There is a problem at the heart of the current debate about ADHD. Those who question its reality tend to describe it entirely from the outside. Those who live with it experience it from the inside. The difference matters.
The philosopher David Chalmers gave this difficulty a name in a lecture delivered in Tucson, Arizona, in 1994. He developed the argument in his 1995 paper, Facing Up to the Problem of Consciousness.
Chalmers distinguished between what he called the “easy problems” and the “hard problem” of consciousness.
That said, the easy problems are not that easy, as far as I can see. They include explaining how the brain:
- processes information,
- directs attention,
- stores memories,
- produces speech and
- controls behaviour.
They are called easy only because they can be investigated using scientific methods.
The hard problem is quite different. It asks why those physical processes are accompanied by subjective experience:
- Why does seeing red feel like something?
- Why does pain hurt?
- Why, in fact, is there a first-person experience of being alive at all?
In other words, science might eventually describe every process taking place in a person's brain while still failing to explain in any way what it is like to be that person. That distinction is obviously relevant to discussion on the existence of ADHD.
ADHD as seen from the outside
The public debate about ADHD is dominated by the easy problems such as:
- How many people have been diagnosed?
- What do brain scans show?
- Do diagnostic criteria identify a distinct group?
- Are private clinics diagnosing too many people?
- Do stimulant medications work?
- Could modern schools, workplaces, smartphones or social media be creating the behaviours now labelled as ADHD?
These are all legitimate questions. I do not dispute that. They are worthy of being investigated. But none of these questions captures the experience of living with ADHD, which is precisely why Channel 4's programme on this issue failed.
This should be obvious.
An observer can see someone arriving late, but they do not necessarily see the desperate attempt to organise time that preceded it.
They might also see a person who has failed to complete a task, but they do not experience the paralysis of knowing exactly what must be done while being unable to begin doing it, from which I do not suffer but which I know many with ADHD do.
Again, they might see distraction, but they do not feel attention being pulled simultaneously in several directions.
Most especially, and here I refer to what was said about Chris Packham, they might see someone apparently functioning well, but they do not see the exhaustion required to maintain that appearance.
I could keep going: I think you get my point. The external behaviour is observable. The internal cost is not.
This is why accounts of ADHD based entirely on observed behaviours are inadequate. A person's visible performance says little about the amount of effort, anxiety, self-monitoring and compensation required to produce it. Success does not prove the absence of ADHD. It may instead reveal the scale of the masking and coping strategies that the person has developed.
The same problem arises when assessing treatment. An outsider may ask whether medication makes someone more productive, but that can be a misplaced criterion for success, since it is externally focused. The person taking a drug might want to do so because they value a quieter mind, a greater sense of choice, or the ability to direct attention rather than being driven by it. Those outcomes are real, even if they are difficult to measure from the outside. Others, more importantly, may use different criteria. Almost by definition, neurodiverse people are not homogeneous.
A social construct is not an invention
This has particular relevance for the suggestion used by some critics that ADHD is a social construct. This is often presented as if it proves that ADHD is imaginary. It proves nothing of the sort.
ADHD is undoubtedly a category created by people. The boundaries of the diagnosis, as is widely recognised, have been agreed by committees. The criteria have changed over time. They may remain inadequate. We can hope they improve. But the reality is, social expectations influence which differences are noticed and when they become disabling.
But every medical diagnostic category is, in this sense, a construct. A category is a tool used to group experiences, signs and symptoms that appear to have something significant in common. This is the most that can be said for the term cancer, as I noted previously. The category is not the person, and the map is not the territory. That, though, does not mean there is no territory.
The demands of a neoliberal society may make ADHD-related difficulties more visible. They may also make those difficulties more disabling. But social circumstances that shape how a condition is expressed do not mean the underlying differences are unreal. As an example, short-sightedness is more disabling in a society that expects people to read. That does not mean short-sightedness is invented by books.
Nor does the hard problem prove that ADHD must have one particular biological cause. That could not settle every diagnostic dispute, validate every assessment or show that medication is always appropriate. Subjective experience has to be considered alongside developmental history, functional impairment, alternative explanations and the available clinical evidence.
What the hard problem does show is the limitation of any account that treats externally observed behaviour as the whole reality of ADHD.
There is no brain scan, blood test or questionnaire that can fully communicate what it feels like to inhabit another person's mind. That is true of ADHD, autism, depression, pain and consciousness itself.
The unavoidable conclusion is that first-person testimony matters. It is not infallible, but neither is observation from the outside. A serious assessment must bring together what can be observed, what has happened throughout the person's life, how they function in different circumstances and what they report experiencing.
The debate about ADHD therefore cannot, then, be resolved by standing outside people's lives and declaring that their experience is merely a product of fashion, social media or inadequate discipline, as some appear to be doing by depending solely on easy questions.
The hardest question is, in fact, not whether an outsider can see ADHD. Those limiting themselves to the easy questions clearly cannot. It is, instead, what it feels like to live with the ADHD mind, every day, over a lifetime, and which explanation best makes sense of that experience. And any debate that refuses to ask that question is not a serious debate about ADHD at all.
Note: I must acknowledge the input of Jacqueline Murphy into this post. I would not have known about the hard problem if she had not drawn my attention to it. This article would not have existed without our discussion of it.
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The adhd.co.uk web site describes ADHD thus: “ADHD is a disorder that is defined through analysis of behaviour. People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with day-to-day functioning and/or development.”
They also have an Adult ADHD Self Screening Tool.
The Attention Deficit Disorder Association (ADDA) says that they “rely on peer-reviewed research—scientific studies evaluated by independent experts—as the foundation for our recommendations.”
They too have an ADHD Test for Adults.
Thank you.
A good start, but there’s an emotional element (or rather emotional regulation) for many, which was noted by physicians earlier but left out some decades ago due to being less easy to measure.
Self-employment for preference and misery at school quite common.
Hi
Excellent balanced article, a refreshing change from the id pol ad hominem shouting on X. When it comes to the law it appears it also becomes problematic as I have seen prosecution inaccurately infer that somebody has a mental illness from an ADHD diagnosis. People should be also aware of this aspect of societal control.
Thank you both
In non Western states this is less of a problem. I have read/spoken to people who have met Indians, trained in ‘western’ science who still subscribe to metaphysical (above or beyond the physical ) concepts such as the siddis -paranormal powers-of yoga. Spiritual healing is used alongside western practices. Non brain generated consciousness is accepted as part of the universe.
Even the Royal College of Psychiatrists has a special interest group ( others involve working with the elderly, prisoners etc ) on Spirituality ( I think one of the biggest ) and on its website published various papers including spiritual healing and quantum processes. They stopped publishing them about 2016 but were still there a couple of years ago.
Attitudes change but as Thomas Kuhn pointed out , often more by the ‘old guard’ retiring or dying rather than by changing their mind.
The Medical and Scientific Network often gives talks on this area.
We may know less than we think.
Extremely salient post that ‘feels right’ about the real problem.
What is screams to me is that human affairs should be a shared world managed by:
‘Accommodation’
‘Compromise’
‘Negotiation’
‘Consent’
What we get instead too often, is the enforcement of one view at the expense of others. We see this in capitalism and modern liberal democracy all of the time.
Agreed
“There is no brain scan, blood test or questionnaire that can fully communicate what it feels like to inhabit another person’s mind.”. It’s true for everyone. No matter how much you love another person, and desire their wellbeing, you simply don’t know what is going on in their mind. All we have to go on is behaviour (needs interpreting), empathy (easy to get it wrong), self-report (often helpful, needn’t be). It is a wonder how we live with, and communicate with, others at all. So often we just have to live on the surface, and assume commonsense answers to real philosophical questions.
The hard problems you refer to are held by many scientists to be the greatest problems facing science. Those referencing the lack of a physical sign in the brain are being duplicitous. They KNOW that most experiential states do not have a known physical sign. They KNOW they can’t find your Ely Cathedral totality of experience in your memory using known scientific methods. Indeed, for those who adhere to the idea of the brain as a quantum engine, you can never ‘know’ in any final manner. It reminds me of the ME/CFS scandal, where for decades it didn’t exist with a known cause but was very much a phenomenon.
Agreed
Richard, there is a very well written article by Marie Le Conte today in the New World that you may find interesting to read, along with a reader’s comment below it.
I agree.
It was good.
While this is an interesting analysis ADHD is by no means unique in this regard: similar comments could be offered in relation to most (perhaps all?) psychiatric conditions, and many neurological diagnoses too. That there are important differences between subjective, first person or ‘lived’ experience and other perspectives is in fact well known and firmly established in the mental health field, largely due to sustained campaigning over recent decades by service-user groups.
So your analysis overlooks the considerable influence that formal notions of ‘lived experience’ already have in mental health. It also overlooks something more subtle but even more important: substantial numbers of mental health professionals have subjective, first person experiences of their own. Few acknowledge this publicly, for obvious reasons. But with between 1 in 4 and 1 in 6 people in the UK experiencing poor mental health at any given point in time, it is inevitable that many workers in mental health (including researchers, managers and administrators) will be affected. Whether ADHD or other diagnostic labels are applied, subjective experience already plays a part in mental health.
Perhaps the more interesting question, then, is why hasn’t the incorporation of perspectives from lived experience done more to improve mental health services?
I agree that lived experience is not unique to ADHD, and I have never suggested otherwise. But I think your final question reveals where we differ.
The issue is not simply whether lived experience has been “incorporated” into mental health services. It is whether it has been allowed to challenge the assumptions on which those services are based.
There is a considerable difference between listening to lived experience and allowing it to define what the experience means. The professional model can listen and still retain the power to say, “We know what is really happening to you.”
That is precisely why neurodiversity matters. It shifts authority towards the person experiencing the difference. In the case of ADHD, that can transform something understood as failure or pathology into an explanation of how a person actually thinks.
That is much more radical than consultation.
I don’t think that such a documentary would have appeared 10 years ago because it was too unbalanced. A bit like the stance of the current BBC.
The Guardian has published a strong criticism of the Channel-4 program today:
https://www.theguardian.com/commentisfree/2026/aug/20/there-is-nothing-scientific-about-the-great-adhd-myth-documentary
Paul
That was very good. Thanks for the link
The i paper also had an article criticising the programme.
https://inews.co.uk/culture/television/this-great-adhd-myth-gets-wrong-4708296
I have an impulse control problem caused by either too much dopamine in my brain or an over sensitivity to dopamine. It’s Bipolar 2. No one else can know how it feels to have this brain unless they have an impulse control problem too. Fortunately, I was prescribed the atypical antipsychotic Quetiapine about 15 years ago. It reduces overactive dopamine signals and has reduced my impulsivity. It has made my life so much easier. Before I couldn’t see how my behaviour was getting me into trouble. Now I can and my behaviour is mostly much better. If your brain is making life difficult for you and others, then it’s much better for you to take whatever medication is needed, so that your life is easier for you and others.
Thank you for sharing your story.
Richard I thought you might be interested in –
https://scitechdaily.com/scientists-reveal-how-adhd-could-fuel-creative-thinking/
In essence, I agree
A well respected connection of mine on LinkedIn posted this which I found very interesting – https://www.sciencemediacentre.org/expert-reaction-to-the-tv-show-the-great-adhd-myth/
Thanks
What a terrific take down of that sham of a ‘program.’
Imagine having ADHD and it ripping you apart only to be told ‘it doesnt exist, your making it up’ that would drive anyone, truly mad.
Wholly agreed