A parent emails on Monday morning. Their child has just received an ADHD diagnosis from a private provider following a Right to Choose referral. The diagnostic report recommends an Education, Health and Care Plan. The school has no record of concerning behaviour. You have not completed any formal observations. The parent expects a meeting this week.
If this scenario sounds familiar, you are not alone. SENCOs across England are reporting a sharp increase in Right to Choose referrals, with parents securing ADHD assessments through NHS-funded independent providers at speeds that bypass the usual multi-agency consultation process. The SENsible SENCO community forums have recorded over 39 comments across four separate threads on this topic since January 2026. The pressure on school-based SEND teams is real, and it is growing.
This guide is for the SENCO who just received their third Right to Choose referral this term and needs a clear, professional framework for what to do next. It is not a guide for parents. ADHD UK, Psychiatry UK, and the NHS have that covered. It is a guide for the professional caught between parent expectations, clinical recommendations, and the evidence they can observe in school.
Right to Choose (RTC) is an NHS England policy derived from the NHS Constitution and the National Health Service (Choice of Accommodation) Directions 2004. It gives patients the legal right to choose a provider for their first outpatient appointment from any provider that meets NHS standards and prices. In the ADHD context, this means a parent can ask their GP to refer their child not to the local CAMHS pathway, which may have a waiting time of two to four years in many areas, but to an NHS-commissioned independent provider such as Psychiatry UK, ADHD UK's clinical arm, or another approved organisation.
The independent provider completes the assessment, often within weeks rather than years, using the NHS tariff. The GP has a legal obligation to make this referral if the parent requests it. The school has no formal role in the referral decision. Many schools discover the assessment has happened only when the completed diagnostic report arrives.
It is worth understanding what Right to Choose is not. It is not a private diagnosis. The assessment is NHS-commissioned and NHS-funded. The diagnosis carries the same clinical weight as one from a CAMHS psychiatrist. Schools cannot treat an RTC diagnosis as inferior or as requiring verification by a local authority clinician. NICE Guideline NG87 (2018) on ADHD sets out the diagnostic criteria, and a diagnosis made against those criteria by a qualified clinician is valid regardless of which provider conducted the assessment.
The practical impact for schools is that the usual information-sharing loop, where CAMHS contacts the school before assessment and gathers teacher observations as part of a multi-disciplinary process, often does not happen with RTC referrals. The assessment is completed with parent report and clinical interview. School observations may not be sought at all. This is the structural gap that creates the difficulty most SENCOs describe.
The pressure is arriving from multiple directions simultaneously. Parents who have secured a fast RTC diagnosis often arrive at school with expectations shaped by the diagnostic report, which routinely includes recommendations such as "an EHCP should be considered" or "the school should implement the following adjustments." These recommendations are clinically appropriate but written without knowledge of what the school already has in place.
At the same time, the SENCO may have limited school-based evidence of the difficulties described in the report. A pupil who masks ADHD traits effectively at school, or whose difficulties are managed well by existing provision, may not appear in the SENCO's records as a cause for concern. The parent is telling the truth about what they see at home. The school is also telling the truth about what is observed in the classroom. Both accounts can be accurate.
The third pressure is from the diagnostic report's EHCP recommendation. Families who have invested time, effort, and sometimes money navigating the RTC process arrive expecting that the diagnosis will open the door to statutory provision. When the SENCO explains the graduated response and the evidence threshold for an EHCP request, this can feel to parents like obstruction rather than professional judgement. The SENCO's professional role becomes contested at precisely the moment when clear communication matters most.
A fourth pressure is administrative. Each RTC referral generates a parent meeting, a written response, a review of existing provision, possible observation and formal assessment completion, and liaison with the assessing clinician. Multiplied across several referrals per term, this represents a significant workload that sits outside the normal SEND review cycle. Schools without a clear RTC response protocol are managing each case ad hoc, which is neither efficient nor consistent.
Barkley (1997) demonstrated that ADHD involves a fundamental difficulty with self-regulation across time. This is useful context for understanding why home and school presentations can diverge. The structured, predictable environment of the classroom, with teacher-directed tasks, clear transitions, and adult oversight, often provides the external scaffolding that compensates for internal self-regulation difficulties. At home, where structure is less consistent and demands are less predictable, the same pupil's difficulties become much more visible. This is not masking in the clinical sense; it is context-dependency. Understanding this distinction helps SENCOs explain the divergence to parents without dismissing either account.
Masking is a genuine clinical phenomenon. Hull et al. (2017) defined masking as conscious or unconscious suppression of neurological traits to appear neurotypical in social contexts. Research on autism has established masking most clearly, but evidence for ADHD masking, particularly in girls, is growing. A pupil who meets diagnostic criteria for ADHD may present as compliant, organised, and attentive in the classroom while experiencing significant cognitive effort to maintain that presentation. The exhaustion often becomes visible only at home, after school.
This means the SENCO's job when receiving an RTC diagnosis is not to decide whether masking is occurring. That is a clinical question. The job is to gather objective, school-based evidence of what the pupil's functioning looks like in the educational environment, and to share that evidence honestly with the assessing clinician and, where relevant, with the local authority.
The Thinking Framework's Compare operation is directly applicable here. A structured comparison between home-reported behaviours and school-observed behaviours, documented systematically, gives the SENCO a professional evidence base that is neither dismissive of the parent's account nor uncritically accepting of the diagnostic report's recommendations. The comparison does not resolve the clinical question; it clarifies what the school sees and what adjustments are already in place.
Completing a standardised rating scale as part of this process is good practice. The Conners Rating Scales (Conners, 2008) provide teacher forms that capture attention, hyperactivity, learning problems, and executive function difficulties in a norm-referenced format. Our guide to the Conners Rating Scale covers how teachers can complete these accurately. The scale score, whether it aligns with or diverges from the parent-reported score, is evidence. Neither outcome is a problem. Both outcomes give the clinician and the SENCO useful information about context-dependent presentation.
What the SENCO should avoid is informal, anecdotal reassurance in either direction. Telling a parent "we don't really see those difficulties here" without formal observation data is not a professional position. Equally, agreeing with every recommendation in a diagnostic report before reviewing the school's existing provision is also not appropriate. The professional stance is: "We will gather our evidence systematically and share it transparently."
A clear, consistent response protocol saves time and prevents misunderstanding. The following steps apply from the moment a parent makes contact about an RTC referral or shares a completed diagnosis.
Step one: Acknowledge the parent's concerns without endorsing or questioning the diagnosis. A brief, warm acknowledgement confirms that you have received the diagnosis, recognises the effort the family has made, and commits to a review meeting within a defined timeframe. This is not the moment for a detailed discussion of what the school can or cannot provide.
Step two: Explain the school's role clearly and early. Schools gather evidence and implement adjustments; they do not diagnose. The SENCO is not in a position to confirm or challenge the clinical diagnosis, and should not be asked to. What the school can do is describe what is observed in the educational setting and identify what provision is already in place and what additional support may be appropriate. This distinction, between the clinical role and the educational role, is one of the most important things to communicate clearly to families at the first contact.
Step three: Gather formal school-based evidence. This means completing a teacher observation using a standardised instrument such as the Conners Teacher Rating Scale, reviewing existing attainment data, consulting with subject teachers about what they observe in class, and reviewing any existing provision mapping entries for the pupil. This process should take no more than two weeks and should be completed before the review meeting, not during it.
Step four: Share evidence objectively with the assessing clinician. If the RTC provider has not sought school observations, the SENCO can contact them directly to share the school's evidence. Most providers welcome this. The aim is not to challenge the diagnosis but to ensure the clinician has the full picture, including what is working in school and what is not. This supports better clinical recommendations and reduces the risk of recommendations that do not reflect the educational context.
Step five: Implement recommended adjustments where appropriate and review in six weeks. If the diagnosis is confirmed and the diagnostic report includes classroom recommendations, the SENCO should assess which adjustments are already in place, which are new and appropriate given the school-based evidence, and which require further consideration. A six-week review meeting with parents confirms what has been implemented and what the impact has been. This graduated approach is consistent with the Assess, Plan, Do, Review cycle at the heart of the graduated approach and the SEND Code of Practice (2015).
Throughout this process, the SENCO's written records are critical. Every conversation, observation, and decision should be documented. If a dispute arises later, whether about EHCP eligibility or the school's response to the diagnosis, those records are the professional foundation.
Diagnostic reports frequently recommend that schools consider requesting an Education, Health and Care needs assessment. This recommendation is clinically appropriate. From the clinician's perspective, a child with a confirmed ADHD diagnosis who is experiencing difficulty at home may benefit from statutory support. The recommendation is written in good faith.
The difficulty for schools is that the SEND Code of Practice (2015) sets a specific threshold for initiating an EHC needs assessment: the child must have or may have special educational needs, and may require special educational provision that cannot reasonably be provided from within the resources normally available to mainstream schools. The threshold requires evidence of significant and persistent difficulty despite quality-first teaching. A clinical diagnosis is one piece of that evidence. It is not, by itself, sufficient.
SENCOs need to be able to explain this clearly to families without appearing to block statutory provision. The following framing is useful: "A diagnosis tells us about your child's neurological profile. An EHCP is about the educational evidence: what the school has already tried, what impact it has had, and whether the level of support needed is beyond what schools are typically funded to provide. We need to build that educational evidence base, and we want to do that with you."
The graduated response, documented through the EHCP process, requires the school to demonstrate what has been put in place at SEN Support level before a statutory assessment is appropriate. This means the SENCO needs to check whether the pupil is already on the SEN register, what provision is currently in place, and what the evidence of impact from that provision shows. If the pupil has only recently come to the SENCO's attention through the RTC diagnosis, and no SEN Support has yet been established, the correct sequence is: register the pupil at SEN Support, implement appropriate provision, review impact over at least one cycle, and then assess whether the EHCP threshold has been met.
Where a pupil already has documented significant and persistent difficulty, has been supported at SEN Support level over time, and the RTC diagnosis confirms what the school has been observing, an EHCP request may well be appropriate and the SENCO should support it. The diagnosis does not create the evidence; it contextualises evidence that may already exist. Our full guide to barriers to learning covers the evidence framework for EHCP requests in detail, including how to present school-based evidence in a way that meets LA thresholds.
It is also worth knowing that LAs have a legal duty to carry out an EHC needs assessment when requested by a parent, even if the school does not initiate the request. Parents can request an assessment directly. If a family chooses to do this, the SENCO's role is to provide the school's evidence to the LA as part of the assessment process, not to determine whether the request is appropriate.
A written response template, agreed with the headteacher and filed in the school's SEND policy folder, creates consistency and protects all parties. The following template is designed to be adapted for individual circumstances. It acknowledges the diagnosis, explains the school's process, commits to a clear timeline, and invites collaboration.
Where to use it: send this letter within five working days of receiving a diagnostic report or a parent's first contact about an RTC referral.
| Section | Suggested Wording |
|---|---|
| Opening | Thank you for sharing [Child's name]'s recent assessment report. We have read it carefully and we are glad you have been able to access a timely assessment. We know this process takes time and commitment from families. |
| School role | As the SENCO, my role is to review what [Child's name] experiences at school, what support is already in place, and what additional adjustments may be appropriate in the educational setting. I am not in a position to confirm or question the clinical diagnosis; that is the clinician's role. My job is the educational picture. |
| Next steps | Over the next two weeks, I will complete a formal classroom observation and gather feedback from [Child's name]'s teachers. I will also review the support already in place. I would like to arrange a meeting with you on [date] to share this evidence and discuss next steps together. |
| EHCP paragraph | Regarding the recommendation for an EHCP, I want to be transparent with you. The threshold for a statutory assessment is set by the SEND Code of Practice (2015) and requires evidence of significant and persistent difficulty despite quality-first teaching. The diagnosis is an important part of that picture. We will discuss whether the full evidence supports an EHCP request at our meeting. |
| Closing | We are committed to working with you and with [Child's name]. If you have any immediate concerns in the meantime, please do not hesitate to contact me. I look forward to meeting with you on [date]. |
Before sending any response, confirm the wording with your headteacher and ensure it aligns with your school's SEND policy. If your school has a legal officer or an LA SEND advisor, a copy of your standard template is worth running past them once, so you are confident the language is consistent with national guidance.
Right to Choose is a national policy, but its implementation is locally variable in ways that create significant inequity between families in different areas. Integrated Care Boards (ICBs), the NHS bodies responsible for commissioning local health services, have responded to the surge in RTC referrals in different ways. Some have maintained open access to RTC ADHD assessments. Others have applied criteria such as requiring GP referral to a local paediatrician first, or have restricted which NHS-commissioned providers families can access. A smaller number of ICBs have suspended new RTC ADHD referrals entirely pending a review of capacity and commissioning.
SENCOs need to know their local ICB's current position because it shapes the conversations they have with families. A parent who has been told they can use RTC but whose GP has declined to make the referral, or whose preferred provider is not approved by their ICB, may arrive at school angry and confused. Understanding the local pathway means you can give parents accurate signposting rather than adding to the confusion.
The NHS England Right to Choose guidance is held at england.nhs.uk/rightchoice, but ICB-specific information is held on individual ICB websites, which vary in clarity. The most reliable way to check your local position is to contact your ICB's SEND or children's mental health commissioning team directly, or to ask your Local Authority SEND Improvement Partner, if your area has one, for the current guidance.
From April 2026, several ICBs have indicated changes to their commissioned ADHD provider lists. If your school is supporting families through RTC referrals, the period before April 2026 is the time to confirm which providers are currently commissioned in your area and whether any pathway changes are planned. This is not the SENCO's statutory responsibility, but it is information that helps families and reduces the calls and emails that arrive at the SENCO's desk when referrals fail.
The variation between ICBs also matters for EHCP applications. If a family accessed an RTC assessment through a provider that is no longer commissioned in their ICB area, some local authorities have raised questions about whether clinical recommendations from those reports carry weight in the EHC needs assessment process. This is contested, and it is worth seeking LA advice if you encounter this situation. The clinical validity of the diagnosis is not affected by the provider's current commissioning status. The recommendation in the report is an opinion; the EHC assessment process weighs all available evidence.
Before implementing any adjustments following an RTC diagnosis, it helps to have a clear understanding of what ADHD actually looks like in the educational setting. The clinical picture in the diagnostic report is based on parent report and clinical interview. The educational picture needs to be constructed from classroom observation.
ADHD involves difficulties across three clusters: inattention, hyperactivity, and impulsivity. In practice, these manifest differently depending on subtype, age, gender, and context. The pupil with predominantly inattentive ADHD, often described as the 'daydreamer', is easy to overlook precisely because they are not disruptive. They miss instructions, lose track of multi-step tasks, produce inconsistent work, and disengage from tasks requiring sustained attention. These difficulties are real and can significantly affect attainment, but they do not draw teacher attention the way hyperactive-impulsive presentations do.
Research on cognitive science approaches to ADHD consistently shows that the most effective classroom adjustments address the underlying executive function difficulties rather than the surface behaviour. Barkley (1997) described ADHD as a disorder of self-regulation, not a disorder of knowledge or ability. A pupil with ADHD knows what they are supposed to do; they struggle to initiate, sustain, and regulate the doing of it. Adjustments that externalise the self-regulation the pupil cannot perform internally, such as visual task breakdowns, timers, check-ins, and structured choice, are far more effective than adjustments that simply lower expectations.
The Thinking Framework's Sequence operation is particularly useful here. When a teacher breaks a complex task into a visible, numbered sequence, they are providing the external planning scaffold that the pupil's working memory cannot hold. This is not differentiation in the sense of reducing demand; it is differentiation in the sense of restructuring the entry point. The task remains unchanged. The planning support is made explicit. For a pupil with ADHD, this adjustment can be the difference between task avoidance and task completion. Our article on ADHD, autism, and PDA in the classroom explores the overlaps and distinctions between these profiles in detail.
For older pupils, a conversation with the pupil directly about their own strategies is worth having. Many adolescents with ADHD have developed self-regulation strategies that are not visible to teachers. Asking a Year 10 pupil what helps them concentrate, what makes tasks harder, and what they do when they get stuck produces information that no diagnostic report can provide. Metacognitive work with neurodivergent students consistently shows that self-awareness of cognitive strategies improves self-regulation outcomes over time.
One reason RTC referrals create friction with schools is that the assessment process used by many independent providers does not routinely include direct school evidence. The gold standard for ADHD assessment, as set out in NICE Guideline NG87 (2018), includes information from multiple settings, specifically home and school. However, the logistics of gathering formal school evidence within the RTC timeline, which can be four to eight weeks from referral to diagnosis, mean this is not always completed.
Some RTC providers send a teacher rating scale, typically the Conners or the SNAP-IV, as part of the assessment pack. When this happens, the SENCO or a subject teacher completes it and returns it to the provider. This is the school's formal contribution to the clinical assessment. It is worth knowing that these rating scales carry significant weight in the diagnostic decision, and that an incomplete or uncompleted scale from school reduces the quality of the assessment data.
If your school receives a teacher rating scale and is unsure how to complete it, our guide to ADHD tests and assessments explains what each scale measures and how teacher observations are weighted in the diagnostic process. Completing the scale accurately and returning it promptly is one of the most direct contributions the school can make to the quality of a child's assessment.
When no rating scale has been sent by the provider, the SENCO can still complete one independently and share it with the clinician. This is good professional practice. It creates a school-side record of the evidence gathered and ensures the clinician has the educational perspective even if it was not formally requested. The Conners 3 teacher form takes approximately fifteen minutes to complete and is widely available through educational psychology teams.
Start with an audit. How many Right to Choose referrals or completed diagnoses has your school received this academic year? Are they recorded consistently, or are they scattered across email threads and parent meetings without a central log? If your school does not have a standard response protocol for RTC referrals, the absence of that protocol is the first gap to address.
A simple RTC referral log, held in the SENCO's records, should capture the date of referral or diagnosis, the provider used, whether the school was asked to complete a rating scale and whether it did, the date of the review meeting with parents, the current level of SEN provision, and whether an EHCP assessment has been requested or is under consideration. This log costs nothing except the hour it takes to create it. It transforms a set of ad hoc responses into a manageable caseload.
If you have received a diagnostic report this week and have not yet responded, use the letter template from section six above, adapt it for the family's circumstances, confirm the wording with your headteacher, and send it within five working days. That response sets the professional tone for everything that follows.
If you do not yet have a Conners Teacher Rating Scale available for your staff to use, contact your educational psychologist service or your LA's SEND support team. Most LAs provide access to standardised rating scales for schools as part of their SEND advisory offer. Having the scale available before the next referral arrives means you are not creating a process under pressure.
Finally, check your ICB's current position on Right to Choose ADHD assessments before April 2026. If there are changes planned to commissioned providers or referral pathways in your area, knowing this now means you can give families accurate information rather than discovering the changes when a referral fails. Your ICB's children and young people commissioning team is the right contact. An email to your LA's SEND Partnership team is a good starting point if you do not have the ICB contact details.
The Right to Choose pathway is not going away. The NHS waiting times that make it necessary are not improving quickly. SENCOs who build a clear, professional framework for managing RTC referrals now will spend less time managing individual crises later. The families who use this pathway are not adversaries; they are parents who have taken significant initiative to get their child an assessment. Meeting that initiative with a clear, consistent, evidence-based response is exactly what the role requires.
The following sources underpin the guidance in this article. They cover ADHD diagnostic criteria, NHS commissioning policy, SEND legislation, and the evidence base for classroom-based ADHD support.
Attention deficit hyperactivity disorder: diagnosis and management (NG87) View guidance ↗
NICE, 2018 (updated 2023)
NICE Guideline NG87 (2018). National Institute for Health and Care Excellence.
The authoritative clinical guideline for ADHD diagnosis and management in children, young people, and adults. Sets out the multi-informant assessment standard and the evidence base for pharmacological and non-pharmacological interventions. Essential reading for any SENCO advising parents on the validity of clinical assessments.
NHS England Right to Choose Policy Guidance View guidance ↗
NHS England, 2023
NHS England (2023). NHS England.
The policy framework governing patients' rights to choose their NHS provider for first outpatient appointments. Explains the legal basis, GP obligations, and the conditions under which ICBs can restrict provider choice. Directly relevant to understanding what schools can and cannot do when a family invokes this right.
SEND Code of Practice: 0 to 25 Years View guidance ↗
DfE and DoH, 2015
Department for Education and Department of Health (2015). HMSO.
The statutory guidance for local authorities, schools, and health and care services on supporting children and young people with SEND. Sets out the graduated approach, the EHCP threshold, and the roles and responsibilities of all parties including schools receiving clinical diagnoses from parents.
ADHD and the Nature of Self-Control View study ↗
4,800+ citations
Barkley, R. A. (1997). Guilford Press.
Barkley's foundational model of ADHD as a disorder of self-regulation across time rather than a simple attention deficit. This reframing has significant implications for school-based adjustments: effective support externalises self-regulation, not just expectations. Directly applicable to understanding why classroom presentations diverge from home reports.
Conners 3rd Edition: Manual View resource ↗
Standardised, norm-referenced
Conners, C. K. (2008). Multi-Health Systems.
The most widely used standardised rating scale for ADHD in schools and clinical settings. The teacher form captures inattention, hyperactivity, learning problems, executive function difficulties, and peer relations in a norm-referenced format that provides objective school-side evidence for both diagnostic and EHCP processes.
A parent emails on Monday morning. Their child has just received an ADHD diagnosis from a private provider following a Right to Choose referral. The diagnostic report recommends an Education, Health and Care Plan. The school has no record of concerning behaviour. You have not completed any formal observations. The parent expects a meeting this week.
If this scenario sounds familiar, you are not alone. SENCOs across England are reporting a sharp increase in Right to Choose referrals, with parents securing ADHD assessments through NHS-funded independent providers at speeds that bypass the usual multi-agency consultation process. The SENsible SENCO community forums have recorded over 39 comments across four separate threads on this topic since January 2026. The pressure on school-based SEND teams is real, and it is growing.
This guide is for the SENCO who just received their third Right to Choose referral this term and needs a clear, professional framework for what to do next. It is not a guide for parents. ADHD UK, Psychiatry UK, and the NHS have that covered. It is a guide for the professional caught between parent expectations, clinical recommendations, and the evidence they can observe in school.
Right to Choose (RTC) is an NHS England policy derived from the NHS Constitution and the National Health Service (Choice of Accommodation) Directions 2004. It gives patients the legal right to choose a provider for their first outpatient appointment from any provider that meets NHS standards and prices. In the ADHD context, this means a parent can ask their GP to refer their child not to the local CAMHS pathway, which may have a waiting time of two to four years in many areas, but to an NHS-commissioned independent provider such as Psychiatry UK, ADHD UK's clinical arm, or another approved organisation.
The independent provider completes the assessment, often within weeks rather than years, using the NHS tariff. The GP has a legal obligation to make this referral if the parent requests it. The school has no formal role in the referral decision. Many schools discover the assessment has happened only when the completed diagnostic report arrives.
It is worth understanding what Right to Choose is not. It is not a private diagnosis. The assessment is NHS-commissioned and NHS-funded. The diagnosis carries the same clinical weight as one from a CAMHS psychiatrist. Schools cannot treat an RTC diagnosis as inferior or as requiring verification by a local authority clinician. NICE Guideline NG87 (2018) on ADHD sets out the diagnostic criteria, and a diagnosis made against those criteria by a qualified clinician is valid regardless of which provider conducted the assessment.
The practical impact for schools is that the usual information-sharing loop, where CAMHS contacts the school before assessment and gathers teacher observations as part of a multi-disciplinary process, often does not happen with RTC referrals. The assessment is completed with parent report and clinical interview. School observations may not be sought at all. This is the structural gap that creates the difficulty most SENCOs describe.
The pressure is arriving from multiple directions simultaneously. Parents who have secured a fast RTC diagnosis often arrive at school with expectations shaped by the diagnostic report, which routinely includes recommendations such as "an EHCP should be considered" or "the school should implement the following adjustments." These recommendations are clinically appropriate but written without knowledge of what the school already has in place.
At the same time, the SENCO may have limited school-based evidence of the difficulties described in the report. A pupil who masks ADHD traits effectively at school, or whose difficulties are managed well by existing provision, may not appear in the SENCO's records as a cause for concern. The parent is telling the truth about what they see at home. The school is also telling the truth about what is observed in the classroom. Both accounts can be accurate.
The third pressure is from the diagnostic report's EHCP recommendation. Families who have invested time, effort, and sometimes money navigating the RTC process arrive expecting that the diagnosis will open the door to statutory provision. When the SENCO explains the graduated response and the evidence threshold for an EHCP request, this can feel to parents like obstruction rather than professional judgement. The SENCO's professional role becomes contested at precisely the moment when clear communication matters most.
A fourth pressure is administrative. Each RTC referral generates a parent meeting, a written response, a review of existing provision, possible observation and formal assessment completion, and liaison with the assessing clinician. Multiplied across several referrals per term, this represents a significant workload that sits outside the normal SEND review cycle. Schools without a clear RTC response protocol are managing each case ad hoc, which is neither efficient nor consistent.
Barkley (1997) demonstrated that ADHD involves a fundamental difficulty with self-regulation across time. This is useful context for understanding why home and school presentations can diverge. The structured, predictable environment of the classroom, with teacher-directed tasks, clear transitions, and adult oversight, often provides the external scaffolding that compensates for internal self-regulation difficulties. At home, where structure is less consistent and demands are less predictable, the same pupil's difficulties become much more visible. This is not masking in the clinical sense; it is context-dependency. Understanding this distinction helps SENCOs explain the divergence to parents without dismissing either account.
Masking is a genuine clinical phenomenon. Hull et al. (2017) defined masking as conscious or unconscious suppression of neurological traits to appear neurotypical in social contexts. Research on autism has established masking most clearly, but evidence for ADHD masking, particularly in girls, is growing. A pupil who meets diagnostic criteria for ADHD may present as compliant, organised, and attentive in the classroom while experiencing significant cognitive effort to maintain that presentation. The exhaustion often becomes visible only at home, after school.
This means the SENCO's job when receiving an RTC diagnosis is not to decide whether masking is occurring. That is a clinical question. The job is to gather objective, school-based evidence of what the pupil's functioning looks like in the educational environment, and to share that evidence honestly with the assessing clinician and, where relevant, with the local authority.
The Thinking Framework's Compare operation is directly applicable here. A structured comparison between home-reported behaviours and school-observed behaviours, documented systematically, gives the SENCO a professional evidence base that is neither dismissive of the parent's account nor uncritically accepting of the diagnostic report's recommendations. The comparison does not resolve the clinical question; it clarifies what the school sees and what adjustments are already in place.
Completing a standardised rating scale as part of this process is good practice. The Conners Rating Scales (Conners, 2008) provide teacher forms that capture attention, hyperactivity, learning problems, and executive function difficulties in a norm-referenced format. Our guide to the Conners Rating Scale covers how teachers can complete these accurately. The scale score, whether it aligns with or diverges from the parent-reported score, is evidence. Neither outcome is a problem. Both outcomes give the clinician and the SENCO useful information about context-dependent presentation.
What the SENCO should avoid is informal, anecdotal reassurance in either direction. Telling a parent "we don't really see those difficulties here" without formal observation data is not a professional position. Equally, agreeing with every recommendation in a diagnostic report before reviewing the school's existing provision is also not appropriate. The professional stance is: "We will gather our evidence systematically and share it transparently."
A clear, consistent response protocol saves time and prevents misunderstanding. The following steps apply from the moment a parent makes contact about an RTC referral or shares a completed diagnosis.
Step one: Acknowledge the parent's concerns without endorsing or questioning the diagnosis. A brief, warm acknowledgement confirms that you have received the diagnosis, recognises the effort the family has made, and commits to a review meeting within a defined timeframe. This is not the moment for a detailed discussion of what the school can or cannot provide.
Step two: Explain the school's role clearly and early. Schools gather evidence and implement adjustments; they do not diagnose. The SENCO is not in a position to confirm or challenge the clinical diagnosis, and should not be asked to. What the school can do is describe what is observed in the educational setting and identify what provision is already in place and what additional support may be appropriate. This distinction, between the clinical role and the educational role, is one of the most important things to communicate clearly to families at the first contact.
Step three: Gather formal school-based evidence. This means completing a teacher observation using a standardised instrument such as the Conners Teacher Rating Scale, reviewing existing attainment data, consulting with subject teachers about what they observe in class, and reviewing any existing provision mapping entries for the pupil. This process should take no more than two weeks and should be completed before the review meeting, not during it.
Step four: Share evidence objectively with the assessing clinician. If the RTC provider has not sought school observations, the SENCO can contact them directly to share the school's evidence. Most providers welcome this. The aim is not to challenge the diagnosis but to ensure the clinician has the full picture, including what is working in school and what is not. This supports better clinical recommendations and reduces the risk of recommendations that do not reflect the educational context.
Step five: Implement recommended adjustments where appropriate and review in six weeks. If the diagnosis is confirmed and the diagnostic report includes classroom recommendations, the SENCO should assess which adjustments are already in place, which are new and appropriate given the school-based evidence, and which require further consideration. A six-week review meeting with parents confirms what has been implemented and what the impact has been. This graduated approach is consistent with the Assess, Plan, Do, Review cycle at the heart of the graduated approach and the SEND Code of Practice (2015).
Throughout this process, the SENCO's written records are critical. Every conversation, observation, and decision should be documented. If a dispute arises later, whether about EHCP eligibility or the school's response to the diagnosis, those records are the professional foundation.
Diagnostic reports frequently recommend that schools consider requesting an Education, Health and Care needs assessment. This recommendation is clinically appropriate. From the clinician's perspective, a child with a confirmed ADHD diagnosis who is experiencing difficulty at home may benefit from statutory support. The recommendation is written in good faith.
The difficulty for schools is that the SEND Code of Practice (2015) sets a specific threshold for initiating an EHC needs assessment: the child must have or may have special educational needs, and may require special educational provision that cannot reasonably be provided from within the resources normally available to mainstream schools. The threshold requires evidence of significant and persistent difficulty despite quality-first teaching. A clinical diagnosis is one piece of that evidence. It is not, by itself, sufficient.
SENCOs need to be able to explain this clearly to families without appearing to block statutory provision. The following framing is useful: "A diagnosis tells us about your child's neurological profile. An EHCP is about the educational evidence: what the school has already tried, what impact it has had, and whether the level of support needed is beyond what schools are typically funded to provide. We need to build that educational evidence base, and we want to do that with you."
The graduated response, documented through the EHCP process, requires the school to demonstrate what has been put in place at SEN Support level before a statutory assessment is appropriate. This means the SENCO needs to check whether the pupil is already on the SEN register, what provision is currently in place, and what the evidence of impact from that provision shows. If the pupil has only recently come to the SENCO's attention through the RTC diagnosis, and no SEN Support has yet been established, the correct sequence is: register the pupil at SEN Support, implement appropriate provision, review impact over at least one cycle, and then assess whether the EHCP threshold has been met.
Where a pupil already has documented significant and persistent difficulty, has been supported at SEN Support level over time, and the RTC diagnosis confirms what the school has been observing, an EHCP request may well be appropriate and the SENCO should support it. The diagnosis does not create the evidence; it contextualises evidence that may already exist. Our full guide to barriers to learning covers the evidence framework for EHCP requests in detail, including how to present school-based evidence in a way that meets LA thresholds.
It is also worth knowing that LAs have a legal duty to carry out an EHC needs assessment when requested by a parent, even if the school does not initiate the request. Parents can request an assessment directly. If a family chooses to do this, the SENCO's role is to provide the school's evidence to the LA as part of the assessment process, not to determine whether the request is appropriate.
A written response template, agreed with the headteacher and filed in the school's SEND policy folder, creates consistency and protects all parties. The following template is designed to be adapted for individual circumstances. It acknowledges the diagnosis, explains the school's process, commits to a clear timeline, and invites collaboration.
Where to use it: send this letter within five working days of receiving a diagnostic report or a parent's first contact about an RTC referral.
| Section | Suggested Wording |
|---|---|
| Opening | Thank you for sharing [Child's name]'s recent assessment report. We have read it carefully and we are glad you have been able to access a timely assessment. We know this process takes time and commitment from families. |
| School role | As the SENCO, my role is to review what [Child's name] experiences at school, what support is already in place, and what additional adjustments may be appropriate in the educational setting. I am not in a position to confirm or question the clinical diagnosis; that is the clinician's role. My job is the educational picture. |
| Next steps | Over the next two weeks, I will complete a formal classroom observation and gather feedback from [Child's name]'s teachers. I will also review the support already in place. I would like to arrange a meeting with you on [date] to share this evidence and discuss next steps together. |
| EHCP paragraph | Regarding the recommendation for an EHCP, I want to be transparent with you. The threshold for a statutory assessment is set by the SEND Code of Practice (2015) and requires evidence of significant and persistent difficulty despite quality-first teaching. The diagnosis is an important part of that picture. We will discuss whether the full evidence supports an EHCP request at our meeting. |
| Closing | We are committed to working with you and with [Child's name]. If you have any immediate concerns in the meantime, please do not hesitate to contact me. I look forward to meeting with you on [date]. |
Before sending any response, confirm the wording with your headteacher and ensure it aligns with your school's SEND policy. If your school has a legal officer or an LA SEND advisor, a copy of your standard template is worth running past them once, so you are confident the language is consistent with national guidance.
Right to Choose is a national policy, but its implementation is locally variable in ways that create significant inequity between families in different areas. Integrated Care Boards (ICBs), the NHS bodies responsible for commissioning local health services, have responded to the surge in RTC referrals in different ways. Some have maintained open access to RTC ADHD assessments. Others have applied criteria such as requiring GP referral to a local paediatrician first, or have restricted which NHS-commissioned providers families can access. A smaller number of ICBs have suspended new RTC ADHD referrals entirely pending a review of capacity and commissioning.
SENCOs need to know their local ICB's current position because it shapes the conversations they have with families. A parent who has been told they can use RTC but whose GP has declined to make the referral, or whose preferred provider is not approved by their ICB, may arrive at school angry and confused. Understanding the local pathway means you can give parents accurate signposting rather than adding to the confusion.
The NHS England Right to Choose guidance is held at england.nhs.uk/rightchoice, but ICB-specific information is held on individual ICB websites, which vary in clarity. The most reliable way to check your local position is to contact your ICB's SEND or children's mental health commissioning team directly, or to ask your Local Authority SEND Improvement Partner, if your area has one, for the current guidance.
From April 2026, several ICBs have indicated changes to their commissioned ADHD provider lists. If your school is supporting families through RTC referrals, the period before April 2026 is the time to confirm which providers are currently commissioned in your area and whether any pathway changes are planned. This is not the SENCO's statutory responsibility, but it is information that helps families and reduces the calls and emails that arrive at the SENCO's desk when referrals fail.
The variation between ICBs also matters for EHCP applications. If a family accessed an RTC assessment through a provider that is no longer commissioned in their ICB area, some local authorities have raised questions about whether clinical recommendations from those reports carry weight in the EHC needs assessment process. This is contested, and it is worth seeking LA advice if you encounter this situation. The clinical validity of the diagnosis is not affected by the provider's current commissioning status. The recommendation in the report is an opinion; the EHC assessment process weighs all available evidence.
Before implementing any adjustments following an RTC diagnosis, it helps to have a clear understanding of what ADHD actually looks like in the educational setting. The clinical picture in the diagnostic report is based on parent report and clinical interview. The educational picture needs to be constructed from classroom observation.
ADHD involves difficulties across three clusters: inattention, hyperactivity, and impulsivity. In practice, these manifest differently depending on subtype, age, gender, and context. The pupil with predominantly inattentive ADHD, often described as the 'daydreamer', is easy to overlook precisely because they are not disruptive. They miss instructions, lose track of multi-step tasks, produce inconsistent work, and disengage from tasks requiring sustained attention. These difficulties are real and can significantly affect attainment, but they do not draw teacher attention the way hyperactive-impulsive presentations do.
Research on cognitive science approaches to ADHD consistently shows that the most effective classroom adjustments address the underlying executive function difficulties rather than the surface behaviour. Barkley (1997) described ADHD as a disorder of self-regulation, not a disorder of knowledge or ability. A pupil with ADHD knows what they are supposed to do; they struggle to initiate, sustain, and regulate the doing of it. Adjustments that externalise the self-regulation the pupil cannot perform internally, such as visual task breakdowns, timers, check-ins, and structured choice, are far more effective than adjustments that simply lower expectations.
The Thinking Framework's Sequence operation is particularly useful here. When a teacher breaks a complex task into a visible, numbered sequence, they are providing the external planning scaffold that the pupil's working memory cannot hold. This is not differentiation in the sense of reducing demand; it is differentiation in the sense of restructuring the entry point. The task remains unchanged. The planning support is made explicit. For a pupil with ADHD, this adjustment can be the difference between task avoidance and task completion. Our article on ADHD, autism, and PDA in the classroom explores the overlaps and distinctions between these profiles in detail.
For older pupils, a conversation with the pupil directly about their own strategies is worth having. Many adolescents with ADHD have developed self-regulation strategies that are not visible to teachers. Asking a Year 10 pupil what helps them concentrate, what makes tasks harder, and what they do when they get stuck produces information that no diagnostic report can provide. Metacognitive work with neurodivergent students consistently shows that self-awareness of cognitive strategies improves self-regulation outcomes over time.
One reason RTC referrals create friction with schools is that the assessment process used by many independent providers does not routinely include direct school evidence. The gold standard for ADHD assessment, as set out in NICE Guideline NG87 (2018), includes information from multiple settings, specifically home and school. However, the logistics of gathering formal school evidence within the RTC timeline, which can be four to eight weeks from referral to diagnosis, mean this is not always completed.
Some RTC providers send a teacher rating scale, typically the Conners or the SNAP-IV, as part of the assessment pack. When this happens, the SENCO or a subject teacher completes it and returns it to the provider. This is the school's formal contribution to the clinical assessment. It is worth knowing that these rating scales carry significant weight in the diagnostic decision, and that an incomplete or uncompleted scale from school reduces the quality of the assessment data.
If your school receives a teacher rating scale and is unsure how to complete it, our guide to ADHD tests and assessments explains what each scale measures and how teacher observations are weighted in the diagnostic process. Completing the scale accurately and returning it promptly is one of the most direct contributions the school can make to the quality of a child's assessment.
When no rating scale has been sent by the provider, the SENCO can still complete one independently and share it with the clinician. This is good professional practice. It creates a school-side record of the evidence gathered and ensures the clinician has the educational perspective even if it was not formally requested. The Conners 3 teacher form takes approximately fifteen minutes to complete and is widely available through educational psychology teams.
Start with an audit. How many Right to Choose referrals or completed diagnoses has your school received this academic year? Are they recorded consistently, or are they scattered across email threads and parent meetings without a central log? If your school does not have a standard response protocol for RTC referrals, the absence of that protocol is the first gap to address.
A simple RTC referral log, held in the SENCO's records, should capture the date of referral or diagnosis, the provider used, whether the school was asked to complete a rating scale and whether it did, the date of the review meeting with parents, the current level of SEN provision, and whether an EHCP assessment has been requested or is under consideration. This log costs nothing except the hour it takes to create it. It transforms a set of ad hoc responses into a manageable caseload.
If you have received a diagnostic report this week and have not yet responded, use the letter template from section six above, adapt it for the family's circumstances, confirm the wording with your headteacher, and send it within five working days. That response sets the professional tone for everything that follows.
If you do not yet have a Conners Teacher Rating Scale available for your staff to use, contact your educational psychologist service or your LA's SEND support team. Most LAs provide access to standardised rating scales for schools as part of their SEND advisory offer. Having the scale available before the next referral arrives means you are not creating a process under pressure.
Finally, check your ICB's current position on Right to Choose ADHD assessments before April 2026. If there are changes planned to commissioned providers or referral pathways in your area, knowing this now means you can give families accurate information rather than discovering the changes when a referral fails. Your ICB's children and young people commissioning team is the right contact. An email to your LA's SEND Partnership team is a good starting point if you do not have the ICB contact details.
The Right to Choose pathway is not going away. The NHS waiting times that make it necessary are not improving quickly. SENCOs who build a clear, professional framework for managing RTC referrals now will spend less time managing individual crises later. The families who use this pathway are not adversaries; they are parents who have taken significant initiative to get their child an assessment. Meeting that initiative with a clear, consistent, evidence-based response is exactly what the role requires.
The following sources underpin the guidance in this article. They cover ADHD diagnostic criteria, NHS commissioning policy, SEND legislation, and the evidence base for classroom-based ADHD support.
Attention deficit hyperactivity disorder: diagnosis and management (NG87) View guidance ↗
NICE, 2018 (updated 2023)
NICE Guideline NG87 (2018). National Institute for Health and Care Excellence.
The authoritative clinical guideline for ADHD diagnosis and management in children, young people, and adults. Sets out the multi-informant assessment standard and the evidence base for pharmacological and non-pharmacological interventions. Essential reading for any SENCO advising parents on the validity of clinical assessments.
NHS England Right to Choose Policy Guidance View guidance ↗
NHS England, 2023
NHS England (2023). NHS England.
The policy framework governing patients' rights to choose their NHS provider for first outpatient appointments. Explains the legal basis, GP obligations, and the conditions under which ICBs can restrict provider choice. Directly relevant to understanding what schools can and cannot do when a family invokes this right.
SEND Code of Practice: 0 to 25 Years View guidance ↗
DfE and DoH, 2015
Department for Education and Department of Health (2015). HMSO.
The statutory guidance for local authorities, schools, and health and care services on supporting children and young people with SEND. Sets out the graduated approach, the EHCP threshold, and the roles and responsibilities of all parties including schools receiving clinical diagnoses from parents.
ADHD and the Nature of Self-Control View study ↗
4,800+ citations
Barkley, R. A. (1997). Guilford Press.
Barkley's foundational model of ADHD as a disorder of self-regulation across time rather than a simple attention deficit. This reframing has significant implications for school-based adjustments: effective support externalises self-regulation, not just expectations. Directly applicable to understanding why classroom presentations diverge from home reports.
Conners 3rd Edition: Manual View resource ↗
Standardised, norm-referenced
Conners, C. K. (2008). Multi-Health Systems.
The most widely used standardised rating scale for ADHD in schools and clinical settings. The teacher form captures inattention, hyperactivity, learning problems, executive function difficulties, and peer relations in a norm-referenced format that provides objective school-side evidence for both diagnostic and EHCP processes.
{"@context":"https://schema.org","@graph":[{"@type":"Article","headline":"Right to Choose ADHD: What SENCOs Need to Know in 2026","description":"A practical guide for SENCOs on managing Right to Choose ADHD referrals: school-side evidence gathering, professional response letters, EHCP thresholds, and regional ICB variations before April 2026.","datePublished":"2026-03-24T10:00:00.000Z","dateModified":"2026-03-24T10:00:00.000Z","author":{"@type":"Person","name":"Paul Main","jobTitle":"Founder & Educational Consultant"},"publisher":{"@type":"Organization","name":"Structural Learning","logo":{"@type":"ImageObject","url":"https://cdn.prod.website-files.com/5b69a01ba2e409e5d5e055c6/5b7ed3e19e6f9b0001c3b8e4_SL-logo.png"}},"mainEntityOfPage":"https://www.structural-learning.com/post/right-to-choose-adhd-senco-guide-2026","about":[{"@type":"Thing","name":"Attention Deficit Hyperactivity Disorder","sameAs":"https://www.wikidata.org/wiki/Q41112"},{"@type":"Thing","name":"Special Educational Needs Coordinator","sameAs":"https://www.wikidata.org/wiki/Q7576897"},{"@type":"Thing","name":"Education Health and Care Plan","sameAs":"https://www.wikidata.org/wiki/Q16975862"}]},{"@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.structural-learning.com"},{"@type":"ListItem","position":2,"name":"Blog","item":"https://www.structural-learning.com/post"},{"@type":"ListItem","position":3,"name":"Right to Choose ADHD: What SENCOs Need to Know in 2026","item":"https://www.structural-learning.com/post/right-to-choose-adhd-senco-guide-2026"}]}]}
