New Australian ADHD guidelines released

New evidence-based guidelines have been published by the Australian ADHD Professionals Association (AADPA), including 132 recommendations designed to support the approximately one million Australians thought to be living with ADHD.
 
Dr Andrew Leech, a GP with paediatric special interest, told newsGP there are several main takeaways for GPs from the new guidelines, which were published after consulting people with ADHD, researchers, clinicians, family members and community members.
 
‘It is useful to have a manual for GPs interested in pursuing ADHD diagnosis and management,’ he said.
 
‘ADHD is a common, neurodevelopmental disorder with onset typically before the age of 12, and affects 6–10% of children. It runs in families, so if one child is diagnosed, screen the other family members as well.’
 
He describes the diagnostic process for patients with ADHD as ‘time consuming’, with guidelines suggesting it takes 2–3 hours.
 
‘It cannot be done simply with screening questionnaires,’ he said.
 
‘It requires a longitudinal view of that patient’s life including home and school or work, and the exclusion of other health and mental health conditions that can mimic ADHD.
 
‘I believe GPs are well placed in terms of understanding the lives of their patients and the impact of an illness like ADHD.’
 
Associate Professor John Kramer, Chair of RACGP Specific Interests ADHD, ASD and Neurodiversity, was part of the ADHD Guidelines Development Group. He told newsGP there is not enough understanding of ADHD.
 
‘A lot of psychiatrists don’t understand ADHD well, and the same applies to paediatricians. There isn’t a lot of formal training,’ he said.
 
‘Public hospitals and mental health systems don’t provide any access for adults who need assessment. They can only go privately, and this affects those that cannot pay the fees.’
 
Dr Leech agrees.
 
‘We should make services available to patients wishing to pursue a diagnosis,’ he said.
 
‘Unfortunately, in many parts of the country services are not available and books are full.

‘Medication prescribing is still a contentious issue and different in every state. Time will tell whether these guidelines will provide any push to government for GP prescribing.’
 
Dr Lara Roeske, Chair of RACGP Specific Interests, told the ABC the new guidelines are important for GPs.
 
‘We’ve been feeling a little bit lonely,’ she said. ‘There hasn’t been anything that we can turn to, to guide us around how we might approach, diagnose and manage patients presenting to us who may or may not have a diagnosis for ADHD.
 
‘That’s because there [wasn’t] really any up-to-date, evidence-based Australian guidelines. And, for the first time, we’re going to actually have those at our fingertips in our clinical practices and that’s really very important.’
 
The 215-page guidelines provide details on diagnosis, clinic interview and rating scales for children and adults.
 
‘It would be useful to have these guidelines available via a portal such as HealthPathways, to enable GPs to easily click through to the section they require,’ Dr Leech said.
 
In relation to medication for ADHD, methylphenidate, dexamphetamine or lisdexamphetamine should be offered as first line treatments for children and adolescents aged 5–17 as well as adults, the guidelines state. If none of these are effective, the next options can include atomoxetine, guanfacine or clonidine among others.
 
‘Stimulant medication is first line when treating ADHD,’ Dr Leech said.
 
‘GPs need to work with families to educate on the benefits of stimulant medication as some parents will only accept medication as a last resort.’
 
When it comes to non-pharmacological treatments, the guidelines recommend addressing sleep, diet and physical activity, parent/family training, and considering cognitive-behavioural intervention.

‘Nonpharmacological treatments can be effective and easily managed by the GP,’ Dr Leech said.
 
‘Areas such as sleep, healthy lifestyle, parent and family training and keeping linked with the school or university help support any amendments [to improve] attention span.
 
‘Enrolling a child or adult in an extra-curricular activity such as music, sport, art or social clubs provides social skills, physical movement and improves self-esteem.’
 
Apart from the individual physical and mental burden, AADPA estimates the economic costs of ADHD in Australia at $20.42 billion annually, or $25,071 per individual with the disorder.
 
The AADPA guidelines can be read in full online.
 
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