People are increasingly seeking to an obtain an ADHD diagnosis without pursuing treatment, according to experts who have called for more research to understand why. Some people now regard 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. This has resulted in a growth in complaints against NHS doctors when they are forced to reject low quality assessments, he added.
Adamou had 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 patients seek low, non-therapeutic doses of medication instead. 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. They are manifestations of a societal problem.” Adamou was speaking ahead of a new Channel 4 documentary airing on 18 August titled 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 that ADHD was both a social construct and a brain disorder. Brain differences are well established through research, and the diagnostic criteria has undergone “a lot of scientific scrutiny and validation”, he said, but added that in recent years “the ADHD concept has been expanded so much, it’s risking becoming meaningless … it’s socially constructed now, it’s something different than what it actually is.” He said this phenomenon was fuelled by “challenges with the quality and the regulation of the [ADHD services] market”. Poor quality diagnoses have created “a double stigma” for many people with the condition.
Prof Dinesh Bhugra, the former head of the Royal College of Psychiatrists who features in the documentary, agreed that “there has certainly been a splurge of diagnosis, and we don’t know why that is”. He said: “The question is why now, and why this? My fear is we medicalise normal human responses because it gives us the power as clinicians and it gives people the label which allows them to either feel they’ve got certain privileges or it gives them certain cachet in society.” In the documentary, he shares his concerns about the growing role of profiteering private companies supplying services that the NHS is under too much strain to provide.
ADHD assessment was “an easy way to make money” for private companies, he said, adding: “Their responsibility is to the shareholders, not the general public.” Bhugra feared that the UK’s current approach was an American import, where the DSM [Diagnostic and Statistical Manual of Mental Disorders]’s checklist-style approach to assessment reflected the demands of insurance companies, and a culture of “health is a commodity and you can buy it and sell it”. He agreed with the documentary’s message that services should be reformed to take a more holistic approach, bringing together the social, biological and psychological facts of ADHD rather than emphasising medical intervention. Jessica Lister, a clinical director and consultant nurse at the private provider Care ADHD, feared that the documentary’s message could be harmful.
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