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Cited by 87Attention Deficit Hyperactivity DisorderClinical practice guidelines implementationBehavioral and Psychological Studies

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

Open access
May, Tamara, Birch, Edwina, Chaves, Karina, Cranswick, Noel, Culnane, Evelyn, Delaney, Jane, Derrick, Maddi, Eapen, Valsamma +20 more·2023·Australian & New Zealand Journal of Psychiatry
DOI 10.1177/00048674231166329PMC PMC10363932
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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.

AI snapshot

Written from the paper’s full text.

TL;DR

The Australian evidence-based clinical practice guideline for ADHD was developed using GRADE and NHMRC processes to provide 113 clinical recommendations for identification, diagnosis, and multimodal treatment across the lifespan. It found limited high-certainty evidence, with only 12 of 113 recommendations evidence-based and most evidence certainty rated low or moderate.

Key findings

  • The guideline generated 113 clinical recommendations plus 21 education, service, policy and research recommendations, covering young children (5 years and under), children, adolescents and adults; it was approved by the NHMRC.
  • Of the 113 recommendations, only 12 were evidence-based recommendations, and the certainty underpinning evidence-based recommendations was more often low or moderate rather than high.
  • Routine population-level screening for ADHD should not occur; in children and adolescents, no screening tool met acceptable sensitivity and specificity (both over 80%), and positive screening should be followed by comprehensive clinical assessment.
  • For ADHD symptoms causing significant impairment, methylphenidate or dexamfetamine or lisdexamfetamine should be offered as first-line pharmacological treatment for children aged 5 years and over, adolescents and adults; parent/family training should be offered for young children and children, and cognitive-behavioural interventions should be offered to adolescents and adults.

Methods

  • Development integrated best available evidence with multidisciplinary clinical expertise and lived experience, underpinned by GRADE, NHMRC (2016) processes, AGREE II and ADAPTE II; 23 guideline development group members addressed 50 prioritised clinical questions in 14 systematic reviews (new and updated from NICE 2018) and 28 narrative reviews.
  • NICE 2018 evidence reviews were updated where appropriate; new reviews used the PICO framework, searched Medline, PsycINFO, EBM Review and EMBASE, were limited to English-language articles with no year limits, and used Review Manager 5.3 for meta-analyses when appropriate.
  • Recommendations were drafted by the guideline development group using GRADE considerations including evidence certainty, balance of benefits and harms, values and preferences, resource implications, feasibility and fairness; recommendation types were evidence-based recommendations, clinical consensus recommendations and clinical practice points.

Limitations

  • Stated in the paper: only 12 of 113 recommendations were evidence-based, and the certainty of evidence was more often low or moderate than high; the authors highlight a lack of appropriately designed, controlled and powered studies in ADHD research.
  • Stated in the paper: there is a lack of research on understanding, identifying, assessing and treating ADHD in Aboriginal and Torres Strait Islander peoples; there was a paucity of evidence for medication effectiveness in children under 5 years, so no evidence-based recommendation about medication use in that age range was made; evidence on medication choice for people with most co-occurring conditions was very limited.
  • Evident from the text: many recommendations are clinical consensus recommendations or clinical practice points based on expert opinion and clinical experience rather than systematic evidence, and this article is an overview that refers readers to the full guideline and technical report online for complete recommendations and methods.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1177/00048674231166329

Cites

38 of 38 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

19 of 47 cited sources checked · 13 supported · 0 flagged · accuracy not yet measured

  • Findingcitation

    The narrative review also identified people with ADHD at risk of not being diagnosed, particularly women and girls.

    “The narrative review also identified people with ADHD at risk of not being diagnosed, particularly women and girls (Hinshaw et al., 2022; Quinn and Madhoo, 2014).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Hinshaw et al., 2022 source
    • cites Quinn and Madhoo, 2014 source
  • Findingcitation

    A further narrative review identified additional high-risk groups for ADHD, including people with foetal alcohol spectrum disorder, extremely low birth weight, eating disorders such as binge eating disorder, sleep disorders, or problem gambling.

    “A further narrative review identified additional groups, for example, people with foetal alcohol spectrum disorder (Lange et al., 2018), extremely low birth weight (Momany et al., 2018), eating disorders such as binge eating disorder (Wentz et al., 2005; Yates et al., 2009), sleep disorders (Cortese et al., 2009; Sedky et al., 2014), or problem gambling (Dowling et al., 2015).”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites Lange et al., 2018 source

      The Abstract reports that ADHD affected 52.9% of children with FASD, a rate 15 times higher than in the comparison general population. This supports identifying children with FASD as a high-risk group for ADHD, but the cited paper does not establish the claim for people with FASD across all ages. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites Momany et al., 2018 source
    • cites Wentz et al., 2005 source

      The Discussion reports ADHD in a small group of women with severe eating disorders, specifically those with binge-eating/purging anorexia nervosa. It does not establish the claim for binge eating disorder, which is distinct from that anorexia subgroup. The other listed groups are attributed to other citations, not Wentz et al. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Premisecitation

    Studies of the ASRS-5 found acceptable sensitivity but not specificity in individuals with bipolar disorder and/or borderline personality disorder and other clinical groups.

    “Studies of the ASRS-5 found acceptable sensitivity but not specificity in individuals with bipolar disorder and/or borderline personality disorder (Baggio et al., 2021) and other clinical groups (Ustun et al., 2017).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites Baggio et al., 2021 source
    • cites Ustun et al., 2017 source
  • Premisecitation

    Another study found both sensitivity and specificity levels at 80% and above for both the ASRS and WURS.

    “Another study of individuals with ADHD and randomly selected controls from the population found both sensitivity and specificity levels at 80% and above for both the ASRS and WURS.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Brevik et al., 2020 source
  • Premisecitation

    Medical conditions, such as epilepsy, can co-occur with ADHD.

    “Medical conditions, such as epilepsy, can co-occur with ADHD (Ilie et al., 2015; Lange et al., 2018).”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites Ilie et al., 2015 source

      The Discussion reports that adults with a lifetime traumatic brain injury had greater odds of ADHD, supporting co-occurrence with a medical condition. Our copy does not address epilepsy, so it does not support the sentence’s specific example (searched: epilepsy, seizures). Page numbers were not available for the indexed passages. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites Lange et al., 2018 source

      The pooled-prevalence section reports that ADHD co-occurs with fetal alcohol spectrum disorder in children. The paper does not report that epilepsy co-occurs with ADHD; its References section mentions epilepsy in relation to fetal alcohol spectrum disorder, not ADHD. No page number is available in our copy. (LLM, conf=0.79)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 40
  • May combine two claims. 27

  • Classified as probably not a substantial claim.

    Premisecitation

    The information parents of children with ADHD need includes information on the causes, mechanisms and potential impacts of having ADHD.

    “This includes information on the causes, mechanisms and potential impacts of having ADHD (Ahmed et al., 2014).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Ahmed et al., 2014 source

  • May combine two claims.

    Premisecitation

    There was acceptable sensitivity but not specificity in studies of substance use disorders and incarcerated women.

    “There was acceptable sensitivity but not specificity in studies of substance use disorders (Daigre Blanco et al., 2009; Van de Glind et al., 2013) and incarcerated women (Konstenius et al., 2015).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Daigre Blanco et al., 2009

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Van de Glind et al., 2013 source

      The Results (section 3.2; page not available) report good sensitivity for treatment-seeking patients with substance use disorders and lower specificity, particularly for drug use disorders. But the Discussion calls overall specificity moderate, not unacceptable, and reports better specificity for alcohol use disorders. The incarcerated-women finding is attributed to a different citation in the sentence, not to this paper. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites Konstenius et al., 2015

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    ADHD is a risk factor for the development of substance use disorders, and people presenting with substance use disorders are at increased risk of ADHD.

    “ADHD is a risk factor for the development of substance use disorders, and people presenting with substance use disorders are at increased risk of ADHD (Groenman et al., 2013; van Emmerik-van Oortmerssen et al., 2012; see also Faraone et al., 2021; Ozgen et al., 2020).”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Groenman et al., 2013 source
    • cites van Emmerik-van Oortmerssen et al., 2012 source
    • cites Faraone et al., 2021 source

      The “Substance Use Disorders” section (page unavailable) reports that people with ADHD were more likely to develop drug or alcohol use disorders, supporting the first part of the claim. It does not separately report that people presenting with substance use disorders are at increased risk of ADHD. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The 50 prioritised clinical questions were addressed in 14 systematic reviews and 28 narrative reviews, generating 113 clinical recommendations and 21 education, service, policy and research recommendations.

    “The 50 prioritised clinical questions were addressed in 14 systematic reviews (new and updated from NICE, 2018) and 28 narrative reviews, generating 113 clinical recommendations and an additional 21 education, service, policy and research recommendations.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites NICE, 2018

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingown data

    In children and adolescents, 12 different high-risk groups were explored, and 8 had significantly higher risk of having ADHD than control groups.

    “In children and adolescents, 12 different high-risk groups were explored, and 8 had significantly higher risk of having ADHD than the control groups (in order of risk):”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    In adults, nine different high-risk groups were identified and seven of the nine had significantly higher risk of ADHD than control groups.

    “In adults, nine different high-risk groups were identified and seven of the nine had significantly higher risk of ADHD than the control groups (in order of risk):”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    For non-pharmacological treatment, the primary outcome is improved functioning and wellbeing and the secondary outcome is symptom reduction.

    “Primary outcome | Symptom reduction | Improved functioning and wellbeing”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    The quality of the evidence for parent/family training was low to moderate for children under 5 and low for children and adolescents.

    “As such, the quality of the evidence for parent/family training was low to moderate for children under 5 and low for children and adolescents.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    An updated evidence review of the efficacy of pharmacological treatments found 16 new studies.

    “An updated evidence review of the efficacy of pharmacological treatments found 16 new studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    The narrative review suggested benefits of parent/family training in one or more domains of parent/family functioning, but through parent ratings.

    “It is also noted the narrative review which explored additional outcomes of parent family functioning suggested benefits of parent/family training in one or more of these domains, but again through parent ratings.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    The effectiveness of parent/family training varied according to raters (parents, clinicians or teachers), with more benefits evident by parent report.

    “Regarding parent/family training, the effectiveness varied according to raters (parents, clinicians or teachers), with more benefits evident by parent report.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    ADHD prevalence is higher in custodial settings than in the general population, estimated to be 5 times higher among youth prisoners and 10 times higher among adult prisoners.

    “ADHD prevalence is higher in custodial settings than in the general population, estimated to be 5 times higher among youth prisoners and 10 times higher among adult prisoners (Konstenius et al., 2015; Moore et al., 2016; Westmoreland et al., 2010; Young et al., 2015; Young and Thome, 2011).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Konstenius et al., 2015 source
    • cites Moore et al., 2016

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Westmoreland et al., 2010 source

  • May combine two claims.

    Findingown data

    Limited evidence showed possible worsening of ADHD symptoms on stopping medication but supported a reduction in adverse effects after withdrawal.

    “Limited evidence showed possible worsening of ADHD symptoms on stopping medication but supported a reduction in adverse effects after withdrawal.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    Non-pharmacological treatments provide additional support to minimise the daily impact of ADHD symptoms and associated difficulties.

    “Clinicians should explain that pharmacological treatment is most effective in reducing core ADHD symptoms and that non-pharmacological treatments provide additional support to minimise the daily impact of ADHD symptoms and associated difficulties (see Table 3).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    An updated evidence review for non-pharmacological interventions identified an additional 28 randomised controlled trials.

    “An updated evidence review was conducted, and an additional 28 randomised controlled trial were identified and included in new GRADE evidence tables (AADPA, 2022).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites AADPA, 2022

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    An updated evidence review on adherence to pharmacological and non-pharmacological treatment identified four new studies.

    “Regarding adherence to pharmacological and non-pharmacological treatment, an updated evidence review was conducted with four new studies identified.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Evidence supports improvement in parent-reported ADHD symptoms in adolescents from cognitive behaviour therapy; improvement for children is unclear.

    “Evidence supports improvement in parent-reported ADHD symptoms in adolescents; improvement for children unclear.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    For pharmacological treatment, the primary outcome is symptom reduction and secondary outcomes are improved functioning and wellbeing.

    “Primary outcome | Symptom reduction | Improved functioning and wellbeing”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    An updated evidence review for medication monitoring and discontinuation identified one new study.

    “An updated evidence review was conducted for medication monitoring and discontinuation and one new study was identified.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Neurofeedback had benefits for ADHD inattention symptoms based on parent-report but not teacher or clinician report, and no benefits for parent- or teacher-reported ADHD hyperactivity-impulsivity symptoms.

    “There were benefits for ADHD inattention symptoms based on parent-report but not teacher or clinician report; and no benefits for parent or teacher-reported ADHD hyperactivity-impulsivity symptoms.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Narrative reviews were prepared by small groups of GDG members according to their content expertise and were informed by published research and clinical experience.

    “Narrative reviews were prepared by small groups of GDG members according to their content expertise. Reviews included key information to answer the clinical question and to guide the GDG to draft clinical consensus recommendations (CCR) or clinical practice points (CPP) and were informed by published research and clinical experience.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Uncertainty was resolved through discussion among the methodologist and the leads of the eight GDG content subgroups.

    “Uncertainty was resolved through discussion among the methodologist and the leads of the eight GDG content subgroups.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Specific, unambiguous, actionable recommendations were drafted by the GDG taking into consideration evidence certainty, relevance to Australian population, balance of benefits and harms, values and preferences, resource implications, and feasibility and fairness.

    “Specific, unambiguous, actionable recommendations were drafted by the GDG taking into consideration evidence certainty, relevance to the Australian population, the balance of benefits and harms, the values and preferences of the community and clinicians, resource implications, and feasibility and fairness, using the GRADE framework.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    A broad-ranging systematic search strategy for ADHD terms was adopted from the NICE guideline and combined with specific searches tailored for each clinical question.

    “A broad-ranging systematic search strategy for terms related to ADHD was adopted from the NICE guideline (NICE, 2018) (https://www.nice.org.uk/guidance/ng87). It was combined with specific searches tailored for the clinical question according to the selection criteria and PICO framework.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites NICE, 2018

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The guideline development process defined by NHMRC (2016) was closely followed to ensure transparent development and conflict of interest processes.

    “The guideline development process defined by the NHMRC (2016) was closely followed to ensure transparent development and conflict of interest processes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Where no evidence review existed in the NICE guideline, the PICO framework was used to explore components of each question and finalise selection criteria.

    “Where no evidence review existed in the NICE guideline to address the clinical questions, the patient/population, intervention, comparison and outcomes (PICO) framework was used to explore the components of each question and finalise the selection criteria.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    For each prioritised outcome, a certainty rating was determined based on consideration of number and design of studies, risk of bias, inconsistency, indirectness, imprecision and other considerations.

    “For each prioritised outcome, a certainty rating was determined based on consideration of the number and design of studies addressing the outcome, and on judgements about the risk of bias of the studies and/or synthesised evidence, inconsistency, indirectness, imprecision and any other considerations that may have influenced the quality/certainty of the evidence.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    The guideline was developed by updating NICE evidence reviews, conducting new evidence or narrative reviews for questions not addressed by NICE, and adopting or adapting NICE guidance to the Australian context.

    “It was developed by updating the NICE evidence reviews, conducting new evidence or narrative reviews for questions not addressed by NICE, and adopting or adapting the NICE guidance to the Australian context.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    A GRADE evidence profile was prepared for each comparison within each clinical question, listed by outcome.

    “A GRADE evidence profile was prepared for each comparison within each clinical question, listed by outcome.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Potential GDG members were asked to declare any COIs over the 3 years preceding the formation of the group and any arising during guideline development.

    “Potential members were asked to declare any COIs over the 3 years preceding the formation of the group and any arising during guideline development.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The guideline was approved by the NHMRC of Australia and relevant medical and allied health professional associations.

    “The guideline was approved by the National Health and Medical Research Council (NHMRC) of Australia and relevant medical and allied health professional associations.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Conflicts or potential conflicts were managed by a COI Management Group comprising the two GDG Chairs and an ethicist who acted as independent observer.

    “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.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Risk of bias for each trial and GRADE quality for the body of evidence was assessed using criteria developed a priori according to study design.

    “Risk of bias for each trial and GRADE quality for the body of evidenced was assessed using criteria developed a priori according to study design as outlined in GRADE.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The methods used to develop the guideline were aligned with AGREE II, ADAPTE II, and GRADE to meet NHMRC criteria for approval of evidence-based guidelines.

    “The methods used to develop the Australian ADHD guideline were aligned with international gold standard Appraisal of Guidelines for Research & Evaluation (AGREE II) criteria, ADAPTE II, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to meet the comprehensive NHMRC criteria for approval of evidence-based guidelines.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Studies were screened by the methodologist based on whether they met the PICO selection criteria established a priori.

    “Studies were screened by the methodologist based on whether they met the PICO selection criteria established a priori.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Where appropriate, evidence reviews in the NICE guideline were updated, with permission.

    “Where appropriate, evidence reviews in the NICE guideline were updated, with permission.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Clinical questions were identified by AADPA in consultation with stakeholders.

    “Clinical questions were identified by the Australian ADHD Professionals Association (AADPA) in consultation with stakeholders.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The multidisciplinary GDG included people with lived experience, carers, and academics, with disciplines including psychology, psychiatry, paediatrics, general practice, and others.

    “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”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The interests of the Chairs were scrutinised by the independent ethics expert of the COI Management Group and the President of AADPA.

    “The interests of the Chairs were scrutinised by the independent ethics expert of the COI Management Group and the President of AADPA.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Evidence-based recommendations were underpinned by the GRADE framework.

    “Evidence-based recommendations were underpinned by the GRADE framework.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Contributors reached consensus on 50 clinical questions to be addressed by the guideline.

    “Contributors reached consensus on the resulting 50 clinical questions to be addressed by this guideline and the method for answering each (either a new or updated NICE systematic review or narrative review).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The NICE 2018 guideline was selected for adaptation because it was the most current and covered similar content to the other two guidelines.

    “The most current of those, the UK National Institute for Health and Care Excellence 2018 guideline ‘Attention Deficit Hyperactivity Disorder: Diagnosis and Management’ [NICE guideline NG87] (NICE, 2018), covered similar content to the other two (German Association of the Scientific Medical Societies [AWMF], 2017; Kemper et al., 2018), and was therefore selected for adaptation.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites NICE, 2018

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites AWMF, 2017

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Kemper et al., 2018

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Narrative reviews were completed where questions were less well suited to a systematic evidence review format, and where there was insufficient evidence for a question where an evidence review was conducted.

    “Narrative reviews were completed where questions were less well suited to a systematic evidence review format, and where there was insufficient evidence identified for a question where an evidence review was conducted.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The search strategy was limited to English language articles, with no limits on year of publication, and searched Medline, PsycINFO, EBM Review, and EMBASE.

    “The search strategy was limited to English language articles, and there were no limits on year of publication. Searched databases included Medline, PsycINFO, EBM Review, and EMBASE.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    When participants, interventions, outcome measures and timing were considered sufficiently similar, Review Manager 5.3 software was used for meta-analyses.

    “When participants, interventions, outcome measures and timing of outcome measurements were considered sufficiently similar, the Review Manager 5.3 software was used for meta-analyses.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A formal process was followed to identify and manage competing interests among GDG members.

    “A formal process was followed to identify and manage competing interests among GDG members.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The preliminary list of clinical questions was refined through a structured prioritisation process conducted by a multidisciplinary group over 2 days of face-to-face workshops.

    “The preliminary list of clinical questions was refined through a structured prioritisation process conducted by a multidisciplinary group representing a broad range of perspectives including clinicians, academics and people with lived experience of ADHD, conducted over 2 days of face-to-face workshops.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Data were extracted from included studies into 'Characteristics of included studies' tables.

    “Data were extracted from included studies into ‘Characteristics of included studies’ tables with relevant details (AADPA, 2022).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites AADPA, 2022

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Additional identified evidence was tabulated using the same outcomes as NICE, assessed for certainty and GRADE, and integrated with existing NICE evidence.

    “Additional identified evidence was tabulated using the same outcomes as NICE, assessed for certainty and GRADE (The GRADE Working Group, 2009), and integrated with the existing NICE evidence.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites The GRADE Working Group, 2009

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    The recommendations were based on the levels of screening test accuracy noted above and costs/benefits.

    “However, the recommendations were based on the levels of screening test accuracy noted above and costs/benefits.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The recommendations for diagnosis were consistent with NICE and CAADRA recommendations.

    “The recommendations for diagnosis were consistent with NICE and CAADRA recommendations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Parents are typically unblinded when rating outcomes, whereas clinician and teacher ratings can be blinded, which could introduce bias in parent ratings.

    “Parents are typically unblinded when rating outcomes, whereas clinician and teacher ratings can be blinded, which could introduce bias in parent ratings.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Direct observations, neuropsychological and psychoeducational assessments, computerised cognitive assessments, neuroimaging and EEG did not increase the accuracy of diagnosis.

    “Direct observations such as observing children in their educational setting, neuropsychological and psychoeducational assessments, computerised cognitive assessments, neuroimaging and electroencephalography (EEG) did not increase the accuracy of diagnosis.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    DSM-5 provides further specific advice on differential and co-occurring diagnoses.

    “DSM-5 provides further specific advice on differential and co-occurring diagnoses (American Psychiatric Association, 2013).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites American Psychiatric Association, 2013

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    This lack of knowledge may result in either over- or under-diagnosis and cause harm to Aboriginal and Torres Strait Islander peoples through stigma or a lack of treatment.

    “This lack of knowledge may result in either over- or under-diagnosis and cause harm to Aboriginal and Torres Strait Islander peoples through stigma or a lack of treatment.”
    Quote in the paperSubstantial claim
55 of 55

  • The paper relies on this without support.

    A high proportion of people with ADHD have co-occurring neurodevelopmental, mental health and medical conditions.

    “A high proportion of people with ADHD have co-occurring neurodevelopmental, mental health and medical conditions.”

  • The paper relies on this without support.

    In children, the most common co-occurring disorders are oppositional defiant disorder, language disorders, autism spectrum disorders and anxiety disorders, with depressive disorders and substance use disorders emerging in adolescence.

    “In children, the most common co-occurring disorders are oppositional defiant disorder, language disorders, autism spectrum disorders and anxiety disorders, with depressive disorders and substance use disorders emerging in adolescence.”

  • The paper relies on this without support.

    Some medical disorders can be present and have symptoms and signs similar to those of ADHD, such as obstructive sleep apnoea/sleep deprivation.

    “Some medical disorders can be present and have symptoms and signs similar to those of ADHD, such as obstructive sleep apnoea/sleep deprivation.”

  • The paper relies on this without support.

    Difficulties with concentration and focusing attention associated with a major depressive episode are usually limited in duration, whereas attention problems due to ADHD are often ongoing.

    “For example, difficulties with concentration and focusing attention that are associated with a major depressive episode are usually limited in duration, whereas attention problems due to ADHD are often ongoing.”

  • The paper relies on this without support.

    There are no specific conditions that must be excluded for a diagnosis of ADHD.

    “There are no specific conditions that must be excluded for a diagnosis of ADHD.”

  • The paper relies on this without support.

    There is no robust research evidence on what information and support should be routinely provided at diagnosis to people with ADHD.

    “There is no robust research evidence on what information and support should be routinely provided at diagnosis to people with ADHD.”

  • The paper relies on this without support.

    Unidentified and untreated ADHD increases the likelihood of offending, being arrested and incarcerated, being involved with prison incidents and recidivism.

    “Unidentified and untreated ADHD increases the likelihood of offending, being arrested and incarcerated, being involved with prison incidents and recidivism.”

  • The paper relies on this without support.

    There are challenges in identification, assessment and treatment including screening, psychological services, and medication administration, particularly stimulants.

    “There are challenges in identification, assessment and treatment including screening, psychological services, and medication administration, particularly stimulants.”
8 of 8

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Age cutoff for young children differs

    Minor

    The abstract includes five-year-olds in the "young children" group, whereas Table 2 defines that group as under five years of age.

1 of 1

Cites

Flagged first, then by citations

2 of the 40 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. Australian ADHD Professionals Association (AADPA), 2022, Australian Evidence-Based Clinical Practice Guideline for Attention Deficit Hyperactivity Disorder
  2. Cortese S, 2009, Journal of the American Academy of Child and Adolescent Psychiatry, 48, 894
  3. Daigre Blanco C, 2009, Actas Espanolas de Psiquiatria, 37, 299
  4. Kemper AR, 2018, Comparative Effectiveness Reviews, 203
  5. Quinn PO, 2014, The Primary Care Companion for CNS Disorders, 16

Cited by

Sorted by citations

Related

Authors
May, T., Birch, E., Chaves, K., Cranswick, N., Culnane, E., Delaney, J., Derrick, M., Eapen, V., Edlington, C., Efron, D., Ewais, T., Garner, I., Gathercole, M., Jagadheesan, K., Jobson, L., Kramer, J., Mack, M., Misso, M., Murrup-Stewart, C., Savage, E., Sciberras, E., Singh, B., Testa, R., Vale, L., Weirman, A., Petch, E., Williams, K., & Bellgrove, M.
Affiliations
  • Monash University (AU)
  • ADHD Foundation, Epping, NSW, Australia
  • Albury Wodonga Health (AU)
  • Royal Children's Hospital (AU)
  • Speech Pathology Australia (AU)
  • Hobart ADHD Consultants, Bellerive, TAS, Australia
  • UNSW Sydney (AU)
  • Griffith University (AU)
  • ADHD Guideline Development Group, Melbourne, VIC, Australia
  • Government of New South Wales (AU)
  • Royal Australian and New Zealand College of Psychiatrists (AU)
  • Royal Australian College of General Practitioners (AU)
  • Applied Neuroscience Society of Australasia (ANSA)
  • The Knowledge Synthesis Lab, Melbourne, VIC, Australia
  • Department of Education and Training (AU)
  • Deakin University (AU)
  • The University of Melbourne (AU)
  • Department of Mental Health, Royal Children’s Hospital, Melbourne, VIC, Australia
  • Occupational Therapy Australia, Splash Paediatric Therapy, Melbourne, VIC, Australia
  • The University of Western Australia (AU)
  • Monash Children’s Hospital (AU)
Corresponding author
Bellgrove, Mark
ORCID
Venue
Australian & New Zealand Journal of Psychiatry
Publisher
SAGE Publications
Published
2023-05-30
Volume
57
Issue
8
Pages
1101-1116
ISSN
  • 0004-8674 (ISSN-L)
  • 1440-1614
DOI
10.1177/00048674231166329
PMC
PMC10363932
OpenAlex
W4378781639
Cited by
87
References
40
Citations by year
2026: 29 · 2025: 31 · 2024: 17 · 2023: 9 · 2020: 1
FWCI
15.48
Type
journal article
Language
en
Open access
Licence
Locations
  • Australian & New Zealand Journal of Psychiatry (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
  • Griffith Research Online (submittedVersion, cc-by)
  • Deakin Research Online (Deakin University)
Funders
Department of Health, Australian Government (4-A168GGT)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
Keywords
attention deficit hyperactivity disorder, ADHD diagnosis, ADHD screening, multimodal therapy, pharmacotherapy, non-pharmacological treatment, children and adolescents, adult ADHD, lived experience, multidisciplinary care, guideline implementation
MeSH terms
Adolescent, Adult, Attention Deficit Disorder with Hyperactivity, Australia, Child, Child, Preschool, Humans, Psychiatry, Evidence-Based Practice, General Practitioners

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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