ADHD and Equal Opportunity Act Amendments

Extract from Hansard

Legislative Council
6 June 2001

Mike Elliott
Leader Australian Democrats
Member of the Legislative Council

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The Hon. M.J. ELLIOTT: Members in this place will be aware that I have been a long-time advocate for better government services for families with children with ADHD. While I recognise the importance of psychostimulant use in multimodal treatment of ADHD, I have raised some concern about the use of psychostimulants alone to treat ADHD in South Australia. I stress that I do not have a problem with psychostimulants being used in some cases: I do suspect that they are being used in too many cases and suspect that too many kids are receiving them as their only treatment. In particular, I have expressed concern that low income families are being forced to use psychostimulants as a first rather than last resort because they cannot afford other treatments.

I see this look of puzzlement from the government benches. When the Hon. Sandra Kanck spoke on this bill she indicated that I would make some comments about equal opportunities in relation to people suffering from ADHD. In fact, we will be moving amendments to address that, which is why I am talking about ADHD, which is an equal opportunity issue.

The Hon. M.J. ELLIOTT: You are: you have to have an attention span that spans a couple of days and to have heard the Hon. Sandra Kanck's speech and understand the relationship between the two. I apologise for those who have not made that link. I have a concern that low income families are being forced to use psychostimulants as the first and often, unfortunately, the only rather than the last resort because they cannot afford other treatments.

It is for this reason that I support amendments proposed by the Hon. Sandra Kanck to the Equal Opportunity ( Miscellaneous) Amendment Bill that will expand eligibility for state government services and provide more low income families with other options to treat ADHD. They are changes that will provide the resources and teachers needed to implement better educational interventions.

First, I want to address the question of what ADHD is. Attention deficit hyperactivity disorder is defined by the NHMRC as a physiological dysfunction that results in hyperactive, impulsive and inattentive behaviours to the extent that they cause social impairment in home, work and school settings. And for some people it is the parliamentary setting. Individuals frequently experience educational failure, poor peer relations and low self esteem and lack adequate social skills as a result of ADHD.

Families experience high levels of stress due to the demanding nature of ADHD behaviours, hostility or criticism from other families, and many are concerned that their child will fail in school and fail to gain employment in the long term. The internationally recognised treatment model for ADHD is called the multimodal approach. This approach uses medical, psychological, educational and sociological interventions.

Research suggests that early intervention for ADHD reduces the risk of other problems developing, such as conduct disorder, oppositional defiant disorder, depression, substance abuse, criminality and suicidal tendencies. Recent estimates in Australia put the number of children with ADHD over 50 000, with some claiming that it has become the second most diagnosed disorder in this nation. No records are kept of numbers of young people with ADHD, but estimates of prevalence are around 5 per cent of all children.

What can be measured is the number of children using psychostimulant medication to treat ADHD, because state governments record psychostimulant prescriptions under various controlled substances legislation. Federal figures show that in 1997 over 290 000 prescriptions were issued through Australian pharmacies for psychostimulants to treat ADHD. In 1998 a study of psychostimulant prescription records for ADHD found that 2.36 per cent of South Australian children aged between five and 18 years were using psychostimulants to treat ADHD.

In 1999 South Australia had the second highest dexamphetamine use for ADHD per thousand population in Australia. Between 1991 and 1999, the number of patients authorised and using psychostimulants for greater than two months to treat ADHD rose from 60 to 5 357 in South Australia. However, by February 2001 the number of people prescribed psychostimulants for ADHD had plateaued and was approximately 5 600.

A recent submission to an inquiry into ADHD heard that in 1990 one could fit all the children in South Australia on medication for ADHD on one city bus: by the year 2000 it would take 90 buses. The committee also heard that in South Australia between 1992 and 2000 there were 1 116 children under six using amphetamines, 54 under the age of three and two under the age of 18 months. This is despite diagnosis and medication use not being recommended under the age of seven years. The committee also heard that, while the effects of ADHD are widespread, the use of medication to treat the disorder is greater in areas of lower income because a full range of services is too expensive.

The eligibility for government service for ADHD is based on state and commonwealth legislation. Currently, the commonwealth Disability Act defines `disability' as a disorder or malfunction that results in the person learning differently from a person without the disorder or malfunction, or a disorder that affects a person's thought processes, perceptions of reality, emotions or judgment, or that results in disturbed behaviour. While this definition clearly encompasses ADHD, the federal government defers responsibility for services for ADHD to the individual states. In South Australia the policy that determines a government service and its availability is based on the Equal Opportunity Act. The existing South Australian Equal Opportunity Act criteria are much narrower than that of the commonwealth DDA and do not recognise ADHD.

While in practice some children with ADHD in South Australia still have their needs met indirectly because the Equal Opportunity Act recognises learning disorders that are co-morbid with ADHD, it has been estimated that up to 50 per cent of young people with ADHD do not receive assistance for it. This leaves 50 per cent of young people having to appeal to the Disability Act to access assistance. This process is costly and intimidating and does not produce equality between South Australian families with children with ADHD. The situation stands in stark contrast to the United States Rehabilitation Act, which has a government-funded child find provision putting the onus on government departments to find and address detention needs presented by ADHD.

A study in South Australia in 1997 by Ivan Atkinson and Roslyn Schute found that, although accommodation of medical and behavioural treatment is recommended as the most effective form of intervention, many families have little choice since they face long waiting lists for free government services or prohibitive costs. It also found that this effectively means that access to private non-medical practitioners, such as psychologists, physiotherapists and speech and occupational therapists is limited to the better off. These findings have been subsequently supported by a review of psychostimulant prescription in South Australia by Brenton Prosser and Robert Reid in 1999, which indicated that psychostimulant use was higher in low income postcodes.

The Democrats' amendments will ensure that multimodal treatment will be available to all South Australian families, irrespective of income and, as a result, will encourage the use of amphetamines as the last resort rather than the first resort and not as the only option. It must always be remembered that, while medication provides a window of opportunity for many children with ADHD, the positive effects disappear once medication has worn off. This window must be used to provide young people with the skills to face the challenges of adult life. Pills alone are not enough. It is worth noting that many people, by the time they are diagnosed, are already behind in school; they have already developed behaviours which do not help them in their further social development. While a medicine, a psychostimulant, might address the chemical imbalance within the brain, it does not address the other problems which are co-existent and which are by that stage often significant.

Research has shown the importance of early intervention with a full range of treatments in the success of young people with ADHD as they encounter the greater social and academic demands of secondary school. I am aware that in his PhD study, Brenton Prosser found that, while the treatment with psychostimulants was effective in many children while they were young, once they entered their teen years difficulties arose if that was all they were receiving. No doubt, opponents will claim that these changes are too expensive but I remind those opponents of the NH&MRC finding that ignoring ADHD will result in significant future costs to education, health, welfare and correctional services. In short, we could pay a little now and we could pay a lot more later.

How often do we see the situation arise where governments say that they have not the money to address an issue yet we know that the costs that will eventuate, if they do not address the issue now, will be far greater later. Our prisons are full of people who for a range of reasons have suffered in ways that could have been addressed when they were young, whether it be ADHD, dysfunctional families or whatever else. Governments have said, `No, we haven't the money for programs to address these problems now', but it usually costs a lot more later.

Already the warning signs are there in a tenfold increase of amphetamine use in the last 10 years to treat a disorder has been recognised under various names for the last 100 years. One cannot but question whether growing class sizes, rising unemployment and cut-backs to funding by governments is at least partly behind the dramatic rise in medication for ADHD over the past 10 years, first, in terms of the children receiving less personal attention and, secondly, in terms of parents finding themselves unable to afford the sorts of treatments that will help the affected child. However, the Democrats amendments will seek to stem this trend.

The amendments that will be moved by the Hon. Sandra Kanck will expand the Equal Opportunity Act criteria to match the federal act's definition of `disability'. This will not only bring South Australia into line with national and international standards but also effectively expand eligibility for state government services and provide more families with other options to treat ADHD. I am confident that many families will welcome the better welfare and school services that will result from these amendments, and I urge all members to support the Democrats amendments.