The casual cruelty of Matthew Parris

This tendency is perhaps no more evident than when it comes to our evolving understanding of various mental health conditions. Summing this up perfectly was Matthew Parris’ recent column in The Times, in which he wrote: “I do not believe in ADHD at all, except as a catch-all for a whole gaggle of unrelated ways in which people behave.”

And… that’s it. That’s the entirety of his argument. A man with absolutely no expertise other than the unshakeable self-certainty that apparently comes with being an old, white columnist, dismisses decades of research and scientific advance without feeling the need to justify his stance by citing evidence, fact or precedent. 

Unsurprisingly, this kind of attitude is a source of great frustration for those who spend their careers trying to advance both understanding and treatment of the condition. Tony Lloyd is CEO of the largest patient-led ADHD agency in Europe, the ADHD Foundation. His reaction was exasperation. 

“There is nowhere that I am aware of that experiences the same kind of criticism and cynicism as the UK does from the right-leaning newspapers,” he told me. 

Of course Parris, for all the approving nods and “hear hears” he’ll receive from his readership, is talking nonsense. I can testify from personal experience that ADHD is indeed very real, having finally been diagnosed myself last year, aged 44. At the very least, this diagnosis brought some level of understanding after a lifetime of struggling to grasp the reasons behind certain habits and behaviours. 

And contrary to the former Tory MP’s flippant narrative, these diagnoses aren’t just handed out casually. The process is lengthy and rigorous. 

Ignoring the several years I had to wait for my assessment to even begin, it took about a year, involving several assessment stages, with a final two-hour assessment focussing on the DSM-5 diagnostic tool. 

Despite a growing backlog, there has been a rise in diagnoses in recent years. As one senior clinician in the UK told me, the reasons for this are varied: “There has been a general growth of awareness of neurodiversity including public figures with diagnoses, Chris Packham, the McGuiness family, Melanie Sykes. People’s kids being diagnosed in early childhood because of better awareness in schools and then adult family members are being diagnosed.”

Across Europe, this is a trend that clinicians have been aware of for some time, as Jan Buitelaar, a professor of psychiatry and child and adolescent psychiatry at Radboud University Medical Centre in the Netherlands, told me. 

“There is a trend for higher levels of ADHD diagnoses over the years. The increase is more outspoken among adults,” he said.

If anything, Jan feels the UK is behind the curve, saying, “In my view, the UK is somewhat low on ADHD diagnosis rates compared to the Netherlands, Germany or Scandinavia.” 

Nina Hoven, president of the grass roots organisation ADHD Europe, agrees and tells me the rate of diagnosis “has increased eightfold in Finland since 2010. Growth accelerated especially during the coronavirus years.” Despite this, the ADHD Association of Finland still believes the condition is underdiagnosed. 

Nina believes this is due to a lack of access to assessment. As with the UK, where people can wait years to be assessed, Finland has experienced backlogs of its own. 

“The queues for mental health patients in general have grown, and only those with the most severe symptoms can move forward,” Nina says. “And the queues continue to grow.”

Despite this being a common problem, attitudes towards assessment and treatment of ADHD across Europe appear to be generally progressive. There are exceptions, however. 

There has long been a perception that France in particular didn’t recognise the condition until recently. Mia Vieyra, an American clinical psychologist practising in Paris, set out her views in an article she wrote in 2022: “Since child psychiatry was long in the hands of psychoanalytically trained psychiatrists, such behaviour was seen as a manifestation of anxiety or of another emotional disturbance. Often this behaviour pattern was considered to be the result of poor or inadequate parenting.”

It has taken until as recently as the last 20 years, and a newer generation of French child psychiatrists for these perceptions to change. Despite recent progress, Jan Buitelaar feels that France still lags behind other nations. In his experience, they are not entirely an outlier in this. 

“The health/political system and attitude in France and Italy for example is rather negative in its attitude towards ADHD,” he said. “There are multiple barriers for prescribing medication, in particular the psychostimulants.”

Anecdotally, the idea that attitudes in France are at odds with other European countries is supported by French ADHD sufferers I’ve spoken to in online forums. Many have been told by their GP that they were “too old” to have ADHD – this despite a sharp increase in diagnosis among middle-aged people in Europe.

One person in France described being literally laughed out of their GP’s office. These experiences have been reflected in wider society. People I spoke to have encountered ridicule and cynicism, to the extent that they are reluctant to talk about their diagnosis.

While there may be fewer barriers to diagnosis and prescribing medication elsewhere, one barrier being experienced across the continent is the supply. There has been a shortage of all of the most commonly prescribed medications since September 2023.

Our Department for Health and Social Care has blamed “increased global demand and manufacturing issues” for the shortage. Despite their prediction that the issue would be resolved by the end of the year, the supply problem is ongoing. 

While I was diagnosed early last year, I only began taking medication in January. Since then, I’ve experienced constant difficulties having my prescriptions filled, and everyone I spoke to had experienced the same thing. There seems to be no end to this in sight, suggesting that the increase in diagnoses is not being matched by an increase in production. 

Along with denying the condition’s existence, Parris also said it was “a pity we’ve ended up with a benefits system that can only stoke bad medical science,” implying that people are either being misdiagnosed, or cheating the assessment process in order to access state benefits. It is embarrassing to read such ill-informed and mean-spirited opinion. 

Even if someone were a good enough actor to convince a professional psychiatrist, would it really be worth the reward? Would somebody really put themselves through potentially years of assessment in order to claim the paltry ninety-odd quid of benefits available?

The charity ADHD ADULT UK estimates that only around 50% of Personal Independence Payment (PIP) claims that reference ADHD are successful. No evidence exists to support the claim that the condition is being either over-diagnosed, faked or abused in order to receive enhanced benefit payments.

Of all the experts I spoke to, none had seen evidence of any such “gaming” of the system. “The recent spate of negative reporting – primarily focusing on ADHD being used as the means to claim state welfare benefits – is mostly unique to the UK,” says Tony Lloyd.

While attitudes like Parris’s are far from isolated, Britain is certainly playing its part in the Europe-wide progress that has been made around both diagnosis and treatment of ADHD and other conditions.  

Although Buitelaar believes we are still playing catch-up when it comes to diagnosing ADHD, he feels there is an area in which the UK has been leading the way. “The UK is more leading on the neurodiversity topic, in particular for autism, and then followed by the neurodiversity movement towards ADHD. I would like to call the UK attitude even activistic.”

UK clinicians have been playing an important role in continent-wide cooperation for a long time now. Despite the determination of some to drag us away from working with our friends in Europe, the treatment of ADHD is at least one area where our involvement shows no sign of slowing. That might infuriate Matthew Parris, but it’s good news for the rest of us.