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Tenfold increase in ADHD medications still insufficient – Expert Reaction

A New Zealand study shows a tenfold increase in the amount of ADHD medication dispensed for adults between 2006 and 2022, but the majority of those with the condition still aren’t receiving treatment.

Authors of the study suggest the ongoing treatment gap is caused by a strained mental health workforce, meaning the gap mostly affects those without the resources to go through the private health sector.

The SMC asked experts to comment. 

Dr Ben Beaglehole, Senior Lecturer at the Department of Psychological Medicine, University of Otago, comments:

Note: Dr Beaglehole is the lead author of this paper.

“We were interested in reviewing medication dispensing data for Attention Deficit Hyperactivity Disorder ADHD in New Zealand because we had noticed a big upsurge in demand for assessments and treatment of adults with ADHD.”We reported that there was a ten-fold increase in dispensing of ADHD medication for adults between 2006 and 2022 compared to a three-fold increase for children over the study period. The group receiving treatment as adults included adults who had never been treated previously and children diagnosed with ADHD growing older.

“We also reported that Māori adults are less likely to receive treatment than Māori children or the overall population suggesting that access to treatment may not be equitable.

“Despite the increased dispensing of medication for ADHD, the treatment rate is still lower than the estimated rate of ADHD in the population.  This suggests that there is under-treatment of ADHD in New Zealand.  However, increasing treatment for ADHD in New Zealand is not without controversy and possible issues include a greater pool of medication for potential misuse and medicalisation of distress.”

Conflict of interest: Dr Beaglehole is the lead author of this paper.

Dr Dougal Sutherland, Senior Supervising Clinical Psychologist, Victoria Psychology Clinic, School of Psychology, Victoria University of Wellington, comments:

“This study is further evidence of increasing rates of ADHD diagnoses in New Zealand, and notably for people who are receiving a diagnosis for the first time in adulthood. However, it also highlights the lack of treatment options that are available for people who have ADHD. Despite increases in the rates of ADHD medication being prescribed it is still lower than expected based on how prevalent the condition is. Obtaining a thorough assessment for ADHD is a lengthy and often costly process with many people going through private healthcare routes to obtain a diagnosis. This has obvious disadvantages for those for whom private healthcare is unaffordable.

“It is likely that many people with ADHD will be undiagnosed and therefore untreated for the condition, not only due affordability reasons but also due to workforce issues. There are many anecdotal examples of people seeking ADHD services being declined access in the public mental health service due to a shrinking workforce focusing only on the most immediate and urgent presentations. It is an open question about the ongoing cost to individuals and society in general of not treating ADHD.”

Conflict of interest statement: Dr Sutherland is the CEO of Umbrella Wellbeing.

Dr Luke Bradford, Medical Director of The Royal New Zealand College of General Practitioners, comments: 

“This paper demonstrates the gains in diagnosis and treatment rates of ADHD in Aotearoa New Zealand over the past 18 years or so, however, it remains below expected levels of prevalence and it’s clear that serious inequities remain.

“The burden of undiagnosed and unmanaged ADHD on educational outcomes, employment, mental health, and corrections are well documented. Access to services that can diagnose, manage, and provide ongoing treatment can be sporadic or unaffordable for many, and multiple barriers to continued and timely treatment are present through a system overloaded with other mental health conditions and the need to avoid unintended consequences of increased stimulant availability.

“More work is needed to focus on the concerns around those unintended consequences such as medication diversion or abuse. In order to address the inequities in access, a broader prescribing base is required as is a removal of bureaucratic barriers which we know impact the most vulnerable in our country.”

Conflict of interest: None