More than 1.5 million Australians were prescribed medication to treat ADHD in the 2020-21 financial year, according to data from the Pharmaceutical Benefits Scheme.
While ADHD is recognised as a disability under the 1992 Disability Discrimination Act, it is not included on the list of conditions supported by the National Disability Insurance Scheme (NDIS).
During an emotional address to the National Press Club in August, Australian presenter and entertainer Em Rusciano shared her experiences of being diagnosed with ADHD as an adult.
The 43-year-old said people with the disorder "need proper government recognition and support".
Her comments have put the spotlight on ADHD, reminding us that myths about the severity, diagnosis and treatment of the neurological condition still persist.
Maddi Derrick is a clinical psychologist, the director of an ADHD specialty clinic in Hobart, and lives with ADHD herself.
"There is a human rights element to this," she said.
"If you are struggling with ADHD, you have a right to have that assessed properly, understand your brain and have the best quality of life."
Here, Dr Derrick breaks down some myths and facts about ADHD:
Myth — ADHD always needs to be treated with medication
People diagnosed with ADHD are not automatically going to be handed a script for Ritalin, according to Dr Derrick.
"This is part of what skews the debate about diagnosis rates, the assumption that when someone is diagnosed that they're going to be on stimulant medication straight away," Dr Derrick said.
"This is simply not true."
Dr Derrick said there were three main avenues of ADHD treatment: medical, both pharmacological and non-pharmacological, and cognitive behavioural intervention, which is administered predominantly by psychologists and other professionals in the ADHD field.
Non-medical intervention, she said, was "really about learning to structure your environment so it fits with your strengths and challenges" and it's an option taken by many adults with ADHD.
When children receive an ADHD diagnosis, its a bit of a different story.
"Because children don't get a choice in their day-to-day environment — with school, and our schooling environments can be incredibly difficult for people with ADHD — that's where I'd argue medication might become more necessary," Dr Derrick said.
Myth — ADHD is over-diagnosed and over-treated
During the past few years, several studies have emerged claiming evidence of an over-diagnosis and over-treatment of ADHD in Australia.
However, the increase in diagnoses is a reflection of doctors better understanding, and treating, the condition, Dr Derrick said.
"One recent study cited evidence of over-diagnosis but what they actually found was evidence of us being able to diagnose ADHD when it's at milder levels," she said.
A study published last year acknowledged that, while the increase in diagnosis was due to identifying milder cases, there was still a lack of evidence of long-term effects of treatment.
However, Dr Derrick said that these cases still deserved the same understanding as more-severe examples.
"It's still ADHD. It's still causing impairment for the individual," Dr Derrick said.
"Just cause it's milder doesn't mean it shouldn't get diagnosed."
Dr Derrick also said that many cases of ADHD — particularly with women — were previously misdiagnosed as anxiety or depression.
"It's assumed that these people are coming out of nowhere and have previously had no diagnosis, but the fact is many of them are already being treated for anxiety and depression, many are already on medication," Dr Derrick said.
"We are actually just getting it right now."
Myth — Only young boys have ADHD
More and more young girls and women are being diagnosed with ADHD.
Dr Derrick said the condition was often missed in girls because the diagnostic criteria used in assessing for ADHD emerged from research focusing on boys.
"It's been filtered through that lens ever since," she said.
ADHD symptoms can also be less obvious in girls, partly because they mature socially and emotionally faster than boys and are "probably a bit aware and focused on how others are viewing them", she added.
"You get lots of girls with ADHD who are trying very hard, who are working hard to concentrate, [so] what you tend to see is talkativeness. They're very, very chatty and outgoing."
Girls can also show fewer hyperactive — and more inattentive — symptoms.
Dr Derrick also dispelled the myth that children "grow out" of ADHD, a fallacy that illegitimises adults with the condition.
"We thought this at a time when ADHD wasn't well understood and when the diagnostic criteria [were] really only suited to picking up ADHD in children," Dr Derrick said.
"There has been some changes in that now and now we also understand people with ADHD will compensate and mask the symptoms. That doesn't mean it makes it less challenging, but the challenges start to look different."
Fact — It can be expensive to get an ADHD diagnosis
Unfortunately, the cost of getting diagnosed with ADHD is often prohibitive for many people, due to it being overwhelmingly in the domain of private medicine.
"Any specialist appointments are expensive and Medicare rebates don't come anywhere near making it affordable for most people," Dr Derrick said.
"There is no assessment or treatment of ADHD in the public system, and it is very limited to children. So that means it all must be done private and not everyone can afford those gap payments."
There is some hope in this space though, with National Disability Insurance Scheme Minister Bill Shorten opening the door for ADHD to be included in the NDIS.
Mr Shorten has asked the NDIS to give him advice about ADHD diagnoses "in terms of eligibility for NDIS" because — currently — eligibility, when it comes to neurodivergence, is not always clear.
Fact — ADHD can greatly affect a person's quality of life
Back in August, comedian Em Rusciano addressed the National Press Club and spoke about, among other things, the persistent idea that people with ADHD are not "neurotypical enough".
"Because I, apparently, appeared to be living a life in an unimpaired way," Ms Rusciano said at the time.
"If only people could see what went on in my head. People are very good at masking. It's why we're exhausted all the time."
Dr Derrick agreed that, despite how good a person was at masking, ADHD symptoms could infiltrate every part of their lives.
"Without getting support, without understanding their own brains, [ADHD] affects everything: Work, study, friendships, intimate relationships, relationships with family, physical health — it's incredibly pervasive," Dr Derrick said.
"It is not like mental health that can come and go. It's invasive. It's with someone from very early in their life and sets certain trajectories.
"ADHD affects quality of life in every single way," Dr Derrick said.
