ADHD is a diagnosis made when an individual has a constellation of symptoms and functional impairment. The diagnostic framework is scientifically valid and can be reliably applied. The diagnostic criteria include the functional impairment of symptoms and the context in which they occur (Royal Australia and New Zealand College of Psychiatrists, 2013).

The approach for assessment, diagnosis, intervention, and support should occur within a holistic, multi- or inter-disciplinary framework and often involves multiagency contributions. Holistic care incorporates biological, psychological, educational, social, spiritual and cultural dimensions, and includes all aspects of a person’s functioning, activities, participation, abilities and disabilities and the context in which they occur.

Individualised plans for interventions, support, care coordination and support will be based on scientific research and evidence, particularly regarding effectiveness, and on best practice principles that are appropriate for the resource setting.

Services for the diagnosis, treatment and support of individuals with ADHD could be provided in a variety of formats. Some services necessitate in-person sessions, such as those that require physical examinations. In-person consultations can sometimes assist the clinician to develop a more nuanced understanding of the person with ADHD (and their family).

For some services, either telehealth or in-person formats could be provided, with the following considerations:

• the person’s and their family’s preference
• required distance of travel
• infrastructure available: private room; quiet space; distraction-free
• access to computer/phone; stable internet connection; sufficient data
• for children, ensuring appropriate childcare is available during feedback or parent sessions
• support person available for family
• interpreter available, if required.

Best-practice principles include individualised plans developed in accordance with principles of co-production, where people with ADHD, families and carers are at the centre of decision-making about all aspects of their healthcare. This requires advocacy, attentive listening, engagement in integrated care pathways that foster continuity of care, the exercise of choice and meaningful informed consent, compassion, empowerment, hope, transparency and partnership.

The best approach to clinical practice will therefore be person-centred and will promote the independence of the person with ADHD. It will also be inclusive, provide choice and give control and include other stakeholders. Best practice also requires a trauma-informed approach and enables supported decision-making. Best practice should also follow the latest evidence-based guidance wherever this is evidence is available.

It is clear from following these best practice principles that the person will be fully informed and involved in treatment decisions and will need to consent to whatever is agreed (and this needs to be formally recorded). The professional has a duty to ensure the person has the necessary capacity to consent, and where this might be in doubt, capacity is formally evaluated, and where it is absent (for example, in younger children), consent is obtained from an appropriate substitute decision maker such as a parent/carer.

Professionals should be appropriately trained and credentialed. They should:

• be in good standing with their professional bodies and adhere to the contemporary standards of good practice for their profession
• act professionally, with integrity and share the core values required of them by their profession
• adhere to the codes of conduct, ethical guidelines and policies and procedures required by their employing organisation and their profession
• have adequate knowledge of applicable laws and regulations in the jurisdiction in which they are practising, particularly as they relate to medications, prescribing, off-label prescribing, safety and use of stimulants
• maintain their professional performance through continuing professional development as required
• ensure they only deliver care to people with ADHD when they have the competence to do so, and that this is within their area of expertise (for example, paediatricians or child and adolescent psychiatrists for children and adolescents, and adult psychiatrists for adults
• seek peer review, supervision or second opinion when needed.

Those not regulated by the Australian Health Practitioner Regulation Agency (for example, ADHD coaches, speech pathologists, counsellors, and peer support workers), should ensure they have undergone formalised training from reputable training providers.

Services, whether they be health, education or justice related, have the responsibility to deliver high-quality care or education to people with ADHD. In order to enable professionals to provide optimal education, care and treatment, the system in which they work should be built on sound best-practice principles based on evidence, informed by lived experience, and designed to produce the best outcomes for people with ADHD. All services need to remain fully accredited and have appropriate governance systems to ensure safety and quality. They must provide a skilled and well-resourced workforce.

Services need to ensure that staff will comply with safety systems to protect people with ADHD, will communicate with others effectively, will provide continuity of education or care, will maintain partnerships with people with ADHD and their family and carers, will maintain trust, honesty, and respect, and will act with sound ethical principles.

Services should strive for equitable access to timely, high-quality education or care, irrespective of locality or circumstance, cultural background, language, identity or age. Services should be culturally safe. Services should acknowledge the strengths and abilities of people with ADHD and contribute to each person with ADHD reaching their potential. Services should not discriminate on the basis of a person having ADHD.

Apart from prescribing, which is restricted to medical practitioners (and, in some circumstances, nurse practitioners), this guideline does not specify which professionals (clinicians) can diagnose, assess and treat ADHD. Restricting permission to provide ADHD care to clinicians with certain credentials can reduce access to services and care and extend waiting lists, deprive certain professionals of autonomy, and can foster the establishment of siloed working. Instead, it is assumed that as professionals, clinicians only provide services for which they are appropriately trained and credentialed (see Professionals, above), which are within their area of expertise.