ADHD and the NDIS

Because of the high number of diagnosed cases involved, there are concerns that classifying ADHD (Attention Deficit Hyperactivity Disorder) as a disability would threaten the viability of the NDIS (National Disability Insurance Scheme). So, what is ADHD, who is taking medication for it and why are they taking it?

ADHD made its diagnostic debut in 1968 in the second edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. According to the American Psychiatric Association, ADHD is one of the most common mental disorders. Guidelines have broadened in recent years, but basically the symptoms centre around inattention (finding it difficult to stay on task), hyperactivity (finding it hard to stay still) and impulsivity (acting without thinking). Diagnosis remains subjective (a matter of opinion) and is based entirely on observations, questionnaires and the self-reporting of adult patients or the anecdotal evidence of the parents/caregivers or teachers of child patients.

The possibility of a potential correlation between ADHD and brain function has been suggested but no physical cause has ever been substantiated. Without strictly objective diagnostic criteria, then. a diagnosis of ADHD can be controversial and some remain sceptical about the condition. Nevertheless, more than 800,000 Australians have been diagnosed with ADHD. 400000 are currently prescribed medication for it and the number of diagnoses has doubled in five years. Fewer than 5000 are currently supported by the NDIS. Worldwide the prescriptions written for ADHD medication number in the tens of millions, if not more.

Internationally the prevalence of ADHD in children and adolescents is said to lie between 5% and 8%. In Australia it is between 6% and 10%. Primarily, children and adolescents take ADHD medication to control impulsive and disruptive behaviour and also to improve their educational outcomes. In the case of ADHD, using prescribed medication to control behaviour is not considered to be employing a chemical restraint. However, the term chemical restraint refers specifically to the use of a medicine or chemical substance for the purpose of modifying behaviour. The distinction between using a chemical restraint or a prescribed medication to control behaviour is a fine one.

Although there are alternative strategies, such as counselling and skills training for managing ADHD, the inadequacy of appropriate resources in our schools to support high-needs students, such as those with ADHD, makes the widespread use of ADHD medication assured. An early advertisement for Ritalin claimed that it helps the problem child become lovable again. The danger here, as ADHD sceptics point out, is that many child ADHD sufferers are simply the product of chaotic environments. They are children given few if any boundaries by parents lacking parenting skills who are struggling with addiction, mental health problems, disability and/or poverty. What must be remembered is that it is easier and far less expensive to medicate a child than it is to address the underlying causes of their problems.

If the sceptics are right, many thousands of vulnerable children are taking powerful psychotropic medications not because they have a medical condition, but because they are floundering in devastating social and family problems over which they have no control. Note that the risk of ADHD diagnosis doubles for children of low economic status (especially boys) and research has shown that the rates of ADHD and the type of drug treatment prescribed depend largely on where you live

The other reason ADHD medications are prescribed is because they increase the ability to focus and to stay on task, thus improving educational outcomes for children and adolescents. ADHD medications, for example, Adderall, Ritalin and Concerta, are all central nervous system stimulants. For individuals with reduced ability to concentrate or attend – as in having an attention deficit – taking stimulant medication allows them to focus, be less distractable and stay on task longer. That is all well and good, but ADHD medication enhances the performance of anyone who takes it. This would, of course, come as no surprise to those who are more familiar with amphetamines as illicit speed or uppers. Note that ADHD medications are much sought after as a study aid for students cramming for exams. One possible issue, of course, is that when it comes to competitive examinations, some students are allowed to take a prescribed performance-enhancing drug, while for others access to the same substance is banned.

Once the preserve of children and adolescents, ADHD has recently become a popular common diagnosis with adults, as well. A study published in the Journal of the American Medical Association reported that the diagnosis of ADHD in adults is now four times that of children. Increased public awareness of ADHD has been attributed to the power of social media. In May 2022, for example, the hashtag #ADHD had 11.4 billion views on Tik Tok. Many adults credit social media for making them suspect they have ADHD and subsequently seeking a diagnosis and treatment for it.

High-profile individuals who have been diagnosed with ADHD as adults include billionaire businessmen, Bill Gates and Sir Richard Branson, millionaire socialite Paris Hilton, British restaurateur and cookbook author Jamie Oliver, and Academy Award-winning actor and author, Whoopi Goldberg. Although it is difficult to see how ADHD might hamper these extraordinarily successful sufferers, each has spoken out about their struggles and the difference their diagnosis and treatment have made. Of course, that’s life. As once Australian Prime Minister Malcolm Fraser famously said, life wasn’t meant to be easy – for anyone.

Having struggles does not mean an individual has a disease, condition or disorder. Everyone has struggles and everyone taking prescribed amphetamines will notice a difference, ADHD sufferer or not.

It is easy to conclude that children are overdiagnosed with ADHD and that adult ADHD has become “the latest fad”, a pathologized social construct which in the context of the NDIS threatens to drop us into a budgetary black hole. Can Australia afford to classify ADHD as a disability opening the NDIS to a tsunami of new claims? What do you think?