Does the NDIS cover people with ADHD? Here’s what you need to know

Do you or someone you care about have ADHD? If so, you're probably wondering if ADHD is covered by the National Disability Insurance Scheme (NDIS).

ADHD is a common neuro-developmental condition, affecting approximately 1 in 20 Australians, and often persisting from childhood into adulthood. It's important to acknowledge that everyone's experience with ADHD is unique. Many individuals also navigate co-occurring conditions like anxiety, depression, learning differences, and autism, which can significantly impact their daily lives.

Recognising the prevalence and diverse impact of ADHD, alongside these other conditions, has led to ongoing discussions about how the NDIS can provide appropriate and person-centred support.

In December 2023, an examination of the National Disability Insurance Scheme (NDIS) was conducted, resulting in suggestions for modifying the system that caters to individuals with disabilities.

One of the key outcomes of the review, particularly for adults with ADHD, is the suggestion to eliminate access lists and shift from diagnosis-based evaluations to assessments based on functional needs. This suggestion aligns with the review’s recommendation for a novel approach to NDIS supports for psychosocial disability, with an emphasis on personal recovery.

In this guide, we'll discuss ADHD and the NDIS, including eligibility, application processes, and available supports.

What is ADHD?

ADHD, short for Attention Deficit Hyperactivity Disorder, is a neuro-developmental condition that affects both children and adults. It's not simply being easily distracted or hyperactive. It's a complex condition impacting attention, impulse control, and hyperactivity.

ADHD is a spectrum disorder, meaning symptoms can vary greatly from person to person. No two people will experience ADHD in the same way, and there's a lot of variation in individual experiences.

ADHD also brings strengths, such as creativity, high energy, and innovative thinking. Research indicates individuals with ADHD excel in imagination and divergent thinking.

While ADHD is a prevalent condition, it can sometimes go undiagnosed or misunderstood. That's why raising awareness and understanding is vital to ensure individuals with ADHD receive the support they need to thrive.

How the NDIS views ADHD

Currently, ADHD itself does not guarantee automatic NDIS eligibility. The NDIS primarily focuses on supporting people with permanent and significant disabilities that substantially affect their ability to participate in everyday activities.

While ADHD is recognised as a neuro-developmental condition that can present lifelong challenges, the NDIS often looks at how these challenges translate into functional impairments.

The NDIS assesses eligibility based on the impact of your disability on your functional capacity. This means they look at how your disability impacts your ability to perform daily activities, participate in community life, and achieve your goals. The assessment considers the support you require to overcome limitations and enhance your independence.

It is important to remember that NDIS eligibility is assessed on an individual basis. Even if you have a specific diagnosis, meeting the eligibility criteria requires demonstrating the functional impact of your disability.

However, it's also critical to know that ADHD frequently coexists with other conditions, such as autism, anxiety, dyslexia, or intellectual disability. If you have one or more of these co-occurring conditions, they may be considered when determining your NDIS eligibility.

Psychosocial disability and ADHD

Psychosocial disability arises from the interaction between a long-term mental health condition and environmental barriers.

ADHD can contribute to this by affecting social interactions and emotional regulation. It is essential to know that not everyone with a mental health condition has a psychosocial disability.

How does NDIS eligibility work?

NDIS eligibility is determined through a comprehensive assessment process that considers various factors. There are several key areas that the NDIS will look at when determining your eligibility for funding, and the extent to which your lifestyle challenges influence your capacity and day-to-day life.

Let’s break these down to give you a clear idea of the main points:

• Age requirement: To be eligible for the NDIS, you must be under the age of 65 at the time of application. The scheme primarily focuses on providing support to individuals during their working-age years. If you or your loved one is outside these age brackets, don’t worry; there are other government-supported schemes available to provide you with the assistance you need. If you’ve been receiving NDIS support and then turn 65, you can opt to keep your current support (meaning nothing changes, and you stay on NDIS funding) OR you can choose to switch to Aged Care support.
• Residence requirement: You need to be an Australian citizen, hold a permanent visa, or have a Protected Special Category Visa to be eligible for the NDIS. Additionally, you must reside in an area where the NDIS has been rolled out.
• Disability requirement: The NDIS provides support to individuals who have a permanent and significant disability that affects their ability to participate in everyday activities. The disability can be intellectual, cognitive, neurological, sensory, or physical in nature. It must have a substantial impact on your functional capacity.
• Early intervention: The NDIS also covers early intervention support for children (0-6 years) who have a developmental delay or disability. The NDIS Early Childhood Approach aims to address developmental challenges early on, promoting better long-term outcomes. While this funding and eligibility look a little different from standard NDIS services, rest assured that there is support available for your child.
• Functional impact: NDIS eligibility is determined based on the functional impact of your disability. It considers how your disability impacts your ability to perform daily activities, participate in community life, and achieve your goals. The assessment considers the support you require to overcome limitations and enhance your independence.
• Accessing the NDIS: To access the NDIS, you need to apply to the National Disability Insurance Agency (NDIA) and provide relevant information about your disability, its impact, and the support you require. The NDIA will review your application and may request additional documentation or assessments to determine your eligibility.

Remember, eligibility for the NDIS is assessed on an individual basis. Even if you have a specific diagnosis, meeting the eligibility criteria requires demonstrating the functional impact of your disability.

If you’re unsure about your eligibility, or if you need assistance with the application process, don’t hesitate to reach out to the NDIA or seek support from a Local Area Coordinator (LAC). They can guide you through the process and provide further information tailored to your situation.

See the NDIS eligibility checklist for a step-by-step guide on whether you meet the eligibility requirements or not.

Functional impairment vs diagnosis

When the NDIS assesses your eligibility, they're less focused on the diagnosis itself and more on how your condition impacts your everyday life.

This means they want to understand the challenges you face in areas like communication, social interaction, learning, mobility, self-care, and self-management.

Think of it as telling your story: how does ADHD, and potentially any co-occurring conditions, affect your ability to participate fully in your community, work, or social life?

NDIS Access Lists

You might have heard about NDIS "access lists" (like “List A” and “List B”). These are guides that help the NDIS determine eligibility for certain conditions.

ADHD is not on these lists. However, this doesn't automatically exclude people with ADHD from NDIS support. The key is to demonstrate how your conditions impact your functional capacity, regardless of whether they're on a list.

Applying for NDIS funding with ADHD and co-occurring conditions

Only 1-in-3 Australians have ADHD as their only diagnosis. If you believe your ADHD and any co-occurring conditions significantly impact your daily life, here's how to approach the NDIS application process:

Identify co-occurring conditions:

• Many conditions commonly co-occur with ADHD, such as autism, anxiety, or intellectual disability.
• Consult a GP or specialist to confirm any diagnoses.
• Having a diagnosed co-occurring condition that is on the NDIS list of eligible conditions, will greatly improve your chances of NDIS access.

Gather comprehensive evidence:

• Medical Reports: Obtain detailed reports from your doctors and specialists outlining your diagnoses and the impact of your conditions.
• Functional impact statements: Write or provide statements describing how your conditions affect your daily activities, work, and social life.
• Therapy and intervention records: If you've received therapy or interventions, include records of these, as well as the outcomes.
• Evidence of exhausted treatment options: Get written confirmation from a doctor that all other treatment options have been exhausted.
• Document functional capacity: Focus on how your conditions impact areas like communication, social interaction, learning, mobility, self-care, and self-management.
• Psychosocial disability: If your ADHD or co-occurring conditions contribute to psychosocial disability, include evidence of this. This may include the "Evidence of psychosocial disability form."

Seek support:

• Consider contacting a Local Area Coordinator (LAC) or an NDIS advocate for guidance through the application process.

Submit an access request form:

• This form officially starts the NDIS application process.

Available supports

Whether you're seeking NDIS funding, exploring mainstream options, or looking for community resources, there are various supports available to individuals with ADHD and co-occurring conditions.

NDIS-funded supports (if eligible):

If your NDIS application is successful, you may access funding for supports tailored to your needs, including therapy, assistive technology, skill development, and support workers.

Mainstream and alternative resources:

Remember that the NDIS is designed to supplement, not replace, mainstream services. Explore options like mental health care plans, community groups, and educational support.

For additional resources, consider organisations like ADHD Australia and the ADHD Foundation, which offer valuable information and support.

By exploring all available support options, you can create a comprehensive support network that meets your individual needs.

How to access ADHD support with Like Family

At Like Family, we’re committed to helping people with disability increase their independence and build lasting relationships.

We can help with various ADHD-friendly activities, including community access, meal preparation, transportation, and a buddy for social events. You can access our disability support services even if you don’t have NDIS funding.

If you or a loved one have ADHD and are interested in hiring a disability support worker, visit our website or contact our friendly team at hello@likefamily.com.au today!