Questioning the Questions about ADHD

My latest complaint about the New York Times

You may have come across the recent New York Times piece questioning the medical establishment's understanding of ADHD. The article revives some old debates: whether the causes of ADHD are biological or environmental, and whether medication should be the first-line treatment approach. To be honest, I was surprised (disappointed?) to see this article published in the year 2025; it felt really outdated. For as long as I’ve worked in this field, it's been clear that ADHD, like all psychological disorders, arises from an interaction between biology and environment. The disorder reflects difficulty adapting to environmental demands—demands that challenge individuals in different ways depending on both nature and nurture.

And regarding pharmacological treatment options: Medication does help improve one's ability to meet environmental demands, and it is considered low-risk for most people. (Certainly leaving ADHD untreated isn’t itself risk-free!) Yet, for some reason, the Times feels the need to call the benefits of medication into question.

The Times article points out that medication doesn't improve the grades of children with ADHD, but I'm not sure anyone ever claimed it did. Rather, medication helps make individuals with ADHD more available to learn in conventional academic settings. But kids still need to engage in the learning process, which requires behavioral and academic interventions alongside medication. Ultimately, since ADHD arises from both biological and environmental factors, the most effective interventions to improve grades combine pharmacological and behavioral approaches, ideally targeting the child, parents, and school in tandem.

The article also underplays how ADHD impacts life beyond the classroom. It affects relationships, careers, emotional regulation, and overall well-being. When medication is effective, it creates space for developing the skills needed for broad-based and long-term success.

Finally, while the Times raises valid concerns about overdiagnosis, it calls into question the validity and seriousness of the diagnosis overall. I appreciate that the Times highlights real problems in evaluation and diagnostic practices: problems that I, too, have written about in this newsletter. Too often, clinicians rely on rating forms and interviews without thorough assessment. This leads to false positives, undermining confidence in ADHD diagnoses. But this is exactly the kind of skepticism the article needlessly amplifies.

Ultimately, the piece reflects our persistent inability to understand complexity in mental health. We stubbornly frame causes as either/or—biology or environment, medicine or therapy—when the reality is both/and. Even as science has embraced integrative models, public discourse lags behind, stuck in outdated binaries the field has long outgrown.

***

Fun fact: I invited her to my fifth birthday party. (Un-fun fact: She couldn’t make it.)