In today’s debates around ADHD, psychotherapist and counsellor Duncan E. Stafford has begun to hear again an uncomfortable argument he experienced as an undiagnosed dyslexic in the 1960s and 70s.

I had a neighbour in Cambridge who was fond of saying, “She who lives longest will always know most.” With Channel 4’s programme The Great ADHD Myth?, I realise I have now lived long enough to have heard much of this sort of argument before.

I grew up as an undiagnosed dyslexic and wasn’t formally diagnosed until after my first year at university, when, as a first-class student to that point, my end-of-year exams appeared to be from a different person.

In the 1970s, dyslexia was not always regarded as a straightforward explanation for why some children struggled to read and write. There was a strong voice of suspicion that the label could be used as a cover-up by middle-class parents to excuse their children for not being quite as bright as their parents hoped. A convenient label. Perhaps, in some cases, an excuse. But dyslexia was no less a reality. There was certainly a class dimension to the argument. Dyslexia was sometimes portrayed as a particularly middle-class way of explaining away educational difficulty. The implication was uncomfortable but clear: perhaps the child wasn’t dyslexic at all. Perhaps they simply weren’t very clever.

It is difficult to watch the current argument about ADHD without experiencing a faint sense of déjà vu.

A diagnosis with a social history

My memory of the 1970s is not entirely reliable. I was, after all, a child, and what I remember is inevitably mixed with what I was experiencing through my primary and secondary education and what I have subsequently learned.

The history of dyslexia in Britain is complicated. The early movement was, in fact, disproportionately middle-class. Specialist assessment and support were initially dependent to a considerable extent on private money, voluntary organisations and parents who had the resources to campaign. That social history was then turned back on the diagnosis itself. Dyslexia could be dismissed by those who wanted to do so as a “middle-class myth”, sadly because the people who had been able to make the case for it were disproportionately middle-class. There is something almost circular about this situation. The people with the resources to seek recognition created a visible movement. The visibility of that movement was then used as evidence that the problem belonged to a particular social class.

The  Warnock Report of 1978* changed the conceptualisation of special educational needs by moving away from rigid categories of disability towards an approach that recognised children’s individual circumstances and educational needs. The report itself recognised that learning difficulties could be “mild”, “moderate” or “severe”, supporting a more flexible understanding of children’s needs.

In my music-teaching career I worked as a musician privately with many children with “mild learning difficulties”, as they were called at the time. I also worked in numerous settings with what was then called “moderate learning difficulties” and, from time to time, with young people who had “severe learning difficulties”. The labels sound like some sort of smooth curve of issues, as though you could simply adapt your subject from one to the other. The reality is something quite different. If you take performance, for example, the “mild” category of learning difficulties could contain children with serious talent – children who could perform at extremely high standards, pass exams and even become professionals within the subject area. The individuals might need some support in getting there, but it was a real possibility.

I was struck by that fact one day as I gave a lecture to students at the Royal College of Music in London. I was sitting at the business end of a nine-foot grand piano, looking out at the Royal Albert Hall, telling teaching students that children with dyslexia really could become professional musicians, totally unaware at that moment that I was talking about myself.

Some children in the “moderate learning difficulties” category, as labelled at that time, would also have had real opportunities to perform well in music. But teaching young people with “severe learning difficulties” became much more about sharing an experience of performance that tapped deeper into their own consciousness and expressive selves, without it necessarily being a real performance as most people might expect or experience. In fact, it was working with young people essentially therapeutically, through music, that was one of the first things that piqued my interest in becoming a therapist.

The terminology has changed considerably since then. The problem of deciding what a diagnosis means has not.

And now ADHD …

So, almost 50 years later, I find myself listening to a rather familiar conversation. The language is different, the diagnostic label is different and the evidence is different, but some of the questions sound remarkably similar: Is ADHD being over-diagnosed? Are we turning ordinary difficulties into a medical or educational condition? Are parents looking for an explanation for behaviour that is really about poor parenting, schools, screens, diet or the pressures of modern life? Are adults being given a diagnosis to explain things that previous generations were simply expected to get on with? And, perhaps most controversially, are we giving medication to people who don’t really need it?

These are not unreasonable questions. Indeed, I think they are questions worth asking. What concerns me is what can happen when the questions become so general that the person disappears from the discussion. And that’s because ADHD is not experienced as one thing – or, at least, I don’t think it is useful to talk about it as though it were.

There can be considerable differences in the way ADHD presents, in the degree to which it affects someone’s life and in the environments in which those difficulties become apparent. Someone may have ADHD and manage their life remarkably well. Someone else may have ADHD and find that it affects almost every aspect of their life. The diagnosis may be similar. The experience may be entirely different.

There are also differences in the way ADHD can present between boys and girls, and between men and women. Some presentations are easier to spot than others, and the quieter, less disruptive difficulties can be missed, particularly in girls. By the time some people reach adulthood they may have spent years compensating for difficulties that nobody had recognised as ADHD. Plus, recognition is not necessarily equal across race and ethnicity either; cultural expectations, differences in how difficulties are understood and recognised, and unequal access to assessment can all influence who gets identified and when.

And this is where I think the words “mild”, “moderate” and “severe” become rather more interesting than they might initially appear. They are not simply labels on a scale with a neat progression from a little bit of difficulty to a lot of difficulty. What matters is the relationship between the person’s difficulties and the life they are trying to lead.

How much ADHD?

I have become increasingly interested in the difference between having a diagnosis and being impaired by the thing that has been diagnosed. These aren’t necessarily the same thing. A person can have quite marked characteristics of ADHD and find a way of living that works well for them. Another person, perhaps with apparently similar difficulties, may find themselves unable to sustain education, employment, relationships or the ordinary business of everyday life without considerable support.

The difficulty doesn’t necessarily sit entirely inside the person either. It also sits in the relationship between the person and the demands being placed upon them. One environment can make some difficulties much more apparent, while another may allow the same person to flourish. In my therapy room I have seen enough people over the years to be wary of the idea that a diagnosis tells us very much about what a person’s life actually looks like.

This is particularly important when we start comparing children with adults. A child doesn’t choose their school, their classroom, their timetable or very much of the environment in which their difficulties have to be managed. An adult has considerably more choice. They may have found a job that suits them, developed elaborate ways of compensating or simply constructed a life in which their particular difficulties don’t cause too much trouble. Or they may have done none of those things.

The consequences of ADHD in a ten year-old struggling every day at school are not necessarily the same as the consequences of relatively mild ADHD in a 40-year-old who has found ways to manage it. Yet we can end up talking about ADHD medication as though those consequences are essentially the same thing.

I’m wary of making the argument that medication is somehow more important for children than adults. That is too simple. But I do think that the age of the person, the severity of their difficulties, the impact this has on their functioning and the environment in which they are living all matter when we think about treatment. A child experiencing substantial impacts from ADHD will be struggling at a point in life when they are acquiring knowledge, developing relationships, discovering what they are capable of and forming their sense of themselves. An adult may have developed years of strategies to compensate for their difficulties. They may have found an environment that suits them. They may also have spent decades wondering why ordinary things seem disproportionately difficult.

The public conversation about medication can easily lose these distinctions. We end up asking whether ADHD medication is good or bad, whether too many people are taking it, or whether children should be taking it at all. Perhaps the more useful questions are much less comfortable: For whom? At what age? With what degree of life impact? In what circumstances? and What difference is the treatment actually making?

So what do we mean when we say “ADHD”? Perhaps this is the question I keep coming back to. When we say “ADHD”, what exactly are we talking about? A diagnosis? A collection of symptoms? The neurodevelopmental condition? A person’s experience of their own brain? The degree to which those difficulties interfere with their life, or some combination of all of these?

The danger of public arguments about diagnosis is that we can start talking about the label rather than the person. We argue about whether ADHD is real. We argue about whether there are too many diagnoses. We argue about whether children are being medicated unnecessarily. We argue about whether adults are finding an explanation for difficulties that previous generations were simply expected to endure. All of these questions may be worth asking. But somewhere underneath them all there is still a person.

Perhaps the more useful question is not simply Does this person have ADHD?, but What does having ADHD mean for this person? How much does it interfere? Where does it interfere? Where does it not? What does the person have to do to compensate? What happens when their environment changes? And how different might the answer be for a child from the answer for an adult?

While dyslexia and ADHD are different things, and we should be careful about pretending otherwise, I do think there is something worth remembering from having lived through one contested diagnosis and now watching another become the subject of such heated public argument. A diagnosis is a useful thing. It can give a name to an experience that has previously been confusing, frustrating or simply unexplained. It can open doors to support and understanding. But a diagnosis is not the person, and neither does it tell us everything about the difficulty that person experiences.

What I recognise in the current argument about ADHD is not that history is repeating itself, it’s that we seem, once again, to be arguing about the legitimacy of a diagnosis while the people living with the difficulty are abandoned somewhere in the middle of the argument.

Note on Warnock Report

* For details of the Warnock Report 1978, see https://education-uk.org/documents/warnock/warnock1978.html (accessed 21 August 2026).

 

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