An estimated one million Australians live with Attention Deficit Hyperactivity Disorder (ADHD), and it has been the topic of much discussion in Australia of late. An increase in awareness of ADHD in recent times has led to more interest in the disorder. This prevalence may have been impacted by several factors including the pandemic and its lockdowns. As a neurodevelopmental condition, characterised by differences in brain and cognitive development, ADHD symptoms are often lifelong, having a lasting impact on the people who are diagnosed, as well as their families.
Bolstered by its prevalence across social media communities and a growing list of high-profile women revealing ADHD diagnoses, much-needed clinical guidelines on the identification, diagnosis and treatment of people with ADHD have recently been endorsed.
The Australian Psychological Society – together with a select group of clinicians, researchers and people with lived experience – worked together to create the evidence-based guideline, a process two years in the making. Unlike some other countries, Australia hasn’t had any ADHD guidelines for clinicians to refer to, leading to disparate support and treatment available.
Released by the Australian ADHD Professionals Association (AADPA), the guideline was created to provide more clarity for health professionals and Australians living with ADHD to be better supported throughout their lives. The guideline offers 111 recommendations to identify, diagnose and treat people with ADHD. It focuses on educating people, while outlining a roadmap for ADHD clinical practice, research and policy, now and in the future, with an emphasis on everyday functioning and quality of life for people who are living with ADHD and those who support them.
How does ADHD manifest?
ADHD symptoms include difficulties with focusing and sustaining attention, and hyperactive and impulsive symptoms greater than those expected for a person’s age or developmental level. People with ADHD can struggle to focus and concentrate, control their impulses and make decisions which take into account longer term consequences. They can experience difficulties with planning and prioritising, getting organised, and time management. These difficulties can impact the ability to study, work, manage responsibilities, develop and maintain social relationships, enjoy leisure time, and relax. They can also negatively impact self-confidence and self-esteem. People with ADHD have many strengths such as being adventurous, the ability to generate novel ideas, problem-solve and hyperfocus which can result in high productivity. ADHD can look different as people can have varying degrees of symptoms; predominantly inattention symptoms, predominantly hyperactivity and impulsivity symptoms, or a mix of both.
Despite ADHD being well understood, not all people with ADHD get identified, and many don’t receive lifelong evidence-based treatment and support. The evidence-based clinical practice guideline for ADHD outlines the care and support people should receive. This includes ensuring they are readily identified, through to the standards for diagnosis, and the evidence-based care they should be offered. The guidelines recommend people with ADHD should be provided with:
- timely identification and diagnosis
- accurate and timely information about ADHD
- access to multimodal treatments including medication and non-medication treatments.
Overview of recommendations
There are several groups at higher risk of having ADHD, including people who have one or more close relatives with the disorder, have neurodevelopmental and mental health conditions, and/or are in certain settings, e.g. prisons.
After confirming an ADHD diagnosis through thorough assessment that includes possible co-occurring or alternative conditions, it’s important to provide information and support, including an explanation of the various treatment options as well as tools and strategies to minimise the impact of ADHD symptoms while maximising each person’s strengths.
There are many non-pharmacological interventions to improve baseline functioning for people with ADHD and, more broadly, their families. For example, a healthy, active lifestyle and better sleep patterns, both have the potential to improve day-to-day functioning. There are useful training options available to parents/carers of children and adolescents with ADHD, while cognitive-behavioural interventions should be offered to adolescents and adults with ADHD. On an institutional level, changes in a person’s school, university or workplace can help the person with ADHD succeed.
Then we come to pharmalogical interventions. Before prescribing medication, clinicians should carefully assess the person’s general health and explain all options in detail, including potential benefits and side effects. Medication-based treatment decisions should be made in tandem with the person with ADHD (or their parents/carers), with choice and dosage optimised for each person.
For children, adolescents and adults, the first medication should be stimulants (methylphenidate, dexamphetamine or lisdexamfetamine), unless they are unable to take such medications due to other health problems. If stimulants prove ineffective or unworkable, some alternative options are atomoxetine or guanfacine. In either case, continued monitoring is required to assess whether the medication is effective, as well as whether there are any unwanted effects. ADHD treatment is a lifelong journey, so clinicians should plan in advance to ensure the the move from health services for children to health services for adolescents, and later to adult health services, is as smooth as possible.
Educational roadmap
The ADHDA guideline is a much-welcomed resource that provides more clarity for health professionals to improve the experience and health outcomes for the many Australians living with this disorder. With a focus on educating people about their diagnosis and empowering them so they can thrive, the guideline offers a roadmap for ADHD clinical practice, research and policy, helping to improve the everyday functioning and quality of life for people with ADHD and those who support them.
Key recommendations
Here is an overview of some of the core recommendations. For more detail, see the guidelines.
- Non-pharmacological interventions, such as lifestyle changes, can improve broader aspects of functioning for individuals and/or their families
- Parents and carers of children with ADHD should be offered training and support
- Children should be given clear pathways for treatment and support into adolescence and beyond
- Cognitive-behavioural interventions should be offered to adolescents and adults with ADHD
- ADHD medication should be carefully monitored for its effectiveness
- Training should be available for all clinicians working with people with ADHD
- Funding should be made available to expand services for people with ADHD
- Further ADHD research needs to be conducted