The biggest reform in the treatment of ADHD in NSW will see GPs empowered to identify and manage the condition, slashing wait times and costs. Catherine Lewis investigates the shift from specialist diagnosis and treatment.
Distracted, disorganised, daydreamer. School day descriptions of my son, Finn, whose life of intensity, eclectic, ever-changing passions – art, music, science, Star Wars and steam trains – left structure, stiff schedules and staying on task in the dust.
Finn is one of the almost 10% of Australian children with attention deficit hyperactivity disorder (ADHD) which affects behaviour and emotions, impacting academic performance and family dynamics. Despite being one of the most common neurodevelopmental disorders, remains stigmatised and misunderstood. Finn’s diagnosis, via a parade of school counsellors, pediatricians and specialists, took an emotional and financial toll and it was two years until diagnosis and treatment – in his case, occupational therapy – not ideal for a condition in which early diagnosis is key.
These long wait times were lamented in more than 700 submissions from ADHD families to the 2023 Senate Inquiry, ‘Assessment and Support Services for People with ADHD.’ High costs, fragmented care, inconsistent prescribing of medication and a dearth of Medicare support were also mentioned as areas of concern.
A mass exodus of almost 200 public psychiatrists in NSW due to ongoing pay and condition frustrations has also sent fees for private appointments soaring. ADHD is a manageable condition, and with suitable treatment, children can see vast improvements to their social skills and ability to focus at school. But a comprehensive diagnostic assessment and creation of a treatment plan can cost upwards of $5,000 in Sydney. Not to mention ongoing care appointments (around $300 to $500), while repeat prescriptions are around $100. Couple this with research from Australasian ADHD Professionals Association (AADPA) showing that early intervention is essential to ‘improve outcomes and learning capacity,’ while linked speech therapies, physio, or additional classroom support were also delayed – and it was clear something had to give.
Enter the biggest reform for ADHD treatment in NSW. From September, State Government legislation, following in the footsteps of Queensland, will see GPs able to provide ongoing prescriptions for children and adults who are on stable doses of medication, without the need for specialist sign-off, slashing wait times, costs and ensuring a more personal touch. From 2026, select GPs who have received specialist training will also be able to diagnose and, if needed, start medication, removing the stigma of a specialist diagnosis. “All of us know how highly trained and skilled our GPs are and the option to see a GP to manage ADHD will provide a timely, safe and appropriate pathway to care, while relieving pressure on in-demand specialists,” says State Health Minister Ryan Park. While consultations would ideally be bulk billed, that would ‘depend on the GP and practice,’ the minister adds.
Jeanette Rossini
Jeanette Rossini says the reforms will especially benefit those in rural and regional areas
The reforms will be introduced in stages, focusing first on supporting child prescriptions, as per the early intervention goal, followed by adult care.
Mona Vale-based Jeanette Rossini, accredited ADHD coach at Into Focus Coaching, tells PL that the reforms will be a ‘positive step’ towards making ADHD treatment more accessible and affordable, ‘especially for adults and families in rural and regional areas.’ “The GPs involved will receive accredited training so they can effectively diagnose and treat ADHD,” Ms Rossini says.
“The key will be to provide comprehensive, evidence-based training to ensure accurate diagnosis, medication management and ongoing support for patients,” she adds. NSW and ACT Chair at the Royal Australian College of General Practitioners, Rebekah Hoffman, agrees, saying that ‘enabling GPs with specific skills to initiate prescriptions for ADHD medications will stop many children from languishing on outpatient waiting lists.’
Additional therapies such as speech or OT will no longer be delayed by a slow ADHD diagnosis
ADHD can be split into three types. Combined – hyperactive and inattentive characteristics; inattentive – struggling to focus and finish tasks; and hyperactive – impulsive, active and with little regard for danger.
Treatment usually involves a combination of counselling, behavioural therapies and, when deemed necessary, stimulant or non-stimulant medication. The NSW Department of Education tells PL: “Our schools provide support to students with an identified need through a range of strategies.”
But are there dangers in opening up the diagnosis and treatment of this complex condition? Yes, says Jessica L’Green, Director at Kids Plan-it Occupational Therapy in Warriewood. “While GPs play a crucial role in early identification and referral, ADHD requires a comprehensive, multidisciplinary assessment,” she tells
PL. “Given the limited time GPs have in consultations and the breadth of health issues they manage, it can be challenging for them to delve deeply into the behavioural, cognitive, emotional and environmental factors that may be influencing a child’s presentation.
“So it is a real concern that GPs, who often don’t have specialist training in neurodevelopmental conditions like ADHD, are being placed in the position of diagnosing and initiating treatment.”
NSW Health Minister Ryan Park says GPs are ‘highly trained and skilled’
The Critical Psychiatry Network Australasia (CPNA) also believes that ‘expanding services to facilitate earlier diagnosis and treatment of ADHD could result in significant harm, particularly to children.’
“Diagnosing ADHD does not identify underlying problems,” CNPA wrote in its 2023 Senate Inquiry into ADHD submission. “Instead (it locates) the problem in the child’s neurobiology with a disingenuous disregard of social determinants such as poverty, housing insecurity, poor schooling and unemployment. This in turn invites biochemical interventions that modify behaviours in the short-term, but carry significant long-term risks.”
Across Australia, ADHD diagnoses and medication levels have more than doubled in the last five years, from 1.4 million prescriptions given to 186,000 people in 2018, to 3.2 million prescriptions to 414,000 people in 2022, says a health department briefing from the ADHD Senate Inquiry.
The rise saw Government PBS spending on ADHD medicines including methylphenidate, (sold under brand names Ritalin and Concerta) soar from $59 million to $151 million. This has been linked to a backlog of undiagnosed cases being addressed as a result of rising awareness.
“Medication can be one part of a treatment plan for children with ADHD, but it should never be the only strategy considered,” says Jessica L’Green. “It is so important to explore all possible factors, which can include sleep quality, breathing issues, sensory processing differences, stress, trauma history, and developmental skill gaps, all of which can mimic or compound ADHD symptoms.
“Without a thorough investigation into these areas, there’s a risk of misdiagnosis or inappropriate medication management. There are many other effective interventions that support a child’s functional performance. Occupational therapy can help children develop cognitive strategies to improve attention, memory, task planning, and self-regulation. “Ultimately, treating ADHD well requires a holistic and collaborative approach, involving paediatricians, psychologists, speech pathologists, educators, and occupational therapists,” she adds.
Lowering wait times and cost burdens for families with children displaying symptoms of ADHD sounds positive on paper, but in practice holds untold questions. NSW Mental Health Minister Rose Jackson refutes claims that the reforms are a band-aid solution for the shortage of psychiatrists across the state, saying that the move is instead about ‘increasing access to diagnoses and prescriptions.’ But isn’t that at the heart of the potential danger of these sweeping changes? That diagnoses and medications become so routine, that Concerta is as commonplace as paracetamol? As occupational therapist Jessica L’Green says: “It’s vital that GPs are supported with clear referral pathways and families have access to multidisciplinary care, rather than relying on short consultations and pharmacological solutions.” Improved access yes, but not at any cost.
