ADHD, a Unicorn in the Psychiatric (Be)wilderness

Attention Deficit Hyperactivity Disorder was invented in America and appeared in the American Psychiatric Association’s 1980 DSM-III diagnosis manual. But what is it?

At an NIH 1998 consensus conference, the chairman asked a leading ADHD expert, Mark Vonnegut, but he couldn’t explain what ADHD is:^1,2 “They cannot sit still … they are difficult and they aggravate their parents … the diagnosis is a mess … I think, you know, we, uhm, I, I do, I think, part of the problem is that the profession keeps changing the diagnoses.”

Today, ADHD is a contagious, fashionable diagnosis.³ When youngsters look up descriptions of people who say they “have” ADHD on social media, they may be convinced they “have” it too and may even self-diagnose.

The diagnostic criteria for ADHD are so vague that when I lecture and ask people to try the adult ADHD test^4,5 on themselves, it never fails that one quarter to half the audience test positive. Dr Iona Heath, Former President of the UK Royal College of General Practitioners, said in August that “if you want the diagnosis, you will be able to get it.”⁶ Many people are proud of their diagnosis and a British comedian said he needed to try the test five times before he passed.

Those who are too quiet can get the diagnosis of “predominantly inattentive” ADHD. So, what about those in the middle? It is so absurd that I invented a disorder for healthy people, Adult Symptom Deficiency Disorder (ASDD), with a 10-item test that guarantees that no matter what your score is, there is a treatment for you.⁷

ADHD is one of the oddest creatures in the psychiatric (be)wilderness. I do not dispute that some people suffer from their symptoms, but if you examine the central tenets of ADHD scientifically and logically, you’ll see that the diagnosis falls apart.⁵

The latest misinformation, the Fogany review

On 9 October 2026, a so-called independent review of ADHD and autism was published. It took up 599 pages plus a 230-pages technical annex.⁸ The Acknowledgements on page 463 show that a huge amount of people had contributed to the report but there are no declarations of conflicts of interest for anyone.

The review noted that the current system is not working but the authors were sitting on the fence and didn’t dare tackle the biggest problem of all: overdiagnosis. This is remarkable considering that the report stated that, by the end of 2025, open referrals in England for ADHD assessment exceeded 560,000, more than 17 times the number recorded in 2019.

In 2011, Allen Frances, chairman for the DSM-IV task force, said that the responsibility for defining psychiatric conditions needs to be taken away from the American Psychiatric Association because new diagnoses are as dangerous as new drugs:⁹

“We have remarkably casual procedures for defining the nature of conditions, yet they can lead to tens of millions being treated with drugs they may not need, and that may harm them.” Frances noted that DSM-IV created three false epidemics because the diagnostic criteria were too wide: ADHD, autism and childhood bipolar disorder.

As I shall explain below, the summary in the Fogany review presented highly misleading statements. It called ADHD a strongly genetically influenced neurodevelopmental disorder, which influences attention, communication, behaviour, learning and how people experience the world; the patients are neurodivergent; and the diagnosis can help explain difficulties that significantly impair a person’s functioning, participation and quality of life.

The Fogany review recommended banning direct-to-public advertising of NHS-funded ADHD and autism assessments. But when the BMJ published a news item about the review,¹⁰ it was accompanied by an ad for methylphenidate:

Methylphenidate is a narcotic on prescription used against ADHD. In the US, Ritalin, Adderall, and methamphetamine, all used against ADHD, are Schedule II controlled substances, which cocaine, oxycodone, and fentanyl also are.

Respectable medical journals avoid placing drug ads close to an article describing that type of drug or disease. But the BMJ is no longer a respectable journal. This summer, the editor, Kamran Abbasi, refused to publish criticisms in print of its highly misleading suicide prevention articles ¹¹ even though he could have contributed to reducing the meaningless suicides caused by antidepressants by telling their readers that antidepressants do not protect against suicide. They double suicides in adults,¹² and very likely also in children.⁵

The photo of the children has a link to an interview Abbasi conducted with Sir Simon Wessely, professor of psychiatry and vice-chair for the Fogany review. The headline shows BMJ’s stance on the issue: “Overdiagnosis is not the biggest problem in ADHD and autism.”

Wessely says that he finds neurodiversity an incredibly useful term and that 20% of school children and young adults identify as neurodiverse (see below why this is bullshit). Eight years ago, Wessely rejected any link between antidepressants and suicide and stated, categorically, that the pills are “not addictive,” both of which are false.⁵

The latest brouhaha, the Channel 4 documentary

On 18 August, Channel 4 in the UK showed the documentary, “The great ADHD myth?”¹³ which sought to determine whether ADHD is a genuine neurodevelopmental disorder or a social construct.¹⁴ The press release from 29 July acknowledged that, while the traits of ADHD undeniably exist, it asked if we should be giving children powerful, mind-altering drugs to treat it.¹⁴

Child and adolescent psychiatrist Sami Timimi said that we have replaced corporal punishment with giving children a pill and Iona Heath said that ADHD is not a medical condition.¹⁴

Heath’s former organisation, Royal College of General Practitioners, immediately denounced her. They made it clear that the quote attributed to a former College President was not made on behalf of the College and recognised ADHD as a neurodevelopmental condition.¹⁵

Many people on social media were so outraged that they called for censorship even before they had seen the documentary.¹⁶ Most critics interpreted it as denying that ”ADHD exists,” yet none of the experts in the film denied that some people diagnosed with ADHD have serious problems.¹⁷ As I shall discuss next, asking pertinent questions in the public arena about one of psychiatry’s holy cows was too much for influential organisations.

Condemnations by ADHD UK

Two weeks before the programme aired, ADHD UK warned Channel 4 that it would cause harm in an open letter that was so misleading that it could have been written by a drug firm.¹⁸ The charity has a commercial relationship with ADHD 360, a private company whose business depends upon people being assessed, diagnosed and treated for ADHD.¹⁹

In response to concerns from anonymous whistleblowers, external stakeholders, and people using the service, England’s healthcare regulator inspected ADHD 360 in 2020 and 2023 and found that improvement was needed.²⁰

A week before the documentary aired, ADHD UK’s CEO Henry Shelford, who offers paid ADHD coaching, called it “sensationalist nonsense” and urged ”the charity’s members (potentially over 10,000 people) to lodge complaints.”^19,20 There was even a complaint form.

ADHD UK used a similar strategy in 2023 in relation to BBC’s Panorama investigation about private ADHD clinics, again complaining to the broadcaster before the programme aired.¹⁹ After the broadcast, ADHD UK announced they would complain to the BBC and ask as many people as possible to join in that complaint. It published a detailed step-by-step complaints guide and noted that “It is fine to copy/paste.”

There were 1,639 complaints, and ADHD UK declared that it was the most complained-about Panorama programme. They might as well have sent the same complaint 1,639 times.

ADHD UK claimed that ADHD is not a social construct but a neurodevelopmental disorder.¹⁸ This claim is everywhere, also in psychiatric textbooks²¹ and in messages from the UK National Health Service and the US Centers for Disease Control and Prevention.²² It gives people the impression that science has found out that there is something objectively wrong with the brains of people with an ADHD diagnosis.

This is totally false,²¹ but if you repeat something often enough, people come to believe it to be true. Psychiatrists use impressive, scientific-looking words to obscure their ignorance and to deceive people, just like quacks do. We call it scientism.²³ Abnormal development of the nervous system involves structural and functional disruptions during embryonic and foetal growth, leading to congenital central nervous system anomalies, e.g. neural tube defects such as spina bifida. To claim that ADHD is a neurodevelopmental condition is plain bullshit.

There is no evidence of a specific neurological state or process that gives rise to or is associated with ADHD.¹⁷ There are no biomarkers, it is not a dopamine deficiency disorder, and the brains are no different from those of people without the label.^5,24,25 But Lancet Psychiatry nonetheless called it a disorder of the brain.²⁵

ADHD UK called Channel 4’s press release “materially misleading” because it noted that boys aged 10-14 comprise the largest group being medicated.¹⁸ Channel 4 referred to NHS data showing that its statement is correct.¹⁸

ADHD UK called the ”chronic underdiagnosis of girls” a national scandal and claimed that the real story was not one of overmedication. This is what we always hear. Even though psychiatric drugs are the third leading cause of death,²⁶ and harm people seriously in numerous other ways,^1,5,21,27,28 we are always told that the problem is undertreatment.

ADHD UK noted that the programme put lives at risk; that ADHD drugs reduce the suicide risk; and that ”adults with diagnosed ADHD die on average around seven years earlier for men and nearly nine years earlier for women.”

This is extreme disinformation. ADHD drugs increase the risk of suicide and violence.^25,29,30 and they don’t improve survival. ADHD UK didn’t provide a reference but I found the study, which is fatally flawed.³¹ People with an ADHD diagnosis had much higher rates of smoking, alcohol use, severe mental illness, and physical illnesses, which the authors of the study glossed over. I could equally well say that old people die earlier than young people but that would not make us wiser either.

ADHD UK claimed that ADHD is a lifelong condition, but many studies have documented that the symptoms that define ADHD can disappear when children grow up. A Canadian study showed that the prevalence of school children in treatment in the same class increased pretty much linearly over the months from January to December,³² with 50% more of those born in December being on drugs. This relative age effect was confirmed in a systematic review of 31 studies.³³ If we allowed children to grow up and mature, fewer would receive an ADHD label and drugs.

A study spanning four decades showed that 90% of adult cases had no history of childhood ADHD.³⁴ To circumvent this problem, psychiatrists have said that ADHD presents differently in adults, or in women and girls, but as psychiatrist professor Joanna Moncrieff noted, this is nonsensical, because how it presents is what it is, and if it is different, it is not the same.¹⁷

About medication, ADHD UK noted that ”133 randomised, double-blind controlled trials, covering around 18,000 people, underpin its use, and its measured benefit is among the largest in psychiatry … research links treatment with better school performance, fewer accidents and injuries.”

The short-term benefit of the drugs is that children may sit still in class, but this effect disappears quickly. The package inserts, e.g. for Adderall, reveal that the harms include sudden death, mania, delusional thinking, aggression, hostility, tics, vasculopathy, and a high potential for drug abuse. There is no improvement in school performance and no reduction in accidents and injuries.⁵

ADHD UK spoke about having ADHD and to live with ADHD,¹⁸ and the Fogany review noted that ADHD can influence attention and behaviour, but this is how the disorder is defined. A name cannot cause anything. ADHD is just a name for a collection of symptoms at one end of a normal behavioural spectrum where people are more energetic, impatient, and irritating than others. When we give a certain behaviour a name, we cannot say that a person behaves this way because he has ADHD. This reification, which is harmful,²² is circular evidence, a tautology. You can have a dog but you cannot have ADHD or live with ADHD, which just means to live with yourself, which we all do. When patients believe that a name can explain anything, they have been fooled.

Condemnations from the Global ADHD Network

The Global ADHD Network also condemned the film before they had seen it.³⁵ They claimed that science had already answered the question if ADHD is a neurodevelopmental disorder and lamented that the question was reopened before a prime-time audience of hundreds of thousands of worried parents, undiagnosed adults, and vulnerable children.

The network claimed that ADHD is one of the most robustly evidenced conditions in psychiatry. If so, it says a lot about the rest of psychiatry!

We are told that genome-wide association studies have identified specific common genetic variants linked to ADHD, confirming a polygenic architecture, and that a condition that is roughly three-quarters heritable is not a “social construct.” However, the genetic emperor is naked. In one study, which claimed ADHD was related to genetic abnormalities, combining two tables shows that 99.7% of the patients don’t have genetic abnormalities.³⁶ I have heard a professor say at a meeting that there is 80% agreement for identical twins.⁵ So, people who are identical behave similarly. Surprise, surprise.

The network claimed that people with ADHD have small brains, with reduced volumes in five regions. They referred to a 2017 review in Lancet Psychiatry with 58 authors,³⁷ which has been debunked. The journal devoted an entire issue to criticisms of the study, and a re-analysis of the data, also in Lancet Psychiatry, found no brain differences.³⁸ It is scientific misconduct to quote the original results 9 years later as if they were true.

Like ADHD UK and the drug industry, the network tried to convince their readers by using big numbers. We are told that every major medical body has already answered the “myth” question and that more than 10,000 clinical and scientific publications on ADHD exist. This is amusing. PubMed lists 2,107 entries with homeopathy or homoeopathy in the title, but that cannot remove the fact that homoeopathy is bogus.³⁹ There is nothing in it.

The network claimed that ADHD is underdiagnosed, especially in women, girls and adults. When we are done with that, we should perhaps turn our attention to underdiagnosed ADHD in dogs. Many of them are impatient, cannot sit still, and bark too much.

The network mentioned “the landmark NIMH Multimodal Treatment Study of ADHD (the MTA), showing that properly prescribed, monitored medication reduces core symptoms and impairment.” This study is fraudulent. A lot has been written about how the investigators manipulated their results or drowned them in incomprehensible statistics to conceal how disappointing the long-term results were.⁵ One of the investigators broke ranks and stated in an interview:⁴⁰ “The children had a substantial decrease in their rate of growth … there were no beneficial effects – none … that information should be made very clear to parents.”

It wasn’t. The public was lied to. An NIMH press release stated that the improvement was sustained in most children and one of the authors, Peter Jensen, said that the investigators were struck by the remarkable improvement in symptoms and functioning across all treatment groups.⁴¹ And rather than saying that the growth of children on drug treatment was stunted, the press release said that children who were not on medication “grew somewhat larger.”

After 16 years, those who consistently took their pills were 5 cm shorter than those who took very little.⁴² I consider it likely that these drugs also harm the developing brain. And methylphenidate doesn’t protect against delinquency and substance abuse, which people usually claim; if anything, it causes them.⁴³

The network said they fight misinformation and that “evidence is our strongest weapon.”³⁵ They distorted the science beyond belief and claimed that Channel 4 presented the views “of a small number of cherry-picked medical professionals as though they constitute fair and balanced representation of the science.” Thou shalt not criticise the Lord’s precious drugs.

The BMJ published sheer rubbish

As so often before,^44-46 the BMJ published a misleading article in support of a failed psychiatry.⁴⁷ The BMJ editor must have thought it was important because it was commissioned, not externally peer reviewed, and published with record speed.

The article had the declarative title, “The Great ADHD Myth documentary is misleading and misinformed.” The authors postulated that a wealth of robust research supports the view that ADHD is a well established, extensively evidenced neurodevelopmental condition; that the disorder is associated with serious adverse outcomes, including substance misuse, suicide, and premature mortality (reification again); and that substantial evidence from randomised trials shows that ADHD responds to treatment.

The key reference is to a consensus report⁴⁸ with 80 so-called authors. All top ADHD experts take drug company money,⁴⁹ and the most interesting part of the consensus report is the financial disclosures. The first author, Stephen V. Faraone from the USA, declared that he, in the past year, had received support from 13 companies and in previous years from 13 other named companies. During a 10-year period, he had put his name on an article every 11 days.⁴⁹ One of my colleagues once remarked that if a doctor had lent Shakespeare a pencil, he would have become co-author of Macbeth.

Two of the three authors of the BMJ article work at departments of clinical neuroscience, even though ADHD has nothing to do with neuroscience. The third author is from the British Association for Neurodiversity and she declared under competing interests that she is neurodivergent.

This is bullshit. Neurodivergent is a nonmedical term coined in 1998 to recognise that everyone’s brain develops in a unique way.⁵⁰ Thus, apart from identical twins, we are all neurodivergent, which renders the notion meaningless.

The authors accused the documentary of having “made the scientifically inaccurate claim that brain imaging studies have shown that ADHD is not a condition of the brain or development,” quoting the consensus report. However, the statement is accurate.⁵ ADHD is not a brain disease. A brain tumour is a brain disease.

The authors said that the “disorder is associated with serious adverse outcomes.” These tautological reifications are everywhere. People don’t realise that such statements are empty.

As usual, the authors also made sacrifices to the industry gods. They rejected that there was overdiagnosis and emphasised that “there is clear evidence of underdiagnosis.” They also claimed that drug effects are clinically meaningful, with significant reductions in adverse outcomes.

Like other authors, these authors opined that the implication that ADHD is a myth is “unhelpful and risks perpetuating stigma and prejudice. It speaks to an ongoing lack of parity between physical health and mental health/neurodevelopmental conditions.”

Mental health issues cannot be compared to physical health issues. If you have a broken leg, you want to have it fixed, not just to get an aspirin to lessen the pain. But in psychiatry, this is exactly what is offered.⁵ A drug that doesn’t really help the patient’s emotional pain⁵ is not a causal treatment like bone surgery is, and it doesn’t stigmatise the patients if their doctors were a little honest about the issues, for a change.

The Guardian got it right

The Guardian’s reviewer of the documentary noted that the presenter, psychiatrist Max Pemberton, answered the questions he posed convincingly, and that the proposed redresses, which included making drugs the last resort, seemed neither radical nor uncompassionate.⁶

A former president of the Royal College of Psychiatrists (Professor Dinesh Bhugra) said that “The industry around ADHD is about making money at the cost of the misery of others,” and child and adolescent psychiatrist Sami Timimi reminded people that the drugs most often involve amphetamines, which are controlled substances, and that there is a good reason why the rest of the population are warned about them.⁶

When Pemberton took a dose of the amphetamine he was prescribed for his spurious ADHD diagnosis, he reported feeling subdued and antisocial.¹⁷ He didn’t want to talk to the people in his local shop as he normally would and wanted the film crew to leave him alone.

Other comments on what ADHD is

Many psychiatrists, psychologists, neurologists and others have documented how false the statements about AHDH offered by mainstream psychiatry are.^{17,21-25, 51,52} But the day after the documentary aired, the President of the Royal College of Psychiatrists wrote that we should not question ”the legitimacy of a well-established neurodevelopmental disorder.”⁵³

Critics of drug focused psychiatry noted that the institutional response to the film illustrated the confused thinking that underpins the mainstream understanding of ADHD.²⁴ Most importantly, the claim that “ADHD is real” has multiple meanings. The experiential reality of the difficulties classified as ADHD are real, but the claim that ADHD is an established neurological disorder that explains those difficulties is not.

A consensus statement claimed^52,54 that there is no disagreement; that numerous studies link ADHD to several specific areas of the brain; that the genetic contribution to the disorder is the highest for any psychiatric disorder, with one specific gene being reliably associated with ADHD; that the propaganda of ”fringe doctors” with a political agenda want the public to believe there is no real disorder; and that publishing stories that ADHD is a fictitious disorder “is tantamount to declaring the earth flat, the laws of gravity debatable, and the periodic table in chemistry a fraud.”

This is the talk of people who are desperately short of arguments. They tried to impress their readers by using big numbers: 86 people were co-signatories and there were 547 references, the largest number I have seen for any article. The first author, Russell A. Barkley, organised the statement and is a strong supporter of narcotics on prescription—amphetamine and amphetamine-like substances—for ADHD.

What should we do?

Some studies have shown that one child in five meets the diagnostic criteria.²⁵ But calling ADHD a common disorder is false. It cannot be pathological that so many children behave rather normally. I can recommend Martin Whitely’s hilarious little video, “ADHD is BS”⁵⁵ that mocks the ADHD pseudoscience. It is a good antidote against hubris and grandiosity.

The difficulties people experience should be understood and supported, without the need to apply a diagnostic label that implies a lifelong underlying neurological disorder. NHS England’s ADHD Taskforce recommends that support should be needs-led and should not require a clinical diagnosis which can be self-fulfilling and life-limiting.²⁴

My views, supported by the best evidence we have, are that the ADHD diagnosis is fake and should be buried in the graveyard of psychiatry’s many failures;⁵ ADHD drugs should be removed from the market because they are harmful; people with symptoms that qualify for an ADHD diagnosis should receive psychosocial interventions; triggers, such as poor parenting or poor schoolteachers, should be addressed; and the social structures that constrain parents and teachers from doing better and having the time and freedom to do so should be addressed.

***

References

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