A Practical Guide to Managing ADHD Medication
Guide for Australian GPs: What your patient's Paediatrician wants you to know.
This guide is part of the Your Neurodiversity Roadmap series.
This information is general guidance to assist you in managing a patient who has been commenced on stimulant medication by a paediatrician or child psychiatrist. If you are ever unsure, it is essential to seek input from the specialist managing the patient.
Key Points and Takeaways
This guide is designed to assist you with managing a patient on ADHD medication between paediatrician visits. The key takeaways for your practice are:
Shared Care: Once a patient is stable on stimulants, it's normal practice to manage their ongoing care, including providing regular prescriptions. A Quick Reference Guide to ADHD Medications table and detailed information is below. The *Brisbane Paediatric ADHD Collaborative Care Pathway empowers you to take on this role with specialist support.
Titration and Monitoring: You can reasonably make dose adjustments as a child grows and gains weight. Regular reviews of height, weight, and blood pressure are recommended every 3-6 months. A table of Common Side Effects and their Management is included.
Legal Framework: Queensland state laws are unique in that they allow GPs to prescribe stimulant medications for children until their 19th birthday without requiring specialist approval. For other states and territories see ADHD Medication Prescribing Regulations & Authorities in Australia & New Zealand.
Parent Resources: To streamline the process and empower parents, a dedicated Parent Information Sheet is available to print off and a Guide for Parents is available on the Your Neurodiversity Roadmap Hub to help them navigate this journey.
Collaboration: A new medication or a significant change should be managed with specialist input. You can use the *Request for Advice service via Smart Referrals for timely support without needing a full appointment.
GP Resources: I have many more GP focused resources available through Your Neurodiversity Roadmap including ADHD Referral Letter and Case Conference Templates for GPs
*Currently this is active for Logan Hospital and Redcliffe Hospital. Children’s Hospital Queensland (CHQ) will be active very soon, and other paediatric facilities to follow.
Quick Reference Guide to ADHD Medications
This is a guide to assist you in managing medication for patients with ADHD. It is intended for general guidance, and if you are unsure at any point, always seek input from the specialist paediatrician managing the patient.
Practical Points for Ongoing Care
Regularly review patients every 3-6 months.
Ensure blood pressure is measured with an appropriately sized cuff on a settled patient to get an accurate reading.
Always ensure the school is aware of any medication changes.
Reassure parents that stimulants are short-acting, so missing a few days will not cause medical problems, though behavioral issues may arise.
Concerns about potential misuse of medications, such as snorting crushed dexamphetamine powder, should be communicated to the specialist.
A Glimpse into the Future: The 'Request for Advice' Service
The *Brisbane Paediatric ADHD Collaborative Care Pathway, an Australian-first model, was officially launched on May 1, 2025. This initiative aims to address the significant demand for ADHD services by empowering GPs to manage a greater role in paediatric ADHD care. It serves as a blueprint for other regions, and there is hope that it will expand, as other regions across Queensland are being invited to adopt the pathway.
A key component of this new model is the Request for Advice (RFA) service, a formal communication channel designed to connect you with specialists and provide the timely support you need.
How and When to Access the RFA Service
What it is: The RFA service allows you to submit a clinical question about a child on the collaborative pathway to a paediatrician without submitting a full referral. This service helps you support timely clinical decision-making and, in most cases, allows care to remain with you, the primary care provider.
How to submit: The RFA is a function within the GP Smart Referrals system. You can type a clinical question and attach relevant patient information.
When to use it: The service is intended for non-urgent ADHD management. For example, you can use it for advice on medication management, addressing a sudden change in behaviour, or managing non-urgent side effects.
Response Time: A specialist from the hospital and health service will provide a written response within five business days.
What if a referral is needed? If a referral back to paediatric care is recommended through the RFA, the child will be prioritised and will not be placed at the end of the standard waiting list.
*Currently this is active for Logan Hospital and Redcliffe Hospital. Children’s Hospital Queensland (CHQ) will be active very soon, and other paediatric facilities to follow.
General Principles of Medication Management
Once a patient is stable on stimulants, it is common for their care to be handed back to their GP for ongoing management. Most paediatricians will request you provide prescriptions between specialist appointments also. In Queensland, state laws allow you to prescribe stimulant medications until a patient's 19th birthday. After that, ongoing prescribing requires confirmation of the diagnosis by a psychiatrist and approval from the Drugs of Dependency Unit.
Your role typically involves reviewing the patient's height, weight, and blood pressure every 3-6 months. It is also reasonable for you to make dose adjustments, as symptoms are likely to recur as children grow and put on weight over the years. A key principle to remember is to aim for the lowest dose that assists in improving the child's functional outcomes. If a certain dose is working well, a higher dose will not necessarily do better.
Medication Details and Usage
Below are the most commonly prescribed medications for children with ADHD in Australia, suggested dosing ranges and prescribing principles.
Short-Acting Stimulants
Methylphenidate (Ritalin)
Dosing Range: 0.5 to 2 mg/kg/day. Most children manage on around 1 mg/kg/day. A higher dose is not necessarily better if the current dose is working well.
Duration of Action: Starts working in about 30 minutes and ceases to work after 3-5 hours. Typically needs a second dose around lunch to last through the school day, and sometimes after school as well for older teenagers with homework (no later than 3:30pm to avoid insomnia).
Adjustment & Timing: The dose can be adjusted over a few weeks based on effect and side effects. A small dose after school can resolve emotional lability as the medication wears off.
Long-Acting Methylphenidate
Ritalin LA
Dosing Range: Similar total doses are given as short-acting Ritalin. The PBS maximum daily dose is 80 mg.
Duration of Action: Typically last 8 hours.
Adjustment & Timing: Dose adjustments are made based on effect and side effects over a few weeks.
Concerta
Dosing Range: A specific dose conversion to Concerta is needed. The PBS maximum daily dose is 72 mg.
Duration of Action: Can last up to 12 hours.
Adjustment & Timing: The dose can be adjusted over a few weeks based on effect and side effects. Concerta should be taken with at least half a glass of water or fluid and not with any laxative medication.
Amphetamine Stimulants
Dexamphetamine
Dosing Range: 0.25 to 1 mg/kg/day, with most children managing on around 0.5 mg/kg/day.
Duration of Action: Fast-acting, usually requiring a twice-daily dose.
Adjustment & Timing: Adjustments are made based on effect and side effects over a few weeks.
Lisdexamfetamine (Vyvanse)
Dosing Range: The usual starting dose for children and adolescents is 30 mg once a day. The daily dosage may be adjusted in increments of 20 mg at intervals no more frequently than weekly. The maximum recommended dose is 70 mg/day.
Duration of Action: Can last up to 14 hours.
Adjustment & Timing: The recommended starting dose is 30 mg once daily in the morning, and doses should be increased in increments of 20 mg in intervals no more frequently than weekly. Afternoon doses should be avoided due to the potential for insomnia.
Non-Stimulants
These are alternatives when neurostimulants are at a maximal dose or not tolerated. Atomoxetine is given once daily, with an effect that may take up to 11 weeks. Guanfacine also has a slower onset of action over several weeks and is taken every day.
Atomoxetine (Strattera)
Dosing Range: 0.5 to 1.4 mg/kg/day. It is usually started at less than 0.5 mg/kg/day and increased weekly to a maximum of 1-1.4 mg/kg/day.
Duration of Action: Given once a day.
Adjustment & Timing: Dose is increased weekly. The timing is not critical and can be taken in the morning or evening. The effect may take up to 11 weeks to become apparent.
Guanfacine (Intuniv Modified Release Tablets)
Dosing Range: The starting dose is 1mg daily. The maximum dose is 4mg for children aged 6-12 years and 7mg for those aged 12-18 years.
Duration of Action: Taken every day for a continuous effect.
Adjustment & Timing: Dose increases should be at least a week apart. It can be taken at night if sedation is a side effect, or in the morning if it contributes to sleep issues. To cease, it must be weaned off slowly (1mg reduction every 3-7 days) to avoid rebound hypertension.
Adjunct Medication for Sleep
Melatonin (Circadin)
Dosing Range: 2mg tablets - usual range 0.5-5mg. Often 2mg not enough for older kids and often needs up titration. Can give second dose if wakes overnight, or switch to slow release formulation. Max daily dose 12mg, but I wouldn't recommend going over 10mg.
Duration of Action: Take 60 minutes before bedtime.
PBS Status: This is not on the PBS but can be obtained on a private Can be helpful for initiating sleep in patients who have difficulties getting to sleep when on stimulants. It can be purchased cheaply online (iherb), but it is important to advise patients to discuss it with their doctor and be aware that these are not pharmaceutical-grade products.
Clonidine (Catapres)
Dosing Range: "Start low and go slow" to a maximum of around 5 microg/kg/day. Tablets can be split.
Duration of Action: Not specified, but often used to initiate sleep when given 30-60 minutes before bedtime.
Adjustment & Timing: The dose should be reduced slowly when weaning to stop if a patient is on larger doses. In low doses, it can have an anxiolytic effect and often helps with initiating sleep when given 30-60 minutes before bedtime. If a patient is on larger doses, it must be reduced slowly to avoid rebound hypertension.
Common Stimulant Side Effects and Management
ADHD State Regulations Stimulant Prescribing (adapted from AADPA)
The Australasian ADHD Professionals Association (AADPA) provides a comprehensive guide to stimulant prescribing regulations across Australia and New Zealand. This resource details the unique rules of each state and territory, as well as the varying maximum dosages for different medications like dexamfetamine, lisdexamfetamine, and methylphenidate. The guide is intended to help healthcare professionals navigate the complexities of prescribing these controlled medications.
This guide is part of the Your Neurodiversity Roadmap series.
The Ultimate Resource Hub: Your Neurodiversity Roadmap
As a pediatrician, I know how challenging it can be to find clear, reliable information on neurodiversity in Australia. That's why I've developed The Neurodiversity Roadmap, a series of guides designed to cut through the confusion and empower both parents and clinicians.
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Important Notice for Australian Prescribers:
This guidance is intended solely for qualified healthcare professionals in Australia and is for general educational purposes only, accurate at the time of publication. It is derived from the Australian Evidence-Based Clinical Practice Guideline For ADHD and expert clinical consensus.
This information does not override any local legal or state-based requirements for Schedule 8 (S8) prescribing, which vary by jurisdiction. Prescribers must adhere to the regulations applicable to their specific practice location.
Individual clinical judgement must guide all treatment decisions. This content is not a substitute for professional medical advice and does not establish a doctor-patient relationship.
References and Resources
Australian Evidence-Based Clinical Practice Guideline for ADHD: The definitive national guideline for clinicians, available from the Australasian ADHD Professionals Association (AADPA).
Brisbane Paediatric ADHD Collaborative Care Pathway: The Australian-first collaborative model developed in partnership with Metro South Health, Children's Health Queensland, and local Primary Health Networks (PHNs).
GP Smart Referrals Request for Advice: Need input from a paediatrician? Submit a clinical question to the hospital where the child is known for ADHD. A written response from a paediatrician will be returned within 5 business days, which is saved into both the GP practice software and hospital medical records.
Currently this is active for Logan Hospital and Redcliffe Hospital. Children’s Hospital Queensland (CHQ) will be active very soon, and other paediatric facilities to follow.
ADHD Medication Prescribing Regulations & Authorities in Australia & New Zealand: The Australasian ADHD Professionals Association (AADPA) provides a comprehensive guide to stimulant prescribing regulations across Australia and New Zealand.
ADHD in Children and Youth HealthPathway: Recently updated to be in line with Australasian ADHD Professionals Association (AADPA) Clinical Guidelines and the Prescribing Guide for ADHD.
AMH Children's Dosing Companion: https://childrens.amh.net.au/
Pharmaceutical Benefits Scheme: www.pbs.gov.au