The Rise of ADHD Diagnoses in Australia
A quiet phenomenon has been unfolding across Australia — a sharp rise in adults being diagnosed with attention deficit hyperactivity disorder (ADHD). While social media might suggest that ADHD is everywhere, the reality is more complex. In some parts of the country, ADHD prescribing is far above what experts expect to see, while in others, it appears that the condition is barely being diagnosed.
Experts at the University of New South Wales (UNSW) have analysed data that, for the first time, paints a detailed picture of ADHD diagnoses nationally. This chart shows just how spectacular that rise has been. It is based on the percentage of adults who have filled at least one prescription for ADHD medication in a financial year and is part of a vast dataset analysed by the Medicines Intelligence Research Program at the UNSW. Nationally, it means that 2.36 per cent of adults aged between 20 and 65 have filled a script for ADHD medication at least once in the 2025 financial year.
In isolation, that percentage may not seem remarkable, particularly when experts say the actual prevalence — or rate — of ADHD in adults is between 2.5 and 3 per cent. Hidden in this data is a much more dramatic — and potentially disturbing — story. You can see it in the map below, where the darker the colour is, the more people are filling ADHD prescriptions. The enormous variation is striking.
[MAP: ADHD diagnosis hotspots]
The rates range from well above the expected prevalence to significantly below. So why might this be happening? One hypothesis is that the more money you have, the more likely you are to be diagnosed. That is because it can cost thousands of dollars to be properly assessed and treated. To test this, we compared the numbers to the level of socio-economic advantage where people filling scripts lived.
Regional Variations in ADHD Prescriptions
Let us start with Western Australia, which is home to 13 of Australia’s 20 highest ADHD-prescription-dispensing neighbourhoods. Each of the dots below represents a neighbourhood. Those closest to the right are more advantaged. The bigger the dot, the larger the population. The higher the dot, the more people are filling scripts for ADHD medication.
This tells us that, generally, it is true that the more advantaged your area, the more ADHD there seems to be. However, there are very significant exceptions that suggest something else is going on. Take Fremantle as an example. It is the hottest spot in both WA and Australia for ADHD, but while it is in the top 20 per cent of advantaged areas of the state, it is not at the top. It is a similar story in places like Bassendean and Bunbury. They are well above the 2.5 to 3 per cent prevalence that experts would expect to see, and they aren’t areas where there is a lot of money.
That means the level of advantage in terms of income, education and occupation is not the only driving factor behind these neighbourhoods with a greater rate of ADHD diagnoses, and it does not explain why there are substantial outliers.
Why Are Fremantle and WA So Much Higher?
Kyle Hoath, a psychiatrist and president of the AMA’s Western Australian branch, has a theory. “WA has historically had higher rates of ADHD treatment, both in children and adults, than other states,” he told Four Corners. “I think with the sort of increase in ADHD awareness and therefore diagnosis and treatment, [it’s] lifted the country up as a whole, which has kept WA proportionally ahead.”
ADHD Rates, State by State
If WA is an outlier, what do other states look like? When you explore the filled prescription rates in Victoria, you can see that the money argument weakens further. If you knew Melbourne, you would think that the highest rates would be in the most advantaged suburbs — the city’s east. Look below and you will see that is not the case. By a long way, it is the areas of Brunswick and Coburg and Darebin South with the highest rates.
That is happening elsewhere too. In NSW, it is not the wealthy eastern or northern suburbs with the highest rates — it is the Marrickville, Sydenham and Petersham area in Sydney’s inner west and the Blue Mountains. The chart below allows you to search your state to see what is happening as compared to the expected prevalence rate of 2.5 to 3 per cent.
Disadvantage, though, does matter. Look at the areas below the prevalence line. Most are in locations where there is not a lot of money and levels of disadvantage are high. They can be considered “ADHD deserts” — parts of the country where up to 90 per cent of adults who do have ADHD are potentially not being treated and therefore, not being diagnosed.
Misdiagnosis and Missed Diagnosis
The wide variance of this prescription-based data suggests that there is misdiagnosis and missed diagnosis of ADHD in adults happening at the same time. That is also the assessment of David Coghill, a psychiatrist and leading expert in ADHD from the University of Melbourne. “There are many people for whom access is difficult. So, I think there are people with a missed diagnosis,” he said. “If that’s the case and the rates of prescribing are what they seem to be, then there also would suggest that there is some misdiagnosis. There are some people who are being treated who wouldn’t meet the diagnostic criteria.”
Factors Contributing to Variation
There’s no straightforward explanation. Several factors could explain the variation in ADHD diagnosis rates. It could be as simple as the neighbourhoods with higher rates may be areas that have greater awareness and acceptance of ADHD. One explanation for that may be social media posts discussing ADHD symptoms, leading people to explore a diagnosis, thinking they have the condition. But we do not know for sure.
As we said earlier, one of the most fundamental enablers is having money and access to psychiatrists to diagnose ADHD and prescribe medication. An initial consultation with a psychiatrist can cost just under $1,000, and the fees can quickly escalate to several thousand dollars.
Another possibility is telehealth. The growth in adult ADHD diagnoses coincides with the rise of telehealth clinics, which prominently advertise ADHD-specific assessments. That is one possible explanation for the high rate of prescriptions being filled in WA, which has the lowest number of psychiatrists per capita compared to the rest of the country.
Concerns About Telehealth Services
“I don’t think every diagnosis of a West Australian is by a West Australian psychiatrist,” Dr Hoath said. “We know that there are a number of national telehealth providers that conduct ADHD assessments and ADHD treatments, so I think that probably muddies the water a little bit.” While telehealth has improved access, these services are not cheap, and mental health professionals have questioned the reliability of some of their psychiatric reports and diagnoses.
“Some of the assessments that I’ve seen coming through, I would question how deep the assessment has been and whether some of those other differential diagnoses have been considered or not,” Hobart-based clinical psychologist David Bakker told Four Corners. He said some of his clients had previously seen telehealth providers. “Some [clients] have had very affirming good experiences. Others may have had slightly dismissive experiences or experiences that it seems to be over very quickly and they don’t really know what has happened.”
Some telehealth clinics appear to rely on questionnaires sent out before the consultation. “We hear a lot of feedback from people living with ADHD and those who suspect they have ADHD, that their assessment has been very quick,” Professor Coghill said. “But it’s really consisted of just filling in those questionnaires, having the doctor look at them and then having a rubber stamp. That’s not acceptable.”
Risks of Misdiagnosis and Medication
Nick Glozier, a professor of Psychological Medicine at the University of Sydney, is concerned that part of the demand for ADHD diagnosis from adults is misled — and is contributing to the rise in telehealth services that specialise in these conditions. “Some people have called it cosmetic psychopharmacology, where people are actually deciding what condition they have,” he told Four Corners. “They go and seek a clinician who will reinforce that or validate their particular view of what they have and then treat that.”
There also needs to be careful consideration of how ADHD is assessed to ensure the diagnosis is accurate. “One of the things I’ve learned through doing the youth mental health setting is it’s equally important for us to count how many people do we say, ‘No, this isn’t ADHD’, to how many people do we say, ‘Yes, this is ADHD’,” Professor Coghill said.
The Harms of Incorrect Diagnosis
The harms are real. Several possible issues can stem from an incorrect diagnosis. First, someone who is misdiagnosed could have a significant mental health issue that goes undiagnosed and untreated. Diagnosing ADHD is challenging. There is no definitive test to prove someone has the disorder, and ADHD symptoms are present in other mental health conditions. That means diagnosis often comes down to a clinician’s subjective view.
“One of the difficulties is, of course, that these symptoms are not diagnostic for ADHD,” Professor Glozier said. “Problems focusing, problems with attention, problems with your memory. These cognitive symptoms cut across every single psychiatric diagnosis.”
Jacqueline Huber, an emergency psychiatrist at St Vincent’s Hospital in Sydney, agrees. “There are many illnesses that can, if you don’t look carefully enough, look like ADHD,” she told Four Corners. “That might include mood disorders, personality disorders, trauma-related sequelae. And if you don’t catch those diagnoses because you’re diagnosing ADHD instead, those individuals won’t receive the treatment they need, and that’s poor practice.”
Then there are the potential harms from the ADHD medications themselves. The medications commonly prescribed are called psychostimulants and are mostly amphetamines. While the medication can make people without ADHD feel more alert, there is no conclusive evidence that they improve cognitive function or productivity. Like all drugs, they are not without side effects. ADHD medications can cause high blood pressure, an elevated heart rate, anxiety, insomnia, and weight loss.
But one of the more worrying — although rare — complications of the prescribed medication is psychosis. There are no statistics that show a link between ADHD medication and psychosis, but Four Corners has spoken to emergency doctors in three states who are seeing more people present with the condition.
The Critical Question
It is clear from the data that ADHD is a significant public health issue for Australia. In the areas where diagnosis rates are far below the prevalence of ADHD in the community, there is no straightforward solution. In general, there are no publicly funded ADHD services, and seeing a specialist in the private system is often unaffordable.
Changes by the state and federal governments are trying to address that by training GPs to diagnose ADHD and prescribe medication, but it is unclear whether this will fix the disparity or make it worse. That is because the current structure of Medicare reimbursement may not adequately remunerate ADHD assessments under bulk-billing and therefore will require a co-payment, which some people may not be able to afford.
And at the other end, it is hard to avoid the conclusion that in some parts of Australia, ADHD diagnosis is out of control. If the data is anything to go by, it is a situation that requires more scrutiny than it is currently receiving.
Watch Four Corners’s investigation into Australia’s ADHD boom tonight from 8:30pm on ABC TV and ABC iview.
