The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder
ADHD Guideline Development Group (AADPA) · 2023 · Australia
Source and licence
- Authors
- Tamara May, Edwina Birch, Karina Chaves et al.
- Title
- The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder
- Journal
- The Australian and New Zealand Journal of Psychiatry, 2023
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC10363932
Licence statement of the original publication
This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Recommendation development
- Clinical consensus recommendationrecommendation was developed in either of the following ways:• Evidence to answer a prioritised question was sought, but there was insufficient evidence to inform an EBR. Therefore, a narrative review was prepared by an expert subgroup of the guideline development group (GDG)• For questions of lower priority, or where high-quality evidence is known to be limited or non-existent, evidence was not sought and an expert subgroup within the GDG prepared a narrative review.
- Clinical practice pointguidance based on expert opinion and clinical experience, provided on important issues arising from discussion of evidence-based or clinical consensus recommendations, outside the scope of the evidence-finding process.
Results
- 1.1.1Clinicians should be aware that the following groups of children, adolescents, and adults, have an increased prevalence of ADHD, compared with the general population:Children:• In out of home care diagnosed with oppositional defiant disorder or conduct disorder a Children and adolescents:• Diagnosed with anxiety disorders• with epilepsy• with a history of substance abuse a Adults:• With any mental health disorder (including substance use disorders, borderline personality disorder, intermittent explosive disorder, internet addiction, psychotic disorders, binge eating disorder, a gambling disorder a )• who experience suicidal behaviour or ideationPeople of all ages:• With neurodevelopmental disorders including autism spectrum disorder, intellectual disability, tic disorders, language disorders a and specific learning disorders a • Born preterm• With a close family member diagnosed with ADHD a • Born with prenatal exposure to substances including alcohol and other drugs a • With acquired brain injury a • Who are imprisoned a • With low birth weight a • With anxiety, depressive or bipolar and related disorders a • With sleep disorders aStrength: ****; Certainty: ⊕⊕ⵔⵔ LOW to⊕⊕⊕⊕ HIGH
- 4Non-pharmacological interventionsStrength: Non-pharmacological interventions; Certainty: Non-pharmacological interventions
- 4.2Parent/family trainingStrength: Parent/family training; Certainty: Parent/family training
Young children (under 5 years of age)
- 4.2.1Parent/family training should be offered to parents/families of young children with ADHD.Strength: ****; Certainty: ⊕⊕ⵔⵔ LOW to ⊕⊕⊕ⵔ Moderate
Children and adolescents (aged 5–17 years)
- 4.2.2Parent/family training should be offered to parents/families of children with ADHD.Strength: ***; Certainty: ⊕⊕ⵔⵔ LOW
- 4.2.3More intensive parent/family training programmes should be offered to parents/families of children with ADHD who have co-occurring oppositional defiant disorder or conduct disorder.Strength: ****; Certainty: ⊕⊕⊕ⵔ Moderate
Children and adolescents aged 5–17 years
- 4.2.8Cognitive-behavioural interventions could be offered to children with ADHD.Strength: ***; Certainty: ⊕⊕ⵔⵔ LOW
- 4.2.9Cognitive-behavioural interventions should be offered to adolescents with ADHD.Strength: ***; Certainty: ⊕⊕ⵔⵔ LOW
Adults (aged 18 years and above)
- 4.2.11Cognitive-behavioural interventions should be offered to adults with ADHD.Strength: ****; Certainty: ⊕⊕ⵔⵔ LOW
- 5Pharmacological interventionsStrength: Pharmacological interventions; Certainty: Pharmacological interventions
- 5.3Medication choice – children and adolescents (aged 5–17 years)Strength: Medication choice – children and adolescents (aged 5–17 years); Certainty: Medication choice – children and adolescents (aged 5–17 years)
- 5.3.1Methylphenidate or dexamfetamine or lisdexamfetamine should be offered as the first-line pharmacological treatment for people with ADHD, where ADHD symptoms are causing significant impairment.Strength: ****; Certainty: ⊕⊕ⵔⵔ LOW
- 5.3.4Atomoxetine or guanfacine or clonidine should be offered to children and adolescents if any of the following apply:• Stimulants are contraindicated• The person cannot tolerate methylphenidate, dexamfetamine or lisdexamfetamine• Symptoms have not responded to separate trials of dexamfetamine or lisdexamfetamine, and of methylphenidate, at adequate doses• The clinician considers that the medication may be beneficial as an adjunct to the current regimenDue consideration of risks and safety is required, especially if medications are used in combinationStrength: ****; Certainty: ⊕⊕ⵔⵔ LOW
- 5.4Medication choice – adults (aged 18 years and above)Strength: Medication choice – adults (aged 18 years and above); Certainty: Medication choice – adults (aged 18 years and above)
- 5.4.4Atomoxetine or guanfacine should be offered to adults with ADHD if any of the following apply:• Stimulants are contraindicated.• They cannot tolerate methylphenidate, lisdexamfetamine or dexamfetamine• Their symptoms have not responded to separate trials of dexamfetamine or lisdexamfetamine and of methylphenidate, at adequate doses• The clinician considers that the medications may be beneficial as an adjunct to the current regimenDue consideration of risks and safety is required, especially if medications are used in combinationStrength: ****; Certainty: ⊕ⵔⵔⵔ VERY LOW
- 5.5Further medication choicesStrength: Further medication choices; Certainty: Further medication choices
- 5.5.1The following could be offered to adults with ADHD, in no particular order:• Bupropion• Clonidine• Modafinil• Reboxetine• VenlafaxineCareful monitoring of adverse side effects is required.Strength: ***; Certainty: ⊕ⵔⵔⵔ VERY LOW
Non-pharmacological interventions
- Offer guidance on sleep, diet and physical activity levels, including offering strategies and/or referral if needed
- Offer an ADHD-focused group parent-training programme to parents or carersMore intensive parent/family support for children with ADHD and co-occurring oppositional defiant disorder or conduct disorder
- Cognitive-behavioural interventions should be offered to adults and adolescents with ADHD and could be offered to children
- ADHD coaching could be recommended as part of a treatment plan
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.
Contents of the original publication
The section headings of the original.
- Introduction
- Method
- Review of existing guidelines
- Development of priority clinical questions
- Evidence review methodology
- Narrative reviews
- Recommendation development
- Results
- Background
- Screening and identification
- Diagnosis
- Information needs after diagnosis
- Multimodal treatment
- Non-pharmacological interventions
- Pharmacological interventions
- Subgroups
- Conclusions
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