ADHD -Diagnosis, management, medications & ongoing care.

The prescription of Stimulant medication for ADHD and ADD is Government-regulated. Currently, the regulations require that a Specialist Paediatrician or Psychiatrist make or confirm a diagnosis under the DSM 5. The regulations require a trial of therapy before the prescription of Stimulants. A management plan with regulated Stimulant medication must be established, overseen and reviewed by the Specialist Paediatrician or Psychiatrist. Your child’s GP may be happy to issue prescriptions in accordance with this management plan, but any changes must be reviewed and established by your specialist. As children and adolescents grow and develop, the management plan may need review and adjustments.

Diagnosis with an Associated Paediatrician at Prosper Paediatrics:

The Associated Paediatricians have closed their books to most referrals, including referrals for diagnosis and management of ADHD in older children. For further details go to New Patient Appointment Requests.

The First Paediatrician Assessment 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 consider 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. 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, progress.

Diagnosing ADHD and ADD -The Next Paediatrician Appointment/s. 

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, once completed and returned. 

• 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 of ADHD/ADD. 

Paediatrician (or Psychiatrist) management of Attention Disorders:

The specialist will recommend or review a management plan 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;

• 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.

• Further questionnaires at a later date to assess how the management and therapies are helping your child;

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 (or psychiatrist) 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 specialist 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 psychiatrist) 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 (or psychiatrist) 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.

But what if we cannot get a paediatrician appointment for our ADHD Concerns?

Speak with your GP about a Mental Healthcare Plan Referral to a psychologist.

This referral allows access to up to 10 sessions a year, which can be used to help assess your child’s issues. The right psychologist can advise about various assessments to drill down on the concerns. They may be able to offer educational assessment, ADHD assessment, therapy and assessment of anxiety issues and also ASD assessment if appropriate.

The Psychologist’s report will provide you, your child, their school and teachers with strategies and recommendations to help them manage their learning and behaviour at school and with homework and socially.

Once the psychologist has an understanding of the issues, they can work with you and your child with therapy. Once diagnosed, and in the following 12 months, a further MHCP Referral to a psychologist or Occupational Therapist can provide access touo to a further 10 rebated therapy sessions.

Your child’s psychologist or occupational therapist may then discuss with you the need for or benefits of Stimulant Medication.

What if Stimulant Medication is needed?

Your child’s psychologist or occupational therapist will provide feedback to your GP about the diagnosis and management of your child. If stimulant medication is recommended, your GP can refer your child to a paediatrician or psychiatrist.

It may be difficult to get into a specialist for this, and there may be long wait times, so it may be advisable to have this referral made at the same time as the MHCP referral is made. After working with the psychologist/occupational therapist over one to two years, it may be time for you to meet the medical specialist in an appointment.

Older adolescents should consider referral to an adult psychiatrist, if it is likely that they will be 16 or more by the time of their appointment.

Some child and adult psychiatrists have a special interest in ADHD management and some focus their practice entirely on ADHD or ADD management.

Some children and adolescents with complex and significant mental health concerns may benefit from management with a child psychiatrist instead of a paediatrician.