Australian Evidence-Based Clinical Practice

Guideline For ADHD: FACTSHEET FOR

CLINICIANS

What is ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) is 1. Identification

a neurodevelopmental condition characterised by
differences in brain and cognitive development. Symptoms What the guideline says
include difficulties with focusing and sustaining attention,
and hyperactive and impulsive symptoms which are greater Several groups of people are at higher risk of having ADHD
than that expected for a person’s age or developmental compared to people in the general population. This includes
level. For most people, ADHD symptoms continue into people with other neurodevelopmental conditions, people
adulthood and are lifelong. with mental health conditions and some medical conditions.
People in some settings will be at higher risk of having ADHD,
People with ADHD can struggle to focus and concentrate, such as those in prison, people using addiction services,
control their impulses and make decisions which take into or children and adolescents in out of home care. Girls and
account longer term consequences. They can experience women with ADHD may be at risk of under-identification.
difficulties with planning and prioritising, getting organised,
and time management. These difficulties can impact the Screening the general population for ADHD is not currently
ability to study, work, manage responsibilities, develop and recommended as current screening tools are not accurate
maintain social relationships, enjoy leisure time and relax. enough for the costs and risks of screening to outweigh the
They can also negatively impact self-confidence and self- benefits. Screening for ADHD in higher risk groups could
esteem. help to identify people with ADHD early so they can receive
support. Screening for ADHD in people in high-risk groups
Around 6-8% of Australian children have ADHD; and around should occur when symptoms continue despite treatment,
3-5% of Australian adults have ADHD which means more there is difficulty adhering to treatment and some signs of
than around 1 million Australians have ADHD. ADHD are present. When screening indicates ADHD may be
present people should undergo a diagnostic assessment.

2. Diagnosis
What is the guideline? What the guideline says
A thorough assessment by an appropriately trained and
credentialled clinician is needed to make a diagnosis of
Considerable gains have been achieved in the identification ADHD. Clinicians should gather a thorough developmental,
and care of people with ADHD, however, many people still mental health and medical history with a clinical and
do not receive guideline-recommended care. psychosocial evaluation of ADHD symptoms. A medical
assessment should be conducted to exclude any possible
The goal of this guideline is to improve the identification,
medical causes of symptoms. Clinicians should check the
diagnosis and treatment and support of people with ADHD.
symptoms result in clinically significant functional impairment
The guideline includes recommendations for young in at least two areas such as academic, occupational or
children, children, adolescents and adults. social domains. Rating scales can assist with diagnosis but
should not be used alone. The assessment should include
This factsheet contains a summary of the guideline identification of personal strengths. Multiple informants such
recommendations for clinicians. as teachers, parents, or partners for adults, should be used.
A person with ADHD may have one or more other Parent/family training should be offered to parents/carers
neurodevelopmental, mental health, or medical conditions of children and adolescents with ADHD to support the
that make diagnosis and treatment more complex. Careful functioning of the family and child with ADHD. Parents
assessment of possible co-occurring or alternative conditions should be informed that the need for parent/family training
is required. Where other conditions are identified, best- does not imply bad parenting but aims to optimise parenting
practice treatment for these conditions should be offered, skills to meet the additional parenting needs of children and
with adjustments for ADHD symptoms. adolescents with ADHD. Parent/family training should be
specific to the needs of parents/families with children with
After a diagnosis, clinicians should provide the person and ADHD. A focus on individual strengths, values and interests
their carers with education and information on the causes should be balanced with any focus on challenges, for both
and potential consequences of ADHD, and information the parent/carer and child. Parent/family training should
about evidence-based treatments, in a way that provides include components of education about ADHD, environmental
hope and motivation. Clinicians should provide information and behaviour modifications and information on positive
about available supports. Information should be provided in parenting approaches.
a tailored way so the person can best understand it, such as
through using plain language and providing small chunks of Cognitive behavioural intervention approaches should be
information when needed. offered to adolescents and adults with ADHD. Clinicians
delivering cognitive-behavioural interventions to children and
adolescents should consider the developmental capabilities
3. Treatment and support of the person, including their capacity to self-reflect and
their awareness of, and ability to influence, their thinking
What the guideline says processes. Cognitive-behavioural interventions should be
specific to the needs of the person with ADHD. A focus
Clinicians should explain and offer both medication and
on individual strengths, values and interests should be
non-medication (e.g. psychological) treatment options.
balanced with any focus on challenges. Components could
Sometimes only one of medication or non-medication
include education about ADHD, environmental and behaviour
treatment will be needed, or is available; or medication may
modifications, and psychological adjustment and cognitive
be needed first due to the severity of symptoms. Medication
restructuring.
treatment is most effective in reducing core ADHD symptoms
and non-medication treatments can provide support to Making modifications in a person’s school, university or
minimise the daily impact of ADHD symptoms and associated workplace can help the person with ADHD succeed. This can
difficulties. include physical changes or educating other people on how to
most helpfully interact with the person.
As a child with ADHD grows up, their clinicians should plan for
a smooth transition from health services for children to health
services for adolescents, and later to adult health services.
It is best if one person takes responsibility for coordinating
between the old and new service, and collaborates with the
person, their family, and all those involved in their care.

4. Non-medication treatment
What the guideline says
Non-medication treatments have value beyond improving
ADHD symptoms, and can improve broader aspects of
functioning for individuals and/or their families. Clinicians
should offer guidance on lifestyle changes such as promoting
a healthy and active lifestyle, including considering sleep
patterns, as these have the potential to improve day-to-day
functioning.
5. Medication treatment Resources for clinicians
What the guideline says
The guideline has several resources for clinicians to support
Before prescribing medication to help people treat their ADHD
clinical quality improvement in ADHD identification, diagnosis,
symptoms, clinicians should carefully assess the person’s
treatment and care. You can access these resources here:
general health and should explain all the treatment options
https://aadpa.com.au/guideline
including potential benefits and side effects. Clinicians and
people with ADHD (or their parents/carers) should make
treatment decisions together, after discussing all relevant
issues. Choice and dosage of medication must be optimised
for each person.

For children aged 5 years and over, adolescents and adults

Questions?
starting treatment for ADHD, the first medication should For more information please visit: https://aadpa.com.au/
be stimulants (methylphenidate [short or long acting], guideline
dexamfetamine or lisdexamfetamine), unless the person
Or email the guideline team: [email protected]
is unable to take these medications due to other health
problems. The dose must be carefully adjusted for the person.
The decision whether to start with short-acting or long-acting
stimulant medication should be based on the individual
person’s suitability. If one type of stimulant medication has
not improved the person’s symptoms enough, or has side
effects, the other should be trialled.

If methylphenidate, dexamfetamine and lisdexamfetamine

are not effective for the person, or they are unable to use
these medications, second line medications - atomoxetine
or guanfacine, can be tried. In children and adolescents,
clonidine is also a second line medication that may be
offered. For adults, there are third and fourth line medications
that could sometimes be helpful.

After someone has started ADHD treatment, their clinician

should carefully monitor whether the medication is effective,
whether there are any unwanted effects, the person’s heart
rate, blood pressure, and height and weight in children.

Parents and carers should oversee ADHD medication for

children and adolescents. Adolescents should be encouraged
to take responsibility for taking their medications. Sometimes,
a person with ADHD, in discussion with their clinician, will
decide to stop a medication for a short time. This needs
careful planning and for some medications, the dose must be
carefully decreased over time to avoid health harms.

Disclaimer
AADPA has produced this clinical practice guideline to support the delivery of appropriate care for a defined condition. The clinical practice guideline is based on the best
evidence available at the time of development. Healthcare professionals are advised to use clinical discretion and consideration of the circumstances of the individual
client, in consultation with the client and/or their carer or guardian, when applying information contained within the clinical practice guideline. People with a lived
experience should use the information in the clinical practice guideline as a guide to inform discussions with their healthcare professional about the applicability of the
clinical recommendations to their individual situation.