Response to Channel 4’s great ADHD myth. Socially constructed does not mean socially invented: a question of ontology and epistemology

Purpose This study critically examines the claims presented in Channel 4’s documentary The Great ADHD Myth?, particularly that attention-deficit/hyperactivity disorder (ADHD) is primarily a social construct and is widely overdiagnosed. This study aims to distinguish legitimate concerns about diagnostic quality, medication and commercialisation from claims that invalidate ADHD, using ontological and epistemological perspectives. Design/methodology/approach An evidence-informed critical commentary was undertaken, drawing on systematic reviews, meta-analyses, clinical guidelines, genetic and neurodevelopmental research and literature concerning social construction, critical realism, trauma and epistemic injustice. The documentary’s principal claims and use of evidence were examined against this literature. A Critical Realist Interactional Model of ADHD was developed to integrate neurodevelopmental dispositions, developmental and psychological influences, environmental contexts, lived experience and diagnostic interpretation. Findings The evidence does not support conceptualising ADHD as either a discrete biological entity or an arbitrary social invention. ADHD-related characteristics are heterogeneous, dimensional and context-sensitive, but demonstrate developmental continuity, substantial genetic influence, clinically significant impairment and responsiveness to evidence-based interventions. Diagnostic categories and thresholds are socially negotiated; however, this does not mean that the difficulties being classified are socially invented. Misdiagnosis and overdiagnosis may occur in particular settings, while underdiagnosis remains evident among adults, women and other overlooked groups. Complex trauma may produce ADHD-like difficulties, intensify ADHD or coexist with it, requiring careful differential assessment rather than an assumed choice between trauma and ADHD. Originality/value A critical realist and epistemologically pluralist position provides a more defensible understanding of ADHD. Responsible critique should improve assessment, treatment and environmental support without invalidating the condition or the knowledge of those who experience it.