More than meds: why easier access to ADHD treatment has to be part of a whole-system approach

New Zealanders with attention-deficit hyperactivity disorder (ADHD) will now have easier access to diagnosis and medication after the government changed prescribing rules.

But there is still so much we don’t know about ADHD in Aotearoa. And while these changes will help many, easier access to medication alone won’t fill the gaps in other supports people with ADHD need to live well.

From February 2026 trained GPS and nurse practitioners will be able to diagnose and treat ADHD. Under the current system, only paediatricians or psychiatrists can make the diagnosis. GPs and nurse practitioners then provide followup care.

The current process – which is both time-consuming and expensive – has been widely criticised. The government’s changes are expected to at least partially address these issues.

ADHD in New Zealand

One major barrier to progress is the general lack of knowledge about adult ADHD.

he condition is broadly understood as causing persistent patterns of inattention, hyperactivity and impulsivity. In adults, ADHD can have a profound impact in family and work situations, substance abuse and a wide range of psychiatric disorders. But it has largely been ignored in older age groups, with some believing people “grow out” of the condition.

People with ADHD also often possess strengths, including creativity, spontaneity, high energy, risk tolerance and an ability to think divergently. Many also demonstrate strong problem-solving skills under pressure, passion-driven focus and persistence when engaged in meaningful tasks.

Worldwide estimates suggest ADHD in adults ranges from 2.5% to 3.4% of most populations. But England’s 2023 Adult Psychiatric Morbidity Survey found 13.9% of adults met criteria warranting clinical assessment. Only 0.5% had been professionally diagnosed.

In New Zealand, estimates rely on indirect measures such as medication dispensing rates.

Recent research found 0.6% of the adult population in New Zealand was receiving drug treatment for ADHD. Based on a conservative estimate of 2.6% of adults with ADHD, this shows a large “treatment gap” exists.

Drug dispensing data in New Zealand also show gaps in who gets diagnosed with ADHD.

Māori and Pacific peoples are less likely to receive ADHD medications. These inequities begin early. Tamariki Māori screened for ADHD at age four are less likely to receive medication than their non-Māori peers.

There are also substantial differences in the age of diagnosis across sociodemographic groups. These inequities raise serious concerns about access and systemic bias.

International research shows untreated ADHD is linked to worse mental and physical health, higher mortality, and reduced life expectancy.

ADHD prevalence is also five times higher among youth prisoners and ten times higher among adult prisoners compared to the general population. In Australia, ADHD’s social and economic costs are estimated at A$20.42 billion per year, or $25,071 per person.

Waiting too long for help

Our ongoing research, including a survey, looks at the lived experiences of adults with diagnosed or suspected ADHD in New Zealand. Many have described the healthcare system as “broken”.

Survey respondents reported long wait times, high costs for diagnosis and treatment and a lack of expertise amongst health professionals. They also described ongoing stigma and misunderstanding about the lived reality of ADHD.

The survey mirrors international research showing how longstanding myths and stigmas about what ADHD is and who it affects have impeded societal understanding.

Adult women were overrepresented in the sample, constituting 83% of the 689 participants, with over 80% reporting being diagnosed after age 24, reflecting global trends of underdiagnosis in early age among women.

Research suggests ADHD in women is often missed or misdiagnosed, partly due to outdated knowledge and lack of understanding about its presentation in women, compounded by high rates of coexisting conditions such as anxiety, depression, substance use and autism.

Treatment matters

Growing evidence shows many of the negative outcomes of ADHD are mitigated by treatment with medication. One study from Sweden found a significant association between initiating ADHD medication treatment and lower mortality.

However, medication is only part of the solution. Strategies focused on the strengths of people with ADHD can have huge benefits for the individual, their whānau and communities. Particularly when they receive timely diagnosis, treatment and necessary accommodations.

Researchers argue that while ADHD medications provide effective treatment, they should never be the only form of treatment offered.

More than meds

Expanding prescribing authority is a vital step, but this alone will do little to increase access to psychological and allied health supports to ensure the right care can be provided to people with ADHD.

There continues to be an urgent need to address gaps in data and understanding, to provide an evidence-based assessment of the areas where research, funding and policy initiatives need to be targeted.

Trends show that some groups, including Māori and women, are disproportionately affected by a lack of knowledge and services. As the government revises how ADHD is diagnosed and treated, it must address these discrepancies.

There is also a complex but poorly understood relationship between ADHD and other neurodevelopmental conditions, such as autism, that needs further investigation. As ADHD New Zealand chairperson Darrin Bull has argued, a “whole-of-system” approach is required to support those with ADHD in New Zealand.