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EXPERT REACTION: Senate report on assessment and support services for people with ADHD

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The Senate has released their report on assessment and support services for people with ADHD. The report has called for national consistency in diagnosis and treatment to improve the lives of those with the condition. Aussie experts give their thoughts on the inquiry report below.

Organisation/s: Australian Science Media Centre

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  • Commonwealth of Australia
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    Senate report

Expert Reaction

These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.

The Australian ADHD Professionals Association (AADPA), the organisation that prepared the Australian Evidence-Based Clinical Practice Guideline for ADHD, has provided the following statement in response to remarks made by some experts regarding the recommendations in the Senate report.

1. The Australian ADHD Professionals Association (AADPA) Board played no role in the development of the guideline or the formulation of the recommendations. The only exceptions were, the Guideline Lead, Professor Mark Bellgrove and Dr Emma Sciberras, a clinical psychologist and researcher at Deakin University.

2. All conflicts were vetted and recorded by the Conflict Management Committee, which included an independent ethicist, who did not otherwise participate in the Guideline development process.

3. The Guideline Development Group (GDG) comprised a broad range of people with experience of ADHD, including those with ADHD, family members, community members, professional groups, Aboriginal and Torres Strait Islander peoples, and health professionals.

4. The GDG developed the recommendations independently through a structured consensus process, with no involvement or influence from AADPA or other stakeholders. The GRADE process used by NHMRC to formulate Guideline recommendations requires expert interpretation of evidence.

5. The two clinical Co-Chairs of the GDG have no vested interest in AADPA. One of the Co-Chairs was specifically chosen because of her academic background in evidence synthesis and review and her broad paediatric clinical experience.

6. An independent methodologist conducted all the evidence synthesis. They had no vested interest in ADHD and no connection with AADPA or the Board.

7. The public consultation for the draft version of the Guideline (as detailed below) was run through April and May 2022:

  • Adverts in The Age and Sydney Morning Herald newspapers for 3 days from Feb 28 – March 2, 2022
  • An article in The Conversation online national newspaper 15 March 2022 with link to the public consultation web portal
  • Emails to all relevant organisations including Colleges, Associations and Consumer organisations
  • Emails to all AADPA members

The Guideline was approved by the NHMRC and endorsed by the APS, RACP, RACGP, Speech Pathology Australia, Occupational Therapy Australia, ACPA, AAPI, ADHD WA, ADHD Foundation, RANZCP, ADHD Australia and the World Federation of ADHD.

Last updated: 08 Nov 2023 10:52pm
Dr Sarahn Lovett is a Paediatrician FRACP, Board member of AADPA, and a Consultant General Paediatrician at Lake Macquarie Paediatrics

Access to ADHD assessment and management is a significant challenge in Australia, particularly in regional and remote areas, leading to lengthy wait lists for non-GP specialist appointments. To address this, involving General Practitioners (GPs) and Nurse Practitioners (NPs) in ongoing ADHD care can expedite specialist appointments.  

Collaborative care partnerships between non-GP specialists and GPs/NPs offer a safe and accessible solution for individuals with ADHD. Patients can receive regular ADHD reviews, including repeat stimulant prescriptions, from their local GP/NP. This model keeps care close to home, reduces disruptions to school and work, and minimises travel costs to specialist centres. Non-GP specialists responsible for the initial diagnosis continue to be part of the ADHD care partnership, with less frequent reviews and provide support to GPs/NPs as needed. Reducing the frequency of non-GP specialist ADHD review appointments will reduce wait times for ADHD assessment and treatment. 

As previous clinical lead and designer of the Hunter New England ADHD Shared Care Program we can see that collaborative care models are viable options for improving access to ADHD care, by utilising current health care professionals. However, implementing supportive frameworks around ADHD collaborative care models requires both financial and logistical investments in healthcare, along with changes in legislation. Providing comprehensive education to all clinicians caring for individuals with ADHD, in line with the National ADHD Guidelines released by AADPA in July 2022, would enhance access to best-practice care. National alignment of stimulant prescription laws would ensure equitable access to ADHD treatment across Australia. It was good to see that the ADHD senate report recognised these as areas for future work and investment.  It will be even better to see funding dedications for collaborative care models Australia wide, and the infrastructure required to develop it and keep it running.

Last updated: 08 Nov 2023 10:27am
Declared conflicts of interest:
Sarahn is a board member of the Australian ADHD Professionals Association (AADPA)

Associate Professor Oliver Schubert is a Clinical Associate Professor of Psychiatry at the University of Adelaide, the Clinical Director of headspace Adelaide Early Psychosis, and Head of Unit – Continuing Care and Youth, Northern Adelaide Mental Health Network

The important impact of ADHD and other neurodiversity on peoples’ mental and physical health, and their progress within society has become clearer over the recent years.

Traditionally, only a few mental health professionals have received formal training in the assessment and management of these conditions, which has created a bottleneck for access and quality of care.

Whole-of-society efforts are required to improve this situation, including more research, better training of clinicians, and better accommodation of people with ADHD and other neurodiversity in education and workplaces.

These efforts will relieve hidden suffering, save money in the long run, and unlock the potential of neurodiverse people within the economy.

Last updated: 14 Nov 2023 4:44pm
Declared conflicts of interest:
None declared.
Professor Jon Jureidini is Research Leader in Critical and Ethical Mental Health (CEMH) at the University of Adelaide.

The positive features of the report include: the recommendation for uniform prescribing rules to ensure consistency between state and territory jurisdictions; the absence of blanket acceptance of ADHD for NDIS eligibility; and no broadening of prescribers.

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’.

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.

Last updated: 07 Nov 2023 12:00pm
Declared conflicts of interest:
Jon gave evidence to the committee on behalf of Critical Psychiatry Network Australasia.
Dr Martin Whitely is Adjunct Research Fellow in the John Curtin Institute of Public Policy (JCIPP) at Curtin University

The fundamental flaw of the report is its answer to the core question: What is ADHD? Without providing any justification it concludes “ADHD is a chronic and complex neurodevelopment condition”. (p.4).

This conclusion mirrors the dominant clinical assumption that ADHD is a neurodevelopmental disorder i.e. a disorder of ‘early brain development…where the integrity and function of the nervous system is damaged during critical periods of brain development’. (Murdoch Children’s Research Institute
https://www.mcri.edu.au/research/strategic-collaborations/flagships/neurodevelopment).

However, the diagnostic criteria of ADHD are all behavioural (with no biomarkers) and the report (p.6) and major medical authorities acknowledge that the cause/s are unknown. In other words, the report and major medical authorities simultaneously claim that ADHD is caused by a malfunctioning brain and that the cause/s are not known.

This duplicity results in the inappropriate medicalisation and drugging with amphetamines of hundreds of thousands of Australian children.

However, in their enthusiasm to advocate for adults who choose to identify as ADHDers the Senators involved in the inquiry have failed in their duty to protect Australian children. Furthermore, they have failed to understand that one size fits all labels are very often a bad fit, and that pills mask problems but don't deal with underlying causes.

Last updated: 07 Nov 2023 11:59am
Declared conflicts of interest:
None declared.
Dr Alison Poulton is Senior Lecturer in Paediatrics in the Nepean Clinical School at The University of Sydney, and Chief Investigator of 'A Pilot Study of Integrated Care for ADHD', Nepean Blue Mountains Local Health District

The Senate Report on assessment and support services for people with ADHD, ,released this evening, highlighted the desperate lack of support in our communities for people with ADHD seeking diagnosis and treatment. This may be particularly acute for adults and there were many contributors who gave their stories about their experiences of living with undiagnosed ADHD: years spent struggling, feelings of inadequacy and failure, and finally their grief and regret about their missed opportunities in life - how their story might have been different if they had understood about ADHD and received appropriate treatment while growing up.  

With growing awareness of ADHD, the lack of information and qualified professionals who can diagnose and treat it has reached crisis point. The Committee found compelling evidence that further investment in ADHD healthcare and support was needed, so that people with ADHD would not be held back from achieving their potential in society. 

New, cost-effective models of care are needed. At the Lifespan Community ADHD Clinic, (a collaboration between Nepean Blue Mountains Local Health District and the University of Sydney) we are training GPs to diagnose and treat ADHD. This is currently only a pilot study, but with investment, it is scalable, with trained GPs able to relieve the treatment bottleneck. It would be great if the result of the Senate Inquiry meant that future generations of people with ADHD were able to get the support and treatment they needed.

Last updated: 07 Nov 2023 11:58am
Declared conflicts of interest:
Declared interest: Alison is an AADPA Board Member; and received personal fees and non-financial support from Shire/Takeda.
Professor Mark Bellgrove is Deputy Head of School (Research), School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University and Director and Lead, Australian Evidence-Based Clinical Practice Guideline for ADHD, Australian ADHD Professionals Association (AADPA)

The Senate Inquiry into Assessment and Support Services for People with ADHD is a landmark moment where the voices of both Australians with a lived experience and professionals involved in care have been heard. The 15 recommendations are appropriate, practical and formulated with due consideration to both the evidence and the needs of consumers.  As a Director of the Australian ADHD Professionals Association (AADPA), and Lead for the development of Australia's ADHD Clinical Practice Guideline, I am delighted that our call for both a National Framework for ADHD (recommendation #1) and funding for the implementation of the ADHD Clinical Practice Guideline (recommendation #13) are put forward as recommendations for the Australian Government to consider. I am also very pleased to see recommendations (#8) encouraging neurodiversity-affirming campaigns to actively shift social attitudes and reduce stigma.

Last updated: 07 Nov 2023 11:57am
Declared conflicts of interest:
Declared interest: Mark was the lead for AADPA in the development of Australian's first NHMRC-approved Clinical Practice Guideline for ADHD. The feasibility of implementation of our Guideline was listed within the TOR of the Senate Inquiry and Recommendation 13 in the released report recommends the Government consider investing in its implementation.

Louise Brown is the Lived-experience Director of the Australian ADHD Professionals Association. She is a PhD Candidate at Curtin University, an ADHD consumer advisor for Monash University, an accredited but non-practicing registered nurse and ADHD coach, and lived-experience advocate.

Although heartbreaking to read, it's very reassuring that the Senate Enquiry report included the voices of people with ADHD and their families. I'm also very happy to see that the report recommends a National ADHD Framework, along with ADHD education and resources, be co-designed with people with lived-experience. All the recommendations are definitely a move in the right direction.

Last updated: 08 Nov 2023 10:33am
Declared conflicts of interest:
Louise is Lived-experience Director of the Australian ADHD Professionals Association (AADPA)
Associate Professor Daryl Efron is a Senior Research Fellow at Murdoch Children's Research Institute, a Consultant Paediatrician at the Royal Children's Hospital and an Associate Professor in the Department of Paediatrics at the University of Melbourne.

The most common reason kids are referred to paediatricians in Australia is to be assessed for ADHD. However, at present, it is extremely difficult for Australian families to get an appointment with a paediatrician in either the public or the private health system. This is true in both metropolitan areas and regional and rural Australia. How to address this problem?:

  1. We need innovative models of care - for example, initial assessment by a paediatrician and then follow-up & monitoring by GPs with an interest, who would refer back to specialists as required. This would free up availability for specialist appointments. We need to train interested GPs in the assessment of ADHD and co-existing problems (e.g. anxiety, depression and learning difficulties), support for families post-diagnosis, and monitoring of medication side-effects. Clinical nurse specialists may also have a role to play in the care system.
  2. We need more publicly-funded developmental paediatric services (hospitals, community health services).
  3. Services need to be more accessible for culturally and linguistically diverse and First Nations communities.  
  4. We need increased access to child and adolescent mental health services for kids with complicated ADHD.
Last updated: 06 Nov 2023 10:33pm
Declared conflicts of interest:
None declared.
Professor Dave Coghill is the Financial Markets Foundation Chair of Developmental Mental Health at the University of Melbourne, President of the Australian ADHD Professionals Association and Professor of Child and Adolescent Psychiatry at Royal Children’s Hospital Melbourne and Orygen Youth Health

The report on the Senate Inquiry on ADHD is a landmark for the 800,000 Australians living with ADHD and those with responsibility to provide them support. The 15 recommendations made by the committee will, if implemented by the government go a long way towards improving the lives of those with ADHD.

The recommendations focus on improving access to services and quality of care for ADHD in Australia and making sure that, through realignment of the Medicare and Pharmaceutical Benefits Scheme, this care is accessible to those who are least able to pay. Importantly the committee makes several strong recommendations that those with lived experience of ADHD are fully involved in developing and implementing these reforms and that strong measures are put in place to reduce stigma and improve participation.

Importantly the committee recommends that the Government invest in the implementation of the Australian ADHD Guideline developed last year by the Australian ADHD Professionals Association (AADPA) and that another of AADPA’s recommendations, a National Framework for ADHD, is established and co-designed together with people with ADHD as well as ADHD advocacy and community organisations.

Last updated: 07 Nov 2023 4:13pm
Declared conflicts of interest:
Potential conflicts of Interest: David Coghill receives funding from the National Health and Medical Research Council and the Medical Research Futures Fund. He is the President of the Australian ADHD Professionals Association and a director of the European ADHD Guidelines Network both not for profit organizations working in the field of ADHD. He has received research funding and/or honoraria from Takeda, Medice, Novartis and Servier.

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