I am looking forward to watching the Channel 4 forthcoming documentary, The Great ADHD Myth, in which Dr Max Pemberton, a psychiatrist working within the NHS, reviews the evidence surrounding the diagnosis and treatment of Attention Deficit Hyperactivity Disorder. It seems that Dr Pemberton will explore three central questions: whether ADHD is properly understood as a neurodevelopmental disorder, meaning that those affected have measurable differences in brain structure or function compared with those who do not have the condition; how ADHD is treated, including the prescription of amphetamines, which are controlled drugs and not medications we would ordinarily expect to see widely prescribed to young people; and, perhaps most pointedly, why, how, and who benefits from the extraordinary rise in diagnoses over the past decade, with referrals for assessment reported to have increased by some 200 per cent in the last five years alone.

A Question That Has Followed Me for Decades

As an education consultant, I have seen at first hand the growing number of families who approach us stating, often as an opening remark, that their child has ADHD. This is not a new preoccupation for me. Across a long career in education, as a teacher, a head teacher, in education management, as head of a centre for examinations, and as a principal at a boarding school, this question has played on my mind for decades, and it is why I am especially interested in Dr Pemberton's documentary.

I recall a student, some five years ago, who would begin almost every conversation with me by explaining, “My ADHD brain tells me that...” I confess I found this immensely irritating. As far as I was concerned, this young woman had a brain, not an “ADHD brain”, and quite why she felt the need to remind me of her diagnosis at every interaction was beyond me. I was sympathetic to her neurodiversity but not her abuse of the diagnosis to challenge the least request made of her.

Genuine Struggle, Real Change

And yet I am not unsympathetic. I have seen young people struggle enormously to control their impulses: to resist shouting out answers, to sit still, to keep quiet, not to fidget. Surely we all remember something of this from our own school days? I have also encountered exam candidates entirely incapacitated by anxiety, a different condition from ADHD, certainly, but one that similarly falls into the category of conditions that can necessitate special accommodations in examinations, whether a separate room, a reader, a prompter, or rest breaks.

There are, without question, young people in education who find it harder than others to fit the mould of being easy to teach and easy to assess. Indeed, some of the most able students I have worked with have carried a diagnosis of some form of neurodiversity.

I have also witnessed, first hand, how medication can transform a student's behaviour. I think of a young man, full of fun and thoroughly delightful, at one of the boarding schools where I was principal. Soon after his diagnosis of ADHD, he was prescribed medication that changed his behaviour almost overnight. He and his family were delighted. He could suddenly focus, began to achieve his full potential, and was far less often in trouble for behaviour that had previously been deemed unacceptable within the school.

A Note of Scepticism

And yet I approach this subject with a degree of scepticism. Having seen genuine and, at times, extreme suffering among students who struggle to focus, who fidget, and who find themselves in trouble because of behaviours they cannot easily control, I nonetheless question how many students are so severely affected by neurodiversity as to account for the huge increase in requests for diagnosis in recent years.

It does seem exceptionally easy to obtain a positive diagnosis, and potentially medication, particularly when going private. This raises, in my mind, a genuine question about the authenticity and reliability of such diagnoses. In my opinion, the payment of a fee seems often to compromise the diagnosis.

A Familiar Pattern

Twenty or thirty years ago, we saw a comparable surge in the number of students receiving a diagnosis of dyslexia. I was frequently asked to recommend an educational psychologist to carry out an assessment, and the fee charged was often considerable. I recall a colleague once describing a confirmed diagnosis of dyslexia as “a middle-class perk.” I want to be clear that I am not unsympathetic to dyslexia, nor to the wide range of other neurodiversities that exist. However, I could not help but notice that in every case where a parent had paid for an assessment, the diagnosis was invariably positive, and the report's recommendations would include 25% extra time in examinations.

I have a particularly vivid recollection of a respected educational psychologist telephoning me to explain that a student's tests had not resulted in a diagnosis of ADHD, but to ask whether I would agree that she should nonetheless recommend the student be given an additional ten per cent extra time to complete examinations, rather than the more usual 25%. The only reason I could discern for this recommendation was that the family had paid a substantial fee.

Are we now seeing the same phenomenon with ADHD? It does seem that those who are able to pay for a private diagnosis receive documentation that, in so many ways, acts as a free pass. This is not a new concern of mine. More than a decade ago, I recall discussing with fellow college principals whether we might lobby Awarding Bodies so that GCSE and A-level certificates could indicate where a candidate had been granted extra time or other access arrangements. Not every A* is equal, was our argument. An employer might reasonably expect to know that a new member of staff is likely to require 25% extra time to complete a task.

The cost of accommodating alternative provision for exam candidates across schools, colleges, and universities is substantial.

A Question Worth Asking

There can be no doubt that a very high proportion of candidates genuinely merit alternative provision, and I do not for a moment argue that neurodiversity does not exist. I have seen a great many candidates who genuinely struggle significantly. My question is simply whether the huge increase in diagnoses, particularly among those who have paid for an assessment, is distorting the reality on the ground. I look forward to watching the documentary, and to reassessing my own views in its light.

Fiona Pocock - Academic Director Education Advisers