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Collaborative shared care for children with ADHD

13 Aug 2025
GP Connect News

GP Connect clinical feature by Dr. Rona Kelly BMBS FRACP MPH; Paediatrician and GP Liaison Consultant, Child Development Service

Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurodevelopmental diagnosis affecting children in Western Australia. Australian data shows seven per cent of children aged four to 17 years of age are affected by ADHD1,2 with a range of long-term outcomes, including mental health conditions that persist into adulthood3,4

Using current service data, children and adolescents with attention issues represent up to 60 per cent of all clients currently receiving services from paediatricians at the Child Development Service (CDS), a multi-site, community-based, multidisciplinary service for the paediatric population of the Perth metropolitan area.

Following assessment and diagnosis by a specialist paediatrician or psychiatrist, children and adolescents who are prescribed medication treatment for ADHD symptoms require regular follow up. This is to ensure adequate effectiveness of their treatment and monitoring for adverse effects on their health and wellbeing.

Many GPs will be aware of the recent election commitment by the Western Australian (WA) Government regarding ADHD diagnosis and treatment pathways; however, further details are yet to be announced. This article instead aims to inform GPs on current shared-care practices in WA and the key aspects of clinical review.

To ensure that families have the best outcomes, the Australian Evidence-Based Clinical Guideline for Attention Deficit Hyperactivity Disorder recommends that an “optimal” model of shared-care should be underpinned by, “a multimodal, multi-professional and multi-agency approach”.

The Royal Australian College of General Practitioners (RACGP) defines shared care as a model of “joint responsibility for planned care that is agreed between healthcare providers, the patient and any carers they would like to engage”.

A model of shared care involving GP and non-GP specialists aims to provide the following benefits for families of children with ADHD:

  • Families: Improved access to responsive and co-ordinated care in their local area, often with a GP who knows the family well.
  • Specialists: Increased availability of time for specialist paediatricians and psychiatrists to undertake assessments for new clients and continue to review complex clients who may not be eligible for GP shared care.
  • GPs: Increased access to support and appropriate resources to be able to provide effective, efficient, and optimal shared care for families.

Schedule 8 stimulant medicines are the most commonly prescribed medications for the treatment of ADHD symptoms. The Monitored Medicines Prescribing Code, approved in December 2024, outlines the requirements for prescribing of monitored medicines in WA.

A medical practitioner or nurse practitioner may prescribe continuing S8 stimulant medication for a patient under a Shared Care Model provided:

  • the S8 stimulant medication was initiated by an Approved Specialist for the purpose of treating ADHD
  • the patient is under ongoing treatment with the S8 stimulant
  • the prescribing (including medication name, formulation and dose) is consistent with the Approved Specialist’s written instructions or the latest prescription on ScriptCheckWA
  • the practitioner has reviewed the patient and is satisfied it is safe to prescribe stimulants.

Under this model, children and adolescents require a review with their Approved Specialist every 12 months.

A step-wise approach to shared care for ADHD for GPs:

  1. Encourage family to book a long appointment

This enables appropriate time to undertake a clinical review of progress and medication effectiveness (including any new issues arising) and enable access to community supports.

  1. Review current management of ADHD

This includes medication and non-medication management strategies using parent and child report, review of symptoms using a standardised scale (e.g., SNAP-IV) and review of any              adverse effects arising from medication use, including:

  • decreased appetite
  • sleep disturbance
  • headache.
  1. Undertake clinical review of patient

An essential part of a clinical review is the assessment for any adverse effects on health and wellbeing from the treatment of ADHD with S8 stimulant medicines. This includes:

  • height and weight, including plotting on a growth chart and review of growth velocity
  • blood pressure and heart rate.
  1. Review ScriptCheckWA and request authority

It is recommended that GPs check the latest prescription on ScriptCheckWA for the S8 stimulant medicine to ensure that the prescription being requested is:

  • current treatment
  • consistent with the Approved Specialist’s written instructions
  • due for renewal.

If appropriate, PBS authority approval can then be requested

  1. Provide information from review to specialist

This is vital to ensure patient safety. Provision of growth parameters and blood pressure measurements is particularly important. This information can be provided using standardised proformas, email to the child’s specialist or clinical letter.

What are common issues that arise from S8 stimulant medicines?

  • Poor growth: A common adverse effect of S8 stimulant medicines is the suppression of appetite and the resulting decrease in overall intake of food. Monitoring of weight and height gain velocity is an important part of clinical review. If a child’s weight gain has slowed, consider recommending medication days off at weekends/holidays to promote eating and providing advice about a high energy, high protein diet. If weight has been lost and growth measurements have crossed a percentile line on standard growth charts, recommend prompt specialist review of medication and provide measurements from your review appointment.
  • Raised blood pressure: If a child’s blood pressure is measured above 90th percentile for age and height, consider requesting a repeat measurement in another setting / at another time. If the repeat measurement remains raised, recommend prompt specialist review of medication, and provide measurements from your review appointment.
  • Reduced medication effectiveness or adverse effects: Adverse effects from medication are common. If these are having a significant effect on child or family function, recommend prompt specialist review of medication, and provide measurements and information from your review appointment.

Children and adolescents with ADHD require regular follow up to ensure adequate effectiveness of their medication and non-medication treatment, and monitoring for adverse effects on their health and wellbeing. By improving care-coordination, documentation and education through the provision of resources and support, shared care has the potential to provide significant benefits for families, non-GP specialists and GPs.

Resources

References

  1. Lawrence D, Johnson S, Hafekost J, Boterhoven De Haan K, Sawyer M, Ainley J, Zubrick SR. The Mental Health of Children and Adolescents. Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. In: Health Do, editor. Canberra: Commonwealth of Australia; 2015
  2. Australian Government. The National Children’s Mental Health and Wellbeing Strategy (2021). Accessed January 13, 2022. Available from: https://www.mentalhealthcommission.gov.au/getmedia/e369a330-f8c3-4b9e-ab76-7a428f9ff0e3/national-childrens-mental-health-and-wellbeing-strategy-report-25oct2021
  3. Biederman J, Monuteaux MC, Mick E, Spencer T, Wilens TE, Silva JM, et al. Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study. Psychological Medicine. 36(2):167-79
  4. Hamed AM, Kauer AJ, Stevens HE. Why the Diagnosis of Attention Deficit Hyperactivity Disorder Matters. Frontiers in Psychiatry. 2015;6(168):1-10

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