Dr. Max Pemberton, a psychiatrist with over two decades of experience, has raised concerns about the significant increase in Attention Deficit Hyperactivity Disorder (ADHD) diagnoses and the widespread prescription of medication. Pemberton, who was himself diagnosed with ADHD during an online assessment for a documentary, argues that diagnostic criteria have become increasingly broad, leading to a surge in diagnoses that may not accurately reflect underlying issues.
"I've been a psychiatrist for more than 20 years, and in that time I've watched ADHD go from a diagnosis made occasionally, after careful assessment, to one that is demanded and all too readily dispensed by healthcare professionals, driven by self-diagnosis based on social media," Pemberton stated. He noted that in England, the number of people prescribed medication for ADHD rose from approximately 107,000 in 2015-16 to over 326,000 by last year. Current estimates suggest around 2.5 million people in England have ADHD, including 741,000 children and young people.
Pemberton's own experience undergoing a £1,200 online assessment, for which he was diagnosed with ADHD combined type, led him to question the validity of the diagnosis. He highlights how criteria such as frequently losing one's phone or staying up late were used to label him as "disabled."
He interviewed experts who suggest that social and environmental factors may be fueling the rise in diagnoses, rather than ADHD being solely a neurodevelopmental condition. Dr. Iona Heath, a former President of the Royal College of General Practitioners, pointed out the vagueness of diagnostic criteria in the DSM (Diagnostic and Statistical Manual of Mental Disorders), questioning if symptoms like "often squirms in their seat" are truly indicative of a disorder. Pemberton noted that when the DSM criteria were revised in 2013, raising the age for symptom onset from seven to 12, the prevalence rate in a US study increased significantly, demonstrating how a simple change in guidelines can affect diagnoses.
Research into the neurobiology of ADHD, including work by Professor Katya Rubia at King's College London, suggests that while group comparisons show minor differences in brain connectivity, these are often very small. Furthermore, individual scans of children diagnosed with ADHD frequently show normal brain structures. "Because it's not a medical condition, we don't have a brain scan where you can say you have abnormality here, now are you ADHD. It's a concept which is based on behaviour," Professor Rubia explained.
Pemberton also detailed his personal experience taking lisdexamfetamine, a common ADHD medication. He described the effects as being "dulled, mute, compliant and withdrawn," significantly diminishing his engagement with the world. He cited a 2024 study in JAMA Psychiatry linking increased years on ADHD medication to a higher risk of cardiovascular disease and high blood pressure. "These drugs work by revving up the same system that governs fight or flight, nudging up heart rate and blood pressure with every dose, and years of that steady pressure take their toll on the arteries," he wrote.
The assessments themselves have become a significant industry, with NHS spending on private ADHD companies increasing substantially. According to the Centre for Health and the Public Interest, there is a lack of mandatory regulation for assessment providers, yet profits are high. Professor Dinesh Bhugra, past President of the Royal College of Psychiatrists, commented, "The industry around ADHD is about making money, at the cost of misery of others."
Pemberton explored the case of Mason, a ten-year-old boy who was taken off his ADHD medication for six weeks as part of the documentary experiment. Initially, Mason exhibited challenging behavior, but after a period of adjustment, he became calmer and happier, stating, "I finally get to be myself." However, school reports indicated he was more disruptive and disengaged. Mason's teacher observed that while he was easier to manage on medication, his friendships improved and he showed a "true and honest and vulnerable self" when off it.
Pemberton stressed that while some individuals with profound attention and impulsivity difficulties may benefit from medication, for many, the rise in diagnoses may be linked to societal factors. "For the majority, though, we've reached for the prescription pad because it's quicker and easier than asking the harder questions about schools, screens, food and the sheer pace of modern life," he concluded. His hope is that viewers will be encouraged to ask more probing questions about the underlying causes of these behaviors.