Melanie McDonagh of the Evening Standard has recently written an article about the rise of ADHD diagnosis rates, showing a gross misunderstanding of ADHD. Both Melanie and the editor of the Evening Standard have failed to uphold journalistic standards in this piece – with the author seemingly not having been willing do to even basic research about ADHD, or speaking to any experts in the field who could have easily debunked the common misconceptions she is touting. This is serious – because it adds to the existing stigma, reinforcing the ignorance already surrounding the condition which has detrimental effects of so many people’s lives. It is at best irresponsible journalism.
Here is her article below, with her writing in italic and my responses in bold.
“It’s the new joke, isn’t it? Hands up anyone who doesn’t have ADHD! Or, am I the only person here who doesn’t have ADHD? And the joke is all the more exquisite in London.”
My Response: ADHD is no joke for those of us with it, it has a profound effect on us, limiting our options and pathways through life due to the way that society is set up, which is why people with ADHD are so over-represented in prisons, four times more likely to commit suicide, 60% more likely to get fired from work, tend to earn less than their peers when working for others, and five times more likely to be expelled from school.
“It turns out that it’s here that there’s been the highest increase in the rate of prescriptions for Attention Deficit Hyperactivity Disorder over the course of four years, from 2020 to last year. Researchers have found that while rates over that time have gone up across the country, in London they’ve really spiked: the annual rate of increase is 28 per cent, followed by South East England, where the annual increase is nearly a fifth. So, why is it that nationally, 25 people in every thousand were getting an ADHD prescription in 2020 and more than 44 are getting it now? And why is it that London is at the front of this particular trend? Is it that the pace of life has rocketed so dangerously over this time – cost of living, febrile world order, climate crisis, smartphone dependency … all that stuff?“
My Response: The rise in diagnosis rates generally, are attributable to the increased awareness of the condition and its traits. This awareness, spreading through social media, does lead to some people thinking they have ADHD when they don’t because they resonate with some of the traits – not realising that the difference with ADHD is the scale and severity of these traits, rather than the existence of the traits. For example, there is a huge difference between getting sad sometimes and being clinically depressed, but that wouldn’t stop some people who felt sad wondering if it might be depression. That’s why it’s important to move from just greater awareness of ADHD, to greater understanding.
So whilst that may explain the rise in people thinking they have ADHD, we’re talking about diagnosis rates here – and diagnosis isn’t something that’s ‘easily obtained’ in most cases. My own diagnosis took years of sessions, going through all of my old medical records, school reports, interviewing friends and family, etc… This is why it isn’t carried out by a GP, but by a specialist who knows what to look for, and knows how to spot ‘Pseudo-ADHD’ when it is present.
When it comes to London, there are a number of factors to explain this:
1) People with ADHD are more likely to find acceptance and tolerance of their differences in cities. Just as cities have diversity in other senses, there are more opportunities to find somewhere to ‘fit in’, as opposed to growing up in some relatively rigid rural places, where expectations to be and think like others is more prevalent.
2) People with ADHD are known to be restless, more likely to move around seeking novelty (more easily found in cities), and the gene variant linked to ADHD is even nicknamed the “Explorer Gene”. This is because the gene has been found to correlate with high migratory patterns – so not just resulting in an increased likelihood of people moving from the country into the city, but people moving from other countries. And where would these ADHD people move to from elsewhere in the world if coming to the UK? Mostly to London.
3) In relation to the two points above, where people with ADHD have an increased likelihood to move somewhere like London, many will stay there, and given that the heritability rate for ADHD is 86%, than means more ADHD kids being born there with ADHD.
4) There are simply more medical institutions, personnel, and services in London, which are more accessible by people than many other places. Many medical experts move to London for the job opportunities and higher salaries, while some villages have just their local GP who will refer a patient to the nearest city in order to get diagnosed, which has just one specialist with a long list of people to see from their own city and referrals from surrounding areas. London, on the other hand, has multiple options a few tube stops away from people.
“My own view is that it’s part of the current, worrying trend to medicalise the human condition, whereby habits and dispositions that used to be attributable to character or circumstances are now seen as something to be solved by the pharmaceutical industry. And if we’re talking about dangerous habits that make for attention disorder, look no further than your smartphone, a device which could have been, and almost certainly was, designed to make us incapable of concentrating on one thing for minutes on end. If the Government wants to address the ADHD problem among young people, it can think again about its decision not to oblige schools to ban smartphones. But only this month, it shelved exactly this proposal.“
My Response: Not all ‘views’ are equal. Some are less (in this case, much less) informed than others. We all have our views on world events, economics, medical science, etc… but some people spend years studying a subject, and are therefore more likely to have a ‘view’ that is closer to accuracy. The sensible thing for Melanie to have done here, was discuss her ‘view’ with some experts before publishing the article. Climate change is a hoax in some people’s views, but those views are not as credible as those who study and work in the fields of climate science.
ADHD existed long before smartphones, it is proven to be genetic and the differences show up in multiple different types of brain imaging technology (MRI, FMRI SPECT, PET, EEG, MEG, DTI). It’s not caused by smartphones, and all the author is really doing here is showing how little they understand what ADHD inattention and focus issues are really like, by analogising it to the (comparatively extremely minimal) effects of distraction by smartphones.
“And then there’s the continuing fallout from lockdown five years ago. Is it actually the case that the numbers of us who, say, procrastinate or show poor impulse control (both symptoms), has gone up by over 40 per cent in four years? Or has lockdown exacerbated our tendency to blame our problems on a mental health condition. In Sweden, which didn’t lockdown, the numbers of people alleging mental health problems fell rather than increased as it did here. You can see by the way I’ve put the question where my thought is going.”
My Response: The numbers of people who say they procrastinate or show poor impulse control? This isn’t something that would get an ADHD diagnosis on its own. Having one or two of the symptoms of ADHD to some extent, is not the same as having ADHD, and no medical professional has claimed that it is. Again though, awareness of ADHD symptoms (more than just procrastination and poor impulse control) has increased considerably, so more people are then realising that there could be an explanation for why they spent their entire lives struggling to fit in, getting into trouble for not being able to follow processes despite their intelligence, and so on. For some of those people, ADHD may not be the right explanation, but for others, it is – and the treatment that follows can improve their lives.
“But there’s another aspect to the condition. It would seem that more people, especially in the savvy capital, have worked out that this particular disorder can actually be rather useful. My own daughter, for instance, established with the diabolical ingenuity of urban youth that she could get an extra 15 minutes for each paper when she sits her A levels if she were diagnosed with ADHD. She urged me to remember how she flits from one subject to another; I told her that she had the attention span of a gnat and if she put her wretched phone away, she’d crack it.”
My Response: I hope for Melanie’s sake that her daughter does not turn out to be ADHD, because if she is and went to her mother for help, that was an awful response. There would need to be more to it than what’s described here though, and perhaps it is just a case of her daughter attempting to get and extra 15 minutes in this case. That will surely happen. Some people pretend to have bad backs which stop them from working, other people have actual bad backs that stop them from working. The existence of some false positives does not negate the existence of the actual positives. So what is the point of this paragraph, other than to chastise her daughter publicly?
“But the problem goes further. ADHD is, for instance, not only one of the most popular grounds for obtaining that useful state benefit, Personal Independence Payments – it’s number 14 of the 500 grounds for claiming – but for obtaining it at an enhanced level. In 2023, there were 52,989 people claiming PIP who gave ADHD as their main problem. Now PIP is rather a useful payment. You can get it even if you’re working, have savings or are getting other benefits. The amount you can be paid is dependent on the impact your health condition or disability has on your ability to do day-to-day tasks. So the more your ability is impaired – the more money you will receive. And of the people claiming it on ADHD grounds, almost half, or 43 per cent, obtain it at an enhanced rate. The standard rate is £73.10 a week from next month; the enhanced rate is £110.40. So for those who are keen to supplement their income from state benefits, ADHD is quite a handy route. Granted there are many people who genuinely suffer from the condition, but if you were unscrupulous about putting in a claim, it’s not that hard. I rather think that I could make a very decent claim myself.”
My Response: This is no different from any other type of government benefit. There will likely be some fraudulent cases – why does that have any bearing on the majority of cases that are not fraudulent? Melanie appears to be suggesting that PIP is a motivation for swathes of people ‘becoming’ ADHD. She states there were over 52,000 people claiming PIP due to ADHD in 2023… this is 0.076% of the UK population. Conservative figures suggest that people with ADHD make up at least 2.5% of the population (probably quite a bit more, though). So 52,000 are claiming PIP from a minimum potential of 1.7 million with ADHD. This means just 3.1% of people with ADHD are claiming PIP for it. With those numbers, why would the assumption be that so much of the 52,000 is fraudulent?
“Looking at one of those handy websites that assist benefits claimants, including PIP, I find that there’s a checklist of ten activities that are affected by the condition, from preparing food to engaging with people, with examples of how ADHD might compromise your difficulties in dealing with them. And reader, I rather think that I could make a very decent claim myself.
For instance: “Procrastination linked to ADHD may mean you keep putting off preparing food until you are so hungry that you just eat whatever is quickest, like a bowl of cereal, so you need prompting to prepare a meal. … You may need prompting to eat cooked food because you are so engaged in other activities or thoughts that you will not spare the time to consume anything but biscuits and coffee.”
I think, reader, that we are looking here at the condition of pretty well any working parent. Which of us hasn’t reached for a bowl of Shreddies or Ben and Jerry’s rather than cooking when we’re up against it?
Or “because of poor impulse control you may frequently speak aloud thoughts that cause offence to other people, so you need social support.” Look, this is pretty well why I have fewer friends than I should. I cannot keep my trap shut. I sound off in a fashion that tends to lose friends and alienate people. And they call that ADHD?”
My Response: Melanie appears to be mistaking examples that exist for demonstrative purposes with full criteria, here. And even then, doesn’t quite get the examples. I can say this with confidence because I am affected by both examples given. It’s not just ‘when you’re up against it’, it’s an ‘always-on’ consistent issue. If my very patient and long-suffering wife wasn’t kind enough to feed me at regular intervals, I wouldn’t eat. If she goes away for work or to see family for a few days, I don’t eat. If I do, it’s a bag of Haribo. Before my wife it was a friend I lived with, before that, it was my mother. This is not laziness, this is being too absorbed and ‘forgetting’ to eat, regardless of the feelings of hunger. And it can easily go on for days until you’re too weak to even try to eat, I’ve been there. It’s a vast difference from being a time restricted working parent.
On the poor impulse control, it’s not just a case of ‘sounding off’, it’s a constant challenge blurting things out regardless of consequences – not just to friends but to complete strangers and people at work, it got me into expelled from school, into lots of trouble with the police, and had a major impact on jobs (including going off on tangents when presenting, etc…). Thankfully my current medication helps with this now, but it caused me a lot of problems over the years. If were as common at this level as Melanie suggests, then why was I the only one expelled from school in my year? Melanie again shows how uninformed she is on this subject, conflating ‘not being able to keep my trap shut’ with the much more extreme version that comes with ADHD impulsivity. I suspect if Melanie were in the presence of a judge in a court room, being challenged for something in which she must keep quiet, that she would find the ability to ‘keep her trap shut’. I couldn’t. That’s why it’s called impulse ‘control’.
“Like every benefit, there are websites and support for those making a claim, and ploughing through the 37-page application, and for supporting those appealing against rejection. You can take a test online to see if you can produce ADHD symptoms. With so many incentives to be diagnosed with ADHD the surprise is not that so many Londoners have an ADHD diagnosis but that so many don’t. If the system is skewed to privilege those with a condition, then it will benefit the deserving, but also those whose claims are a little more tenuous. And this, in brief, dear reader, is why the Government is today getting on with its crackdown on sickness benefits, including mental illness benefits.”
My Response: An important point here, is that one absolute essential in the diagnostic criteria for ADHD as an adult, is that you have a history of it. ADHD doesn’t just appear as you grow up, it was there as a child, and so there will be evidence of it from when you were a child. This matters, because when Melanie states “No surprise that so many Londoners have an ADHD diagnosis” she isn’t just saying here, that people are self-diagnosing to get extra time in exams or PIP, they’re actually going through the several year waits on the NHS or shelling out thousands of pounds for a private diagnosis, where-upon they must be doctoring old school reports, hacking into the system to change their past medical records, coaching friends to lie for them, and then pulling the wool over the eyes of trained psychiatrists?
“So, hands up if you don’t have ADHD? Anyone?”
My Response: Most people would need to put their hands up at this point, unless they’ve been completely misled and totally misunderstand what ADHD is, and how it manifests, by an article that massively oversimplifies it, by someone with no actual knowledge beyond her ‘view’, however uninformed that might be.
For real information about ADHD, there is a consensus statement by actually qualified people, who properly research and apply evidence, it can be found here: https://www.sciencedirect.com/science/article/pii/S014976342100049X