The Evolving Role of GPs in ADHD Care
Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders, affecting approximately 5-7% of children and 2-5% of adults worldwide. Yet for decades, General Practitioners have been largely excluded from the diagnostic process, forced to refer patients to overburdened specialist services with waiting lists stretching months or even years .
From December 1, 2025, specialist GPs in Queensland gained the authority to diagnose ADHD in adults and prescribe psychostimulants within existing maximum dose limits building on existing authorisations for paediatric ADHD care that have been in place since 2017 . Similar reforms are being debated and implemented across other Australian states and territories.
But with expanded scope comes expanded responsibility. ADHD diagnosis is complex. The symptoms overlap with anxiety, depression, bipolar disorder, and trauma-related conditions. The medications involved are Schedule 8 controlled substances requiring careful monitoring. And the consequences of misdiagnosis or missed diagnosis can be significant for patients.
This guide provides GPs with the evidence-based, practical information needed to confidently navigate ADHD diagnosis in primary care settings.
What Is ADHD? A Clinical Overview
ADHD is a neurodevelopmental disorder characterised by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning or development . The condition is:
- Dimensional in nature symptoms exist on a continuum, with no clear cutoff between “typical” and “clinical”
- Lifelong for most individuals, though symptom presentation changes with age
- Highly heritable, with genetic factors accounting for 70-80% of variance in liability
- Associated with significant functional impairments in academic, occupational, social, and emotional domains
If left untreated, ADHD can result in significant lifelong functional impairments with poor long-term outcomes . These include higher rates of unemployment, relationship difficulties, substance use disorders, accidental injuries, and involvement with the criminal justice system.
The GP’s Role in ADHD Diagnosis: What Has Changed?
Historical Context
Traditionally, ADHD diagnosis and psychostimulant prescribing were restricted to paediatricians and psychiatrists due to state and territory laws governing Schedule 8 controlled medicines . GPs could:
- Suspect ADHD based on clinical presentation
- Refer patients for specialist assessment
- Prescribe under shared care agreements after specialist initiation and stabilisation
Current Landscape (As of 2025)
Queensland has led the way with progressive reforms:
- Since 2017: Specialist GPs in Queensland have been authorised to prescribe psychostimulants for children (aged 4-17 years) with ADHD
- From December 1, 2025: Specialist GPs in Queensland can now diagnose adults (18+ years) with ADHD and prescribe psychostimulants within existing maximum dose limits
- Paediatricians can now prescribe to young adults (18-24 years)
Other states and territories are following suit, though regulations vary. The RACGP continues to advocate for:
- National consistency across state and territory legislation
- Increased Medicare rebates for longer consultations
- Funding for GP training and mentorship in ADHD care
What GPs Cannot Do?
Even in Queensland, not every GP can independently diagnose ADHD. The authorisation applies to specialist GPs (Fellows of RACGP or ACRRM) who have undertaken appropriate training . In other jurisdictions, GPs may still need to refer to specialists for initial diagnosis, though shared care arrangements remain an option.
The NHS maintains a similar position: “GPs are not able to make a diagnosis of ADHD and a referral is needed to an ADHD specialist” . Shared care agreements allow GPs to continue prescribing once a specialist has stabilised the patient, but the specialist retains overall responsibility.
Step-by-Step: The ADHD Diagnostic Process in General Practice
Step 1: Recognition and Initial Presentation
Patients may present with:
- Direct concerns: “I think I might have ADHD”
- Indirect complaints: Difficulty concentrating at work, relationship problems, chronic disorganisation
- Parental concerns about a child’s behaviour at school or home
- Comorbid presentations: Anxiety, depression, or substance use that may be secondary to undiagnosed ADHD
Step 2: Comprehensive Clinical Assessment
A thorough diagnostic assessment must include :
Clinical Interview
- Detailed developmental and medical history
- Current symptoms mapped to DSM-5-TR criteria
- Onset before age 12 (retrospective recall)
- Symptoms present in two or more settings (e.g., home, work, school)
- Clear evidence of functional impairment
Informant Reports
- Multiple informants are essential: parents, partners, teachers, employers
- Cross-informant correlations for ADHD symptoms are moderate (r = 0.3-0.5), so discrepancies are expected
- “The referral question and source play a critical role” in clinical decision-making
Collateral Information
- School reports (comments about attention, behaviour, incomplete work)
- Employment records
- Previous assessments or medical records
Step 4: Rule Out Medical Causes
Before confirming an ADHD diagnosis, consider and exclude:
- Hearing or vision problems (especially in children)
- Thyroid disorders
- Lead toxicity (if risk factors present)
- Sleep apnoea or other sleep disorders
- Medication side effects
- Substance use
Step 5: Formulate Diagnosis
If criteria are met, other conditions are ruled out, and there is clear evidence of functional impairment, an ADHD diagnosis can be made.
Documentation should include:
- Specific DSM-5-TR criteria met (with examples)
- Age of onset (<12 years)
- Cross-setting impairment evidence
- Differential diagnosis reasoning
- Comorbid conditions identified
Screening Tools: A Deeper Dive
For Children: Vanderbilt Assessment Scales
The Vanderbilt scales are recommended by the National Institute for Children’s Health Quality for children aged 6-12 . They include:
- Parent Assessment Scale (55 items)
- Teacher Assessment Scale (43 items)
- Follow-up scales for monitoring treatment response
For Adults: ASRS-6
The ASRS-6 is the most extensively validated screening tool for primary care settings . Key findings from a 2024 systematic review and meta-analysis:
- Sensitivity: 0.83 (0.67–0.92)
- Specificity: 0.87 (0.93–0.8)
- AUC (Area Under Curve): 0.92
- Low heterogeneity (I² = 8.6–12.3%), indicating consistent performance across studies
Clinical pearl: The ASRS-6 is a screener, not a diagnostic tool. A positive screen indicates need for full assessment; a negative screen makes ADHD unlikely but does not completely rule it out.
Comorbidity: The Rule, Not the Exception
ADHD rarely travels alone. Up to 70-80% of adults with ADHD have at least one comorbid psychiatric condition . Common comorbidities include:
- Anxiety disorders (47%)
- Depressive disorders (38%)
- Oppositional defiant disorder (40% in children)
- Substance use disorders (15-25% in adults)
- Learning disorders (20-30%)
Clinical implications: Comorbid conditions must be identified and addressed. Sometimes treating the comorbidity (e.g., anxiety) improves ADHD symptoms. Other times, untreated ADHD exacerbates the comorbid condition. A hierarchical approach treating the most impairing condition first is often appropriate.
Prescribing Considerations
For Queensland GPs (as of December 2025):
- Specialist GPs can prescribe psychostimulants to diagnosed adults within existing maximum dose limits
- Existing authorisations for children (4-17 years) continue
- Prescribing must follow Queensland Health regulations for Schedule 8 medicines
For GPs in other jurisdictions (and UK NHS):
- Initial prescribing typically requires specialist initiation
- Shared care agreements allow GPs to continue prescribing after specialist stabilisation
- GPs are not obligated to enter shared care agreements with private providers
Side Effects to Monitor
- Common: Decreased appetite, sleep disturbance, headache, dry mouth, irritability
- Less common but significant: Increased BP/HR, growth suppression (children), tics, mood changes
- Rare: Psychosis, cardiovascular events, priapism
Shared Care Agreements: A Practical Guide
Shared care is a formal arrangement where a specialist initiates and stabilises ADHD medication, then requests that the GP continue prescribing and monitoring .
Essential Components of a Shared Care Agreement
- Diagnosis confirmed by an appropriate specialist
- Medication stabilised (typically 3 months of monitoring)
- Clear responsibilities outlined for each party
- Monitoring schedule specified
- Annual specialist review required (minimum)
- Communication protocols established
Important Caveats
- GPs are not obliged to accept shared care agreements, particularly with private providers
- If a GP declines shared care, the specialist remains responsible for prescribing
- Some practices have formal policies: “We will not enter into a shared care agreement with a private provider“
- Patients should be informed of potential costs if shared care is declined (private prescriptions typically £30-50 per month in the UK)
Resources for GPs
Free Evidence-Based Resources
The Australasian ADHD Professionals Association (AADPA) offers free clinical resources for GPs :
- ADHD diagnosis checklist – Aids the diagnostic process
- Factsheet for GPs – Summary of screening, diagnosis, and treatment
- ADHD Prescribing Guide – RACGP-endorsed, practical prescribing advice
- Treatment overview with flowcharts – Multimodal treatment recommendations
RACGP Resources
- Gp learning: Identification and Management of ADHD (CPD-approved)
- Gp learning: Pharmacological Management of ADHD
- Adult ADHD in General Practice (recording and slides)
- Paediatric ADHD in General Practice (recording and slides)
Screening Tools
- ASRS-6 (adults) – Free, downloadable
- Vanderbilt Assessment Scales (children) – Free, downloadable
- WURS-25 (adult retrospective) – Free, downloadable
Pros and Cons of GP-Led ADHD Diagnosis
Pros:
- Improved access – Reduces specialist wait times (often 6-18 months)
- Continuity of care – GPs know the patient’s full medical and family history
- Holistic approach – GPs can address comorbid physical and mental health conditions
- Cost-effective – Reduces burden on overstretched specialist services
- Patient-centred – Single provider for comprehensive care
Cons:
- Complexity – Differential diagnosis requires significant clinical skill
- Time-intensive – Comprehensive assessment requires longer consultations (Medicare rebates may not fully compensate)
- Risk of misdiagnosis – Symptom overlap with anxiety, depression, bipolar disorder
- Schedule 8 regulations – State-by-state variation creates confusion
- Training gaps – Not all GPs have received adequate ADHD training
Frequently Asked Questions
Can a GP diagnose ADHD?
In most jurisdictions, GPs cannot independently diagnose ADHD; a specialist (psychiatrist or paediatrician) is required. However, Queensland specialist GPs can now diagnose ADHD in adults (from December 1, 2025) and have been able to diagnose children since 2017 . Other states and territories are considering similar reforms.
What screening tools should GPs use for ADHD?
For adults, the ASRS-6 is the most validated tool for primary care, with sensitivity of 0.83 and specificity of 0.87 . For children aged 6-12, the Vanderbilt Assessment Scales (parent and teacher forms) are recommended .
