Ritalin is often first choice for ADHD – but a new Australian guide says there’s no one-size-fits-all

When Emma* was diagnosed with ADHD in 2022, her psychiatrist immediately prescribed her Ritalin.

There was no discussion about different ADHD medications, or that people with ADHD can respond differently to different stimulants.

Emma says the diagnosis “was a therapy in itself”.

While Ritalin alleviated some of her symptoms, it also made her anxious. In late 2023 she was admitted to hospital with heart attack symptoms, where she says doctors advised her to stop taking it.

“I just thought [it] best to go off it,” she says, “to try and do the other things I’d read might help.”

She tried lifestyle changes: following a routine, practising mindfulness, improving her diet, taking cold showers, and not looking at her phone first thing in the morning.

It was only in June 2024, after she read about an alternative ADHD medication, Vyvanse, that she went back to her psychiatrist for a prescription. Two years on from her diagnosis, Emma feels she has “finally found this solution”.

Related: ‘Feels quite cruel’: Australians with ADHD scrambling to find medication amid shortage

On Tuesday the Australasian ADHD Professionals Association introduced an ADHD prescribing guide, aimed at making it clear that there is not a one-size-fits-all approach to treatment – especially as diagnoses rise.

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The AADPA’s guide offers clear and consistent information on starting, adjusting and discontinuing ADHD medication across different age groups and settings.

The AADPA board president and co-lead author of the guide, Prof David Coghill, says the biggest problem is that people with ADHD are often not given the opportunity to optimise their medication.

“ADHD is easy to treat but hard to treat well,” Coghill says. “[Doctors] really need to understand the medications, understand how you can use the different medications to optimise people’s care and that takes a lot of hard work.”

The need for better education among health professionals was highlighted in the Senate inquiry investigating support for Australians with ADHD .

While diagnoses have risen alongside ADHD awareness , Coghill says there has not been an increase in clinicians, so “the pressure is on everyone to provide more services with the same resources”.

The association published evidence-based clinical guidelines in 2022 with recommendations on how to diagnose and treat ADHD but recognised there was still a need to provide more detailed information about medications.

“Medication needs to be tailored for the individual and there isn’t a one-size-fits-all,” Coghill says.

The new guide has two parts: the first covers every person with ADHD, and the second focuses on advice for particular patient groups – pregnant women, those with other conditions such as anxiety and depression, or substance-use disorders, and many others.

It was developed by an advisory group of cross-disciplinary health professionals and people with lived experience of ADHD, and was peer-reviewed by Prof Allan Young, chair of mood disorders at King’s College London, and Prof Philip Asherson, inaugural chair of the UK Adult ADHD Network.

Related: ‘A diagnosis can sweep away guilt’: the delicate art of treating ADHD

The guide suggests one approach for clinicians discussing a patient’s first choice of medication “is to be clear at the outset that there are several different medications that are licensed for the treatment of ADHD in Australia”.

The guidelines explain that stimulants – most commonly Ritalin, which delivers methylphenidate, and Vyvanse, which delivers lisdexamfetamine – have the strongest evidence as first-line treatments but it is still impossible to predict how individuals will respond.

“It’s still to a degree trial and error,” Coghill says. “For people with ADHD, there’s a degree of imbalance in the way that different parts of the brain are communicating, and that leads to the symptoms of ADHD.”

“All of the medications that we use work in slightly different ways, but in the end, they’re doing very similar jobs, helping reinforce some of the connections within different parts of the brain in order to balance that that activity,” he says.

Coghill says medication is the only treatment available to really improve the core symptoms of ADHD. But while the AADPA guide focuses on medication, the association emphasises the most successful approach for managing ADHD is a mix of strategies, including psychoeducation, cognitive therapy, ADHD coaching and more.

“Medication on its own doesn’t teach you the skills. Alongside that you need the other kinds of support that will help you learn or improve your skills in organisation, in management.”

Prof Brenton Prosser, from the University of New South Wales public policy hub and school of population health, has worked in the field of ADHD for more than 20 years and calls the guide “a really important step forward”.

Prosser says inconsistency in prescription practices has been a consistent challenge, with particular disparities between socioeconomic groups, and urban and regional areas.

“Initially, medication was prescribed primarily by psychiatrists, but over time this has expanded to GPs,” Prosser says. “This guide will be helpful for this workforce to consistently get the right treatment to the right people with the right mix of medical and non-medical treatment.”

*First name only used to protect medical information