ADHD diagnoses are rising. But a critical cohort is being missed.

More Australians than ever are being diagnosed with ADHD. But for a condition marked by poor focus, disorganisation and difficulty finishing tasks, the process of getting assessed is often so complex and costly it can exclude those who need support the most.

Mick Owar, 42, was diagnosed with ADHD when he was in primary school.

Energetic and restless, Owar was considered a ‘problem child’. He remembers the assessment to explain his hyperactivity as relatively straightforward.

He was prescribed medication but didn’t like how it made him feel and stopped taking it after a couple of years. Owar learned to get by, creating systems and workarounds to help his busy mind function in a neurotypical world, gradually absorbing his ADHD symptoms as background noise.

Still, by the time he was approaching his 40s, he knew he wasn’t operating as sharply as he could.

“As an adult, my work has always been a mess of lack of focus, half-finished tasks and mental chaos,” Owar says. “I started to think, ‘maybe this is ADHD’, and decided to revisit it.”

He discovered much has changed in the decades since his childhood diagnosis.

Awareness around ADHD has grown dramatically, and a label once reserved for “naughty little boys” is now applied across a much broader group, with more than 800,000 Australians diagnosed with the condition. Now children, teens and adults well into midlife across all genders are gaining greater insight into themselves following an ADHD diagnosis. Some describe the revelation as life-changing.

But with greater acceptance of ADHD has come a complicated and expensive system, as more people begin to recognise symptoms within themselves and line up to be assessed.

“The system is ridiculous,” Owar says. “As an adult, I found endless hoops, waiting lists, screenings, referrals and assessments.”

After about the third appointment, exhausted by the process, he gave up.

“I don’t have the energy to jump through endless life hoops,” he says. “Ironically, the ADHD makes the ADHD process almost impossible.”

Why is ADHD diagnosis so complicated?

Most diagnosis and treatment of ADHD in Australia happens through the private system.

Patients are usually referred by their GP to a psychiatrist or psychologist – or, for children, a paediatrician – but when they try to schedule an appointment with a specialist, they face long waiting lists and out-of-pocket costs of around $2000.

Why the ADHD assessment process is so expensive is unclear. In an article published in the Medical Journal of Australia in October, psychiatrist Dr Rich Bradlow and co-authors pointed out the procedures involved are no more complex or time-consuming than other mental health assessments.

It’s a system causing concern among some experts, who worry people without the money or organisational capacity to navigate the process may be missed. Meanwhile, those with milder presentations are more likely to receive an ADHD diagnosis and treatment, but may be at greater risk of misdiagnosis if other psychosocial factors that may be driving their symptoms, such as anxiety or depression, are not explored.

“One of the main things doctors look for when diagnosing ADHD is impaired functioning,” says Bradlow. “But there are no standardised definitions of ‘functional impairment’.

“We all have traits of many mental illnesses – it [a diagnosis] comes down to the view of the psychiatrist as to whether it’s affecting your ability to function.”

He says the lack of clarity can lead to variation in diagnosis, often compounded by patients who have spent months on waiting lists and stumped up thousands of dollars arriving with the expectation their suspicions will be confirmed.

“I have met people who have been diagnosed after becoming medical specialists,” Bradlow says.

“To me, if someone has managed to navigate getting into medical school, passing medical school, applying to specialist training programs and the exams of specialist training programs with untreated ADHD, then I don’t see how they could have functional impairment severe enough to meet a diagnosis.”

Bradlow says this logic can be applied to other areas of education and career success.

“There needs to be evidence of symptoms impairing someone’s functioning [to get an ADHD diagnosis],” he says.

‘ADHD was the missing piece of the puzzle’

Caroline Beresford began to suspect she may have ADHD after helping a family member navigate their diagnosis and recognising some traits within herself. (Studies show ADHD has a high heritability link.)

She began the process of seeking an assessment, and was lucky to have her six-month wait for a psychiatrist appointment cut to four following a cancellation. After two appointments, some paperwork and assessments, Beresford, aged 47 at the time, discovered she has ADHD.

“It was the missing piece of the puzzle of my life – a piece I had been searching for a really long time,” Beresford says.

She describes experiencing a powerful emotional shift following her diagnosis.

“Finally, I had the opportunity to understand why I have found different parts of life challenging and understand my brain better,” she says. “With that deep knowledge and understanding comes a strong sense of self. I am now able to be kind to myself and more self-accepting.”

Beresford was prescribed medication and recommended to an ADHD coach, who helped her find strategies to support her brain and executive functioning.

Now working as an ADHD coach herself, she realises her journey to diagnosis was relatively smooth compared to many.

“People that can afford the private system pathway have a much simpler and faster experience,” she says.

“ADHD shows up differently for all of us. In my case, I believe my executive functioning helped me, however for others I know their executive functioning has made the path to diagnosis more difficult to manage.”

What does treatment look like? Who is falling through the cracks?

Stimulant medication, which at the moment in Australia can only be prescribed by a psychiatrist or paediatrician, is often a first-line treatment for ADHD.

Generally effective at reducing core symptoms and well tolerated, prescriptions for ADHD medication rose by almost 300 per cent to 470,000 Australians in the decade prior to 2022-23, according to PBS data.

However, psychologist Cameron Brown says best practice of ADHD management should also involve skill development and therapy.

“We know ADHD is well treated with medication; however, there are also countless self-beliefs, habits and stereotypes people hold about themselves that also need to be addressed,” Brown says. “Medication can help with motivation and execution, but it can’t address an entrenched belief system of ‘I always fail’ or ‘I will never follow through’ which can sabotage people even after they have commenced medication.”

Brown believes people with inattentive ADHD are more likely to be missed.

“This is commonly associated with an older age diagnosis,” he says. “They often lack or mask the hyperactive symptoms and as a result aren’t noticed in educational settings as easily.

“When struggles appear it can seem like people are being ‘difficult’ or ‘lazy’ rather than struggling with focus and inattention.”

Bradlow says increased demand for ADHD diagnoses has fuelled the rise of single-session online clinics offering faster assessment. He worries this model may fail to distinguish ADHD from symptoms of other mental health issues, provide limited follow-up care, and rely on medication without offering comprehensive treatment options.

“I cannot say if patients are given enough non-pharmacological treatment options,” he says. “I hope they are, but am concerned they may not be.

“Treatment of ADHD is not just pharmacological. There are also very effective non-pharmacological treatments that should be offered.”

What more equitable care could look like

Bradlow believes there needs to be more emphasis on functional impairment when making a diagnosis.

“A lot of people have symptoms, but symptoms don’t make a diagnosis. Impairment from symptoms makes a diagnosis,” he says.

He would also like to see more public options that make it possible for disadvantaged people who can’t afford high prices to access treatment.

There is a move in some states to allow specially trained GPs to assess, diagnose and treat ADHD.

Nationally, several states are beginning to reform pathways. Queensland is introducing specially trained GPs who can diagnose ADHD from December 2025, with NSW, the ACT, Tasmania, Western Australia and South Australia planning similar moves in early 2026.

While Bradlow welcomes the changes, he stresses they need to be well executed.

“GPs diagnosing and treating ADHD could be great if done well,” he says. “It could increase access to treatment and bring equity.”

However, he can also foresee a scenario where only select GPs can do it, who then still charge exorbitant rates for an assessment.

“It could also result in increased misdiagnosis or over-diagnosis, whereby GPs with limited mental health knowledge view patients through an ADHD lens only and misdiagnose other conditions as ADHD, leading to patients not receiving the right care.”

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