What is National Health and Medical Research Council’s (NHMRC) role?
Under its enabling legislation, NHMRC can either prepare and issue clinical guidelines itself, or can be asked to approve guidelines developed by other organisations (for example RACP in relation to these ADHD guidelines). In respect to the latter, NHMRC provides procedures and guidance to help the development of guidelines by third party organisations.
NHMRC issued Clinical Practice Guidelines for Attention Deficit Hyperactivity Disorder in 1997 but these were withdrawn in December 2005, as sections, particularly those relating to drug therapies, were out-of-date.
What is Royal Australasian College of Physicians’ (RACP) role?
In November 2006, the Department of Health and Ageing (DoHA) funded the Royal Australasian College of Physicians (RACP) to review and update the 1997 guidelines and submit the revised guidelines to NHMRC for approval in accordance with NHMRC’s legislation.
In order to meet the NHMRC's requirements for approval, RACP undertook the development process in accordance with NHMRC procedures and guidance. RACP issued draft guidelines for public consultation in June 2008. The RACP took into account consultation feedback and then submitted draft Guidelines for consideration by the Council of NHMRC at its 10-11 March 2009 session. The Council provided comments to RACP and revised draft guidelines were submitted to the NHMRC in early June 2009.
How does NHMRC approve third party guidelines?
Prior to asking the Council of NHMRC to consider guidelines developed by third parties, NHMRC undertakes a technical review of the draft guidelines to ensure that they were developed according to established and tested NHMRC standards and procedures. NHMRC also obtains independent peer review of the third party guidelines by internationally respected experts in the field.
Has NHMRC approved the RACP Australian Guidelines on ADHD?
No. In June 2009 — about the same time that the RACP submitted its revised draft guidelines — the NHMRC became aware of a formal investigation in the United States into conflict of interest allegations made about a leading US researcher in ADHD whose work is referenced in the draft RACP Guidelines. Subsequently (October 2009), the Council of the NHMRC advised that it would not consider the RACP guidelines until this investigation is resolved. The US researcher was not involved in the production of the guidelines.
It would be inappropriate for the NHMRC to comment on the merits of the particular case in the US.
When will NHMRC Council consider the guidelines?
Since November 2009, the NHMRC website has advised that the Council of the NHMRC will not approve the draft Australian Guidelines on ADHD prepared by the Royal Australian College of Physicians until a formal Conflict of Interest investigation into a researcher is completed in the US. While the work of this US-based researcher is referenced in the draft Guidelines, the researcher has not been involved in any way in the production of the Guidelines.
However, in the interim the NHMRC agreed to make the draft guidelines available on its website, along with other useful information to assist parents and medical professionals to recognise and appropriately treat ADHD, taking an holistic, multimodal approach to treatment.
NHMRC has continued to monitor progress of the US investigation and is advised that it is not complete and may not be made public. Until these matters are resolved NHMRC will keep the draft guidelines on the website. NHMRC is working with the Department of Health and Ageing in considering the best approach to update this clinical advice.
Where should I go for advice in the interim?
To assist health practitioners and the community with information on ADHD, pending the completion of the US investigation, NHMRC has established a portal on its website containing links to up-to-date information from a number of national and international expert bodies
NHMRC has also placed the RACP’s draft Australian Guidelines on Attention Deficit Hyperactive Disorder on this page. This is the latest draft that takes into account consultation feedback.