CAMHS Learning Disability Service Referral Criteria

Psychosis

• Positive symptoms – Paranoia, delusional beliefs, abnormal perceptions (hallucinations on all sensory modalities)
• Negative, symptoms – deterioration in self-care and daily personal, social and family functioning
• Disinhibited behavior, over activity, risk taking, with pressure of speech and agitation
• Severe depression with psychomotor retardation, social withdrawal, suicidal ideation
• See Appendix 10

Mood Disorders

• We provide a service to young people whose primary presenting problem is a mood disorder. This includes those presenting with moderate to severe depression as well as those young people who present with complex diagnostic issues involving mood and bipolar disorders.

Eating Disorders

• Anorexia -Anorexia Nervosa is an eating disorder characterised by excessive food restriction and an irrational fear of weight gain and distorted body image.  It typically involves excessive weight loss
• Bulimia – Engaging in binge and purge behavior
• Eating Disorders – Other difficulties around food and eating

Significantly impairing Anxiety Disorders of a diagnosable level (e.g. OCD, PTSD)

• Severe or debilitating Anxiety panic attacks
• Separation anxiety which severely impacts on the child’s functioning
• Phobias including phobic anxiety

Depression

• Physical symptoms – poor sleep / appetite / libido
• Cognitive symptoms – negative thoughts about self / others / world
• Suicidal ideation – level of intent, current thought, etc
• Co-morbidity – depression often occurs concurrently with other presenting mental health problems

Post Traumatic Stress Disorder

• Symptoms occurring more than 3 months after a recognised traumatic event
• Intrusion and avoidance of thoughts and memories about the trauma
• Hyper-vigilance, hyper-arousal and emotional numbing

Obsessive Compulsive Disorder

• Obsessions and / or compulsions with functional impairment

Attention Deficit Hyperactivity Disorder (ADHD) & Autistic Spectrum Disorder (ASD) and Tourettes

• For initial assessment and diagnosis, follow the local multi-agency protocol
• Complex ADHD cases with co-morbidity should be referred to Specialist CAMHS
• Tourettes Syndrome with complex motor and vocal tics, particularly with co-morbidity with OCD and rage

Deliberate Self Harm

• most commonly skin-cutting but might include burning, scratching, banging or hitting body parts, interfering with wound healing, hair-pulling (trichotillomania) and the ingestion of toxic substances or objects
• may be associated with suicidal ideation and intent  and/or a pattern of emotional disregulation, interpersonal difficulty and maladaptive coping strategies

Under 5’s

• Age –Children from 0 to 5 year olds including infants
• Presenting symptoms This is not an exhaustive list but the following examples are a guideline of appropriate referrals 
• Behavioural: sleeping, eating difficulties, toileting, aggression, selective mutism etc.
• Emotional/social: attachment/bonding difficulties, trauma, abuse, quality of family relationship, carers mental health issues, birth trauma / separation anxiety
• There needs to be some evidence or indication that the presenting difficulties have not been alleviated by Tier 2 Interventions.

Complex Trauma

Complex trauma occurs when an individual is exposed to multiple traumatic events with an impact on immediate and long-term outcomes. Complex trauma is sometimes described as Developmental Trauma when:

• It occurs through childhood with early onset
• Is chronic and prolonged
• Within the family, (interpersonal)
• Impacts on development

Developmental trauma is sometimes called complex PTSD, but this label is not satisfactory because children can experience developmental trauma and not fulfil the criteria for a diagnosis of PTSD.

CRITERION 1: Level of learning disability

TYPICAL ABILITIES AND NEEDS		GENERAL CAMHS TEAM		LD-CAMHS CLINICIANS
		MILD learning disabilities	MODERATE learning disabilities		SEVERE/PROFOUND learning disabilities
COMMUNICATION	Expressive language	Often delayed - but usually able to use everyday speech and hold conversations	Delayed and limited – typically acquire the use of only simple phrases/manual signs		Few words only or speech absent
	Comprehension	Often delayed – explanations may need to be simplified to aid understanding	Delayed and limited – typically to understanding simple phrases or requests		Very limited understanding if any
ADAPTIVE FUNCTIONING	Self-care	Fully independent in majority of areas (eating, washing, dressing, continence etc)	Some supervision required in majority of areas		Constant supervision/support always required in all areas
	Academic	Difficulties with reading, writing and arithmetic common	Limited - may develop basic literacy and numeracy skills		Severely limited – focus is often on acquiring other skills
	Mobility	No delay in development	Delayed but usually full mobility is achieved		Often severely limited (and sensory impairments common)
	Social	Social immaturity common (more impaired if co-morbid ASD)	Limited – but often acquire the basic social skills necessary for interaction		Restricted (and ASD common)
Education		Usually in mainstream school	Usually in special school		Always in special school
Overall support needs		Limited – intermittent and focused support usually needed (e.g. at times of transition)	Extensive – regular, long-term support needed in at least some environments		Pervasive – constant, high-intensity support needed across all environments
Mental health needs		Needs and presentation similar to children without learning disabilities	Diagnosis often dependent on third-party reports or observing changes in behaviour		Difficulty diagnosing – severe and chronic  behavioural difficulties common
A comparison of terminology
CAMHS/Health		MILD learning disabilities	MODERATE learning disabilities		SEVERE/PROFOUND learning disabilities
Pre-school		Mild developmental delay	Moderate developmental delay		Severe/profound developmental delay
Education		Moderate learning difficulties	Severe learning difficulties