Kielda. I'm Chelsea Daniels and this is the Front Page, a daily podcast presented by the New Zealand Herald. BARMAC is now funding a new medicine and has removed renewal criteria for ADHD treatments. Advocates are welcoming the move, saying it's a game changer that will save the health system tens of millions of dollars, but there are warnings it
could lead to over diagnosing and over prescribing. Today on the Front Page, co founder of Divergent Thinking and registered psychologist Anton Ashcroft joins us to discuss First off, Anton, can you explain to me in the simplest terms what ADHD actually is?
I wish I could in terms of well, I can make it simple. But ADHD in itself is a broad spectrum of traits and if you go and see a psychiatrist they use a Diagnostic and Statistical Manual DSM five it's called which gives you a list of defined traits and deficits that if you fulfill enough of the criteria then you would get a diagnosis of attention deficit hyperactivity disorder.
And there are three different types. There are the hyperactive type, which is the predominant traits are almost like an engine that is either on or off, that ability to think enormously and think about a lot of things, but also do a lot of things. Being physically very active, can't sit still, lots of fidgeting, finding it hard to focus on one thing at once, brain bouncing from one area
to another. That's the hyperactive aspect. Then you've got attention deficit hyperactivity disorder of the inattentive type, and that's less on the body activity and it's more on the brain activity. So it's people who are often quite creative but also very easily distracted, find it hard to get into action on things. They've often very strong, strong sense of morality and so will often not do things for themselves. They might find they know they ought to do exercise, but
they find it very hard to do exercise. But if they agree with someone else that they will do it, then they will often feel more obliged to do it. But the classic feature of all of these is not actually the presentation, because you for a psychiatrist, it's about a tension deficit, and it's either through physically being distracted
or mentally or both. But my description of It is much more about whether they have a hyper focus, so they have the ability when they're interested in something to hyper focus on it, and they can spend hours focusing on something that they love. So, for example, a lot of ADHD bras will focus for hours and hours on gaming, and that's because it's interesting, it's novel, it's stimulating. They're
getting a dopamine hit. But if it's something that they are not getting a dopamine hit, they're not getting a reward from doing. The brain isn't telling them that it's a nice thing to do. That's when it is really hard to focus or really hard to get into action. So yeah, simply put, you can have a very busy brain and or a very busy body, and if you are not interested in something, it's incredibly hard to get focused on it.
Barmac announced changes to ADHD medications which kick in this month. Can you take me through the changes and why they matter?
Yeah. So far, MAC has said that now that there's not going to have to be a review for medication, which means that rather than having to go and get re diagnosed as to whether you have ALIHD or not, well, it's a lifelong condition and because of the waiting lists, it's very hard to get psychiatric appointments in a good enough time. So now people can just have their medication renewed, and they can also get it renewed more regularly without them having to go and see a psychiatrist as well,
which is going to be incredibly helpful. So GPS, I think and I are going to be able to prescribe as long as psychiatrists have given that diagnosis and approved the use of medication.
Now, a lot of these things can apply to a lot of different people. ADHD is a highly over diagnosed condition that some people who are just absent minded or have other things going on, label themselves as number two, they misplace items. If you like this list and want more lists about other nonsense, follow me, leave me a comment with your signs of ADHD and share this with somebody who you think is ADHD. Also follow my Instagram. Number one is they have difficulty focusing.
Just the other week, Farmac announced a nationwide shortage of extended release methyl finnie date for example. It also said demand has increased rapidly here and overseas by actually one hundred and forty percent in New Zealand over the last two years. Does that surprise you?
It doesn't, and I think there's two reasons for that. One of them is that the awareness of ADHD and ADD and I do still separate out the two, even though DSM five doesn't. The awareness of attention deficit hyperactivity disorder traits is becoming more and more prevalent in our society, so more and more people know about it. There has been a large, I think a large undiagnosed population for a long time, and now that people are developing the awareness,
they're seeking more support. So it makes sense that the requirement for medication is going up. The other thing is that because it's more popular and it's being normalized, more people are thinking, well, maybe i've too, So I think there is an aspect of people now being more focused, and so we do need to have more stringent or really really helpful diagnostic criteria to say, well, is this person really got ADHD or have they just got traits.
The challenge is that for some people, even if they have what are called narrow and deep traits rather than a broad range of traits, ADHD, medication can be useful even though they may not fulfill the broad criteria, because when it comes to medication. For some people it's absolutely life changing. It allows them to think in a consequential way and think at one thing at once and focus.
For some people it doesn't have a massive effect, and for other people it can increase unhelpful side effects like paranoia or anxiety or other types of distress. So it's not a panaceic cure all. But for some brains it can be incredibly useful. And I think if it's useful, then why not let people use it rather than have this very very stringent, narrow criteria of whether someone can
or can't. It's almost like, we'll try it and see if it works, and if it works, that's great, and if it doesn't, we know that's not a medication for you.
Well, this shortage actually began worldwide during COVID. Hey would I be right in saying there has been a surge in interest due to the likes of say TikTok.
I think just media media in general. I mean, it wasn't that long ago that bipolar got a resurgence of interest because more and more celebrities were coming out saying that they had bipolar disorder. So I think the more that it's talked about in all the media, the more people have an awareness of it, and we all have some traits that you could ascribe. You know, most of us at times will forget things. But it's the intensity
of it. It's the level to which is it causing distress or discomfort or difficulties in your life.
Well, I was going to say, some of those traits or symptoms can almost everyone can almost resonate with at least one of them, right. And on the other hand, isn't it true that some symptoms of ADHD and add can be similar to other conditions.
Yes, there's a massive overlap. I mean most of the clients that I work with would also have an overlap with some autistic traits as well, So and OCD is also over represented with autism. You can have a combination which is called AUDHD, which is where you have a broad range of autistic traits and you have a broad range of ADHD traits. So yeah, there's a big overlap. These are not mutually exclusive disorders.
Is there a risk if it becomes easier to diagnose of over prescribing or overdiagnosing ADHD?
There is. I'm in two minds about it, As I said, earlier. I think it's a it's a practical and pragmatic challenge because if you are prescribing for people who don't benefit or it could be detrimental to them, then obviously that's a bad thing. But if we make our offering of medication so limited and so stringent that we are ignoring a lot of people for whom the medication could be helpful just because of how we diagnose ADHD, then I
also think that's unhelpful too. So I really think there needs to be a conversation about how do we match the benefit of medication to those who are likely to benefit from it. And it's because ADHD is not a neuroscientifically defined disorder. It's defined by traits, so we don't know the brain chemistry of the unique individual who sat
in front of us. So for someone, for example, may not fulfill all the stringent criteria, but a benefit from the medication, and I think that's a conversation we need to have and explore further.
How would you change that criteria? Because I know people do to take ADHD medication recreationally right illegally obviously.
Yeah, I mean it's interesting that if people are taking it recreationally, they are probably getting the neurotypical response to amphetamine, which is stimulation, rather than the neurodiverse response or the ADHD response to the medication, which is about clarity of thinking and focus. One of the things I will often ask people when I'm working with them is what's your
reaction to caffeine? Because if you've got an ADHD brain that is likely to respond well with amphetamine based ADHD medication, then your reaction to caffeine is either it makes me sleepy or it has no effect whatsoever, And that can often be quite an indicative thing to ask in terms of whether the medication is likely to help. So I
don't think it's easy, but I do. I have come across quite a few people who it would appear that they haven't had a formal diagnosis agreed, but they could have benefited from the ADHD medication.
There is massive challenges as somebody with ADHD and trying to get a diagnosis for ADHD litt alone, even enabling yourself to believe that that might be something that you
might have. If you were to design a system that was navigable for somebody with ADHD would not look like the one that we currently have because alongside the fact that eight percent of New Zealanders who do AADHD struggle and navigating through the system that's ADHD, and said research, it's also the case that a third of adults give up along the way, and that is a huge number of people for whom they're not getting the help that they need. All that kind of legitimizing experience that I.
Had, well, when it comes to being diagnosed as an adult with ADHD, I've heard it's quite difficult, isn't it.
Yes, we have quite a long waiting list at the moment. I mean, ADHD in New Zealand has been pushing the government to try and bring in new legislation so that GPS can assess and prescribe and we're on that journey, which would be fantastic, But at the moment, you're absolutely right, it can only be a clinical psychologist or a psychologist can make that diagnosis, but it still has to go through a psychiatrist in order to be prescribed in medication.
At the moment, So if somebody sees one of these videos say on TikTok and identify as with some of the symptoms, what would be their first steps to be diagnosed.
There are some quite good online tools where you can start to just explore it a little bit more and go, well, if I look at even more of the traits, do I fulfill the diagnosis according to some of these online assessment measures. If you then think you still are, then to go and see your GP and see if you can get a referral through. But as you said earlier, a referral to a psychiatrist may take quite some time.
You could go to a through the private through private psychiatrists, but again even private psychiatrists have quite a lengthy waiting list, So at the moment there's no easy solution if you think you have to get to the point of being prescribed the appropriate medication.
Is There a fear though, that people who identify with these symptoms, say, might go to get diagnosed and because ADHD, I guess is the popular diagnosis of choice, that they might be diagnosed with that straight off the bat. But there are other underlying issues, say like bipolar disorder.
That's a great question and it depends on who you see. There are some people, some psychiatrists who will do quite a brief assessment and they won't do a differential assessment in enough detail, and so there could be some quote comorbidities that might be missed. But other psychiatrists will spend longer and they'll they'll do a differential diagnosis, so they'll try and exclude other alternative descriptions or additional pathologies at
the same time as trying to assess for ADHD. But yes, the risk is that if you just go to someone to say, have I got ADHD? A classic one is that quite a few people I work with have been diagnosed with ADHD, but they're also clearly autistic but haven't been diagnosed with autism.
Is that a fear? Then if GPS were to become able to diagnose ADHD, that that might that might happen.
Yes, it would be a risk in terms of getting the bigger picture. But what we're talking about in terms of prescribing is, and we do this with anxiety meds and depression meds. At the moment, GPS can prescribe anxiety meds and they can prescribe meds for depression, and we sort of do a suck at and see will this work. If it works, great, If it doesn't, let's try something else. So in a sense, why would ADHD medication from its pure therapeutic benefit point of view, Why would we look
at it in a different way. If it works great, If it doesn't work, stop it or try something else.
In October, the New Zealand Drug Foundation found ADHD patients were more likely to have a substance abuse disorder, and young people who get diagnosed and treated for ADHD are far less likely to develop drug problems later in life. Likewise, an Australian study actually of people who regularly used illicit stimulants found that forty five percent screened positive for adult ADHD. Is this something that you've seen firsthand?
Oh definitely. I mean the whole notion of what is ADHD in terms of that lack of executive function, that prefrontal cortex, that rational problem solving, emotional self regulation, if you have a challenge in that area your body, in your brain is driven by the need for a pleasure and immediate gratification, and that's why addicative patterns of behavior
are so rewarding and nourishing for ADHD brains. So there's an absolute overrepresentation of a propensity towards addictions because of that dopamine hit and that chemical hit an immediate reward from taking the drug of choice or that engaging in that addictive pattern of behavior.
Do you think that ADHD has been widely misunderstood for so long now?
Yeh, well, that is a question that could take a whole podcast on its own. I have very strong views about the trauma that can be created for neurodiverse brains in general, not just ADHD. Because of our schooling methods, teachers are doing their best, but when you've got large class sizes and a whole range of different brains in the room, to be able to adapt your teaching style to the need of that particular children is very hard.
And if you've got a problematic child in the sense that typical ADHD over talkers, over sharers, overactive, over passionate. They can also have rejection sensitivity dysphoria, So if the teacher isn't playing paying attention to them, they might get angry. They can be quite reactive, they can be quite blaming or attacking, and you can see how immediately for an overworked teacher, how that child could be labeled in an
extremely unhelpful and unfortunate way. And working with predominantly adults myself or young adults and older adults. People will often come to me with those labels I am stupid, I am lazy, I am not good enough, I am a problem. And that's come simply from not understanding that how they are reacting is not a choice. This is how their brain is wired. We can manage our brains if we understand our brains, but we can't necessarily well. We can't
instantly change our brains and our brain wiring. So I totally, totally agree that those with ADHD have often been really miss represented and undervalued, if you like, for a lot of the strength that they can display, because a lot of these things if you think about sports people, if you think about entrepreneurs, a lot of these traits that we find problematic at school can often translate into incredibly successful people if well supported.
Thanks for joining us, Santon, Pleasure, nice to talk to you. That's it for this episode of the Front Page. You can read more about today's stories and extensive news coverage at enzhrald dot co dot nz. The Front Page is produced by Ethan Sills and Richard Martin, who is also our sound engineer. I'm Chelsea Daniels. Subscribe to the Front Page on iHeartRadio or wherever you get your podcasts, and tune in tomorrow for another look behind the headlines.