Until now it\u2019s been the domain of psychiatrists and psychologists only, but from February 1, GPs can diagnose and treat ADHD. With soaring demand, this could improve access \u2013 but doctors are warning it\u2019s no quick fix.<\/b><\/p>\n
\u201cYou\u2019re a distraction to others and yourself.\u201d Growing up, Christchurch woman Pamela often saw these words on her school report cards. But it wasn\u2019t until 2020, when she was at uni, that she started wondering whether she might not be eminently distractible \u2013 and instead have ADHD.\u00a0<\/p>\n
Getting a diagnosis was straightforward, if expensive. She rang around private psychologists and found one offering assessments. The appointment took an hour and cost \u201cabout $340, $350, something like that\u201d. A follow-up report cost another $300. Pamela feels lucky she got an ADHD diagnosis when demand was lower; she\u2019s heard of people paying upwards of $1,000 for a diagnosis in Christchurch more recently. The report from the clinical psychologist was sent to a psychiatrist, who had the special access number required to prescribe ADHD medication.\u00a0<\/p>\n
Pamela\u2019s process of receiving an ADHD diagnosis is pretty standard for adults. Assessments can only be done by clinical psychologists or psychiatrists (paediatricians can assess and diagnose children). Waiting lists in the public system are long, so those who can afford it go private, but there will still often be a very lengthy wait for an appointment. Only psychiatrists and paediatricians can initiate prescribing ADHD medication, but GPs and NPs (nurse practitioners) can continue prescribing on written recommendation from the specialist who initiated.\u00a0<\/p>\n
From February 1, that changes. GPs and NPs will now be able to assess people with suspected ADHD, make diagnoses and prescribe medication (methylphenidate, which is sold under brand names such as Ritalin, Rubifen and Concerta, dexamfetamine and lisdexamfetamine). \u201cGPs have been prescribing treatment, but only with the endorsement of a psychiatrist who has reviewed an [ADHD] assessment,\u201d says Ben Beaglehole, a psychiatrist and University of Otago lecturer who has researched under-treatment of ADHD in New Zealand.\u00a0<\/p>\n
For some, ADHD becomes obvious in the classroom. Many others realise they have the condition as adults (Image: Tina Tiller)<\/p>\n
But GPs are warning that the change will not be an instant solution for people seeking ADHD diagnosis or treatment. \u201cIt will be a slow burn, not a magic bullet to increase diagnoses,\u201d says Angus Chambers, GP and chair of the General Practice Owners Association. With general practices often \u201csnowed under\u201d managing patients with complex, overlapping, chronic health conditions, ADHD diagnoses will just be another thing on the list.\u00a0<\/p>\n
\u201cWe need to lower people\u2019s expectations \u2013 you can\u2019t walk in saying \u2018I have ADHD, can I have a prescription?\u2019 and walk out with a prescription for amphetamines,\u201d Chambers says. A diagnosis may take multiple appointments. The service is unfunded, meaning the government won\u2019t subsidise GP appointments for ADHD diagnoses. It\u2019s also optional; GPs can choose whether to offer the service, and many may want to do additional training before deciding whether to provide it at their clinics. Because an ADHD assessment takes time, the change may direct GP capacity away from other work. Patients unable to access early interventions from their GPs could end up in hospital, costing the health system more.\u00a0<\/p>\n
The broader context is a rapidly growing demand for ADHD diagnoses as knowledge and understanding of the condition increases, particularly in previously neglected groups like women and girls. \u201cI\u2019ve seen a huge interest in assessments, and that interest hasn\u2019t been met by public providers,\u201d says Beaglehole. He and other researchers analysed prescription rates<\/a> for people with ADHD between 2006 and 2022. There was a 10-fold increase in ADHD prescriptions for adults during that time.\u00a0<\/p>\n Demographic data is telling. \u201cMost psychiatric disorders tend to cluster to socio-economic disadvantage,\u201d Beaglehole says. That isn\u2019t the case for ADHD \u2013 a possible sign that only those who can afford private assessments are getting treated. \u201cThat makes me think that more people who can pay for their assessments receive treatment.\u201d While treatment has increased, international ADHD prevalence data shows that many people likely aren\u2019t receiving treatment that could help them.<\/p>\n One reason ADHD prescriptions have been tightly restricted is the medications can be used recreationally. \u201cWhen I first got diagnosed, people asked me \u2018are you going to sell your pills?\u2019\u201d Pamela says. While most of her friends were joking, the \u2018street value\u2019 of medications may add to demand for prescriptions. \u201cThere has to be tight oversight of a treatment which is a recreational substance and has the potential for misuse,\u201d Beaglehole says.<\/p>\n The upside of making prescriptions available directly through GPs is easier access, even though not all GP clinics will provide this service from the get-go. However, the downside is that stretched GPs may be stretched further. \u201cIt\u2019s unclear if people will still get thorough assessments, it depends what GP practices do,\u201d Beaglehole says. Many may still rely on private psychologists\u2019 reports for diagnosis, which will not mean a significant cost reduction for patients. Beaglehole is concerned there may be more misdiagnoses, or pressure from patients for particular medications.<\/p>\n Even if a diagnosis is correct, medication isn\u2019t an instant fix. \u201cI had to trial medication throughout 2021 and 2022 while finishing uni,\u201d Pamela says. She tried different strengths of pills, long-acting and short acting medication, and kept returning to her GP and an ADHD specialist until she found a combination of drugs and timing that worked. There are still side effects, like a loss of appetite and trouble sleeping. \u201cEven if I time [my afternoon dose well] I have to work a bit harder to fall asleep,\u201d she says.\u00a0<\/p>\nBen Beaglehole has researched how many people in New Zealand are not receiving care for ADHD (Image: Supplied)<\/p>\n