“Kids don’t have a choice” to quote Channel 4’s “Is ADHD a Myth?” perhaps summarises the mantra of the programme and belies its fundamental issue. If you start from that position, there is perhaps no amount of evidence which will change that premise.
This was not a programme that sought to explore ADHD in a balanced way, but rather to challenge what was presented as the current orthodoxy in diagnosing and treating children who display the symptoms and impairment of the condition. There is value in doing this and the documentary was not without merit, however by ignoring best practice, this programme may have caused considerable harm.
“Is ADHD a Myth?” focused on a case study of an individual going through the education system, highlighting the Complex issues arising from the philosophical and moral dilemmas that parents are forced to confront when a diagnosis is given and treatment options are being considered, especially when the primary driver is the need to ensure that young people remain engaged in the education system. The programme ended with a reluctant parent re-starting treatment for this very reason despite witnessing the benefits of non-pharmacological support.
Ignoring evidence
The focus was narrow and the programme did not consider the broader range of risks associated with untreated ADHD including an increased likelihood of hospital admission for accidental injury, involvement in road traffic accidents and school exclusion which is in itself strongly associated with poor long-term outcomes.
Morbidity and mortality are significantly higher in the ADHD population when compared to those unaffected by the condition and yet was not presented to the viewer to provide a more balanced appraisal of how treatment options must be weighed by clinicians and parents. Nor did the programme make mention of the high rate of heritability or any consideration of genetics, large-scale population studies, or empirical data on prevalence rates or treatment effect.
Confusion
Adjustments made by the parent in terms of nutritional intake, exercise, outdoor activities and a reduction in screen time were all sensible and appeared to yield benefits to the boy concerned and to his family but the message was confused by the fact that the same benefits might well have occurred had the medication continued. Most clinicians would be advising such adaptations at home regardless of whether or not medication was going to be offered. Nor were there discussions about medication holidays which are common for certain categories of ADHD medication.
Although presented as an experiment misleading information was selected. This was not robust science.
The presenter was correct in asserting that diagnosis relies on the identification of symptoms that lie on the outer edge of what might be seen as “normal” childhood behaviours but placed little or no emphasis on the need for these to be leading to actual impairment across more than one domain and for collateral information to be available before a diagnosis can be given. The complexities of a thorough diagnosis were selectively presented as a simple check list, when this is only the initial part of that process.
Conclusion: Oversimplistic
The main criticism of the documentary is that it is oversimplistic and appears to end with the message that “ADHD is really only a problem because we have a flawed education system” that does not accommodate children and young people who struggle to sit still and concentrate. That is at best unhelpful to the thousands of families who encounter a broad range of difficulties that extend beyond the classroom into family life, and to pupils who miss out on early social development, who are unable to build resilient peer relationships, and who may struggle for years to develop an understanding of themselves as individuals. It also ignores lived experience outside of the education system, throughout the rest of society.
If Dr Pemberton and those who contributed to the programme are suggesting that “all we need to do is change the education system and ADHD will disappear as a treatable condition” then we would argue in the strongest possible terms that the real-life experiences of thousands of children and their families, and of adults left to cope without assessment or intervention, have been misunderstood.
What the ADHD population wants more than anything else is to be understood. The programme did little if anything to advance this aspiration.
The Scottish ADHD Coalition brings together voluntary organisations providing support to adults and children with Attention Deficit Hyperactivity Disorder (ADHD), and their parents, carers and families. You can sign up to our mailing list here, read our FAQs, or find your nearest support group.