Review — The Great ADHD Myth?

Channel 4’s slickly produced new documentary The Great ADHD Myth?, presented by psychiatrist Max Pemberton, was released on 18 August amid a storm of controversy. Charity ADHD UK issued an open letter and an Ofcom complaint against the programme. Rights charity Amnesty International questioned the framing of the programme. The Royal College of Psychiatrists warned against ‘invalidating the condition’ of ADHD.

The heart of the documentary is the story of Mason, a ten year old boy diagnosed with ADHD and prescribed lisdexamfetamine (the programme glosses over the differences between the various ADHD medications, preferring blanket statements and comparisons to ‘slow-release cocaine’). In a six-week monitored ‘experiment’, he is taken off the medication, in addition to implementing a whole raft of lifestyle changes, including quitting screens, spending more time outside, and eating less processed food. He initially struggles with the new regime, becoming bored and irritable. However, with time, his self-reported mood and comments from his family indicate that he is happier and more ‘fun’ and feels more ‘himself’. However, he also finds that his schoolwork and grades decline.

Interspersed with Mason’s story are interviews with various talking heads and psychiatric industry professionals, weaving a narrative that ADHD is overdiagnosed and medication is massively overprescribed, the polar opposite of the NHS Taskforce’s conclusion that ADHD is in fact “under-recognised, under-diagnosed and under-treated”.

The science

It is easy to pick holes in the lack of scientific rigour in the experiment: It fails to uphold even the most basic scientific standards. There is no controlling for confounding variables: The parameters of the experiment explicitly include both stopping medication and various lifestyle changes, invalidating any generalisation of its findings to relate to stopping medication alone. The experiment also actively introduces a “good subject” effect: The makers of the programme make no efforts to disguise their desired outcome. And even if the utmost rigour had been upheld, a sample size of 1 would still be an anecdote, not data.

To make things worse, before the end credits roll, text onscreen reveals that Mason since reverted to taking his medication after the end of filming in order to keep up with school, contradicting in large part the programme’s thesis that coming off meds would be a viable choice for many children with ADHD.

A social construct?

A key question the programme asks is whether ADHD is indeed a neurodevelopmental disorder, or rather a ‘social construct’. The conclusion the program draws is that it is indeed a social construct, at odds with the consensus among researchers and psychiatrists. Thanks to careful cherry picking of its experts, the documentary offers no pushback against its preferred conclusion, nor even any indication that it contradicts the consensus view.

In a pivotal interview, cognitive neuroscience professor Katya Rubia says that although MRI brain scans do show differences, the differences are small and are statistical averages of ADHD and non-ADHD groups, rather than being statistically detectable for every individual within the group. However, after the programme aired, Rubia publicly withdrew her support for the programme and spoke out against it, saying it had misrepresented her views and quoted her out of context, going so far as to call the show ‘irresponsible’ and saying it could lead to an increased suicide risk.

Valid critiques that fail to land

There are many points in the documentary that come frustratingly close to excellent critiques—of the psychiatry industry, of Big Pharma, of the education system—but then veer wildly off course into reactionary or counterproductive ‘solutions’ or are simply not followed up on.

It is entirely true, for example, that a cottage industry has sprung up around the diagnosis of ADHD, with many private clinics in receipt of NHS contracts, fulfilling a need that crumbling state capacity increasingly fails to provide. Those who can pay are rewarded with a diagnosis, and those who can’t fall by the wayside, with the corresponding degradation in quality of life and decline in life expectancy that entails. Meanwhile, money that could have been used to develop and expand NHS capacity instead ends up lining the pockets of shareholders.

Similarly, as the programme correctly points out, the pharmaceutical industry is driven by greed rather than need, and as such it would be naive to expect it not to market its medications in irresponsible ways in order to maximise profits. Yet the documentary stops short of a systemic analysis, preferring to use this fact to score cheap points in pursuit of its pre-determined conclusion.

The education system comes in for criticism for its myopic focus upon examinations and grades at the expense of children’s social development and creativity, which is correctly pointed out as having hugely detrimental impacts on children with ADHD. This lines up with the Social Model of Disability, which states that disability is caused by societal barriers and attitudes, rather than essentialised as being caused by a deficiency in the disabled individual. It is not that untreated ADHD makes an individual an objectively worse learner, but rather that the expectations placed upon them by the capitalist education system (and later the capitalist workplace) expect them to act as a cog in the machine, ready to be exploited for profit. The more that human labour can be molded to fit into rigid processes with standardised outputs, the better it fits with this model of production. Unsurprisingly, ADHD brains are uniquely unsuited to this task.

There is also one target that is notably absent from the programme’s critique, despite reduced screen time playing a key role in Mason’s transformation: Big Tech. In the attention economy, platforms vie for ‘engagement’, attempting to monopolise as much of our time and attention as possible, fragmenting it into ever smaller chunks that can then be sold and converted into ad revenue. This undeniably has an outsized impact on ADHD brains and exacerbates symptoms, as distraction is seen as a feature rather than a bug. But The Great ADHD Myth? doesn’t seem interested in why screen time causes distraction, instead settling for the magical thinking of the standard liberal critique—it’s the screens themselves that are the problem, being imbued with some mystical (and thus inexplicable and unfixable) capacity for distraction.

The war on ADHD

It would be incomplete to consider an ideologically driven documentary such as this one in isolation, without looking at the wider context that produced it and that it discursively feeds back into. Well over a decade of chronic NHS underfunding has left over 700,000 people on waiting lists for ADHD referral, often for many years at a time, during which time untreated ADHD continues to wreak havoc in their personal and professional lives.

Successive governments have waged war against disabled people through ideologically driven welfare cuts and austerity policies. Andy Burnham already faces calls to cut personal independence payments (PIP), while Reform UK promises to ramp up attacks against the disabled by scrapping PIP entirely. Meanwhile, pliable legacy media outlets blithely advocate for the idea that some disabled people don’t “deserve” to receive PIP. All of this contributes nothing to public understanding and only increases the stigma around mental illness.

In a hypothetical world where Channel 4 took its public service remit seriously, this programme would never have been commissioned, much less released with such an inflammatory title, replete with disingenuous question mark to absolve the creators of responsibility. In such a world, perhaps a different programme would have been made, accurately reflecting the scientific consensus while still asking probing questions about the attention economy and the capitalist education system, which combine to make life with ADHD increasingly unlivable without medication. Perhaps it would have also critically examined the chronic underfunding that contributes to ever-increasing waiting lists for ADHD referrals. It might even have proposed solutions to some of these problems (even if they were reformist half-measures such as better regulation for Big Tech). And it could still have asked the very valid question as to whether ADHD people should be forced by a confluence of social pressures into medicating, while acknowledging that under current conditions, medication often is the only workable solution. Unfortunately, that’s not the programme that was made, and the public understanding of ADHD is the worse for it.