Review

. 2023 Aug;57(8):1101-1116.

doi: 10.1177/00048674231166329. Epub 2023 May 30.

The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder

Tamara May¹, Edwina Birch², Karina Chaves³, Noel Cranswick^{4

5

6}, Evelyn Culnane⁷, Jane Delaney⁸, Maddi Derrick⁹, Valsamma Eapen¹⁰, Chantele Edlington⁸, Daryl Efron^{5

7

11}, Tatjana Ewais^{12

13}, Ingrid Garner¹⁴, Michael Gathercole¹⁵, Karuppiah Jagadheesan^{16

17

18}, Laura Jobson¹⁹, John Kramer^{20

21}, Martha Mack²², Marie Misso²³, Cammi Murrup-Stewart¹⁹, Evan Savage²⁴, Emma Sciberras^{5

25}, Bruce Singh²⁶, Renee Testa^{27

28}, Lisa Vale²⁹, Alyssa Weirman¹⁴, Edward Petch^{30

31}, Katrina Williams^{1

32}, Mark Bellgrove^{19

33}

Affiliations

¹ Department of Paediatrics, Monash University, Clayton, VIC, Australia.
² ADHD Foundation, Epping, NSW, Australia.
³ Albury Wodonga Health, Albury, NSW, Australia.
⁴ Clinical Pharmacology Unit, Department of Medicine and Melbourne Children's Trials Centre, Royal Children's Hospital, Parkville, Vic, Australia.
⁵ Murdoch Children's Research Institute, Parkville Vic, Australia.
⁶ University of Melbourne, Parkville, VIC, Australia.
⁷ The Royal Children's Hospital Melbourne, Parkville, VIC, Australia.
⁸ Speech Pathology Australia, Melbourne, VIC, Australia.
⁹ Hobart ADHD Consultants, Bellerive, TAS, Australia.
¹⁰ South Western Sydney Local Health District and Ingham Institute for Applied Medical Research, UNSW Sydney, Liverpool, NSW, Australia.
¹¹ Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
¹² Faculty of Medicine, University of Queensland, Herston, QLD, Australia.
¹³ School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia.
¹⁴ ADHD Guideline Development Group, Melbourne, VIC, Australia.
¹⁵ Youth Justice, Department of Community and Justice, Grafton, NSW, Australia.
¹⁶ NWAMHS-North West Area Mental Health Services, Melbourne, VIC, Australia.
¹⁷ Bi-National ADHD Network Committee, RANZCP - Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia.
¹⁸ Swinburne University, Melbourne, VIC, Australia.
¹⁹ Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia.
²⁰ ADHD, ASD and Neurodiversity Special Interest Group, Faculty of Special Interests, RACGP.
²¹ Rural Medical School, UNSW Medicine & Health, Coffs Harbour, NSW, Australia.
²² Applied Neuroscience Society of Australasia (ANSA).
²³ The Knowledge Synthesis Lab, Melbourne, VIC, Australia.
²⁴ Department of Education, VIC, Australia.
²⁵ School of Psychology, Deakin University, Burwood, VIC, Australia.
²⁶ Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.
²⁷ Department of Mental Health, Royal Children's Hospital, Melbourne, VIC, Australia.
²⁸ Department of Psychology, Monash University, Melbourne, VIC, Australia.
²⁹ Occupational Therapy Australia, Splash Paediatric Therapy, Melbourne, VIC, Australia.
³⁰ Hakea Prison, Department of Justice, Perth, WA, Australia.
³¹ University of Western Australia, Perth, WA, Australia.
³² Monash Children's Hospital, Clayton, VIC, Australia.
³³ AADPA Australian ADHD Professionals Association, Melbourne, VIC, Australia.

PMID: 37254562
PMCID: PMC10363932
DOI: 10.1177/00048674231166329

Review

The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder

Tamara May et al. Aust N Z J Psychiatry. 2023 Aug.

. 2023 Aug;57(8):1101-1116.

doi: 10.1177/00048674231166329. Epub 2023 May 30.

Authors

Affiliations

¹ Department of Paediatrics, Monash University, Clayton, VIC, Australia.
² ADHD Foundation, Epping, NSW, Australia.
³ Albury Wodonga Health, Albury, NSW, Australia.
⁴ Clinical Pharmacology Unit, Department of Medicine and Melbourne Children's Trials Centre, Royal Children's Hospital, Parkville, Vic, Australia.
⁵ Murdoch Children's Research Institute, Parkville Vic, Australia.
⁶ University of Melbourne, Parkville, VIC, Australia.
⁷ The Royal Children's Hospital Melbourne, Parkville, VIC, Australia.
⁸ Speech Pathology Australia, Melbourne, VIC, Australia.
⁹ Hobart ADHD Consultants, Bellerive, TAS, Australia.
¹⁰ South Western Sydney Local Health District and Ingham Institute for Applied Medical Research, UNSW Sydney, Liverpool, NSW, Australia.
¹¹ Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
¹² Faculty of Medicine, University of Queensland, Herston, QLD, Australia.
¹³ School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia.
¹⁴ ADHD Guideline Development Group, Melbourne, VIC, Australia.
¹⁵ Youth Justice, Department of Community and Justice, Grafton, NSW, Australia.
¹⁶ NWAMHS-North West Area Mental Health Services, Melbourne, VIC, Australia.
¹⁷ Bi-National ADHD Network Committee, RANZCP - Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia.
¹⁸ Swinburne University, Melbourne, VIC, Australia.
¹⁹ Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia.
²⁰ ADHD, ASD and Neurodiversity Special Interest Group, Faculty of Special Interests, RACGP.
²¹ Rural Medical School, UNSW Medicine & Health, Coffs Harbour, NSW, Australia.
²² Applied Neuroscience Society of Australasia (ANSA).
²³ The Knowledge Synthesis Lab, Melbourne, VIC, Australia.
²⁴ Department of Education, VIC, Australia.
²⁵ School of Psychology, Deakin University, Burwood, VIC, Australia.
²⁶ Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.
²⁷ Department of Mental Health, Royal Children's Hospital, Melbourne, VIC, Australia.
²⁸ Department of Psychology, Monash University, Melbourne, VIC, Australia.
²⁹ Occupational Therapy Australia, Splash Paediatric Therapy, Melbourne, VIC, Australia.
³⁰ Hakea Prison, Department of Justice, Perth, WA, Australia.
³¹ University of Western Australia, Perth, WA, Australia.
³² Monash Children's Hospital, Clayton, VIC, Australia.
³³ AADPA Australian ADHD Professionals Association, Melbourne, VIC, Australia.

PMID: 37254562
PMCID: PMC10363932
DOI: 10.1177/00048674231166329

Abstract

Objective: The objective of this article was to provide an overview of the development and recommendations from the Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder (ADHD). The guideline aims to promote accurate and timely identification and diagnosis, and optimal and consistent treatment of ADHD.

Methods: Development integrated the best available evidence with multidisciplinary clinical expertise and the preferences of those with lived experience, underpinned by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. The 23 guideline development group members included psychiatrists, paediatricians, general practitioners, psychologists, speech pathologists, occupational therapists, educators, Indigenous psychologists, and people with a lived experience; with two independent chairs and a methodologist. Where appropriate, evidence reviews from the National Institute for Health and Care Excellence (NICE) 2018 'Attention Deficit Hyperactivity Disorder: Diagnosis and Management' guideline were updated. Fifty prioritised clinical questions were addressed in 14 systematic reviews (new and updated from NICE 2018) and 28 narrative reviews.

Results: The 113 clinical recommendations apply to young children (5 years and under), children, adolescents and adults. They provide guidance for clinicians on identification, screening, diagnosis, multimodal treatment and support, including pharmacological and non-pharmacological interventions. The guideline and supporting information are available online: https://adhdguideline.aadpa.com.au/.

Conclusions: The guideline was approved by the National Health and Medical Research Council (NHMRC) of Australia and relevant medical and allied health professional associations. It is anticipated that successful implementation and uptake of the guideline by organisations, health care providers and other professionals will increase delivery of evidence-based treatment and improve health outcomes for the more than 800,000 Australians with ADHD.

Keywords: Attention deficit hyperactivity disorder; guideline; neurodevelopmental disorder.

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Conflict of interest statement

The multidisciplinary GDG was convened by inviting people with experience living with ADHD, people caring for people with ADHD, and academics with experience in ADHD, to participate in the development of the guideline. Disciplines represented included psychology, child and adolescent psychiatry, adult psychiatry, paediatrics, general practice, applied neuroscience, speech pathology, occupational therapy, nursing, education, clinical pharmacology, and government and private health services. There were eight content subgroups led by members of the GDG.

A formal process was followed to identify and manage competing interests among GDG members. A Conflict of Interest (COI) was defined as an interest of a member of the GDG that conflicted with, or could be perceived to conflict with, the duties and responsibilities of membership and the process of guideline development. This included any outside interest which could introduce any bias into the decision making of committee members. Potential members were asked to declare any COIs 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 comprised the two GDG Chairs, and an ethicist (who also acted as the independent observer), 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 NHMRC ‘Procedures and Requirements for Meeting the 2011 NHMRC Standard for Clinical Practice Guidelines’ (NHMRC, 2011). The interests of the Chairs were scrutinised by the independent ethics expert of the COI Management Group and the President of AADPA.

The author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: The guideline conflict of interest information can be found at: https://adhdguideline.aadpa.com.au/appendices/conflict-of-interest/

Figures

**Figure 1.**
Non-pharmacological and pharmacological treatments.

See this image and copyright information in PMC

References

1. Ahmed R, Borst JM, Yong CW, et al.. (2014) Do parents of children with attention-deficit/hyperactivity disorder (ADHD) receive adequate information about the disorder and its treatments? A qualitative investigation. Patient Prefer Adherence 8: 661–670. - PMC - PubMed
1. American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.Washington, DC: American Psychiatric Association.
1. Australian ADHD Professionals Association (AADPA) (2022) Australian Evidence-Based Clinical Practice Guideline for Attention Deficit Hyperactivity Disorder. Melbourne, VIC, Australia: AADPA.
1. Baggio S, Bayard S, Cabelguen C, et al.. (2021) Diagnostic accuracy of the French version of the adult attention deficit/hyperactivity disorder self-report screening scale for DSM-5 (ASRS-5). Journal of Psychopathology and Behavioral Assessment 43: 367–375.
1. Brevik EJ, Lundervold AJ, Haavik J, et al.. (2020) Validity and accuracy of the adult attention-deficit/hyperactivity disorder (ADHD) Self-Report Scale (ASRS) and the Wender Utah Rating Scale (WURS) symptom checklists in discriminating between adults with and without ADHD. Brain and Behavior 10: e01605. - PMC - PubMed

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The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder

Affiliations

The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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LinkOut - more resources

Full Text Sources

Medical