When Channel 4 announced that it would air a documentary titled The Great ADHD Myth?, an outpouring of fury followed. Despite this, I set out to approach it as a scientist – not just as a scientist whose own work has dealt with developmental disorders, but as someone who has enormous respect for the scientific process and for the importance of evidence-led debate.
Channel 4’s press release claimed the documentary sought to determine whether attention deficit hyperactivity disorder was a “genuine neurodevelopmental disorder, or a social construct”. At one level this is a brave enterprise. ADHD is recognised worldwide as a disorder, by the World Health Organization and our own NHS among others. Estimates suggest ADHD affects roughly 8% of children and adolescents and about 3% of adults worldwide. To overturn this consensus would require robust, reproducible findings capable of explaining away decades of genetic, developmental and clinical research. The press release described the documentary as “science-led”, which hinted at just such an enterprise. Was it really science-led?
The answer is a resounding “no”. It bore little relation to a genuine scientific debate; in fact, there was no evidence of a debate at all.
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One thing science tries to do is eliminate bias – not always successfully, but the intention should be there. The documentary does not start out well on this front. Max Pemberton, the presenter, has published widely about his ADHD scepticism: an article he wrote for the Daily Mail last year was headlined: “This is the REAL reason why there’s been an explosion in cases of ADHD – and why we should all be scared of the consequences.”
The very title of this programme does not promise a balanced discussion (ADHD UK has said its question mark does not serve as a “get-out-of-harm-free card”). Asking whether this is a “genuine” disorder or a “social construct” can all too easily be read as:“or made-up”.
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As the late physicist Richard Feynman pointed out, good science should be as ruthless with the evidence that supports your thesis as it is with the evidence that contradicts it. This “documentary” (having seen it, I am deliberately putting this term in scare quotes) doesn’t report any evidence that might contradict the conclusion it has clearly reached at the outset. Not only that, the “evidence” (ditto) it does present mostly comprises a series of trenchant opinions from carefully selected talking heads, and focuses on a couple of so-called experiments that break just about every rule of genuine scientific inquiry.
Is ADHD a “genuine developmental disorder”? Setting aside the support from the likes of the WHO and Nice, as well aspowerful genetic evidence unmentioned in the documentary, the presenter decided that if we could “see” ADHD in the brain, this might prove it to be genuine. He interrogated Prof Katya Rubia, a cognitive neuroscientist who does have a genuine track record in ADHD research. She reported that key differences had been spotted at the group level and added that they were small. A landmark study in 2017, combining MRI data from more than 3,000 people, reports just such findings. Pemberton missed the point she was making, and asked that perennially naive question that plagues brain imagers: can you “spot” ADHD in a single scan, or use it for a diagnosis? In response to her honest answer, no (which is exactly what you might expect, confronted with a single example from an enormously heterogeneous population), he appeared to conclude that if there was no brain-based marker that distinguished a brain with ADHD from one without, ADHD could not be a brain-based disorder. And, therefore it was not a genuine developmental disorder.
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Apparently, this means ADHD is a social construct – even if the evidence in favour of that conclusion is deeply flawed.Opinions about screen time and ultra-processed food and big pharma conspiracy theories were wheeled out in support of this claim, as well as scornful references to diagnostic manuals, this time without any attempt to offer supporting evidence. The presentation of “genuine” condition or “social construct” as a simple binary choice harked back to the old “nature or nurture” debates, with no acknowledgment of contemporary findings about the entanglement between the brain and its world. Just because you believe that something “out there” is responsible for certain kinds of behaviour, it doesn’t mean that the brain is not involved.
At the heart of the programme were two so-called “carefully monitored experiments”. One involved a 10-year-old boy, Mason, being taken off his medication for six weeks. He was not randomly selected but “volunteered” by his mother, who felt that the medication was masking the real Mason. In addition to stopping the medication, a holistic practitioner removed items such as screens and mobile phones, ultra-processed food and chocolate, and suggested walks in nature, exercise and yoga. The consequences of this were reported throughout the programme.
This was not a scientific experiment in any sense. Setting aside the fact that a case study such as this would not produce any kind of reliable evidence, you could point out that there were no “control” conditions. Was there a child taken off their meds but not offered holistic alternatives? Was there a child who stayed on their meds, but was also offered alternatives? One could go on. Mason’s story is powerful television because it is complicated, human and emotionally engaging. Those are not, unfortunately, the usual ingredients of a controlled experiment.
Pemberton’s own contribution comprised a demonstration of the diagnostic process. After handing over £1,200 for a private online assessment, he triumphantly reported that he had (almost instantaneously) been diagnosed with ADHD. He seemed to conclude that ADHD therefore could not be a valid clinical construct. Setting aside, again, the non-contribution of an anecdote such as this to a genuinely science-led inquiry, his conclusion seems to be that if you can wrongly get an ADHD diagnosis, then ADHD can’t be real. It is worth noting that his foray into costly online clinics bears no resemblance to the immensely painstaking procedures behind an ADHD diagnostic procedure as laid out by Nice guidelines. Yet again, Pemberton displayed a warped non-scientific logic. A diagnostic process being flawed does not mean the construct it is trying to measure does not exist.
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The frustrating thing about The Great ADHD Myth? is that buried inside it are several questions that science really does need to ask. Are diagnostic thresholds becoming too broad? Are all private assessments rigorous enough? Are drugs sometimes used where environmental changes would be better? Do schools demand an unnecessarily narrow range of behaviour from children? And do we know enough about the long-term effects of stimulant medication? These are important questions. But none require us to pretend that decades of genetic, developmental, clinical and neuroscientific evidence simply disappear.
There is nothing unscientific about questioning ADHD. Science progresses by questioning accepted wisdom. But genuine scientific scepticism means subjecting your preferred explanation to the strongest evidence against it. It does not mean assembling a procession of experts and anecdotes that point in the same direction and calling the result “science-led”.
