Health – No excuse for bad behaviour

I was hoping to deliver some good news about ADHD (Attention Deficit Hyperactivity Disorder) in this column, but we are still stuck in a system which prevents children and adults getting the support they need. 

The issue became very public two years ago when an Auckland GP, experienced in treating ADHD, was found guilty of misconduct. He had been prescribing Ritalin and its related drugs without specialist approval. A situation he felt he was forced into when his supportive psychiatrist retired. Almost all the public response was positive and there was never any suggestion that he did harm. Moreover, everybody agreed that the current system was unsatisfactory, even those who administer it. 

I gave evidence to the Health Practitioners Disciplinary Tribunal, a nerve-wracking experience in itself as the process is quite adversarial.  But I tried to make the point that all the expense and resource involved in negatively auditing him would have been better spent on identifying some GPs and nurse practitioners who could do this job and helping them to get on with it. 

But ‘rules are rules’ and we are still constrained by the requirement for a specialist to diagnose ADHD and sign off treatment. In addition, this approval has to be renewed every two years, creating a considerable barrier to treatment and all sorts of inequity issues.

Since then, I understand there have been high level meetings to find a better solution. An announcement could be pending, or not, it’s hard to find out, but since I have been waiting decades for some progress in this area, I am not holding my proverbial breath. 

ADHD has escaped from its reputation as a seventies’ fad and an excuse for bad behaviour. There is a ton of clinical evidence that shows that some people are just ‘wired differently’ from birth, and that for many of them this results in continuing impairment and frustration in their adult lives.  Also, our understanding of neurodiversity is getting better all the time, as we realise the many links between ADHD, learning difficulties, autism, eating disorders, emotional dysregulation and mood disorders. 

Everywhere I work as a locum, I come across adults with undiagnosed ADHD, many with secondary damage in their lives which should have been avoidable. But finding specialists, whether public or private, with the capacity to see these patients has been a real challenge.  Any private specialist who expresses an interest in ADHD is quickly swamped with referrals, creating a perverse situation where the specialists I can recommend are frequently unavailable.

Nevertheless, the ADHD community is strong and support organisations like Beehyve and ADHD NZ do a tremendous job. There is also a growing pool of ADHD coaches who help with organisation, emotional regulation and psychoeducation. Many of these are available online.

All in all, I think we will get there eventually.  Medical authorities have been describing ADHD behaviours since 1775.  Effective treatments have been available for over 50 years. International guidelines for diagnosis and treatment are well advanced.  Clinical practice must eventually catch up with the science and the humanity we bring to this disorder.