I watched last night's Channel 4 documentary, “The Great ADHD Myth?”. The programme was presented by Dr Max Pemberton, who explained he had been a consultant psychiatrist for around 25 years. He failed to mention that he specialises in geriatric care. He was supported by a range of psychologists and a GP, every one of whom was sceptical about the existence of ADHD, as was the person interviewed because of her work in scanning brains over a period of 30 years.
The programme appeared to set out to prove three things.
The first was that ADHD does not result in identifiable changes in a person's brain, and as such it cannot exist.
Secondly, and as a result, it suggested that treating what is described as ADHD with drugs is not beneficial. In doing so, it only looked at children. The possibility that ADHD might continue into adulthood and have serious consequences there appeared not to have occurred to those taking part.
The third was to claim that an exploitative industry has developed over the last decade or so, offering ADHD diagnoses to people who do not need them because ADHD is not a neurodevelopmental concern. This was described as neoliberal.
The uncritical viewer might think that the programme achieved its goals. The evidence supporting these hypotheses seemed overwhelming. However, there are very simple explanations for that.
No evidence was presented from anyone who suffered from the condition, except a 10-year-old boy.
Nor was any sought from any psychologist who believes that the condition exists and could explain why.
Nor was evidence offered that shows that, at the population level, evidence for the existence of ADHD does exist, even though it cannot provide a diagnostic test using individual brain scans.
Nor was there any explanation provided for the characteristic traits found amongst ADHD sufferers suggesting differences in how dopamine and noradrenaline systems are regulated and used within their particular brain networks.
In other words, this was an argument won because the counterargument was never presented. It was as if this was a football match that a team was so desperate to win that it inadvertently forgot to invite any opponents. That is how biased the presentation was.
For a regulated public service broadcaster to present such a piece on an issue of significance for so many people, without seeking to offer a balanced view when drawing conclusions, was shocking. This might have been expected of GB News when discussing immigration, but not of Channel 4 when discussing an issue of genuine medical concern. The programme's failure to offer balance may be the best evidence that it did not believe its own arguments.
Some other issues stood out. The first was what I thought to be the abuse of the child on whom an experiment was conducted that required him to go cold turkey on three fronts simultaneously as a result of the withdrawal of his ADHD medication, the denial of access to his electronic devices and a ban on eating sugary stimulants. Could he really have provided informed consent to take part in this way? I question the ethics of that. It is also worth noting that the experiment failed: he ended up back on the drugs the programme wanted to prove he did not need.
The second was the total absence of any discussion on adult ADHD. The issue was totally ignored, except when Max Permerton was diagnosed as having ADHD - evidence for which he inadvertently supplied, in my opinion - but which he denied, and then, unethically, in that case, took the prescribed drugs he had been given for it.
The third was that the possibility of living with ADHD without drugs was not discussed, and yet that is what most people do. The diagnosis is vital to their understanding of their condition, and to their learning how to adapt to it. The value in this was never mentioned. The arrogance in that was staggering. This was an exercise in psychologists granting themselves the power to decide whether other people's lived experiences exist, which they appeared to deny just because they did not have them. I think that was abusive. Just imagine they were deciding instead whether people suffered racism or not, and they were all white. The parallel is obvious, as is the potential for abuse.
But perhaps most staggeringly, the programme did, in reality, and by properly interpreting its proposed closing recommended course of action, conclude that ADHD not only does exist, but requires radical adjustment within society if those with it are to be treated appropriately.
How do I know this? That is because the programme argued that massive reform to the UK education system is required to manage the symptoms that are collectively called ADHD, the existence of which it denied.
It said schools should devote much more time to arts and creativity, to time in nature and on physical activity, and, by implication, reduce the time spent on academic disciplines.
I have sympathy with some of that. I am a critic of the current education system, because it does not meet the needs of children with autism and ADHD, and of all others as well, as well as the needs of society. But I would not advocate such reform primarily - as this programme did - to manage a condition that I simultaneously claim does not exist. That they did so was quite bizarre.
Conclusions
So, what is there to conclude?
The most obvious thing to say is that this was a massively arrogant and profoundly unbalanced programme, clearly intended to present a biased view on a subject where the opinion presented will cause significant harm to a very large number of people in the UK. That, I think, was unforgivable.
Secondly, we were presented with a range of opinions which were staggeringly ill-considered. The argument that ADHD is just a social construct was presented as if this was an isolated fact, when, as I have noted on this blog, all medical diagnoses are social constructs, as is medicine itself, and as, of course, are both psychiatry and psychology. Those making the claim appeared unaware of this fact. Their lack of awareness shone through their claim and discredited the programme, when much of its argument hung on it.
Third, the programme seemed to argue that ADHD exists to exploit vulnerable people by charging them for diagnosis and drugs, and is, as a result, a neoliberal construct. What no one then mentioned was that the conditions that they suggested create the environment requiring radical reform to our education system, arising as a consequence of people having the characteristics that are described as ADHD, are all caused by neoliberal enterprise. They range from ultra-processed food and electronic devices to social alienation and much more.
The finger of blame was pointed very firmly in the wrong direction in that case. Those who have identified and seek to address issues arising from ADHD were blamed as being neoliberal, when what they have actually identified are faults caused by neoliberalism. A DARVO effect appeared to be in action in that case, which happens when a standard right-wing response of 'denial, attack, and reversing the victim and offender' is in operation.
Fourthly, for reasons I've already noted, drawn from the conclusions that the programme itself reached, ADHD is real, and does require accommodation in society, but not necessarily through the use of drugs on all occasions.
Lastly, neurodivergence needs to be much better treated in the media when those making programmes such as this know that politicians intent on abusing minorities in society will use them as weapons against those they deem to be “others”. In that sense, this programme was deeply ethically and politically irresponsible. Channel 4 should hang its head in shame and make amends by offering an informed programme on the reality of neurodivergence and how we should adapt society to assist those with such conditions.
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Thanks for this review. I don’t think I can bring myself to watch the programme, I would get too angry. You have saved me from that.
I hope no one wants any condition to be unnecessarily medicalised. Society should, very much, adapt to accept the needs of everyone, not try to crush everyone into a neurotypical mold. But for some people with ADHD, medicine is needed. No amount of adjustment would be able to alleviate the detrimental symptoms. Providing that very necessary medicine, which actually is not particularly expensive (a few tens of pounds per month) is not a neoliberal scam. It is needed and makes a huge difference to people’s lives.
Much to agree with
Can a brain scan diagnose other neurological conditions and disorders – depression or bipolar or schizophrenia? No. But all of these have physical causes that in most cases cannot be detected by imaging the brain. (Brain scans are used to rule out other causes, such as trauma or substance abuse.). In many cases this sort of condition is responsive to drugs treatments.
This seems another instance of the old fashioned “doctor knows best” mentality that refuses to listen to the lived experience of patients and leads for example to delayed or missed diagnosis of all sorts conditions – notably presentations by women or people of colour.
I hope they are planning a second documentary that puts the other side of the story. Or are they only platforming a doctor discussing matters outside their direct medical specialism. That often ends badly for the doctor concerned.
Much to agree with
I can’t even read this article without my blood boiling, let alone watch the programme.
My child doesn’t need medication or a diagnosis to make me believe that his difficulties are real. I see the impact they have on everyday life. A diagnosis, when appropriate, can simply give a child and their family an explanation and a framework for understanding those difficulties. It can help stop the blame and help us find strategies that actually work.
When you’re a parent watching your child struggle, this isn’t an academic debate. The way ADHD is portrayed in the media matters. It influences how our children are understood, how parents are judged, and whether families feel justified in seeking the support they need.
We absolutely should have difficult conversations about ADHD. But they need to be honest, balanced and evidence-based, not at the expense of the children and adults who actually live with it.
You have nailed what they did/do not understand with this:
“A diagnosis, when appropriate, can simply give a child and their family an explanation and a framework for understanding those difficulties. It can help stop the blame and help us find strategies that actually work.”
Thank you
There are very clear rules for clinical trials being carried out on children. Should Dr Pemberton be reported to the GMC for this?
Might be worth not only writing to Of on but possibly the GMC with relation to the “experiment” with the boy? This seems to break ethical guidelines and surely whoever supervised this should loose their licence?
Pathologising behaviours, particularly in areas that are not properly understood, is an ill in itself. The requirement for conformity that our societies demand is far too narrow a lens to allow for the vast range of human experience. There is of course a continuum of experience at one end of which some can experience such difficulties that some form of symptomatic relief is needed whether that be medication or withdrawing into a less stimulating environment.
Naming things is an important part of navigating life and being able to communicate but the tendency – particularly in the mental health arena – is to pretend that observed behaviours can be neatly categorised and labelled so as fit a particular therapy (usually pharmacological) that can be prescribed. Much of this has more to do with the validation of professionals and the profits of drug companies than it does with a truly empathetic approach to understanding someones’ distress.
Medicine has its place but we need to reclaim the bigger picture and relational ontology of life. Social constructs can be useful but they are static and incomplete and part of our left hemisphere brain function. The right hemisphere’s function is to fit the learning from the left into a much broader canvas that sees the whole. That part of the process is so often missing.
As Foucault put it, a disease is a word. Cancer, for example. The condition is real. I suggest we worry about what is real. These people are not.
I have been involved with Sail Training for over 45 years and have often take out crews of “naughty boys” (many excluded from mainstream schooling). “Back in the day” I would have been sceptical of ADHD – these “monsters” in the classroom were, on a sailing boat, perfectly decent young men. No electronic devices (batteries drain quickly at sea), freshly prepared food, no reading/writing/sums (unless you had an interest in navigation) and lots of exercise. We all understood that we were in the same boat (literally and metaphorically) and that we had a purpose – to get to France or wherever. In short, given the right environment these people could thrive.
Then, about 15 years ago there was a lad on ADHD medication. He was fine until we had stormy weather and was seasick and threw up his medication. The change was profound….. and so was my view on the issue.
My point?
I am not an expert but it seems obvious to me. If the current narrow, prescriptive educational environment fails some people then we need to change that environment (eg. send them sailing!)…. but for some that is not enough – additional help (through medication) is essential.
Life is rarely “either/or” rather it is “horses for courses”. Why is that so hard for the media to capture this idea?
Thank you and much to agree with
People differ in attention, impulse control, temperament and cognitive style. Some people experience substantial impairment. They deserve help. Schools and workplaces should accommodate genuine difficulties. Medication can be useful. But none of that settles the question of whether ADHD is a discrete neurodevelopmental disease, whether diagnostic prevalence has expanded too far, or whether some behaviours currently labelled ADHD are better understood as responses to modern environments.” Hopefully another channel will take up the challenge C4 failed to address in a balanced way …
To use the lack of a brain scan diagnostic as a reason to suggest it’s not a ‘real’ condition is nonsensical, and ignores a range of conditions that are diagnosed by having ruled out other options.
For example, Functional Neurological Disorder (FND) can result in seizures, loss of limb control, vocal tics and more. The seizures are separated from Epilepsy precisely because Epilepsy can be identified in a brain scan. There’s no doubt the seizures are real and debilitating, but FND specifically lacks a signature in brain scans.
Other conditions like Polyendocrine Metabolic Syndrome (previously known as PCOS) are also regularly diagnosed based on indicative symptoms, not requiring a specific scan for an underlying indicator.
Anyone who argues that symptoms alone cannot provide a classification or diagnostic dismisses a range of medical conditions as a result. ADHD may not be the most obviously medical of these, but hopefully the above shows others that would be similarly dismissed by that lack of a scan criteria which very clearly need medical treatment.
Unfortunately, that lack of recognition means that diagnosis is often delayed – in FND patients can sometimes struggle for decades before getting a diagnosis, and in my daughter it took more than 4 years going round multiple assessments before getting a diagnosis. It also means there’s often less certainty about medications to treat it and research and understanding to resolve the problem as without a specific pathway to address the solution is less clear.
The solution has to be to try to help these conditions, not to dismiss them as somehow ‘too vague’ to classify or treat.
Thank you. Good luck!
I caught the second half of this programme and I too was shocked. I work with severely traumatised kids in a residential setting many have additional diagnoses of ADHD, the connection and differences between the two is a whole different debate. However just the title of the programme really got my back up. The part I saw was completely unbalanced and appeared to show only one side of the story. Medication can be life-changing when the diagnosis is correct, it treats the symptoms, but not necessarily the cause. The cause again is a whole different debate.
A bit off topic
The debate is not limited to autism. The most commonly diagnosed ‘conditions’ are anxiety and depression. Explanations also range from the biological to social conditions. For a few years I co-presented IAPTs courses (Improving Access to Psychological Therapies -now renamed Talking Therapies ) for MIND on behalf of the NHS We were given a manual and it consisted of projecting slides and they had a booklet which covered the ground. It was a worthwhile attempt to improve mental health. I must confess we didn’t always stick to the manual. We encouraged people to talk and listen to each other. The feedback was good. The two most common responses were “I thought it was just me” and “we should be taught this in school / more widely”.
Unless the condition is very bad, I feel compassion is one of the best treatments. When I came across Compassion Focused Therapy developed by Paul Gilbert, I thought this is what I do.
Interestingly The Quakers -like William Tuke, who pioneered ‘refuges’ thought the same.
That is the power of ‘diagnosis’ which should be called ‘revelation’ or ‘unmasking’
I didn’t watch the programme, as I haven’t switched my TV on for several months. As I find all factual programmes unreliable sources of information.
On the wider point of accepting difference, not just atypical ways of thinking, complexion, religion etc. as well. I’m reminded that Fisher’s fundemental law of evolution demonstrates that speed of optimisation to fit any evolutionary niche is proportional to phenotype diversity. Thus diverse human societies are better able to sustain life in adversity.
As recent events show the world is becoming more adverse, and if British society wishes to have a future is must become more accepting of diversity and atypicy in every way.
Thank you
Lucy Mangan in Guardian says of the programme ‘ it will offend many ‘ <p>
https://www.theguardian.com/tv-and-radio/2026/aug/18/the-great-adhd-myth-review-most-controversial-show-of-the-year-channel-4<p>
She concludes ” Pemberton answers his questions convincingly. And the redresses proposed – try changing diet, screen and activity levels first, making school curricula more flexible, and making drugs the last resort – seem neither radical nor uncompassionate.”<p>
There will always be snake oil salesmen trying to make money out of ill-defined conditions. As Richard says there are many ‘socially constructed’ conditions – which are ‘real’ , and can be ‘treated’ with or without drugs – <p>
The framing of the programme – ‘Myth’.. seems deliberately provocative – to get eyeballs, while his conclusions as to how ADHD (‘real’ or not) might be treated seem not too dissimilar to what Richard might say.
The Guardian seems incredibly keen to promote this line.
I found her review small-minded, at best.
This reminds me of the anti-psychiatry movement that became popular in the 1960s, spearheaded by Laing and Szasz, among others, who claimed that mental illness is a cultural (or social) construction. Very similar spurious arguments appear to be being employed. To be clear, I’m not suggesting that ADHD is a mental illness, I’m well aware that it is a neurodevelopmental disorder.
I wonder if there is a connection between the attempted dismissal of ADHD and neurodiversity in general by the media and politicians, and the recent case where an employee won against an employer based on being diagnosed with ADHD? Would it be unkind to suggest that our overlords would throw thousands of people under the bus just in case their existence might cause them to make reasonable adjustments and spend money?
You know tha answer to that.