Perhaps the most common misconception about ADHD diagnoses is that only psychiatrists can perform them. Psychoanalysts, psychologists and neurologists can, too. But only psychiatrists and a handful of other specialists can sign the special authority that allows Ritalin or dexamphetamine – both controlled drugs with potential for abuse – to be prescribed.
Being the official pill-dispensers doesn’t sit easily with some psychiatrists. No only are there too few of them to meet the diagnostic demand, but, one psychiatrist told the Listener, they face strife and sometimes outright threats from patients and families who don’t get the diagnosis and prescription they want – typically because an anxiety disorder is diagnosed instead. “So we tend not to stick our heads up above the parapet.”
Auckland psychoanalyst Kyle MacDonald can’t prescribe without psychiatric approval, but says his clinic has seen “a marked increase in the last couple of years for people self-referring and asking the question. It doesn’t seem to be restricted to New Zealand. It seems to be an international Western phenomenon and no one really knows exactly why.”
MacDonald says there is good research indicating that physical activity can be helpful as a non-pharmaceutical therapy for ADHD.
“A lot of people find that doing physically active things is quite helpful and calming. Mindfulness is a bit of a buzzword, but it’s incredibly helpful for anxiety. It needs to be adapted slightly for people who have ADHD, to be active in some way, and that can be as simple as just walking. There are also meditation traditions that involve physical activity – the slow martial arts such as t’ai chi are very mindful practices, but they involve moving the body at the same time.”
But the problem with diagnostic capacity is real, he says.
“Part of the problem is we’re still dealing with the war on drugs. The whole reason these medications are scheduled is because they’re seen as being dangerous drugs of abuse. So actually doing something about the way in which we schedule medications and making them accessible for people is the obvious thing.
“The other bit is really just the same problem that we have with every other mental health issue in this country, which is there just aren’t enough trained people. Psychiatrists are the smallest group of any of the practitioners because they take anywhere from eight to 12 years to train.”
MacDonald praises Green MP Chlöe Swarbrick for working to improve the system. Ironically, it was her engagement with the issue that led to Swarbrick’s own diagnosis. She agreed to meet ADHD advocate Rory McCarthy to discuss a study he’d conducted about the experiences of adults with ADHD in the system and, McCarthy recalls, “another ADHD person and I talked to her about ADHD and said everyone was just struggling, the way we get medication sucks, there’s no aftercare support. And also about our experiences at school. Chlöe messaged me afterwards to say, hey, you were saying a lot of stuff that I could relate to quite a lot.”
McCarthy, who is not a medical practitioner but takes on clients as an ADHD consultant, says it’s no accident that one of the most popular ADHD self-help books is called You Mean I’m Not Lazy, Stupid or Crazy?
“If you don’t have a diagnosis, you get told that you’re lazy, that you don’t care, which is why so many of us end up as people-pleasers. We’re trying to do as much as we possibly can because we have this thought that unless we do everything, we’re not showing that we care.”
He says problems both before and after diagnosis can be particularly acute for women.
“Being followed up and talked to about side effects – for people who have periods, that is a huge issue. There are hormonal changes that happen every time that you have your period or in menopause and I have to talk to a number of my clients about that because it’s just not covered when they go and get diagnosed. They get given medication and then they start panicking because it stops working properly every so often.”
Like MacDonald, he believes meditation is helpful, along with any therapy “that gets you to be okay with the person that you are, rather than try to be something that is going to be impossible for you. If you don’t set an impossible standard for yourself and understand that you have strengths and limitations that you need to acknowledge, that makes it a lot easier to set yourself up for success.”
