Coalition Senators Additional Comments

1.1Coalition Senators would like to thank the many individuals and groups who provided submissions and evidence on what is clearly an important issue for Australians. The Coalition acknowledges the concerns expressed in the evidence of witnesses who made submissions and appeared before the Community Affairs References Committee (committee) inquiry into assessment and support services for people with attention deficit hyperactivity disorder (ADHD).

1.2The previous Coalition government had a strong track record on the treatment of ADHD, including adding Intuniv® to the PBS for the treatment of ADHD. This change provided a new treatment option for patients six to 18 years of age that are otherwise unable to use other ADHD medicines.[1]

1.3An estimated 147,000 patients benefited from this new treatment.

1.4Coalition Senators agree in-principle with the committee view however have concerns over the lack of consideration of alternative views and areas of focus.

Careful Diagnosis of Children

1.5Coalition Senators acknowledge the concerns expressed by witnesses regarding practice around diagnosing children with ADHD.

1.6In its submission, the Critical Psychiatry Network Australasia (CPNA) points out the risk of overreliance on ADHD diagnosis for children:

… expanding services to facilitate the earlier diagnosis and treatment of ADHD could result in significant harms, particularly to children. Diagnosing ADHD does not identify underlying problems, instead locating the problem in the child’s neurobiology with a disingenuous disregard of social determinants such as poverty, housing insecurity, poor schooling and unemployment. This in turn invites biochemical interventions that modify behaviours in the short-term but carry significant long-term risks. What is needed is services that respond to the needs of each individual child.[2]

1.7Of the concerns raised by the CPNA, one thing universally agreed was that the diagnosis of children must be done wholistically. During the committee’s public hearing in Melbourne, the Australian Association of Psychologists said:

While we don't agree with everything the Critical Psychiatry Network has put forward, there are some things that we agree with. There is a need for multidisciplinary care of children and adults presenting with ADHD symptoms. We believe that it's really important for a full assessment of people to be done at that point when they're looking for diagnosis.[3]

Need for a Truly Independent Design of Guidelines

1.8The Coalition believes the guideline document should reflect unbiased instruction to aid practitioners in their assessment of people for ADHD.

1.9In its submission, the CPNA also outlines concerns around potential conflicts of interest within expert evidence given within the guidelines:

… there are significant conflicts of interest. The Guideline primarily reflects the collective opinions and biases of the AADPA, a guild group invested in the ADHD concept and its treatment. AADPA and its executive have significant engagement with the pharmaceutical industry and should not have been regarded as independent or suitable to develop guidelines, a task that should have been entrusted to an independent body.[4]

1.10During the Melbourne hearing, Professor Jon Jureidini emphasised this point when he stated:

The group that developed the guideline are all people for whom diagnosis of ADHD benefits them. Now, I'm not suggesting anything nefarious here—I'm sure that people are operating sincerely in what they're doing—but, if you're somebody whose profession consists of diagnosing and treating ADHD, you're an ADHD life coach, you're a carer of somebody with ADHD or you're somebody with ADHD who embraces the concept, it is more likely that you're going to see the evidence in a particular way. There was no attempt, as far as I can see, to collaborate with people like us who take a strong, scientifically based stance, who would have been happy to collaborate and cooperate and come to a consensus on these things but were never consulted in the process.[5]

1.11It is important that any guidelines and policies created around the diagnosis and treatment of ADHD take in both lived experiences and scientific expertise.

Access to diagnosis and treatment for ADHD patients in regional and remote areas.

1.12Coalition Senators share concerns about access to diagnosis and treatment pathways for Australians living in remote or regional areas.

1.13As stated by both WA Health[6] and the Royal Australasian College of Physicians (RACP),[7] the treatment and diagnosis of ADHD becomes significantly more difficult and expensive the further away from city centres people are.

1.14Coalition Senators believe where possible, the Australian Government should strive for equity in services to those in the regions.

Adult Diagnosis and Treatment

1.15Coalition Senators note concerns raised by witnesses with lived experience who expressed frustrations with inconsistent rules for the management of Adult ADHD.

1.16One way in which this frustration could be alleviated would be through the provision of nationally consistent prescribing rules, as outlined in Recommendation Five. Coalition Senators believe where it is possible and safe to do so, regulation which impedes an adult’s ability to manage their existing diagnosis, whilst also placing unnecessary pressure on an already limited set of services, should be reviewed, or repealed.

NDIS

1.17As outlined in Chapter 7, ADHD is a consideration when assessing an individual’s eligibility for the NDIS. Coalition Senators do not believe any changes are required in this space.

Conclusion

1.18Coalition Senators once again thank the hundreds of people who provided submissions and gave evidence at the public hearings. The Coalition calls upon the Federal Labor Government to consider the additional points outlined above to ensure a more comprehensive understanding of assessment and support services for all people with ADHD.

Senator Wendy AskewSenator Maria Kovacic

MemberMember

Liberal Senator for TasmaniaLiberal Senator for New South Wales

Senator Kerrynne Liddle

Member

Liberal Senator for South Australia

Footnotes

[1]The Hon Greg Hunt MP, Former Minister for Health and Aged Care, 'Thousands benefit from ADHD and rheumatoid arthritis treatment', Media Release, 1 September 2018, www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/thousands-benefit-from-adhd-and-rheumatoid-arthritis-treatment (accessed 6 November 2023).

[2]Critical Psychiatry Network Australasia, Submission 7, p. 1.

[3]Mrs Amanda Curran, Chief Services Officer, Australian Association of Psychologists, Proof Committee Hansard, 26 September 2023, p. 2.

[4]Critical Psychiatry Network Australasia, Submission 7, p. 5.

[5]Professor Jon Jureidini, Proof Committee Hansard, 26 September 2023, p. 6.

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

[7]Royal Australasian College of Physicians, Submission 6, p. 4.