Have We Been Thinking About A.D.H.D. All Wrong?
With diagnoses at a record high, some experts have begun to question our assumptions about the condition — and how to treat it.
By Paul Tough
It was still true that after 14 months of treatment, the children taking Ritalin behaved better than those in the other groups. But by 36 months, that advantage had faded completely, and children in every group, including the comparison group, displayed exactly the same level of symptoms. Swanson is now 80 and close to the end of his career, and when he talks about his life’s work, he sounds troubled — not just about the M.T.A. results but about the state of the A.D.H.D. field in general. “There are things about the way we do this work,” he told me, “that just are definitely wrong.”...
Edmund Sonuga-Barke, a researcher in psychiatry and neuroscience at King’s College London, described the situation in personal terms. “I’ve invested 35 years of my life trying to identify the causes of A.D.H.D., and somehow we seem to be farther away from our goal than we were when we started,” he told me. “We have a clinical definition of A.D.H.D. that is increasingly unanchored from what we’re finding in our science.”
Despite the questions these scientists have begun to raise, the growth of the diagnosis shows no signs of stopping or even slowing down...
Now, however, some scientists have begun to argue that the traditional conception of A.D.H.D. as an unchanging, essential fact about you — something you simply have or don’t have, something wired deep in your brain — is both inaccurate and unhelpful. According to Sonuga-Barke, the British researcher, the traditional notion that there is a natural category of “people with A.D.H.D.” that clinicians can objectively measure and define “just doesn’t seem to be the case.”
Accurately diagnosing A.D.H.D. can be challenging, for a number of reasons. Unlike with diabetes, there is no reliable biological test for A.D.H.D. The diagnostic criteria in the D.S.M. often require subjective judgment, and historically those criteria have been quite fluid, shifting with each revision of the manual....
So what’s going on? If these studies are accurate, stimulant medications don’t do much to improve cognitive ability or academic performance. And yet millions of young Americans (and their parents) feel that the pills are essential to their success in school. Why?
One possible explanation can be found in the work of Martha Farah, a cognitive neuroscientist at the University of Pennsylvania. In one study, she and a colleague, Irena Ilieva, recruited 46 young adults, gave half of them a dose of Adderall and half a placebo and then had them perform 13 different cognitive tests. The ones who took the medication didn’t do better on any of the tests than the ones who took the placebo, but when the researchers asked the subjects to evaluate their performance on the assessments, the ones who took Adderall believed they had done better. They felt more confident, even if their actual abilities didn’t improve...
There was another distressing result they noticed in their data — a physiological one. The children who took Ritalin for an extended period grew less quickly than the nonmedicated children did. By the end of those 36 months, subjects who had consistently taken stimulant medication were, on average, more than an inch shorter than the ones who had never received medication. Many of the scientists in the M.T.A. group assumed that this height suppression in childhood would be temporary — that the shorter children would catch up during adolescence — but when data was collected again nine years after the initial experiment, the height gap remained...
For the whole article:
https://www.nytimes.com/2025/04/13/magazine/adhd-medication-treatment-research.html