About This Guideline
The guideline outlines a roadmap for ADHD clinical practice, research and policy, now and in the future, with a focus on everyday functioning and quality of life for care based on age, gender, culture, setting and geography of people who are living with ADHD, and those who support them.
Development of the ADHD guideline integrates the best available evidence with multidisciplinary clinical expertise and the preferences of those with lived experience. All stages of the rigorous development process were underpinned by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. This considers the volume and quality evidence informing a recommendation and the feasibility, acceptability, applicability, cost, and implementation considerations of the recommendation.
Where appropriate, evidence reviews in the National Institute for Health and Care Excellence (NICE) 2018 ADHD: diagnosis and management guideline were updated. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) was adopted as a conceptual framework to anchor discussions and deliberations. Fifty prioritised clinical questions were addressed in 14 systematic reviews (new and updated from NICE 2018) and 28 narrative reviews, generating 132 recommendations.
There are several groups at higher risk of having ADHD, such as people with a close relative with ADHD, people with neurodevelopmental and mental health conditions and people in some settings, such as prisons. Routine screening for ADHD at the population level is not recommended.
A thorough assessment is needed to make a diagnosis of ADHD, including careful assessment of possible co-occurring or alternative conditions. Upon diagnosis, information and support should be provided to the person, their parents/carers, including an explanation of available treatment options and information about how they can minimise symptoms impacting on the enjoyment of their lives and maximise their strengths.
Non-pharmacological interventions can improve broader aspects of functioning for people with ADHD and/or their families. Parent/family training should be offered to parents/carers of children and adolescents with ADHD to support the functioning of the family and child with ADHD. Cognitive-behavioural interventions should be offered to adolescents and adults with ADHD. Making changes in a person’s school, university or workplace can help the person with ADHD succeed.
Before prescribing medication to help people treat their ADHD symptoms, clinicians should carefully assess the person’s general health and explain all medication options, including potential benefits and side effects. Clinicians and people with ADHD (or their parents/carers) should make treatment decisions together. Choice and dosage of medication must be optimised for each person.
For children, adolescents, and adults, the first medication should be stimulants (methylphenidate, dexamfetamine or lisdexamfetamine) unless the person is unable to take these medications due to other health problems. If stimulants are not effective for the person, or they are unable to use these medications, other medications (for example, atomoxetine or guanfacine) can be tried.
Ongoing monitoring is required to assess whether the medication is effective and whether there are any unwanted effects. As a child with ADHD grows up, their clinicians should plan for a smooth move from health services for children to health services for adolescents and later to adult health services.
Through the adoption of these recommendations, the guideline aims to improve the experience and health outcomes for the estimated more than 1 million Australians with ADHD.