ADHD report shows issues
A Senate report urges national consistency in ADHD diagnosis and treatment.
The report on assessment and support services for people with ADHD highlights the need for national consistency.
It details the significant challenges in accessing ADHD assessment and management in Australia, particularly in regional and remote areas, resulting in extended wait times for non-GP specialist appointments.
To tackle this issue, the report suggests involving General Practitioners (GPs) and Nurse Practitioners (NPs) in ongoing ADHD care to expedite specialist appointments.
Collaborative care partnerships between non-GP specialists and GPs/NPs are proposed as a safe and accessible solution for individuals with ADHD.
This model allows patients to receive regular ADHD reviews and repeat stimulant prescriptions from their local GP/NP, reducing disruptions to daily life and travel costs.
Non-GP specialists who initially diagnose ADHD continue to be part of the care partnership, offering support as needed. This approach aims to decrease wait times for assessment and treatment.
While collaborative care models appear promising for enhancing ADHD care accessibility, their successful implementation requires financial and logistical investments in healthcare and legislative changes.
The report also addresses the need for national alignment of stimulant prescription laws to ensure equitable access to ADHD treatment across Australia.
These issues have been recognised as areas for future work and investment by the ADHD Senate report, which calls for dedicated funding for collaborative care models nationwide.
Notably, the report recommends uniform prescribing rules to ensure consistency between state and territory jurisdictions, refrains from broad acceptance of ADHD for NDIS eligibility, and avoids expanding the range of prescribers.
It also suggests investment in the implementation of the Australian ADHD Professionals Association's clinical practice guideline for ADHD, along with funding to promote the guideline to healthcare professionals and policymakers.
However, some experts have raised concerns about the guideline, emphasising potential flaws in its evidence-based recommendations and the need to consider alternative explanations for distress and dysfunction.
Professor Jon Jureidini, Research Leader in Critical and Ethical Mental Health (CEMH) at the University of Adelaide, has expressed reservations about potential harm arising from the guideline's adoption.
“My focus is on Recommendation 13 that ‘all levels of government consider investing in the implementation of the Australian ADHD Professionals Association’s Australian evidence-based clinical practice guideline for ADHD, along with funding to promote the guideline to healthcare professionals and healthcare policymakers’,” Prof Jureidini says.
“That guideline is a deeply flawed document produced by an organisation with a vested interest in promoting the ADHD concept.
“It makes strong recommendations based on weak evidence, fails to take account of important research, does not acknowledge the poor evidence for meaningful outcomes from diagnosis and treatment, and does not adequately address harms from medication.
“Adoption of the guideline will result in many people being diagnosed and treated for ADHD with uncertain benefits and possible serious harms.
“One such harm is that the oversimplification involved in attributing distress and dysfunction to ADHD means that more meaningful and disparate explanations (for example, language disorder, family violence) are missed.”
In response to these concerns, the Australian ADHD Professionals Association (AADPA) has clarified its role in developing the guideline and the rigorous processes involved. The AADPA underscores that the guideline was created independently by a diverse Guideline Development Group (GDG) with no influence from external stakeholders.
The GDG considered a wide range of perspectives, including those with ADHD, family members, community members, and health professionals.
The AADPA also notes that the guideline was independently reviewed and publicly consulted, with broad participation, and it received approval from the National Health and Medical Research Council (NHMRC) and endorsement from various healthcare organisations.