Access Without Accuracy: The ADHD Reform That Could Backfire
The risk of turning careful clinical assessment into checkbox medicine — why Australia’s ADHD reform must not sacrifice rigour for speed.
Allowing some GPs to diagnose and prescribe medication for ADHD has been hailed as a breakthrough and, on some fronts, it is.
But let’s not kid ourselves – this reform is also a Pandora’s box.
ADHD is a serious neurodevelopmental disorder that requires careful and comprehensive assessment.
That cannot change.
The state government’s decision, announced on Monday, followed a 2023 Senate inquiry that recommended nationally consistent rules around ADHD care – acknowledging that Australians in rural and low-income areas are particularly disadvantaged by the current system.
For families who've spent months on waitlists, forked out thousands in private specialist fees, or driven hours just to get a repeat script, this reform will offer genuine relief.
The ability for GPs to prescribe ongoing medication for those already diagnosed is perhaps a practical measure in a system that’s long been plagued by bottlenecks and inaccessibility.
But if GPs are to take on a greater role in diagnosis, we must ensure it doesn’t come at the cost of clinical rigour. This isn’t a decision that should ever be made in a quick, standalone appointment.
And what’s most concerning is that this policy opens the door for exactly that: fast-track diagnoses without the thoroughness and rigour that children, in particular, deserve.
We are now facing both underdiagnosis and overdiagnosis at the same time - and that’s a dangerous place to be.
We know there are thousands of Australians living with the very real and debilitating symptoms of ADHD who have never been formally diagnosed or treated.
Their struggles are often misunderstood as laziness, disorganisation, or behavioural problems.
These individuals absolutely deserve better access to timely care, and for them, this reform could be life-changing.
But in my work as a child psychologist, I also see the other side - the overdiagnosis.
I see children referred for ADHD assessments who are simply exhibiting age-appropriate immaturity. I see kids who are anxious, overtired, digitally overloaded, or struggling with family instability.
They’re not neurodivergent - they’re overwhelmed. And yet, we’ve reached a point where challenging behaviour is too often pathologised, and ADHD becomes a default label.
One of the biggest challenges with ADHD is that there’s no definitive test - no blood test, no X-ray, no brain scan.
While we know it’s a neurological condition involving changes in the brain’s dopamine and noradrenaline systems, we can’t diagnose it the way we do diabetes or a broken leg.
ADHD is a clinical diagnosis based on professional opinion, after careful consideration of behaviour patterns over time and across settings.
But somewhere along the way, diagnosis has shifted. It’s become less about carefully ruling out other possible causes - like anxiety, trauma, learning difficulties, or sleep issues - and more about ticking boxes on a symptom checklist.
If enough behaviours are present, the label sticks. But ADHD is supposed to be a diagnosis of exclusion - not a shortcut to explain every struggle with focus or behaviour. When we skip the process of proper differential diagnosis, we risk missing what’s really going on.
Critically, many of the symptoms - distractibility, impulsivity, forgetfulness, restlessness - are things that we all experience from time to time, especially in today’s fast-paced, tech-saturated world.
That’s why we have to get this right. We can’t afford to conflate ordinary struggles of modern life with a lifelong diagnosis.
It takes a brave clinician to look a patient – or a parent – in the eye and say: “I don’t think this is ADHD.”
In an age where diagnoses can bring validation, support, and funding, being told that there’s nothing wrong can feel like a slap in the face. But sometimes the honest truth is that a person’s struggles are the result of poor habits, lifestyle choices, or unresolved emotional issues – things that, while difficult, can be changed.
The reality is, people often pay a lot of money for an assessment, and when they’re told there’s no diagnosis, they’re angry. But clinical work isn’t about keeping people happy, it’s about getting it right.
The question isn’t whether we should improve access – it’s how we do it without sacrificing clinical integrity.
If we’re going to give GPs a larger role in ADHD care, then we must ensure they are properly trained. Not just a one-day course. Proper diagnosis requires a comprehensive psychosocial history, input from educators, and observation across multiple environments.
It takes time and discernment and is something that shouldn’t be rushed to meet demand.
If the government wants this reform to succeed, it must come with clear safeguards: strong training, monitoring of outcomes, and perhaps most importantly, the clinical humility to say, “This might not be ADHD. Let’s dig deeper.”
When we misdiagnose a child, we don’t just medicate them unnecessarily – we reframe their entire story. We risk locking them into a narrative that may never have belonged to them in the first place.
Clare Rowe is a Sydney based child & adolescent psychologist
Excellent article. So often I hear parents self-diagnose their children with ADHD and when I ask them about their sleep patterns I am told they can't get them to bed. Overtiredness often mimics some of the behaviours associated with ADHD and other behavioural conditions. Access to thorough assessment needs to be addressed alongside the access to medication.
Great article, Clare. I’ve often seen that the label ADHD also becomes a “track” - once on it, it’s difficult to get off it, as the diagnosis itself has social and identity impacts for the child and family that are very difficult to undo.