NSW has entered a new chapter in the ADHD landscape. Under the updated guidelines, GPs can now provide repeat scripts for stimulant medication when a child already has an ADHD diagnosis. If the rollout continues as expected, the next step will allow GPs to diagnose ADHD and write the first script. Until now this has been the responsibility of paediatricians and psychiatrists.
On the surface this shift feels sensible. Families wait far too long for specialist appointments. Costs are high. Children who genuinely need support are forced to sit on waitlists for months or years. Increasing access looks compassionate and practical.
So why does something about this make me uncomfortable
I have tried to sit with it and justify the changes. I understand the realities of our health system. But as a child psychologist who sees the full complexity of childhood behaviour every day, there is a feeling in my gut that I cannot ignore. My concern is not that GPs are incapable. Many are highly skilled and deeply committed. My concern is what happens when increased access meets system pressure and human nature.
If you increase the number of professionals who can prescribe a medication, script rates increase. This is not a criticism. It is simply how healthcare works. In the current system there are relatively few paediatricians and psychiatrists in NSW. That naturally limits how many stimulant prescriptions are issued each year. Opening this authority to thousands of GPs lifts the ceiling dramatically.
This matters because ADHD is already one of the fastest growing diagnoses in Australia. Stimulant use has risen sharply over the last decade. Many children benefit from medication, but it is also true that Australia has seen diagnostic inflation and inconsistent assessment practices. More prescribers means more prescriptions, and it will happen quickly.
A key concern is not the skill of GPs or the length of their appointments, which I understand may be extended under this new model. The issue is the overall context in which GPs are working. General practice carries high workload demands, broad clinical responsibilities and significant pressure to support families who are often distressed and seeking immediate solutions. Even with longer appointments available, the pull toward providing a clear pathway forward can be strong. In a medical setting that pathway often becomes medication, simply because it offers rapid relief for families who have already endured long waits and significant frustration.
This is not because GPs are careless. It is because they are human and they want to support struggling families within the constraints of their day.
One of my biggest questions is whether GPs will realistically have time to explore differential diagnoses. A thorough ADHD assessment should consider multiple factors. These include:
sleep quality and quantity
daily screen habits
learning difficulties or literacy problems
anxiety or trauma
family conflict and home structure
sensory issues
school environment and behavioural expectations
These conversations take time. They require patience, depth and often collateral from teachers and caregivers. The worry is that scripts will be written and these recommendations offered alongside them, which typically means they are not followed through.
It is also true that specialists are not perfect. There are paediatricians and psychiatrists who diagnose ADHD in thirty minutes and provide immediate scripts. But because specialists are few in number, the overall system effect is still contained. If the same shortcuts occur across a much larger pool of GPs, the impact becomes far broader.
I am also concerned about a two tier ADHD system emerging. Families with higher socioeconomic resources can afford thorough assessment and ongoing therapy. They are able to invest in behavioural interventions, sleep support, parenting systems and school collaboration. Medication becomes one part of a larger treatment plan. Families with fewer resources may rely heavily on GP diagnosis and prescribing because it is quicker and cheaper. It means:
medication becomes the primary or only intervention
behavioural strategies are less likely to be implemented
environmental changes at home or school may never occur
children with complex or overlapping issues may be misdiagnosed
This is not genuine equity. It is a divide in quality of care that tracks along socioeconomic lines.
If NSW moves toward a system where GPs diagnose and initiate stimulant medications, several safeguards are essential. These include:
GP training that expands beyond symptom checklists and covers sleep, screen use, parenting dynamics, learning difficulties and trauma
clear assessment protocols before a first script can be written
structured review timelines and monitoring
improved public access to non medication supports so that behavioural change is possible across all income levels
transparent reporting on prescribing rates over time
There are moments in health policy where well intentioned decisions have long and unintended consequences. My fear is that in a decade or two we may look back and realise we medicalised a generation of children before exhausting simpler interventions that build resilience, emotional regulation and behaviour change. Not because anyone set out to do harm, but because a pressured system will always default to the fastest solution.
I hope that my concerns prove overly cautious. I hope that increased access improves care without fuelling over-diagnosis or over-medication. But my instinct tells me that this shift deserves close attention. After working with children and families for many years, I have learnt that listening to that instinct is usually worthwhile.
Clare Rowe is a child & adolescent psychologist, writer and speaker.
No posts
Comments
Nothing yet. Say the first thing.
Sign in to join the conversation.