ADHD guidelines for Australian general practitioners - clinical fact sheet and MCQ

Overview

The Australian Clinical Practice Guideline for ADHD provides evidence-based recommendations for diagnosing, managing, and supporting individuals with ADHD, tailored to the Australian context. Developed by the Australasian ADHD Professionals Association (AADPA), the guideline emphasises person-centred, multidisciplinary approaches to improve quality of life for the over one million Australians affected.

Identification and diagnosis of ADHD

Universal screening for ADHD is not recommended. However, clinicians should remain vigilant for ADHD in populations with a high prevalence which include individuals with a history of ADHD in immediate relatives, those with neurodevelopmental conditions, or those in correctional facilities (see Guideline for full list). 

It is important to be aware that ADHD is often under-recognised in females. 

Diagnosis requires a comprehensive assessment, incorporating clinical and psychosocial assessment, developmental and medical history, observer reports, and the use of validated criteria (DSM-5, ICD-10/11) by an appropriately trained clinician. Comorbid conditions, such as anxiety or substance use disorders, should be carefully evaluated. 

Treatment of ADHD

A multimodal treatment approach is advised:

1. Non-pharmacological interventions:

• parent/family training: to equip parents/carers with the specific skills required to meet the additional needs of children and adolescents with ADHD  

• cognitive-behavioural interventions: include a variety of approaches that aim to address behavioural factors, psychological distress, and mental ill-health, rather than ADHD symptoms

• lifestyle modifications: with a specific focus on optimising sleep, diet, and physical activity to improve day-to-day functioning

• ADHD coaching: to improve executive functioning, symptoms, self-esteem, general wellbeing, and overall quality of life
  
  

2. Pharmacological treatment:

• pharmacological treatment for children ≤5 should involve a clinician with experience in child development and ADHD 

• first-line medications include monotherapy with stimulants (methylphenidate, dexamfetamine, lisdexamfetamine) for children >5 years old, adolescents, and adults, where symptoms are causing significant impairment

• non-stimulant alternatives such as atomoxetine or guanfacine may be used if stimulants are ineffective or contraindicated

• comprehensive monitoring of medication effects include height/weight, cardiovascular function, sleep, sexual function, seizures, emotional and mental health 

• medication should be initiated and monitored by appropriately trained clinicians

Implementation

Practitioners are encouraged to adopt the guideline’s recommendations collaboratively with patients and their carers, integrating evidence, clinical judgement, and individual preferences. Consistent monitoring and adjustment of treatment plans ensure optimised outcomes.

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