Psychiatrists and psychologists push to get ADHD diagnosis on NDIS

Thousands more people should be able to join the National Disability Insurance Scheme with a diagnosis of attention deficit hyperactivity disorder, according to a fresh push from peak psychiatrist and psychologist groups to boost support for those with the common neurodevelopmental disorder.

But the professions face resistance from the federal government, which is trying to tie the $35 billion scheme down to an 8 per cent annual growth target, as NDIS numbers balloon and thousands more children join the scheme with autism and developmental delay than was ever expected because they struggle to find support in mainstream systems.

One in 20 Australians is estimated to have ADHD.Credit: Getty

An architect of the NDIS, Professor Bruce Bonyhady, last week warned the NDIS was functioning in the opposite way he had intended 10 years ago because school and health system supports had dried up, leaving the NDIS as the only “oasis in the desert” for families needing support.

About 280,000 children and 530,000 adults in Australia have ADHD, according to a Deloitte Access Economics report, but fewer than 5000 are on the NDIS. That means most people are diagnosed and treated in the private sector, where they face long waitlists and high out-of-pocket costs that may lead them to delay support.

That structural flaw forms part of the reason why professional organisations are pushing for the NDIS to recognise ADHD – which is estimated to affect 4 per cent of Australian children and adults under 45 – on its list of eligible disabilities.

Despite high numbers in the community, only 188 people are currently on the NDIS with ADHD as their primary disability, while 4864 participants have ADHD as well as other conditions.

A submission from the Australian Clinical Psychology Association to a Greens-led Senate inquiry said forcing patients to use the private system meant that assessments and treatment were “out of reach for lower income groups, where there is likely to be a higher prevalence of ADHD”.

However, a spokeswoman for NDIS Minister Bill Shorten said the government had “no plans to make changes to the limited list of disabilities that grant automatic eligibility for the NDIS”.

“People with ADHD can become NDIS participants if they meet the criteria of being permanently and significantly disabled and provide evidence showing they meet the requirements set out in the NDIS Act,” she said.

However, psychologists say people are frequently knocked back from the scheme, even with severe functional impairments.

The clinical psychologists’ association said it was aware that there was pushback against including further diagnoses in the NDIS – particularly since the increase in the number of NDIS participants with autism had skewed its composition – but that more support was needed for people with ADHD, either through Medicare or the insurance scheme.

A submission from the Australian Association of Psychologists Inc also said the NDIS had a “crucial role” to play in supporting people with ADHD, who should be able to access the NDIS if they had demonstrated their condition had a substantial impact on their ability to participate in daily activities.

“We recommend that the scheme recognises ADHD as a primary disability and provides appropriate support, including access to diagnostic assessments, evidence-based interventions, and ongoing care throughout the lifespan,” their submission said.

The third major psychologist body, the Australian Psychological Society, agreed that people with ADHD should be included on the scheme’s list of conditions.

“The [APS] is not suggesting that all people with ADHD should categorically receive, nor do they always require, support through the NDIS,” its submission said.

“However, if a person has symptoms that are difficult to manage, likely to be permanent and substantially reduce psychosocial functioning, and require ongoing and possibly lifetime treatment, then it may be appropriate for them to seek support through the NDIS.”

The peak training body for psychiatrists, the Royal Australian and New Zealand College of Psychiatrists, has also called for ADHD to be included on the scheme because of its complex presentation, persisting impairments from childhood into adult life and comorbidities with other psychological conditions.

However, it said support from the NDIS should be based on the functional needs of the person with ADHD, and not solely on diagnosis. Occupational Therapy Australia agreed the NDIS should be offered when people have significantly reduced functional capacity.

Peak patients’ body the Consumers Health Forum said ADHD could significantly impact the education, employment, financial and social elements of a person’s life, and there weren’t enough supports available for people with the condition.

“People with ADHD are more likely to experience mental health issues, addiction, die by suicide, and are overrepresented in the criminal justice system than the neurotypical population,” its submission said.

Both the Consumer Health Forum and the Australian College of Mental Health Nurses said there should be a scale of need for ADHD that is similar to how the scheme treats Autism Spectrum Disorder, where eligibility depends on the level of diagnosis.

However, growing numbers of children with autism on the NDIS have fuelled concern that higher levels of autism are being over-diagnosed in children so that families can receive help.

Autism expert Andrew Whitehouse has warned that including ADHD on the list of NDIS disabilities could have a similar effect. “[This] will further entrench inequity in access. It may also drive changes to family health-seeking behaviour and practitioner diagnostic practices,” he has written in The Conversation.

Greens senator Jordon Steele-John, who initiated the inquiry, said ADHD healthcare in Australia needed urgent reform. “As a condition that significantly impacts every part of the lives of one in 20 Australians, getting support shouldn’t be available only to those who can afford it,” he said.

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