ADHD -Diagnosis, management, medications & ongoing care.
The First Appointment (or several appointments)
When your child is referred to a paediatrician for concerns about Attention Disorder (ADHD/ADD), the paediatrician will conduct a general paediatric assessment to consider
your child's emotional, cognitive, social and physical development and also whether there are medical concerns.
your child's sleep, nutrition,
behavioural patterns and concerns.
indications or diagnoses of Attention Disorder or other developmental or neurodiverse conditions such as ASD.
any reports or diagnoses regarding ADHD/ADD from another provider.
The paediatrician will ask you and the child about your child's and family's medical and developmental history and about the child's history and patterns of behaviour, symptoms and difficulties.
They will want to rule out other conditions that can look like ADHD/ADD but may require different management.
This may take several appointments.
If your paediatrician considers further investigation of ADHD (or ADD) appropriate, they give you some questionnaires for you and your child's teacher to complete.
These questionnaires are also required to assess and review how current therapies or medications are working to help your child.
Older children and adolescents should also complete a questionnaire.
Your child may need some blood tests or other investigations.
The paediatrician will then ask you to book another appointment in a month or so.
Most paediatricians will write to your GP to update them on their assessment, diagnosis and management progress.
Diagnosing ADHD and ADD -The Next Appointment
Your paediatrician will
review any diagnostic reports but,
they require a report to include input from at least two domains, such as from home (by parents) and from school, kindy or childcare (by a teacher who knows the child well in the that non-home setting.
they will generally want to get new questionnaires completed to provide a recent assessment of functioning and before any medication is started.
score results of the paediatrician's questionnaires, if required and once completed and returned.
then discuss any reports, results and the scores with you and your child.
Diagnosis of ADHD/ ADD requires input from family, older patients and teachers or other carers. They need to have observations from more than one setting.
They may then make a diagnosis or a provisional diagnosis. They will recommend or review management that may include:
Psychological or Occupational Therapy;
Improving sleep behaviours, perhaps including with medication;
Other therapies or assessments;
Watch and wait to see if your child improves;
Further questionnaires to be completed at a later date;
A trial of short-acting stimulant medication or Vyvanse as per PBS prescribing rules;
A trial of another Medication, such as for anxiety or nutritional supplementation;
Letters to the school about the diagnosis or about medications, etc.
They will normally write a Letter to your GP to advise of their progress with diagnosis and management.
A review appointment may be required to assess progress with behavioural management.
If starting a trial of stimulant medication or other medications, the paediatrician will need to review your child's progress with the medication in about 2 to 4 weeks to consider:
Is the medication helping?
Are there side effects?
Dose changes or trialling a different medication.
the benefit of taking an extra dose at lunchtime.
If they have responded well to short-acting stimulant medication, would a change to long-acting doses of the medication be helpful?
A further Review Appointment is then needed- in about eight weeks.
This appointment is face-to-face. Stimulant medication can cause difficulty maintaining appetite, so your child’s weight and growth will be checked. Other possible side effects of medication are monitored, including by checking your child's blood pressure. Is the medication helping significantly? Are side effects a concern? Together, the paediatrician and you may be happy to proceed with that medication or consider other medication or therapy options.
Once medication management stabilises, and if this is with stimulant medication, your child will need to attend review appointments,
at least every six months with their paediatrician or their GP.
to review your child's progress and the effectiveness of the medication
monitor for any concerning side effects.
to obtain a repeat prescription of the medication.
with their paediatrician when the medication plan needs review
probably every 12 months or so
when medication effectiveness declines or concerns about management re-emerge
in response to growth and development.
Your paediatrician will recommend review appointments be timed to ensure you can renew your child's prescription before your last repeat runs out. It will be important to ensure appointments are not delayed or rescheduled.
State Regulation of Stimulant Medication Prescription & the Prescribing Authority
The Regulations require ongoing monitoring of your child for effectiveness, dose and side effects and whether your child is growing well and generally benefiting.
Stimulant Medication is prescribed under an "Authority" given by the State Regulator of Drugs of Dependence personally to your child's Specialist (Paediatrician or Psychiatrist) or GP.
Management of ADHD and ADD with stimulant medication involves a commitment to at least six monthly face-to-face review appointments with your prescriber.
The Regulations about the prescription of stimulant medication ensure that your child must have continuity of care with the doctor who holds the Authority.
Your GP's role in prescribing Stimulant Medication.
Your child's GP can prescribe the medication in accordance with their Specialist's management plan, either under the GP's or the Specialist's Authority. However,
Some GPs are happy to prescribe the Medication under your Paediatrician's Authority, and some are happy to apply for the Authority themselves.
Many GPs want the Paediatrician to hold the Authority and fully manage and prescribe stimulant medications for paediatric patients.
Once a child turns 18, the Regulations make it easier for GPs to prescribe stimulant medication but ongoing Specialist oversight will need to be with a Psychiatrist.
GPs are generally able and happy to prescribe non-stimulant medications in accordance with any specialist management plan provided to them by the specialist.
Older adolescent patients
Once a young person turns 18 years of age, the prescription authority for stimulant medication should be transferred to a psychiatrist or their GP. They must be reviewed by their psychiatrist and their GP from time to time as required by Government regulation.
Both paediatricians and psychiatrists have extensive wait times for New Patient appointments. Hence, an older adolescent New Patient seeking an ADHD diagnosis and management with stimulant medication should try to book with a psychiatrist. This will allow them to establish continuity in their ongoing care of their ADHD and may avoid some costs.