Diagnosis and management of attention deficit hyperactivity disorder (ADHD)

Specialty: Children's developmental concerns
Age group: Children

Criteria for referral to public hospital service

• Primary school aged children and adolescents with either:
  • confirmed diagnosis of attention deficit hyperactivity disorder (ADHD)
  • suspected ADHD based on at least 6 months of behaviour showing inattention, hyperactivity and impulsivity, evident in two or more settings, resulting in significant functional impairment.

Information to be included in the referral

Information that must be provided

• Reason for referral and expectation or outcome, anticipated by the patient or their carer, and the referring clinician from referral to the health service
• If previously diagnosed ADHD, details of any previous paediatric, psychological or psychiatric assessments or opinions and current management plan
• Current growth measurements, including height, weight and head circumference, as well as previous growth measurements where there has been slow weight gain or concern for growth trajectory (indicate if these measurements cannot be provided due to the child’s sensory sensitivity or behavioural issues)
• Teacher reports, school assessments or school cognitive, education or language assessments (these often assist with identifying clinical urgency and the most appropriate specialist clinic or service)
• Relevant information, such as
  • General Practitioner (GP) assessment
  • occupational therapy assessment for sensory problems, motor skills and social or emotional skills
  • psychology assessment for cognitive, behaviour, emotion or social skills
  • psychiatric assessment
• Completed Vanderbilt Assessment Scales scores (parent and teacher assessment scales)
• History of alcohol, recreational or injectable drugs, or prescription medicine misuse
• If a lack of sleep or chronic sleep deprivation has been addressed, including any measures suggested or applied to optimise sleep routine
• The functional or psychological impact on quality of life or activities of daily living including impact on work, study, social activities or carer role
• Relevant history of any abnormal neurological or physical findings, medical conditions or psychosocial risks (e.g. adolescent substance abuse, faltering growth, maternal drug or alcohol use during pregnancy, family violence, parental mental health issues, homeless or at risk of homelessness, the child lives in out-of-home care, signs of abuse or neglect)
• If the child has been excluded, or is it at risk of exclusion from school due to physical aggression or other behaviours that place themselves or others at risk
• Details of previous management including the course of treatment(s) and outcome of treatment(s)
• Details of current medical and non-medical management (e.g. community health services, supports or services through the National Disability Insurance Scheme (NDIS), speech therapy, physiotherapy, psychology)
• If the child is in the criminal justice system or under Youth Justice supervision in the community.

Provide if available

• Other relevant assessments such as
  • diagnostic audiology assessment (this often assists with identifying clinical urgency and the most appropriate specialist clinic or service)
  • comprehensive eye and vision assessment including cycloplegic refraction and dilated retinal examination (usually performed by an optometrist or ophthalmologist) with best corrected visual acuity (i.e. measured with spectacles or contact lenses) for both eyes or visual behaviour assessment if the child is pre-literate or non-verbal
  • Parents’ Evaluations of Developmental Status-Revised (PEDS-R^®),
  • occupational therapy assessment
  • psychology assessment
  • psychiatric assessment
  • child behaviour checklist (CBCL)
• Any relevant pathology tests results (such as free thyroxine (T4) and thyroid stimulating hormone level (TSH))
• If the child identifies as an Aboriginal and/or Torres Strait Islander
• If the child is neurodiverse
• If the child is gender diverse
• If the child has a disability
• If the child lives in out-of-home care (foster care, kinship care, permanent care or residential care) or is at risk of moving to out-of-home care
• If the child has a preferred language other than English and if they rely on cultural or linguistic support (e.g. Aboriginal cultural support, an interpreter)
• If the child is a refugee, seeking asylum or has a bridging visa while waiting for an immigration outcome.

Additional comments

The Minimum information for referrals to non-admitted specialist services lists the information that should be included in a referral request.

Referrals for children younger than primary school age will not usually be accepted, they should be referred through the statewide referral criteria for Assessment of learning and developmental problems in children.

Note there are statewide referral criteria for Assessment of functional disability in adolescents.

If audiology and vision assessments have not been performed a referral should be made immediately to inform future review/treatment.

Where appropriate, a lack of sleep or chronic sleep deprivation should be addressed prior to referral.

The referral should note if the request is for a second or subsequent opinion as requests for a second opinion will usually not be accepted.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

Not applicable.