in the past, may also be asked for information. For example, your child’s GP and teacher are usually asked for information.

Speech and Language Therapy supports children and young people with neurodevelopmental needs. Neurodivergent people often have communication differences that can lead to difficulties with interaction with others.

For children and young people, these include:

• Speech, language, and social communication: understanding and using words, interacting with others
• Eating, drinking, and swallowing: developing safe and effective feeding skills
• Functional communication: using strategies and tools (visual supports, talking mats, speech-generating devices)
• Emotional regulation and behaviour: expressing feelings and reducing frustration through communication

They help by:

• Providing advice and practical strategies for families and schools
• Offering early identification and assessment of communication needs
• Delivering training and capacity building for teachers, parents, and carers
• Collaborating with education and health professionals to create integrated support plans
• Supporting transitions such as starting school or moving to secondary education

Get in touch:

• Phone your local Speech and Language Therapy department for advice. Helplines are available here
• Visit their website for children and young people
• Learn more about requesting assistance from Speech and Language Therapy

Find them on social media:

• Facebook: NHS Lothian SLT
• Instagram: NHS Lothian Speech and Language

Occupational therapy (OT) helps children and young people with neurodevelopmental needs participate in everyday activities at home, school, and in the community. Their goal is to promote independence, wellbeing, and inclusion by supporting skills for daily life and adapting environments where needed.

OT focuses on enabling children to engage in activities that matter to them—what they call “occupations.”

For children and young people, these include:

• Self-care: dressing, eating, using the toilet
• Productivity: play, attending nursery or school
• Leisure: playing with friends, enjoying hobbies

They help by:

• Providing advice and practical strategies
• Offering early intervention and signposting to resources
• Delivering training and support for families and schools
• Carrying out individual assessments and tailored interventions

Get in touch:

• Children and Young People’s Occupational Therapy
• Teachers, health care professionals or social workers, can also request help from occupational therapy with the parent or carer’s consent. Request for Assistance Form
• If you are a parent or carer, you can contact the service directly on the numbers below to arrange a telephone appointment for an initial discussion.
  • Edinburgh: 0131 312 1070
  • East Lothian & Midlothian: 0131 446 4013
  • West Lothian: 01506 524 134

Find them on social media:

• Facebook: Children and Young People’s Therapies and Support
• YouTube: Children and Young People’s Therapies and Support

Where appropriate, ADHD assessments will be considered for children over the age of 5 years who have completed at least 1 term at school or structured learning environment. As children’s attention, concentration and emotional regulation develop at different rates, this approach means that they have time and opportunities to benefit from helpful supports and strategies. There can be many reasons why children may struggle with attention, concentration and managing their emotions, assessment within a school environment together with parent and carers experiences is a really important step in making sense of whether further ND assessment would be helpful. A consistent approach to supporting and responding to your child is also extremely important so this joined up approach is essential.

In addition, medication for ADHD is only licensed for children aged 5 years and over therefore for younger children, parenting supports are the recommended first line intervention, as well as environmental adaptations.

Learn more about ADHD in children and young people from the Royal College of Psychiatrists

We accept pre-school children for assessment of their development where concerns are present. Pre-school children who have delay across multiple developmental domains* may be described as having Global Developmental Delay (GDD). This is a descriptive term used in the preschool period to describe the pattern of delay.  This is not the same as an intellectual disability.

Some children who have GDD in their pre-school years may later be diagnosed with an intellectual disability. The age at which this can be completed varies dependent on the child’s profile .

*Developmental domains include:

• Fine and gross motor skills.
• Cognitive, including problem-solving, memory and understanding of the world around them.
• Language, which includes understanding what’s been said and communicating in gestures, sounds and, later, speaking and sentence formation.
• Social-emotional, for example, forming relationships and manage emotions.

Referrals can be made by:

• Schools
• GPs
• Health Visitors (for those under 5)
• Other professionals

Note on terms we use: Referral forms may be called a “Request for Assistance” form or “RfA” form.

• The referral is screened by either Community Paediatrics or CAMHS depending on age and your child’s circumstances. In most cases, children under 7 are seen by Community Paediatrics and those over 7 are seen by CAMHS.
• If seen by CAMHS, the referrer will usually receive a letter explaining the outcome of the screening. 
• If the referral is accepted, the child is placed on the waiting list. It will likely take multiple years before your child is seen for an assessment.
• Before your first clinical assessment appointment, you should be contacted by the assessment team – usually around 3 months beforehand for CAMHS, or around 6 weeks beforehand for Community Paediatrics.
• Your child’s school will usually be contacted for further information such as the GIRFEC child’s plan and to arrange a telephone call to complete the Teacher Questionnaire. 

Note on terms we use: Referral forms may be called a “Request for Assistance” form or “RfA” form.

Note on terms we use: Referral forms may be called a “Request for Assistance” form or “RfA” form.

Differences between settings are normal and may occur for a variety of reasons. One example is masking, which is a common behaviour among neurodivergent people, especially in girls and older children. Learn more about masking above.

You can record how your child copes after school, levels of exhaustion, anxiety, meltdowns, or sleep difficulties, as these are valid indicators of need.

When seeking information about a clinical assessment, you can go through the referral forms and information gathering with your referrer to help determine if an assessment is appropriate. This is a helpful conversation to ensure that all appropriate supports are in place across home and school.  

Your school may advise you that your child is receiving support at a universal level, meaning they are not needing additional supports within school. Usually for a clinical assessment to be considered, examples of significant impact in a child’s day-to-day life, at both home and another setting is needed.

Note on terms we use: Referral forms may be called a “Request for Assistance” form or “RfA” form.

For life-threatening emergencies, please dial 999.

If you need urgent mental health support, please phone NHS 24 at 111 anytime and select “1” for Mental Health option.

If concerns increase:

• Discuss non-urgent changes with school or GP who can advise of other supports that may be available more locally.  If your child is preschool, talk to your health visitor. 
• Urgent mental health or physical concerns should be escalated via GP who can work with you to decide if a request for a mental health assessment through CAMHS is needed. 
• If your child is not in school, has left school or is home schooled and is finding it difficult to manage their emotions, please contact your community health service.
• If your child is in school and is finding it difficult to manage their emotions, please talk to the key person at their school. They can advise about any available school counselling, anxiety management or nurture support, as well as exploring adjustments that might be helpful at home and in school.

Waiting times for a clinical neurodevelopmental assessment are currently very long, with some waiting multiple years. The exact waiting time can vary depending on your child’s age, and the capacity of local services. Although we can’t provide an exact timeframe, we are working hard to see children and young people as soon as we can and to prioritise those with the most urgent needs.

You can access most support without a clinical assessment or formal diagnosis. Our Supports and Resources page includes recommended materials, local and national services, and more.

Please know, clinical assessments are part of NHS Lothian, and your GP and school cannot influence or provide updates on waiting times.

NHS Lothian is redesigning the neurodevelopmental clinical assessment pathway in order to make the process more streamlined and accessible to those who need it.

If your child is within 3 months of being 18, referrals can be made to CAMHS for a clinical assessment.  Following screening and if accepted, the referral will be sent on to the Adult Services wait list for your area.  The original referral date is retained.

If your child is between 16 and 18, they will be transferred to Adult Services once they are 18.  The original referral date is retained.

Note on terms we use: Referral forms may be called a “Request for Assistance” form or “RfA” form.

After diagnosis, your child should receive:

• Updated school support planning
• Therapy recommendations
• Advice on community supports
• Guidance on benefits and entitlements

Diagnosis does not replace ongoing planning and support — it informs it.

Your child will still receive needs-based support. Not receiving a diagnosis does not mean support should stop.

You can:

• Ask for clarification
• Request further discussion with the assessment team

Seek independent advice (e.g. Enquire, Scottish Autism, or other advocacy services)

Yes.  Re-referral may be appropriate if there are significant changes in needs or new information becomes available.

Note on terms we use: Referral forms may be called a “Request for Assistance” form or “RfA” form.

If a private ADHD diagnosis meets NHS standards, the ND service may take over prescribing once reviewed.  Due to waiting times governance guidance, a child or young person can neither be advantaged or disadvantaged according to ability to pay for private assessment which is why children and young people who have received a diagnosis privately are required to be added to the waiting list from the date of their referral.

GPs are unable to prescribe medication for ADHD as it needs to be initiated and overseen by a healthcare professional with training and expertise in diagnosing and managing ADHD. Shared Care agreements with GPs for repeat prescriptions are in place in some practices, but the ND service maintains responsibility for on-going reviews and amendments to dose.

It is not the responsibility of GPs to start melatonin, and this is usually done by specialist services (like CAMHS) as specified in clinician guidance. Individual clinicians in primary care may have sufficient experience and be prepared to start melatonin under direct guidance of an experienced prescriber from a specialty service. This guidance is available from CAMHS if requested by a GP, otherwise you will need to wait until the ND assessment if completed before a trail of melatonin can be considered.

If your child is being referred for a clinical assessment and sleep is a concern, this should be highlighted on the referral form or RfA.

The following information on developing sleep routines can help and many of this guidance should be followed even if Melatonin is prescribed:

• Choice and Medication Handy Fact Sheet on Sleep Hygiene
• Sleep Action Resources and Booklets

Families can also access support from Sleep Action

Note on terms we use: Referral forms may be called a “Request for Assistance” form or “RfA” form.