[redactions made under s47F of the FOI Act]
From:
Sent:
Tuesday, 15 June 2021 3:41 PM
To:
Clinical Guidelines
Cc:
Mark Bellgrove;
Subject:
ADHD guideline progress report
Attachments:
ADHD guideline progress report_NHMRC_June 2021_Final.docx
Dear Sally and Stephanie,
Apologies for the long silence. We have been getting through as much evidence review as possible. I
have cc'd
into this email.
is managing our deliverables and liaising with the clinical groups to ensure they are supported to
interpret the evidence and draft recommendations. I am happy to remain the NHMRC contact.
Our next GDG meeting in July is intended to discuss recommendations and GRADE evidence to
recommendation considerations. We hope to begin public consultation in October.
Please find attached the progress report according to the NHMRC template. I note that we will miss the
October NHMRC guideline council meeting. Is there a date for the next council meeting after October?
Thank you and best wishes,
--
Diagnosis, management and treatment of ADHD - an Australian ADHD Professionals Association
(AADPA) evidence-based guideline, in development.
Monash University Affiliate, Monash Centre for Health Research and Implementation
E:
I acknowledge the Traditional Owners and Custodians of the lands on which I live and work and pay my
respect to Elders both past and present.
1
NHMRC Progress Report: Australian ADHD Professionals Australia
(AADPA) guideline for the diagnosis, assessment and management
of ADHD
Governance and stakeholders
1. List the key organisation or organisations responsible for development and publication of the
guideline.
Australian ADHD Professionals Australia (AADPA).
2. List the sources of al funding for the development of the guideline and its publication.
The development of this guideline is funded via a Grant Agreement (4-A168GGT) between the
Australian ADHD Professionals Association and the Commonwealth of Australia represented by the
Department of Health. The Department of Health has been made aware of this via the submission
of activity reports and budget requests.
3. Describe the processes for ensuring editorial independence from funders.
Professor Mark Bellgrove is the AADPA President. Professor Bel grove represents the organisation
as a member of the multidisciplinary guideline development group (GDG) and reports to the board
as the funding organisation.
Relevant representation from stakeholders with ADHD or who are involved in the care of people
with ADHD will contribute at all stages of the guideline development process in the
multidisciplinary GDG. An experienced guideline development methodologist wil also be involved
at each step of the process.
4. List al the people involved in the guideline development process (including
discipline/expertise, organisational affiliation and role in the guideline development process).
Please see Appendix A. The beginning of this document contains a table of all GDG members,
including their role, discipline/expertise, and organisational affiliation where a representative.
5. Describe the processes to be used for declaration and management of competing interests for
al people involved in the guideline development process.
Please see Appendix B for the AADPA ADHD Guideline Conflict of Interest Policy and Process.
6. Describe the processes that will be/are being used to ensure consumer perspectives are
incorporated in the guideline.
GDG members, listed in Appendix A, include four consumer representatives, one of whom
represents the Aboriginal and Torres Strait Islander community.
7. List the organisations (if any) that will be approached to endorse the guideline.
Please see Appendix A. The beginning of this document contains a table of all GDG members,
including their organisational affiliation where a representative.
Scope and purpose
8. List the clinical research questions which are being addressed by the guideline that inform the
evidence review.
Please see Appendix A, from page 4.
NHMRC progress report for ADHD guideline
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9. List the population groups to which the guideline recommendations wil apply and any
population subgroups for whom specific information may be required (such as risks or
treatment considerations).
As outlined in Appendix A, al age groups wil be considered for each question: preschool, school
age, adult, older adult; Settings: primary or specialist health; school or educational institution;
workplace; aged-care; prison; welfare/foster care; rehabilitation; home, and subgroups to be
considered for every question: Indigenous groups; CALD groups; those with learning disabilities;
substance use; co-occurring conditions.
10. List any issues (such as particular risks, treatment considerations or sociocultural
considerations) identified as relevant to Aboriginal and Torres Strait Islander peoples or any
other groups (e.g. culturally and linguistically diverse (CALD) groups) which will be considered
as part of the guideline scope, and describe how these issues have been addressed in the
evidence review and formulation of recommendations.
As above. Such groups will be considered across all clinical questions, including through general
searches designed to capture al groups reported in the literature; and captured in judgments
outlined in the GRADE guided evidence to recommendation framework (see Appendix C).
Evidence review
11. List the names of the evidence experts who will be involved in the search and appraisal of the
literature (if not provided at 4).
12. List the publication date cut points (as month/year) for all evidence searches, including any
differences if multiple searches were completed as part of the evidence review process.
Multiple searches were conducted, according to the questions addressed as NICE guideline updates
and those addressed as new evidence reviews. A search for questions relevant to interventions
updated from NICE 2017 was conducted in August 2020. If time permits, this search may be
updated for any key eligible studies. Subsequent searches to answer non-intervention questions
(e.g., diagnosis, treatment pathways) have been conducted as recent as May 2021. We do not
intend to conduct any more searches and are currently focused on synthesizing evidence and
preparing recommendations.
Recommendations
13. List the types of recommendations which have been or will be derived from the clinical
questions. For example, these may include recommendations based on a systematic evidence
review, recommendations developed where a systematic evidence review was conducted and
low quality or no evidence was identified (and consensus processes may have been used) and
recommendations developed to provide additional information to support recommendations
where a systematic evidence review was not conducted (sometimes cal ed practice points or
points of note).
The proposed types of guideline recommendations:
EBR
Evidence Based Recommendations: Based on evidence review, with sufficient
evidence to inform a recommendation made by the guideline development group.
CCR
Clinical Consensus Recommendations: Based on evidence review, in the absence of
evidence, a clinical consensus recommendation has been made by the guideline
development group.
CPR
Clinical Practice Points: Evidence not sought. A practice point has been made by the
NHMRC progress report for ADHD guideline
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guideline development group where important issues arose from discussion of
evidence-based or clinical consensus recommendations.
14. Describe the process which wil be used to reach expert or group consensus in the
development of recommendations.
If government restrictions do not permit face to face meetings to reach consensus on
recommendations and their GRADE, meetings will proceed via zoom.
Consultation
15. Indicate whether any recommendations will specify the use of medicines or services that are
currently not available or restricted in Australia, and how the relevant authority/ies will be
consulted.
To be confirmed upon discussion of GRADE guided evidence to recommendation frameworks in
July 2021 meeting. Should this be required, we will liaise with the relevant authorities to determine
how best to progress.
16. List any organisations/individuals that will be specifical y approached to provide comment on
the guideline.
• Royal Australian and New Zealand College of Psychiatrists
• RACGP
• RACP
• APS
• NBPSA
• Applied Neuroscience Society of Australia
• National ADHD Forum
• Speech Pathology Australia
• Occupational Therapy Australia (think this is the name)
• ADHD Australia
• ADHD Foundation
17. Describe the processes that are in place to collaborate with organisations that are
producing/have produced advice in related areas. For example they may be involved in the
review of evidence, review of drafts, and/ or notified when potentially conflicting
recommendations are proposed.
Despite multiple attempts to liaise with NICE about updating their evidence reviews, we have been
unable to obtain a response. We are stil attempting to contact them.
Additionally, please see Appendix A a table of all GDG members, including their organisational
affiliation where a representative.
Dissemination and implementation
18. List the organisations/agencies who will be responsible for the implementation of the final
guideline.
Australian ADHD Professionals Australia
19. Provide a summary of the dissemination plan for the final guideline.
To be finalised following guideline development group meeting in July 2021.
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20. List the tools and resources that wil be developed to accompany the guidelines.
To be confirmed. Web-based guideline with resources designed for different audiences.
Key dates
21. Provide the start and end dates for the public consultation period.
To be confirmed. Estimate from October for 1 month.
22. Provide the intended submission date of the final draft guideline for NHMRC approval.
To be confirmed.
General
23. Summarise any difficulties or delays which have been encountered in progressing the
development of the guideline to date.
Due to multiple lockdowns since the group was convened, there have been difficulties in gathering
groups for discussion of evidence processes and results; as well as training in the GRADE process.
In terms of evidence synthesis, where timelines are difficult to predict, we prioritized the large,
intervention type evidence reviews updated from NICE and the questions where there is most
uncertainty. Due to the abundant, yet inconsistent nature of the outcome measures in this field,
integration of new evidence into existing NICE evidence took considerably longer time than
anticipated.
24. Provide details of any controversial or contentious issues associated with the guideline content
or development process.
The guideline project management team maintain a risk log as well as an issues log.
The following are potentially controversial or contentious issues:
• There are individuals and groups in Australia who believe ADHD is not a real disorder and
believe stimulant medication shouldn't be prescribed and results in later drug misuse.
• There are individuals that believe ADHD is over-diagnosed and overtreated with stimulant
medication.
• The past controversies of the previous guideline might be brought up again by these
individuals/ groups re conflicts of interest.
• The guideline consultation process will likely result in these individuals/groups publicly
criticising the guidelines.
NHMRC progress report for ADHD guideline
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