Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that can affect attention, impulsivity, emotional regulation, and executive functioning. While ADHD typically presents in childhood (usually before the age of 12), many people continue to experience symptoms into adulthood, sometimes without ever receiving a diagnosis.

At Eastern Suburbs Psychiatry, our psychiatrists provide comprehensive ADHD assessments, diagnosis and treatment for adults and adolescents aged 16+ in Sydney. Our neuropsychologist also offers ADHD and cognitive assessments for school-aged children (6+) and adults. From our Darlinghurst practice, we assess attention difficulties, impulsivity, executive functioning, and related mental health concerns as part of a thorough diagnostic process.

ADHD Diagnosis Process

Diagnosing ADHD involves a comprehensive psychiatric and physical assessment. Symptoms of ADHD can overlap with other conditions, including anxiety, depression, sleep disorders, trauma and learning difficulties, so careful, expert assessment is important.

In diagnosing and treating ADHD, Eastern Suburbs Psychiatry follows the guidelines set by the Royal Australian and New Zealand College of Psychiatrists, NICE, and the NSW Department of Health. Accordingly, a diagnosis of ADHD in adults can only be made with corroborating evidence such as school reports and corroborative history for a parent, guardian or sibling who was raised with you. Self-report alone may not meet the threshold set out by the guidelines. In children, corroboration occurs via forms completed by and/or interviews conducted with parents and teachers.

Please also note that medication will not be provided during the first 2 appointments, as a thorough assessment must first be completed.

Types of ADHD

There are three different ways ADHD presents:

1. Predominantly Inattentive Presentation: It is difficult for the person to organise or finish tasks, pay attention to details, or follow instructions or conversations. The person is easily distracted or forgets details of daily routines.
   2. Predominantly Hyperactive Presentation: The person fidgets and talks a lot. It is hard to sit still for long periods of time. Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may frequently interrupt others, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.
   3. Combined Presentation: Symptoms of the above two types are equally present in the person.

As symptoms can change over time, the presentation may also change over time.

ADHD in Children

While many children often have trouble focusing and behaving from time to time, children with ADHD have symptoms that persist and can be severe, causing difficulty at school, at home, or with friends. Common symptoms include:

• Frequently daydreaming
• Forgetfulness
• Fidgeting
• Excessive talking
• Impulsivity
• Difficulty waiting for turns
• Having difficulty getting along with others

ADHD in Adults

ADHD symptoms in adults can present differently to ADHD in children. While hyperactivity may become less obvious with age, many adults continue to experience difficulties with attention, organisation, impulsivity, and emotional regulation.

Common symptoms of adult ADHD may include:

• Difficulty concentrating or staying focused
• Chronic disorganisation
• Frequently losing or misplacing items
• Forgetfulness in daily tasks
• Difficulty managing time or meeting deadlines
• Restlessness
• Impulsivity
• Difficulty completing tasks
• Emotional dysregulation or frustration intolerance
• Problems maintaining routines

ADHD in adults can affect work, study, relationships, and overall daily functioning. Many adults are not diagnosed until later in life, particularly if symptoms were overlooked in childhood.

Causes of ADHD

The causes and risk factors for ADHD are unknown, but current research shows that genetics plays an important role. However, if your child has ADHD, this does not necessarily mean you also have this illness, and vice versa.

Diagnosis of ADHD

There is no single test to diagnose ADHD, and many other illnesses, such as anxiety disorders, depression, primary sleep disorders, and certain types of learning disabilities, can have similar symptoms. Diagnosing ADHD, therefore, entails a thorough assessment, including a comprehensive history, as well as seeking corroboration from school reports and reports from a parent, guardian or sibling raised with you (for adults), and from parents and teachers (for children). This is strongly recommended by The Royal Australian & New Zealand College of Psychiatrists who state that “A confident diagnosis of ADHD in an adult usually requires corroborative evidence from family sources and educational and employment settings, previous and current.”  

Treatment for ADHD

ADHD treatment is individualised and may include a combination of medication, psychological strategies, and cognitive remediation and lifestyle support. Treatment recommendations depend on a person’s symptoms, medical history, daily functioning, and overall health.

There are various types of medicines licensed for the treatment of ADHD:

Stimulant Medication

Stimulant medications are commonly used in the treatment of ADHD and work by affecting neurological pathways involved in attention and behaviour regulation. These medications may help improve focus, reduce impulsivity and support executive functioning.

• Methylphenidate – this is the most commonly used medicine for ADHD. It belongs to a group of medications called stimulants, which work by increasing activity in the brain, particularly in areas that play a part in controlling attention and behaviour. This comes in an immediate-release formulation (Ritalin), a long-acting medication (Ritalin-LA), and a slow-release version (Concerta).
• Dexamfetamine – is also a stimulant medication that stimulates certain parts of the brain. It improves concentration, helps focus attention and reduces impulsive behaviour. This comes in an immediate-release formulation (Dexamfetamine) and a slow-release version ( Lisdexamfetamine).

Non-stimulant Medication

Non-stimulant medications may be considered where stimulant medications are not suitable or are not well tolerated.

• Atomoxetine – this works differently from other ADHD medicines. It’s a selective noradrenaline reuptake inhibitor (SNRI), which means it increases the amount of a chemical in the brain called noradrenaline. This chemical passes messages between brain cells, increasing concentration and helping to control impulses.
• Guanfacine – this acts on part of the brain to improve attention, and it also reduces blood pressure.

Important Information About ADHD Medication

ADHD medication is not suitable for everyone, and medication is only considered following a thorough psychiatric and physical assessment. Medication is not prescribed during the initial appointments, as symptoms affecting attention and concentration may also be caused by other psychiatric, psychological, or medical conditions.

Before prescribing medication, our psychiatrists will explain the benefits and potential side effects of the drugs in order for you to make an informed decision. If you are prescribed one of these medications, you’ll probably be given a low dose initially, which may then be gradually increased depending on efficacy. Some medicines need to be taken every day, while others can be taken only on workdays. Treatment breaks are often recommended. This also helps to prevent the development of tolerance and dependence on these medications. It’s important to let your Psychiatrist know about any side effects you are experiencing.

You will need to be reassessed to ensure the treatment is working effectively and to check for signs of any side effects. You will also need to be reviewed in person before a repeat prescription can be provided by our psychiatrists. Repeat prescriptions cannot be provided without a face-to-face appointment and physical examination.

Our psychiatrists provide assessment and treatment for ADHD from across Sydney, including the Eastern Suburbs, Sydney CBD and surrounding areas, with patients attending from suburbs such as Darlinghurst, Bondi Junction, Woollahra and Randwick.

For an appointment, please call our practice on (02) 8359 1930 or complete the inquiry form here.