Chapter 2The lived experience of ADHD

It is important to note that while individuals with ADHD may have similar characteristics, everyone's situation is unique, and their lives are often impacted differently.[1]

2.1As outlined in Chapter 1, over one million Australians are estimated to have Attention deficit hyperactivity disorder (ADHD). Many more are impacted indirectly as the partners, family members and carers of those with ADHD.

2.2The Community Affairs References Committee (committee) received many hundreds of submissions from people with a lived experience of ADHD. Additionally, many submissions were received from people who are partners, family members or support people for a person with lived experience of ADHD.

2.3This chapter focuses on the experiences shared by people with lived experience of ADHD, and their partners, family members or support people. This chapter includes individual submissions that clearly state the practical impacts of ADHD on individuals, families and society. It includes an examination of the government systems that are failing people with ADHD; across education, work, employment, healthcare, social services and the justice systems.

2.4Due to the volume of submissions, this chapter cannot include the full breadth of individual experiences. However, the committee assures submitters their experiences have been read and considered in the development of this report. Itis the committee's intention for this chapter to provide readers with a snapshot of the triumphs, challenges and struggles being fought every day by ADHDers across Australia.

Life impacts of ADHD

2.5Many submissions made by people with ADHD noted the ways in which the condition has impacted their whole life. Extracts from various submissions are below:

I struggle with all executive functions and this impacts my life, family, relationships, employment, health and well-being on a daily basis. I was diagnosed with ADHD in August 2022 at 31 years of age. This diagnosis profoundly changed how I viewed myself. I have spent my life being misunderstood and misdiagnosed by family, friends, education systems and the health system.[2]

…

Having ADHD and not having the proper support has really affected my life and not just mentally. I must take regular days off work due to what is called ADHD burnout from over working myself and masking in social settings. Which then affects my home life by not being able to do regular house chores. Executive dysfunction plays a big part in my struggles and affects my life, work and study, and I always leave things to the last minute or put it off completely because I physically cannot do it.[3]

…

ADHD has negatively impacted my entire life. My childhood, schooling, jobs, friendships, relationships, my mental health, my parenting.[4]

…

I struggle with all executive functions and this impacts my life, family, relationships, employment, health and well-being on a daily basis.[5]

…

I never felt that I fit anywhere. I struggle with social connection, memory, focus, time management, task paralysis and feeling like a failure throughout school and in past work experiences. Shame, guilt and anxiety have been the fuel of my existence.[6]

As a student … I often struggled to meet deadlines, organize my schedule and study materials, or retain new information from classes, and suffered for it academically. In my personal life, I was irritable and moody, constantly tired, and socially isolated. I struggled with chronic apathy and boredom, and would find myself constantly starting new hobbies or projects, only to completely lose interest just days, or weeks, later, and start the cycle over from scratch. My mental health had already taken a significant hit after a protracted cancer battle just years earlier, and each one of these problems only compounded the debilitating effects of that lingering trauma. I felt worthless and powerless. I had thoughts of ending my life. I still do. Ironic, given how much I've been through.[7]

2.6People with lived experience of ADHD, organisations and healthcare professionals all emphasised that ADHD is not constrained to one particular aspect of a person's life. ADHD can profoundly affect any or all aspects of a person's life. ADHD Australia noted that living with ADHD can create 'lifelong challenges in educational achievement, mental health and wellbeing, securing stable employment, and avoiding interactions with the criminal justice system'.[8]

2.7The Australian ADHD Professionals Association (AADPA) noted that the stigma, misdiagnosis and insufficient treatment of ADHD is associated with a wide range of negative impacts on a person's life, including:

… relationship problems, family breakdown, poor academic achievement, increased unemployment, teenage pregnancy, abuse, anxiety, depression, eating disorders, substance misuse, suicide ideation and completion, accident and injury, criminality and incarceration, physical health problems, and decreased life expectancy.[9]

Impact on education

2.8This section looks at the evidence received by the committee relating to education.

2.9The Children's Hospital at Westmead noted the educational impacts of unidentified ADHD. Of children referred to the New South Wales (NSW) Centrefor Effective Reading, most students 'are more than 3 years behind in their literacy skills and 60–80% have undiagnosed ADHD at the time of consultation'. Due to long waitlists to see local paediatricians to manage access to medication, there is 'a further loss of access to the school curriculum, associated further academic decline, and risk of mental health co morbidity, such as anxiety and depression'.[10]

2.10Many submissions made by people with ADHD noted that they had great difficulties in school, and despite exhibiting classic signs of ADHD, were instead treated as 'problem children':

School was in general very hard. Due to symptoms, most teachers believed I was considerably less intelligent than I was. This led to much of my schooling being in classes which did not fit my needs in terms of learning.

I am unsure of what the formal terms are, but I was often put in the "dumb" classes, where topics were basic and watered down versions of the curriculum … In secondary school I was often put in detention for being late to school. I frequently would not hand in assignments. Towards the end of my schooling life I arrived at school at 12:00 pm. On my report card I had lost 20+ days of schooling due to absence. How this didn't raise alarms I am not sure.[11]

…

As for school, I was failing to complete assignments on time, I was not able to socialise with people, I was finding it difficult to do any of my schoolwork and homework, and I ended up getting detention numerous times throughout high school as I continuously failed to complete my homework. Sitting through classes was a struggle as I just could not sit there and concentrate for multiple hours a day, and I would always get in trouble for talking or drawing in class.[12]

…

In high school my grades fell, I found it extremely difficult to make friends, and I noticed that there was something different about me compared to my peers. I began self-medicating with alcohol, drugs, and self-harm, and developed an eating disorder – all to fit in or feel normal. Obviously, it did not work, that's just not how ADHD goes. By some miracle I both survived and graduated. After high school I went to university to study psychology, and my issues just became more pronounced. I could no-longer rely on my own background knowledge or problem-solving skills to succeed, so I failed. Every single unit, for 2 years, I failed. No matter how hard I tried to study or pay attention in class, I just could not absorb the information. Iblamed myself and tried to end my life several times. I dropped out, thinking that I was just 'bad at life' and would never amount to anything.[13]

2.11Parents noted similar negative impacts on behalf of their children:

I moved my daughter between 3 kindergartens and 3 primary schools desperate to find a safe and kind environment for her. My son was often in trouble for daydreaming, not concentrating, drawing pictures and forgetting things. The sad part is that my children couldn't help it and the school didn't understand what they were dealing [with]. The school teachers did not understand ADHD and were often blaming the child for not behaving and performing in the same way as others and in doing so unintentionally caused great damage to my children's self-esteem. I have no doubt that my daughter has C-PTSD (childhood trauma) from years of bullying.[14]

2.12Anita provided extensive direct quotes from her school reports that consistently commented on her lack of concentration and being distracted, and noted:

… It literally just goes on and on … every subject, every teacher and yet NO ONE saw ADHD because I was inattentive, not hyperactive. Because I didn't cause any problems in class, any issues with concentration were put down to me not trying, being lazy and wilfully deciding to do other things instead of my work. High School wasn't much better until Year 12 when I finally managed to squeeze together enough motivation and calm in my life to get almost straight A+'s. I was smart, I just couldn't focus. And it wasn't because I wasn't trying hard enough.[15]

2.13For many children, the behavioural symptoms of their unidentified ADHD resulted in social isolation, bullying or exclusion from school. Alexander told the committee that:

Throughout high school there were many times when I could have had an assessment - when I was bullied, the time in Year 8 where I impulsively punched someone on a bad day, my panic attacks before, during and after every test, the severe lack of proofreading in my work (often humorous, never intended) and the best symptom: the presentation of my tests. And that was just in my school life! But despite working with no less than seven psychologists, finding myself in the offices of school leaders and the ongoing civil war I had with my parents, I did not sit an ADHD assessment until I was 18 and things were out of hand.[16]

2.14Several submitters—both parents and healthcare professionals—noted that the threat of exclusion or actual exclusion from the school system is used to punish children for not meeting expectations they cannot hope to achieve:

… our child was locked out of school. She was excluded and the time frame of exclusion became almost six months. She was not given adequate access to school lessons, (as well as barred from attending school festivals, which led to distressing situations for all of us) creating a huge hole in her learning that we are still trying to resolve, she was denied home visits by her class teacher and school counsellor. My daughter packed her bags every morning for a month, and insisted on going to school. She asked why everyone else was allowed to go but not her. The school were not transparent with us about what was happening and would often say they would email the following week, to which we'd receive an email at 5pm on the Friday of the following week.[17]

2.15The committee also received evidence about what it was like for people with ADHD to enter into—and remain in—higher and vocational education. Consumer Health Forum of Australia told the committee that people with ADHD:

… said that their support plans could not be applied to their TAFE course or that the process of applying for reasonable adjustments at university was inaccessible to them. There is clearly a gap between the intention to support people with ADHD and the skills, knowledge and resources to do so.[18]

2.16Jess submitted that she thought she was 'lazy' and 'undisciplined' when she was at university and had not yet been identified as living with ADHD. Jess said:

I didn't know what executive dysfunction was. I didn't know that I could ask for help, at and outside of Uni. It was too confronting to reach out to student services and tell them that I was struggling and dropping out without a good reason. I didn't know that I was eligible for disability accommodations. I wasn't good at navigating this stuff.[19]

2.17A parent of a son with ADHD also told the committee that:

Last year, my son started, but did not complete TAFE studies because of the demands placed for delivering tasks on time. The inability to self-manage resulted is severe anxiety and depression. This was repeated this year when my son started first job. As a result, he is now not employed.[20]

Education after diagnosis

2.18Some submitters noted the benefits that a formal ADHD diagnosis brought to their education. Cheryl submitted the after being diagnosed 'in the third year of my second university degree I got more high distinctions than ever and was in fact able to go back and finish the first degree I had started 7 years before'.[21] Others made similar observations, saying that:

Returning to a different university since being diagnosed was a completely different experience. My course was online due to the pandemic. COVID-19 has improved accessibility, changes which I sincerely hope remain permanent. While studying online is not my preferred learning approach, I had both maturity, medication and a better understanding of how I best learn due to my ADHD diagnosis.

With a formal diagnosis I was also able to access supports, including extensions, additional time for test as required and other flexibility in the course. While there were also difficulties, including working full time, and having approximately 20 hours of course work each week, I significantly improved my university results, increasing my average score by 17percentage points.[22]

2.19A mother noted similar benefits for her daughter after her diagnosis and implementation of a treatment plan:

Late last year, my 8yr old daughter was diagnosed with ADHD … Her high levels of anxiety and perfectionism were enabling her to mask all signs of ADHD at school and often at home. It turned out her IQ was in the 97th percentile and yet she was sitting at the 10th percentile for maths for her age. Her ADHD was inhibiting her ability to meet her high IQ. They did a medication test and said they'd very rarely seen such a huge difference in the before and after of taking ritalin.[23]

2.20Others noted the consequences—including financial impacts—of a late diagnosis on their engagement with schools and learning:

The biggest cost of not being diagnosed has been a lack of understanding of how unregulated my emotions and responses from myself – the lack of understanding from myself, my teachers, and other adults. If I had been diagnosed far earlier, I would have been far more comfortable and been able to achieve far more both within school and beyond. The ongoing effects have been quite devastating in terms of understanding and regulating my own diagnosed anxiety, especially as the cause of these more extreme emotions or reactions were from some aspects of my ADHD.[24]

…

I am one of many late in life diagnosed ADHD people with a large HECS debt, but I am unable to complete a uni degree. I did not know that the paralysis, migraine and other issues that I experienced half way through each semester were due to sensory overwhelm, executive functioning and not knowing or being able to put strategies in place to fully participate to my full potential at university. After receiving my diagnosis, I have realized that the time period has passed to try and receive a refund or waive my HECS debt. This is another ongoing financial burden and a great deal of ongoing shame of having a late in life diagnosis.[25]

2.21Similarly, many submissions made by people with ADHD noted that due to their ADHD being unidentified or poorly supported, they were unable to complete their education, with life-long impacts:

When I started a university degree, I couldn't finish it because I didn't know how to manage the workload on my own and didn't have any support from my uni to stay on top of it. I don't think I would've known where to get support at uni or even if I could get support. I really wish I did have some kind of support to finish the degree. I think I would be in a very different situation today if I had that qualification and think I would have enjoyed the career.[26]

…

During my early school years, it felt as if I had missed an orientation day where everyone else had been given a head start on how to navigate the educational system. I became the classic case of an intelligent child who didn't ever hand in homework and was "not living up to her potential." This was made more difficult for me due to being the daughter of a school teacher. In the education system's eyes, I had no excuse to not be doing well.

Despite my best efforts, I dropped out of high school in year 11. The following year, I attempted to return, but the challenges posed by my undiagnosed ADHD lead to me leaving a second time. I have always wanted to study at university and so despite my struggles in school, I decided [to enrol] in a number of university units in my early 20's. Again, I was unable to complete anything without understanding why. It lead to me having a large HECS debt and no degree.[27]

…

[M]y failure to complete two university degrees [was] due to my undiagnosed ADHD symptoms. This has significantly impacted my career, earning potential and self-esteem. Had I been diagnosed and received the correct supports I have no doubt that I would have graduated. The grief and shame I felt then about not completing a degree remains with me even today.[28]

…

Throughout high school I struggled with inattentiveness but had my physical agitation under control (which I would later find out was called 'masking' and due to above average cognitive ability) and would manage school through natural ability, not homework, study, or much effort in class. I couldn't focus and by year 11 and 12 had dropped from higher difficulty classes to standard. I had been berated and scolded by teachers, had teachers tell me how disappointed they were in me and how I was wasting my intelligence. I even had one tell me 'I'll see you in 10 years collecting my Garbage' and another yell at me in front of the class for 'bringing down everyone's marks'. … I remember each teachers frustration, disappointment and verbal tongue lashings to this day. Not one teacher suggested a learning disability might be at play, only laziness and daydreaming. I finished school with a low ATAR mark and worked minimum wage jobs in retail and hospitality for years after school.[29]

Impact on employment

2.22Similar to the negative impacts that unidentified or poorly supported ADHD can have on people's lives in relation to education, the same negative outcomes are experienced in workplace settings.

2.23ADHD Connect Australia provided information from their members on the various ways that ADHD has impacted on their working life, and statistics on how that then impacts their success in work and education (see Figure 2.1 below):

Source: ADHD Connect Australia, Submission 1, p. 4.

2.24Carers Queensland noted that gaining and maintaining employment 'can be difficult for those diagnosed with ADHD as workplaces may not have a robust understanding of the condition or know how to adequately support employees in managing their work in line with any reasonable adjustments'. Carers Queensland submitted that many people with ADHD must rely on the kindness of colleagues to assist them because appropriate workplace adjustments are either not provided, or due to the stigma around being neurodivergent, many feel unable to inform their employer of their condition.[30]

2.25Ms Emma Sharman detailed her personal experiences and emphasised that many workplaces are not flexible enough:

Many workplaces do not have options for supportive sensory environments and work-practices post-diagnosis. There is often a lack of flexibility in considering the needs of a worker with ADHD. Sometimes 'supporting' documents are provided but the emphasis is placed on the person with ADHD needing to supress the impacts of their ADHD rather than managers and co-workers considering how to be supportive.[31]

2.26ADHD Australia similarly submitted that workplaces rarely have access to the information, training or resources they need to support employees with ADHD, and that:

Many people with ADHD are reluctant to disclose their ADHD diagnosis with employers due to stigma and fear of negative responses. In addition, people with ADHD who have disclosed their ADHD diagnosis with employers report their manager or workplace's fail to understand or are unwilling to support their requests for flexible working arrangements or reasonable accommodations.[32]

2.27The Royal Australian and New Zealand College of Psychiatrists (RANZCP) noted that people with ADHD 'are more likely to face difficulty gaining and maintaining employment compared to neurotypical adults', due to 'difficulty with listening and recalling instructions, speaking and listening at meetings, time management … and managing workplace burnout'. RANZCP argued for 'improved services across healthcare and community settings to remedy this issue'.[33]

2.28Many submissions made by people with ADHD also noted that many workplaces lack suitable policies or supports to address their needs:

My workplace is also not equipped to dealing with ADHD in an employee. While they do try to do best by those struggling with mental illness, it is hard to articulate and explain my own needs when they change pending the day.[34]

…

I have been chronically underemployed since entering the workforce. Despite knowing that I am capable, being told that I am capable and being able to show I am capable of producing excellent results, most workplaces are unwilling to accommodate my needs.

I have been let go from many jobs, I have been fired from jobs for ADHD related symptoms before accommodations were discussed. I have struggled to fit expected communication, work and organisation styles for a workplace.[35]

2.29This lack of accommodation and understanding of ADHD in workplaces can have significant impacts on peoples' working lives, as explained in many personal submissions to the inquiry:

I have found that workplaces have hindered access to supports for ADHD as they don't know or care how it impacts me. If I make a mistake because of ADHD (I'm currently unmedicated) my ADHD isn't taken into consideration, and I'm treated harshly.[36]

…

I would have progressed further in my career and had a more fulfilled and rewarding life if I had adequate ADHD services earlier in my life. Since being diagnosed and starting medication, colleagues have commented that I seem like a different person. Focused. More confident. More effective. I am [now] able to demonstrate better leadership, productivity, decision making and innovation. I do not have to mask anymore, which is better for my mental health. I understand and can help management and team workers better understand my strengths and unique capabilities. And I can contribute more to the economy.[37]

…

While she [my daughter] has been able to hold down full-time jobs, these have been mostly low paid in education support and administration. Certainly, her employers have benefited enormously from her intellectual capacity and high-level skills and knowledge but she is certainly not working in a position which is commensurate with her educational outcomes. She prefers to work within her capacity, rather than risk overextending herself. There is always the difficulty of whether to declare that she is neurodivergent.[38]

…

I struggled to learn new skills that would enable me to advance in my position. In effect, I remained a labourer. Later in my years in the job a tertiary requirement became mandatory – A Certificate in Zoo Keeping. I attended a TAFE College on just two occasions because the information in the course was delivered too quickly and I couldn't learn it. Not long afterwards it became clear that I would not gain the qualification and my contract was terminated. It felt as though the management had been waiting for an opportunity to dismiss me.[39]

…

Having this condition has heavily affected my ability to progress in life, especially financially and career-wise. If I knew much earlier and had better access to support services my life would be completely different. I would have been able to finish my university degree and work full time and be able to pay off my HELP debt.[40]

…

Growing up, I always struggled with inattention, forgetfulness, and disorganization, though I did my best to compensate for and hide these struggles. These symptoms only worsened as I entered adulthood and began to pursue my career. I had trouble completing tasks, meeting deadlines, and keeping up with work demands. As a result, I became increasingly anxious and depressed, which only made things worse.[41]

2.30Many of the comments from people with a lived experience of ADHD noted that work and career impacts compounded:

I have been unemployed for several years, but I am studying a Bachelor of Social Work in the hopes of one day pursuing a career that gives me purpose and financial independence. I lost my job in 2016 because I was unable to meet the demands of a full-time job due to my poor mental health at the time. I was experiencing major depression and anxiety, and I was suicidal. After losing my job I spent months applying for hundreds of jobs, but the rate of unemployment was high and I was competing with hundreds of other applicants for a single job vacancy. I've experienced chronic headaches and pain and a poor immune system my entire life because of the stress of pushing myself to meet the demands and expectations of school or employment, and I developed a binge eating disorder as a maladaptive coping mechanism as a result of the chronic stress.[42]

…

My husband has suffered greatly in his life so far due to untreated ADHD. In 30 years, he has not been able to progress in his career. This has limited his income and taxpaying ability. In attempts to further his career, he has started numerous degrees without completion leading to a large HECS‑Help debt that is unlikely to be paid off in full. He has also had health issues due to untreated ADHD. Impulsive eating has likely influenced his recent diagnosis of Type II diabetes. Had he been diagnosed sooner he could have avoided this illness. Lack of access to adult diagnosis and treatment has been greatly detrimental to our family.[43]

…

I have ADHD and I was diagnosed at age 49. The biggest cost of not being diagnosed was the financial burden of not being able to remain employed for extended periods of time. Aside from the times where I did not work, this has also meant that I have not had continuous opportunities to build up sick leave, annual leave, or long service leave. This made life events such as pregnancy, traumatic events, time with my children and illness expensive, often having a significant impact on my family's quality of life.[44]

Improved employment pathways

2.31The AADPA noted that ADHD has a substantial impact on productivity. Australia could save over $12 billion per year if appropriate supports were provided. As such, AADPA noted a need for improved employment pathways for people with ADHD.[45]

2.32Many of the submitting organisations noted that while improved access to assessment and treatment would have positive impacts on the ability of people with ADHD to participate in work, there were other workplace-specific strategies that could also be used. For example, the Tasmanian ADHD Support Group noted that greater access to ADHD coaches to help with 'functional life strategies' could be 'life changing for adults with ADHD'.[46]

2.33Ms Emma Sharman, a lived experience ADHD advocate, submitted a copy of the resource that she developed and self-published online titled WorkplaceAdjustments for Executive Disfunction. This resource has been downloaded over 40 000 times, and Ms Sharman has been:

… contacted by human resources teams in private companies, diversity and inclusion teams in federal government departments, and organisations advocating for both disabled and neurodivergent people to confirm they can access my resource and share it without cost.[47]

2.34The widespread take-up of this unfunded resource highlights the depth of need in the community and in workplaces for greater knowledge in how to implement adjustments for people with executive dysfunction—such as ADHD—so they can achieve greater success in the workplace.

2.35Occupational Therapy Australia made a similar recommendation noting that occupational therapists 'have a unique focus on the skill development required for maintaining employment and increasing productivity' and listed several ways this cohort of professionals could be better utilised to provide support to increase the workplace participation of people with ADHD.[48]

Social impacts

2.36The social impacts felt by people with ADHD and their family members or carers are both deep and widespread. Inadequate opportunities to access support and develop an understanding of self over time, can result in people with ADHD experiencing friction and stress within families, marriages and partnerships, and for people with ADHD themselves it results in social isolation.

2.37Some of these social impacts are detailed below, drawing on the submissions made by people with ADHD and the people who support them.[49]

Social isolation

2.38Many people with ADHD experience difficulties in forming or maintaining relationships, causing social isolation. It was made clear to the committee that for children, this can lead to them being unable to form friendship and support groups at school, resulting in life-long negative consequences. Submitters told the committee that:

The impact of being severely bullied and completely socially isolated because of ADHD throughout the entire school years is significant – my son was never able to really celebrate his birthday because he had absolutely no one he could invite to a party.[50]

…

ADHD impacts every aspect of my son's life. He struggles to regulate his emotions, to think through the consequences of his actions, to form friendships, to interact with others in appropriate ways, to engage with non‑preferred activities, to get started on activities, including getting dressed in the mornings, and with complying with the requests of others.[51]

…

Our daughter faces social challenges constantly. She loved being at home during COVID as she didn't have to think so hard about behaving in a social setting, being judged, not saying the right things at the right time and being rejected by other kids.[52]

…

… As a result of his behaviour in primary school, my son developed deep depression in relation to the effect he was having on others, and because children were often prevented from playing with him by their parents. Also, as a direct result of his inability to focus and control his behaviour, he was frequently targeted by school bullies – they'd attack or provoke him just to watch him explode, then he'd be the one who'd get in trouble. People would steal his belongings, physically attack him, even pull his pants down in the playground, just for the fun of watching him get in trouble. With this as his day-to-day experiences, the depression was deep and profound. Then, of course, he'd become anxious that it would happen again and that he wouldn't be able to control himself. As a result, he first attempted to take his own life at age 8. Then again at 10, and around 14. He is far more settled now as a young adult, but still struggles with depression and anxiety and struggles to commit deeply to personal relationships.[53]

2.39Many other submissions made by people with ADHD noted the difficulties they faced in social interactions because of ADHD symptoms, including intense social anxiety:

… feeling isolated and unsupported with my ADHD exacerbates my depression and anxiety and makes it difficult to leave the home and be a part of society.[54]

…

Due to the social difficulties and lack of social skills associated with ADHD, I was isolated from having any sort of social relationships outside of my family after finishing Year 10 , and it was not until I started my graduate position in the APS in that I developed any friendships or interacted with anyone outside of my family unless it was for something I needed to attend like a medical appointment or at my part-time sales position. During these years … the social isolation, as well as being misdiagnosed over this period with ADHD never being mentioned as a potential cause, resulted in me only entering the workforce for the first time at 28 while undertaking post‑graduate studies, and there were several instances over these years where I had suicidal and self-harm ideation. Without the support of my family, it is not an exaggeration to state that it is likely that I would not be alive today.[55]

…

I have difficulty with many social interactions and struggle with feelings of inadequacy or low self-esteem, particularly if I have faced real or perceived criticism or negative feedback in response to my symptoms. I also find it challenging to maintain positive relationships with friends, family, and co‑workers.[56]

…

Socially, it is difficult to make friends or build healthy relationships with people who aren't ADHD, due to the lack of understanding people have. 'Ifyou cared, you would have remembered/done it/called/responded' are all common phrases we hear despite the fact the memory centre of our brain is only functioning if we can engage in our interests that creates a natural dopamine flow or are medicated to ensure that flow is regulated.[57]

…

As a 34 year old adult, I found it difficult to access an ADHD diagnosis. I am non-binary, but grew up female. This meant that the behaviours I displayed were not that of traditionally accepted ADHD, such as hyperactivity. Instead, I was withdrawn, prone to 'daydream' and lose focus, and struggled deeply with change. This impacted my schooling profoundly. I was an absconder, choosing to leave the classroom and not engage in areas that I lacked interest in. I was in constant trouble for being late to class, absent from class and for choosing to read or draw instead of focusing on the learning or the teacher. In primary school, I spent most of my time in the front office. I was unable to connect with my peers, which led to being bullied and excluded for most of my schooling.[58]

…

I am isolated because of my ADHD. Accessing the internet is overwhelming, limiting my ability to speak to others with ADHD and get support from them. I am barely in contact with my friends because the amount of executive function required to maintain those relationships is overwhelming.[59]

…

I grew up thinking I was stupid because I couldn't do the simple things my friends did. The very few friends I had, because not everyone wants to put up with someone who will totally forget you exist for weeks at a time, then feel so guilty they then won't make contact because they feel like failure. Fairenough, I don't know if I would either.[60]

…

I had almost no social life at the time as I found it anxiety-inducing to meet and talk to new people, especially in an unavoidably chaotic and fast-paced setting like a university campus. … I therefore had a university experience that was very different and isolating than what many others had or what is generally expected by others that I would have.[61]

2.40Caroline described how ADHD has impacted her ability to form romantic relationships:

I can't begin to explain to you how hard it is trying to maintain relationships and fall in love. This is a public apology to all the people I matched with on Tinder who think I ghosted them. I didn't. I just completely forgot the app existed because I've spent 6 consecutive hours trying to beat level 789 on Candy Crush.[62]

2.41The Australian National University Law Reform and Social Justice Research Hub noted the particular impacts on adolescent girls who 'often seek social conformity and robust social networks but may face difficulties such as rejection and social isolation' and recommended that social skills and interpersonal relationships should be a key focus on support services for this cohort.[63]

Marriage and family impacts

2.42Many submitters noted the impacts that ADHD has on marriage, partnerships and family units. Square Peg Round Whole, for instance, noted that for families with children with ADHD, it was 'a common story to hear of disputes within marriages/partnerships because the behaviours and the needs of our neurodivergent children are not like other children's'.[64]

2.43The Australian Association of Psychologists Inc. (AAPi) submitted that 'ADHD can have a significant impact on family dynamics and relationships, leading to increased stress, conflict, and decreased parental well-being', and furthermore that these stressors could result in negative outcomes for all family members, not just the person with ADHD.[65]

2.44The committee received a great deal of evidence regarding the impact of ADHD on families, relationships, and child wellbeing, and provides some examples below:

About 25 years ago I married a soldier who had ADHD but neither of us knew anything about it as my husband was undiagnosed and untreated. Given he also had PTSD [Post-Traumatic Stress Disorder], depression and anxiety (all of which can be a result of untreated ADHD) we of course had problems on the home front and in particular his ability to look after small children, manage finances and explosive outbursts. I knew something was wrong but no idea what it was… Eventually we separated due to high conflict which was affecting my young children (4 & 6 yrs). People with ADHD have higher rates of relationship breakdown and divorce.[66]

…

We are now in a crisis situation involving significant support from various agencies with a child significantly falling behind her potential. There is also significant strain on our family's mental well being with my husband now taking antidepressants, our son engaging with the school psychologist and our undertaking family counselling.[67]

…

ADHD impacts all aspects of our family life. Our other kid sees how her sister and parents react to ADHD, which is not nice to see, as we are all on edge, screaming at times, having mental breakdowns, crying… and being depressed and anxious which in turn impacts on other people around us, such as grand parents, and other kids. We don't do anything with a big group of people nor do we get out much since our ADHD kid can make things hard and throw a massive tantrum that we can't manage in public.[68]

…

Our daughter's symptoms only increased with time; her inability to concentrate made homeschooling impossible, and her lack of impulse control made our family life stressful and utterly exhausting.[69]

…

I struggle to hold down a job, I have had several car accidents. I sought [a] diagnosis because my body began to shut down. My hair began to fall out, I stopped ovulation and I was having frequent "meltdowns" during the first year of COVID. The effects this was having on my marriage made me afraid I would become another victim to the statistics of divorce that disproportionately effect people with ADHD.[70]

…

The biggest cost for not having my husband diagnosed sooner has been the impact on his education (barely completed high school), employment prospects (he's a manual labourer with low aspirations and self esteem despite being really clever), addictions (he self medicates with nicotine and alcohol) and interpersonal relationships (we are close to divorcing, as well as his negative relationship with his kids due to his unmanaged anger) … I'm grieving what could have been for my husband's life, as well as our marriage.[71]

…

I gave up hope of finding support for a couple more years and just battled on until it became untenable, I was so scattered, disorganised and chronically overwhelmed and I was on the verge of divorce, with a highly dysfunctional family dynamic and in fear of being terminated from my dream job due to chronic overwhelm and underperformance.[72]

Mental health and wellbeing

2.45Undiagnosed and unsupported ADHD is well-known to negatively impact people's mental health and wellbeing for a range of reasons. This can be because the ADHD is unidentified or poorly supported, or simply due to the pressures of managing the behavioural symptoms. The AADPA noted that some of the potential impacts of ADHD, such as academic failure, social isolation, and unemployment 'can have lifelong knock-on effects on mental health and wellbeing'.[73]

2.46ADHD is also known to coexist with other conditions, as described later in this chapter. The ADHA Foundation noted that ADHD can lead to mental health issues.[74]

2.47Amy described the mental health and wellbeing impacts that ADHD has on her entire life:

Growing up undiagnosed has caused irreparable damage to my self-esteem and self-worth. In the absence of external explanation, I forced myself to take accountability for challenges that were out of my control. Relying on self‑blame resulted in constant feelings of guilt and shame, self-loathing, suicidal ideation, and suicide attempts. I have struggled with maladaptive coping mechanisms, including disordered eating, self-harm, risky sexual behaviour, and substance use, as means of self medicating.

I rely on anxiety to motivate, perfectionism to maintain my attention, and I punish myself with self-blame to reinforce these organisational strategies. As an adult, I'm caught in a cycle of unattainably high standards and low sense of achievement, where I always fear failure and never feel like I've done enough. This affects every aspect of my life, including my education, my job, and my relationships.[75]

2.48Other submitters described the devastating impacts that ADHD has on their mental health and wellbeing:

I experienced significant social difficulties growing up because of my ADHD. I was bullied, constantly in trouble for interrupting people in conversations and for going off on tangents. I always had this deep feeling that there was something very wrong with me. To this day I am still working through some of the trauma and self-esteem issues that all of this caused in therapy. All this also made me more susceptible to some much more significant traumas that had a massive negative impact on my life and resulted in PTSD.[76]

…

Due to lack of awareness of ADHD in pre-school setting, one of the children had received negative messaging from a young and impressionable age. Due to lack of awareness and guidance from early child care services, we parents implemented damaging discipline and parenting approach based on behaviour modification which the child was simply unable to achieve.

This combination has led to significant distress and suicidal ideation in this child by the age of 6 years. This trauma is continued and presents [as] poor self-esteem and a distrust of authority.[77]

2.49One parent noted of their child:

… my then 7 year old boy was so lost and beaten down by schooling and being 'different' that he was talking about no longer being alive, that he felt he was so 'naughty' he would just rather die. He felt so 'other,' so constantly misunderstood in school and at home that his innocence and joy in childhood was muddied by his early ADHD experiences.

I cannot express to the committee the heartbreak and gut wrenching fear that hearing these thoughts and feelings from your child does to a parent. Itliterally felt like a matter of life or death to access paediatric and professional support as quickly as possible for our son.[78]

Exhaustion

2.50Many submitters and witnesses expressed their exhaustion from being neurodivergent in a world not built for their brain. Adam described it has having 'rolling burnouts'.[79] Other submitters noted:

I struggle to maintain a high quality and standard of life. I struggle to balance work and self-care, I struggle to maintain friendships, I struggle to maintain employment. I am exhausted.[80]

…

ADHD is a disorder that impacts executive functioning—the ability of people to transition from one task to another, hold multiple pieces of information in their short-term memory, and manage multiple small tasks at once. Living with ADHD often means having to divert more mental energy to mundane tasks and activities—I often compare it to the daily household task of emptying the dishwasher. Those without ADHD would process that as an individual task, whereas my brain processes it as forty. Each individual plate, bowl, and mug in that dishwasher is mentally processed as an individual task. It becomes exhausting very quickly.[81]

…

In my own experience, my good grades and nice manners blinded everyone to the truth of my disabilities. Nobody appreciated how incredibly hard Itried, how exhausted and isolated it felt to have to try so very hard.[82]

…

At the moment my ADHD causes me to be overstimulated by most situations causing drastic mood swings, never being able to focus on one task at a time, and have multiple things on the go, causing crippling stress and anxiety. My brain is literally doing 20 things at a time and never switches off, it's exhausting.[83]

…

I usually am exhausted by the end of the day from masking, overcompensating and trying to keep everything somewhat under control. I have already found myself burnt out so have made sure to prioritise self care, self compassion, and meditation.[84]

…

I was a wife, mother, and I also was employed mostly as a support worker, but it was exhausting; concentrating so hard to remember things. I just wanted to be like everyone else. I never understood why it seemed so easy for others. I burnt out a few times, and had melt downs, a mixture of anger, hurt and a broken heart. I always meant well and never wanted to hurt anyone but somehow, I always did; feelings of failure, and yes, in the past I've been suicidal.[85]

…

Working so hard my whole life to do what others could easily do and what came naturally to them was exhausting. Feeling the burden of this weight, made life that much harder for me.[86]

…

The effort it takes to get moving is monumental and leads to being absolutely exhausted by the end of the day, sometimes without even achieving much, the mental exhaustion one feels from battling your brain to let you get up and do what you want and need to do is overwhelming. As you can imagine, this causes problems everywhere with your life.[87]

…

I developed constant, general anxiety, and periods of depression which therapy and medication largely failed to manage. My self-esteem and confidence have been at times very low. Being "driven by a motor", and a tendency to hyper-focus, has driven me to burnout and fatigue and my mental and physical health has suffered as a result.[88]

Suicide and self-harm

2.51In the following section, the committee provides some examples from submitters with their experiences of suicide ideation and self-harm. Readers should take care and only proceed if they are comfortable doing so. A list of support services is provided at the start of this chapter.

2.52The committee was told that for people with ADHD, suicide is an increased factor in their experiences, particularly when they are not supported.[89]

2.53Suicide Prevention Australia submitted that it holds concerns about the increased risk of suicide for people living with ADHD, because 'ADHD symptoms such as hyperactivity, impulsivity and inattention can have a profoundly debilitating and disruptive impact on people's lives and can cause significant behavioural, emotional, and social difficulties'. It pointed to alarming international research showing that:

… people with ADHD may be up to five times more likely to attempt suicide, and three times more likely to die by suicide compared to the broader population. While a study undertaken in New South Wales found that children and young adolescents hospitalised for suicidal behaviour were four times more likely to be diagnosed with ADHD.[90]

2.54Many submitters with ADHD described their experiences of self-harm or attempted suicide:

I was 14 the first time that I self-harmed. I didn't know why at the time, but I would later come to learn that it was a coping mechanism for when I felt emotionally overwhelmed … Throughout my teen years my parents were given numerous explanations for my behaviour, not once was ADHD suggested. I was labelled an attention seeker, and many of my struggles were dismissed by medical professionals.

I attempted suicide numerous times during my adolescence. My treatment team told my family to prepare for when I died, not if. They predicted that I was unlikely to make it past my 21st birthday. My most serious attempt was an impulsive decision. I had been actively suicidal for months and was placed on daily pick-up restrictions for my medications. I was searching for pens when I came across boxes of medication. Hours later I was in a coma.[91]

…

I developed depression during my teenage years. In fact, I only completed year 11-12 because I was told that my future would be bleak and I would [not] be able to finish anything if I didn't finish school. So instead of getting rest and seeking help, I pushed it all aside and delved deeper into depression, self harm and suicidal thoughts.[92]

…

I left school in year 10, abused both drugs and alcohol, ran away from home, spent time in hospital and youth refuges, engaged in risky sex resulting in teen pregnancy before I would even legally drink, and I was diagnosed late. That means my 3 children are 4 times more likely to have their mother die. I just hope it's when they are much older than they are now.

I am unsure what all that costs the government, but I am fairly sure it's a lot of money.[93]

Crime and justice

2.55It must be recognised that not all people with ADHD engage in criminal activities.

2.56It was noted by many submitters that interactions with the criminal justice system are often a failure of access to healthcare, an interaction with inadequately trained police officers, challenges with managing finances, or the inability to find work that meets their needs.

2.57AAPi shared that 'individuals with untreated or poorly managed ADHD are at an increased risk of involvement in the criminal justice system', particularly when people have not been able to access a formal ADHD diagnosis, or be given appropriate healthcare and supports post-diagnosis.[94]

2.58Occupational Therapy Australia noted:

The prevalence of ADHD in the correctional system is much higher than in the general population … The correctional system would benefit from occupational therapy input to assist people with ADHD in the correctional system to learn to manage their executive dysfunction and maximise employment opportunities.[95]

2.59Dr Kay-Sheree Spurling, a psychologist working in a residential alcohol and other drug (AOD) service, explained what she saw as the 'social cost of failing to provide services for people who experience ADHD', saying:

I see clients with undiagnosed, untreated or ADHD diagnosed in childhood but not followed up as an adult with severe AOD concerns. This is often accompanied by involvement in the criminal justice system, unemployment, financial hardship, health concerns and separation from children via child protection involvement. This has a significant social cost to the individual, their family and society as a whole.[96]

2.60One parent noted that for their son, interactions with police were largely due to his 'cheeky' behaviours often being misinterpreted by inadequately trained police, while also leaving him at heightened risk of exploitation:

During this period of his late teens, there were also incidents that made him known to police, and most can now be seen in the context of his condition, such as retrieving him from the back of a paddy wagon for giving unrelenting cheek to police, climbing the fence of a closed McDonalds and throwing eggs or milk at the wall after staff were rude to him, and throwing a party at our home when I was away, involving hundreds of teenagers. His notoriety also made him a target for his contemporaries – he was assaulted and robbed at knifepoint and his car was vandalised beyond repair.[97]

2.61More parents noted the inappropriate use of police for minor offences by children who have ADHD:

Our daughter has now been to the police station twice for things that are relatively minor (kicking/pushing one time, pulling on a school bag the second time – there are police records to back this up). This has been very distressing for her, and us … having the police called in has been one of the most distressing and worrying things to go through. In my opinion also a fine waste of NSW Police resources due to the other family's lack of understanding for our daughter's condition. The NSW Police themselves were understanding, professional and clearly just doing their job, however the stigma my daughter may feel in the short and long-term at being required to attend a police station at 13 years of age is worrying.[98]

…

The police could also do with a lot of training around mental health and neurodiversity. Please. Particularly since there is an increasing and alarming trend for schools to call the police to deal with student meltdowns that should have been avoided by the actions of better trained school staff and better systems.[99]

2.62ADHD Australia argued that in some cases, the symptoms of ADHD themselves resulted in people being disadvantaged in participating in police and court processes, leading to 'disproportionate sentencing, and inadequate support for rehabilitation which can lead to higher rates of recidivism'. ADHD Australia noted that once incarcerated:

… there are significant barriers to people living with ADHD in justice settings accessing ADHD treatment, including when they're frequently moved or when correctional staff are not trained to recognise 'behaviours of concern' as potential signs of ADHD.[100]

2.63Once people are in contact with the criminal justice system, there is limited awareness of ADHD within that system, where ADHD is both mis‑ and under‑diagnosed.[101] RANZCP noted that young people with ADHD are unfairly treated within the justice system, noting they 'are more than twice as likely to be convicted of a crime and three times more likely to be incarcerated, with substantially higher rates of recurrent offending with earlier re-entry to justice systems than young people without ADHD'. RANZCP raised concerns with the lack of appropriate care for these young people in the care and justice systems:

The fragmentation of care between state funded custodial health services and community-based health services, both public and private, presents a significant barrier to successfully implementing evidence-based treatment in a custodial setting. Even if treatment is initiated, it is often discontinued upon a person's release from custody because they are unable to access the necessary treatment providers for both pharmacological and non‑pharmacological interventions.[102]

2.64Mr Jobson of Insync for Life made several recommendations specific to ADHD in the justice system, suggesting they could 'lead to improved rehabilitation outcomes, reduced recidivism rates, and safer communities' as well as 'providing support and resources to individuals with ADHD' which could assist them to 'reintegrate into society, contribute positively, and lead fulfilling, pro‑social lives'. These recommendations are outlined below:

Screening and assessment: Implementing routine screening and, if necessary, comprehensive assessments for ADHD among individuals entering the justice system is crucial. This can help identify individuals who may have undiagnosed ADHD and require appropriate interventions.

Staff psychoeducation and awareness training: To increase awareness of the impact of adult ADHD on offenders and their behaviour, education and training initiatives for prison staff are essential. This can involve providing comprehensive information about ADHD, its symptoms, and its potential influence on individuals' behaviour within the prison environment.

Offender psychoeducation and skill development: Following assessment and diagnosis of offenders with ADHD, the availability of skills development programs can focus on areas such as impulse control, anger management, problem-solving, and social skills, empowering individuals to develop coping strategies and make positive behavioural choices.[103]

Coexisting conditions

2.65As outlined in Chapter 1, there is a strong occurrence of coexisting conditions for people with ADHD, particularly other forms of neurodivergence such as autism, or mental health conditions such as depression and anxiety. More than 65 per cent of children with ADHD have at least one coexisting condition.[104]

2.66The Tasmanian ADHD Support Group noted that many adults with ADHD and coexisting mental health or substance dependence issues, together with 'long wait times to access treatment and the high costs exacerbate these issues, leaving some people in great emotional distress for extended periods of time, with all the attendant risks this brings'.[105]

2.67Many submitters noted the impacts that having coexisting conditions has on their lives:

I live with ADHD, ASD, Insomnia and Fibromyalgia.

My doctor also diagnosed me with Depression and Anxiety before the pandemic even started. The lockdowns, long periods of WFH and isolation have severely impacted my mental health and I'm struggling to perform basic life tasks -let alone meet people or study for work. I have difficulty focusing on anything important - work tasks, conversations. My memory is terrible - longterm memory, short-term memory and working memory all don't work well. I experience constant tiredness and brain fog. I am overly sensitive, especially to injustice. I am great at starting projects but I don't follow them through to completion.[106]

… my son suffers from anxiety and depression … these conditions are frequently diagnosed as comorbid conditions alongside ADHD. My daughter also suffers from anxiety, mainly severe social anxiety. While these conditions may be regularly associated with ADHD, they are often exacerbated by the outcomes of the ADHD. This is true for both my children.[107]

…

More than half of all individuals with ADHD (with some sources putting this at two-thirds) also live with at least one other adverse health condition, which can immensely reduce quality of life. As I am writing this submission, I still struggle to determine which events or behaviours of mine are attributed to ADHD, which ones are due to autism spectrum and which ones are anxiety. The symptoms of these conditions, while distinct, also overlap and interact with each other, which makes it very difficult to talk about ADHD in isolation from other conditions, including in my submission despite the inquiry only referring to ADHD.[108]

…

During adolescence, the anxiety, stress, depression, critical self, self-harm, mood disorders, eating disorders, suicidal behaviour, all seemed intolerable and far too much to bear. Now knowing all the ways young girls were not diagnosed in the 90's and 2000's, and how often girls were expected to be good and quiet and attentive in the school work, all these things made this fly under the radar at the time.

Coupled with awful bullying, underlying trauma and instances of abuse, the co-morbidities created the perfect storm for a teenager spiralling out of control.[109]

…

… being diagnosed with ADHD finally linked all off the issues I have, and gave me answers. At the same time, I got my dual diagnosis. My "noises" are tics, with tic disorders and Tourette's being incredibly common comorbidities with other forms of neurodivergence. But nobody in all the years I sought help for this could tell me that. And so I suffered…[110]

…

It's been a hard fought battle to address the complex web of mental health concerns and overlapping symptoms. I cannot neatly unpack my experience of ADHD and these comorbid conditions into neat separate boxes. Theywere experienced together. It's all the same package to me.[111]

2.68A submitter noted a Harvard Medical School study which found that 'girls with ADHD were almost four times more likely to have an eating disorder than those without ADHD'. In relation to her own daughter, she submitted:

My daughter developed an eating disorder at about 13 years of age in an attempt to control her weight and in a desperate attempt to be accepted by her peers. This soon becomes an addiction to overeating to soothe emotional pain followed by shame and guilt and then purging. Over time the purging becomes associated with a euphoria and is addictive.[112]

First Nations and culturally diverse people

2.69Cultures which may have behavioural differences to the dominant cultural background of health practitioners can often be misdiagnosed in relation to ADHD. This can impact on both First Nations peoples as well as culturally and linguistically diverse (CALD) people, and depending on the context, can result in people either being under‑diagnosed or over-diagnosed, and can include inappropriate medications intervention.[113]

2.70The Aboriginal Health Council of Western Australia noted that while ADHD is not a culturally specific phenomenon, it is 'perceived differently across cultures with some viewing mental health holistically beyond the notion of symptoms and functional impairment'. One Aboriginal Community Controlled Health Service noted that children in its region would be highly unlikely to be diagnosed with ADHD prior to attending school, 'based on the fact that behaviours often triggering assessment are not likely to be identified by family members as particularly abnormal'.[114]

2.71The AADPA similarly noted that both Indigenous and CALD communities can view the symptoms of mental health conditions differently, which can lead to the 'misidentification of symptoms that are otherwise considered as culturally appropriate'.[115]

2.72Square Peg Round Whole highlighted concerns that for First Nations families where a child may have ADHD behavioural symptoms, the families can be at increased risk of being 'gaslit on their parenting approaches, and assumed not to be parenting well' and suggested that many providers were not appropriately trained in the trauma informed approaches that can be required.[116]

2.73The Institute for Urban Indigenous Health noted that there are often delays in appropriately assessing First Nations children, which can then lead to those children being restricted from attending school as they are typecast as the 'naughty kid', further exacerbating cycles of disadvantage.[117]

2.74The Institute further noted that as many First Nations children have multiple intersecting areas of disadvantage, this can increase the prevalence of ADHD, the risk of misdiagnosis, and the risk of a lack of appropriate supports following identification. These areas of risk include increased rates of coexisting conditions, such as Fetal Alcohol Spectrum Disorder, socio‑economic disadvantage, higher rates of incarceration and out‑of‑home‑care, living in rural and remote locations with reduced access to health services, as well as institutional racism.[118]

2.75A mother made a submission detailing the experiences of three Aboriginal adult children, each of whom had a difficult pathway to being identified as having ADHD. One of her daughters had initially been misdiagnosed as not having ADHD, and then later re-assessed by a different service which did find inattentive-type ADHD. She noted that:

Ideas of 'Cultural safety' and the 'working together report' look impressive in writing and give the right impression that the Indigenous experience is being considered. But, on the ground, I see no evidence of this happening.[119]

2.76Similarly, coming from a CALD background can mean people have additional barriers to proper assessment and treatment of their ADHD. The MulticulturalDisability Advocacy Association told the committee that:

Invisible disability such as ADHD frequently goes unrecognised within CALD communities for a variety of reasons. These reasons can include the cultural stigma attached to disability…[120]

2.77Submissions made by people with ADHD from CALD backgrounds noted that their cultural diversity meant they were not appropriately assessed or supported for ADHD:

I am 27 years old and I was born in Perth Western Australia and I was diagnosed with ADHD on the 27th of March 2023. I was born in Perth, Western Australia to my parents who are first generation immigrants from Sri Lanka. I was not noted as having any significant health difficulties growing up. Unbeknownst to anyone at the time, I had ADHD, combined type and hypermobility spectrum disorder.

I had immediate family members with symptoms of ADHD that were not assessed. Cultural barriers meaning diagnosis such as ADHD were not discussed or spoken about and carried significant stigma. If this family member was able to be assessed I may have had more luck.[121]

…

I grew up in a Southeast Asian country … I was undiagnosed in childhood not because of negligence on my parents' part, but because of their lack of understanding of mental health conditions, including ADHD, and believing that my behaviour was "normal" for my age.[122]

Carers

2.78Carers of people with ADHD, most usually parents of children, noted the many challenges associated with their carer role. The impacts of caring for someone with ADHD include financial costs associated with health needs along with reduced earning capacity due to carer duties, as well as social isolation and exhaustion. Additionally, as ADHD has a genetic component, many families have more than one member with ADHD, sometimes including the primary caregiver themselves.

2.79Those who care for people with ADHD noted the overwhelming nature of their carer functions:

People with ADHD and their families are constantly coping with the effects of ADHD from the time they or their kids wake to the time they fall asleep, and in most cases after then too. It is an impairment that will need to be managed and accommodated throughout life … Parental stress is extremely high in a household with ADHD. For the parent/s to take on the executive functioning load for other members of the family that are not capable of performing basic self-care and life skills without consistent reminders or assistance is draining.[123]

…

I now have depression after years of trying to survive this beautiful yet full on child. I am constantly advocating for him and had fallen on deaf ears. I had thought about ending my life during home schooling before being taken seriously to diagnose. We have little government support. All our savings go to paying for occupational therapy, medication, paediatricians and psychologists. It feels like ground hog day.[124]

…

I have always and will always continue to advocate for my children and support them to develop the life skills they will need for the rest of their lives. But I am exhausted. I am so, so, so, so, so, tired. I really need help – this job of case managing my children's care is just too much now.[125]

…

This had a significant impact on the family. We were all emotionally exhausted. It was distressing not to be able to support him, and our work suffered due to terrible reliability and reduced income from exhausting leave allowances.[126]

…

The challenges in parenting an ADHD child today and the internalized shame that comes from disapproving comments or looks from those who do not understand what ADHD is (be it friends, family, the schools etc) can severely impact on a parents self esteem, on their ability to trust their instincts and to not feel like they are to blame for what is happening for their child. This stress and isolation affects every aspect of a family's life - on how siblings interact, on how marriages cope, on how parent-child bonding occurs- just to name a few. My marriage is one of so very many under strain due to the burnout.[127]

Carers: the impact on employment and finances

2.80Advocacy group Square Peg Round Whole noted that for families with a child with ADHD, it is common for one parent to reduce their work hours or stop work completely due to the repeated calls upon their time to attend school and therapeutic appointments, or because children are not allowed to attend after school care programs, or even to provide a homeschooling environment.[128]

2.81This finding was supported by the evidence provided to the committee by numerous carers:

The financial burden of having children with ADHD is monumental. Notonly is the cost of accessing services such as psychologists, tutors, speech therapy, occupational therapy, medical professionals absolutely prohibitive but there is the double burden, especially in single parent families, that because your children require so much additional care and support, that requires physically taking them to appointments etc, your capacity to actually work and earn an income is severely reduced. It is impossible to work full time when your children need so much additional support but are unable to access any funded support programs because ADHD is a diagnosis that excludes access.[129]

…

With the limited support currently available to us within all systems, including education, managing our young son is currently having economic implications on us, his parents. I am unable to work to my full capacity due to the need to be on call for the school should any safety issues arrive and if he needs to be collected from school and also to manage the reduced attendance timetable currently in place.[130]

2.82Carers Queensland discussed the impacts on parents of having children with ADHD in schools:

Children with ADHD and other co-morbid conditions can engage in behaviours which are deemed to be unacceptable by schools. Carers have reported to us that they will receive several calls per week to collect their child early because they have been removed from the classroom or are only allowed to attend for a limited number of hours. In some cases, parents have been advised by their child's school to always be within a fifteen-minute radius so they can collect their child with very little notice.[131]

2.83Many carers noted the impact on their working life or careers due to their carer role, with one submitter saying:

I am tertiary educated and have been employed full time in the marketing sector. With the challenges in finding appropriate support for my second child, I left paid employment.

Managing requirements of a family with members affected by ADHD requires daily involvement from me that I believe is significantly greater than may ordinarily be required in a family with neurotypical needs. I take on executive functioning load for all in planning, reminding and executing many tasks. Assistance with school / school work has been a significant use of my time. Parenting children with needs and difficulty in navigating health and education systems have often impacted my stress and health.[132]

Carers and relationships

2.84The committee heard that being a carer of a person with ADHD has significant negative impacts on carer's relationships. Carers NSW noted that 73 per cent of carers of people with ADHD reported social isolation, compared to 57 per cent of other types of carers reporting the same impact.[133]

2.85Many carers of people with ADHD documented the impacts that the carer role has on their ability to form and maintain relationships. In many cases the stress contributed to the breakdown of marriages:

While there are numerous reasons for the breakdown of many marriages, my marriage was severely impacted by the effect of ADHD on our entire family. The strain and tension of dealing with an unknown condition for years, dealing with children self-harming, dealing with constant issues at school, these things robbed our family of joy and spontaneity … As I said, there are many reasons for the breakdown of a marriage, but I do wonder where we'd be today if we and our children had received adequate and appropriate support.[134]

…

Today was the first day that I had a professional ask me how the diagnosis has affected me and my marriage, our family. This was during S's intake appointment with a psychologist. The diagnosis has affected our whole household, we are constantly strained and stressed.[135]

…

At the point of diagnosis of ADHD for me I was really struggling to work fulltime, I was working 20 hours a week but any more than that would be too exhausting for me, I had separated from my husband and my daughter (both ASD) as I had carer burnout from their difficulties and my own as well without support it was too hard. This was all because I had undiagnosed ADHD.[136]

Multigenerational family clusters

2.86Due to the genetic nature of ADHD, many adults with ADHD can also be carers of children with ADHD, or experience ADHD across their wider family supports. This can exacerbate the challenges of caring for a person with ADHD. NursePrac Australia told the committee they often see the intergenerational impacts of ADHD on whole families:

[W]e're seeing many families with things like ADHD that has been through multiple generations, and we're seeing the consequences. We're seeing parents who've had school failure themselves, educational failure and work failure and who have been in and out of the justice system, and now we're seeing the next generation.[137]

2.87Many submissions made by people with ADHD and the people who care for them, told of similar cases in their families:

It is taxing for parent and child relationship for the parent to take on coaching role that is needed to build up skills in basic developmentally‑relevant tasks – especially during adolescence. This is made even harder if the parent's own executive function is affected by having ADHD.[138]

…

Our family has multigenerational ADHD … The burden of multigenerational ADHD in the home is exponentially more difficult to navigate with strained relationships (struggles with emotional regulation & childhood traumas), often instability in the workplace due to the traits of often life-long unsupported ADHD (impulsivity, challenges with regulating productivity), the cost of medication and/or support services doubling with every diagnosis received and the very human, emotional toll that takes on all individuals in the home.[139]

…

My daughter's diagnosis was so hard to get … I fought long and hard for my daughter, and kept at it, so very exhausting when I have a high level of Executive Dysfunction from my own ADHD … Diagnosis is only the beginning of finding me and my daughter the supports we deserve to navigate our neurodiversity.[140]

…

On my father's side of my family I have twelve cousins, six of us have been diagnosed with ADHD, and a further three suspect they may have it. Fiveof the six are females, and only the male was diagnosed during school, the remainder were in the last few years, and we are all in our 30's and 40's now.[141]

…

Emotional dysregulation is a common symptom of ADHD. It can be more difficult to manage and control emotions around children. Family situations can become volatile very easily and it is difficult to teach children how to [regulate] emotions when the parents also have difficulty regulating emotions.[142]

Diagnosis later in life

2.88In a significant number of cases the committee was told of people being diagnosed with ADHD later in life—often after a child of theirs had been formally diagnosed:

Unfortunately, I was not diagnosed with ADHD until after my daughter was (I was approx. 37 years of age) when I started to read up on it to help her.[143]

…

When my son was 6, he was diagnosed with ADHD. The process was straightforward and was able to be completed through our local paediatric clinic … In 2021, after rereading my son's WISC [Wechsler Intelligence Scale for Children] report, I began to see my own struggles. I researched ADHD in women and approached my psychiatrist for an assessment … I was diagnosed with ADHD in 2021 at 33years of age.[144]

…

Following my son's diagnosis, my husband was diagnosed at the age of 39 by a psychiatrist … I am glad that my children will hopefully not have a lifetime of struggling, wondering why they can't focus, why it's hard to sit quietly, why their brain works at a million miles an hour, thinking they're stupid when in fact they're both incredibly intelligent. All of which, my husband suffered through.[145]

2.89One mother described the stress of raising a child with ADHD which resulted in exhaustion and financial barriers, and saw her delay seeking a diagnosis for herself:

In the course of ten years, I attempted to seek help for my ADHD twice. Bothtimes I have been unsuccessful at receiving proper treatment. This was due to a number of reasons. We couldn't afford the expense of regular appointments. Additionally, I was so overwhelmed at even the thought of having to keep up with medication and appointments, I simply gave up, and focussed on raising my son.

In October … unable to cope with the stress of raising a child with a disability, and fighting to keep my own mental health in check unaided, things finally took their toll. I experienced a complete breakdown. I sought the help of a psychologist and she encouraged me to address my ADHD. Iwas prescribed antidepressants and given a referral to a private psychiatrist.[146]

2.90Another submitter observed that by going through the 'ADHD and autism journey with my son', they in turn learned more about themselves:

All of the areas that he struggled with the most, such as fitting into the school dynamic, making relationships and keeping friendships with his peers, uncontrollable impulsive outbursts, dysregulation, hyperactivity, uncontrollable fidgeting and distractibility; this was all me …

What came with this realisation, was a devastation and an overwhelming sense of sadness at the lost years and struggles, and the times where I was so angry with myself because I could not figure out my brain. All the years I could not save myself, I was drowning, and it took me years to rise my head above the water. All the poor coping skills that I still attempt to abandon are products of overwhelm, giving too much of myself and not understanding boundaries to protect myself.[147]

Late diagnosis and grief

2.91A number of submitters wrote of their grief at a late diagnosis, including MsEmma Sharman, an ADHD advocate with lived experience:

It is common for people who are late-diagnosed to experience grief – that their ADHD was not seen sooner, and therefore they did not receive help. This grief also makes you consider how your life might have been different for the better, if you had. I am happy with the life I have, but that does not mean I do not grieve for my younger self who should not needed to survive all the challenges that resulted from a lack of diagnosis and support.[148]

2.92Many other lived experience submitters who were diagnosed as adults described a similar period of grieving for the life they could have lived, had they received a diagnosis as a child. Submitters told the committee the following:

For my husband, after being told all of his life that he was stupid or just not trying enough, and as such choosing to not pursue tertiary education or the career path that he dreamed of, the diagnosis was bitter sweet. Whilstgrateful to know he isn't and never was stupid, it doesn't change the damage to his mental health that has already been done. It doesn't change the anger and frustration he felt at the life he could have had, if he had have been diagnosed and received adequate support as a child. It was a lot for him to handle and he needed to go back onto anti-depressants for a while.[149]

…

There was tremendous grief about the "lost years" – of what might have been had I been diagnosed much earlier, and known what I was up against. This, and years judging myself not knowing I was different to other people, has had a profound effect on my life in many ways.[150]

…

Receiving an ADHD diagnosis has been life changing. However, it has also made me reflect on the missed opportunities and how different my life could have been if I had received a diagnosis as a teenager. It is my hope that through this inquiry, more girls won't be misdiagnosed and experience the same struggles I did. Since my diagnosis I have been able to recommence study, and finally see a life that I didn't believe was possible.[151]

…

For many people diagnosed with ADHD or Autism as adults, there is a profound feeling of grief. We grieve for the happy, over-achieving children we were, and for the studious and friendly teens we could have been. Wegrieve for the relationships that were lost because of our inability to maintain them, and for all the times we failed and blamed ourselves, only to find out that it was never a problem of competence, but of accessibility. Itis difficult to describe the feeling of loss that comes from only fully understanding your experiences, and even yourself, in hindsight.[152]

…

The late diagnosis of ADHD has had a profound effect on my life, firstly as I question my identity, I now have an explanation for why I struggled so much in education settings and employment settings, why I struggle with daily living tasks and why my mental health is so poor. But also I wonder would I have so many mental health conditions if I was diagnosed as a child and managed to seek treatment in my early years, would I be doing better in life? Would I have a more successful career and education? I struggle with this a lot at present as my diagnosis is quite new.[153]

…

When I was first diagnosed I was angry. I had spent years unknowingly articulating my ADHD symptoms in great detail to more than a dozen different doctors, psychologists and psychiatrists, who did not pick up on it or know what to do with me. I was repeatedly offered hormonal contraception which worsened my symptoms, or antidepressants. After my ADHD diagnosis, it felt like the lights were coming back on. I had all the pieces of the puzzle. I had a new vocabulary for what I experienced. I had new options for managing my symptoms that could change my life… except I can't afford them.[154]

Stigma

2.93As all the experiences detailed in this chapter show, stigma is constantly attached to those living with, or around, ADHD. Stigma around ADHD was a deep concern raised with the committee by many professionals, people with ADHD and those who support them.

2.94WA Health noted two different types of stigma and its manifestation—personal stigma, and affiliate stigma felt by caregivers. Both types of stigma occur when people perceive and internalise negative community and professional beliefs around ADHD. WA Health contended that these negative beliefs:

… most commonly stems from lack of access to public information on child mental health and behavioural disorders in general as well as specific knowledge and beliefs about ADHD. Lack of knowledge about the diagnosis/diagnostic requirements and the benefits and risks of treatment as well as the range of treatments available is widespread amongst the medical profession and the community at large.[155]

2.95ADHD Australia similarly advised that '[p]eople with ADHD experience daily community judgement due to common misconceptions and misunderstanding the different realities of living with ADHD'.[156]

2.96The Royal Australian College of Physicians submitted that many people who are higher functioning with their ADHD can often face stigma that they may be 'following a trend rather than genuinely struggling to function to their full capacity because of ADHD'.[157]

2.97AAPi advised that stigma around mental health, including ADHD, 'can discourage individuals and families from seeking a diagnosis', can 'lead to scepticism or dismissal of the disorder's legitimacy' and can lead to a 'risk that the individual is labelled as lazy or unmotivated when they have educational difficulties due to their executive function challenges'.[158]

2.98Consumers of Mental Health WAreported that stigma makes it harder for people to seek treatment. Of particular concern, some people reported experiencing dismissive stigma from their psychiatrists and doctors in relation to considering an ADHD diagnosis. One person reported:

My first psychiatrist ... ended up telling me not to 'get excited', because 'you're not getting any stimulants.[159]

2.99The AAPi likewise suggested that stigma was present in treating professionals and recommended that programs be implemented to promote:

… neurodiversity affirming positive attitudes towards ADHD, and reducing stigma are of high importance, as are educational initiatives targeting healthcare professionals, educators, and the public.[160]

2.100Consumers of Mental Health WA submitted that stigma extends from the condition of ADHD to medications for ADHD. As one person reported to that organisation:

You basically feel like a criminal. I wish that ADHD medication wasn't a drug that is restricted and abused by some people because you feel judged, and like your psychiatrist and the pharmacy are constantly monitoring you like a criminal. I also found there is a lot of stigma in the community from people who don't understand ADHD and the medication. For example, people saying ADHD medication is basically 'meth'.[161]

2.101Consumers of Mental Health WA summarised the issue by noting that it 'is not appropriate for consumers suffering from a recognised disorder to be subjected to suspicion and judgement while pursuing treatment'.[162]

2.102Submissions by people with ADHD noted the impacts that negative attitudes and stigma have had on them:

ADHD is misunderstood, and even stigmatised, at an enormous scale. There simply does not exist a way for me to briefly describe the torturous, utterly Sisyphean chore of dealing with people who think the fundamentally different construction of our brains can be explained as "being a bit hyper" or the malicious and insidious assumption of "bad parenting", "drugging kids" because of "overdiagnosis" and/or "sugar". These assumptions are as prevalent and inescapable as they are utterly false.

I struggle to find the words to describe the abject misery of quietly tolerating the malice with which some of these people respond to the suggestion that some changes could be made in the environment around them, which may not even affect them, to accommodate the increasing portion of the population known to have ADHD. It is a hateful and unnecessary drain on the life and happiness of everyone dealing with ADHD, for whom life is already inordinately difficult. It is informed by nothing but ignorance and, I cannot stress this enough, it is everywhere. In some individuals it is utterly inextricable.[163]

…

I am a parent of two children with ADHD. This process of stigma starts at a very young age and often eventuates in significant bullying in the school setting. It then progresses through school leavers trying to enter the workplace and employers not understanding how they engage to really, on the one hand, get the best out of these young individuals and manage them to be successful. That progresses throughout the lifecycle of an individual with ADHD. That stigma shows up almost certainly at every stage of life in almost every interaction but probably most significantly in the school setting, particularly with peers and teachers, and in the workplace.[164]

2.103Many submissions put forward recommendations on addressing stigma, including public awareness campaigns and education for professionals who commonly interact with people with ADHD, in order to reduce the negative impacts that stigma can have on people's health and wellbeing. Theserecommendations are discussed in Chapters 5 and 9.

Footnotes

[1]Australian Psychological Society, Submission 42, p. 4.

[2]Name withheld, Submission 244, p. 1.

[3]Renee, Submission 363, p. 2.

[4]Name withheld, Submission 397, p. 4.

[5]Name withheld, Submission 244, p. 1.

[6]Mrs Mel Lawrence, Intake Advocate, Disability Advocacy NSW, Committee Hansard, 29 June 2023, p.16.

[7]Brenton, Submission 382, p. 1.

[8]ADHD Australia, Submission 11, p. 2.

[9]Australian ADHD Professionals Association, Submission 14, p. 3.

[10]The Children’s Hospital at Westmead, Submission 71, p. 1.

[11]Genevieve, Submission 93, p. 1.

[12]Joey, Submission 392, p. 2.

[13]Name withheld, Submission 268, p. 1. See also: Mrs Julie Brooks, Senior Vice President, Western Australian Council of State School Organisations, Committee Hansard, 24 July 2023, p. 46.

[14]Name withheld, Submission 139, p. 1.

[15]Anita, Submission 80, p. 1.

[16]Alexander, Submission 323, p. 2.

[17]Name withheld, Submission 114, p. 2. See also: Dr Cherry Baylosis, Policy and Communications Lead, Disability Advocacy NSW, Committee Hansard, 29 June 2023, p. 15; Mr Paul Schwerdt, LifeMember, Canberra and Queanbeyan ADHD Support Group, Committee Hansard, 29 June 2023, p.23; Dr Michele Toner OAM, Chair, Board of Management, ADHD WA, Committee Hansard, 24July 2023, p. 3; Mr Stuart Schonell, Chief Executive Officer, Advocacy WA, Committee Hansard, 24 July 2023, p. 18.

[18]Consumer Health Forum of Australia, Submission 3, p. 7.

[19]Jess, Submission 394, p. 3.

[20]Name withheld, Submission 540, p. 3.

[21]Cheryl, Submission 89, p. 1.

[22]Name withheld, Submission 207, p. 4.

[23]Name withheld, Submission 115, p. 2.

[24]Name withheld, Submission 204, p. 1.

[25]Name withheld, Submission 244, p. 2.

[26]Name withheld, Submission 255, p. 5.

[27]Trisha, Submission 340, p. 1.

[28]Name withheld, Submission 206, p. 2.

[29]Jacob, Submission 96, p. 1.

[30]Carers Queensland, Submission 24. P. 6.

[31]Ms Emma Sharman, Submission 28, p. [3].

[32]ADHD Australia, Submission 11, p. 5.

[33]Royal Australian and New Zealand College of Psychiatrists, Submission 21, p. 5.

[34]Jacinda, Submission 95, p. 1.

[35]Name withheld, Submission 292, p. 6.

[36]Tristan, Submission 339, p. 1.

[37]Name withheld, Submission 248, p. 4.

[38]Name withheld, Submission 200, p. 1.

[39]Paul, Submission 342, p. 1.

[40]Tim, Submission 345, p. 2.

[41]Amie, Submission 78, p. 1.

[42]Name withheld, Submission 142, p. 2.

[43]Name withheld, Submission 285, p. 1.

[44]Kathleen, Submission 378, p. 1.

[45]Australian ADHD Professionals Association, Submission 14, p. 19.

[46]Tasmanian ADHD Support Group, Submission 167, p. 3.

[47]Ms Emma Sharman, Submission 28, Attachment 1,pp. 1–25.

[48]Occupational Therapy Australia, Submission 30, p. 9.

[49]The impacts on relationships from the perspective of carers is captured later in this chapter.

[50]Name withheld, Submission 264, p. 12.

[51]Name withheld, Submission 270, p. 1.

[52]Name withheld, Submission 294, p. 1.

[53]Name withheld, Submission 104, p. 4.

[54]Maddi, Submission 240, p. 2.

[55]William, Submission 319, p. 3.

[56]Name withheld, Submission 134, p. 1.

[57]Courtney, Submission 335, p. 2.

[58]Ashleigh, Submission 372, p. 1.

[59]Danielle, Submission 329, p. 2.

[60]Claudia, Submission 92, p. 3.

[61]Name withheld, Submission 195, p. 1.

[62]Caroline, Submission 108, p. 2.

[63]Australian National University Law Reform and Social Justice Research Hub, Submission 154, p. 5.

[64]Square Peg Round Whole, Submission 221, p. 6.

[65]Australian Association of Psychologists Inc., Submission 20, p. 15.

[66]Name withheld, Submission 139, p. 1.

[67]Name withheld, Submission 251, p. 1.

[68]Name withheld, Submission 257, p. 5.

[69]Name withheld, Submission 407, p. 2.

[70]Name withheld, Submission 59, p. 1.

[71]Name withheld, Submission 408, pp. 1–2.

[72]Name withheld, Submission 272, p. 2.

[73]Australian ADHA Professionals Association, Submission 14, p. 21.

[74]ADHD Foundation, Submission 12, p. 9.

[75]Amy, Submission 325, p. 3.

[76]Name withheld, Submission 53, p. 1.

[77]Name withheld, Submission 198, p. 4.

[78]Name withheld, Submission 216, p. 1.

[79]Adam, Submission 197, p. 2.

[80]Name withheld, Submission 59, p. 1.

[81]Paul, Submission 474, p. 1.

[82]Polly, Submission 333, p. 2.

[83]Name withheld, Submission 150, p. 1.

[84]Name withheld, Submission 231, p. 3.

[85]Name withheld, Submission 256, p. 1.

[86]Name withheld, Submission 422, p. 1.

[87]Name withheld, Submission 432, p. 5.

[88]Name withheld, Submission 209, p. 3.

[89]ADHD WA, Submission 121, p. 2.

[90]Suicide Prevention Australia, Submission 31, p. 2.

[91]Name withheld, Submission 230, p. 1.

[92]Name withheld, Submission 231, p. 1.

[93]Claudia, Submission 92, p. 4.

[94]Australian Association of Psychologists Inc., Submission 20, p. 15.

[95]Occupational Therapy Australia, Submission 30, p. 8.

[96]Dr Kay-Sheree Spurling, Submission 50, p. 2.

[97]Name withheld, Submission 297, p. 2.

[98]Name withheld, Submission 294, p. 1.

[99]Name withheld, Submission 426, p. 8.

[100]ADHD Australia, Submission 11, p. 6.

[101]Royal Australian College of General Practitioners, Submission 8, p. [3].

[102]Royal Australian and New Zealand College of Psychiatrists, Submission 21, p. 11.

[103]Insync for Life, Submission 222, pp. 5–6.

[104]ADHD Foundation, Submission 12, p. 9.

[105]Tasmanian ADHD Support Group, Submission 167, p. 2.

[106]Evan, Submission 553, p. [1].

[107]Name withheld, Submission 104, p. 4.

[108]Name withheld, Submission 195, p. 3.

[109]Name withheld, Submission 422, p. 2.

[110]Clare, Submission 470, p. 2.

[111]Sara, Submission 379, p. 3.

[112]Name withheld, Submission 139, p. 2.

[113]Institute for Urban Indigenous Health, Submission 26, p. 17 and Australian ADHD Professionals Association, Submission 14, p. 24.

[114]Aboriginal Health Council of Western Australia, Submission 68, p. 2.

[115]Australian ADHD Professionals Association, Submission 14, p. 24.

[116]Square Peg Round Whole, Submission 221, p. 5.

[117]Institute for Urban Indigenous Health, Submission 26, p. 17.

[118]Institute for Urban Indigenous Health, Submission 26, pp. 5, 14, 29 and 32.

[119]Name withheld, Submission 283, p. 5.

[120]Ms Yvonne Munce, Manager, Capacity Building Support Program, Multicultural Disability Advocacy Association, Committee Hansard, 29 June 2023, p. 16.

[121]Name withheld, Submission 292, p. 1.

[122]Name withheld, Submission 195, p. 1.

[123]Name withheld, Submission 266, p. 4.

[124]Name withheld, Submission 259, p. 1.

[125]Name withheld, Submission 264, p. 10.

[126]Name withheld, Submission 463, p. 2.

[127]Name withheld, Submission 216, p.4.

[128]Square Peg Round Whole, Submission 221, p. 6.

[129]Name withheld, Submission 264, p.11.

[130]Name withheld, Submission 270, p.2.

[131]Carers Queensland, Submission 24, p. 6.

[132]Name withheld, Submission 198, p. 5.

[133]Carers NSW, Submission 72, p. 4.

[134]Name withheld, Submission 104, p. 5.

[135]Name withheld, Submission 250, p. 2.

[136]Name withheld, Submission 234, p. 3.

[137]Ms Stephanie Dowden, Director, Children's Nurse Practitioner, NursePrac Australia, CommitteeHansard, 24 July 2023, p. 9.

[138]Name withheld, Submission 198, p. 3.

[139]Name withheld, Submission 216, pp.4–5.

[140]Name withheld, Submission 238, p. 1.

[141]Name withheld, Submission 280, p. 2.

[142]Name withheld, Submission 413, p. 8.

[143]Name withheld, Submission 225, p. 1.

[144]Name withheld, Submission 230, pp. 1–2.

[145]Name withheld, Submission 115, p. 2.

[146]Name withheld, Submission 298, p. 2.

[147]Name withheld, Submission 422, p. 2.

[148]Ms Emma Sharman, Submission 28, p. [2].

[149]Name withheld, Submission 137, p. 2.

[150]Name withheld, Submission 206, p. 2.

[151]Name withheld, Submission 230, p. 3.

[152]Name withheld, Submission 268, p. 3.

[153]Name withheld, Submission 132, p. 1.

[154]Jess, Submission 394, p. 1.

[155]WA Health, Submission 23, p. 4

[156]ADHD Australia, Submission 11, p. 4–6.

[157]Royal Australian College of Physicians, Submission 6, p. 5.

[158]Australian Association of Psychologists Inc., Submission 20, p. 3.

[159]Consumers of Mental Health WA, Submission 32, p. 7.

[160]Australian Association of Psychologists Inc., Submission 20, p. 7.

[161]Consumers of Mental Health WA, Submission 32, p. 10. See also Mr Christopher Ouizeman, Executive Director, ADHD Foundation, Committee Hansard, 29 June 2023, p. 4.

[162]Consumers of Mental Health WA, Submission 32, p. 11.

[163]Name withheld, Submission 245, p. 4.

[164]Mr Matthew Tice, Chair, ADHD Australia, Committee Hansard, 29 June 2023, p. 3.