ABC’s Four Corners aired “Attention Deficit” in April. Norman Swan, UNSW data, a national map of adult ADHD medication use that should unsettle anyone working in this space. The proportion of Australian adults being treated for ADHD has increased more than six-fold since 2017. In some Western Australian postcodes, over 4% of adults are on stimulant medication. In parts of south-west Sydney, it is 0.3%.
I watched the whole thing. And I kept waiting for the conversation to land where it matters most for the families I work with. It never did.
The Piece I Wrote in 2022
In December 2022, I published a piece on this blog called How a Holistic Approach Can Help Prevent Over-Prescribing for ADHD. COVID prescriptions were surging and most of the discourse was about whether we were overprescribing. I thought the question was too narrow.
ADHD is not an infection. It results from delayed brain development, shaped by genetics and lived experience. If you assess it without understanding the child’s developmental story, their relationships, the family system they live in, you will default to medication as the whole answer. I wrote that in 2022 and I still think it is the core of the problem.
Three and a half years on, the national data says the same thing I was hearing in my consulting room back then. More prescriptions are being written. Families are not getting better support.
What the Investigation Left Out
Four Corners focused on adults, and there are valuable things in that data. The gendered shift is real (women now outnumber men in ADHD medication use). The socioeconomic barriers that leave outer suburban and regional communities undiagnosed are real.
But the piece largely treated the adult ADHD story and the child ADHD story as if they exist on separate tracks. In my experience, they rarely do.
A parent who receives an ADHD diagnosis at 35 very often has a child being assessed at 7. The genetics run through families. So do the patterns of emotional reactivity, impulsivity, difficulty staying regulated when things get tense at home or at the school gate.
I had a family in recently where the child had been referred for explosive behaviour. Three sessions in, it became clear that the mother had been managing her own undiagnosed ADHD since adolescence. She had never had a name for it. She just thought she was not coping. Once she got support, the whole dynamic at home shifted. Not overnight, and not perfectly, but the change was tangible within weeks.
That pattern comes up constantly. And it is the one the national conversation keeps skating past.
The Loop That Medication Cannot Break on Its Own
When a parent is managing their own challenges with attention and regulation, whether they carry a formal diagnosis or not, their capacity to co-regulate with their child takes a hit. This is about biology, not parenting failure. A parent whose own prefrontal cortex is running flat out just to hold things together has less bandwidth for the calm, attuned response their child needs when things go sideways at 7:30 in the morning.
The child’s distress activates the parent. The parent’s frustration activates the child. Both nervous systems are firing, and the relationship gets stuck in a reactive cycle.
Medication can take the edge off that cycle. I prescribe stimulant medication regularly and I have seen it genuinely change the texture of a family’s day. Mornings become possible. School stops feeling like a threat. The low-level conflict at home drops enough for everyone to get a breath.
But here is what medication does not do. It does not teach a parent how to stay alongside their child in a hard moment instead of reacting from their own survival brain. It does not repair the ruptures that have accumulated over months or years of both people being dysregulated at the same time. It does not build the regulatory wiring in a child’s prefrontal cortex, because that wiring develops through relationship. Through thousands of small moments where a trusted adult stays steady enough for the child to borrow their calm.
Medication creates the conditions for those moments to happen more easily. It cannot replace them.
Telehealth, Checklists, and What Gets Lost
One of the factors behind the high prescribing rates in WA is a shortage of local psychiatrists. That gap has been filled by telehealth providers, some of whom are running assessments that lean heavily on checklist-based screening. A score, a script, and the family is on its way.
I need to be careful here because we use telehealth at Relational Minds. We have families across regional Victoria who cannot get to a clinic, and for some of them telehealth is the only pathway to specialist support. When it is done well, telehealth can hold a family’s story over time, track how things are changing, and keep the clinician genuinely connected to what is happening at home.
The issue is not the medium. It is when a 20-minute video call replaces a proper developmental assessment. When no one asks the parent about their own history, their own regulation, how they are going in the relationship with their child. When a checklist score becomes the entire basis for treatment. That is not a proper assessment.
What I Actually Mean by Holistic
It has become a vague word, so let me be specific.
A holistic approach to ADHD means assessing the child in the context of their family. It means paying attention to the parent’s own developmental and mental health history. It means understanding the quality of the relationship between the parent and child, because for children, that relationship is the primary vehicle for brain development. The prefrontal cortex, the area most implicated in ADHD, does not mature in isolation. It develops through co-regulation with a trusted adult. That is neurobiology.
It means treating what needs treating. Sometimes that includes medication, and I am direct about that when the clinical picture supports it. But it also means equipping parents with the skills and understanding to become the steady, regulated presence their child needs. Teaching them that the behaviour makes sense when you can see what is underneath it. Giving them a way to respond that does not leave everyone feeling worse afterwards.
We have been working this way at Relational Minds for years, across Mildura, Sunbury, Bendigo, and via telehealth for families in regional Australia who would otherwise have nothing. Or worse, a checklist and a script. Our model is psychiatry-led, parent-focused, and grounded in developmental neurobiology and relational therapy. We treat the child, the parent, and the system around both of them, because anything less only gets you part of the way.
Where the Conversation Needs to Go
The ADHD conversation in Australia is louder than it has ever been. Four Corners has made sure of that, and the data UNSW produced deserves attention.
But if the conversation stops at prescribing rates and postcode heat maps, we will keep getting the same outcomes. More prescriptions written. More families in under-serviced areas left without access. And in the families who do get medication, a lingering sense that something is still not working because the mornings are still hard and the relationship is still frayed.
For children with ADHD, the difficulty almost always involves the relationship with the adults around them. Recognising that is not about pointing fingers at parents who are already doing everything they can. It is about recognising where the most powerful lever for change sits. And right now, across most of the system, no one is touching it.
I wrote about this in 2022. The data caught up this week. I am still waiting for the system to follow.
Read the original 2022 article: How a Holistic Approach Can Help Prevent Over-Prescribing for ADHD
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