Only public opinion — not scientific consensus — will end ADHD over-diagnosis
“I’m not mad, my mother had me tested,” used to be a joke, now it’s a cocktail party conversation. We’ve all participated in such exchanges, politely asking how someone’s child is, and listening as they gravely explain their offspring’s recent diagnosis of ADHD, anxiety or neurodiversity. It is psychopathic party pooper who will dare to respond: “But how are these diagnoses made? Where are the biomarkers? What about the growing medical acknowledgement of whole-sale over-diagnosis? Do you know that Adderall and Ritalin suppress growth? Even Wes Streeting has his doubts about it all. Are you sure they’re not just spending too much time doom-scrolling?” Instead, we all nod along and ask kind questions about extra tutoring, therapy and, if we’re feeling masochistic, medication.
These cocktails conversations regarding mental health diagnoses are the staple also of newspapers and panel shows. Barely a week goes past without a celebrity revealing their ADHD diagnosis: Annabel Fenwick Elliott wrote how her TikTok-diagnosed ADHD and autism explained why she had no friends, Susannah Constantine spoke of her and her daughter’s matching ADHD and Lucy Frazer the former culture secretary suggested her daughter’s ADHD was the reason she preferred trying on bikinis in her bedroom during lockdown rather than online learning. Nadine Dorries has ascribed her ability to write so many books to her ADHD — as diagnosed by her daughter. Simon Hart’s book “Ungovernable” includes Andrea Jenkyns’ blaming of her foul-mouthed outbursts on her ADHD.
It is often easier to reach for a label, than address the — often messy — underlying causes
That so many people, both ordinary and celebrity, are entangled in this mental health construct, explains how it will be difficult — but not impossible — for society and the medical profession to reverse out of it all. Helen Joyce articulated it perfectly when describing the problems with pulling down the edifice of trans medicine: so many influential people had involved their own children that it became easier to defend an incorrect medical idea than admit how they had harmed their own child: “A lot of people have done the worst thing that you could do, which is to harm their children irrevocably … those people will have to believe they did the right thing until the end of their lives for their own sanity and own self-respect.”
The same is true for the broader mental health misdiagnoses. Ranks of high-profile people in public life and within educational and healthcare systems, have invested too heavily in the ADHD / Anxiety / neurodiversity industry to easily admit its shortcomings. When the cracks start to show, it is easier to defend the medically dubious system than admit that as parents, care givers, teachers, medical practitioners, they unnecessarily, and perhaps dangerously, medicalised children’s quirks, foibles, puberty or ability to deal with the bumps of normal life.
I work with children who refuse to go to school or have been expelled. All of whom have been diagnosed with ADHD, ASD, ODD, anxiety, depression or SPD. I see on a daily basis the self-fulfilling prophecy of it all: “I can’t go into the shop, I’ve got anxiety … I can’t read, I’ve got dyslexia … I can’t concentrate, I’ve got ADHD … I can’t use a pen, I’ve got sensory issues … I can’t meet new people, I’ve got autism.” Beyond socialisation difficulties from spending so long alone at home, the children show no signs of mental illness. I think of them like Clara from Heidi or Colin from The Secret Garden — both children made ill by misguided adults in unhappy homes and not enough time spent playing outside with friends.
The well-intentioned idea behind these diagnoses is to give the parents and child the provision required to support their special needs. What happens in practice, I have found, is that the child is reduced to their weakest characteristic and comes to embody and even embrace what they have been told is wrong with their brain. No brain scans, blood tests or any other biomarker indicators are required, just behaviour — sometimes observed by a doctor, sometimes just recorded on a questionnaire, sometimes paid for at exorbitant cost after an online consultation.
That these children — and people like Nadine Dorris or Andrea Jenkins — have challenging behaviours is not to be debated, they do. What causes such behaviours is the issue. It is easier in many cases to reach for a mental health label, than address the underlying causes, which are generally sad and messy. No sane person wishes to wade into such dangerous territory as: parental abandonment, family breakdown, two parents working full time and having no bandwidth for the children, an inability to regulate children’s phone use and gaming, violence within the home, sexual abuse or generational poverty — all much more realistic explanations for why certain children prefer to remain in their bedrooms scrolling on their phones than engaging in school work or socialising.
Adding a mental health label to a child with an already difficult background is, to my mind at least, unhelpful in the extreme, particularly if medication then follows. I’ve been with children who are given by their parents a can of Monster, a vape and their ADHD medication for breakfast — the effects are exactly as you would imagine. Equally, the focus on organising school SEN support for an autistic girl whose only evidence for the condition is enjoying her own company and drawing with charcoals, takes much needed finances and personnel away from children with very real mental illness. I am thinking here particularly of my eight-year-old niece who has a diagnosis of autism and ADHD following frontal-lobe damaging meningitis when a newborn. She bites herself in a vain effort to stop hitting and kicking people. She’s given her Mum a black eye and broken two of her fingers. She was out of school for 18 months owing to no place at a suitable special school. When Hollywood star Aimee Lou Wood talks of her “ADHD with autistic traits,” I wonder how such conditions can have such varied presentations — from practically nothing to extreme violence.
Thankfully I am not the first person to notice such diagnostic irregularities. Three books on the same theme have recently been published by eminent doctors in the field: The Age of Diagnosis by Suzanne O’Sullivan, Sami Timimi’s Searching for Normal and Alastair Santhouse’s No More Normal. They variously argue that by making the definitions of mental illness so capacious, the real causes of mental irregularity are not addressed and ordinary life and emotions are instead pathologized.
What has long been suspected within medical corridors is now authorised for public conversation. But is the public ready to listen? Those who have forked out thousands for private diagnoses, who have advertised their child’s “conditions” loudly in national newspapers, who have arranged for extra time in exams, who have collected SSRI, betablocker or amphetamine prescriptions for their children, will be the staunchest defenders of the current system — no matter how medically shaky it is increasingly recognised as being, or unhappy their children still are.
And yet as a society we have been able to reverse out of damaging behaviours and trends. It always struck me as strange that the fact it is impossible for a human to change sex — clearly stated by Professor Lord Robert Winston on BBC Question Time — carried little water in the trans debate. Similarly, it will take more than sensible doctors pointing out some facts around mental health over-diagnosis to shift public debate. What was most significant in the slow turning of the trans oil tanker was the bravery of de-transitioners such as Keira Bell who told of the harm caused by gender doctors. All of a sudden, the glamour of having a trans child took on an ugly face. Will any of the almost one million children and young people with an active referral to the Children and Young People’s Mental Health Services in England step forward and say their being labelled as mentally ill has been harmful rather than helpful? Only then will the chattering classes turn away from this topic of conversation, and allow public opinion to catch up with the rapidly developing medical science.
