Summary:

From 1^st December 2025, Queensland GPs will have the ability to diagnose and treat ADHD in adults with stimulant medications, similar to the authorities currently held by psychiatrists. This may help reduce barriers to necessary care for people negatively impacted by their ADHD characteristics. Currently, no extra ADHD-specific training is mandated, but I argue that comprehensive training must be required to ensure that accessibility is balanced with ethical care for the individual/community. This change is likely to result in increased and more appropriate access to necessary care for many Queensland residents, but must be provided by informed professionals.

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ADHD Management by General Practitioners: Balancing Protections and Accessibility

The Queensland Health Minister Tim Nicholls has announced that “…GPs in Queensland will be able to initiate, modify and continue to prescribe psychostimulant medications for the treatment of adults with ADHD”, and that they “will gain the opportunity to expand [their] clinical capabilities and play a direct role in the part of the management” of ADHD. These changes come into effect on the 1^st December 2025. Practically, this means that GPs who are recognised as specialist GPs will be authorised to diagnose ADHD and prescribe stimulant medications to adults, not just provide shared care after another specialist has already started treatment.

Currently GPs in Queensland, (and broadly around the country, with jurisdictional nuance) may only prescribe schedule 8 stimulant medication for the management of adult ADHD when approved and previously initiated and titrated (modified) by a psychiatrist.  This regulatory update is likely to reduce barriers to required care and treatment for many people whose core ADHD-traits yield barriers to their goals.

While various, related professional organisations (e.g., APS; RANZCP; AMA Qld; AADPA) support the involvement of GPs in the diagnosis and management of ADHD, this announcement has been somewhat controversial. Some commentators expressed concerns that without training, there are considerable risks to service provision and people, and others stated non-support for the change, citing overdiagnosis of adults who function to an average standard (please see my lived experience post regarding my own experience in this arena). Other risks must also be considered, including those relating to the impact of stimulants on physical and mental health conditions, and diagnostic inaccuracy resulting in inefficient treatment planning. Additionally potential medication misuse, and the over-reliance on medication for difficulty management must also be central considerations to optimise related outcome

However, the potential real-world benefits of the change include reduced wait times for diagnostic assessment and treatment planning, related reductions in stress, emotional and psychological difficulties, and their impacts on mental and physical health for many people who are currently unable to access timely, affordable assessment and treatment services.

The language “Specialist GPs” used in the Minister’s announcement could easily be interpreted as implying that the GPs doing this will have an advanced skill-set in diagnosing and treating ADHD. However, while many undoubtedly will, no extra training is required before GPs are authorised to take on this new, and complex, responsibility.

As a clinical psychologist, and human, who both diagnoses and experiences the difficulties and benefits resulting from ADHD traits, I propose that the following would be extremely helpful (if not necessary) for any professional diagnosing ADHD, to balance accessible service provision against minimising the risks of harm/optimising outcomes:

1. Be explicitly trained in the diagnosis of ADHD, including a strong focus on:
   1. developmental history
   2. cross-context impairment
   3. differential diagnosis
   4. confounding factors
   5. circumstantial indicators of its presence including commonly co-occurring physical and mental health conditions:
      1. In the context of GPs with a general focus on physical health conditions, formal training in the large number of emotional and psychological experiences that can resemble ADHD will help minimise diagnostic inaccuracy.
      2. This may also allay some of the genuine care-based concerns expressed by doctors in the RACGP article linked above.
2. A sound understanding of the Australian Evidence-Based Clinical Practice ADHD Guideline.
3. In the absence of training/competence in differential diagnosis, confounding factors and circumstantial evidence, collaborative engagement with other, appropriately knowledgeable professionals to ensure ethically sound diagnostic assessments, which may further address some cited fears regarding this regulatory change;
4. Have an understanding of the lived-experience of ADHD, both of difficulties and benefits experienced, to;
   1. improve understandings of internalised presentations,
   2. improve decision-making confidence
5. Be aware of other conditions that may impact attention and impulsivity/impulse control/hyperactivity, and explicitly querying these during history-taking;
6. Have a detailed understanding of the conditions commonly seen alongside ADHD, to broaden understanding that the presence of one condition does not automatically demonstrate the absence of another, and that many of the conditions that are considered diagnostic confounds are underpinned by similar characteristics (e.g., trait impulsivity);
7. Have a sound understanding of the contextual influences on trait expression.
   1. We need to see the characteristic expressed across different areas of life (i.e., not context-specific), however,
      1. Some contexts will place fewer demands on our cognitive resources (attention, impulse control), than others, so we may not see related difficulties in those domains, or domains where more supports are in place (e.g., at home),
      2. Interest and novelty act as attentional anchors in ADHD, so we may not see related difficulties in a high-interest job or task,
      3. If a person’s attention is intently focused on something, they are less likely to respond impulsively to other things in the environment.
8. Explicit engagement in a reflective practice regarding personal biases and how these may impact on the care provided to individuals and the community;
   1. These can be both help and hindrance,
      1. For example, my lived experience of ADHD means that I’m biased towards wanting to minimise the difficulties that other “ADHDers” may encounter, and gives me a richer understanding of what ADHD actually looks like outside of the diagnostic manuals, however,
      2. it also means that I need to constantly reflect on whether my desire to help is influencing my impartiality during the diagnostic process, and how I can manage this even when I’m not aware of the impact.
   2. if I believe that a condition is over- or under-diagnosed, this is very likely to present as a bias, and I must ensure that it does not influence my decision-making
9. Use psychometrically valid diagnostic tools to reduce the impact of biases on diagnostic decision-making.
   1. We are all human and beautifully flawed, so we all have biases.
   2. As healthcare professionals, we are ethically obligated to the principles of beneficence and non-maleficence (do good, mitigate avoidable or undue harm) including managing harms caused by our biases and ensuring that that we don’t fall victim to the hubris of being “the expert”.
   3. The use of valid and reliable diagnostic (not screening) measures is the most impartial evidence that we can obtain when conducting diagnostic assessments. This is one of the few areas where I actively advocate to “doubt yourself”.

Many healthcare workers choose their career with a genuine want to help but are also very busy doing the helping. Firm and structured professional guidelines and training continua must be established to ensure that our healthcare systems (both private and public) provide optimal access to, and outcomes from the care that we provide. If complemented with comprehensive training in the diagnosis of ADHD, professional collaboration (where appropriate), and reflective practice, this change has the capacity to strike the best balance between access for individuals and outcomes for communities.

A closing comment: ADHD is diagnosed in the presence of difficulties that arise from characteristics, but the characteristics are not inherently disordered. Disorder is constructed when the expectations of our context are misaligned with the characteristics and resources that we possess. No characteristic is inherently ordered or disordered. All characteristics are helpful in some contexts and unhelpful in others…….When viewed through the lens of difference, rather than disorder, we often find that it’s expectations that warrant changing, not humans.

Aaron Howearth.
Clinical Psychologist.
AuDHDer.