When Emma* was diagnosed with ADHD in 2022, her psychiatrist immediately prescribed her Ritalin.
There was no discussion about different ADHD medications, or that people with ADHD may respond differently to different stimulants.
Emma says the diagnosis “was therapy in itself”.
While Ritalin relieved some of her symptoms, it also made her anxious. In late 2023, she was hospitalized with heart attack symptoms, where she says doctors advised her to stop taking it.
“I was just thinking [it] best to move on from that,” she says – “trying to do the other things I’d read might help.”
She tried lifestyle changes: following a routine, practicing mindfulness, improving her diet, taking cold showers and not talking on her phone in the morning.
It wasn’t until June 2024, after reading about an alternative ADHD medication, Vyvanse, that she went back to her psychiatrist for a prescription. Two years after her diagnosis, Emma feels she has “finally found [a] solution”
Australasian ADHD Professionals Association (AADPA) launched the first ADHD prescribing guide on Tuesday, which aims to make it clear that there is no one-size-fits-all approach to treatment – especially as diagnoses rise.
The guide provides clear and consistent information on starting, adjusting and discontinuing ADHD medication across different age groups and settings.
AADPA board president and co-lead author of the guide, Prof David Coghill, says the biggest problem is that people with ADHD are often not given the opportunity to optimize their medication.
“ADHD is easy to treat, but difficult to treat well,” says Coghill.
“[Doctors] really need to understand the medication, understand how you can use the different medications to optimize people’s care and that takes a lot of hard work.”
The need for better education among health professionals was highlighted in the Senate inquiry examines support for Australians with ADHD.
While diagnoses rose along with ADHD awarenesssays Coghill there hasn’t been an increase in clinicians, so “the pressure is on everyone to provide more services with the same resources.”
The association has published evidence-based clinical guidelines in 2022 with recommendations on how to diagnose and treat ADHD, but acknowledged that there was still a need to provide more detailed information about medications, he says.
“Medication must be tailored to the individual and there is no one-size-fits-all,” says Coghill.
The new guide has two parts: the first covers every person with ADHD, and the second focuses on advice for specific patient groups – pregnant women, those with other conditions such as anxiety and depression, or substance use disorders, and many others.
It was developed by an advisory group of cross-disciplinary health professionals and people with lived experience of ADHD, and was peer-reviewed by Prof Allan Young, Chair of Mood Disorders at King’s College London, and Prof Philip Asherson, First UK Chair. Adult ADHD Network.
The guide suggests one approach for clinicians discussing a patient’s first choice of medication “is to be clear at the outset that there are several different medications licensed for the treatment of ADHD in Australia”.
The guidelines explain that stimulants – mostly Ritalin, which delivers methylphenidate, and Vyvanse, which delivers lisdexamfetamines – have the strongest evidence as first-line treatments, but it’s still impossible to predict how individuals will respond.
“It’s still trial and error to some degree,” says Coghill. “For people with ADHD, there is some imbalance in the way different parts of the brain communicate, and this leads to the symptoms of ADHD.”
“All the medications we use work in slightly different ways, but in the end they do very similar jobs, helping to strengthen some of the connections within different parts of the brain to balance that activity,” he says.
Coghill says medication is the only treatment available to truly improve the core symptoms of ADHD. But while the AADPA guide focuses on medication, the association emphasizes that the most successful approach to managing ADHD is a mix of strategies, including psychoeducation, cognitive therapy, ADHD coaching and more.
“Medication on its own does not teach you the skills. In addition, you need the other types of support that will help you learn or improve your skills in organization, in management.”
Prof Brenton Prosser, from the University of New South Wales’ public policy center and school of population health, has worked in the field of ADHD for more than 20 years and called the guide “a very important step forward”.
Prosser says inconsistency in prescribing practices has been a consistent challenge, with particular differences between socio-economic groups, and urban and regional areas.
“At first, medication was mainly prescribed by psychiatrists, but over time it expanded to general practitioners. This guide will be helpful for this workforce to consistently get the right treatment to the right people with the right mix of medical and non-medical treatment,” says Prosser.
* First name is used only to protect medical information
