The number of young Australians prescribed medication for attention-deficit hyperactivity disorder (ADHD) has increased dramatically over the past two decades, with a notable shift in who is receiving diagnoses. New research reveals a more than tenfold rise in prescriptions between 2003 and 2022, alongside a reversal in the socioeconomic patterns previously observed.
For years, children from the most disadvantaged postcodes in Australia were disproportionately likely to be prescribed ADHD medication. However, this trend has flipped, with children from wealthier families now being the most frequently medicated, according to a study published this week.
The research, conducted by Brenton Prosser, Professor of Public Policy and Leadership at UNSW Canberra and Yogi Vidyattama, an Associate Professor at the University of Canberra, analyzed data from Australia’s Pharmaceutical Benefits Scheme (PBS) – the national system that subsidizes medication costs. The study examined prescription patterns across states and territories, and crucially, correlated them with postcode-level socioeconomic data.
ADHD is the most commonly diagnosed neurological disorder in Australian children, characterized by inattention and/or hyperactive-impulsive behaviors that can significantly impact daily life. Psychostimulant drugs are the most common form of treatment.
The data shows a significant increase in prescriptions overall. In 2003, approximately 0.5% of Australian youth aged 5-17 (20,147 individuals) were prescribed ADHD medication. By 2022, this figure had risen to 4.2% (246,021 young people). The most substantial increase occurred during the COVID-19 pandemic, particularly in 2020 and 2021, with a 2.1 percentage point jump for teenagers aged 15-17 between 2020 and 2022, rising from 3.1% to 5.2%.
Researchers suggest the pandemic-era spike may be linked to increased awareness of neurodivergence and learning difficulties, as well as the challenges presented by lockdowns and remote learning. “Lockdowns seem to have pushed more families to get help or at least start paying more attention to neurodivergence and learning issues,” the researchers wrote.
While prescription rates have risen nationally, the study highlights a narrowing of variations between states and territories, suggesting a move towards more consistent diagnostic and treatment practices. Previously, states like Queensland and Western Australia had significantly higher prescription rates than others. This convergence is attributed to efforts to standardize best practices and reduce regional disparities in care.
However, the most striking finding concerns the shift in socioeconomic patterns. In 2003, the wealthiest postcodes were the least likely to have children prescribed ADHD medication, with a standardized medication ratio of 0.612 (where 1.0 represents the national average). By 2021, these same postcodes had climbed to the top, with a ratio of 1.245 – indicating a significantly higher prescription rate than the national average.
Conversely, the lowest 10% of postcodes, previously exhibiting higher prescription rates, now have a ratio of 0.708. This represents a complete reversal of the trend observed two decades ago.
The researchers posit that increased access to healthcare services may be a key factor driving this change. Twenty years ago, the healthcare system was able to meet demand. Today, obtaining a diagnosis can involve lengthy waits for specialist appointments and psychological assessments, potentially creating barriers for families with limited resources. “The poorest families might face longer waits or may not pursue diagnosis and medication at all if it feels out of reach,” the study notes.
The study acknowledges certain limitations. The data is based solely on prescriptions filled through the PBS, excluding those obtained privately. This means the actual prescription rates in wealthier areas may be even higher. The data does not include information on cultural or ethnic backgrounds, nor does it track repeat prescriptions or individual postcode comparisons to the national rate, preventing a definitive assessment of potential overdiagnosis or overmedication in specific areas.
Despite these limitations, the findings suggest a growing acceptance of ADHD and a willingness among families to seek help. The researchers conclude that the trend points towards improved awareness of neurodivergence, more consistent care, and a society increasingly focused on supporting the well-being of all children. However, they emphasize the need for continued attention to equity of access, ensuring that all children, regardless of their socioeconomic background, have the opportunity to receive appropriate diagnosis and treatment.
Brenton Prosser has a background in public policy, governance, and mental health, and is currently a Government & Public Sector Partner and a Providence / Honorary Fellow at the Australian National University. Yogi Vidyattama’s research focuses on access to mental health care in Australia.
