Latest news with #NicholasBowden
RNZ News
02-07-2025
- Health
- RNZ News
More than meds: Why easier access to ADHD treatment has to be part of a whole-system approach
By Belinda Wheaton, Byron Rangiwai, Nicholas Bowden, and Stephanie D'Souza* of 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 .
Otago Daily Times
17-05-2025
- Health
- Otago Daily Times
Study provides data on life with ME
A new study examining the challenges faced by people with chronic illness highlights areas for improvement. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a long-term illness that can make everyday activities very difficult for those living with it. New research using anonymised government records in Stats NZ's Integrated Data Infrastructure reveals what life is like for people with ME/CFS. The study identified 1902 working-age New Zealanders with ME/CFS who were receiving a benefit and compared their experiences with those not receiving one. Principal investigator University of Otago department of paediatrics and child health senior research fellow Dr Nicholas Bowden said people with ME/CFS used health services far more often. In the past year, 18.8% had visited an emergency department, compared with 12.8% of the general population, and 32.8% had been dispensed 10 or more medications, compared with 14.2%. The study also hinted at diagnostic inequity because Māori and Pasifika were under-represented. "It is certainly not consistent with the general trends of benefit use in the population. "So a low percent of Māori, low percent of Pasifika in this ME group on a benefit is very different to the distribution of ethnicity among that other benefit group. "There is some evidence around access and equities of access to diagnosis." Long-term data on employment, unemployment and benefit reliance showed how debilitating the condition was, he said. Only 18.3% of people with ME/CFS were employed, compared with 83.8% of the general population. Even when looking back one, two or five years, about half of those affected had earned no labour-market income in the preceding five years. "And that's quite a lot higher than the other comparison benefit groups." Co-investigator University of Otago department of biochemistry emeritus professor Warren Tate said the research added weight to discussions with government ministries. He has more than 30 years of experience with the conditions, both as a biomedical researcher and as someone whose family members have lived with ME. "I've done a lot of research now and published internationally on it. "So what I knew was that there were high health needs." However, data from New Zealand suggesting limited access to support services and very low employment was all anecdotal. "There was no data to support that and that made it very difficult for the ME community to argue with the ministry and areas of government to try and get better support." The study supported efforts to secure better access and greater understanding of the challenges posed by the conditions. Dr Bowden noted the population-level data used in the study was the government's own. "They are pretty hard for the government to turn a blind eye to." The research was funded by a grant from the Associated New Zealand Myalgic Encephalomyelitis Society. The study is now under peer review at BMC Public Health.
