More than meds: Why easier access to ADHD treatment has to be part of a whole-system approach
Photo:
AFP / Thom Leach / Science Photo Library
Analysis -
New Zealanders with attention-deficit hyperactivity disorder (ADHD) will now have easier access to diagnosis and medication after the
government changed prescribing rules
.
But there is still so much we don't know about ADHD in Aotearoa. And while these changes will help many, easier access to medication alone won't fill the gaps in other supports people with ADHD need to live well.
From February 2026, trained GPs and nurse practitioners will be able to diagnose and treat ADHD. Under the current system, only paediatricians or psychiatrists can make the diagnosis. GPs and nurse practitioners then provide follow-up care.
The current process, which is both
time-consuming and expensive
, has been
widely criticised
.
The government's changes are expected to at least partially address these issues.
One major barrier to progress is the general lack of knowledge about adult ADHD.
The condition is broadly understood as causing persistent patterns of inattention, hyperactivity and impulsivity. In adults,
ADHD can have a profound impact
on family and work situations, substance abuse and a wide range of psychiatric disorders. But it has largely been ignored in older age groups, with
some believing people "grow out" of the condition
.
People with ADHD also often possess strengths, including creativity, spontaneity, high energy, risk tolerance and an ability to think divergently. Many also demonstrate strong problem-solving skills under pressure, passion-driven focus and persistence when engaged in meaningful tasks.
Worldwide estimates suggest
ADHD in adults ranges from 2.5 percent to 3.4 percent
of most populations.
But England's 2023
Adult Psychiatric Morbidity Survey
found 13.9 percent of adults met criteria warranting clinical assessment.
Only 0.5 percent had been professionally diagnosed.
In New Zealand, estimates rely on indirect measures such as medication dispensing rates.
Recent research
found 0.6 percent of the adult population in New Zealand was receiving drug treatment for ADHD. Based on a conservative estimate of 2.6 percent of adults with ADHD, this shows a large "
treatment gap
" exists.
Drug dispensing data in New Zealand also shows gaps in who gets diagnosed with ADHD.
Māori and Pacific peoples are
less likely to receive ADHD medications
. These inequities begin early. Tamariki Māori screened for ADHD at age four are
less likely to receive medication
than their non-Māori peers.
There are also substantial differences in the age of diagnosis across sociodemographic groups. These inequities raise serious concerns about access and systemic bias.
International research
shows that untreated ADHD is linked to worse mental and physical health, higher mortality, and reduced life expectancy.
ADHD prevalence is also five times higher among youth prisoners and ten times higher among adult prisoners compared to the general population. In Australia,
ADHD's social and economic costs
are estimated at AU$20.42 billion per year, or $25,071 per person.
Our ongoing research, including a survey, looks at the lived experiences of adults with diagnosed or suspected ADHD in New Zealand.
Many have described the healthcare system as "broken".
Survey respondents reported long wait times, high costs for diagnosis and treatment and a lack of expertise amongst health professionals. They also described ongoing stigma and misunderstanding about the lived reality of ADHD.
The survey mirrors international research showing how
longstanding myths and stigmas
about what ADHD is and who it affects have impeded societal understanding.
Adult women were overrepresented in the sample, constituting 83 percent of the 689 participants, with over 80 percent reporting being diagnosed after age 24, reflecting global trends of underdiagnosis in early age among women.
Research suggests ADHD in women is
often missed or misdiagnosed
, partly due to outdated knowledge and lack of understanding about its presentation in women, compounded by high rates of coexisting conditions such as anxiety, depression, substance use and autism.
Growing evidence
shows many of the negative outcomes of ADHD are mitigated by treatment with medication.
One study from Sweden
found a significant association between initiating ADHD medication treatment and lower mortality.
However,
medication is only part of the solution
. Strategies focused on the strengths of people with ADHD can have huge benefits for the individual, their whānau and communities.
Particularly when they receive timely diagnosis, treatment and necessary accommodations.
Researchers argue that while ADHD medications provide effective treatment, they should
never be the only form of treatment
offered.
Expanding prescribing authority is a vital step, but this alone will do little to increase access to psychological and allied health supports to ensure the right care can be provided to people with ADHD.
There continues to be an urgent need to address gaps in data and understanding, to provide an evidence-based assessment of the areas where research, funding and policy initiatives need to be targeted.
Trends show that some groups, including Māori and women, are disproportionately affected by a lack of knowledge and services. As the government revises how ADHD is diagnosed and treated, it must address these discrepancies.
There is also a complex but poorly understood relationship between ADHD and other neurodevelopmental conditions, such as autism, that needs further investigation.
As ADHD New Zealand chairperson
Darrin Bull has argued
, a "whole-of-system" approach is required to support those with ADHD in New Zealand.
This story was first published on
The Conversation
.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
RNZ News
an hour ago
- RNZ News
Nurses union dismisses latest pay offer as 'massive backward step'
Indications are the union will vote to strike. Photo: RNZ The nurses union says Health New Zealand's latest pay offer is a "massive backward step" for the health system and patients, and there are "very strong indications" members will want to strike. New Zealand Nurses Organisation chief executive Paul Goulter says Health NZ has "given very little, if anything" and "it really throws into doubt the sincerity of the government in trying to settle this". "We have had clear indication the government is involved - and is increasingly involved - in directing the course of these negotiations. "It's not bargaining. It's just being told what you're going to get and that's it." Health New Zealand told RNZ it was committed to reaching an agreement, but it was also "operating within tight financial constraints". Negotiations began last October, but the union said bargaining had stalled over "big ticket items" centred on public safety and a nationwide strike in December saw a complete withdrawal of labour at every Te Whatu Ora facility. Early last month, a series of stopwork meetings took place to discuss next steps, after the previous offer was turned down. Goulter said the key issue was staffing and making sure there was enough staff to "ensure patient safety", which was "foremost in the minds of our members" during negotiations. "While, obviously, there's a wage element, we're trying to do our best to ensure we get staffing that's appropriate to meet what patients need and we seem to have come up short on that." Health NZ acting chief executive Robyn Shearer said the agency was committed to reaching an agreement with nurses on the collective agreement, but specified it was operating within "tight financial constraints". In May, registered nurses were offered a pay increase of 1 percent in 2025 and 1 percent in 2026. This week's latest offer included a "higher 2025 pay increase of 2 percent", Shearer said, "meaning nurses will get a total 3 percent pay increase over two years". The statement also outlined an offer of two lump-sum payments of $325, which weren't included in the previous offer. Goulter said that wasn't, on the face of it, "better" and explained it was a "regression actually", because of the extended term. The previous offer set a term of two years from the expiry of the current collective agreement, while the latest offer adds three months to the term, effectively reducing the value of the wage increases. Goulter said the first priority was guarantees around staffing and the second was a wage increase that reflected the cost of living. "The government have come up short on this, on both those scores, and it needs to be fixed." He also pointed to the withdrawal of Māori issues the union thought were settled, such as a 'tikanga allowance' for nurses required to use tikanga in their daily work with Māori patients. That and the development of a 'Kaupapa Māori dispute resolution process', which Te Whatu Ora had previously agreed to support, had been removed from the latest offer, without an explanation. Goulter wouldn't speculate on why they had been removed, but said it was "widely known this government is trying to remove any references to addressing Māori health outcomes". "This is probably a very low-rent sort of action by the government to attack that. "Until Māori health outcomes are lifted, this government will stand condemned in the eyes of our members and among the public at large, I'm sure." RNZ requested an explanation from Health NZ about the removal of those elements from the offer. RNZ also approached Health Minister Simeon Brown, who said this offer was "stronger than most public-sector settlements, many of which have included no increase". He also noted the government was committed to "ensuring all New Zealanders are cared for on the basis of need and Health NZ is reflecting this principle in the offers it makes to employees". Overall, Goulter said analysis from union members indicated the new offer was worse than the previous one. "We're undergoing a wide survey at the moment and our members are really clear that this is taking us backwards, not forward." He said the next step was to finalise getting feedback from members, but he has "very strong indications" members wanted to move to action to change these circumstances. "They don't find the circumstances acceptable. At this stage, it looks likely we'll move to a strike ballot." The Health NZ statement said the overall offer meant a new graduate nurse on $75,773 would gain a total pay increase of $8337, or 11 percent, by the end of June 2026. Most registered nurses are on the highest step, with a current salary of $106,739, and under the new offer, their pay will increase by $3224 to $109,963 in the same period. The average salary for both senior and registered nurses, including overtime and other allowances, was $125,662. It also stated the "landscape" for the nursing workforce had changed significantly in recent years, with turnover decreasing from 14 percent in December 2022 to 8.6 percent in December 2024. Health NZ indicated the offer expired at the end of July, if it wasn't ratified before then. "We encourage the union to take this offer to their membership for a vote." Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
RNZ News
12 hours ago
- RNZ News
Money spent on locum doctors could be used to attract and retain permanent staff
Health NZ has spent almost $45m on locum doctors in the Midlands Te Manawa Taki region including Waikato, in less than a year. Photo: Supplied/ Waikato Hospital The amount of money Health New Zealand is spending each year on locum doctors to plug staff shortages is increasing by tens of millions of dollars a year, and could reach $200 million this year. RNZ has obtained figures that show the spend on fill-ins is rising fast, leading a frontline doctor and the senior doctors' union to voice frustration. Dr Ralston D'Souza is a rural hospital medicine specialist at Taupō Hospital, where a shortage of senior doctors means there's a revolving door of locums. "The frustration though is that we're being told constantly there's no money to improve recruitment and retention of our permanent staff in terms of any initiatives, but there's no limit, it seems, at spending money on locums." Health's a big-budget item. It's expected the government will spend $32.7 billion in the 2025-26 financial year. The figures RNZ has obtained show in the 2022-23 financial year, the cost of "outsourced specialist medical staffing" was more than $150 million. It was more than $183m in 2023-24 and for the nine months to March in the 2024-25 financial year it climbed over $155m, meaning it was on track to break $200m for the full year. Health NZ doesn't "hold records centrally" before its creation in July 2022, when locum spends were managed by district health boards. D'Souza wasn't surprised to see that growth. "We know on the ground that locums probably get paid three to four times more than a permanent staff member, but the locums don't actually do anything apart from service delivery. "They don't contribute to the training of the other staff, including resident [junior] doctors, and they don't improve the quality of the service in terms of quality-improvement initiatives." Health NZ won't release its full list of rates for locum work, but has given RNZ a summary, which shows junior doctors get between $55 and $130 an hour, and seniors between $1500 and $3000 a day. D'Souza wants officials to think about why it's so difficult to recruit and retain permanent specialists. "Health New Zealand seems to be spending a lot of resources on being reactive when a gap occurs, but they're not spending as much resource on being proactive - understanding why the gap has occurred in the first place." Health NZ's interim chief human resources officer Fiona McCarthy said although Health NZ would rather employ permanent medical specialists, locums had been used for decades. "Locums for specialist medical staffing are used for a diverse range of medical specialities, including general surgeons, anaesthetists, psychiatrists, sonographers, cardiologists amongst many others," she said. "Reasons for employing a locum can include staffing gaps due to sickness, leave or unfilled posts. "Locums are most often required for weekend and acute calls. At times locums can also be employed to address surges in demand or reduce waitlists." McCarthy said there were "long-standing workforce challenges" in some specialist areas, and officials were "working at pace to address this to ensure the needs of local communities continue to be prioritised". Health NZ grew its clinical workforce by 1689 full-time equivalent staff members in the 2024 calendar year, she said. The senior doctors' union head Sarah Dalton says there's a large number of locums working in New Zealand. Photo: LDR / Stuff / Kevin Stent Association of Salaried Medical Specialists executive director Sarah Dalton said the problem of specialist shortages was sizeable. "If you want to think about how many locums are being paid in a year to work in our system, we were looking at the numbers and thinking that's the equivalent of the entire medical staff of either Waikato or Waitematā districts." RNZ asked Health NZ for the number of locums it uses, but it said it didn't have that information, instead providing full-time equivalent figures that show 374 FTEs were used in the first nine months of the 2024-25 financial year, and 380 the previous year. It did, however, provide regional breakdowns, and in the 2024-25 year's first nine months the largest locum spend was in Te Manawa Taki Midlands region, at just under $45m. The region includes Waikato, Bay of Plenty, Lakes, Taranaki and Tairāwhiti. The central region, including Palmerston North, Whanganui and Wellington, spent just over $44m. RNZ also asked for a breakdown in figures by speciality, but was told this couldn't be done because the information "is not held in that form and would require considerable technical expertise to create". Sarah Dalton and the association, the senior doctors' union, were critical of this. Union officials knew, for example, of shortages in psychiatry, and had heard anecdotal evidence of psychiatrists giving up permanent work for locum jobs, but there were gaps in knowledge in other areas. "That's an endless bugbear for us, that they [Health NZ] aren't doing sufficient work on their workforce, current or future planning, to have an intelligent or informed conversation about the state of the problem," Dalton said. "But, what we can see from this data is they are spending more and more money on locums. It is a wildly expensive way to staff hospital." Settling senior doctors' collective agreement claims would cost less than a quarter of the annual outsourced specialist spend, she said. An over reliance on locums led to lower productivity, while permanent staff were burdened with doing the tough shifts temporary workers turned down. "It's incentivising our senior doctors to pick up locum work at the expense of a salaried job. "We really need to turn that around and that's what we've been trying to do by trying to look at improved conditions, recruitment and retention payments, and bonuses for people who choose to work only in public [hospitals]." Health Minister Simeon Brown said locums play an important role. Photo: Nathan Mckinnon / RNZ Patient Voice Aotearoa's Malcolm Mulholland has heard at the advocacy group's nationwide roadshows endless stories about how staff shortages are affecting patients and the health workforce. "The sad picture that it paints is that it's a horrific cost and one would have to think are these resources best allocated elsewhere in the health system? "I can't help but think that perhaps we need to bolster something like the bonding system in hard-to-staff areas, which is traditionally where locums are needed." Health Minister Simeon Brown said his priority was to make sure patients received the care they needed, where they needed it. "Locums play an important role in keeping services running, especially in hard-to-staff areas, but ultimately, we want more permanent staff delivering care across New Zealand," he said. "Since 2023, we've grown our health workforce, with over 1700 more nurses and more than 200 additional doctors employed by Health New Zealand as at December last year. "That's real progress, but there is more to do." Brown said the challenge wasn't unique to New Zealand and there was a "global war for talent in healthcare". Given the better pay rates and flexibility, even D'Souza had considered joining the army of temporary medical specialists. "I think that's definitely a thought that's occurred to all permanent staff and it goes back to that there's probably no great incentive to be permanently employed. "All of us are probably sticking at it because of the goodwill we have towards our community, towards our patients." Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
RNZ News
14 hours ago
- RNZ News
Work resumes on new Dunedin Hospital inpatient building after delays
The project will be overseen by a community oversight group representing Health New Zealand, local government, infrastructure partners and tertiary institutions. Photo: RNZ / Delphine Herbert Health Minister Simeon Brown confirms work is back underway on Dunedin's new hospital inpatient building, after years of delays and controversy. In January, Brown announced the government would build the new facility at the former Cadbury factory site, after several months deliberating whether to build a scaled-back version or to retrofit the existing Dunedin Hospital. In recent days, diggers have been spotted on site, as well as billboards proclaiming the involvement of Australian construction firm CPB. Speaking from Dunedin on Thursday, Brown labelled the early work "a major step forward" in the coalition's commitment to the critical health project. When complete, the building would be the largest single health facility in New Zealand, covering approximately 70,000 square metres. Under the current timeline, Brown said construction on the steel structure would begin in August next year. He also announced a new panel of community leaders would be set up to keep locals well informed on the progress. The group would include representatives from Health New Zealand, local government, infrastructure partners and tertiary institutions. It was expected to meet quarterly to consider matters related to the hospital, but would not provide advice on its design scope, clinical models of care or procurement decisions. Brown said the project would be the largest health investment ever made in the South Island. "We're getting on with the job," he said. "This will ensure the project is well embedded into the fabric of the city and the region, playing a vital role in ensuring the public receives clear and consistent updates, as the project progresses." Dunedin Mayor Jules Radich said he was delighted the minister had taken up his recommendation for a "community oversight group", given the keen interest in the construction and fitout. "The people of the south are rightly passionate about our new hospital," Radich said. "I'm pleased the government has listened to the community's call for it to be built on the right site, with all 11 floors promised." Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
