No, Gabor Maté Did Not Actually Diagnose Prince Harry with ADHD on Live TV
Leading ADHD experts address the unorthodox and reckless live-streamed ADHD diagnosis of Prince Harry, Duke of Sussex, by Gabor Maté, the controversial author who calls ADHD a curable trauma response.
The Sun newspaper boldly proclaimed it on March 4: “Prince Harry diagnosed with Attention Deficit Disorder by trauma expert Dr. Gabor Maté in tell-all interview.”
“Reading the book, I diagnose you with ADD,” Maté said, referring to the Duke of Sussex’s autobiography, Spare. “I see it as a normal response to normal stress, not a disease.”
Maté, author of Scattered Minds: The Origin and Healing of Attention Deficit Disorder and The Myth of Normal, also diagnosed the prince with anxiety, panic disorder, depression, post-traumatic stress disorder (PTSD), and substance abuse issues during the 90-minute, live-streamed event, which has been described as both unorthodox and reckless.
Maté made his diagnosis before meeting the prince and, admittedly, based his evaluation solely on stories of grief, trauma, and substance abuse from Spare. In his past work, Maté has called ADHD a “normal response to normal stress,” which he says may be healed without medication. In last week’s conversation, he suggested Prince Harry’s ADHD stemmed from his childhood, especially the death of his mother, Princess Diana, when he was just 12.
There is a lot to unpack here and so much ADHD misinformation to correct. Here, leading ADHD experts address Maté’s claims regarding ADHD and trauma, respond to his spontaneous diagnosis, and fact-check his treatment advice.
Can Clinicians Diagnose ADHD Based on a Patient’s Life Story?
In short, no.
“An accurate and well-rounded ADHD diagnosis is a complex, multi-step process including a clinical interview, a medical history review, and the completion of normed rating scales by loved ones, educators, and/or colleagues,” says Thomas E. Brown, Ph.D., a clinical psychologist who served on the clinical faculty of the Yale School of Medicine for 21 years and has published six books on ADHD.
Only a medical professional, such as a pediatrician, a psychologist, a psychiatrist, or an advanced practice registered nurse (APRN), should diagnose ADHD. An in-depth, well-rounded ADHD evaluation comprises several components, explains Brown, the director of the Brown Clinic for Attention and Related Disorders in California.
First, Brown says, a clinician will determine whether the patient has the ADHD symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V). (A patient must have shown at least six of the nine symptoms of inattention and/or hyperactivity and impulsivity before age 12.) Next, the clinician will conduct an interview with the individual (and, if possible, with one or two people who know that person well) or refer the patient to a medical or mental health clinician who is familiar with ADHD and with the other medical or psychological disorders that produce similar symptoms, Brown explains.
“A good clinical interview may take two to three hours, including time explaining to the patient what we now understand about ADHD and what it means for them,” he said in the ADDitude article, “The Building Blocks of a Good ADHD Diagnosis.”
The clinician should use normed ADHD rating scales, such as the Barkley, BASC, Brown, Conners, or BRIEF scales, to gather self-reported information from the patient and observer information from parents, teachers, partners, or others who have seen how this individual has functioned over recent months and previously in various aspects of daily life.
“A clinician should also conduct a complete physical exam to rule out medical problems, such as thyroid conditions or pinworms,” Brown says. A physical exam can also assess whether an individual can safely take ADHD medication.
A complete assessment may take several visits and/or visits with an ADHD specialist.
Does Trauma Cause ADHD?
Not exactly. Studies show that experiencing trauma increases a patient’s chances of being diagnosed with ADHD. However, research does not support the idea that trauma causes ADHD.1
“Research does tell us that ADHD is a condition that’s largely genetic and inherited and that it causes specific areas of the brain to be underdeveloped or otherwise impacted,” says Nicole M. Brown, M.D., MPH, MHS, a general pediatrician and health services researcher and Chief Health Officer of Strong Children Wellness Medical Group in New York.
“Because trauma affects those same areas of the brain, it exacerbates ADHD symptoms,” she said in the ADDitude webinar titled How Stress and Trauma Affect ADHD in Children of All Colors — and How to Heal the Wounds. Her research on the topic was published in Academic Pediatrics, the official journal of the Academic Pediatric Association.
“ADHD is a brain-based disorder often diagnosed after a child struggles in school, or even later in life,” adds Kerry J Heckman, LICSW, a Seattle-based licensed therapist specializing in somatic therapy for the treatment of trauma. “Trauma is the result of exposure to stressful events or experiences that can occur anytime during a person’s life. Childhood trauma that occurs when the brain develops may lead to cognitive and emotional changes resembling ADHD.”
Epigenetics, which the Centers for Disease Control and Prevention (CDC) defines as “the study of how your behaviors and environment can cause changes that affect the way your genes work,” sheds some light on how environmental factors and experiences, such as trauma, may impact brain development. However, ADHD is not solely a result of trauma.
“It starts with genes,” says Joel Nigg, Ph.D., a clinical psychologist, and professor in the departments of psychiatry and behavioral sciences at Oregon Health & Science University. “But everyone is exposed to different environmental toxins and advantages beginning at conception — and after we’re born, psychological inputs like stress, adversity, and even trauma begin to factor in. Epigenetics uses this input to change how genes are expressed — meaning a gene’s output isn’t fully known until environmental and personal histories are factored in.” Nigg further explained how epigenetics affects ADHD in the ADDitude webinar titled Genes and the Environment: How Biology and Exposures Contribute to ADHD in Children.
Can ADHD Be “Healed?”
No silver-bullet solution or magic elixir exists for ADHD; it is a lifelong condition that persists well into adulthood for most people who have it.
The best treatment for managing the core symptoms of ADHD in children is a combination of behavioral parent training and medication. Stimulants (methylphenidate and/or amphetamine) are considered a first-line pharmacological treatment for adult ADHD.2 Several types of non-stimulants (considered second-line treatments) can address ADHD symptoms as well.
Even medication can’t “cure” ADHD. “There is no ‘cure’ that we know of,” said Larry Silver, M.D., a psychiatrist, and former Clinical Professor of Psychiatry at Georgetown University Medical Center in Washington, D.C. “Think about a person with diabetes on insulin. Insulin corrects a chemical deficiency and allows a person to metabolize sugar. Once it wears off, however, the person can no longer do this. At this time, we can’t correct the problem, only compensate for it, and medication is an effective approach.” Silver was the former Acting Director and Deputy Director of the National Institute of Mental Health (NIMH).
Laurie Dupar, PMHNP, RN, PCC, a senior certified ADHD coach, trained psychiatric nurse, and founder of the International ADHD Coach Training Center, agrees with Silver. “We know from years of research that ADHD medications work — in fact, studies show they work up to 80% of the time,” she says.
Adults should expect to work closely with their physicians to adjust medication and dosage and to find the right ADHD treatment combination to alleviate symptoms.
For those individuals with ADHD who cannot or prefer not to take medication, cognitive behavioral therapy, nutrition, meditation, exercise, lifestyle changes, and/or brain training, among other natural treatments, may help alleviate or lesson some ADHD symptoms like poor focus and memory.
Can Individuals with ADHD Effectively Self-Medicate with Marijuana and Psychedelic Drugs?
The Duke of Sussex and Maté talked candidly about the benefits of drinking ayahuasca, a plant-based psychedelic from South America.
“I would say it [taking ayahuasca] is one of the fundamental parts of my life that changed me and helped me deal with the traumas and pains of the past,” Prince Harry said. He also described his experiences using cocaine, smoking marijuana, and trying magic mushrooms (Psilocybin).
While some individuals with ADHD seek alternatives to first-line treatments, research does not support the idea that illegal substances assuage ADHD symptoms. According to Roberto Olivardia, Ph.D., a Clinical Psychologist and Clinical Instructor of Psychology at Harvard Medical School, the risk of developing cannabis use disorder (CUD), a problematic pattern of cannabis use linked to clinically significant impairment, is twice as high in people with ADHD.3
“Contrary to popular belief, individuals can be mentally and chemically dependent on and addicted to cannabis. Contemporary marijuana has concentrations of THC higher than historically reported, exacerbating this. What’s more, the adverse effects of cannabis are especially amplified in people with ADHD,” he says.
Cannabis use may also exacerbate paranoia, panic, and mood disorders, explains Olivardia. Further, the increased risk of suicide associated with cannabis use further complicates marijuana among individuals with ADHD, who already face an elevated risk for suicide compared to neurotypical individuals.4
“The substance’s negative effects are most harmful to developing brains,” Olivardia says. “Many studies show that usage earlier in life, particularly before age 25, predicts worse outcomes. One study found that heavy marijuana use in adolescence was associated with a loss of 8 IQ points, on average, in adulthood.5 Another study found that people under 18 are four to seven times more at risk for CUD than adults.6 Olivardia discussed marijuana and the ADHD brain in the ADDitude webinars titled Marijuana and the ADHD Brain: How to Identify and Treat Cannabis Use Disorder in Teens and Young Adults and Marijuana and the ADHD Brain, Part 2.
The use of very low (micro) doses of psychedelics, such as LSD and psilocybin, appears promising for treating symptoms of obsessive-compulsive disorder, cluster headaches, and ADHD; however, additional research is required and these treatments are not without risks, cautions psychologist Ari Tuckman, Psy.D., and Stephanie Moulton Sarkis, Ph.D., NCC, LMHC, an AMHCA Diplomate and Clinical Specialist in Child and Adolescent Counseling. They stressed that psychedelics can potentially worsen symptoms of bipolar disorder or lead to psychosis and said that “these drugs are illegal unless they are administered in medical or research settings.”
Why Is a Public ADHD “Diagnosis” Like Prince Harry’s So Dangerous?
Doctor-patient confidentiality prohibits doctors from sharing patients’ medical information with others. It appears Maté disregarded this by diagnosing Prince Harry with ADHD in a public — and profit-generating — setting. Access to the interview required purchasing a $25 ticket (ticket holders received a hardcover copy of Spare.).
According to the American Academy of Family Physicians website, “a confidential relationship between physician and patient is essential for the free flow of information necessary for sound medical care. Only in a setting of trust can a patient share the private feelings and personal history that enable the physician to comprehend fully, to diagnose logically, and to treat properly.”
ADHD is not globally understood. Myths and misinformation abound, leading to systematic barriers to helping and supporting adults and children with ADHD. Some people falsely believe ADHD is a fake disorder, an excuse for bad behavior, or a pharmacological fairy tale. None of these things is true, but that doesn’t change the fact that enduring stigma impacts how and whether adults with ADHD choose to share their diagnosis.
The UK did not recognize ADHD until the publication of the NICE (National Institute of Clinical Excellence) Clinical guideline CG72 in 2008.7 According to a 2022 study published in BMC Psychiatry, before that time, there was an enormous amount of skepticism about ADHD and virtually no recognition of it in the UK.8
“While the last two decades have seen a stepped change and increase in the provision of adult ADHD clinical services in the UK and elsewhere, demand currently outstrips provision by a long way in many regions and countries,” the study’s authors wrote.
ADHD is treated as more of a “niche problem,” they wrote, “with diagnosis, treatment initiation and monitoring frequently constrained to scarce specialist services with limited capacity.”
By offhandedly diagnosing a public figure, Maté diminishes the experience of many people with ADHD in Europe who already struggle to access care.
The ADHD Foundation, UK’s leading neurodiversity charity, tweeted: “Gabor Maté — it is neither ethical nor appropriate to tell someone for the first time, — in a public interview, that they have ADHD. It is for the individual to decide whether to disclose their neurodiversity.”
Debunking Prince Harry’s ADHD “Diagnosis:” Next Steps
- Download: 31 ADHD Myths in 31 Days —Debunked
- Learn: The Brain Circuits that Link ADHD and PTSD
- Read: 21 Ignorant Comments (and Lies) About ADHD
- Q: Who Can Diagnose ADHD?
- eBook: Secrets of the ADHD Brain
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