Opinion


The need for greater access to care for those with the disorder is finally being recognised, says Associate Professor John Kramer.


Definition of ADHD highlighted in dictionary

Several additions to the ‘ADHD toolkit’ have helped improve diagnosis and management for Australian GPs, according to expert Associate Professor John Kramer.


Until recently, a major barrier to better access to attention deficit hyperactivity disorder (ADHD) care was the virtual exclusion of GPs from its diagnosis and management.

 

This long-term barrier was combined with the totally inadequate number of paediatricians and psychiatrists to assess patients and prescribe medications where needed.

 

A further structural barrier has been the almost total lack of capacity, and will, of public hospital psychiatry to address the needs of the financially and socially disadvantaged neurodiverse population.

 

Some paediatric outpatient access has existed but waiting times for appointments of 12–18 months in many cases seem to be the norm where access does technically exist.

 

The essential first step was a study on the annual cost of ADHD to Australia, released by Deloitte in 2019, which revealed a final figure of $20.6 billion – a staggering amount.

 

Next came the development of National guidelines for the diagnosis and management of ADHD in Australia. This work was funded by the Commonwealth via a grant to the Australasian ADHD Professionals Association (AADPA).

 

I was nominated by the RACGP to the Working Party as its representative, along with a wide range of experienced health professionals and consumers.

 

Work began in 2020 with several large meetings in Melbourne, but the arrival of COVID-19 compelled the transfer of all meetings to the virtual realm.

 

The work started with the existing NICE ADHD Guidelines from the United Kingdom but underwent a comprehensive revamp with new research findings being utilised, together with major allowances for the Australian context.

 

In 2022 we saw the launch of the new Australian ADHD guidelines. That seminal document fuelled the next stage of reform by establishing clear information of what to do when ADHD was suspected.

 

Consumers also had access to high-quality information with which to lobby their elected representatives.

 

The exponential growth in the many forms of social media enabled rapid spread of information about ADHD. Unfortunately, this also allowed ill-informed comment and provided fresh material for conspiracy theorists everywhere.

 

Notwithstanding those retardant factors, awareness of ADHD and its impacts if unrecognised, continued to increase through most levels of society.

 

Ignorance about ADHD had been highly prevalent in every stratum of society. Much time and effort was consumed by the essential counter responses with attached firm evidence. Seeds that had been planted in many quarters were beginning to germinate.

 

Many paediatricians and psychiatrists entered private practice with little or no training about ADHD. Thus, they were as subject as the wider community to misconceptions about a condition that affects up to 10% of the population.

 

The RACGP established a Specific Interests Group for ADHD, Autism Spectrum Disorder (ASD) and Neurodiversity in 2021. I was honoured to take up the role as its inaugural Chair. I am still in that position, but always mindful of the need for ‘succession planning’.

 

The next major addition to the ‘ADHD toolkit’ was the prescribing guide developed by AADPA, released in 2024. This invaluable tool had to be self-funded by AADPA, as submissions for Commonwealth funding were unsuccessful.

 

Behind the scenes, consumers all over Australia were developing partnerships with suitable clinicians, knocking on MPs doors, responding to media requests for comment on an increasing number of ADHD news stories, and gaining confidence in achieving some much needed reforms.

 

The ability of all GPs in Queensland to initiate stimulants from 2017 for children and adolescents had been a surprise, but didn’t appear to influence any other jurisdictions, at least for some time. It was taken up by some, but there apparently wasn’t any landslide.

 

However, it must have ultimately been an influence for change elsewhere in Australia.

 

In early 2025 a bright light shone in the west. The Labor Government and WA Health went to their March election with a platform to bring GPs into the stimulant initiation fold.

 

A modest target was set, and the election was won comfortably. One condition was the availability of robust educational material on ADHD for the involved GPs. An ADHD medication module was already under development by the RACGP. An urgent request to speed things up came in January.

 

NSW was the next domino to fall. The Premier and Health Minister visited RACGP NSW&ACT Chair Dr Bek Hoffman’s Practice at Kymeeagh to make the big announcement. A working party was formed and a target of 1000 GPs was set, with changes to be introduced by 1 December.

 

Tasmania, South Australia and the ACT all joined in with their own versions of reform. At the time of writing, Victoria and the NT are the only jurisdictions yet to announce any reforms. It seems inevitable that they must fall into line, sooner, rather than later.

 

This article is perhaps best regarded as the first chapter in a rapidly developing book of ADHD reform. Of necessity, I have not listed the many compelling reasons that make these reforms essential. That information is widely available, and will be the subject of another article.

 

Adjunct Associate Professor John Kramer is Chair of RACGP Specific Interests ADHD, ASD and Neurodiversity

 

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