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Senate Inquiry into ADHD highlights need for First Nations guidelines and diagnostic tools

Jess Whaler -

A recent Senate Inquiry into ADHD in Australia has that found over one million Australians have Attention Deficit Hyperactive Disorder (ADHD) and significant barriers in the ability to access and receive appropriate treatment and diagnosis were identified.

The inquiry reviewed approximately 700 public submissions and the evidence of 79 witnesses.

The Senate Community Affairs References Committee has made fifteen recommendations to the Australian government aimed at improving outcomes for people with ADHD and their families which included; a more coordinated approach, affordable and accessible services, better quality of care and improved awareness and reduced stigma.

Experts have said the prevalence of ADHD in First Nations communities is unclear due to little research in the field and limits with current diagnostic testing which is based on Western science and does not factor in cultural differences or Indigenous ways of being and knowing.

Without culturally appropriate measurement tools for ADHD diagnosis, like many areas of health and socio-economic outcomes, First Nations people are significantly disadvantaged in this area.

Aboriginal psychologist Dr Tracey Westerman told National Indigenous Times the Senate Inquiry lacked clear cultural guidelines on the manifestation of ADHD.

"We parent our kids very differently. Natural growth parenting means kids learn by exploring and movement. We are collective cultures - we look more to the group than the self," she said.

"Too many differences like this are appraised as deficits and particularly ADHD - inattention in classrooms for example."

The inquiry found people with ADHD who have not been able to access the healthcare and supports, can experience lifelong impacts on them and their families, including on their self-esteem, health, relationships, education, employment and financial situation.

The Australian ADHD Professionals Association (AADPA) have also reported that ADHD rates are higher in custodial settings, with incarcerated youth being five times more likely to have ADHD and adults ten times more likely than general populations. In 2013, the American Psychiatric Association 2013 highlighted a link with re-offending, which potentially arises from the major symptoms of ADHD.

Considering First Nations people in Australia continue to be the most incarcerated people in the world, these statistics are of high importance. AADPA also reported criminal justice systems are not equipped to treat ADHD and tend to focus more on acute mental illness and suicidal ideation.

AADPA have stated that the potential benefits of addressing ADHD in prison includes reducing the rate of critical incidents in prison and make them safer places and reducing the rate of recidivism after release.

One survey by the Western Australian Aboriginal Child Health organisation found First Nations children had a higher risk of clinically significant hyperactivity difficulties compared to non-Indigenous children.

ADDPA highlighted that some symptoms of ADHD, as defined by the Diagnostic and Statistical Manual of Mental Disorders Fifth edition (DSM5), may not be considered problematic by Aboriginal and Torres Strait Islander peoples, and may be viewed as usual and appropriate responses to the context the person lives in, which could even result in an under-diagnosis.

In response to the Senate inquiry Professor Mark Bellgrove, Deputy Head of School (Research), Monash University School of Psychological Sciences and Turner Institute for Brain and Mental Health who is also the Director and Lead, Australian Evidence-Based Clinical Practice Guideline for ADHD, Australian ADHD Professionals Association (AADPA) said that this is a landmark moment where the voices of both Australians with a lived experience and professionals involved in care, have been heard.

"The 15 recommendations are appropriate, practical and formulated with due consideration to both the evidence and the needs of consumers," he said.

"As a Director of the Australian ADHD Professionals Association (AADPA), and Lead for the development of Australia's ADHD Clinical Practice Guideline, I am delighted that our call for both a National Framework for ADHD (recommendation #1) and funding for the implementation of the ADHD Clinical Practice Guideline (recommendation #13) are put forward as recommendations for the Australian Government to consider.

"I am also very pleased to see recommendations (#8) encouraging neurodiversity-affirming campaigns to actively shift social attitudes and reduce stigma."

Professor Bellgrove told National Indigenous Times there is very little data on the prevalence of ADHD in First Nations communities and as per recommendation number 15 in the Senate Enquiry "we need to be doing much better much better on that front".

He also highlighted that the majority of data collected has been under western measures and is not accurate for use with Indigenous children, and said there needs to be a focus on the development of culturally appropriate tools for First Nations children.

Whilst experts agree research and diagnostic tools need attention from a cultural perspective and on a national scale, $18.4 million dollars worth of support has been granted to First Nations communities in Central Australia to assist with FASD, ADHD and autism, as part of the $250 million plan for A Better, Safer Future for Central Australia.

The federal government said funding will more than double the number of First Nations children with neurodevelopmental issues who can access assessments through the Child and Youth Assessment and Treatment Services (CYATS) Program.

Assistant Minister Malarndirri McCarthy said FASD is often referred to as an invisible disability but "as far as many families and communities are concerned, it's a very visible part of life with a profound impact on children and their families".

"Expanding the specialist youth assessment service will mean hundreds of children and teenagers get the diagnoses and interventions they need," she said.

Minister for Indigenous Affairs Linda Burney said the Federal Government are working in partnership with Central Australian Aboriginal Congress, the largest Aboriginal Community Controlled Health organisation in the NT, to improve health services for First Nations children and young people in the region.

"Because we know that early support and intervention for children with neurodevelopmental issues can make a big difference at school, at home and in the community," she said.

Elders in regional New South Wales have told National Indigenous Times smaller regional communities and First Nations people outside the Northern Territory are missing out.

In submissions to the Senate inquiry, the Institute for Urban Indigenous Health drew attention to the need for 'multiâ€'sectoral' supports and 'wrap around' services for First Nations children and people diagnosed with ADHD, needed to address the specific needs and vulnerabilities of First Nations peoples.

The National Aboriginal Community Controlled Health Organisation (NACCHO) emphasised the vital role that aboriginal community controlled health organisations play in delivering better health outcomes, including for people with ADHD.

NACCHO proposed that communities show more engagement with information for example when it is accessed in a culturally safe place for community members to access primary health care and other services that are free from stigma and shame.

Other Indigenous priorities that were raised during the inquiry by Indigenous organisations included; children in out of home care who present higher rates of ADHD and are already vulnerable and at risk and the transition from childhood to adulthood where First Nations children often start to fall through the cracks and issues with self medication and risk taking behaviours emerge due to lack of appropriate services.

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