Clinical perspectives on the identification of neurodevelopmental conditions in children and changes in referral pathways: qualitative interviews

Barry Coughlan, Matt Woolgar, Alissa Mann, Robbie Duschinsky

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1 Citation (SciVal)


Objective Previous work has raised questions about the role of general practitioners (GPs) in the identification of neurodevelopmental conditions such as autism spectrum disorders (autism) and attention deficit hyperactivity disorders (ADHD). This study aimed to explore how GPs identify these conditions in practice and their perspectives on recent changes to local referral pathways that mean referrals to the neurodevelopmental team come through educational professionals and health visitors, rather than GPs. This study also aimed to explore Child and Adolescent Mental Health Services (CAMHS) specialist’s perspectives on the role of GPs.

Setting GP practices, local neurodevelopmental services and specialist CAMHS services in the UK.

Participants: semistructured interviews were conducted with GPs (n=8), specialists in local CAMHS (n=7), and professionals at national CAMHS services around the country (n=10). Interviews were conducted between January and May 2019. A framework approach informed by thematic analysis was used to analyse the data.

Results GPs drew on various forms of tacit and explicit information including behavioural markers, parental report, prior knowledge of the family, expert and lay resources. Opinions varied between GPs regarding changes to the referral pathway, with some accepting the changes and others describing it as a ‘disaster’. CAMHS specialists tended to feel that GPs required more neurodevelopmental training and time to conduct consultations.

Conclusion This study adds to the literature showing that GPs use an array of information sources when making referral decisions for autism and ADHD. Further work is urgently required to evaluate the impact of reconfiguring neurodevelopmental referral pathways such that GPs have a diminished role in identification.
Original languageEnglish
Article numbere049821
JournalBMJ Open
Issue number4
Publication statusPublished - 13 Apr 2022
Externally publishedYes

Bibliographical note

Funding Information:
Funding The authors wish to thank NIHR School for Primary Care Research [RG94577] for their support for work on this paper. This research was also funded in whole, or in part, by the Wellcome Trust [WT103343MA]. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. We would also like to the CRN for help with recruitment. Warm thanks are extended to authors Prof Marinus van IJzendoorn for feedback on a draft of the manuscript.

Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.


  • Child & adolescent psychiatry
  • Community child health
  • Developmental neurology & neurodisability

ASJC Scopus subject areas

  • General Medicine


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