Who Pays the Price for ADHD Skepticism?

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In the early 1970s, Klaus Minde, a German-Canadian child psychiatrist, arrived in Uganda on a WHO secondment. He was looking for something that he did not expect to find: ADHD. At the time, research and clinical understanding of what would become ADHD was dominated by studies of boys in North America and Europe. In Uganda, he established the first child psychiatry clinic in East Africa and began conducting research, including comparative studies on childhood mental disorders in Canada and Uganda.

When publishing his findings, Minde acknowledged that he had approached the research assuming he would not find hyperactive children in Africa (Minde & Cohen, 1978). Instead, he was surprised to identify children with similar features to those observed in North America. Drawing on reports from teachers and parents, he identified a subgroup of Ugandan children who showed a pattern of high activity levels with differences in attention and impulsivity, features consistent with those seen in a comparison group of Canadian children. What was different was not the behaviour itself, but how it was understood. In the Ugandan context, these characteristics were more likely to be viewed as nuisances requiring punishment rather than difficulties needing support. As a result, many of these children were not kept in school beyond the first few years.

The boundaries between difference and disorder are inevitably shaped by social context. In that sense, ADHD can be viewed, at least partly, as a social construct. But that does not mean that the characteristics—or the impairments associated with them—disappear when they are not given a medical label.

Earlier this week, a major UK television broadcaster, Channel 4, aired a documentary called The Great ADHD Myth?

Much of the programme's skepticism centred on how commonplace individual ADHD symptoms can sound. But symptoms alone do not make an ADHD diagnosis. Persistence, pervasiveness, and, critically, significant impairment are fundamental to diagnosis.

The programme also gave considerable authority to eminent doctors and psychiatrists, but with the notable exception of ADHD researcher Professor Katya Rubia, many of its most prominent skeptical voices were not specialists in ADHD. Prominence in psychiatry is not synonymous with expertise in ADHD.

Like many psychiatrists of my generation, I started out as an ADHD skeptic. It was skepticism born of ignorance. We had little or no training in it. It is true that in the UK it was rarely diagnosed in children and almost never diagnosed in adults. But as Minde found in Uganda, that doesn’t mean it didn’t exist. That skepticism lasted until I started working with people with ADHD, initially in a specialist national adult ADHD service, later in prisons, and more recently with a large-scale adult ADHD service. I was struck by the significant impairment I encountered and the often dramatic response to treatment.

I am not alone. I recently conducted a qualitative study with consultant psychiatrists working in a UK adult ADHD service, exploring their attitudes towards ADHD diagnosis and treatment. Several described a similar journey, from limited awareness or skepticism to a very different understanding after gaining direct clinical experience of ADHD.

That said, there are legitimate questions to be answered about how to improve ADHD assessment and support. ADHD is associated with well-documented negative outcomes affecting education, work, relationships, physical health, and even life expectancy. Concerns about overdiagnosis coexist with substantial unmet need for ADHD assessment and treatment in the UK. An equally important question may therefore be not simply whether too many people are being diagnosed, but who gets diagnosed—and who does not. Studies have highlighted substantial disparities in access to ADHD care (French et al., 2026).

This is one of the reasons ADHD skepticism and programmes like The Great ADHD Myth? have the potential to be so damaging. Marginalised and ethnic minority communities already face significant barriers to care that include unhelpful stigma and cultural narratives in relation to mental health, including ADHD. These were clearly identified in our qualitative study of Black women’s experiences of adult ADHD diagnosis and care in the UK (Gibbs et al., 2026). Participants described encountering outright disbelief that ADHD existed:

• “I think from what I observed in the African communities, they don’t think ADHD exists at all.”
• “When I mentioned it to my friend in university...it was like, ‘Black people don’t have that'."

Other participants highlighted how increased public awareness and negative portrayals in mainstream and social media had generated a different form of stigma, with ADHD being reframed as a "trend diagnosis" within their communities. Such narratives can create additional barriers to recognising ADHD and seeking or accessing appropriate care and support.

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For people in communities where ADHD is already regarded as something that does not exist, or does not happen to people like them, a documentary in which eminent doctors question the diagnosis does not introduce skepticism. It legitimises it.

The question isn't simply whether we risk diagnosing ADHD where it isn't present. We also need to ask who pays the price when ADHD is present and we refuse to see it.