AJGP’s September ADHD focus is practical GP territory: non-drug supports, Schedule 8 compliance, a trained-GP care model, and day-to-day medication titration. The same issue also carries several standout clinical pieces that travel well beyond ADHD clinics.
ADHD focus — what matters in rooms
Care remains multimodal. Stimulants help many people, but routines, sleep, movement, meals, visual planning and psychological work still carry a large share of functional gain. Externalise organisation with lists, calendars, timers and task breakdown; screen for emotional dysregulation, rejection sensitivity, trauma and maladaptive coping.
For children, behavioural parent training, predictable routines, positive reinforcement and school collaboration sit at the centre. Neuro-affirming, strengths-based language helps engagement while specialist assessment or medication decisions are pending.
Medicolegal articles underline that methylphenidate, dexamphetamine and lisdexamfetamine are S8 medicines with state-specific authorisation, training, shared-care and monitoring rules that keep changing. Confirm TGA licensing and PBS Authority separately, use real-time prescription monitoring where required, and document diagnosis, impairment, consent, risks and rationale. Telehealth needs a genuine therapeutic relationship — identity, diversion and assessment quality are live risks.
A NSW prospective cohort of 207 children seen by four trained GPs reported a median three-week wait, high stimulant stabilisation rates, improved teacher-rated inattention/overactivity, and only rare specialist escalation. That supports structured GP-led care for uncomplicated ADHD, not unsupported prescribing. Stable patients need at least six-monthly review of growth, BP, function, school feedback and dose.
When starting medication, define success as better function across settings. Titrate gradually; expect switches. At each review check appetite, weight, sleep, mood, adherence, duration of benefit, BP and heart rate. Non-stimulants need longer trials, and guanfacine/clonidine require careful tapering.
In clinic
- Offer multimodal ADHD care even while waiting for specialist input.
- Recheck current state S8 and RTPM rules before every new stimulant script.
- Review height, weight, BP, sleep and school/work function at least six-monthly once stable.
- Treat poor response as a diagnostic/adherence/dose question before escalating class.
Lp(a): actionable today
Lipoprotein(a) is largely inherited and independently raises ASCVD and calcific aortic stenosis risk — about one in five people carry a risk-associated level. Consider a one-off test in established or very-high-risk ASCVD, premature family disease, progressive aortic stenosis, FH, diabetes, CKD or unexpectedly stubborn LDL. Fasting is unnecessary; treat the result as a risk modifier, not a stand-alone target. Until dedicated therapies arrive from outcome trials, push absolute risk hard: smoking, BP, diabetes, weight, lifestyle and LDL. Statins still help overall risk even though they do not lower Lp(a).
In clinic
- Order Lp(a) once in selected high-risk patients; do not chase serial values.
- Intensify conventional risk reduction now; keep an eye on emerging RNA therapies.
AAS and other PIEDs — harm reduction without collusion
Ask directly, without judgement, about steroids, peptides, SARMs, stacking and blast-and-cruise patterns. Screen for hypertension, dyslipidaemia, polycythaemia, hepatic/renal injury, cardiomyopathy, hypogonadism, infertility/virilisation, sleep apnoea, mood change and blood-borne infection. Unregulated peptides and SARMs have uncertain contents and real metabolic, CV and endocrine risk. Harm reduction (safer injecting, monitoring, treating complications) can sit alongside a clear recommendation to stop, with referral to endocrinology, cardiology, fertility, mental health or AOD services as needed.
The Medicare 3-year health check
From November 2026, the Thriving Kids 3-year check covers eligible children from their third birthday until the day before age four. Use a structured screen across parent concerns, red flags, development, examination and family/social context. The CHILD frame (Child, Home, Interactions, Links, Development) helps capture attachment, routines, stressors and strengths. Ask about speech, hearing/vision, sleep/snoring, diet, activity, screens, toileting, regression and family mental health. Convert findings into concrete help — speech therapy, parenting programs, sleep support, diet/activity advice — and plan 3–6 month follow-up.
In clinic
- Build a template now for the November 2026 3-year check item.
- Escalate regression, autism concern, hearing/vision problems and major psychosocial risk early.
Methamphetamine and the heart
Keep a low threshold for CV screening in current or past methamphetamine use — cardiomyopathy can present young. Resting ECG is a practical start; echo early if symptomatic, remembering a normal NT-proBNP does not exclude compensated dysfunction. Think cardiomyopathy, ACS, hypertension, arrhythmia/QT issues, pulmonary hypertension, dissection and stroke. Abstinence can allow reverse remodelling, but guideline-directed therapy and cardiology input still matter. Contingency management plus psychosocial care has the best evidence; no approved medication reliably treats methamphetamine use disorder.
Case: scaly hyperpigmented patches in skin of colour
Pityriasis versicolor leads the differential for scaly trunk patches on dark skin, but also weigh confluent and reticulated papillomatosis, mycosis fungoides, dermatitis, pityriasis rosea and erythrasma. Evoked scale and Wood lamp help at the bedside; KOH microscopy beats biopsy when scarring or pigment change matters. Colour change can persist after clearance — treat until scale settles, not until tone normalises. Topical azoles or selenium sulphide are first-line; oral fluconazole is for severe/resistant disease. Terbinafine and griseofulvin miss this organism. Maintenance shampoo reduces relapse; reassure that it is not contagious.
Clinician notes for personal CPD — not patient advice.
Article takeaways
Non-pharmacological strategies in the management of ADHD
Multimodal supports — routines, CBT skills, parent training and school collaboration — remain core even when medication is used.
Open article →Balancing care with compliance: medicolegal issues for GPs treating ADHD
S8 rules, RTPM, documentation and telehealth safeguards vary by jurisdiction and need checking before each stimulant script.
Open article →New model of management of ADHD by trained GPs: prospective cohort in 207 children
Trained GP-led care shortened waits and stabilised most uncomplicated paediatric ADHD, with rare specialist escalation.
Open article →Medication initiation and optimisation in ADHD: a practical approach for general practice
Titrate to function, review growth/BP/sleep/mood regularly, and give non-stimulants a longer fair trial.
Open article →Lipoprotein(a): actionable today, treatable tomorrow?
One-off Lp(a) testing modifies risk; until dedicated drugs arrive, intensify absolute ASCVD risk reduction.
Open article →Management of patients using AAS and other PIEDs: a harm reduction approach
Non-judgemental enquiry, metabolic/CV screening and harm reduction improve engagement alongside a stop recommendation.
Open article →A guide to the 3-year-old health check for general practice
Prepare structured CHILD-framed templates for the Medicare 3-year check starting November 2026.
Open article →Methamphetamine-associated cardiovascular conditions in general practice
Screen young methamphetamine users for cardiomyopathy and ACS; abstinence helps but GDMT still matters.
Open article →Scaly hyperpigmented patches on a patient with skin of colour
Pityriasis versicolor: confirm with KOH, treat scale not pigment, and avoid terbinafine/griseofulvin.
Open article →
Sources
- AJGP home
- Non-pharmacological strategies in ADHD
- Medicolegal issues for GPs treating ADHD
- Trained GP ADHD management cohort
- Medication initiation and optimisation in ADHD
- Lipoprotein(a)
- AAS and other PIEDs harm reduction
- 3-year-old health check guide
- Methamphetamine-associated CV conditions
- Pityriasis versicolor case study