SINGAPORE: “ADHD is certainly not a medical condition, as far as I’m concerned,” says Dr Iona Heath – former president of the Royal College of General Practitioners (RCGP). Speaking on Channel 4’s thoughtful and compassionate new documentary The Great ADHD Myth? on Tuesday, Dr Heath joins a chorus of professionals who say that the condition is “a social construct” rather than the “neurodevelopmental condition” it’s currently described as by the NHS.
Talking warmly via video link from her home in north London, Heath (who is in her mid-70s and now retired after 35 years of practising as a GP) says that despite the popular belief that people with attention deficit hyperactivity disorder are “wired differently”, “there’s no evidence that the structure of the brain is any different in the people being diagnosed”. This is true. But there’s no difference in the brains of people with depression, dyslexia, schizophrenia and bipolar disorder either. Those conditions surely exist? Heath nods.
She says she finds it horrifying that so many people are being labelled. “I have an antipathy to labels,” she tells me, “because they’re such huge generalisations. They stop us paying attention to people as individuals. Labels have no sensitivity to nuance.” She sighs. “Psychiatry is in a terrible mess.”
Diagnoses of ADHD among children aged 10-17 have more than doubled in the past eight years, with the use of amphetamine-based stimulant medication – “like a slow-release cocaine”, according to the documentary’s presenter, NHS psychiatrist Dr Max Pemberton – used to treat them increasing by 90 per cent. Clinicians interviewed on the programme express serious concerns about the long-term impacts of the central nervous system (CNS) stimulants doled out to control impulsive and inattentive behaviour in the classroom. One expert fears that we have “put a chemical cosh on an entire developing generation of brains”; another characterises the medication taken by 278,000 patients in England alone as personality-flattening drugs, comparable to those given to patients in the 1950s and Sixties “to make people not homosexual anymore”.
We meet 10-year-old Mason, who was diagnosed with ADHD and given medication two years earlier. As a sweet, articulate child, he tells Pemberton that before being medicated he would “get a headache from thinking of one thing and one thing so rapidly”. His mother, Shawna, says he would describe “squiggly moments” during which he was unable to focus and keep still. Though clearly bright, Mason was failing school tests before starting medication. After taking the drugs, he began achieving much higher grades on a par with his peers. But he tells the camera he doesn’t want to take the drugs. “I have to because it works,” he says, because “it takes my fun-ness away.”
Mason’s mother is between a rock and a hard place. “What’s better for him?” she asks. “To allow him to have his thoughts moving at a thousand miles an hour but to be himself, or to have him focus more but he doesn’t quite feel himself? It’s horrible that a child has to pick.” She would like him to come off the medication – which Mason has had to take in increasingly high doses as he builds tolerance – and “to develop coping strategies”.
In the programme, the family runs an experiment, stopping Mason’s medication for six weeks, moving him to a healthier diet (cutting out processed food), reducing his screen time and introducing more outdoor activities and yoga.
My heart goes out to them. My own son was diagnosed with ADHD at seven years old. Like Mason, he couldn’t sit still in the classroom and infuriated teachers by failing to produce written work reflecting his intelligence. He had been a live wire from birth. He was early to walk and his toddler years felt like the Wacky Races, with me constantly chasing him as he hurtled headfirst into the world: slipping his hand from mine to pelt across parks, around supermarkets and museums.
Before he started school, I managed this by spending most of our time outdoors. We would go to the local nature reserve every day in all weathers. He did swimming, karate and football clubs. He had no electronic devices, barely watched TV and ate a wide, healthy diet. No junk. Other mothers and fathers boggled at the amount we did or – seeing him in action – would joke, “Lucky you, he’s going to sleep well tonight!” I’d smile as my soul sank. He would not sleep. I would sing and read into the small hours. He would be up at 5am to do it all again. It was maddening to be judged harshly by parents of much easier children. I was putting twice the energy into parenting for half the results.
When my son started school, teachers joined the chorus of tutters: why was this clever child fleeing his desk to shimmy up the sports equipment in the hall? Didn’t he know this wasn’t safe? He was distracting the other, better-behaved children; something must be done. I knocked myself out trying to keep him engaged with the curriculum. When Arctic exploration was a class topic, I decorated his bedroom as Captain Scott’s camp. There was a tent, stuffed seals and a pile of wood in the corner with fabric flames. “You’ve put actual wood in his bedroom? That’s why he’s bringing sticks into the school after lunch.” I couldn’t win.
Like Mason’s mother, I was worn down. We went to the doctor and got the pills to make my son focus and pills to help him sleep. He became a more compliant student and a sadder human being who now struggled to eat because the stimulants made him feel sick.
Heath is hugely sympathetic. She understands why so many of us prefer the ADHD label to the “bad mum, naughty kid” labels. She recalls the day her own son – now a successful ecologist – came home from school, aged eight, having realised for the first time that “lessons weren’t there to give kids a rest between the important business of playtime”.
“This is why I say it’s a societal problem and not a medical one,” she says. “The ADHD crisis is a crisis for society.” She argues that the children who can’t sit still in class are canaries in the coal mine, flagging the way the education system is failing. “There have been so many cuts to the creative arts and to sport in schools,” she says. “The arts – the drama, music, dancing, painting and pottery that was an outlet for so many of these kinds of children – has been shutting down. We’re shutting down potential avenues of success.”
Heath – who began practising in Kent in 1975, when she “hardly ever” saw patients referred from schools with behavioural issues – believes that “Mrs Thatcher was so vile to teachers that many of them stopped volunteering [to run] after-school clubs too.
“So many of our elite sports stars now come from private schools,” she says. “It makes me wonder how much talent we are missing.” A sigh. “So many of these [ADHD-type] kids think with their bodies. They need to move. They’re different from somebody like me – a more intellectual type person – but they have so many abilities that we’re not recognising and rewarding. We just write them off, and that’s wrong.”
I felt that Michael Gove’s education reforms – which saw five-year-olds required to break down language, with complex terms such as “split digraphs”, before they had been given a chance to feel the joy of good stories – made it harder for restless children to engage with classes. Heath agrees that Gove made education “boring”.
“I’ve never known what a gerund is,” she says briskly. “It is very possible to have a productive and fulfilling professional life without being forced to learn that sort of thing.” Many ADHD children are also sensitive to – and distracted by – the uncomfortable textures of school uniforms. Heath thinks uniforms should be scrapped. “They don’t wear them in Sweden, where they are now also opening clinics to help people get de-diagnosed with ADHD.”
She fears that pressures on teachers have pushed a generation into the greedy hands of big pharma. She says children and adults alike are being bombarded with “online invitations to self-diagnosis. They’re not selling the treatment, they’re selling the diagnosis. They put out all these questionnaires, and it’s in their interest for people to get the diagnosis so they can sell more medication.”
In the documentary, Dr Pemberton takes such a quiz and comes up positive for an ADHD diagnosis, which annoys him.
“They are spreading the net too wide,” says Heath. Although the current leadership of the RCGP “supports evidence-based care for people with ADHD in line with current national guidance”, Heath doesn’t see enough biological evidence for medicating children in these numbers. “It’s so important to question everything in medicine,” she concludes. “Historically, medicine has assumed we’re at the peak of understanding. Yet looking back at previous generations, we can see where mistakes were made. If we are not interrogating the label of ADHD, we will never formulate a better understanding of the people [diagnosed with] it.”
The documentary ends with Mason back on his medication. My son stopped taking his at 14, but also stopped attending school consistently at the same age. Now, at 17, he has just passed his assessment to join the Army, where his energy and intelligence were commended by interviewing staff. After years of being told by teachers what he couldn’t do, the Army focused on what he could. But this result only came after months of worry that a historic ADHD diagnosis might bar him from acceptance.
“Good for him,” says Heath. “We all need to be giving these kids more chances to be comfortable and useful.”