A 12-month wait and a $1400 bill: ADHD diagnosis in Australia

In February 2026, the NSW and Victorian governments both announced reforms to allow trained general practitioners (GPs) to diagnose and treat ADHD, joining other states attempting to reduce barriers to ADHD assessment and support. 

These reforms arrive amid ongoing public debate about ADHD – why diagnoses appear to be rising, whether the condition is being overdiagnosed, and whether stimulant medications are being misused.

That same month, University of Wollongong (UOW) PhD candidate Clare O’Toole in the School of Psychology published her first two peer-reviewed studies, examining the accessibility of ADHD assessment in Australia, and psychologists’ assessment practices.

While Ms O’Toole welcomes efforts to increase access, she hopes the current reforms will be guided by evidence rather than assumptions.

“Increasing accessibility is fantastic,” she says. “But we also want to make sure the training clinicians receive is effective, and that assessments are being done in a way that actually helps people.”

Against the backdrop of a 2023 Senate Committee inquiry into ADHD, Ms O’Toole began her research driven by a want to improve treatment accessibility. While anecdotal evidence of long waits and high costs was widespread, she says there was little representative data capturing what was happening across the system.

“Anecdotal evidence is valuable,” she says. “But it’s difficult to build policy off anecdotes.” 

Instead, her work asks, what is actually happening on the ground and how can the system be improved without making access worse?

What is ADHD and why is everyone talking about it?

Attention deficit hyperactivity disorder is a neurodevelopmental disorder that begins in childhood and continues into adulthood. Characterised by patterns of inattention, hyperactivity and impulsivity, ADHD affects executive functioning – the brain’s ability to regulate emotions, focus, thoughts, motivation and behaviour. 

Without appropriate treatment and support, ADHD can significantly impact education, employment, relationships, mental health, finances and self‑esteem.

Historically misunderstood, the condition has gained a lot of attention over the last decade. Social media has increased awareness, particularly among adults who were never assessed as children and are now seeking explanations for lifelong difficulties.

While it’s difficult to quantify the prevalence of ADHD, estimates suggest 800,000 Australians were living with the condition in 2019, rising to as many as 1.5 million Australians in 2023.

About the myth that ADHD is overdiagnosed and overtreated based on the recent increase in attention, Ms O’Toole points to a well-known historical parallel: “I think the same thing happened with left-handedness.” 

Despite research consistently showing that ADHD remains underdiagnosed – particularly among girls, women and older adults – debate continues concerning the condition being seen as a trend, self-diagnosis, and fears of stimulant misuse. Yet we know that even after diagnosis, people often go without ongoing or long-term medication, or nonpharmacological treatment.

These conversations often overlook the significant impacts of untreated ADHD, including poorer health outcomes and long-term economic costs for individuals and society, as well as the vast improvement in quality of life for those with appropriate care and support. 

Deloitte Access Economics estimated that the total cost of ADHD in Australia in 2019 was $20.42 billion.

“I think it's a valid concern that there are people being misdiagnosed,” says Ms O’Toole. “But that includes overlooking diagnoses that should be made, as well as diagnosing people where it’s not appropriate.”

“I’m glad that ADHD is more visible because it increases the chance that people who would benefit from help can access it. People can also share tools and non-pharmacological strategies that improve their lives.”

Still, stigma, long waits, high costs and confusion about the diagnostic process mean many people self‑identify with ADHD without receiving a formal assessment. 

“There aren’t any required processes for what needs to be included in an assessment, and there’s no limit on what clinicians can charge,” Ms O’Toole says. “People are unclear on who they can go to, what to expect, and what they’re paying for.”

The how, how long and how much of getting diagnosed in Australia

In Australia, ADHD can be diagnosed by a paediatrician, psychiatrist or psychologist (and, in some states, by trained GPs or nurse practitioners). Most patients require a GP referral and often attend multiple appointments before receiving a diagnosis.

Assessments typically involve a clinical interview, a detailed developmental, medical and mental health history, rating scales, and reports from family members or teachers where relevant. However, there are no national requirements specifying what must be included.

This lack of consistency contributes to public confusion and makes it difficult for patients to know what constitutes best practice.

“It’s important to be able to call the clinic and find out what’s involved, what you’re paying for, and what you’re waiting months for,” Ms O’Toole says. “But because we don’t have requirements, that burden falls on consumers.”

To understand what navigating this system looks like in practice, Ms O’Toole led a national secret shopper study, in which researchers posed as clients seeking ADHD assessments.

More than 700 clinicians across Australia were contacted and the barriers began immediately.

“Accessibility starts from: can I even get someone on the phone?” Ms O’Toole says.

Only 59 per cent of clinicians responded within two calls, and fewer than half were available to book an ADHD assessment. For people with ADHD, this administrative burden can be especially challenging.

“It’s a very difficult system, particularly if you have executive functioning issues,” she says.

The study found that the average wait time for an adult’s initial appointment was just over 10 weeks, with some waits extending to a year. For children, the average was 19 weeks, with some families waiting up to two years.

Psychiatrists had significantly longer wait times than psychologists, reflecting workforce shortages. Access was particularly limited in remote and very remote areas, where many clinicians were either unavailable or closed to new referrals.

Costs were similarly prohibitive.

The average initial assessment for an adult cost more than $530 without rebates, with total assessment costs averaging nearly $1,400 – and reaching almost $4,000 in some cases.

Costs for children were comparable.

Interestingly, while psychiatrists charged more for initial appointments, psychologists had higher total assessment costs, likely reflecting a greater number of sessions.

“In conclusion,” the study found, “substantial barriers to accessibility remain, with long wait times, low clinician availability and high costs contributing to healthcare inequality.”

Why are wait lists so long?

One of the most significant drivers of long wait times is workforce capacity; there are just 125 psychologists, 16 psychiatrists and seven paediatricians per 100,000 Australians. Psychologists vastly outnumber psychiatrists and paediatricians, yet cannot prescribe stimulant medication, which is widely regarded as the most effective treatment for ADHD.

As a result, many patients bypass psychologists altogether in favour of waiting months to see a psychiatrist. Additionally, individuals who have received a psychologist’s diagnosis often find that psychiatrists will insist on re-assessing them, citing responsibility for prescribing controlled medication. 

“It makes sense that they want to do their own assessment,” Ms O’Toole says. “But as a patient, that can be really difficult. You ask, ‘Why do I have to do this again?’”

The absence of national assessment standards means psychiatrists may not trust the thoroughness of a psychologist’s evaluation.

This duplication clogs an already strained system and drives up costs.

Inconsistent but not necessarily incorrect

Australia’s lack of a national ADHD framework also means there is limited understanding of how assessments are conducted nationwide.

Although clinical guidelines from the Australian ADHD Professionals Association exist, their dissemination and implementation have been minimal.

Ms O’Toole’s first study surveyed psychologists to examine assessment practices and knowledge of diagnostic criteria. 

While 75 per cent reported adhering to guidelines, fewer than half demonstrated adherence to recommended assessment components. When asked to identify all ADHD diagnostic criteria, 23 per cent of respondents incorrectly endorsed a non-ADHD symptom.

However, Ms O’Toole is careful not to frame these findings as an indictment of clinicians.

“I’m also a psychologist – I’m not fighting my own people,” she says. “This isn’t about saying clinicians are bad at their jobs.”

Instead, the results highlight systemic gaps rather than individual failings. Additionally, it doesn’t mean clinicians are making invalid diagnoses, given the diversity in how ADHD presents.

“You could tick all the boxes and still get the wrong answer,” she says. “Or not tick them and still get the right one.”

Guidelines, she argues, function as guardrails, reducing the risk of misdiagnosis or missed diagnosis, both of which carry significant consequences.

PhD candidate Clare O'Toole hopes to contribute to improving accessibility of diagnosis and support for those living with ADHD.

A step in the right direction

State‑based reforms allowing GPs to diagnose and treat ADHD may help address workforce shortages, particularly in regional areas.

“One of the really good things about GPs being involved is that we simply don’t have enough psychiatrists or paediatricians,” Ms O’Toole says.

However, there is still no national standard for GP training, a concern echoed during the Senate inquiry.

“These aren’t new issues,” she says.

Ms O’Toole’s future research will further examine what clinicians include in assessments, how diagnostic decisions are made, and how objectivity can be strengthened, including through neurocognitive assessment tools.

While patient‑reported data remains a vital component of assessment, she believes combining it with objective measures can help reduce bias, particularly for underdiagnosed groups such as women, culturally diverse communities and First Nations Australians.

“I would like to live in a world where ADHD assessments are effective and accessible,” she says. “It’s a small dream.”

Her research, she hopes, will help identify system bottlenecks, inform policy decisions and ultimately ensure people can access timely, appropriate care.