Psychologists have issued a stark warning about the exponential rise in ADHD diagnoses in children, arguing that some childhood behaviours are being wrongly medicalised through a flawed and subjective diagnostic system.
The research, published in new book States of Mind, reveals that ADHD diagnoses in the West have surged dramatically in recent years, with experts questioning whether millions of children are being unnecessarily labelled as disordered, when they are instead responding to rigid educational environments.
The research, by charity States of Mind, comes from eight years of collaboration with secondary schools, sixth form colleges, community settings and supported housing organisations to examine the dynamic inter-relationship between teenagers and the education and mental health systems.
They found that young people are routinely left out of life-altering decisions, such as what environments would benefit their education and wellbeing. The authors argue these rigid systems alienate young people and leave them experiencing psychological or emotional distress – and the authors propose addressing this cause, rather than medicating the symptoms and marginalising children.
“Labelling individual children as ill or disordered does not investigate the deeper causes of psychological distress, nor enable meaning to emerge from the experience of suffering,” they explain. “Without thoroughly exploring the contextual triggers, it is not possible to genuinely consider or re-consider the core societal drivers that shape our young people’s mental health and wellbeing. In actuality, the expansion of mental health interventions, while helpful for some and likely well-meaning, are often nothing more than a sticking plaster. Unless we think together, with children and young people, about which aspects of their systemic contexts lead them to feel the way they do, our mental health provision will remain reactive and at best, marginally effective.”
One such example they cite is around diagnoses. The authors argue that the current diagnostic process for ADHD lacks scientific objectivity, relying instead on checklists that pathologise adaptive childhood behaviours, or behaviours shown in response to emotional distress.
The book highlights a fundamental flaw in the diagnostic process: children need only display symptoms in two contexts, typically home and school, to receive an ADHD diagnosis. Yet the same children may show no signs of inattention or hyperactivity when engaged in activities they enjoy, such as cooking, fishing or playing sport. This suggests, the authors argue, that the learning environment should change, not the child.
“We have met children and young people who are ‘off-the-wall’ in a classroom but can focus wholeheartedly for hours when cooking, fishing or playing sport,” the authors write. “Doesn’t this confirm that any perceived inattention or hyperactivity is triggered by one’s environment?”
The book also tackles neurodiversity, arguing that whilst the movement has made important strides in helping marginalised individuals gain a sense of security, it has inadvertently reinforced the biomedical paradigm by suggesting that some brains are fundamentally different from others.
“There is no such thing as a ‘typical’ brain, everyone is unique,” the authors argue. “Suggesting otherwise requires us to believe in a fanciful ‘average’ brain, against which forms of divergence can be measured.”
The research challenges the genetic basis often cited for conditions like autism, pointing out that no specific genes have been definitively identified despite widespread assumptions of heritability. The authors highlight significant flaws in twin studies commonly used to support genetic theories, noting that identical twins share more similar environments both in the womb and after birth than is typically acknowledged.
But above all, the authors question why children and families should require medical diagnoses to access support.
“It is extremely harmful that, at present, children, young people and families are often unable to access support without medical diagnoses,” the authors write, advocating instead for an approach where “people should be trusted to define themselves and co-construct what works in collaboration with their nearest and dearest.”
The research calls for a fundamental shift away from what it terms the “psychiatrisation of our consciousness”, arguing that educational and support approaches should be tailored to children based on who they and their families perceive them to be, rather than blunt psychiatric labels imposed by external authorities.
“There is not, and never can be, a single understanding of childhood as a stage of the human life cycle, nor a fixed way of instructing or nurturing. Pretending there is and cementing things in place, as we have done with schooling and the biomedical model of healthcare, create a disposition of the modern, Western mind. These decisions are political. They are not educational or scientific,” they argue.
“In sum, believing that we have discovered the universal way to educate, through schooling, is profoundly unreasonable. Believing that we can objectively label some people abnormal, then medicate them back to normality is delusional. In a desperate yearning for certainty we coerce and control, we marginalise and harm many children. And those children carry those harms into adulthood. It doesn’t have to be this way.”
The authors advocate for institutions that can respond to individual human beings without being dependent on psychiatric labels, considering instead how children think, feel and present in the world.
“We suggest that people should be trusted to define themselves,” the authors conclude, “and this does not require submission to the dubious jurisdiction of the biomedical paradigm.”
The authors instead argue for education and mental health systems to have authentic and participatory feedback mechanisms in place for improving the system and supporting one another’s health and wellbeing.
States of Mind have demonstrated that an approach grounded in ‘liberation dynamics’, where young people are active participants, rather than passive recipients, provides space for the co-design of meaningful solutions that genuinely address their needs.
“Anyone can do this work and what is needed is not extra resources or extraordinary expertise, but a shift in our imagination about who we are and what is possible. It starts with recognising that something needs to change, then becoming the change ourselves,” they conclude.
