Summary of "Have We Been Thinking About A.D.H.D. All Wrong?"

The Daily
Host/Author: The New York Times
Episode Title: Have We Been Thinking About A.D.H.D. All Wrong?
Release Date: June 17, 2025
Hosts: Michael Barbaro, Rachel Abrams, Natalie Kitroeff
Contributor: Paul Tough

Introduction

In the June 17th episode of The Daily, titled "Have We Been Thinking About A.D.H.D. All Wrong?", host Rachel Abrams delves into the escalating diagnoses of Attention Deficit Hyperactivity Disorder (ADHD) in the United States. Over the past thirty years, ADHD diagnoses and the prescriptions for managing its symptoms have surged. However, this growth has sparked debates among seasoned researchers who question the foundational approaches to identifying and treating the disorder. Paul Tough, a contributor to The Daily, explores these contentious perspectives, highlighting potential flaws in the current understanding of ADHD.

Personal Connection and Motivation

Paul Tough opens the discussion by sharing his personal motivations for investigating ADHD. As a father of two sons aged 10 and 15—both within the predominant ADHD demographic—Tough observed ADHD pervasive in his conversations with parents and educators. He noted the ambiguity surrounding ADHD diagnoses, where the boundaries between having ADHD or not appeared "fluid and porous."

Paul Tough [01:27]: "It felt like there were a lot of puzzles in this diagnosis that on the one hand, it seemed like something that was very clear and straightforward."

This personal stake led him to engage deeply with ADHD researchers to uncover the underlying issues in its diagnosis and treatment.

The Complexity of ADHD Diagnosis

The episode highlights the intricate nature of diagnosing ADHD, which relies on a checklist of symptoms outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Diagnosing ADHD entails identifying a specific number of symptoms across various settings over several months, accompanied by a significant level of impairment.

Paul Tough [07:25]: "There is this checklist of symptoms that doctors look at when they want to diagnose ADHD."

ADHD symptoms bifurcate into two main categories: hyperactivity and impulsiveness, and inattentiveness. This duality means that two individuals diagnosed with ADHD can exhibit markedly different behaviors, complicating a straightforward diagnosis.

Paul Tough [07:50]: "They can have two kids who are diagnosed with ADHD who might, from appearances, seem very different."

Additionally, many ADHD symptoms overlap with other conditions like anxiety or trauma, further muddling the diagnostic process. This complexity has driven the scientific community to seek a definitive biomarker—a biological indicator—that could unequivocally diagnose ADHD, thereby reducing subjectivity and legitimizing the disorder.

The Search for Biomarkers

Efforts to identify a biomarker for ADHD began with optimism in the early 2000s, fueled by advancements in genetics and neuroimaging. Initial studies suggested potential brainwave differences and specific genetic markers associated with ADHD. However, subsequent, more rigorous studies failed to replicate these findings.

Paul Tough [12:44]: "Edmund said, 'Basically, what we thought was there isn't really there.'"

The Enigma Consortium, an international network of neuroscientists and psychiatrists, analyzed 4,000 brain scans to find consistent differences between individuals with and without ADHD. Their results were underwhelming, revealing negligible differences in brain structures, especially in adults and adolescents. Only a slight variation was noted in children, but it was too minor to serve as a reliable diagnostic tool.

Paul Tough [12:51]: "It means we haven't found one yet, but it also means we probably won't find one that is as simple and clear as we'd hoped."

This setback has caused many researchers, including Edmund Sanuga Bark, to reconsider the biological-centric approach to understanding ADHD.

ADHD Medication: Efficacy and Concerns

The mainstay of ADHD treatment has been stimulant medications like Ritalin and Adderall, derivatives of amphetamines. Their usage skyrocketed from 1 million diagnoses in the early 1990s to 7 million by 2025. Initial studies, reminiscent of Charles Bradley's 1930s experiments, showcased remarkable short-term behavioral improvements in children administered these drugs.

Paul Tough [15:21]: "When you gave them to kids, their symptoms improved, often almost overnight. But they wanted to be more scientific about it."

A significant randomized controlled study compared the long-term effects of Ritalin against behavioral treatments and no specific treatment. Initially, Ritalin-treated children showed substantial symptom reduction at 14 months. However, by the 36-month mark, these benefits had dissipated, showing no significant advantage over other treatment groups.

Paul Tough [19:35]: "The relative benefits of Ritalin faded. By the end of those three years, the children in each of these treatment groups were doing exactly the same."

Moreover, despite improved classroom behaviors, these medications did not translate into enhanced academic performance. Cognitive tests revealed no improvement in learning outcomes, although students reported feeling more motivated and connected to their work.

Paul Tough [20:33]: "The main impact of stimulant medication is on our emotions more than on our cognition."

Significant concerns also emerged regarding side effects. The most notable was a consistent reduction in height among children who took stimulant medications over extended periods.

Paul Tough [22:59]: "The ones who had taken stimulant medication consistently were about an inch shorter than the ones who hadn't taken the medication at all."

While addictive potential was a concern, data indicated that prescribed stimulant use did not significantly increase addictive behaviors. Many teenagers expressed a desire to discontinue usage, associating it with discomfort rather than dependence.

Rethinking ADHD: Environmental Mismatch

Edmund Sanuga Bark, a British researcher diagnosed with ADHD in his childhood, embodies the challenges and reevaluations within the field. Reflecting on his past, Edmund suggests that ADHD might be better understood as a mismatch between an individual's unique cognitive profile and their environmental context rather than a fixed medical condition.

Edmund Sanuga Bark [27:11]: "I think the best way to think about ADHD is as this mismatch, this misalignment between the specific brain of a young person and the environment in which they're living."

Edmund's academic success in a university setting, contrasting his struggles in a conventional school environment, underscores this perspective. He argues that instead of solely focusing on pharmaceutical interventions, there should be an emphasis on adapting environments and building resilience and coping strategies in individuals with ADHD.

Edmund Sanuga Bark [29:26]: "It's not a silver bullet. It never will be."

Medication, in this view, serves as a temporary aid that can provide families with the space to implement more sustainable, environment-centric strategies.

Conclusions and Future Directions

The episode concludes with a call to shift the narrative around ADHD. Instead of viewing it as a rigid medical disorder necessitating pharmaceutical intervention, there is a growing advocacy for understanding the lived experiences of those diagnosed and tailoring environments to better suit their unique cognitive landscapes.

Edmund Sanuga Bark [31:11]: "Because your mates, your school, this kind of sense of shame when you fail. Those are the things I think are crucial in terms of the long-term well-being."

Paul Tough emphasizes that redefining ADHD could lead to more holistic and effective support systems, ultimately fostering environments where individuals with ADHD can thrive without solely relying on medication.

Paul Tough [35:32]: "Instead of telling kids that there is this absolute, essential, inherent thing in you that is disordered, that you have this deficit, that that is not actually a helpful message to give to kids."

This episode of The Daily challenges conventional perceptions of ADHD, urging a paradigm shift towards a more nuanced and empathetic understanding that prioritizes individual experiences and environmental adaptations over a strictly medical model.