ALL OF IT: ADHD Diagnoses Have Been Rising Steadily. Why?
Host: Alison Stewart | Guest: Paul Tough | Release Date: July 8, 2025

Introduction

In this episode of ALL OF IT, Alison Stewart delves into the burgeoning rise of ADHD diagnoses among American children. Joined by Paul Tough, a seasoned journalist and contributing writer for The New York Times Magazine, they explore the complexities surrounding ADHD, its diagnosis, treatment options, and the profound impact it has on individuals and families.

Rising ADHD Diagnoses

[02:47] Paul Tough:
"I have two boys who are now 10 and 15. As they grew up, I found myself often in conversations with parents from school or the playground where attention just kept coming up as the conversation. A lot of kids seemed to be struggling with it. That was more true during the pandemic, and for a lot of them, that ended up with an ADHD diagnosis."

Paul Tough highlights a significant uptick in ADHD diagnoses, particularly exacerbated by the challenges posed by the COVID-19 pandemic. The Centers for Disease Control and Prevention (CDC) reported that ADHD diagnoses rose from 6 million in 2016 to 7 million during the pandemic, contributing to an overall steady increase since the 1990s.

Defining ADHD

[03:16] Paul Tough:
"ADHD, despite the fact that the 'A' stands for attention, doesn't necessarily have to do just with attention. There are symptoms related to hyperactivity, impulsivity, and inattention, but there's a lot else going on as well."

Alison and Paul discuss the multifaceted nature of ADHD, emphasizing that it's not solely about attention deficits but also encompasses hyperactivity, impulsivity, and varied behavioral symptoms. This complexity makes the condition challenging to define and diagnose accurately.

Diagnostic Criteria and Challenges

[07:46] Paul Tough:
"ADHD is diagnosed using the DSM, the Diagnostic and Statistical Manual. Clinicians use a list of 18 symptoms, and if a child exhibits six symptoms from either the hyperactive-impulsive or inattentive categories over a certain period, they can be diagnosed with ADHD."

Paul explains the reliance on the DSM for diagnosing ADHD, which lists 18 observable behavioral symptoms. However, he points out the difficulties in drawing clear distinctions, as the symptomatology often exists on a continuum, making it hard to determine precise diagnostic boundaries.

The Impact of the Pandemic

[05:09] Paul Tough:
"The pandemic played a significant part. The numbers went up, but ADHD diagnoses have been on a steady rise since the 1990s, indicating a long-term trend rather than a pandemic-induced spike."

While acknowledging the pandemic's role in exacerbating ADHD symptoms due to increased screen time and disrupted routines, Paul emphasizes that the rise in diagnoses is part of a broader, decades-long trend.

Personal Experiences: Caller Stories

Lisa from the Bronx

[09:30] Lisa:
"My daughter was diagnosed with ADHD at six. After deciding to medicate her, her teacher noticed a significant improvement in her attention in class. However, the medication's effects wore off after school, leading to behavioral changes at home."

[11:11] Paul Tough:
"Lisa's experience is common. Stimulant medications can rapidly change behavior, making school more engaging for children. However, the effects are often temporary, lasting only during school hours."

Joe from Brooklyn

[13:40] Joe:
"I've been on ADHD medication since age five. While it helped me focus through school and college, in my early 30s, stopping the medication has been challenging. I lose motivation and find it hard to engage without it."

[14:38] Paul Tough:
"Joe's struggle highlights the potential for psychological dependency on ADHD medications. While physically, stimulant medications leave the system quickly, the psychological aspect of needing them to maintain focus can create long-term reliance."

Veronica from Brooklyn

[22:35] Veronica:
"My son was diagnosed in second grade. Medication and open communication about his learning style have been pivotal. However, we've had to advocate fiercely for his needs due to inadequate support from the NYC Department of Education."

[26:08] Paul Tough:
"Veronica's approach—encouraging her son to understand his ADHD and advocating for his needs—is essential. It empowers children to manage their condition proactively."

Beth in Brooklyn

[24:30] Beth:
"Diagnosed as an adult, ADHD explained so much about my lifelong struggles. Embracing the diagnosis has empowered me, improving my self-esteem and relationships. It’s been a transformative revelation."

[25:52] Paul Tough:
"Beth's experience reflects how an adult diagnosis can provide clarity and empowerment, fostering personal growth and improved self-understanding."

Vincent from Warren, New Jersey

[30:08] Vincent:
"My daughter, diagnosed in third grade, excelled academically with medication and support. The meds helped her graduate early. I urge parents to seek the necessary help for their children."

[31:35] Paul Tough:
"Vincent's story underscores the positive impact of ADHD treatment when combined with robust support systems, leading to significant academic and personal achievements."

Biomarkers and Diagnostic Challenges

[19:07] Paul Tough:
"We do not have a biomarker for ADHD. Many scientists believe we never will, similar to other psychiatric disorders like depression and anxiety. ADHD symptoms exist on a continuum, making it impossible to pinpoint a definitive biological marker."

The episode examines the ongoing search for biological markers to diagnose ADHD definitively. Paul Tough explains that unlike some physical ailments, ADHD lacks a clear biological signature, complicating diagnosis and fostering skepticism about its validity as a distinct disorder.

Medication Use and Long-term Viability

[20:53] Alison Stewart:
"Why are we still treating ADHD with medication when there are questions about its long-term viability?"

[21:07] Paul Tough:
"Medications are part of a clinician's toolbox and can be highly effective initially. However, their effectiveness may wane over time, and there are risks associated with long-term use. Families should view medication as a potentially temporary solution, adjusting as needed."

The discussion highlights the dual nature of ADHD medications: they can offer significant short-term benefits but may lose efficacy or present side effects over time. Paul advocates for a flexible approach to treatment, emphasizing the importance of not viewing medication as a lifelong necessity.

ADHD and Personal Identity

[26:08] Paul Tough:
"ADHD diagnoses can profoundly shape an individual's identity. For adults, it can provide clarity and empowerment, while for children, it's crucial to remain open to change and not become too attached to the diagnosis."

Alison and Paul explore how an ADHD diagnosis can influence self-perception and personal development. For adults like Beth, it can be empowering, while for children, it's vital to maintain flexibility as they grow and evolve.

Controversies and Reactions

[31:19] Alison Stewart:
"Your article has created strong reactions. What do you think about that?"

[31:35] Paul Tough:
"ADHD has been a controversial diagnosis for over 30 years. It's a deeply personal and impactful issue for many families, so strong reactions are expected."

Paul Tough acknowledges the contentious nature of ADHD as a diagnosis, emphasizing its significant impact on families and individuals. The varied experiences and emotions attached to ADHD contribute to the intense reactions elicited by his article.

Conclusion

In this comprehensive exploration, ALL OF IT sheds light on the intricate landscape of ADHD diagnoses and treatments. Through expert insights and heartfelt personal stories, Alison Stewart and Paul Tough reveal the multifaceted challenges and triumphs associated with ADHD. The episode underscores the importance of nuanced understanding, flexible treatment approaches, and the profound personal implications of living with ADHD.

Notable Quotes:

• Paul Tough [02:47]:
  "A lot of kids seemed to be struggling with it. That was more true during the pandemic, and for a lot of them, that ended up with an ADHD diagnosis."

• Lisa [09:30]:
  "She’s not really daydreaming as much. We don't have to redirect her attention as much."

• Joe [13:42]:
  "Things that I usually find interesting on the medication, I no longer find interesting. I find motivation hard to find."

• Beth [24:30]:
  "Knowing how I operate and how my brain works has really helped me set myself up for success and it's changed my self-esteem, my personal relationships, my professional life."

• Veronica [22:35]:
  "The NYC DOE... we have to become our own advocates and become really well educated. And as a result, we are leaving Brooklyn because of those challenging years."

This detailed summary encapsulates the key discussions, insights, and personal narratives presented in the episode, providing a comprehensive overview for those who haven't listened.