Executive Summary
This guideline is mainly intended for clinicians, including medical and allied health professionals, nurses (including mental health nurses and mental health nurse practitioners), pharmacists, and other people involved in the support of people with ADHD, such as educators. We anticipate this guideline will also be used by people with ADHD and their families, parents, carers and partners.
Attention deficit hyperactivity disorder (ADHD) is classified as a neurodevelopmental disorder with onset typically before 12 years of age. Symptoms include difficulties with attention and/or hyperactivity and impulsivity, which are incongruent with a person’s age and interfere with activities, including a person’s family life or participation in their community.
ADHD is the most common neurodevelopmental condition in children and adolescents. However, ADHD can be diagnosed for the first time in adulthood. The precise causes are unknown, but there are multiple factors that make a person more likely to develop ADHD. ADHD often runs in families.
Some groups of people are more likely to meet the criteria for a diagnosis of ADHD, such as people with a close relative who has ADHD, people with other neurodevelopmental and mental health conditions and people in some settings, such as prisons. Clinicians should consider the possibility of ADHD when providing care to people in these high-risk groups. However, routine screening for ADHD at the population level is not currently recommended. This is because screening tools are currently not sufficiently accurate and efficient, and the costs and burden to the healthcare system of universal screening are not yet established.
A thorough assessment by an appropriately trained and credentialled clinician is needed to make a diagnosis of ADHD. A person with ADHD may have one or more other neurodevelopmental, mental health, or medical conditions that make diagnosis and treatment more complex. Careful assessment of possible co-occurring or alternative conditions is required.
When a clinician makes the diagnosis of ADHD, they should provide the person (or their parents/carers) with information and support. Clinicians should explain all the treatment options available and information about how they can minimise symptoms impacting on the enjoyment of their lives and maximise the person’s strengths.
Services for Aboriginal and Torres Strait Islander people should be culturally safe. Where services are not delivered by Aboriginal or Torres Strait Islander providers, non-Indigenous professionals should ensure that all care is based on the principles set out in the Working Together report (Dudgeon, Milroy, & Walker, 2014).
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. It is best if one person takes responsibility for coordinating between the old service and the new service and collaborates with the person, their family, and all those involved in their care.
Non-medication treatments for people with ADHD and their families
Non-pharmacological interventions 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. 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. This can include physical changes or educating other people on how to most helpfully interact with the person with ADHD.
Medication for people with ADHD
Before prescribing medication to help people treat their ADHD symptoms, clinicians should carefully assess the person’s general health and should explain all the treatment options, 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 6 years and over, adolescents and adults starting treatment for ADHD, the first medication should be stimulants (methylphenidate, dexamfetamine or lisdexamfetamine) unless the person 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, other medications (for example, atomoxetine or guanfacine) can be tried. For adults, there are other medications that could sometimes be helpful.
Ongoing care for people with ADHD using medications
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. Sometimes it is helpful to adjust the timing of medications and meals or snacks or plan a break in treatment to help a child’s growth to catch up.
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. For some medications, the dose must be carefully decreased over time to avoid health harms.
What decision-makers and researchers can do to help people with ADHD
Funding should be made available to expand services for people with ADHD and to deliver timely and accessible assessment, support and intervention, and an ADHD helpline accessible to all Australians.
Laws and regulations for prescribing ADHD stimulant medications and for shared care should be uniform between the states and territories in Australia. These regulations should reflect scientific evidence and best practice and not restrict the availability of medication or treatment where it is required.
Training should be available for all clinicians working with people with ADHD. ADHD research is needed to better understand many aspects of ADHD, with the goal of improving the quality of life for people living with ADHD.