ADHD is one of the most common and most misunderstood conditions I see in my practice. Adults often arrive having spent years finding their own workarounds, not realising that what they were managing had a name and a clear treatment pathway. This guide covers the signs, the diagnosis process, the treatment options, and exactly what to do next if you’re in Sydney.
Dr Saini is an accredited ADHD Continuation Prescriber and can assist with your ongoing prescribing and care right now. Book an ADHD Annual Review ($285, 20–30 minutes, available in person or via Telehealth) for a comprehensive review of your treatment. Follow-up reviews are scheduled every 6 months.
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Australian adults live with ADHD
of adults with ADHD remain undiagnosed
average age at first adult diagnosis in Australia
What Is ADHD, Actually?
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition characterised by persistent difficulties with attention, impulse control, and in some presentations, hyperactivity. Despite its name, it’s not a deficit of attention overall. People with ADHD can hyperfocus intensely on stimulating tasks. The core challenge is regulating attention: directing it where it needs to go, when it needs to go there.
ADHD is caused by differences in dopamine and norepinephrine signalling in the prefrontal cortex, the brain’s command centre for planning, impulse control, and working memory. It’s strongly heritable, appearing in families across generations, and it does not go away at age 18.
The patients I see most often aren’t the ones who fit the textbook picture of ADHD from childhood. They’re the high-achievers who’ve managed their ADHD for 30 years through sheer determination, until life became complex enough that determination alone wasn’t sufficient. Late diagnosis is incredibly common in women, professionals, and people who developed strong compensatory strategies early in life.
The Three Presentations of ADHD
ADHD is classified into three presentations under the DSM-5. Understanding which applies to you shapes both how it looks in your life and how it’s best treated.
Predominantly Inattentive
Difficulty sustaining focus, frequent mind-wandering, losing things, forgetting appointments, trouble following through on tasks. Often goes unrecognised in adults, particularly in women, who tend to develop strong compensatory strategies.
Predominantly Hyperactive-Impulsive
Restlessness, talking excessively, difficulty waiting, impulsive decisions, interrupting others. More obvious in children; in adults this often presents as internal restlessness or emotional impulsivity.
Combined Presentation
Significant symptoms of both inattention and hyperactivity-impulsivity. The most commonly diagnosed presentation in adults seeking a first assessment.
Emotional Dysregulation
Not a formal presentation, but a hallmark feature: intense emotional reactions, rejection sensitivity, mood swings, and difficulty recovering from setbacks. Often the most impactful aspect for adults in day-to-day life.
What ADHD Looks Like in Adults
Adult ADHD rarely looks like a child who can’t sit still. By adulthood, the symptoms are more nuanced, shaped by years of adaptation and developing workarounds. Here are the patterns I most commonly see:
- Difficulty initiating tasks: a brain that needs urgency or genuine interest to get started, rather than willpower alone
- Time blindness: consistently running late, misjudging how long tasks take, losing track of hours
- Working memory gaps: forgetting what was just said, losing train of thought mid-sentence, re-reading paragraphs repeatedly
- Hyperfocus: deep absorption in a stimulating project while other important tasks wait
- Emotional sensitivity: intense reactions to criticism, conflict, or perceived rejection (rejection sensitive dysphoria)
- Relationship challenges: forgetting commitments, difficulty following long conversations, acting impulsively
- Sleep difficulties: racing thoughts at night, trouble winding down, waking unrefreshed
- Inconsistent output: performing well below capacity on some days despite real effort and capability
- Self-medicating patterns: using caffeine, alcohol, or other substances to regulate focus or calm the mind
Many ADHD symptoms overlap with anxiety, depression, sleep disorders, and thyroid conditions. A proper assessment considers all of these, identifying what is primary and what may be co-occurring, which is extremely common. Please don’t rely on symptom lists alone to draw conclusions about your own health.
How ADHD Is Diagnosed in Australia
In Australia, ADHD diagnosis involves a clinical assessment. There is no blood test or brain scan. The process considers symptoms across multiple life domains, evidence from childhood, functional impairment, and the exclusion of other explanations.
In New South Wales, a GP who holds endorsed prescriber status can diagnose ADHD and initiate treatment independently. Dr Saini is currently completing endorsed prescriber training and expects to hold this qualification by mid to late 2026. Until then, Rosedale Medical Practice coordinates the assessment pathway with trusted private psychiatrists, and Dr Saini manages all ongoing care. Patients who already have a diagnosis can be seen immediately for continuation prescribing and ongoing management.
The Assessment Process
Initial GP Consultation
Comprehensive history taking, symptom review, validated rating scales (ASRS, Conners), and ruling out medical differentials. Dr Saini prepares a thorough foundation for diagnosis, whether that leads to a psychiatry referral now or in-house assessment once endorsed prescriber status is confirmed in mid to late 2026.
Diagnosis
Currently coordinated with trusted private psychiatrists for a streamlined assessment. From mid to late 2026, Dr Saini will be able to diagnose directly as an endorsed prescriber, removing the need for a separate specialist appointment entirely.
Treatment Initiation
Medication is initiated following diagnosis. Dr Saini will prescribe directly as an endorsed prescriber from mid to late 2026. Psychological therapy and lifestyle referrals are coordinated at this stage as well.
Ongoing Management and Prescribing
Structured, GP-led care through a dedicated ADHD Annual Review appointment ($285, 20–30 minutes, available in person or via Telehealth). Covers prescriptions, side effect monitoring, dosage, and overall functioning. Follow-up reviews every 6 months. Dr Saini provides this service now for patients with an existing diagnosis.
At Rosedale Medical Practice, we offer a structured, GP-led ADHD service. If you already have a diagnosis, Dr Saini can take over your prescribing and ongoing care immediately as an accredited Continuation Prescriber. If you are seeking a new diagnosis, we coordinate a streamlined pathway with trusted private psychiatrists, with most patients reaching diagnosis within 4 to 8 weeks. From mid to late 2026, Dr Saini will offer full in-house diagnosis and treatment initiation as an endorsed prescriber.
ADHD Treatment: Your Options Explained
Effective ADHD treatment is almost always multimodal, meaning it combines more than one approach. Medication alone is not the complete picture. The best outcomes come from a tailored plan that addresses both the neurobiology and the patterns of thinking and behaviour that have built up over time.
Medications
Ritalin, Concerta
Stimulant
How it worksIncreases dopamine and norepinephrine in the prefrontal cortex.
NotesFirst-line. Short and long-acting formulations. PBS-listed.
Stimulant
How it worksSimilar mechanism to methylphenidate; slightly different side-effect profile.
NotesOften preferred when methylphenidate is ineffective. PBS-listed.
Vyvanse
Stimulant (prodrug)
How it worksConverted to dexamphetamine in the body; smoother onset and offset.
NotesLower abuse potential. Private script, not PBS-listed for adults.
Strattera
Non-stimulant
How it worksSelective norepinephrine reuptake inhibitor.
NotesSuitable when stimulants are contraindicated. Takes 4 to 6 weeks to work fully.
Psychological Therapies
Cognitive Behavioural Therapy (CBT) adapted for ADHD is the most evidence-based psychological intervention. It targets the thinking patterns, avoidance behaviours, and organisational deficits that medication alone doesn’t address. Dialectical Behaviour Therapy (DBT) is particularly useful for emotional dysregulation. Executive function coaching, sometimes called ADHD coaching, is a practical, skills-focused complement to therapy.
Lifestyle Interventions
The evidence on lifestyle is stronger than most people realise. Aerobic exercise increases dopamine and norepinephrine and is, in physiological terms, a mild stimulant with no side effects. Sleep hygiene is non-negotiable: ADHD and sleep disruption are deeply linked, and poor sleep worsens every ADHD symptom significantly. Diet plays a supporting role, with stable blood sugar, adequate protein, and omega-3 supplementation all having evidence behind them.
Frequently Asked Questions
In NSW, a GP with endorsed prescriber status can diagnose ADHD and initiate treatment independently. Dr Saini is currently completing this training, with full endorsed prescriber status expected by mid to late 2026. Until then, Rosedale Medical Practice coordinates the diagnostic pathway with trusted private psychiatrists. Dr Saini is already an accredited ADHD Continuation Prescriber, meaning patients who have an existing diagnosis can receive ongoing prescribing and care right now, without any delay.
Via the public system, psychiatric waitlists can be 12 to 18 months or longer. Through our structured pathway with private referral, most patients reach diagnosis within 4 to 8 weeks. From mid to late 2026, Dr Saini will be able to complete the assessment and initiate treatment in-house as an endorsed prescriber, making the process faster still. If you already have a diagnosis, there is no wait at all.
Yes, when appropriately prescribed and monitored. Stimulant medications for ADHD have decades of safety data and are among the most studied psychiatric medications in existence. The most common side effects, including appetite suppression, sleep effects, and mild cardiovascular changes, are monitored during regular GP check-ins and are usually manageable.
Extremely common. Around 50% of adults with ADHD also meet criteria for an anxiety disorder. The two conditions interact in complex ways: ADHD can contribute to anxiety through chronic overwhelm and a sense of falling behind, and anxiety can mimic or worsen ADHD symptoms. A thorough assessment is essential to understand which is primary and how to treat both effectively.
ADD is an outdated term, last used in the DSM-III. It referred to what we now call the inattentive presentation of ADHD. The current diagnostic category is ADHD, which includes three presentations: predominantly inattentive, predominantly hyperactive-impulsive, and combined.
The evidence suggests the opposite is true for adults. ADHD is significantly underdiagnosed in the adult population, particularly in women, older adults, and those from non-English speaking backgrounds. The perception of overdiagnosis is often based on visible increases in diagnosis rates, which partly reflect improved awareness and better assessment tools.
It depends where you are in your journey. If you already have an ADHD diagnosis, book an ADHD Annual Review ($285, 20–30 minutes, available in person or via Telehealth). This is a comprehensive review of your current treatment, prescribing, and overall functioning, with 6-monthly follow-ups from there. If you are seeking a new assessment, book a dedicated ADHD consultation and come prepared with specific examples of how your symptoms affect your daily life at work, in relationships, and at home.
Ready to Get Clarity?
Already diagnosed? Book an ADHD Annual Review — $285, 20–30 minutes, in person or via Telehealth, with 6-monthly follow-ups. Seeking a new assessment? We’ll get you on the right pathway, quickly.
West Pennant Hills · Sydney NSW
West Pennant Hills, Sydney NSW
This article is written by Dr Jaspreet Saini for general educational purposes. It does not constitute medical advice and is not a substitute for a consultation with a qualified healthcare professional. Always seek the advice of your GP or other qualified health provider with any questions you may have regarding a medical condition.