The Sydney Morning Herald‘s Natassia Chrysanthos last week reported that a group of Australian psychiatrists is concerned attention deficit hyperactivity disorder is being over-diagnosed and overmedicated and that a Senate inquiry into the neurodevelopmental disorder was dominated by one view.
SMH revealed the number of Australians prescribed medication for ADHD had more than doubled in five years to 414,000 in 2022.
The Senate’s report will be published when parliament resumes next week and is expected to recommend expanded access to diagnosis and treatment, particularly for people from lower-income groups.
According to the SMH, the Critical Psychiatry Network Australasia’s spokesperson, psychiatrist, and professor Jon Jureidini, he and 30 other psychiatrists, GPs, psychologists, and academics felt the Greens-led inquiry’s terms of reference supported a medicalised model of ADHD.
“The inquiry was set up … in the direction that ADHD is underdiagnosed, undertreated, and the world would be a better place if we gave people more access to diagnoses and medications.”
He said those claims were contested and needed to be scrutinised.
“The danger is this will entrench the influence of a demand-based medicine practice, where people identify they’ve got ADHD, and the role of the medical profession is to rubber stamp that,” Prof. Jureidini said.
The Critical Psychiatry Network Australasia operates under the Robinson Research Institute at the University of Adelaide. It has been critical of the pharmaceutical industry and the standard prescription of antidepressants.
The network’s views on ADHD are at odds with the dominant perspective of medical colleges representing GPs and psychiatrists, which told the inquiry more support, including for diagnostic assessments, was needed.
Several also advocated for people with ADHD to access to the National Disability Insurance Scheme.
As reported in the SMH, Jureidini said ADHD symptoms such as hyperactivity and impulsivity could have a variety of causes – from language disorders to violent environments – and require different treatment approaches.
“It’s a dumbing down and oversimplification: ‘If you’ve got these symptoms, you’ve got this disorder’,” he said in an interview.
He added that “medicating the symptoms and suppressing them, you may contribute to missing something significant,” such as physical, environmental or interpersonal issues. ”
Labor MP and paediatrician Dr Mike Freelander was also worried the Senate report would give “undue prominence to medical management”.
“I’m worried about the over-medicalisation of a multitude of issues associated with a diagnosis of ADHD, [when there is] importance in concentrating on the social determiners of health and education,” he said.
A 2019 Deloitte report commissioned by the Australian ADHD Professionals Association estimated about 280,000 children and 530,000 adults in Australia have the neurodevelopmental disorder.
Dr John Kramer, the ADHD and neurodiversity chair of the Royal Australian College of General Practitioners, told the SMH that he did not believe there was overdiagnosis or overmedication because prescribing doctors went through rigorous processes that safeguarded against wrong diagnoses.
Jureidini said the public debate about ADHD was asymmetrical, and he believed the push for NDIS access would serve professions that could capitalise on that funding.
“There are fewer people on my side of the argument. People say we are fringe dwellers and sceptics, but we have no pay-off in this process. We’re just trying to protect people from inappropriate prescribing and labelling,” he said.
Jureidini said he and other sceptical colleagues who are members of the Royal Australian and New Zealand College of Psychiatrists were not included in developing the college’s submission. “There was a complete marginalisation of dissent,” he said.
However, the college’s ADHD network chair, Dr Karuppiah Jagadheesan, said its submission was developed with a wide range of experts.
“[They] contain a good balance of academics as well as clinicians”, who Dr. Jagadheesan said were “experts in the management of ADHD and have frontline experience seeing patients with ADHD”.
He said the college stressed the importance of multimodal treatments, meaning both pharmaceutical and non-medicated interventions.
The inquiry’s chair, Greens senator Janet Rice, said its terms of reference were broad and set by a cross-party committee.
“That [their] opinions happen to be in the minority is not due to the inquiry; rather the reality that their views differ from those of the vast majority of experts and people with ADHD who gave evidence and made submissions.”
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