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About This Guideline


This Australian clinical practice guideline on attention deficit hyperactivity disorder (ADHD) addresses the priorities of people with a lived experience of ADHD, health professionals, educators, and service providers. The guideline integrates the best available evidence with multidisciplinary clinical expertise and consumer preferences to provide clinicians, educators, consumers and policymakers with guidance.

The guideline promotes accurate and timely diagnosis and optimal and consistent assessment and treatment of ADHD, and improved experience and health outcomes for the estimated more than 1 million Australians with ADHD (Deloitte Access Economics, 2019; Sciberras et al., 2022).

This guideline is in part based on the evidence-based UK National Institute for Health and Care Excellence (NICE) guidance on the diagnosis and management of attention deficit hyperactivity disorder (NICE, 2018), and was developed by updating the evidence reviews, conducting new evidence reviews for questions not addressed by NICE and adapting the guidance to the Australian context.

The accompanying technical report, resources and other relevant documentation can be found on this website.

Context and background

The Guideline Development Group (GDG) acknowledges that societal barriers are obstacles for full and equal participation in the community for a person with ADHD, rather than viewing ADHD symptoms as a personal impairment. In this guideline, we have attempted to balance traditional medical, biopsychosocial and social disability models, to ensure a considered approach to the identification, diagnosis and support of people with ADHD.

ADHD is classified as a neurodevelopmental disorder with onset typically before 12 years of age (American Psychiatric Association, 2013). The symptoms include difficulties with attention and/or hyperactivity and impulsivity, which are incongruent with a person’s age and interfere with activities and participation (American Psychiatric Association, 2013). For example, the symptoms of ADHD can interfere with cognitive and social development, academic and occupational achievement, or daily living and participation in leisure activities (American Psychiatric Association, 2013).

Inattentive symptoms include difficulty sustaining attention on tasks and directing attention, distractibility and organisational challenges. Hyperactivity refers to excessive motor activity and difficulties being still, particularly in structured situations that require self-control, as well as internal restlessness. Impulsivity refers to a reduced or inconsistent capacity to pause and reflect before acting, to ensure actions are in keeping with wanted consequences and longer-term goals.

Individuals with ADHD present with different combinations of symptoms. Some present with predominantly inattentive symptoms, some with predominantly hyperactive-impulsive symptoms and some with a combination of both.

There is a growing body of research exploring the numerous strengths and abilities of people with ADHD and positive aspects of ADHD features (Climie & Mastoras, 2015; Mahdi et al., 2017; Sedgwick, Merwood, & Asherson, 2019). Strengths related to ADHD features include the ability to generate novel ideas, adventurousness, and the ability to hyperfocus, which can result in high levels of productivity (Sedgwick et al., 2019).

ADHD occurs in approximately 6–10% of Australian children and adolescents and 2–6% of adults (Graetz, Sawyer, Hazell, Arney, & Baghurst, 2001; Sawyer, Reece, Sawyer, Johnson, & Lawrence, 2018). If left untreated, ADHD can result in significant lifelong functional impairment with poor long-term outcomes. The social and economic burden of ADHD in Australia is estimated at $20 billion per year (Deloitte Access Economics, 2019). There are effective non-pharmacological and pharmacological treatments for ADHD, which can reduce symptoms and improve function and participation, with better personal outcomes and a reduction in community and economic costs.

Purpose of the guideline

This is a guideline for the identification, diagnosis and treatment of people with ADHD. This clinical practice guideline for ADHD was developed to provide a roadmap for ADHD clinical practice, research and policy, now and in the future, and to help people in Australia who are living with ADHD, and those who care for them, to improve their health and wellbeing.

The goals of this guideline are:

  • to standardise clinical practice across Australia by providing clear advice about evidence-based ADHD identification, diagnosis and treatment
  • to integrate the voices and opinions of those with lived experience of ADHD into information for clinicians and decision-makers
  • to focus on everyday functioning and quality of life as well as symptom-based outcome measures
  • to address appropriate care based on age, gender, culture, setting and geography
  • to identify areas of unmet need and opportunities for research, advocacy and policy development.

Intended users of the guideline

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 for other people involved in the support of people with ADHD, such as educators. It includes guidance for clinicians in education, forensic and addiction service settings. We anticipate this guideline will also be used by people with ADHD and their families, parents and carers and partners.

Professionals with appropriate credentials and training can use this guideline to guide identification, diagnosis and treatment and provide support for individuals with ADHD. Health Service providers and policymakers can use it to guide local services and policy development. Those in organisations responsible for making funding decisions can use this guideline to develop a deeper understanding of the challenges faced by those with ADHD and the many approaches that, with adequate funding, will make a real difference for individuals and the community.

It is hoped that those who assist individuals with ADHD in educational, occupational, juvenile justice, community, disability and aged-care settings will be able to use this guideline to optimise the functioning and participation of people with ADHD and, ultimately, their wellbeing, welfare and productivity.

To whom the guideline applies

This guideline is relevant to the identification, assessment, treatment and support of young children (aged less than 5 years), children (aged 5–12 years), adolescents (aged 13–18 years), adults (aged 18 years and over) and older adults (aged 65 and over) with ADHD.

What the guideline does not address

This guideline does not provide full safety and usage information on pharmacological interventions. The guideline does not address drug dosages, including maximum daily limits. Before using pharmacological interventions recommended in the guideline, prescribers should consider each person’s clinical profile and personal preferences. It is recommended that prescribers consult guidance from Therapeutic Guidelines ( for detailed prescribing information, including indications, drug dosage, method and route of administration, contraindications, supervision and monitoring, product characteristics and adverse effects. Guidance can also be found in product information and from other web resources.

This guideline does not include a formal analysis of the cost-effectiveness of recommended practice versus current/established practice. Nor does it consider the economic feasibility and cost-effectiveness of recommendations, such as whether medications are on the Australian pharmaceutical benefits scheme (PBS) or the economic impacts of combined medication use. The clinical and organisational impact of cost on recommendations has been considered in GDG meetings using the GRADE approach. The guideline does not cover jurisdictional regulations regarding the prescribing of stimulants.

Consideration of issues relevant to Aboriginal and Torres Strait Islander peoples

Issues relevant to Aboriginal and Torres Strait Islander peoples have been addressed in this guideline through engagement with Aboriginal and Torres Strait Islander representatives via membership of the GDG. Recommendations specific for Aboriginal and Torres Strait Islander peoples have been developed and are documented in section 6.2.

Consideration of issues relevant to other groups

The following special-needs groups have been specifically considered in this guideline:

Other subgroups that have been considered throughout the guideline include:

  • culturally and linguistically diverse communities
  • people with co-occurring neurodevelopmental and mental health conditions
  • women and girls
  • people with low socioeconomic status
  • children in out-of-home care
  • older adults aged 65 years and above.

Relevant settings

These recommendations are relevant for the identification, diagnosis and support of people with ADHD in all healthcare settings, including community-based health and hospital settings, public and private sectors, and in educational settings, occupational settings, detention settings and the general community.

The International Classification of Functioning, Disability and Health (ICF) Framework

The GDG adopted the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) as a conceptual framework to anchor discussions and deliberations. The ICF complements traditional diagnostic systems such as the Diagnostic and Statistical Manual of Mental Disorders – fifth edition (DSM-5) (American Psychiatric Association, 2013) and International Statistical Classification of Diseases and Related Health Problems 11th edition (ICD-11 World Health Organization, 2018), offering a comprehensive, integrative framework of functioning and disability.

The ICF is a useful framework for explicitly identifying ways in which ADHD impacts everyday functioning and disability and the ways in which professionals, society, and the government might improve their response/s to these functional challenges. This framework may also serve a pragmatic purpose in aligning this guideline and its recommendations more closely with the priorities of Australian agencies, such as the National Disability and Insurance Agency.

Guideline development methods overview

The methods used to develop this guideline are aligned with the international gold standard Appraisal of Guidelines for Research & Evaluation (AGREE II) criteria, ADAPTE II, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to meet the comprehensive NHMRC criteria for approval of evidence-based guidelines. Where prioritised questions were addressed by the existing NICE guideline (NICE, 2018), the evidence reviews were updated and adapted to the Australian context. The steps are summarised in Figure 1 (See Methods section for details).

Figure 1: Guideline development process

Guideline development process
*Time points and tasks where prioritisation of engagement from GDG is required

Identification of clinical priorities in ADHD care

Clinical questions were identified by the Australian ADHD Professionals Association (AADPA) in consultation with stakeholders. This preliminary list was later refined through a structured prioritisation process conducted by a multidisciplinary group representing a broad range of perspectives and involving people with lived experience of ADHD (see Methods).

Through this process, contributors reached consensus on the clinical questions to be addressed by this guideline (Table 4) and the method for answering each (either a systematic review or narrative review; Table 5)

Table 4. Clinical questions addressed by this guideline

Characterising ADHD

  • What is ADHD?
  • What is the prevalence of ADHD in Australia and internationally?
  • What is the aetiology of ADHD?
  • What are the outcomes (i.e. prognosis) for individuals diagnosed with ADHD?
  • Does ADHD have a characteristic course and does its presentation change across the lifespan?
  • What other disorders commonly co-occur with ADHD?
Diagnosis and assessment

  • Should screening for ADHD occur at a population level?
  • Which groups are at high risk of developing ADHD?
  • Should screening for ADHD occur in high-risk populations?
  • How should ADHD be assessed, diagnosed and monitored, and by whom?
  • Which condition/s need to be excluded to make a diagnosis of ADHD?
  • Which condition/s should be considered for a co-occurring diagnosis with ADHD?
Non-pharmacological interventions

  • What is the clinical effectiveness of non-pharmacological interventions for people with ADHD?
  • What are the adverse events associated with non-pharmacological treatments for people with ADHD?
  • Should treatments be provided individually or in groups? Who should deliver them?
  • Is there a role for ADHD coaches?
  • Is there a role for peer support workers?
  • Is there a role for consumer groups (e.g. online forums)?
  • What educational/school/teacher interventions are possible, and are they effective?
Pharmacological Interventions

  • What is the clinical effectiveness of pharmacological treatments for people with ADHD? (And what is the optimal sequence?)
  • What are the adverse events associated with pharmacological treatments for people with ADHD?
  • How should initial medications be titrated?
  • Which clinicians should initiate pharmacological therapy and continue it long-term?
  • What principles should clinicians follow when discussing decisions to start, adjust, or discontinue pharmacological treatment for people with ADHD?
  • Which factors need to be considered when making initial treatment decisions for ADHD?
  • How should ADHD symptom severity and clinical profile guide treatment decisions?
Multimodal treatment

  • What is the clinical effectiveness of combined non-pharmacological and pharmacological interventions for people with ADHD?
  • What are the adverse events associated with combined non-pharmacological and pharmacological treatment for people with ADHD?
Care pathways – (non-pharmacological and pharmacological)

  • What is/are the most clinically effective initial sequence(s) of non-pharmacological/pharmacological treatment for people with ADHD?
  • What is the most clinically effective subsequent sequence of non-pharmacological/pharmacological treatment for people with ADHD when the initial treatment is ineffective, inadequate or treatment is not tolerated?
  • How should treatment effectiveness be monitored and supported?
  • How should adequacy of treatment response be assessed?
  • What are the indicators of remission and when should treatments be stopped?
  • What are the most effective approaches to increasing treatment adherence in ADHD for both non-pharmacological and pharmacological approaches?
  • How do co-occurring disorders impact treatment effects?
  • Does the optimal treatment approach for ADHD vary when co-occurring disorders are present?
Care pathways – pharmacological

  • Are there specific clinical effects of discontinuing from pharmacological treatment and if so how should these be supported?
  • Should ‘drug holidays’ from pharmacological treatment for ADHD be recommended, and if so, when?
Care pathways – principles

  • What are the information, support and educational needs of those diagnosed with ADHD, family, carers, and agencies who support people with ADHD?
  • At what intervals should clinical care be reviewed for people with ADHD?
  • What are shared care models, and are they effective?
  • What services should prison mental health services provide across life stages?
  • What referral pathways should be established?
  • Which agencies should be involved in the treatment and support of ADHD?
  • How should services be configured?
  • Are health professionals, including psychiatrists, paediatricians, psychologists GPs, nurses, allied health professionals and educators, adequately trained to support ADHD?
  • For which people with ADHD should a transition to further services take place (preschool to school, primary to secondary school, school to adulthood, older adults)?
Implementation considerations

  • How should services for those with ADHD in Australia be funded?
  • What should services provide and to whom?
  • How should a health professional maintain professional integrity and practice?

Table 5. Types of evidence reviews conducted

  • An evidence review was conducted, where a systematic search was run, and relevant research was identified and synthesised using GRADE
  • This method applied to high-priority questions and areas of greatest controversy
  • May be an update of a NICE evidence review
  • These reviews were completed by the evidence team and are found in the technical report
  • Narrative evidence reviews contained literature relevant to the question, selected based on the expertise within the GDG. Evidence review (selection criteria and systematic evidence search) was not conducted in narrative reviews
  • This method applied to questions that were less well suited to a systematic evidence review format (e.g. for questions where the GDG were aware of a paucity of evidence and thus were better suited to a consensus discussion approach)
  • The narrative review may build upon a NICE evidence review or NICE guideline section
  • These reviews were completed by GDG members and are found in the technical report
  • An evidence review was conducted, where a systematic search was run, and no evidence (or no new evidence where an update of NICE evidence review) was identified
  • For those areas of greatest controversy
  • May build upon a NICE evidence review or NICE guideline section
  • Evidence team completed systematic search. GDG members completed a narrative review. Details in technical report

NICE: UK National Institute for Health and Care Excellence 2018 guideline for the diagnosis and management of ADHD (NICE 2018)

See Methods for details of each type of review.

Developing the recommendations

Specific, unambiguous, actionable recommendations were drafted by the GDG based on systematic assessment of the best available evidence, together with consideration of evidence certainty, the relevance to the Australian population, the balance of benefits and harms, the values and preferences of the community and clinicians, resource implications, feasibility and fairness, using the GRADE framework. The process is described in detail in the Methods section.

Guideline Development Group Members


Professor Katrina Williams

Head of Department of Paediatrics, Monash University; Director of Research & Developmental Paediatrician, Monash Children’s Hospital, Victoria.

Dr Edward Petch

Consultant Forensic Psychiatrist, Clinical Associate Professor Department of Justice, Hakea Prison, Western Australia.


Dr Marie Misso

Evidence synthesis and guideline development methodologist, The Knowledge Synthesis Lab, Victoria

Project management

Professor Mark Bellgrove

President Australian ADHD Professionals Association (AADPA); Director of Research, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria

Dr Tamara May

Monash University, Victoria

Dr Nicole Stefanac

Australian ADHD Professionals Association, Victoria

Ms Robyn Scarfe

Australian ADHD Professionals Association, Victoria

Voting Members of the Guideline Development Group (GDG)

  • Professor Mark Bellgrove
  • Ms Edwina Birch
  • Dr Karina Chaves
  • Associate Professor Noel Cranswick
  • Ms Evelyn Culnane
  • Ms Jane Delaney
  • Dr Madelyn Derrick
  • Professor Valsamma Eapen
  • Ms Chantele Edlington
  • Associate Professor Daryl Efron
  • Dr Tatjana Ewais
  • Mr Michael Gathercole
  • Ms Ingrid Garner
  • Dr Karuppiah Jagadheesan
  • Dr John Kramer
  • Ms Martha Mack
  • Dr Tamara May
  • Mr Evan Savage
  • Associate Professor Emma Sciberras
  • Emeritus Professor Bruce Singh
  • Dr Renee Testa
  • Ms Lisa Vale
  • Ms Alyssa Weirman

Appendix 2 lists members’ affiliations and representation.

Representation from relevant colleges and societies

Membership included representatives from the following organisations:

  • Australian ADHD Professionals Association (AADPA)
  • World Federation of ADHD
  • Royal Australian and New Zealand College of Psychiatrists (RANZCP)
  • Royal Australian College of General Practitioners (RACGP)
  • Royal Australasian College of Physicians (RACP)
  • Australian Psychological Society (APS)
  • Occupational Therapy Australia
  • Neurodevelopmental and Behavioural Paediatric Society of Australasia (NBPSA)
  • Speech Pathology Australia
  • Applied Neuroscience Society of Australasia (ANSA)
  • Australian Clinical Psychology Association (ACPA)

Consumer representation

The following members provided perspectives of people with ADHD and their families, including consumer organisations:

  • Ms Edwina Birch
  • Dr Madelyn Derrick
  • Ms Ingrid Garner
  • Ms Alyssa Weirman.

Representation from, and consultation with, Aboriginal and Torres Strait Islander peoples

Mr Michael Gathercole and Dr Cammi Murrup-Stewart provided perspectives from Aboriginal clinical practice, academic research and advocacy. They co-developed Section 6.2 with the GDG. Mr Michael Gathercole, as a member of the GDG, participated in the development of the guideline and all the resulting recommendations.

Management of conflicts of interest

A formal process was followed to identify and manage competing interests among GDG members (Appendix 4).  A Conflict of Interest (COI) was defined as an interest of a member of the GDG that conflicted with or had the potential to conflict with the duties and responsibilities of membership and the process of guideline development. This included any outside interest which could be perceived to introduce any bias into the decision-making of committee members. Potential members were asked to declare any conflicts of interest over the 3 years preceding the formation of the group and any arising during guideline development.

Conflicts or potential conflicts were managed by a COI Management Group, which consisted of the two GDG Chairs and an independent observer, ethicist Professor Lynn Gillam, who did not otherwise participate in the guideline development process. This group operated within the AADPA policy for the Identification and Management of Potential Conflict of Interests, which was developed to align with standard A6 of the National Health and Medical Research Council (NHMRC) Procedures and requirements for meeting the 2011 NHMRC standard for clinical practice guidelines (National Health and Medical Research Council, 2011). The interests of the Chairs were scrutinised by the independent ethics expert of the COI Management Group and the President of AADPA. The process is described in detail in Appendix 4 and Appendix 1 of the Administration report which can be found here.


This guideline has been approved by the NHMRC and endorsed by APS, RACP, RACGP, Speech Pathology Australia, Occupational Therapy Australia, ACPA, AAPI, ADHD WA, ADHD Foundation, RANZCP, ADHD Australia and the World Federation of ADHD.