Rethinking ADHD
Last spring the NYT published a piece titled, Have We Been Thinking About A.D.H.D. All Wrong?
I wanted the info, but I wasn’t interested in reading the article. I’m ADHD after all, and they didn’t make it ADHD friendly if you ask me.
Though I’m fully aware that I did lose the experience of reading it and having all the sensations and recollections that getting through a long form piece of writing gives me…in this case a chance to reflect on early childhood behavior and educational experiences.
I’m okay with that on this one. There’s just too much these days and this article validated what I know intuitively and has been informing my approach for a long time already. Since I made the decision years ago to start trusting myself (and learned how to do that.)
So I gave it to AI and below is a cleaned up version of what it gave me.
The Thesis
ADHD may be less a permanent defect in the brain and more a mismatch between a person and their environment.
The article argues that ADHD is increasingly being treated as a fixed brain disorder requiring lifelong medication, but the science no longer supports that simple story.
While stimulant medications reliably improve short-term behavior, they show little to no long-term benefit for learning, achievement, or symptom persistence, and they may carry real costs.
Meanwhile, growing evidence suggests ADHD symptoms are contextual, fluctuating, and deeply shaped by environment, not just biology.
Key Points & Findings
1. Medication works—briefly and behaviorally
Stimulants like Ritalin and Adderall reliably reduce symptoms in the short term.
They make children quieter, more compliant, more “on task.”
But across multiple large studies (including the landmark M.T.A. study):
Benefits fade within a few years
Academic learning does not meaningfully improve
Long-term outcomes are no better than for unmedicated peers
2. No clear biological marker for ADHD
Despite decades of effort:
No brain scan
No gene
No reliable biomarker
Brain differences, when found, are small, inconsistent, and overlapping with non-ADHD populations
This undermines the idea that ADHD is like “diabetes of the brain”
3. ADHD symptoms exist on a continuum
Most people have some ADHD traits some of the time
Symptoms often come and go across development
Only a small minority show persistent, severe symptoms year after year
Many people meet diagnostic criteria only under certain conditions (school, boring work, stress)
4. Environment matters more than we’ve admitted
Symptoms often improve when:
Work is intrinsically interesting
The setting is more active or hands-on
People have autonomy and choice
Demands are structured but meaningful
Many adults diagnosed as children report that their “ADHD disappeared” once they found the right niche.
5. What stimulants may really be doing
Rather than improving intelligence or learning, stimulants:
Increase motivation
Make boring tasks feel emotionally tolerable
Increase confidence and perceived performance
This explains why people feel they work—even when objective learning doesn’t improve.
6. There are real costs
Growth suppression (about 1 inch on average, persisting into adulthood)
Emotional flattening (“losing my spark”)
Appetite suppression
Increased risk of psychosis or mania at higher doses
High discontinuation rates, especially among teens
7. Diagnosis can help—or harm
For some, diagnosis brings relief and legitimacy
For others, it creates stigma, shame, and a fixed identity of being “defective”
Framing ADHD as a permanent brain disorder may actually reduce agency and hope
An Emerging Alternative Model
Researchers like Edmund Sonuga-Barke propose a shift from:
“You have a disordered brain that needs fixing” —> “Your traits may be clashing with your current environment”
Under this model:
Medication is a tool, not a cure
Environmental changes matter as much, or more than, pills
ADHD is treated as contextual, developmental, and dynamic
The goal shifts from symptom suppression to well-being, fit, and self-understanding
Why this matters
Because the current system:
Diagnoses more than 1 in 5 teenage boys
Prescribes stimulants to millions of adults
Treats short-term compliance as success
Often ignores whether people are actually learning, thriving, or happy
The article isn’t anti-medication. It’s anti-oversimplification.
One-Sentence Takeaway
ADHD may tell us less about what’s “wrong” with a person’s brain and more about what’s misaligned in their world—and medication, while sometimes useful, cannot substitute for environments that actually fit human minds.