Complex Neurodevelopmental Disorders Service (CNDS) Referral Form 

CNDS offer 3 categories of referral; please select which category you are requesting:

Select a category: Required

For all referrals;

  • the child or young person must remain open to the locality team for the duration of CNDS involvement. 
  • the child or young person must have been seen by a local consultant/senior psychologist for a face-to-face appointment to review the clinical presentation and determine appropriateness of referral.   
  • the child or young person must be under the age of 18 years old.


Referrals must include: 

  • CNDS electronic referral form with all sections completed.
  • Copies of reports relating to initial ASD assessment - this must include a diagnostic report summarising the first line assessment (if category 1 or 2 is selected).
  • References to reports being available on RiO will not be accepted. 

Without the above, the CNDS team are not able to process referrals.

Child or young person's essential details

This section must be fully completed for all referrals.

Required
Date of birth Required
Invalid date
Preferred pronouns Required
Required
Birth assigned gender Required
Current gender identity Required
Address Required
Required
Required
Required
GP address Required
Required
Required
Are parents/carers aware of/in agreement with referral? Required
Is the young person aware of and in agreement with the referral? Required
Current involvement from social services? Required

If yes, please provide details: 

Early Help Plan
Child in Need
Child Protection Register

Legal status

Looked After Child Required

If YES please indicate:

  • Section 20 accommodated
  • Interim Care Order
  • Full Care Order
  • Section 25
Mental Health Act Required

Referral details

This section must be fully completed for all referrals.

Referrer details

Required
Required
Address Required
Required

The CNDS Team may contact you to discuss the referral.

Care Coordinator

Required
Required
Required
Required
Required
Required

Please do not complete this section if you have selected a category 3 referral, please move forward to ‘Referral Checklist’.
 

Initial ASD Diagnostic Assessment

ASD Pathway Assessment 

Please provide the team with reports relating to components of assessment and diagnostic report shared with the family.

Structured observations

Date
Invalid date

ASD Specific Developmental History 

Date
Invalid date

ADOS-2

Date
Invalid date

MDT Diagnostic Report

Date
Invalid date

Additional assessments

Speech and Language Therapy Assessment 

Date
Invalid date

Occupational Therapy Assessment 

Date
Invalid date

Cognitive Assessment 

Date
Invalid date

Other

Date
Invalid date

Conclusion of ASD Assessment

If (following assessment) a diagnosis of ASD has not been given, this section MUST include information about how the clinical team have formulated the child / young person’s presenting problem.

Risk assessment

To self Required
To others Required
To property Required
Of exploitation Required

Any other relevant risks

The CNDS team often visit families at home and go into schools, as well as seeing children in clinic. Please detail any other information that is relevant in terms of safeguarding children, their families and professionals. 

Any other risks? Required
Would you like to speak to a CNDS clinician in order share any information? Required

Family history

Ongoing support

Required

Referral checklist

Have you included the following?

  • Referral form with all appropriate sections completed
  • A specific clinical question to be considered
  • Copies of reports relating to first line ASD Assessment, including diagnostic report/summary shared with family (For category 1 or 2)
     
I understand that the child/young person must remain open to and be supported by my service for the duration of the CNDS Team involvement.  Required
Required