We’ve gone way too far with stimulants and our kids!
The extremism around the question of how to treat gender dysphoria has begun to erode under the pressure of science and common sense. Is it possible that the same will happen regarding ADHD?
A long New York Times Magazine piece skeptical of the ADHD consensus, by Paul Tough, published about a week ago, could be an inflection point in the debate and, one hopes, lead to a fundamental reconsideration of how we think about this overdiagnosed, overprescribed, highly ambiguous disorder.
For a couple of decades now, we’ve made fidgeting in the classroom and other typical childhood behavior, especially among boys, a medical condition that should be treated with amphetamines.
It’s past time to acknowledge that this is insane and that the Ritalin regime as it’s been practiced in this country has failed. That doesn’t mean that Ritalin — and its close cousin Adderall — doesn’t have its uses, but it shouldn’t be prescribed as a costless wonder drug.
ADHD diagnoses have soared. From 1997 to 2016, they increased overall from 6.1 percent to 10.2 percent. Today, 11.4 percent of kids are diagnosed with ADHD, and nearly one in four 17-year-old boys have had an ADHD diagnosis at some point.
If teenage boys have the highest prescription rate, the skyrocketing numbers are now among adults. The Times piece notes that thirtysomethings received 5 million prescriptions for treatment of ADHD in 2012, and, by 2022, the number had climbed to nearly 20 million.
With surging demand, we’ve actually been experiencing shortages of these drugs.
Either ADHD is an infectious disease, spreading steadily throughout the population, or we’ve changed how we regard behavior that has always existed (or changed how it was avoided or dealt with in the past).
An element of all this clearly has been the pathologizing of the idiosyncrasies of boys and casting an ever-wider net to define suboptimal behavior as a pathology.
Tough relates the doubts that researchers and others in the field have about the current norms around how to diagnose and treat ADHD.
A focus of his piece is a long-term study of the effects of Ritalin, the so-called “Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study,” or MTA. This research seemed to indicate that Ritalin worked. After 14 months of taking the drug, the kids on it had fewer attention problems. Then, it emerged that, after 36 months, this effect washed out and the kids on Ritalin had the same symptoms as kids who weren’t on the drug.
The drugs positively affect classroom behavior, but, tellingly, they don’t really affect academic outcomes.
The Times piece relates that some scientists are also questioning whether ADHD is as cut-and-dried as it’s been portrayed. The effort to find readily discernible so-called biomarkers of the condition hasn’t borne fruit.
One researcher told the Times that there’s “an empirical crisis” for ADHD because “there literally is no natural cutting point where you could say, ‘This person has got A.D.H.D., and this person hasn’t got it.’ Those decisions are to some extent arbitrary.”
That should be a flashing red light, and the MTA study emphasized it. “Only about 11 percent of the children who entered the study with an A.D.H.D. diagnosis experienced the symptoms consistently year after year,” Tough writes. “More often, their symptoms would come and go; for a few years, they might stay above the D.S.M.’s symptom threshold, and then for a few years, their symptom count might dip below the cutoff, sometimes disappearing altogether.”
That’s not all: “Not only did most of the A.D.H.D. subjects improve, at least temporarily, but 40 percent of the children in the comparison group — who were originally selected for the study specifically because they didn’t have A.D.H.D. — at some point in adolescence had enough symptoms to qualify for an A.D.H.D. diagnosis.”
What accounts for this variability? Part of it is that, as kids get older, they have more agency to select what they do and gravitate toward what interests them most — and it becomes easier, naturally, to pay attention to that. Someone who might find it impossible to sit in a classroom and read David Copperfield might much more easily focus on writing a computer script or working on a transmission.
A friend of mine had the hardest time with her boy in school. He had trouble sitting still and paying attention, and the school staff insisted there was something wrong with him. She resisted the effort to define her son as some sort of aberrant and found that swimming was a good outlet for his energies. He went on to become a collegiate swimmer.
That ADHD goes away based on social context doesn’t mean it’s a fake condition; depression and anxiety are real and can subside or increase based on the circumstances of the person afflicted with them.
What is a certainty, though, is that not all of the kids diagnosed with ADHD actually have what should be considered a serious disorder — it’s likely only some fraction of the current diagnosed population.
An expert quoted in a recent article in Forbes said, “It’s important to educate teachers and parents on what to look for with regards to ADHD in children, such as daydreaming, interrupting conversations, impulsive behaviors, talking too much in class and becoming easily frustrated.”
Even if we stipulate that these alleged indicators of pathology could be so severe they might indeed indicate a problem, they make up a list that shows how easily diagnoses of ADHD can run out of control. Really, daydreaming? Talking in class?
An article in the journal Missouri Medicine a couple of years ago posited that gender bias “is likely to play a major role” in girls lagging behind in ADHD diagnoses. Note the premise that it’s a boon to males to have their behavior disproportionately pathologized.
That article noted that “studies show that boys have historically been more likely to exhibit hyperactivity and disruptive behaviors. ”You don’t say? And this prompted “earlier detection of the disorder.” Girls, meanwhile, are supposedly suppressed into behaving. “ADHD,” the paper argues, “manifests differently across gender, as there may be stronger social pressures for girls to sit quietly compared to boys.”
The emphasis here, as so often, is to get everyone else to catch up in ADHD diagnoses instead of restraining the diagnoses of the boys. “While some are concerned about the overdiagnosis of ADHD,” the article concludes, “there are still many groups who are underdiagnosed and unaccounted for in the data. Ultimately, focusing on the idea of ‘overdiagnosis’ among providers may be harmful, particularly for these populations, as this may present additional barriers to them receiving appropriate care.”
Too often, the “appropriate care” is drugs. There’s no doubt that amphetamines help people focus. But stimulants make kids who take them grow less quickly, and the children in the MTA study taken Ritalin for 36 months were about an inch shorter than those who hadn’t. There is evidence that the drugs can increase the risk of psychosis.
The Tough piece points to a horrifying article giving clinicians advice on what to say to parents who worry that their kids on stimulants are no longer funny. “Parents should know that not all personality changes sparked by medication are negative,” the article advised. “If a child known for his sense of humor seems ‘less funny’ on medication, it could be that the medication is properly inhibiting them. In other words, it’s not that the child is less funny; it’s that they’re more appropriately funny at the right times.”
Nothing to see here — you’ve just flattened the personality of your once-funny child.
All of this means that the pendulum should be swinging toward the likes of the clinician Lawrence Diller, who isn’t opposed to prescribing stimulants, but has long counseled against them as the first and only intervention.
That should have been commonsense a couple of decades ago — now, perhaps the scientific consensus can begin catch up.
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Written by Rich Lowry for National Review ~ April 21, 2025