Attention problems are a starting point
A primary-school child is referred for possible inattentive ADHD. The history also includes early anxiety, separation difficulty, poor sleep, heavy screen use and intense distress at home.
Clinical question: What else could produce or worsen this presentation?
The lecture's strongest theme was to resist premature closure. Build a formulation before assigning the symptoms to ADHD.
Ask broadly
- Development and onset
- Sleep and health
- Learning and language
- Anxiety, mood and trauma
- Autism and social communication
- Family and school context
Look for impact
- Academic participation
- Relationships
- Home routines
- Safety and impulsivity
- Self-esteem and distress
- Strengths and coping
Interview first. Scales second.
Australian guidance supports a clinical interview, developmental and medical history, assessment of co-occurring conditions, and information from multiple informants. Rating scales such as Vanderbilt or Conners can structure the picture, but should not stand alone as the diagnosis.
Neuropsychological testing is not routinely required to diagnose ADHD. It can help when learning, language, intellectual or other cognitive conditions are suspected.
When home and school disagree
Differences between informants are data. Explore classroom structure, task demands, fatigue, anxiety, coping effort, family dynamics and the reliability of each report.
Diagnosis does not automatically mean medication
Define the treatment target with the child and family. Symptom counts matter less if there is no meaningful impairment or agreed outcome to improve.
Possible targets
Learning, unsafe impulsivity, emotional regulation, relationships, participation and manageable routines.
Ask before starting
What benefit would make treatment worthwhile? How will we measure it? What burden or adverse effect is unacceptable?
Titrate to benefit, not to a number
Use shared decision-making. Discuss benefits, adverse effects, formulation, timing, administration and monitoring. Start cautiously and adjust against agreed targets.
- If medication seems ineffective, check adherence and administration before escalating.
- If another medicine is added mainly to treat an adverse effect, review the original dose, timing, sleep and diagnosis first.
- Medicine-food and drink interactions are formulation-specific. Check product information or pharmacist advice rather than applying one rule to all stimulants.
Work with the adults around the child
For younger children, support often needs to change the environment and caregiver response, rather than placing the whole task on the child. Consider psychoeducation, parent training, school adjustments and targeted psychological care that fits the child's developmental level.
Queensland: separate adult reforms from paediatric shared care
Queensland's expanded GP prescribing rights from 1 December 2025 concern adults. Paediatric patients may be suitable for shared-care monitoring and prescribing in general practice when management is stable, expected adjustments are within the GP's scope, and there is a clear pathway back to paediatrics.
Before prescribing, check current Queensland requirements, QScript, PBS authority and the individual shared-care arrangement.
Six takeaways
- Start with the whole child, not the referral label.
- Confirm onset, settings, impairment and development.
- Use rating scales as aids, not verdicts.
- Investigate discrepancies between home and school.
- Set measurable treatment targets with the family.
- Review the formulation before adding medicine to manage medicine.
Podcast version
A five-minute clinician summary of the lecture, edited against current Australian guidance.
Narrated slides
The same clinician summary as an 11-slide narrated video.