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A steep rise in ADHD referrals deserves scrutiny. So do private assessments, prescribing and the demands modern life places on attention. But those are different questions, and none of them makes ADHD a myth.

Ahead of Channel 4’s broadcast of The Great ADHD Myth? on 18 August 2026, it would be unfair to review a film that viewers have not yet seen. The finished programme may be more careful than its title and publicity. Its contributors may challenge one another. Evidence and uncertainty may receive more space than a press release can provide.

The advance framing nevertheless makes an argument of its own. Channel 4 asks whether ADHD is a “genuine neurodevelopmental disorder, or a social construct”, whether modern life is the real cause of the difficulties attributed to it, and whether children should receive “mind-altering drugs”.¹

Those are legitimate subjects for investigation. They are not one question.

A poor assessment does not show that the condition being assessed is fictional. A rise in referrals does not distinguish overdue recognition from overdiagnosis. The absence of a diagnostic brain scan does not invalidate a clinical syndrome. Environmental influence does not exclude neurodevelopmental vulnerability. Adverse effects from medication are an argument for careful prescribing, not evidence that its indication was invented.

If these distinctions disappear, every genuine problem in ADHD care becomes rhetorical evidence for every larger claim. That may make forceful television. It does not make sound reasoning.

The strongest version of the concern

The serious sceptical case is worth stating fairly.

ADHD traits are dimensional. Everybody can be distracted, restless, forgetful or impulsive; the clinical boundary depends on persistence, developmental history, pervasiveness and impairment. There is no blood test or scan that confirms the diagnosis. Sleep loss, anxiety, depression, trauma, substance use, physical illness and an attention-hungry digital environment can produce or worsen similar difficulties.

Meanwhile, referrals have risen much faster than NHS capacity. Long waits have helped a private market expand. Patients often arrive after researching ADHD and may strongly hope that it explains their difficulties. A provider is paid for the assessment and may also provide titration and follow-up. Some online content turns familiar lapses into diagnostic revelation. Medication can help, but it can also suppress appetite, disturb sleep, raise pulse and blood pressure, or make a person feel unlike themselves.

These are real risks. A credible defence of ADHD cannot depend on denying them.

The larger claim would be that these problems show ADHD itself to be an invalid or fashionable diagnosis. That conclusion requires different evidence.

What Pemberton has argued

The documentary is not Dr Max Pemberton’s first contribution to this debate.

In a 2023 column, he called the rise in adult ADHD a “new craze” and wrote, “I’m afraid that — in many cases — I just don’t buy it.”² He argued that some adults invoking ADHD to explain problems with concentration needed instead to reduce phone use and tolerate boredom.

In The Spectator in January 2025, he moved across a wider field: disputed the scientific status of childhood ADHD, described private diagnosis as a “gold mine”, linked diagnosis to screens and parenting, raised medication harms and suggested that labels could weaken responsibility.³ His final warning — “If everyone can have a diagnosis, then no one does” — contains a sound principle if it means criteria must be applied carefully. It is misleading if recognising one familiar symptom is treated as equivalent to meeting the full diagnostic standard.

In publicity for the film, Pemberton points to rising referrals, small average brain-imaging differences, the lack of an individual diagnostic scan, his own disputed private diagnosis and his unpleasant experience of lisdexamfetamine.⁴ Each raises a question worth examining. None can stand in for a representative study of diagnostic accuracy, the validity of the clinical construct or the average balance of treatment benefits and harms.

His most defensible contention is that difficulties should be understood in context and that changing schools, technology, sleep or family support may sometimes help more than changing the person. His least defensible move is to imply that an environmental contribution and a neurodevelopmental disorder are rival explanations.

Six questions hidden inside one title

This series will separate six issues that the word myth risks collapsing.

1. What exactly is being claimed?

A television programme might show that one assessment was poor, that one child did better without a medicine, or that one expert disputes the mainstream account. Those findings must be judged on their own terms. Article 2 will review what the documentary actually shows after broadcast; until then it remains an explicit working draft.

2. What does “neurodevelopmental disorder” mean?

Article 3 asks what genetics and group-level brain findings can support, why they cannot diagnose an individual, and how a clinical category can be partly constructed without its subject being imaginary.

3. Can a diagnosis be bought?

Article 4 examines Pemberton’s £1,200 private assessment. It takes seriously the possibility of inadequate practice while distinguishing a disputed case from a measurement of false-positive diagnosis across providers.

4. What is the balance of medication benefit and harm?

Article 5 considers short-term efficacy, gaps in long-term evidence, adverse effects, cardiovascular findings, monitoring and the patient’s authority to decide whether a treatment helps them live better.

5. Are we diagnosing too much, too little, or both?

Article 6 examines the evidence for overdiagnosis alongside persistent under-recognition, then asks what data and systems would reduce both errors.

The sixth question runs through the whole series: what should society change even if ADHD is real? Support based on need, more inclusive schools and workplaces, better sleep, less exploitative technology and access to non-drug interventions do not depend on declaring neurodevelopmental disability unreal.

What can already be said with confidence

ADHD is recognised as a neurodevelopmental disorder in both ICD-11 and DSM-5. The World Federation of ADHD consensus statement assembled 208 evidence-based conclusions covering genetics, associated impairments, outcomes and treatment.⁵ That breadth does not make every claim in it incontestable, but ADHD is not a speculative idea sustained only by drug companies or social media.

The evidence does not provide a single “ADHD brain”, a diagnostic scan or one gene. Biological findings are probabilistic, average differences overlap, and the condition is heterogeneous. The diagnostic threshold sits within continua of attention, activity and impulse control. Its placement involves judgement about impairment and likely benefit, as clinical thresholds often do.

That combination — substantial evidence without a unique biomarker — is not a contradiction.

Nor does the current numerical picture support a simple national “epidemic of false diagnosis”. The independent NHS England ADHD Taskforce concluded that clinician-defined ADHD remains under-recognised, underdiagnosed and undertreated in England, while explicitly calling for better data, regulation and monitoring of both under- and overdiagnosis.⁶ Its reference estimates were roughly 3–5 per cent in children and 2–3 per cent in adults; recorded recognition was lower.

That does not authenticate every diagnosis. It shows why referral counts, population prevalence, recorded diagnosis and prescribing must not be treated as interchangeable measures. A 200 per cent rise in referrals is a 200 per cent rise in people entering a pathway, not proof of a 200 per cent rise in either ADHD or false diagnosis.

Ordinary symptoms, clinical patterns

One of the most intuitive sceptical arguments is that everybody loses things, procrastinates or struggles to concentrate on boring work. That is true. It is also insufficient.

Many disorders involve experiences found outside disorder: breathlessness, anxiety, low mood, pain and memory lapses among them. Clinical importance comes from pattern, severity, persistence, setting and consequence.

NICE guidance says an ADHD diagnosis should follow a specialist clinical and psychosocial assessment, developmental and psychiatric history, observer reports and assessment of mental state. Symptoms must cause at least moderate impairment and occur in two or more important settings. Rating scales can support the process but should not make the diagnosis on their own.⁷

This is a standard against which services can be audited, not a guarantee that every service meets it. If a provider substitutes a questionnaire for that process, the failure belongs to the assessment. It does not demonstrate that occasional distractibility and impairing ADHD are the same thing.

Explanation, responsibility and agency

A diagnosis can be used badly. It can become a totalising identity, end curiosity about other causes or be invoked as though explanation removed all responsibility. Pemberton is right to resist that.

But the relationship between explanation and agency can also run the other way. Understanding a persistent pattern may allow somebody to build better systems, seek adjustments, choose treatment and take responsibility more effectively. A diagnosis should enlarge useful choices, not reduce a person to a label.

Whether it does so depends on the quality of the assessment and what follows it. “ADHD explains part of this” is not the same as “nothing can change”, “nothing else matters” or “this action has no consequences”.

Disclosure is not evidence

I am a doctor working in emergency medicine and intensive care. I was diagnosed with ADHD in my late thirties and take lisdexamfetamine, which I have found helpful.

That explains my interest and gives me a perspective to examine; it gives me no special authority over the science. My experience does not prove that ADHD is valid or medication effective, any more than Pemberton’s rejection of his diagnosis or dislike of the same medicine proves the opposite. Anecdotes can reveal outcomes worth studying. They cannot estimate population effects.

Nor does having a diagnosis require me to defend poor assessments, careless prescribing or every claim made in the name of neurodiversity. Better standards protect people who do have ADHD and people who do not.

Better questions

The documentary may identify genuine weaknesses. If it does, they should not be dismissed because its title has caused anger. Equally, evidence of one weakness must not be allowed to migrate into a conclusion it cannot support.

The useful argument is not between believing every diagnosis and disbelieving the condition. It is about how a dimensional, heterogeneous and environmentally responsive disorder should be recognised; how diagnostic thresholds should be applied; how services should be audited; and how treatment should be chosen and reviewed.

ADHD does not become a myth because its boundaries are debated. Medicine need not choose between biology and biography, treatment and social change, or support and agency.

We can ask better questions than that.

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Series disclosure: I am a doctor diagnosed with ADHD in adulthood and take lisdexamfetamine. This is context, not evidence; the clinical claims in this series should stand or fall on the sources cited.

Sources and further reading

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