From February 2026, GPs and nurse practitioners will be able to start medical treatment for adults with ADHD.
The Medsafe and Pharmac decisions will help patients avoid the ballooning wait times to see a specialist psychiatrist.
The SMC asked experts for comment.
Anna Elders, mental health nurse practitioner, The Psychology Group, comments:
“I’m really welcoming these changes. I think it’s absolutely fantastic for the ADHD community and the mental health sector.
“I’ve been working specifically with ADHD for around 10 years now, so I’m somewhat of an expert – but I still have to go via the process of consulting with a psychiatrist to apply for the special authority, which holds things up. So this change will mean no waiting time for patients getting a prescription, and will save money and time.
“People with ADHD are particularly vulnerable to falling through administration gaps. People often struggle to come forward and can delay going for an assessment. They can then struggle to get things in line for starting medications and so they don’t need an added delay.
“We also have to think about those that are the most vulnerable, who find themselves in the justice system and in prisons. There’s been a real call out from the police, and the Department of Corrections for us to get this right and do a better job sooner, so that they don’t have a whole bunch of people that are struggling, that end up finding their way down trajectories they may not have otherwise been on.
“I think there’s going to be some misconceptions that GPs and nurse practitioners can diagnose within a 15 or a 30 minute consult, and that’s not accurate. There are really firm guidelines from the working group, the ministry, and all of the colleges around what a really good, comprehensive assessment will look like. GPs are going to have to identify that they want to develop special skills and knowledge and undertake training in working with ADHD, just like they would if they developed a specialism in skin cancer for example.
“When you assess someone for ADHD, you have to look at things like social anxiety, OCD, bipolar disorder – and these are all conditions that are that are often undetected in primary care. So training a whole bunch of GPs and primary care nurse practitioners will mean that they’ll have to learn more about those conditions too. So it’s got the potential to benefit how primary care can work with mental health overall, which is much needed, because at the moment there’s an 11 year delay to getting an OCD diagnosis.”
Conflict of interest statement: Anna was part of the ADHD Clinical Reference Group which worked to develop a NZ ADHD consensus document ahead of these changes.
Dr Melanie Woodfield, Consultant Clinical Psychologist; HRC Clinical Practitioner Research Fellow; and Honorary Senior Lecturer at the University of Auckland, comments:
“It’s great to see that assessment of ADHD in children and adolescents will largely remain the remit of child health or mental health services. Assessing ADHD in children is a complex process that aligns well with specialist expertise and resources. Of course, we must balance comprehensive, high-quality assessments with timely, appropriate support and this can be challenging given the demands on both specialist and primary care services.
“However, assessing ADHD in children requires a thorough understanding of the child’s functioning across different settings (looking wide) and developmental history (looking back). This approach acknowledges that many conditions—such as hearing loss, trauma, or anxiety—can mimic or occur alongside ADHD symptoms in children. Sure, “when you hear the sound of hooves, think horses, not zebras”, but sometimes there is a zebra. Other times there is neither a horse nor a zebra. This nuanced understanding goes far beyond checklists or screens and ideally is conducted by child and adolescent mental health professionals.
“We must also carefully consider normal developmental changes. For example, hyperactivity and impulsivity are common in toddlers and don’t necessarily indicate a mental health disorder. Distinguishing between age-appropriate behaviour and clinical symptoms is important and takes time.
“Also, according to best practice guidelines, medication is not the first-line treatment for ADHD in children under five. In these young children, behavioural interventions and environmental adjustments are prioritised, reflecting the need for developmentally appropriate, comprehensive care from multidisciplinary teams.”
No conflict of interest.