ADHD is not a myth or social construct, it is a neurodevelopmental condition……..when you conclude on the basis of the research evidence

Last Tuesday, 18^th August, Channel 4 aired a programme called ‘The Great ADHD myth’ presented by psychiatrist Max Pemberton. He interviewed a range of experts who presented their opinions that collectively concluded that ADHD is not a neurodevelopmental condition but is in fact a social construct.

How do we best come to a conclusion as to whether ADHD is a neurodevelopmental condition or a social construct? The critical way to address this is to look systematically at the research evidence. Only one of the experts interviewed, Professor Katya Rubia, who conducts imaging research with those with ADHD, spoke specifically about relevant research evidence. One of the first things she said was that the research evidence shows that there ARE brain differences at a group level. This point was completely disregarded.

Professor Rubia herself has now stated online that her interview was cherry picked. It is clear that this was to support a pre-determined narrative. Opinions expressed like “the scientific findings of something characteristically different that marks out people who get a diagnosis than people who don’t is entirely absent” does not fit with what was actually stated by Professor Rubia at the beginning of her interview.   

The rest of the programme involved a so called ‘experiment’ with one boy with ADHD. If you follow the programme right through to the end you will see the experiment of taking him off medication did not work. He returned to medication shortly after his involvement in the programme because of difficulties regulating himself to tasks at school and exam progress. He, and his family, did report that he was happier and had better relationships off medication. But across that 6 week period they made other changes as a family such as increased family time outdoors which will have contributed to that.    

The presenters and several of the experts conclude that medication is being chosen solely because of a broken school system. We know that schools need more support for these children, including more specialist support, employing more teachers, and increasing evidence based neurodiversity training for all education staff. But even in a Utopian world where that existed, most children with ADHD would still highly benefit from medication. This is because of the range of cognitive/thinking difficulties they have and how we know the medication works.   

How does the medication work? Well it’s not in the way the experts in the programme described. One said “it causes a kind of tunnel vision where you become more absorbed in what you are doing”. That’s not what the research shows.  How it works is actually best captured in the descriptions given by the child’s mother and the teacher. Their comments allude specifically to how we know this medication works. The mother said that off medication she was worried that “he is not going to be able to retain information to pass his exams”. The teacher said on medication he was “more able to work independently on his own and ask questions when needed. Off medication she said he found it “hard to regulate himself”.  These references to retain and independent working map on to what we call ‘executive functions’ – the thinking processes we have that help us start, stay on and complete tasks and activities and generally achieve a goal. They include processes like memory, planning and timing. There is extensive evidence that stimulant medication improves executive functions (Rhodes et al., 2004, 2006, Coghill et al. 2007).   

Both the child and the presenter (who also took a dose of medication on the programme) reported that the medication made them quieter, slow down, and not feel themselves. The presenter continually used the word “suppressed” when he referred to the medication effects. Ironic that the programme talked about individual variation but did not examine more systematically beyond one child and one adult how this medication works in this way for the rest of the ADHD population.  Let’s look at the research again.  Stimulant medication works on self-regulation – exactly the issue the teacher identified. This means it sometimes slows the child down, on complex tasks, where it is good to stop and think. But on other tasks it also speeds up their performance – on tasks where fast responding is beneficial and there is little effect on accuracy (both findings reported in Rhodes et al., 2006).

How else does the medication work? From the research evidence we can see that stimulant medication improves memory (Rhodes et al., 2004). The medication improves complicated aspects of memory where we both have to hold and organise information in our memory (‘working memory’). But it also has an even bigger effect on more simple aspects of memory (“short-term memory”). Stimulant medication improves the ability to hold that information in memory over time (Rhodes et al., 2004). When children with ADHD are listening to instructions from their teacher that are necessary to carry out a task, they lose that information from memory more quickly than their peers. The medication substantially improves this difficulty.

The programme focused very selectively on the impact of medication on school work. It was quite ironic that when the presenter took the medication it showed him crossing busy roads. Children with ADHD have a much higher chance than their peers of having pedestrian related accidents. As adults they are much more likely to have traffic accidents driving vehicles. But this is when they are not medicated. Stimulant medication is known to improve the executive function skills, such as short-term memory and the ability to control responses, that are linked to pedestrian decisions. In fact, it also directly improves the pedestrian skills themselves.  Evidence based knowledge of how medication works is what should be considered when parents or adults think about medication choices.  

We now have a growing body of evidence that long-term stimulant medication use in those with ADHD reduces the risk of suicidal behaviours. Again we see none of this evidence discussed. Instead we hear multiple opinions that do not map on to research evidence such as “medication doesn’t cure, it simply masks the symptoms” and it is now being used for “discipling kids”.

That said, as a psychologist whose work has also focused on psychological and educational interventions, medication is just one part of the picture. For those children for whom it works it paves the way to put in the supports that the children need not only for academic attainment that is on a par with their peers, but also positive relationships, wellbeing and mental health.   

ADHD is much more than the list of inattention, hyperactivity and impulsivity symptoms you see in the DSM diagnostic manual. Experienced clinicians know this only too well. We also see it in the research evidence. In one study we reported a lack of relationship between cognitive function and clinical outcomes (Coghill et al, 2014). The findings suggest that many of the broad cognitive difficulties we see in ADHD sit alongside the list of symptoms in the diagnostic manual.  Research has also shown that cognition is just one area of difficulty.  In one part of the programme, a contributor referred to a child getting a fast pass at a venue because they were bored waiting in turn. We know these children often have significant sensory processing difficulties. If that is the case for a child with ADHD, they will have similar difficulties in those noisy complex environments as autistic children have.         

During this programme the concept of ADHD as a neurodevelopmental condition was ridiculed throughout. The language around ADHD by the experts who discussed their opinions was largely old fashioned and focused on looking at ‘behaviour’ leaving a   feeling like we had gone back several decades. The child has a behavioural difficulty that is being ‘drugged out of existence’ by the medication. Then at the end of the programme there is a complete shift in focus to say that environmental changes on their own would be sufficient to avoid the dire developmental outcomes these children have.

Neither of these approaches is supported by current research on ADHD or other neurodevelopmental conditions. Supporting the child’s difficulties that are part of their neurodevelopmental condition, while also looking at opportunities to make environmental adaptations to support the child, is at the heart of most current programmes and support approaches.   A neurodiversity affirmative approach that helps the parent and teacher identify the child’s difficulties on an individual level and correspondingly put strategies in place acknowledges the difficulties both within the child and within the environment.  My own research has focused on this approach and has now been translated into resources that are available as parent and teacher supports via a social enterprise spin-out EPIC Think Learn.   I followed this path because I am passionate about getting the research evidence out to parents and teachers and those with neurodivergent conditions themselves. This programme feels like it set out with the completely opposite intention.

Taking medication should never be seen as a quick fix. It is one part of an intervention plan. The programme referred to concerns that medication leads the child away from developing long term coping skills and everyday strategies. Why is it one or the other? Stimulant medication is recommended as a treatment alongside educational and psychological supports. This combination is what is optimal for most of these young people and indeed adults with ADHD.   As an aside, across all of the research studies I have conducted, we have never found that stimulant medication impairs any of the aspects of developmental outcomes assessed.     

There was no discussion of the range of cognitive/thinking, social and emotional difficulties that these children disproportionally experience.  A fundamental issue is that these children don’t understand themselves. Not understanding why situations like completing a task in school seems so difficult for them and their difference to their peers is impactful. Research has shown that these children show emotion difficulties from early in development (Wang et al., 2026). Not surprisingly they have a much higher rate of mental health problems than their peers (Wang et al., 2025) and for most of them this presents from middle childhood – the primary school years not later higher school like their peers. 

We completely missed reference to girls with ADHD from this programme. While many children are waiting on long lists for diagnostic assessment of ADHD, girls receive assessments later. Girls are less likely to be diagnosed and when they do it is on average several years later than boys. Not surprising then that when we dissect the depression ADHD research studies, those that include girls show much higher rates of depression (Wang et al., 2025).         

Another surprising issue is the discussion of ADHD completely as if it typically occurs on its own. Research shows on average 50% co-occurrence of ADHD and autism (Eaton et al., 2023). We also know that co-occurrence with Dyspraxia/DCD and a range of specific learning difficulties like dyslexia is much more common in those with ADHD than you see in the general population.  We know from the research evidence that having more than one condition is even more impactful on psychological and academic functioning.  There was no mention of any of this. Perhaps because if they referred to these other conditions the many statements that were made about no evidence of ADHD being a neurodevelopmental condition would be questioned under that broader neurodevelopmental lens. Why are autism and Dyspraxia/DCD bonafide Neurodevelopmental conditions and ADHD is not? They are similarly assessed by questionnaires, interviews and observing behaviour. Those with all of these conditions show similarities in cognitive, learning ,social and mental health risk If ADHD is not a neurodevelopmental condition why does it co-occur so commonly with these other neurodevelopmental conditions?

Throughout the programme we heard the argument of ADHD not being a condition but instead that the symptoms reflect natural variation. One contributor said that society is describing the behaviour as being problematic. The experts referred to symptoms like ‘waiting your turn’ and ‘following instructions’. But to receive a diagnosis of ADHD the child’s difficulties with these common daily processes are extremely different from their peers and they are disabling. They make doing every day tasks and activities routinely difficult. The programme raised the question of how we draw the line. This is disrespectful to clinical teams. They are drawing not only on their knowledge of the diagnostic symptoms but on their experience of when these symptoms are extreme, pervasive and impairing the child’s daily function. Clinicians engage in extensive ruling out of other explanations that could account for the symptoms.  They use their experience to determine impairment and diagnosis is assessed within that framework.                 

In this programme we hear a complete destruction of the concept of ADHD as a neurodevelopmental condition. We even hear towards the end one contributor say “ban the label ADHD”.  How does this help the mental health of these young people? The research evidence shows us they have a range of cognitive/thinking and social difficulties that here is being suggested is individual variation. What happens if we embrace a scenario where we ban ADHD as a label and these young people are expected to understand their difficulties in relation to their peers?

We only have to look at the outcomes of girls who are either not yet diagnosed or have been diagnosed after a lengthy wait. For a long time they don’t understand their ADHD symptoms and the difficulties they have. They experience a lot of stigma about their differences and the result is they mask their neurodevelopmental characteristics (McKinnney et al., 2024). The evidence shows that these girls engaging in masking is directly related to increasing their depression and anxiety symptoms (McKinnney et al., 2024). When we interviewed adult women with ADHD looking back on their teenage years they prioritised masking as the number one issue they felt researchers should focus on.

I think we can agree that all of those with expertise of ADHD – whether that is researchers, educational professionals, psychologists, psychiatrists or those with lived experience – want better developmental outcomes for these young people. We want them to have equity with their peers. We want them to achieve their best relationships, academic attainment, participation in school, and positive mental health. We also simply want them to stay safe in relation to accidents and suicide. Reducing the stigma around ADHD as an accepted neurodevelopmental condition – not increasing it – is where we need to be to achieve those good outcomes. A lot of people are angry at this programme. I am really disappointed. The programme raises overwhelming concern that the enormous progress we have made to understand these children and young people via systematic research and inclusion of lived experience in a systematic way is being questioned and even ridiculed.                

Going back to the question – How do we best come to a conclusion as to whether ADHD is a neurodevelopmental condition or a social construct? Consideration of the research evidence and lived experience in a thorough and systematic way is the only way to answer this. Together that leads to the conclusion that ADHD is not a myth or social construct – it is a neurodevelopmental condition.