The Children's Attention Project (CAP) is Australia’s first longitudinal ADHD study. CAP is a large community-based cohort study of children with ADHD using matched controls (same school class and gender). Dr Daryl Efron is a paediatrician at the Royal Children's Hospital, Melbourne, and a senior research fellow at the Murdoch Childrens Research Institute. He is also one of the chief investigators on CAP, and KidsMatter is honoured to be able to ask him a few questions about CAP and ADHD.

What are some of the effects of ADHD on children’s behaviour, learning and day-to-day living during their development and on their parent’s wellbeing?

CAP has demonstrated that ADHD is not a trivial condition. At baseline (seven years of age), the children with ADHD were already demonstrating significantly poorer outcomes across academic, mental health and social domains. These functional impairments appear to persist through until at least age ten. Outcomes were similar for boys and girls with ADHD. Medication status did not affect outcomes even when taking into account initial ADHD severity.

One striking finding from CAP was that at baseline, only 17% of the children with ADHD had been clinically diagnosed (and 13% prescribed medication), and at age 10 only 38% had been diagnosed (26% prescribed medication). This means that many of these children were missing out on the opportunity for effective interventions and support.

ADHD also causes significant stress on parents and families. Parents of children with ADHD are at risk of poorer mental health, which in turn can adversely affect the child’s functioning. Families with a child with ADHD often experience higher levels of conflict.

What should professionals look for and do if they observe possible symptoms of ADHD in a child?

Many small children are impulsive and have relatively weak sustained attention to task. This is often developmentally within normal limits, and will improve over time. If, however, children are having significant functional difficulties in relation to these symptoms, such as problems learning or interacting with peers, then they should consider seeing a paediatrician for an assessment.

What changes have there been over the years in the diagnosis and treatment of children with ADHD?

In my article in the Journal of Paediatrics and Child Health titled “ADHD: The past 50 years”, I examine the changes and developments in understanding and treating ADHD. The key points and findings of the article were:

  • There has been scientific interest in ADHD for over 100 years, with an emphasis on neurocognition since 1980.
  • In spite of an enormous body of research into causes and treatments, the diagnostic method and medical management of ADHD has not changed substantially for over 30 years.
  • Future advances in understanding and treating ADHD will require cross-disciplinary longitudinal research, incorporating biological, neuropsychological and social-environmental data.

CAP provides a perfect opportunity to utilise a longitudinal, multidisciplinary and ecological model to help understand the symptoms, contributing factors and outcomes for both children and families across children’s development.


Efron, D. (2015). Attention-deficit/hyperactivity disorder: The past 50 years. Journal of Paediatrics and Child Health, 51, 69-73.

How is CAP looking at the relationship between brain changes and behaviour?

A longitudinal neuroimaging CAP sub-study commenced in 2014. We are performing multimodal MRI in CAP study children at three time points - ages 9.5, 11, and 12.5 years. We will examine 1) how brain structure and function changes across late childhood to early adolescence; and 2) whether differences in trajectories of brain structure and function reflect differential outcomes.

How will CAP help improve the management of ADHD?

While medication can effectively reduce many of the symptoms of ADHD, at present the treatment approach is relatively generic. Furthermore, while medication has been shown to reduce symptoms of ADHD, it does not appear to influence broader functional outcomes such as academic and mental health functioning. Insights gained from CAP will hopefully open windows into the development of targeted, novel and individually-focussed interventions delivered at the optimal time to selected patients, with a view to improving adolescent and adult outcomes for people with ADHD.

This innovative project is based at the Murdoch Children’s Research Institute, located on the Melbourne Children’s Campus (alongside the Royal Children's Hospital, and the University of Melbourne Department of Paediatrics). The multidisciplinary team of investigators are from Melbourne, Sydney and Perth.