“The New York Times Reruns Familiar ADHD Tropes”
“Munjaro does not repair my diabetes. A beta-blocker does not repair my high blood pressure. I got those from my mom, just as most folks with ADHD inherited it from their parents or grandparents. All we can do is treat the symptoms of most chronic health conditions with medication and lifestyle changes. That’s integrative treatment.”
The following is a professional commentary that reflects the opinions and experiences of its author.
April 16, 2025
Every few years, the ADHD community must endure another skeptic – an author, a journalist, a contrarian mental health provider, quite frequently a chiropractor – recycling claims like “ADHD is overdiagnosed,” “stimulants don’t work,” or, most remarkably in one case, “ADHD does not exist.”
In every instance, including Paul Tough’s recent New York Times Magazine feature, the articles serve only to obfuscate the conversation about ADHD because:
- They attempt a critique of the diagnosis based mostly on thought experiments and persuasion rather than qualitative or quantitative analysis.
- They focus almost exclusively on the medical aspects of ADHD and not on the behavioral change that integrates with and complements it, providing a wholly reductive understanding of treatment.
- They neglect to spend sufficient time with any of the millions of children, teens, and adults who are immensely helped by an integrative treatment for ADHD, including medication management. If they interview anyone, they cherry-pick folks who decided they didn’t want or like treatment for ADHD.
Invariably, in such analyses, clients of ADHD services are portrayed as hapless dupes of a psychiatric industrial complex hellbent on profiting from a made-up affliction that is really just the same thing that everyone else experiences but somehow handles quite nobly and with aplomb. In reality, almost no one seeking help for ADHD feels hoodwinked. Why would they? The work they do to overcome ADHD is certainly difficult. I have found that anyone benefiting from stimulant medication typically has a love-hate relationship with it; if it weren’t working, nobody anywhere any time would pay their hard-earned dollars each month to receive it.
The Truth About ADHD Medication Efficacy
In his article, Tough retreads a very old tire of ADHD tropes dating back to the genesis of my career in doctoral school in the late 1980s. To do so, he latches onto the Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) study, without any meaningful clinical understanding of its nuances.
In my book, ADD and Zombies, I point out that a major problem with the MTA study is that it does not account for stimulant tolerance – the problem that, with prolonged usage, people adjust to medication and need more and more to get the same results. While stimulant tolerance somehow remains controversial among some prescribers, it is not controversial among the clients who take these medications. For them, it’s obvious.
As is often the case when laypeople storm the ADHD castle, the author misstates the recommended treatment as stimulant medication alone. Nearly all professional organizations recommend a combination of therapy and medication management, or what we call “integrative treatment.” As I say in my books, “If you are taking meds only for ADHD, it’s like putting gas in your car and driving around and around the parking lot.” The MTA study is simply a study of stimulants over time and, therefore, not a true reflection of real-world results for patients undergoing integrative treatment.
The Truth About ADHD Diagnoses
The author points out, somewhat ham-handedly, that the process of diagnosing ADHD is problematic. He is correct, largely because that process is mostly conducted in primary care offices, and not in collaboration with psychiatric providers and/or in tandem with a longer-term relationship with a therapist. However, he is incorrect that there is no test for ADHD. There are several.
It’s true that ADHD has no genetic marker test, but this is true also of depression, anxiety, and just about every other psychiatric condition. But, somehow, very few skeptics write articles about how “depression is overdiagnosed” or maybe “doesn’t exist.” Almost nobody claims that anxiety is a trick diagnosis to lure people into taking medication. No one disavows bipolar disorder.
As mental health providers, we don’t diagnose people with ADHD to stigmatize or pathologize them; we do so to describe their experiences and behavior so that we might, with their most enthusiastic consent, bill their insurance and devise treatment plans to reduce those symptoms. And if we do it right, we do it well.
To make these diagnoses, we use norm-referenced psychological testing, alongside a good psychiatric interview and history taking. At our office, this process takes a minimum of five sessions and is quite good at predicting who does and does not have ADHD. And contrary to Tough’s supposition in quoting me in his article, a diagnosis really is just that, a categorical variable. You either qualify for it or you don’t. And if you do, you either are impaired by it or you are not. That’s the essence of every psychiatric diagnosis in the DSM-5. Love it or hate it, it is not unique to ADHD.
If Tough wants to complain about the quality of diagnosis rendered in various medical offices, he might actually read my book and find in me a willing ally. I have that same concern, not because prescribers lack the tools or resources to do better diagnoses, but because they are not paid to use them. Had Tough asked or read beyond the popular press or the low-hanging MTA fruit, he’d have found a much more interesting story there – one that describes how to get a good ADHD diagnosis and why so many people don’t pursue that path and yet end up on stimulants.
Instead, he leans on a highly reductive approach, as evidenced in this quote: “That ever-expanding mountain of pills rests on certain assumptions: that ADHD is a medical disorder that demands a medical solution; that it is caused by inherent deficits in children’s brains; and that the medications we give them repair those deficits.”
There’s a lot to unpack here.
Yes, ADHD is a medical disorder because we have decided it is a medical disorder and because we have found that integrative treatment brings tremendous improvement to people’s lives, and people want to use their insurance to get that treatment. I know this because I, unlike the Times author, have spent thousands of hours over 32 years talking to those folks.
Wouldn’t it be great if stimulants “repaired those deficits” of attention and concentration, as Tough laments, they do not? Does Mounjaro reverse my diabetes? Does a beta-blocker repair my high blood pressure? Of course not. I got those from my mom, just as most folks with ADHD inherited it from their parents or grandparents, which is well demonstrated in the literature ignored by Tough. All we can do is treat the symptoms of most chronic health conditions with medication and lifestyle changes. That’s integrative treatment.
Far less amusing is Tough’s next quote, another tired and rather offensive supposition that ADHD is caused by some environmental bugaboo. He notes, “Scientists who study ADHD are… uncovering new evidence for the role of a child’s environment in the progression of his symptoms. They don’t question the very real problems that lead families to seek treatment for ADHD, but many believe that our current approach isn’t doing enough to help — and that we can do better. But first, they say, we need to rethink many of our old ideas about the disorder and begin looking at ADHD anew.”
While Tough doesn’t flesh out this idea, most of us recognize it as the “bad parenting” theory of ADHD that is far from new. As I point out in my books, the diathesis-stress model best explains how predisposition and environment work together to produce the actual symptoms and behavior of any given psychiatric diagnosis and many medical ones.
Tough is correct to wonder if environmental factors might also impact ADHD, but to propose it as an astounding new development that dislodges genetic predisposition as a primary contributor to ADHD is no more accepted in the field than the false belief that autism is caused by vaccines.
I could wax on responding to Tough’s analysis, but I will close my remarks, content in the understanding that people will continue to seek and receive services for ADHD, regardless of his words, because they like how the treatment impacts their lives. And if they do not, they are free not to be treated. At our clinic, that’s true regardless of one’s age or status. If children do not want to be treated, we do not treat them. We invite them to be part of our team, and most are happy to do so. Those who are not, we respect equally.
As Tough notes in the article, we do help parents encourage their children to receive treatment by pointing out how difficult their kids’ lives are in school, among friends, and at home. I saw several such teens today. But, in the end, we are radical believers in informed consent.
What is disappointing is not the return of these old saws, repackaged as new news, but the fact that too few clients receive the benefits of integrative treatment. The medical folks hand out prescriptions. The traditional therapists eschew them. And diagnosis is often eyeballed rather than scrupulously tested. There is much to critique in these bifurcated treatment models. Tough could have made that a central point of his article had he stepped a little farther into our world and shown a bit more empathy for the millions of folks who are in no way hapless dupes, and who might not appreciate the implication that they are.
ADHD Article Corrections: Next Steps
- Read: Setting the Record Straight on ADHD and Its Treatments
- Free Download: The Ultimate Guide to ADHD Medication
- Reader Reactions: MAHA Commission Means Fear, Stigma, Health Threats for Two-Thirds of ADDitude Readers
- Read: Is ADHD Real? Yes — and Still Heavily Stigmatized
Wes Crenshaw, PhD is Board Certified in Couple and Family Psychology (ABPP) and the author of I Always Want to Be Where I’m Not: Successful Living with ADD and ADHD and coauthor with Kelsey Daugherty, DNP of ADD and Zombies: Fearless Medication Management for ADD and ADHD.