The committee called for a national ADHD framework, but the recommendation to adopt the AADPA’s clinical guideline drew fierce criticisms.
Two ADHD experts have slammed one key recommendation of the Senate inquiry into assessment and support services for people with ADHD, with one saying the senators involved had “failed in their duty to protect Australian children”.
The inquiry released its report yesterday, revealing that poor consumer experiences and the high cost of already restricted services had limited the access and quality of care.
The committee made 15 recommendations, following 700 submissions and 79 testimonials.
Key recommendations included the development of a national ADHD framework, a review of the MBS and PBS to improve access to medicines and services, the expedition of uniform prescribing rules across Australia, and expanding the scope of practice of healthcare professionals.
Other recommendations included investment in ADHD lived experience advocacy organisations and the implementation of the Australian ADHD Professional Association’s evidence-based clinical practice guideline – a recommendation that drew pointed criticism.
Professor Jon Jureidini, a researcher in clinical and mental health, criticised the AADPA’s clinical practice guideline, saying it was 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,” he said.
“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.”
Dr Martin Whitely, adjunct research fellow at Curtin University, also criticised the Senate report, saying it had “a fundamental flaw”.
“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’,” said Dr Whitely.
“This conclusion mirrors the dominant clinical assumption that ADHD is a neurodevelopmental disorder. However, the diagnostic criteria of ADHD are all behavioural (with no biomarkers) and the report and major medical authorities acknowledge that the cause/s is 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 results in the inappropriate medicalisation and over-prescription of amphetamines to hundreds of thousands of Australian children.
“In my view, the inquiry has failed in its duty to protect Australian children and 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.”
Professor Mark Bellgrove, director of the AADPA, said the organisation was “delighted” with the inquiry’s recommendations.
“The 15 recommendations are appropriate, practical and formulated with due consideration to both the evidence and needs of consumers,” he said.
“I am delighted our call for both a national Framework for ADHD and funding for the implementation of the ADHD Practice Guideline are put forward as recommendations for the Australian Government to consider.”
Professor Dave Coghill, president of the AADPA, said the recommendations will “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.”
The Senate committee also recommended further research to better understand ADHD and ways to address stigma. They identified research aimed at improving ADHD supports such as evidence-informed clinical care and peer support, addressing social stigma around ADHD, better understanding non-hyperactive presentations of ADHD and challenges around ADHD in First Nations, culturally and linguistically diverse and LGBTQIA+ communities.
Professor Daryl Efron, a senior research fellow at Murdoch Children’s Research Institute called for innovative models of care, alongside publicly funded paediatric services.
“It is extremely difficult for Australian families to get an appointment with a paediatrician in either the public or private system … in both metropolitan and rural Australia,” he said.
He recommended training GPs in the assessment of ADHD and co-existing problems, involving nurses in the ADHD care system, and increasing support for families post-diagnosis.
This view was echoed by Dr Alison Poulton, senior lecturer in paediatrics in the Nepean Clinical School at the University of Sydney, who described a pilot study between Nepean Blue Mountains LHD and USyd, 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,” she said.
“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.”
For a full list of the Senate inquiry’s recommendations, click here.
