Speaker 1: Kielda. I'm Chelsea Daniels and this is the Front Page,
Speaker 1: a daily podcast presented by the New Zealand Herald. BARMAC
Speaker 1: is now funding a new medicine and has removed renewal
Speaker 1: criteria for ADHD treatments. Advocates are welcoming the move, saying
Speaker 1: it's a game changer that will save the health system
Speaker 1: tens of millions of dollars, but there are warnings it
Speaker 1: could lead to over diagnosing and over prescribing. Today on
Speaker 1: the Front Page, co founder of Divergent Thinking and registered
Speaker 1: psychologist Anton Ashcroft joins us to discuss First off, Anton,
Speaker 1: can you explain to me in the simplest terms what
Speaker 1: ADHD actually is?
Speaker 2: I wish I could in terms of well, I can
Speaker 2: make it simple. But ADHD in itself is a broad
Speaker 2: spectrum of traits and if you go and see a
Speaker 2: psychiatrist they use a Diagnostic and Statistical Manual DSM five
Speaker 2: it's called which gives you a list of defined traits
Speaker 2: and deficits that if you fulfill enough of the criteria
Speaker 2: then you would get a diagnosis of attention deficit hyperactivity disorder.
Speaker 2: And there are three different types. There are the hyperactive type,
Speaker 2: which is the predominant traits are almost like an engine
Speaker 2: that is either on or off, that ability to think
Speaker 2: enormously and think about a lot of things, but also
Speaker 2: do a lot of things. Being physically very active, can't
Speaker 2: sit still, lots of fidgeting, finding it hard to focus
Speaker 2: on one thing at once, brain bouncing from one area
Speaker 2: to another. That's the hyperactive aspect. Then you've got attention
Speaker 2: deficit hyperactivity disorder of the inattentive type, and that's less
Speaker 2: on the body activity and it's more on the brain activity.
Speaker 2: So it's people who are often quite creative but also
Speaker 2: very easily distracted, find it hard to get into action
Speaker 2: on things. They've often very strong, strong sense of morality
Speaker 2: and so will often not do things for themselves. They
Speaker 2: might find they know they ought to do exercise, but
Speaker 2: they find it very hard to do exercise. But if
Speaker 2: they agree with someone else that they will do it,
Speaker 2: then they will often feel more obliged to do it.
Speaker 2: But the classic feature of all of these is not
Speaker 2: actually the presentation, because you for a psychiatrist, it's about
Speaker 2: a tension deficit, and it's either through physically being distracted
Speaker 2: or mentally or both. But my description of It is
Speaker 2: much more about whether they have a hyper focus, so
Speaker 2: they have the ability when they're interested in something to
Speaker 2: hyper focus on it, and they can spend hours focusing
Speaker 2: on something that they love. So, for example, a lot
Speaker 2: of ADHD bras will focus for hours and hours on gaming,
Speaker 2: and that's because it's interesting, it's novel, it's stimulating. They're
Speaker 2: getting a dopamine hit. But if it's something that they
Speaker 2: are not getting a dopamine hit, they're not getting a
Speaker 2: reward from doing. The brain isn't telling them that it's
Speaker 2: a nice thing to do. That's when it is really
Speaker 2: hard to focus or really hard to get into action.
Speaker 2: So yeah, simply put, you can have a very busy
Speaker 2: brain and or a very busy body, and if you
Speaker 2: are not interested in something, it's incredibly hard to get
Speaker 2: focused on it.
Speaker 1: Barmac announced changes to ADHD medications which kick in this month.
Speaker 1: Can you take me through the changes and why they matter?
Speaker 2: Yeah. So far, MAC has said that now that there's
Speaker 2: not going to have to be a review for medication,
Speaker 2: which means that rather than having to go and get
Speaker 2: re diagnosed as to whether you have ALIHD or not, well,
Speaker 2: it's a lifelong condition and because of the waiting lists,
Speaker 2: it's very hard to get psychiatric appointments in a good
Speaker 2: enough time. So now people can just have their medication renewed,
Speaker 2: and they can also get it renewed more regularly without
Speaker 2: them having to go and see a psychiatrist as well,
Speaker 2: which is going to be incredibly helpful. So GPS, I
Speaker 2: think and I are going to be able to prescribe
Speaker 2: as long as psychiatrists have given that diagnosis and approved
Speaker 2: the use of medication.
Speaker 3: Now, a lot of these things can apply to a
Speaker 3: lot of different people. ADHD is a highly over diagnosed
Speaker 3: condition that some people who are just absent minded or
Speaker 3: have other things going on, label themselves as number two,
Speaker 3: they misplace items. If you like this list and want
Speaker 3: more lists about other nonsense, follow me, leave me a
Speaker 3: comment with your signs of ADHD and share this with
Speaker 3: somebody who you think is ADHD. Also follow my Instagram.
Speaker 3: Number one is they have difficulty focusing.
Speaker 1: Just the other week, Farmac announced a nationwide shortage of
Speaker 1: extended release methyl finnie date for example. It also said
Speaker 1: demand has increased rapidly here and overseas by actually one
Speaker 1: hundred and forty percent in New Zealand over the last
Speaker 1: two years. Does that surprise you?
Speaker 2: It doesn't, and I think there's two reasons for that.
Speaker 2: One of them is that the awareness of ADHD and
Speaker 2: ADD and I do still separate out the two, even
Speaker 2: though DSM five doesn't. The awareness of attention deficit hyperactivity
Speaker 2: disorder traits is becoming more and more prevalent in our society,
Speaker 2: so more and more people know about it. There has
Speaker 2: been a large, I think a large undiagnosed population for
Speaker 2: a long time, and now that people are developing the awareness,
Speaker 2: they're seeking more support. So it makes sense that the
Speaker 2: requirement for medication is going up. The other thing is
Speaker 2: that because it's more popular and it's being normalized, more
Speaker 2: people are thinking, well, maybe i've too, So I think
Speaker 2: there is an aspect of people now being more focused,
Speaker 2: and so we do need to have more stringent or
Speaker 2: really really helpful diagnostic criteria to say, well, is this
Speaker 2: person really got ADHD or have they just got traits.
Speaker 2: The challenge is that for some people, even if they
Speaker 2: have what are called narrow and deep traits rather than
Speaker 2: a broad range of traits, ADHD, medication can be useful
Speaker 2: even though they may not fulfill the broad criteria, because
Speaker 2: when it comes to medication. For some people it's absolutely
Speaker 2: life changing. It allows them to think in a consequential
Speaker 2: way and think at one thing at once and focus.
Speaker 2: For some people it doesn't have a massive effect, and
Speaker 2: for other people it can increase unhelpful side effects like
Speaker 2: paranoia or anxiety or other types of distress. So it's
Speaker 2: not a panaceic cure all. But for some brains it
Speaker 2: can be incredibly useful. And I think if it's useful,
Speaker 2: then why not let people use it rather than have
Speaker 2: this very very stringent, narrow criteria of whether someone can
Speaker 2: or can't. It's almost like, we'll try it and see
Speaker 2: if it works, and if it works, that's great, and
Speaker 2: if it doesn't, we know that's not a medication for you.
Speaker 1: Well, this shortage actually began worldwide during COVID. Hey would
Speaker 1: I be right in saying there has been a surge
Speaker 1: in interest due to the likes of say TikTok.
Speaker 2: I think just media media in general. I mean, it
Speaker 2: wasn't that long ago that bipolar got a resurgence of
Speaker 2: interest because more and more celebrities were coming out saying
Speaker 2: that they had bipolar disorder. So I think the more
Speaker 2: that it's talked about in all the media, the more
Speaker 2: people have an awareness of it, and we all have
Speaker 2: some traits that you could ascribe. You know, most of
Speaker 2: us at times will forget things. But it's the intensity
Speaker 2: of it. It's the level to which is it causing
Speaker 2: distress or discomfort or difficulties in your life.
Speaker 1: Well, I was going to say, some of those traits
Speaker 1: or symptoms can almost everyone can almost resonate with at
Speaker 1: least one of them, right. And on the other hand,
Speaker 1: isn't it true that some symptoms of ADHD and add
Speaker 1: can be similar to other conditions.
Speaker 2: Yes, there's a massive overlap. I mean most of the
Speaker 2: clients that I work with would also have an overlap
Speaker 2: with some autistic traits as well, So and OCD is
Speaker 2: also over represented with autism. You can have a combination
Speaker 2: which is called AUDHD, which is where you have a
Speaker 2: broad range of autistic traits and you have a broad
Speaker 2: range of ADHD traits. So yeah, there's a big overlap.
Speaker 2: These are not mutually exclusive disorders.
Speaker 1: Is there a risk if it becomes easier to diagnose
Speaker 1: of over prescribing or overdiagnosing ADHD?
Speaker 2: There is. I'm in two minds about it, As I said, earlier.
Speaker 2: I think it's a it's a practical and pragmatic challenge
Speaker 2: because if you are prescribing for people who don't benefit
Speaker 2: or it could be detrimental to them, then obviously that's
Speaker 2: a bad thing. But if we make our offering of
Speaker 2: medication so limited and so stringent that we are ignoring
Speaker 2: a lot of people for whom the medication could be
Speaker 2: helpful just because of how we diagnose ADHD, then I
Speaker 2: also think that's unhelpful too. So I really think there
Speaker 2: needs to be a conversation about how do we match
Speaker 2: the benefit of medication to those who are likely to
Speaker 2: benefit from it. And it's because ADHD is not a
Speaker 2: neuroscientifically defined disorder. It's defined by traits, so we don't
Speaker 2: know the brain chemistry of the unique individual who sat
Speaker 2: in front of us. So for someone, for example, may
Speaker 2: not fulfill all the stringent criteria, but a benefit from
Speaker 2: the medication, and I think that's a conversation we need
Speaker 2: to have and explore further.
Speaker 1: How would you change that criteria? Because I know people
Speaker 1: do to take ADHD medication recreationally right illegally obviously.
Speaker 2: Yeah, I mean it's interesting that if people are taking
Speaker 2: it recreationally, they are probably getting the neurotypical response to amphetamine,
Speaker 2: which is stimulation, rather than the neurodiverse response or the
Speaker 2: ADHD response to the medication, which is about clarity of
Speaker 2: thinking and focus. One of the things I will often
Speaker 2: ask people when I'm working with them is what's your
Speaker 2: reaction to caffeine? Because if you've got an ADHD brain
Speaker 2: that is likely to respond well with amphetamine based ADHD medication,
Speaker 2: then your reaction to caffeine is either it makes me
Speaker 2: sleepy or it has no effect whatsoever, And that can
Speaker 2: often be quite an indicative thing to ask in terms
Speaker 2: of whether the medication is likely to help. So I
Speaker 2: don't think it's easy, but I do. I have come
Speaker 2: across quite a few people who it would appear that
Speaker 2: they haven't had a formal diagnosis agreed, but they could
Speaker 2: have benefited from the ADHD medication.
Speaker 4: There is massive challenges as somebody with ADHD and trying
Speaker 4: to get a diagnosis for ADHD litt alone, even enabling
Speaker 4: yourself to believe that that might be something that you
Speaker 4: might have. If you were to design a system that
Speaker 4: was navigable for somebody with ADHD would not look like
Speaker 4: the one that we currently have because alongside the fact
Speaker 4: that eight percent of New Zealanders who do AADHD struggle
Speaker 4: and navigating through the system that's ADHD, and said research,
Speaker 4: it's also the case that a third of adults give
Speaker 4: up along the way, and that is a huge number
Speaker 4: of people for whom they're not getting the help that
Speaker 4: they need. All that kind of legitimizing experience that I.
Speaker 1: Had, well, when it comes to being diagnosed as an
Speaker 1: adult with ADHD, I've heard it's quite difficult, isn't it.
Speaker 2: Yes, we have quite a long waiting list at the moment.
Speaker 2: I mean, ADHD in New Zealand has been pushing the
Speaker 2: government to try and bring in new legislation so that
Speaker 2: GPS can assess and prescribe and we're on that journey,
Speaker 2: which would be fantastic, But at the moment, you're absolutely right,
Speaker 2: it can only be a clinical psychologist or a psychologist
Speaker 2: can make that diagnosis, but it still has to go
Speaker 2: through a psychiatrist in order to be prescribed in medication.
Speaker 1: At the moment, So if somebody sees one of these
Speaker 1: videos say on TikTok and identify as with some of
Speaker 1: the symptoms, what would be their first steps to be diagnosed.
Speaker 2: There are some quite good online tools where you can
Speaker 2: start to just explore it a little bit more and go, well,
Speaker 2: if I look at even more of the traits, do
Speaker 2: I fulfill the diagnosis according to some of these online
Speaker 2: assessment measures. If you then think you still are, then
Speaker 2: to go and see your GP and see if you
Speaker 2: can get a referral through. But as you said earlier,
Speaker 2: a referral to a psychiatrist may take quite some time.
Speaker 2: You could go to a through the private through private psychiatrists,
Speaker 2: but again even private psychiatrists have quite a lengthy waiting list,
Speaker 2: So at the moment there's no easy solution if you
Speaker 2: think you have to get to the point of being
Speaker 2: prescribed the appropriate medication.
Speaker 1: Is There a fear though, that people who identify with
Speaker 1: these symptoms, say, might go to get diagnosed and because ADHD,
Speaker 1: I guess is the popular diagnosis of choice, that they
Speaker 1: might be diagnosed with that straight off the bat. But
Speaker 1: there are other underlying issues, say like bipolar disorder.
Speaker 2: That's a great question and it depends on who you see.
Speaker 2: There are some people, some psychiatrists who will do quite
Speaker 2: a brief assessment and they won't do a differential assessment
Speaker 2: in enough detail, and so there could be some quote
Speaker 2: comorbidities that might be missed. But other psychiatrists will spend
Speaker 2: longer and they'll they'll do a differential diagnosis, so they'll
Speaker 2: try and exclude other alternative descriptions or additional pathologies at
Speaker 2: the same time as trying to assess for ADHD. But yes,
Speaker 2: the risk is that if you just go to someone
Speaker 2: to say, have I got ADHD? A classic one is
Speaker 2: that quite a few people I work with have been
Speaker 2: diagnosed with ADHD, but they're also clearly autistic but haven't
Speaker 2: been diagnosed with autism.
Speaker 1: Is that a fear? Then if GPS were to become
Speaker 1: able to diagnose ADHD, that that might that might happen.
Speaker 2: Yes, it would be a risk in terms of getting
Speaker 2: the bigger picture. But what we're talking about in terms
Speaker 2: of prescribing is, and we do this with anxiety meds
Speaker 2: and depression meds. At the moment, GPS can prescribe anxiety
Speaker 2: meds and they can prescribe meds for depression, and we
Speaker 2: sort of do a suck at and see will this work.
Speaker 2: If it works, great, If it doesn't, let's try something else.
Speaker 2: So in a sense, why would ADHD medication from its
Speaker 2: pure therapeutic benefit point of view, Why would we look
Speaker 2: at it in a different way. If it works great,
Speaker 2: If it doesn't work, stop it or try something else.
Speaker 1: In October, the New Zealand Drug Foundation found ADHD patients
Speaker 1: were more likely to have a substance abuse disorder, and
Speaker 1: young people who get diagnosed and treated for ADHD are
Speaker 1: far less likely to develop drug problems later in life. Likewise,
Speaker 1: an Australian study actually of people who regularly used illicit
Speaker 1: stimulants found that forty five percent screened positive for adult ADHD.
Speaker 1: Is this something that you've seen firsthand?
Speaker 2: Oh definitely. I mean the whole notion of what is
Speaker 2: ADHD in terms of that lack of executive function, that
Speaker 2: prefrontal cortex, that rational problem solving, emotional self regulation, if
Speaker 2: you have a challenge in that area your body, in
Speaker 2: your brain is driven by the need for a pleasure
Speaker 2: and immediate gratification, and that's why addicative patterns of behavior
Speaker 2: are so rewarding and nourishing for ADHD brains. So there's
Speaker 2: an absolute overrepresentation of a propensity towards addictions because of
Speaker 2: that dopamine hit and that chemical hit an immediate reward
Speaker 2: from taking the drug of choice or that engaging in
Speaker 2: that addictive pattern of behavior.
Speaker 1: Do you think that ADHD has been widely misunderstood for
Speaker 1: so long now?
Speaker 2: Yeh, well, that is a question that could take a
Speaker 2: whole podcast on its own. I have very strong views
Speaker 2: about the trauma that can be created for neurodiverse brains
Speaker 2: in general, not just ADHD. Because of our schooling methods,
Speaker 2: teachers are doing their best, but when you've got large
Speaker 2: class sizes and a whole range of different brains in
Speaker 2: the room, to be able to adapt your teaching style
Speaker 2: to the need of that particular children is very hard.
Speaker 2: And if you've got a problematic child in the sense
Speaker 2: that typical ADHD over talkers, over sharers, overactive, over passionate.
Speaker 2: They can also have rejection sensitivity dysphoria, So if the
Speaker 2: teacher isn't playing paying attention to them, they might get angry.
Speaker 2: They can be quite reactive, they can be quite blaming
Speaker 2: or attacking, and you can see how immediately for an
Speaker 2: overworked teacher, how that child could be labeled in an
Speaker 2: extremely unhelpful and unfortunate way. And working with predominantly adults
Speaker 2: myself or young adults and older adults. People will often
Speaker 2: come to me with those labels I am stupid, I
Speaker 2: am lazy, I am not good enough, I am a problem.
Speaker 2: And that's come simply from not understanding that how they
Speaker 2: are reacting is not a choice. This is how their
Speaker 2: brain is wired. We can manage our brains if we
Speaker 2: understand our brains, but we can't necessarily well. We can't
Speaker 2: instantly change our brains and our brain wiring. So I totally,
Speaker 2: totally agree that those with ADHD have often been really
Speaker 2: miss represented and undervalued, if you like, for a lot
Speaker 2: of the strength that they can display, because a lot
Speaker 2: of these things if you think about sports people, if
Speaker 2: you think about entrepreneurs, a lot of these traits that
Speaker 2: we find problematic at school can often translate into incredibly
Speaker 2: successful people if well supported.
Speaker 1: Thanks for joining us, Santon, Pleasure, nice to talk to you.
Speaker 1: That's it for this episode of the Front Page. You
Speaker 1: can read more about today's stories and extensive news coverage
Speaker 1: at enzhrald dot co dot nz. The Front Page is
Speaker 1: produced by Ethan Sills and Richard Martin, who is also
Speaker 1: our sound engineer. I'm Chelsea Daniels. Subscribe to the Front
Speaker 1: Page on iHeartRadio or wherever you get your podcasts, and
Speaker 1: tune in tomorrow for another look behind the headlines.