Attention Disorder

 What I find strange is that everywhere else in psychiatry we take a person's circumstances seriously and understand that the world someone lives in can impact on how they feel and behave. No competent doctor treating a depressed woman would disregard the fact that she has been made redundant, or hasn't slept since the baby arrived, and we'd think it negligent to hand her a prescription and not consider the environmental, psychological and social factors. With ADHD that habit has been mislaid and we have settled on the idea that the difficulty sits inside the child and the world around him is beside the point.

Patients Waiting to See the Doctor, with Figures Representing Their Fears
Rosemary Carson (b.1962
Photo Credit:: Wellcome Collection [CC BY]  

Yet look at the world we have built for him. The criteria have widened over the years, so behaviour once thought unremarkable now falls inside the diagnosis. We've handed children devices engineered to capture their attention and then fragment it and built an education system that measures them by how still they sit and how well they do in exams.

We've given everybody a way of comparing their chaotic inner lives with others' edited outer ones, leaving them convinced that everyone else is coping and they alone are not. My film examines all of this and I came away thinking that if you set out to manufacture a population with attention difficulties, you'd build something close to the world we live in. Now we diagnose those who struggle in it.

Which brings me to the most hopeful thing anybody said to me while making the film. Professor Katya Rubia at King's College London has spent 30 years scanning the brains of people with ADHD. She told me that no scan will tell you who has it, because as she puts it, "it's a concept which is based on behaviour."

Then she said the thing we almost never hear, which is that the brain is highly plastic, that brain and behaviour are two sides of one coin and that when behaviour changes the brain changes with it. So even where a difference shows up, it may be the result of how a child has been living rather than a cause of it, and it isn't fixed. Nor is there an ADHD gene - only small parts of genes, each of vanishingly small effect and most turning up in depression, autism and schizophrenia too...

There are people whose attention and impulsivity are so overwhelming that day-to-day life is beyond them, and if the medication helps them, I'd never take it away. But I don't believe millions of us have been ill all along and are only now being noticed, and I think we have stopped asking what we are doing to our children, because a prescription is quicker and easier.

(Dr Max Pemberton, The Times, 2026)

So, ADHD may not be wholly genetic and when a child's behaviour changes its brain can change too. What was once considered unremarkable behaviour is now considered remarkable. Why is this? Why is the diagnosis of ADHD given to many more adults and children than it used to? Is technology or more precisely the smart phone and social media major negative environmental influences on behaviour?

People are increasingly seeking to obtain an ADHD diagnosis without pursuing treatment, according to experts who called for more research to understand why.

Some people now see ADHD as "an identity, rather than a disorder", with the result that many obtain assessments from poor quality private providers, which lead them to "believe they have a condition needing treatment", said the psychiatrist Dr Marios Adamou, the founder of the UK Adult ADHD Network (UKAAN)

This has resulted in a growth in complaints against NHS doctors when they are forced to reject low quality assessments, he added.

Portrait of a Doctor 
Francis Picabia (1879-1953)
Photo Credit: Tate [CC BY-NC-ND]

Adamou has seen recent figures showing that 50% of child patients did not pursue treatment after diagnosis, and observed a similar trend among adult patients in his clinic.

Some seek low, non-therapeutic doses of medication instead. "A lot of people would benefit from having amphetamines. You feel better, you can focus better, you can do more. But there hasn't been  a debate that this country should be cognitively augmented to increase productivity with stimulants," he said.

"Why do people feel they can identify with these conditions? They are manifestations of a societal problem."

Adamou was speaking before a new Channel 4 documentary airs tonight called The Great ADHD Myth? It is presented by the NHS psychiatrist Dr Max Pemberton, who concludes that ADHD is a social construct rather than a medical condition, and that schools should adapt to better support a wider range of children rather than medicating them into fitting into a restrictive norm.

Adamou said ADHD was both a social construct and a brain disorder Brain differences are well established through research, and diagnostic criteria have undergone "a lot of scientific scrutiny and validation", he said. But he added that "the ADHD concept has been expanded so much it's risking becoming meaningless"...

(Rachell Hall, The Guardian, 2026)

So, some people who think they may have ADHD get an assessment done privately. Sometimes this is not of good quality. They then try and get treatment on the NHS and feel angry when they are told that the initial assessment was incorrect. Other people, up to 50% are given a diagnosis but then don't do anything about it. Others see ADHD as an identity. What is that supposed to mean? Is the article referring to the clinicians here? And didn't Professor Katya Rubia say you couldn't tell from a brain scan whether a person had ADHD while Adamou said it was both a social construct and a brain disorder? All very confusing!