As Australia moves towards more GP-led ADHD care, an expert says prescribing is only part of the job – and good assessment, monitoring, and knowing when to call for help will be critical.
Australia is moving closer to widespread GP-led ADHD care, putting the spotlight on whether GPs have the appropriate training and practical support they need to diagnose, prescribe, and monitor patients safely.
NSW is weeks away from allowing trained GPs to assess and diagnose ADHD and initiate treatment, including psychostimulants, in patients aged six and over, while Victoria has begun training its first cohort of 150 GPs for an expanded role.
Queensland has already opened psychostimulant initiation to specialist GPs treating adults, while moves are underway nationally to bring greater consistency to the patchwork of state and territory prescribing rules.
But Professor David Coghill, a child and adolescent psychiatrist and president of the Australian ADHD Professionals Association (AADPA), said expanded prescribing needed to be backed by high-quality training.
Professor Coghill has been involved through AADPA in developing GP ADHD training in Western Australia and NSW and said GPs were well placed to manage a condition that required long-term care.
“GPs are the medical group who are just so skilled at managing chronic disorders, chronic health problems. They do it with hypertension. They do it with diabetes. They do it with obesity and so many other things,” he told The Medical Republic.
He said GPs already managed most adult mental health problems, including anxiety and depression, making their inclusion in ADHD care logical given the condition’s prevalence.
But Professor Coghill cautioned against treating the expansion of GP prescribing as simply teaching doctors how to use ADHD medicines, as prescribing medication was only one part of managing ADHD.
“A core part of that is saying this isn’t just about teaching you about medicines,” he said.
A thorough clinical assessment was fundamental, he said, particularly given the overlap between ADHD symptoms and other mental health and neurodevelopmental conditions.
“You don’t just do an ADHD assessment. You do a more general assessment, and that includes assessing people’s other mental health difficulties and challenges,” said Professor Coghill.
GPs also needed to take a developmental history, establish when symptoms emerged and how they had changed over time and, particularly for adults, consider why ADHD may not have been identified earlier.
Before prescribing, Professor Coghill said GPs should conduct a face-to-face clinical interview rather than relying on questionnaires.
“You can’t diagnose ADHD with questionnaires alone,” he said.
“The reason you can’t is that questionnaires just tell you about symptoms. Lots of people have symptoms, but we need to know about how those symptoms are impacting on people.”
Once a diagnosis had been established, baseline physical assessment was relatively straightforward.
Professor Coghill recommended taking a cardiac risk history, including asking about a family history of arrhythmias, and measuring height, weight, blood pressure, and pulse.
Those measurements also needed to be charted to provide a baseline against which subsequent changes could be assessed.
Routine ECGs and cognitive testing were not required unless there was a clinical indication, he said.
Professor Coghill stressed that medication should not be the starting point of the treatment conversation, however.
“First line treatment for ADHD is psychoeducation, and so the first thing that people need to be able to do is give good quality psychoeducation,” he said.
Medication should then be offered to patients with ADHD, with stimulants generally the first pharmacological choice, he said.
There were important exceptions, particularly patients with active substance use, psychosis, bipolar disorder, or eating disorders such as anorexia, where GPs should seek additional expertise from a specialist.
For most patients starting stimulants, finding the right dose was an individual process rather than one determined by age, weight, or symptom severity.
Professor Coghill advised optimising the first medicine before switching drugs.
“So always up or down first before sideways, so we very strongly advise that people try to optimise the outcomes using that first medication, and not thinking about high doses or low doses, just thinking about what’s the optimal dose for that person because actually it’s very unpredictable,” he said.
His treatment target was straightforward – “maximum response at minimum dose with the least side effects”.
Monitoring should look beyond attention alone to changes in the broader core symptoms of ADHD, including focus, organisation, memory, overactivity, and impulsivity.
Once treatment was optimised, Professor Coghill said patients generally required ADHD reviews every three to six months, although other mental health, psychosocial, or functional problems could require more frequent follow-up.
For children and adolescents, monitoring also needs to include appetite, weight, and growth.
Appetite suppression is a common adverse effect of stimulant treatment and can become particularly important in younger patients, where inadequate energy and nutrient intake may affect weight gain and growth. Therefore, the practical nutrition advice part of ADHD prescribing is a necessity rather than an optional extra.
Professor Coghill said families may need help working around the child’s daily appetite pattern – for example, making breakfast count before medication suppresses appetite, taking advantage of stronger appetite later in the day, and prioritising nutrient-dense foods when the amount a child is willing to eat is limited.
He said eggs could be particularly practical because they provided high-quality protein and a range of vitamins and minerals in a relatively small serving.
“It’s about helping families make every eating opportunity count, while recognising when changes in weight or growth require dietary, prescribing, or specialist review,” he said.
Height, weight, and BMI should be followed over time, with significant changes prompting consideration of dietary strategies, medication adjustment, or further clinical review.
As children moved into adolescence, routines became less predictable and young people took greater responsibility for their own medication and food choices, the advice needed to be practical and achievable.
“In adults, monitoring remains important, but the focus is less on physical growth and more on the person’s overall health, nutrition, functioning, and response to treatment,” said Professor Coghill.
Medication choice could also be influenced by appetite and sleep effects. Professor Coghill said he generally favoured shorter-acting methylphenidate when initiating treatment in younger primary school-aged children.
“You don’t want the longer-acting medicines that can cause longer appetite problems, sleep problems. First off, you may work up to that,” he said.
Adolescents and adults may benefit from longer-acting treatment for practical reasons, while the individual response and adverse-effect profile should ultimately guide prescribing.
GPs also needed to recognise when a patient is moving beyond the limits of straightforward primary care management.
His advice to GPs entering the field was pragmatic.
“You know what we say to the GPs we are working with is just keep your sensible hat on and don’t try to push it,” he said.
The difficulty, he acknowledged, was that GPs could be forced towards the edges of their scope because there was simply nobody available to take over more complex care.
Access was one of the drivers behind the reforms, but Professor Coghill said governments also needed to resolve how GPs would be paid for the substantially longer consultations required for ADHD assessment.
“You can’t do an ADHD assessment in a 10-minute appointment, you can’t do it in a 20-minute appointment. And GPs need to be able to be reimbursed properly,” he told TMR.
Related
NSW’s reforms are now approaching their next major stage. From late October, endorsed GP prescribers will be able to assess, diagnose and initiate ADHD treatment, including psychostimulants, in eligible patients aged six and over.
More than 700 expressions of interest were received for around 300 places in the first round of endorsed prescriber training, according to the NSW Agency for Clinical Innovation, while NSW Health said in June that 330 GPs were undergoing training.
Victoria’s first 150 GPs began RACGP-delivered ADHD training in September, with regulatory changes intended to allow those who complete the program to diagnose and treat ADHD in adults and children aged six and over.
Queensland has taken a different approach. Since December 2025, specialist GPs have been able to initiate, modify, and continue psychostimulants for adults with ADHD without additional mandatory ADHD training.
Professor Coghill said AADPA supported mandatory training for doctors prescribing stimulants – but stressed that requirement should not single out GPs.
“If I were making the rules, I would mandate training, but not just for GPs. I would say anyone working in this space should be able to receive training,” he said.
At a national level, the Medicines and Poisons Advisory Group is considering harmonisation of prescribing and medicines rules, with advice on a national approach to GP diagnosis and treatment of ADHD its first priority.
For Professor Coghill, most patients with ADHD should ultimately be manageable in the community if GPs have the skills, support and ability to refer when needed.
“If you do your job with the medication and thinking about other supports, then most people with ADHD can be well treated and maintained in you know that community setting,” he said.
