What did the documentary show?
There were different elements to the documentary, including interviews with different experts, the presenter going through a diagnosis and medication experience and a family with lived experience of ADHD. These elements were presented through the framing of two main questions: Is ADHD actually a neurodevelopmental disorder? And how should ADHD be treated? (especially in young boys who seemed to be the focus).
The family who was featured included a son called Mason, who has a diagnosis of ADHD. Mason and his mother had already decided they wanted to stop Mason’s ADHD medication, and the documentary followed the family’s experience of this.
The family and Mason were supported throughout the stopping of his medication both by experts provided by the production team and Mason’s school. This included six simultaneous lifestyle changes at once: medication withdrawal, removal of screentime and gaming devices, a change in diet (removing processed food and sugar and increasing protein), unnamed nutritional supplements, a yoga routine and substantially more one-to one outdoor time and parental attention.
It’s clear throughout that Mason and his family are very keen to stop his medication entirely. In the first four weeks after stopping, the report from both Mason, his mother and his teacher is that it’s going well. Mason feels like he is more himself, he is engaging more with friends, and his schoolwork isn’t significantly declining.
For the last two weeks of the six-week trial his behaviour at school does begin to change with reports from his teachers that he is struggling to concentrate on his schoolwork.
At the end of the six weeks, the family decide not to return immediately to medication, however, within a further two months of the filming ending, they do decide to return to medication following a continued decline in Masons’ performance at school.
The documentary presents this as an experiment. However, experts have made it very clear that this should not be considered evidence of anything and is certainly not a ‘true experiment’.
As MQ Fellow Dr Jessica Eccles, Chair, Royal College of Psychiatrists Neurodevelopmental Psychiatry Special Interest Group explains:
“The follow-up period was too short, and the programme’s own data undercuts its conclusion. By week five, the child’s teacher was recording him as “more disruptive, more talkative, more fidgety, disengaged,” struggling to complete work he had previously managed, and his mother described him needing “normal breaks” and getting frustrated that he “can’t do it” anymore. That is the clinical picture the medication had been controlling, re-emerging on cue — which is closer to evidence for the diagnosis than against it.”
Indeed, many of the lifestyle changes made during the trial period are already proven to be beneficial for everyone. A healthier diet, more exercise, time in nature, reduced screen time and more time spent with loved ones all have been proven to have health benefits including reduction of symptoms for a range of different mental health conditions.
But just because they are proven to be beneficial for a range of conditions, doesn’t mean they are completely effective for managing serious health conditions long term or without additional support and intervention.
“The ‘experiment’ with Mason was not an experiment. Nor was it a case study. It was an uncontrolled exercise for entertainment’s sake, which teaches us nothing.”
says Dr Rachel Moseley, Principal Academic in Psychology, Bournemouth University.
“The child and the family were very aware of the film crew and the narrative of the documentary, and many factors changing during the very short and artificial “test” period means that any changes in the child’s behaviour cannot be attributed to stopping medication (they might, for instance, be related to the stress and/or excitement of being followed by TV cameras).
The presenter, Dr Max Pemberton, is an NHS Psychiatrist and a columnist for the Daily Mail. In the documentary, he undertook a private consultation for himself with a Consultant Psychiatrist which was conducted over a video call. This was an extensive assessment which took around an hour and a half and resulted in a diagnosis of combined type ADHD.
In his Daily Mail column, Dr Pemberton wrote more about this experience:
“The assessment cost £1,200, paid for by a TV production company for a documentary on the rise in ADHD – and I want to be fair about the subject.
I’d deliberately selected a consultant psychiatrist as I knew they would do the job properly, since the point was never to go hunting for some rogue clinic dishing out diagnoses.
So, over the next hour-and-a-half, I answered everything the psychiatrist asked me honestly.
Yes, I keep going more or less every night until half two in the morning and then fall asleep on the spot. Yes, my phone lives in my pocket and nowhere else, because otherwise I lose it multiple times a day. And yes, I’ve a dreadful sense of time, which is why every clock in my flat is deliberately set to a different time, to keep me on my toes.
At the end, I was diagnosed with ADHD, combined type – characterised by inattention, hyperactivity and impulsivity.
Even though it’s the judgment of a highly qualified professional, I don’t accept it.”
The diagnostic process depicted in the documentary is, of course, edited, and so it is not clear if the consultation followed the best practice guidelines. Professor Subodh Dave, President of the Royal College of Psychiatrists said:
“An ADHD diagnosis should never be based solely on questionnaires. It requires a comprehensive clinical assessment that considers differential diagnoses, co-occurring conditions and an individual’s wider circumstances. Getting this right is essential, as both missing or misdiagnosing ADHD and related conditions can have lasting consequences for patients.”
Following this diagnosis, the documentary shows clips of experts discussing how ADHD is not diagnosable through brain imaging or other physiological tests. Of course, this is true of many psychological conditions and some physical health issues too. In fact, many health conditions are diagnosed clinically after an analysis of symptoms, as opposed to using scan or blood tests.
However, the documentary fails to mention that there is evidence of a biological basis for ADHD. As Dr Eccles explains:
“The evidence for a neurobiological basis is substantial and long-standing. The ENIGMA-ADHD mega-analysis pooling MRI data from over 3,200 participants across dozens of international sites, found significantly smaller volumes in several subcortical brain regions (including the amygdala, caudate, putamen, nucleus accumbens and hippocampus) in people with ADHD compared with controls, effects most pronounced in childhood. Later ENIGMA work extended this to cortical thickness and surface area.
Twin and family studies put heritability at roughly 70–80%, among the highest of any psychiatric condition and comparable to height; genome-wide association studies have identified specific common genetic variants associated with ADHD.”