The different medical professionals who can diagnose and treat ADHD

The type of professionals who can assess, diagnose and treat ADHD has been widened to include registered health practitioners who are competent in working with people with ADHD. The framework says:

“Quality care for ADHD is based on the development of competence in working with ADHD, rather than qualification alone.”

For more information on ADHD diagnosis, visit: ADHD NZ - ADHD diagnosis

General principles

• ADHD assessments should be thorough, centering on an in-depth clinical interview with supporting information from multiple sources
  
• valid ADHD rating scales should be used as part of an assessment, but shouldn’t be the sole basis for a diagnosis
• to make a diagnosis, the assessment should show symptoms of ADHD have impacted a person throughout their life, across time, and in multiple settings. This includes evidence of symptoms in childhood by 12 years
• an assessment should consider differential diagnosis. This is a ‘shortlist’ of conditions that could possibly be causing your symptoms alongside ADHD
• a diagnosis should be made with explicit reference to the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5) or the World Health Organisation’s International Classification of Diseases (ICD)
• an assessment needs to be responsive to Māori and any assessment of Māori should take into account Te Ao Māori worldviews
• Assessments should take into account cultural considerations, particularly for those who may face barriers to accessing ADHD diagnosis
• Assessments should be approached in a culturally safe manner with a focus on equity and cultural competency in assessment, treatment, follow up and discharge
• treatment and assessment should be person-centred, with management plans actively involving the individual, their family and whānau. The approach and information provided should be tailored to their needs, preferences, and understanding
• people should have access to combined (multi-modal) support strategies, tailored to their individual needs. You can find more about these here: ADHD NZ - Combining support strategies
  

Priciples for children and young people

ADHD treatment and management for children and young people 

Expected standards: 

A treatment and management plan should include:

• developing a plan together with the child or young person, their family and whānau (as appropriate)
• discussing the pros and cons of medication and other approaches
• considering cultural safety and sensitivity
• communicating in a clear and timely way with primary care teams (ie GPs) to keep them updated on treatment and management approaches and
• considering how treatment can be managed across different settings as the child or young person grows and develops.

Medication

Clinicians are required to prescribe medication in line with current best practice guidelines, consider both stimulant and non-stimulant options, and take any potential side-effects into account.

Monitoring requirements for stimulant medications include:

• a review two to four weeks after starting or changing prescribed medications
• checking weight months after starting medications
• a review every six months to monitor blood pressure, pulse, weight and height
• checking blood pressure and heart rate before and after each medication dose change and
• more frequent reviews if there are any concerns and referring to a specialist if needed.

Non-medication-based treatments

The framework says it is essential to involve family and whānau in any treatments that provide alternatives to medication. This includes:

• considering education programmes for parents, family and whānau, particularly where younger children are involved
• offering access to resources and tools to manage challenges associated with ADHD
• supporting a healthy lifestyle by addressing physical activity, lack of sleep and nutrition and discussing this issues around substance use
• considering psychological therapies, mindfulness therapies and ADHD coaching
• looking into education and school-based accommodations and supports.

Other considerations include:

• managing conditions the child or young person may have alongside ADHD and
• ADHD support groups for parents or young people.
  

ADHD assessment and diagnosis for adults 

Further considerations include:

• managing other conditions that commonly present with ADHD
• alternative causes of ADHD symptoms including sleep disorders, trauma disorders, mood disorders, brain injuries, hormonal changes and other neurological conditions
• working with multiple clinicians trained in ADHD - for example social workers and occupational therapists, who may assist with assessments. 

ADHD treatment and assessment for adults 

Expected standards 

A treatment and management plan includes:

• developing plans together with the person and (if appropriate) family, whānau and/or support people
• discussing the pros and cons of medication and alternatives
• considering cultural safety and sensitivity
• communicating in a clear and timely way with primary care teams (ie GPs) to keep them updated on treatment and management approaches.

Medication

Clinicians are required to provide access to medications to treat ADHD, while carefully considering possible side effects and current medications they are on. They must prescribe treatments according to current best practice guidelines.

Monitoring requirements for stimulant medication include:

• a clinical review two to four weeks after starting new medication
• a follow-up for cardiac and mental health reviews after six to 12 months
• an annual review of how well the medication is working and how the person is tolerating it – including weight, pulse and blood pressure checks
• more frequent reviews if there are any concerns and referring to a specialist if needed
• reviewing the medication every two to four years.

Non-mediation-based treatments

In cases of mild to moderate ADHD symptoms, the framework suggests considering alternatives to medication first. This includes:

• self-education – offering access to information, resources and tools to manage challenges associated with ADHD
• supporting a healthy lifestyle – including physical activity, sleep and nutrition and managing substance use
• providing access to psychological therapies, as appropriate and where available – such as cognitive behavioural therapy, mindfulness and ADHD coaching.

Further considerations include:

• appropriately managing any significant co-existing conditions that come up during the assessment
• working with multiple clinicians skilled in ADHD treatment and management
• access to ADHD coaches, peer support, ADHD networks and support groups.

Visit the Ministry of Health website for the full framework

New Zealand Clinical Principles Framework for Attention Deficit Hyperactivity Disorder | Ministry of Health NZ