E186 | Channel 4’s New ADHD Documentary Missed a Huge Opportunity

In this episode of The Thinking Mind Podcast, Dr. Alex responds to Channel 4’s new documentary The Great ADHD Myth?

Presented by psychiatrist Dr Max Pemberton, this film asks whether ADHD is really a neurodevelopmental disorder, and whether ADHD diagnosis and medication have gone too far.
 
He discusses this documentary and examines where it raises important questions, and where its conclusions go beyond the evidence.

The episode explores the evidence as to whether ADHD is a neurodevelopmental disorder, ADHD genetics and heritability, brain imaging, whether ADHD is overdiagnosed in the UK, the quality of ADHD assessments, ADHD medication, non-medication ADHD treatment, lifestyle factors and the potential impact of the documentary on ADHD stigma.

This discussion is intended for education and general information and is not individual medical advice.

Research Papers Mentioned:

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2835661
https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/adhd-over-diagnosis-fiction-fashion-and-failure/1163426C23804A7049FE35D940EA938C

Presented by Dr. Alex Curmi. Dr. Alex is a consultant psychiatrist and a UKCP registered psychotherapist. Website: alexcurmitherapy.com

Check out The Thinking Mind Blog on Substack: https://thinkingmindblog.substack.com/

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Transcript

SPEAKER_00 0:00

I think this documentary makes some big, glaring errors. I've seen a lot of people for these assessments, and they're often so filled with shame and often so reluctant to come forward. I think medication is overly demonized, frankly. I think this documentary as it is now will contribute a lot to stigma. By the same logic, if ADHD is a myth, then also depression is a myth, schizophrenia is a myth, bipolar disorder is a myth. Today we're gonna be discussing the brand new channel 4 documentary which just came out, The Great ADHD Myth. And yes, it is pronounced like that because it does end in a question mark. I think it's common for documentaries like this to use a question mark when they're gonna say something really provocative in the title, they can couch it as a question. So this documentary is called The Great ADHD Myth, and it's hosted by a psychiatrist named Dr. Max Pemberton, and he's on a journey to find out more about ADHD, talking to different experts, trying to figure out if ADHD is a myth. I think this documentary actually raises a lot of really important questions, but then I think it goes on to give some very confident answers and make some much bigger leaps than the evidence actually allows for. I think this documentary makes some big, glaring errors. So we're gonna discuss all of that and hopefully separate fact from fiction a little bit. For those of you who are new to this podcast, I'm a consultant psychiatrist specializing in general adult psychiatry. I also have a lot of experience working with ADHD, assessing people for ADHD and treating them, sometimes with medication, sometimes without, sometimes with a combination of medication and non-medication strategies. And I'm also very experienced at treating things like depression, anxiety, psychosis, bipolar disorder. In addition, I'm trained as a therapist and I do psychological coaching as well. So I like to work with people in lots of different ways, including psychological, but I have a lot of ADHD experience. So I was very interested in this documentary, and I know a lot of people are gonna be curious to find out about it. This documentary really is asking a few questions. It's asking questions about whether or not ADHD is a so-called neurodevelopmental disorder, and it's asking questions about treatment, the value of medication, and how ADHD fits into our cultural landscape and how we should be approaching ADHD in children. Firstly, I think this documentary's framing is a bit of a problem. So again, this documentary is framed in a very polemic way. Is ADHD a myth or not? Should we buy into the consensus about ADHD and the status quo and the way experts tend to frame it, or is it all completely wrong? And this kind of simplified black and white dichotomy already is going to force the audience to make an unhelpful decision. Either they're going to buy into the mainstream view or they're going to question it entirely and discard it entirely. And that's a huge problem because the truth is when it comes to ADHD and mental health in general, there are too many, I think, unanswered questions, especially scientifically, to reach such a radical conclusion, especially in a 45-minute documentary. The documentary presents a variety of experts. And if you know anything about the field, immediately you're going to realize it's a very unbalanced selection of experts. There are several contributors, people like Dinesh Bugra, who is the ex-president of the Royal College of Psychiatry, Iona Heath, the ex-president of the Royal College of GPs, Lucy Johnstone, a very respected psychological researcher, Matthew Smith, a historian, Sami Timimi, a child and adolescent psychiatrist, and they're all legitimate professionals. I'm not throwing shade on them. They all make valid contributions, but even at a glance, you can realize there's not none of those experts are ADHD specialists. None of those experts work with ADHD clinically day in and day out. And that's a huge problem. Again, especially if you're going to make such big claims about such a big problem and a problem that people have been working on for decades upon decades. There was one clinician, uh, Sarah Worley. So she works with ADHD, but primarily from a nutritional and lifestyle perspective, and she's not a medical doctor or a psychiatrist. And there is a psychologist named Courtney Raspin featured in the documentary. She's a psychologist, and it seems like she works with ADHD, but it's not even her primary specialty. It looks like body image and eating disorders seems to be her primary specialty. So again, that's a huge problem. You can't make such sweeping statements about such an important issue if you're not going to have specialists in that issue being interviewed. The most uh I think legit expert they had was Katya Rubia. So she's an expert in neuroimaging and specifically an expert in neuroimaging when it comes to ADHD and autism and things like that. But again, she's not a clinician. I think that's a huge problem. It's a bit like if you're making a documentary about diabetes, and the best expert you had was an expert, for example, on insulin, and you had plenty of people who worked around diabetes or in diabetes-adjacent fields, but you had no doctors who worked day in and day out with diabetes and prescribing for diabetes and stuff like that. I think it's a huge problem. There are many like obvious mainstream ADHD experts they could have interviewed to make the documentary more balanced. So names like Philip Asherson, David Coghill, Russell Barclay, Stephen Farone, Samuel Cortez. These are all people who are very much established in the ADHD field, uh, who do a lot of research in the area, who are experienced clinicians, and I think they would have provided a much more balanced argument. And I'm not saying you can't have outside voices. Again, these are great professionals that they had on the documentary, and sometimes outside voices are incredibly useful to shine a fresh perspective, but you can't just show the outside voices. You also need to show the mainstream voices for whom ADHD is their bread and butter, it's their everyday and it's their real um area of clinical expertise. The documentary, as I said in the beginning, is asking this question: Is ADHD a neurodevelopmental disorder? And so the host, Dr. Pemberton, interviews Katia Rubia. She's the expert on neuroimaging. And she says that there are no individual biomarkers that someone can identify on a brain scan to diagnose someone with ADHD, which is true. She says there are some group differences. So if you take groups of people with ADHD and groups of people without, and you compare, so you can see some differences there. And she says with recent studies, these differences have become more and more modest. As far as I know, that's true. And Dr. Pemberton then reaches the conclusion that as a result of that, ADHD can't be a neurodevelopmental disorder. And I think it's a bit more complicated than that. The term neurodevelopmental doesn't just mean you can identify it on a brain scan. Neurodevelopmental means there are problems that emerge in childhood as the brain is developing and which can potentially persist into adulthood. Neurodevelopmental may uh imply things that you can see on a brain scan. And again, if you do compare groups of people with ADHD and groups without, you can see some differences, albeit modest differences. But uh neurodevelopmental also implies potentially a strong genetic linkage. And what Dr. Pemberton left out is that there's a lot of studies, including adoption studies, which show that ADHD is actually highly heritable, meaning there's a strong genetic influence. Studies generally estimate between 70 and 80% heritable, and that's like a big deal. That makes ADHD more heritable than depression, more heritable than schizophrenia, more heritable than bipolar disorder. And I think another important point here is that neurodevelopmental often implies symptoms which are like separate from a person's personality. And you see this quite a lot with ADHD. So, for example, with adults with ADHD, and I should clarify, it's adults that I've worked with when it comes to ADHD. I haven't worked with children with ADHD, but in adults, you'll often find that the individual really cares about one particular thing. They really care about hard work, for example. But because of the ADHD type symptoms they describe, difficulty with delayed gratification, difficulty with focus, with procrastination, they can't bring that value into reality. So they care about work a lot and they want to do well at work. But because of the bottleneck of their uh difficulty with concentration and difficulty with organization, they can't manifest their hard work in reality as much as they would like. And I think that is also something, especially if it's happening in a child, that suggests a neo-developmental issue, something that's happening in the development of that child and therefore interfering with their growth and their ability to gain skills and gain competencies. If you're liking this podcast so far, do like, comment, and subscribe. Next, the documentary is making points about the environment, like lifestyle, things like smartphones, things like nutrition, things like lack of exercise or lack of time spent in nature as factors potentially influencing ADHD. And if you ask anyone who works with ADHD regularly, they will probably agree and tell you, yes, lifestyle is extremely important. And they highlight this in the case study of the child they work with in this documentary whose name is Mason, we'll talk about a bit later. Of course, lifestyle is important, but lifestyle alone is unlikely to be sufficient to explain ADHD. And again, anyone who works with ADHD will tell you that individuals can have really good lifestyles, they can have good nutrition, they can exercise regularly, they can spend tons of time in nature, and they may not be addicted to technology, but they still have very prominent uh ADHD symptoms. Which brings me to my next point. One major omission in this documentary is they left out adults with ADHD. They didn't include the adult perspective. Now, why do I think this is so important? I think it's important because when you interview adults who have had a lifelong history with these kinds of problems, you get a very clear perspective and often a much clearer perspective than you can get when talking to a child. Adults will often be able to clearly point to that lifelong history of difficulties with inattentiveness, and that could be like finishing tasks, focusing, having uh their ability to focus incredibly tied to interest, such that their attention is either like fully, fully switched on or fully, fully switched off, difficulties with time organization, object organization, and they can talk about how that's influenced their lives pretty much at every stage: primary school, secondary school, work, relationships, finances. And so if the documentary is going to make such big claims, which it does at the end about ADHD, basically declaring it a myth or a social construct, I think you should have included an adult uh perspective and maybe gotten an adult case study as well. Adults with ADHD are also often in a much better position to comment on how valuable treatment is and how treatment helped them in different ways. And this could be treatment with medication or without medication or a combination, and of course they're able they're much more able to talk about the value of autonomy and choosing what kind of treatment works for them. But I think it stands to reason that if adults can find treatment for ADHD and interventions for ADHD useful and the diagnosis useful, then potentially children can as well, albeit it's a bit more complicated, and you have to think about making decisions in their best interests, which is normally made between the parents and the doctor. But it stands to reason it could still be incredibly useful, and I'm sure many families and many children would report that it's very useful. But the documentary really doesn't get into all that nuance again, which I think is an issue. The documentary portrays medication itself in a very black and white way. In many instances, the documentary kind of conflates diagnosis with medication, in other words, you get a diagnosis of ADHD, and therefore that diagnosis means you must immediately start taking medication. Um, having a diagnosis of ADHD doesn't mean you have to take medication. Many patients get a diagnosis and find that in itself to be therapeutic, in that it helps explain a lot of the difficulties they've had, and then they may or may not decide to take medication. Often patients take medication for a period of time, often they take it for seasons of their life, depending on their responsibilities, what support they have available, their preference for non-medication strategies and how well that's working. And it's also very normal for patients, both adults and children, to take time off from medication. Sometimes people on medication take weekends off to reduce the side effects burden a bit. Sometimes kids take summer break off. Sometimes children or adults just decide to take some time off ADHD medication to see how they are off it. That's totally normal. And the documentary portrays this as a really big deal. So when the case study, the child who I think is around uh eight, nine, ten years old, and his name is Mason, when he and his mum decide to do a trial off medication, they kind of treat it as this really big deal, this experiment, like, oh my god, he has ADHD, but he's gonna go off his medication and we're gonna try this experiment. In clinical reality, this happens all the time and is totally normal. And I think a good clinician will understand that medication isn't always the right intervention at a particular point in time. Of course, the documentary also doesn't mention uh psychological treatments for ADHD, which can include environmental adaptations. The documentary doesn't mention cognitive behavior therapy adapted for ADHD or ADHD coaching, which has good evidence for helping people really reduce the impact of their symptoms. These kinds of interventions are useful for many people. In terms of the potential adverse effects of medication, again, this is portrayed in a very black and white way. Throughout the documentary, the child Mason and his mom are deciding whether or not to continue medication. And the way it's framed is when Mason's on medication, he does well at school and is kind of much more unhappy. When he's off the medication, he objectively does a lot worse at school and has worse behavior, but is generally a happier, more thriving personality. The documentary really gives the impression that ADHD medication really does your personality. In the reality we see every day, actually, you can reduce the dose. Again, you can adjust the timings, you can do all sorts of things, change the drug, change the formulation, have good medication hygiene, make sure you're taking the medication on a full stomach, making sure you're hydrated to try and ameliorate the side effects, you know, taking breaks on the weekends after taking medication during the school week or the work week. None of this is mentioned by the documentary. Um, I think medication is overly demonized in this documentary, frankly. Really, Mason's case, if you don't pay too much attention to the narration, uh, actually demonstrates the complexity of treating something like ADHD. I think is definitely it sounds like, from what we know, quite a legitimate case. A lot of uh inattentive and hyperactive and impulsive type symptoms. This young boy who's clearly dealing with quite a lot, and there's clear pros and cons to being on medication and off medication. By the end of the film, the documentary film, uh, it's said that his mum has decided for Mason to remain off medication. And Mason's very happy about that because he feels that medication kind of suppresses parts of his personality. But then actually, in the postscript uh subtitles after the documentary actually finishes, it's then revealed actually Mason has restarted on medication two months after his break because he's not doing well in exams. And again, this really highlights there's a lot of complexity around decisions. I'm not saying these are easy decisions to make, um, but I think the documentary is really rushing to a lot of conclusions and not actually sitting with the complexity as much as it should. The documentary kind of caricatures how ADHD is diagnosed, which is easy to do, you know. The documentary highlights a few common symptoms which are asked about uh in ADHD assessments, and they're there are symptoms which are easy to caricature when you take them out of context. So symptoms like fidgeting, having trouble staying in your seat, having trouble waiting, and in situations which require waiting, like cues or delays or stuff like that. It's easy to isolate those symptoms and say, isn't this stupid? Doesn't everyone struggle with that? The documentary really leaves out that ADHD assessments require a very careful kind of lifelong history. An ADHD diagnosis requires at least five inattentive or five hyperactive impulsive symptoms to be present. And again, it doesn't mention the inattentive symptoms, which can be quite debilitating, like problems focusing on tasks, problems with time organization, problems with object organization, problems with short-term memory. The documentary doesn't mention that impairment is very important and that impairment needs to be demonstrable across different settings, school, work, mental health, relationships, etc. The documentary doesn't mention the last criteria for diagnosing ADHD, which is that you have to explore alternative explanations like lifestyle, like stress, like trauma, like other mental disorders or other physical health disorders. Doesn't mention can you guess what I'll can you guess like what I'm thinking about this documentary? Doesn't mention any of that stuff, um, but rather it kind of carictures the diagnostic process. It says things like we're diagnosing children for being children, which I think is incredibly misleading. At one point in the documentary, it's also mentioned that diagnosis and treatments for ADHD is kind of a way of punishing children, which I don't think um that's really based in the fact of clinical practice at all. I think it's also important to mention that every psychiatric condition is similar to ADHD in that every psychiatric condition doesn't have clinical biomarkers yet and is based on a list of criteria, and most psychiatrists understand these criteria are flawed and they're guidelines and they're not perfect. But by the same logic used in this documentary, if ADHD is a myth, then also depression is a myth, schizophrenia is a myth, bipolar disorder is a myth, and I think it's important to identify there are limitations in how we diagnose it. There is a hell of a lot of subjectivity in the diagnosis. That doesn't mean we can throw out the baby with the bathwater wholesale. Max Pemberton, the host, has his own ADHD assessment, and he does get diagnosed with ADHD. I'm not really sure how this happened, I'm not really able to comment on the assessment. Before he goes into the assessment, he says, I strongly believe I don't have ADHD, but I'm here to test the process. I imagine if he said anything like that to a clinician, a good clinician would say, you know, are you experiencing impairment? Are you experiencing distress? Are you experiencing any significant interruption to your work life, your financial life, your personal organization, your ability to relax and sleep, uh, various other things? And if you're not experiencing that impairment, uh a diagnosis of ADHD shouldn't be applied. I think many ADHD diagnoses are made or broken based on the level of impairment. Again, we don't know what happened in this assessment, so I'm not really able to comment. Um, there's a there's a question about whether ADHD is actually overdiagnosed. And actually, one of the experts I mentioned earlier, an expert who I think they should have interviewed for this documentary, Philip Asherson, he released a paper about this in March 2026, a study which indicates that in all likelihood ADHD is still not overdiagnosed in the UK. In all likelihood, this paper suggests that ADHD is likely to be underdiagnosed, under-recognized, and points to the risks of underdiagnosis, under-recognition, and a lack of intervention for people who are struggling day to day. And there's other research which suggests, and I'll link both of these papers in the description, there's other research that suggests that identification and treatment of ADHD is linked to better life outcomes, things like reduced crime, reduced self-harm, reduced traffic accidents, in particular because ADHD is associated with a lot of mental distress and impulsivity, treating that obviously is very helpful. And again, I don't necessarily mean treating that with medication, but with non-medication strategies potentially as well. I think the documentary is raising a really important uh point about ADHD essentialism, and that is something I do really worry about. And by ADHD essentialism, I mean this idea that someone gets diagnosed with ADHD, therefore, they mean their brain is on some fundamental level different to a person's brain who doesn't have ADHD, and that person really strongly identifies with that diagnosis, it's top of mind whenever they think about themselves, they think of themselves as a person with ADHD, therefore, fill in the blank, it explains almost everything about them. And I am worried about ADHD essentialism as well. Um, but I don't think rejecting that essentialism necessarily means rejecting the diagnosis as potentially useful for a lot of people, and I actually often warn patients against ADHD essentialism when I do give the diagnosis, and I certainly don't think rejecting essentialism doesn't mean rejecting sound intelligence. Interventions again, non-medication, medication. There's a discussion because the documentary is primarily focused on ADHD in children, even though it makes sweeping statements about ADHD in general. There's a lot of discussion about school and what school should be doing. And there's kind of a basic contradiction in different parts of the documentary. There's one sense in the documentary that we're over-accommodating young people, and young people should be more tolerant of boredom and frustration and difficulty. And I kind of relate to that a little bit. I think that's a valid point. At other points in the documentary, they suggest, experts suggest, that we should radically overhaul the educational system to help people with ADHD-like traits. And I think that that's um there is validity to that as well. I think there are changes that could be made to the educational system to help people who might have different learning styles or different ways of approaching things, or people who have things like ADHD or autism. But environmental accommodation still has its limits. Like schools and workplaces can improve. The fact of the matter is, part of being in modern society is needing the ability to absorb, retain information, to be able to pay attention and concentrate for decent periods of time, to be able to organize your time, to be able to organize the space around you. And so that that leaves, I think, a really meaningful path for again intervention and treatment in different ways. For example, if a 14-year-old or a 15-year-old person with a lot of ADHD traits thinks, okay, I'm really interested in medicine, I potentially want to get into medical school, there's a limit to what school and sixth form and university can do to accommodate them and accommodate their learning style. I think they should do as much as they can, but ultimately that individual will need to sit through a lot of boredom, frustration, delay gratification, to absorb a lot of information that that requires to study, to do really well in their GCSEs and in their A levels and then throughout medical school. And if that person has a lot of ADHD-like traits, I think a diagnosis of ADHD and treatment could be super useful to help them accomplish their goals. So I think even in young people, there is a role for ADHD intervention to help someone with their autonomy and not to be this tyrannical thing we enforce on a child. I think it's again much more complicated than the documentary chooses to go into. Clearly, the documentary's overall framing matters so much. And I think that's the biggest problem. If you watch this documentary and you're really outside of the mental health space, potentially, even if you are in the mental health space but you've never really worked with ADHD, you're not super familiar, chances are you're going to walk away with the conclusion that ADHD probably isn't real, the diagnosis doesn't really make sense, medication is mostly harmful and not really helpful, and that really it's just about lifestyle and social change. And I don't think that's a balanced representation of the facts. And I don't think it's really the clinical reality that ADHD clinicians see every day. This matters hugely because of stigma. I think this documentary as it is now will uh contribute a lot to stigma, and that's both stigma from the community. Again, someone who's never heard of ADHD will watch this documentary, or perhaps just see the title of the documentary as they're scrolling and think, okay, channel four says ADHD is probably a myth. And then if they encounter someone who has the diagnosis, maybe who takes medication, they're going to be suspicious of that person, skeptical of that person, maybe a bit prejudiced towards that person as a result of this messaging. And I think it also contributes to self-stigma. I think if someone isn't sure, maybe they're struggling with ADHD-like problems and they're thinking of getting an assessment. Chances are if they watch this documentary, yes, they might make some helpful changes to their life, which I think is good. I'm for those lifestyle changes, but probably I suspect they won't get an assessment. Perhaps they won't get any kind of psychological help, and probably they'd be a lot more reluctant to access medication. And those things could all really help them. And I should also add, you know, I've seen a lot of people for these assessments, and they're often so filled with shame and often so reluctant to come forward. Often they really feel patients who are being assessed for ADHD really don't feel like they have a right to be there, especially if they don't get the diagnosis. And to be clear, I think if you're not sure and if you're struggling, you should get an assessment. And even if the outcome is negative, perhaps there's a different issue, or perhaps you maybe have some traits of ADHD, but not warranting a full diagnosis. If you're thinking about it, I think you should get an assessment to clarify that and get an overall assessment of your mental health. I don't think we should be uh letting flawed, kind of unbalanced documentaries like this uh stop people from accessing expert professional help. And that's the biggest danger I worry about with a documentary like this. So my overall position isn't that everything in this documentary is wrong. I think this documentary raises good points that I want to talk about and try and talk about as much as I can, you know, concerns about over-medicalization, too much reliance on medication, concerns about neglecting lifestyle, concerns about poor assessments, assessments for ADHD that aren't as thorough as they should be, concerns about technology addiction, concerns about our educational system, uh, concerns about the diagnosis affecting our identities. I really want to talk about all of this stuff, but the way the documentary does it is too rushed and too overconfident and makes, I think, quite a simplistic argument out of problems that, again, experts and researchers have been dealing with for many decades without easy answers. We should absolutely, as a society, be scrutinizing the way we treat and diagnose conditions like ADHD. But scrutiny should make our understanding more nuanced. We shouldn't simply be replacing one simplistic narrative with another simplistic narrative. But, you know, at the very least, this documentary is gonna get us talking and hopefully, you know, conversation and debate like this will be useful. I hope you guys found that useful. Tell me what you think about the documentary. Feel free to comment, especially comment on YouTube. So, ideally, if you're gonna give feedback or suggestions about the podcast, we'd like you guys to do that on YouTube so I can make sure I can answer each and every piece of feedback. Do like, comment, and subscribe wherever you're watching or listening. If you're not watching or listening on YouTube, please consider watching us there because we do want to become a YouTube first podcast. If you're interested in any of the services I provide, like coaching or speaking, there are links in the description. Thank you so much, and I'll see you here next time.