The anticipated MAHA Commission report released yesterday misrepresents ADHD causes and care in the U.S., misinterpreting studies and disregarding compelling new research and patient voices to suggest that ADHD is contributing to a “crisis of overdiagnosis and treatment” in American children.

The MAHA Report, spearheaded by Health and Human Service (HHS) Secretary Robert F. Kennedy, Jr., equates ADHD with obesity, heart disease, and diabetes in calling these harmful contributors to the “childhood chronic disease crisis” in the U.S. It disregards the genetic underpinnings of ADHD to suggest it is solely caused by environmental factors and foods, twists data to stoke fear over rising diagnosis rates, and excludes a wealth of studies that link stimulant medication use to improved health outcomes.

It assumes ADHD is a disease caused and cured by environmental factors. And it suggests that curing ADHD will “make America healthy again.” We disagree, and so does the research.

Should the U.S. government take a long, hard look at the impact of ultra-processed foods, environmental chemicals, and declining physical activity on American children? Absolutely. Should it invest in programs to provide healthy foods, affordable health care, and screen-free activities for all children, regardless of socioeconomic status or means? Yes. Do we support efforts to eliminate toxins from our kids’ food, water, and air? To protect them from unhealthy screen use? To help them live longer, healthier lives? 100%.

Will any of these efforts “cure” ADHD, as the MAHA Report suggests? No, the research does not support that notion. But these efforts, if undertaken by Kennedy, do stand to improve quality of life for many children, and so they should be seriously considered by HHS through investment in the FDA, CDC, and NIH.

Do you know what else improves quality of life for kids? Less stigma and shame, and more investment and solutions. The MAHA Report, sadly, increases ADHD stigma by claiming the condition is overdiagnosed and disparaging its treatment as ineffective without any credible evidence to support these claims. On the flipside, it makes no mention of the proven, life-saving benefits of ADHD treatment or the risks associated with undiagnosed, untreated ADHD. It makes no mention of behavioral parent training, cognitive behavioral therapy, dialectical behavior therapy, or classroom interventions for ADHD, all of which are shown to improve outcomes for individuals with ADHD. Instead, the report’s “solutions” for ADHD suggest more scrutiny of and restricted access to stimulant medication.

Finally, it is notable that the commission included few scientists or experts in pediatric health care. The commission conducted no new research and it apparently did not seek comment or insight from the American Professional Society of ADHD and Related Disorders (APSARD), the American Academy of Pediatrics (AAP), or the World Federation of ADHD regarding the established science on ADHD causes and treatments. No patients were interviewed for or quoted in the report.

The next steps outlined in the report are vague and we expect the commission to propose more detailed strategies in August, but here are three takeaways from the May 22 MAHA Report that may impact the ADHD community.

#1: The Report Misrepresents the Causes of ADHD

ADHD is a highly genetic condition, as confirmed by brand-new research that identified measurable genetic traits that essentially act as biomarkers for ADHD. Lifestyle factors such as nutrition, exercise, and sleep exert epigenetic changes on DNA that influence how strongly or weakly ADHD genes are expressed. However, diet, physical activity, sleep, or screen use alone do not cause — and have not been shown to “cure” — ADHD.

Scientific research has established no causal link between consumption of sugar, food additives, or food dyes and ADHD, though some studies show a heightened sensitivity among children with ADHD to these foods, which may exacerbate existing symptoms. Likewise, scientific research has established no causal link between excessive screen time, video game play, or social media use and ADHD.

Despite clear evidence to the contrary, the MAHA Report claims that ADHD is caused by all of the following, but it never mentions genetic factors:

• Antibiotics: The report cited as evidence a study that “could not disentangle the effects of antibiotics from those of the underlying conditions” and “could not verify adherence to antibiotic prescriptions.” Other recent studies have found gut microbiome alterations in children with ADHD but no causal link between antibiotic use and ADHD in humans.
• Food additives: Research shows that food dyes may worsen symptoms of inattention or hyperactivity in children with ADHD, however there is no evidence of a causal relationship.
• Environmental toxins: This article by Joel Nigg, Ph.D., contains a thorough overview of all existing research on environmental toxins and ADHD, but the bottom line is this: “Genes and environments work together to shape development of the brain and behavior throughout life, but especially — and most dramatically — in very early life. ADHD, like other complex conditions, doesn’t have a single cause. Both nature and nurture influence its development.”

#2: The Report Casts Doubt on the Validity of an ADHD Diagnosis

The MAHA Report claims that “research shows ADHD has the strongest evidence of overdiagnosis,” however no such research is cited in the report. Perhaps that is because there is no definitive evidence that ADHD is overdiagnosed in America today. ADHD diagnosis rates have increased over the last few decades, however this may be a result of any of the following, and other factors:

• The high diagnosis rate cited in the report comes from a problematic and misleading CDC study that is “terribly designed to assess the prevalence of the disorder,” says Russell Barkley, Ph.D., a leading authority on ADHD. “In this survey, there is one question about ADHD: ‘Has a doctor or other healthcare provider ever told you that this child has ADD or ADHD?’ That could be anybody associated with the healthcare profession who has no training in ADHD… and there is no effort in this study to follow up to see if these children were, in fact, diagnosed.” Barkley goes on to say that meta-analyses of better-conducted studies that apply diagnostic criteria to their research populations find that the prevalence of ADHD among children ranges from 5 to 8 percent, not 10 to 11 percent.
• Revised diagnostic criteria published in the DSM-5 changed the age of onset from 7 to 12 and added the first-ever qualifier symptoms for ADHD in adulthood
• With ongoing research and clinician training on ADHD, education and symptom recognition have improved
• Twenty years ago, ADHD was viewed as a disorder that affected young males. As research on females began to take hold, girls and women were able to secure ADHD evaluations for the first time
• Likewise, as mental health stigma dissipates within time, historically underserved populations are seeking care for the first time

The report further suggests that “the harms associated with an ADHD diagnosis may often outweigh the benefits” without naming those supposed harms or acknowledging the many health risks associated with undiagnosed ADHD. Research shows that undiagnosed and untreated individuals face a higher risk for fatal car accidents, unwanted pregnancies, serious injury and hospitalizations, job loss, academic interruptions, self-harm, anxiety, depression, eating disorders, and more. The harms associated with undiagnosed ADHD are too severe to ignore, yet the MAHA Commission does just that.

#3: The Report Misrepresents the Efficacy and Risks of ADHD Medication

The MAHA Report draws faulty conclusions from the ​​Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder (MTA) study to argue that ADHD medication use offers no benefits “in grades, relationships, achievement, behavior, or any other measure” after 14 months of use. This is untrue.

In reality, the MTA study ended after 14 months, so the control group members with ADHD who did not initially receive medication were free to seek it out after 14 months. As many of the controls began treating their ADHD symptoms with medication, the differences between the control and treatment groups faded because the control group members began to improve on medication, not because the treatment group began to do worse. It is wrong and irresponsible to suggest that no patients experienced benefits from ADHD medication use after 14 months.

“The groups became very contaminated after that 14-month follow-up,” Barkley says in a video on his YouTube channel. “Therefore, we can’t make comparisons at years 2, 3, or 4 between or among the treatment groups and draw any conclusions about them because the treatments were mixed up among all the groups.”

The report claims that stimulants, “when stopped, often lead to disabling and prolonged physical dependence and withdrawal symptoms.” This is untrue. The research cited in the report was a study of antidepressants, not stimulants. There is no evidence to support this assertion regarding stimulant medication. In addition, we know that half of teens and adults with ADHD stop taking stimulant medication within one year of starting it, often due to stigma or access problems. This suggests that it is not addictive. In fact, stimulant medication has been used safely and effectively for nearly 100 years — more than enough time for long-term adverse outcomes to come to light, yet none has.

Finally, the report’s claim that stimulant medication use does “not improve outcomes long-term” is also false.

Research dating back more than 40 years has documented the positive impact of ADHD treatment on specific symptoms like inattention and hyperactivity, and on life expectancy overall. Recently, a Swedish study, published in JAMA Network Open, documented these findings:

• ADHD medication use reduced overall risk of death by 19%. Among people with ADHD who did not receive medication, there were 48 deaths for every 10,000 people, contrasted with 39 deaths per 10,000 people within the medicated cohort.
• ADHD medication use reduced the risk of overdose by 50%. Medication use also reduced the risk of death from other unnatural causes, including accidental injuries, accidental poisoning such as drug overdoses, and suicide.
• ADHD medication use reduced the risk of death from natural causes, such as medical conditions, for women.

People with childhood ADHD are nearly twice as likely to develop a substance use disorder as are individuals without childhood ADHD. However, research suggests that patients with ADHD treated with stimulant medications experience a 60% reduction in substance use disorders compared to those who are not treated with stimulant medication. Considerable evidence also suggests that children taking ADHD medication experience improvements in academic and social functioning, which translates to improved self-esteem, lower rates of self-medication with drugs or alcohol, and decreased risk of substance abuse.

Given all of the above, it’s difficult to view the increase in stimulant medication use flagged by the MAHA Report as anything but positive. “Why isn’t that evidence of improvement in good public mental health?” Barkley asks. “The fact that there is a rise in the occurrence of a particular treatment does not provide prima facie evidence that there is something bad, wicked, evil, wrong going on here; it simply means that, over time, we are getting closer and closer to identifying conditions that produce harm in individuals, and that we try to alleviate that harm and suffering.”

The Threat to ADHD Care Access

The MAHA Commission plans to release its recommended strategies in August, but it’s easy to see the writing on the wall now. The arguments presented in Thursday’s MAHA Report, based largely on outdated or poorly interpreted research, suggest that Kennedy may seek to restrict access to ADHD care and that he’s building a foundation of doubt and misinformation now to support that action.

We fear efforts to dissuade physicians from diagnosing and treating ADHD may be forthcoming from the Drug Enforcement Administration (DEA) with support from the CDC, which Kennedy oversees. Of course, we hope we are proven wrong. We hope that, instead, HHS chooses to fully restore funding for ADHD research efforts through the National Institutes of Mental Health, for mental healthcare initiatives through the CDC, and for nationwide nutrition assistance programs through the FDA.

ADDitude supports an investment in unbiased research into the root causes of and effective treatments for ADHD to support, not ‘cure,’ individuals living with neurodivergent brains. We welcome the opportunity to engage in transparent dialog with the MAHA Commission and to introduce the voices and viewpoints of individuals and families living with ADHD, which were excluded from this report. And we hope that this administration will fund initiatives to improve food quality and access, eliminate harmful food additives, provide mental health services to all children, and crack down on the industries and companies contributing toxins to our environment.

We also stand ready to defend the legitimacy of the robust library of credible, science-backed research studies that confirm ADHD’s genetic underpinnings, that validate its diagnostic tools, and that confirm the benefits of its uninterrupted treatment.

Reactions from the ADHD Community

Mark Bertin, M.D., PLLC, of Developmental Pediatrics

“Lifestyle changes that promote child health are a wonderful idea. However, the MAHA paper ignores the reality of ADHD, a common medical disorder with genetics nearly as strong as the inherited trait of height. Undertreated ADHD is a public health concern that affects school performance, relationships, and driving; increases the risk of substance abuse; and shortens lifespans. Research and clinical experience show clear benefits to ADHD medication, which has been used for a century without evidence of chronic side effects. Supporting individuals with ADHD requires more understanding, not less, while making medical, educational, psychological, and health-related supports affordable and easily available. The MAHA document completely misrepresents ADHD in ways that are judgmental, demeaning, and will be harmful to individuals, our health care system, and society.”

Russell Barkley, Ph.D.

The ADHD Evidence Project, Founded by Stephen Faraone, Ph.D.

“ADHD is one of the most discussed neurodevelopmental disorders in the MAHA Report, but many of its claims about ADHD are misleading, oversimplified, or inconsistent with decades of scientific evidence, much of which is described in the International Consensus Statement on ADHD, and other references given here.”

Misdiagnosis is a significant barrier to care. Black children and adolescents with ADHD are more likely to be labeled with oppositional defiant disorder and to have their ADHD symptoms misunderstood as defiance. Also, cultural stigma surrounding mental health can prevent Black families from seeking care and from using ADHD medication when it is prescribed. Black parents report a preference for interventions like parent training and executive function skills training, to which their access is often limited.

One possible solution: integrated primary care, in which behavioral health services are embedded within primary care practices. When children go to a pediatrician appointment, they may also see a behavioral health care specialist for common concerns like depression, anxiety, and a range of disruptive behaviors from failing to follow caregivers’ directions to disrupting the classroom.

[Read: ADHD Clinicians Must Consider Racial Bias in Evaluation and Treatment of Black Children]

Integrated primary care can address the treatment disparities in Black youth by enabling more personalized, collaborative treatment for ADHD and its co-occurring difficulties. Parents should ask their pediatrician whether an in-office behavioral health specialist is available. Additionally, many primary care practices affiliated with academic medical centers or children’s hospitals have integrated primary care clinics.

Mental Health Stigma in ADHD Care: Next Steps

• Learn: Why We Need Clinicians of Color to Normalize ADHD in BIPOC Communities
• Read: Evaluating and Treating ADHD in African American Children: Guidance for Clinicians
• Watch: “Health Equity in ADHD: Addressing Racial Disparities in Diagnosis and Treatment” [Video Replay & Podcast #495]

Heather A. Jones, Ph.D., is an associate professor of psychology at Virginia Commonwealth University.
Alfonso L. Floyd, Ph.D., is a postdoctoral fellow in the Department of Child & Adolescent Psychiatry and Behavioral Sciences at The Children’s Hospital of Philadelphia.

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Amid this dearth of research, men* are becoming increasingly interested in testosterone’s suspected benefits on strength, energy, and mood. Testosterone replacement therapy, approved to treat hypogonadism (testosterone deficiency), has become more common among men with typical hormone levels. In the last five years, testosterone replacement prescriptions have risen dramatically, from 7.3 million to more than 11 million, and a third of these recipients have not been diagnosed with testosterone deficiency, according to the American Urological Association.

Besides being potentially ineffective at achieving desired outcomes, testosterone supplementation without a medical indication can be harmful for men, and may lead to side effects such as fertility problems, acne, sleep apnea, breast swelling, benign prostatic hyperplasia, and high red blood cell counts, which could increase the risk of blood clots

As these very real risks emerge from a murky landscape, here is a summary of what’s known — and not yet known — about the impact of testosterone on the bodies and brains of men, both with and without ADHD.

Testosterone and ADHD: Is There a Connection?

Is there an association between an individual’s testosterone level and their likelihood of developing ADHD. Is symptom severity impacted by hormones? The answer is: we don’t know. There’s no conclusive evidence to suggest an association, however research is extremely scarce.

[Read: For Men With ADHD — and Those Who Love Them]

Estrogen’s impact on mood and cognition is well-established. It plays a key role in modulating neurotransmitters, increasing dopamine and serotonin, which leads to elevated mood and focus. Recently, researchers have begun to explore the influence of estrogen on ADHD, which is thought to be significant. Women with ADHD experience premenstrual dysphoric disorder, postpartum depression, and perimenopausal challenges at far higher rates than do women without ADHD. Additionally, ADHD symptoms are often more severe and ADHD medication less effective during the luteal phase of the menstrual cycle, when estrogen is low.

Testosterone’s implications on ADHD are far less clear.

In the past, ADHD was thought to be a disorder affecting mostly boys, leading some to speculate that testosterone played a role in the development of ADHD symptoms. Some studies have explored whether prenatal exposure to high testosterone is associated with an elevated risk of ADHD. The results were mixed, with some studies finding a link between high prenatal exposure to testosterone and development of ADHD, and some finding no association.^1,2

[Read: When ADHD and Puberty Collide]

No research has been conducted investigating whether testosterone levels are related to ADHD symptom severity.

Research has investigated the influence of testosterone on mood and behavior more generally, including several studies that have tested a potential association between testosterone and depression, with conflicting results. Some studies have found an association between low levels of testosterone and depressive symptoms ^3,4 while others have found that both low and high levels of testosterone are linked to risk of depression.^5,6 Because of confounding factors, these studies have failed to show a causal relationship between hormone levels and depression. Studies regarding testosterone’s impact on cognition have been similarly inconclusive. ^7,8

Even research on testosterone’s most famous behavioral trait — aggression — fails to find a direct cause-and-effect relationship. Experts believe testosterone plays a role in the regulation of aggression, however the exact function it serves remains unclear. Testosterone fluctuates in response to cues of challenge in the environment, and it interacts with other fluctuating hormones such as cortisol, making the tangle of factors very difficult to unknot.^9,10

Testosterone research is inconclusive, in part, because testosterone is difficult to measure. Variability in testing and analysis methods, fluctuations in the hormone over the course of the day, and inconsistencies among labs regarding the parameters of “normal” levels all add to the challenge of studying testosterone.¹¹

Testosterone Over the Lifespan

Hormone levels in women rise and fall dramatically on a constant basis for the whole of their reproductive years. This regular menstrual cycle exists in stark contrast to the hormonal experience of men, for whom testosterone levels change significantly during two periods: puberty and in mid-life. While testosterone levels fluctuate slightly throughout the course of the day, their levels remain stable from the end of adolescence until roughly age 40.

Challenging Conventional Wisdom About “Hormonal” Teens

During puberty, testosterone levels in males increase exponentially. Research has found that the average total testosterone level of a male rises from 3 ng/dl to 355 ng/dl over the course of adolescence ¹² Testosterone levels reach their peak in late adolescence or early adulthood and remain stable until ages 35 to 40, when they begin to decrease very gradually.
The explosion of hormone production in puberty causes:¹³

• development of the male sex organs
• deepening of the voice
• appearance of facial and pubic hair
• muscle size and strength
• sex drive
• sperm production

Puberty is also a time of significant emotional, social, and behavioral changes — changes that are generally attributed to the dramatic hormonal escalation. But drawing a direct line between pubertal hormones and mood, behavior, and cognitive changes is an over-simplification of a complex developmental period, says Ben Balzer, M.D., pediatrician in Sydney, Australia, and Conjoint Lecturer at the University of New South Wales.

Balzer and colleagues conducted a systematic review of 27 studies in order to assess what evidence exists on the effects of testosterone on mood and behavior in teen boys. The review concluded that there was insufficient data to confirm a significant association.¹⁴

“Hormones are an easy culprit to go after,” says Balzer. “But their role may potentially be small because of the overall cognitive changes and neurological maturation that occurs in that period of life.”

Similar results were found in a 2024 systematic review of 55 studies investigating the role of pubertal hormones on mental health conditions. The review concluded that most of the studies that exist on hormones and mental health outcomes were at high risk for bias and involved many confounding factors. They determined that there wasn’t solid evidence that pubertal hormones cause mental health problems.¹⁵

The challenge of conducting this kind of research, Balzer says, is that hormones don’t act in isolation.

“When we study hormones in mice, we can control every aspect of their life,” he explains. “But when you’re looking at adolescents in the community, you’ve got to factor in their genetics, family environment, living environment, school situation, their social media use. It’s a really complicated thing to tease out.”

When Testosterone Tapers Later in Life

Testosterone levels remain more or less steady until midlife, when they begin to decline very gradually, approximately 1% a year. ¹⁶

While this decrease in testosterone is sometimes compared to menopause in women, the decline for men is far more gradual and happens over a much longer period of time. While men on average, lose 30% of the testosterone by age 75,¹⁷ women on average lose 65% of their estrogen by age 51.

No evidence exists to demonstrate that declines in testosterone due to normal aging cause mood or cognitive issues, as declines in estrogen often do for women in menopause.

Normal declines of testosterone due to aging are distinct from hypogonadism, a condition in which problems with the pituitary gland or the testicles result in the body failing to produce normal amounts of testosterone. Men with hypogonadism may suffer from chronic fatigue, low libido, erectile dysfunction, muscle loss, and weight gain, as well as mood symptoms including irritability and depression. Several studies have found a higher incidence of depression in men with hypogonadism, however research has not shown a causal link between the lack of testosterone and depression.

“The association between depression, testosterone levels, and sexual symptoms in males is difficult to assess, due to numerous confounding factors, such as medical conditions, obesity, smoking, alcohol use, diet, and stress,” according to the authors of a recent study in Frontiers in Endocrinology.¹⁸

Testosterone and ADHD in Men: Next Steps

• Read: ADHD Symptoms in Men Manifest Differently
• Watch: “ADHD and Puberty – How Hormones Shape Behavior and Mental Health in Adolescents”
• Read: Men with ADHD Are Asking: “Why Am I So Angry?”

*ADDitude is dedicated to honoring gender diversity and fluidity. For the purposes of this reporting, the terms “men” and “boys” refer to individuals assigned male at birth.

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Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹Wang LJ, Chou MC, Chou WJ, Lee MJ, Lee SY, Lin PY, Lee YH, Yang YH, Yen CF. Potential role of pre- and postnatal testosterone levels in attention-deficit/hyperactivity disorder: is there a sex difference? Neuropsychiatr Dis Treat. 2017 May 16;13:1331-1339. doi: 10.2147/NDT.S136717. PMID: 28553119; PMCID: PMC5439987.

²Kocaman O, Aydoğan Avşar P, Kara T, Kuru T. The 2D:4D ratios in the mothers of children with attention deficit hyperactivity disorder. Early Hum Dev. 2025 Feb;201:106203. doi: 10.1016/j.earlhumdev.2025.106203. Epub 2025 Jan 20. PMID: 39855032.

³Joshi D, van Schoor NM, de Ronde W, Schaap LA, Comijs HC, Beekman AT, Lips P. Low free testosterone levels are associated with prevalence and incidence of depressive symptoms in older men. Clin Endocrinol (Oxf). 2010 Feb;72(2):232-40. doi: 10.1111/j.1365-2265.2009.03641.x. Epub 2009 May 25. PMID: 19486021.

⁴McIntyre RS, Mancini D, Eisfeld BS, Soczynska JK, Grupp L, Konarski JZ, Kennedy SH. Calculated bioavailable testosterone levels and depression in middle-aged men. Psychoneuroendocrinology. 2006 Oct;31(9):1029-35. doi: 10.1016/j.psyneuen.2006.06.005. Epub 2006 Sep 5. PMID: 16908107.

⁵Booth A, Johnson DR, Granger DA. Testosterone and men’s depression: the role of social behavior. J Health Soc Behav. 1999 Jun;40(2):130-40. PMID: 10467760.

⁶Määttänen I, Gluschkoff K, Komulainen K, Airaksinen J, Savelieva K, García-Velázquez R, Jokela M. Testosterone and specific symptoms of depression: Evidence from NHANES 2011-2016. Compr Psychoneuroendocrinol. 2021 Mar 10;6:100044. doi: 10.1016/j.cpnec.2021.100044. PMID: 35757365; PMCID: PMC9216439.

⁷Emmelot-Vonk MH, Verhaar HJ, Nakhai Pour HR, et al. Effect of testosterone supplementation on functional mobility, cognition, and other parameters in older men: a randomized controlled trial. JAMA. 2008;299:39–52. doi: 10.1001/jama.2007.51.

⁸Cherrier MM, Asthana S, Plymate S, et al. Testosterone supplementation improves spatial and verbal memory in healthy older men. Neurology. 2001;57:80–88. doi: 10.1212/wnl.57.1.80.

⁹Geniole SN, Bird BM, McVittie JS, Purcell RB, Archer J, Carré JM. Is testosterone linked to human aggression? A meta-analytic examination of the relationship between baseline, dynamic, and manipulated testosterone on human aggression. Horm Behav. 2020 Jul;123:104644. doi: 10.1016/j.yhbeh.2019.104644. Epub 2019 Dec 28. PMID: 31785281.

¹⁰Armstrong, T., Wells, J., Boisvert, D. L., Lewis, R. H., Cooke, E. M., Woeckener, M., & Kavish, N. (2021). An exploratory analysis of testosterone, cortisol, and aggressive behavior type in men and women. Biological Psychology, 161, Article 108073. https://doi.org/10.1016/j.biopsycho.2021.108073
[11] Tyagi V, Scordo M, Yoon RS, Liporace FA, Greene LW. Revisiting the role of testosterone: Are we missing something? Rev Urol. 2017;19(1):16-24. doi: 10.3909/riu0716. PMID: 28522926; PMCID: PMC5434832.

¹¹Yao Q, Zhou G, Xu M, Dai J, Qian Z, Cai Z, Zhang L, Tan Y, Hu R. Blood metal levels and serum testosterone concentrations in male and female children and adolescents: NHANES 2011-2012. PLoS One. 2019 Nov 7;14(11):e0224892. doi: 10.1371/journal.pone.0224892. PMID: 31697766; PMCID: PMC6837506.

¹²Duke SA, Balzer BW, Steinbeck KS. Testosterone and its effects on human male adolescent mood and behavior: a systematic review. J Adolesc Health. 2014 Sep;55(3):315-22. doi: 10.1016/j.jadohealth.2014.05.007. PMID: 25151053.

¹³Luo D, Dashti SG, Sawyer SM, Vijayakumar N. Pubertal hormones and mental health problems in children and adolescents: a systematic review of population-based studies.
EClinicalMedicine. 2024 Oct 1;76:102828. doi: 10.1016/j.eclinm.2024.102828. PMID: 39403116; PMCID: PMC11472636.

¹⁴Cheng H, Zhang X, Li Y, Cao D, Luo C, Zhang Q, Zhang S, Jiao Y. Age-related testosterone decline: mechanisms and intervention strategies. Reprod Biol Endocrinol. 2024 Nov 14;22(1):144. doi: 10.1186/s12958-024-01316-5. PMID: 39543598; PMCID: PMC11562514.

¹⁵Decaroli MC, Rochira V. Aging and sex hormones in males. Virulence. 2017 Jul 4;8(5):545-570. doi: 10.1080/21505594.2016.1259053. Epub 2016 Nov 10. PMID: 27831823; PMCID: PMC5538340.

¹⁶Indirli R, Lanzi V, Arosio M, Mantovani G, Ferrante E. The association of hypogonadism with depression and its treatments. Front Endocrinol (Lausanne). 2023 Aug 10;14:1198437. doi: 10.3389/fendo.2023.1198437. PMID: 37635965; PMCID: PMC10449581.

Use the examples below to help you explain ADHD to your child in easy-to-understand language that diminishes shame and accentuates strengths.

Executive Dysfunction: A Short-Staffed Airport Control Tower

Our brains are like busy airports with control towers that guide the airplanes of executive function — planning, prioritizing, organizing, managing time, and other skills that help us get through everyday life — to take off and land smoothly.

Except the ADHD brain’s control tower isn’t always well-staffed. It often feels like you’re the only one who showed up to work! You scurry around ensuring that airplanes take off and land without incident — a feat that requires enormous amounts of energy. Sometimes, airplanes become delayed in their take off, or fail to take off altogether.

This is called executive dysfunction. It’s why an ordinary day at school feels so exhausting for you, and why some things may seem harder for you than for your classmates.

How to Support Executive Function Skills: Next Steps

• Read: Your Child’s 7 Executive Functions — and How to Boost Them
• Read: How to Sharpen Executive Functions — Activities to Hone Brain Skills
• Free Download: Common Executive Function Challenges — and Solutions

Regulation: A Volume Button (Sometimes) Gone Haywire

Do you sometimes feel absolutely stuck, unable to get started on your homework even though everyone tells you to “just do it?” Does it ever feel difficult to wind down and get to sleep?

If you answered yes, your brain’s volume button may be stuck or off kilter. The volume buttons in our brains help us regulate and moderate energy, emotions, appetite, sleep, and activity levels. In ADHD brains, the volume button sometimes gets jammed, or it develops a mind of its own, tuning to sound levels that don’t match your commands.

You know your volume button is at zero when it feels impossible to get anything done. It looks like a lack of motivation and procrastination. Maybe you have no appetite, and you struggle to get out of bed.

Sometimes, for no reason in particular, your brain’s volume button will ramp up to 100. Big feelings will flood your brain, your appetite will surge, and it will feel impossible to stop scrolling through social media or to turn off your video game. Even falling asleep will be difficult with a mind that is going full blast.

Self-Regulation: Next Steps

• Read: How to Teach Emotional Regulation Skills
• Read: How to Motivate an Unmotivated Teenager
• Read: Why Task Switching is Difficult for ADHD Brains — and 7 Ways to Smooth Transitions

Sensory Sensitivity: Operating with No Filter

Every minute of every day, our brains filter through sensory input from inside and outside of our bodies. But the filters in ADHD brains are sometimes unreliable — allowing too much or too little information to break through. Often, every little input is received and processed in your brain, making you ultra-sensitive to things like how clothes feel on your body, the intensity of certain smells, the lighting in your classroom, and other sensations. Everything competes for your attention.

This is why hanging out with friends can feel so tiring sometimes. It’s not that you don’t like spending time with them, it’s just that your brain heightens the sensations of everything around you, draining you of your energy as you try to handle competing stimuli.

Sensory Sensitivities: Next Steps

• Read: What Is Your Child’s Sensory Profile?
• Read: Too Loud, Too Bright, Too Sticky!
• Free Download: Sensory Issues — Triggers, Symptoms & Types of SPD

Rumination: A Sticky Gearbox

We all have bad days. To move past challenges, you rely on your brain’s gearbox to shift out of negative thinking and cruise into a lighter perspective. If you find that you’re stuck in loops of negative, toxic thoughts, it’s because your gearbox is sticking — a common problem in ADHD due to emotional dysregulation. Once you notice what’s happening, strategies from cognitive behavioral therapy can be incredibly helpful in getting you unstuck.

How to Shift to Healthier Thoughts: Next Steps

• Read: How Do I Teach My Teen to Manage Emotions?
• Read: When Your Child Wants to Give Up
• Read: How Can I Help My Teen Adopt a Growth Mindset?

How to Explain ADHD to Kids and Teens: More Resources

• Free Download: 5 Ways to Build Self-Advocacy Skills
• Read: Your Brain Is a Ferrari
• Read: How Do You Talk to Your Child About ADHD? Advice from Fellow Parents
• Read: Your Brain Is Amazing! 5 Things All Neurodivergent Teens Need to Hear

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “The Emotional Lives of Girls with ADHD [Video Replay & Podcast #488]“ with Lotta Borg Skoglund, M.D., Ph.D., which was broadcast on January 23, 2024.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

When Robert F. Kennedy, Jr. calls autism a “preventable disease” and floats the idea of an autism registry, he’s not only spouting fringe opinions. He’s echoing a long and harmful legacy of framing neurodivergent people — especially autistic people — as broken, burdensome, and in need of fixing.

As an autistic adult raising two autistic children, I know firsthand how this rhetoric shapes public perception, policy, and everyday life. I know how much damage it can do.

In casting autism as a public health crisis and something that “destroys families,” RFK, Jr. is stripping autistic people of their humanity. Our identities become problems to be solved, not lives to be understood or supported. The implication is that people like me and my children should not exist — or at the very least, should be feared, tracked, or corrected.

[Read: “Rising ADHD and Autism Rates Reflect Education — Not a Crisis”]

These comments from the secretary of Health and Human Services aren’t new. They echo decades of pathologizing narratives, including from some mainstream autism organizations that have historically centered some parents’ despair at raising neurodivergent children while ignoring autistic perspectives. But when the nation’s health secretary proposes a government registry of autistic people, it takes that fear-based framing out of the shadows and puts it on a national stage. It taps into old eugenic ideas and weaponizes public health rhetoric against a marginalized group.

Research shows just how dangerous this framing is. Autistic people already face higher rates of discrimination, mental health challenges, and suicidality — especially when we lack acceptance and community.¹ Portraying autism as a tragedy increases stigma, which in turn predicts worse well-being and reduced access to needed supports.² It also correlates with more negative parenting experiences: studies show that when caregivers view autism through a deficit lens, they report higher stress and lower family quality of life.³ In contrast, when autism is understood as a neurotype rather than a disease, outcomes improve — not just for autistic individuals, but for their families as well.

In raising two young children — both delightful, both autistic — my days are filled with sensory swings and deep chats and meltdown management and belly laughs. It’s not always easy, but parenting never is. The hard parts don’t necessarily come from my kids’ neurotypes. They often stem from systems and expectations that were never built for people like us.

When public figures portray autism as a tragedy, they reinforce those broken systems. Insurance becomes harder to access for affirming therapies. Schools and workplaces feel justified in denying accommodations. Families are instructed to control and conform instead of adapt. And autistic people — especially those who are also queer, BIPOC, or multiply disabled — internalize the message that their very being is a mistake.

[Read: ADHD, Autism, and Neurodivergence Are Coming Into Focus]

But there is another story we can tell, one rooted in dignity, interdependence, and acceptance. It’s the story I live every day as I advocate for my kids and unlearn the shame I once felt about my own mind. It’s the story of thousands of autistic adults who are fighting not just for services, but for belonging. It’s the story the neurodiversity movement has been telling for years, and it deserves a louder megaphone than RFK, Jr.’s.

We don’t need a registry, and we don’t need a “cure.” We need a revolution in how we understand autism — not as something to be feared, but as a natural part of human diversity. Our job isn’t to eliminate autism. It’s to eliminate barriers and provide support so that all autistic people can live joyful, self-directed lives.

Autism and Neurodiversity: Next Steps

• Free eBook: The Truth About Autism in Adults
• Read: MAHA Commission Means Fear, Stigma, Health Threats for Two-Thirds of ADDitude Readers
• Read: “ADHD Is an Actual Condition. You Can’t Beat It Out of a Child.”

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Cassidy, S., Bradley, L., Shaw, R., & Baron-Cohen, S. (2018). Risk markers for suicidality in autistic adults. Molecular Autism, 9(1), 42. https://doi.org/10.1186/s13229-018-0226-4

² Botha, M., & Frost, D. M. (2020). Extending the minority stress model to understand mental health problems experienced by autistic people. Society and Mental Health, 10(1), 20–34. https://doi.org/10.1177/2156869318804297

³ Botha, M., & Frost, D. M. (2020). Extending the minority stress model to understand mental health problems experienced by autistic people. Society and Mental Health, 10(1), 20–34. https://doi.org/10.1177/2156869318804297

Women are raising their voices against long-established male-centric thinking about ADHD and demanding diagnostic criteria that reflect the female experience of ADHD. Most diagnostic tools have been developed by men and screen for symptoms seen in boys with ADHD, a huge impediment to proper care and treatment for girls and women with the condition. Even the questionnaires that are considered gender normed — meaning adjusted to ensure equal rates across genders — ask male-centric questions but require fewer points for a female to meet the threshold for a clinical diagnosis.

For example, the Adult ADHD Self-Report Scale (ASRS) is widely accepted as a standard screener for identifying adults with ADHD. This questionnaire, like many others, was developed by males to identify traits consistent with the male-centric Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria.

How Screeners Fail Women

All six of the most salient items on the ASRS describe most men with ADHD, while only three pertain to most females. Individuals must respond with “sometimes,” “often,” or “very often” to at least four of the questions to warrant further assessment for an ADHD diagnosis, causing an obvious problem for women.

[Get This Free Guide: ADHD Diagnosis for Women]

Here’s my analysis of the three problematic questions:

1. How often do you have trouble wrapping up the final details of a project once the challenging parts have been done?

This question implies that an intellectually challenging project becomes difficult to complete after it’s no longer interesting. The “projects” many women face are mountains of laundry, dishes piled in the sink, managing kids’ schedules, and grocery shopping. Completing these tasks is not related to losing interest; these projects were never interesting to begin with.

2. How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?
Because many women fall into the predominantly inattentive category, they are less likely to routinely fidget or squirm.

3. How often do you feel overly active and compelled to do things, like you were driven by a motor?
Again, because women are predominantly inattentive, they are not “driven by a motor.”

Due to the working of these questions, few women with ADHD would ever reach the “four or more” requirement to indicate that further ADHD investigation is warranted. Even when follow-up does take place, no clear guidelines exist to tell clinicians how ADHD impacts females. When ADHD is misdiagnosed or undiagnosed and untreated, the consequences can be extremely serious.

[Get This Free Download: Hormones and ADHD in Women]

Better Training = Accurate Diagnoses

Clinicians need better training to recognize the unique ways that ADHD impacts and manifests in women. For example, women are more likely than men to experience:

• co-occurring anxiety and depression that can be viewed inaccurately as the primary cause for their inattention and feelings of overwhelm
• feelings of overwhelm and failure in response to unreasonable societal expectations that they are unable to meet
• intense reactions to social rejection
• social isolation
• hidden symptoms due to masking and strong efforts to compensate
• emotional regulation problems
• hormone-related symptom variation
• self-harm, psychiatric hospitalization, and suicidality
• domestic abuse

One of the most urgent needs in the ADHD community is more gender-appropriate diagnostic criteria and treatment approaches for females. We must continue to speak out until the medical community responds appropriately and effectively.

Diagnostic Criteria for ADHD: Next Steps

• Learn: ADHD in Adults Looks Different. Most Diagnostic Criteria Ignores This Fact.
• Symptom Test: Signs of ADHD in Girls and Women
• Understand:Why We Need U.S. Guidelines for Adults with ADHD

Kathleen Nadeau, Ph.D., is the author of more than a dozen ADHD-related books, including her most recent, Still Distracted After All These Years: Help and Support for Older Adults with ADHD. (#CommissionsEarned)

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Deficits in working memory, response inhibition, and processing speed are present not only in individuals with ADHD but also in their family members without the condition, according to a new study published in the Journal of Psychopathology and Clinical Science that suggests these shared cognitive deficits may be “endophenotypes,” or measurable genetic traits that essentially act as biomarkers for ADHD. 1

The multilevel meta-analysis found that “unaffected first-degree relatives” (parents, siblings, or children) of individuals with ADHD performed significantly worse than non-ADHD controls in working memory, processing speed, response time variability, temporal processing, and cognitive flexibility. However, unaffected first-degree relatives did not display significant differences in inhibition, arousal, motor functioning, planning, or delay aversion compared to the control group.

“This is an incredibly important study,” Russell A. Barkley, Ph.D., said recently on his YouTube channel. “This study suggests that there is a larger endophenotype within families of people with ADHD, such that first-degree relatives show some symptoms and signs of the disorder. Think of it as an iceberg; underneath the surface lies the variability in the genetic endophenotype within these families. Then above the surface is a smaller peak, that’s the diagnosed people with ADHD.”

The researchers said that more studies focusing on basic cognitive functions, like working memory and cognitive flexibility, are needed to better understand how genes predispose someone to ADHD and how these genetic factors interact with other influences to cause ADHD symptoms.

Subthreshold ADHD

Identifying and studying potential ADHD endophenotypes may help researchers better understand subthreshold ADHD, which may be experienced by individuals who display ADHD symptoms but not to the severity or frequency required for a formal ADHD diagnosis.

“People with subthreshold ADHD may not exhibit impairing symptoms before age 12, as required in the current DSM-5 for a diagnosis. However, these undiagnosed, untreated adults may experience significant distress later in life and face an elevated risk for substance abuse, burnout, and professional and personal problems as a result,” said Maggie Sibley, Ph.D., a professor of psychiatry and behavioral sciences at the University of Washington School of Medicine, during the 2024 American Professional Society of ADHD and Related Disorders (APSARD) conference.

Sibley cited research from the 2022 Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) study showing that 63.8% of people with ADHD experienced symptom fluctuations throughout their lives. “We need to recognize that ADHD symptoms are not stable; they wax and wane over the lifespan,” she said. “Even individuals with mild, non-clinical symptoms can experience fluctuations that temporarily send their symptoms or impairment severity into the clinical range.”2

Sibley expanded on the MTA data in “ADHD’s Vanishing (and Reappearing) Act,” an article in the Spring 2025 issue of ADDitude magazine. “Most adults today with new diagnoses of ADHD probably did not develop their symptoms in adulthood,” she wrote. “Instead, they were likely missed, or they had mild, non-clinical symptoms in childhood that became more impairing as life’s demands multiplied. The study suggested that ADHD is more likely to be missed in childhood in females and minorities. People with intellectual gifts or supportive environments are more likely to compensate for their ADHD in childhood, so symptoms appear milder.”

Sources

¹ de la Paz, L., Whitney, B.M., Weires, E.M., Nikolas, M.A.(2025). A meta-analytic evaluation of cognitive endophenotypes for attention-deficit/hyperactivity disorder: Comparisons of unaffected relatives and controls. J Psychopathol Clin Sci. https://doi.org/10.1037/abn0000985

² Sibley, M.H., Arnold, L.E., Swanson, J.M., Hechtman, L.T., Kennedy, T.M., Owens, E., Molina, B.S.G., Jensen, P.S., Hinshaw, S.P., Roy, A., Chronis-Tuscano, A., Newcorn, J.H., Rohde, L.A. (2022). MTA Cooperative Group. Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD. Am J Psychiatry. https://doi.org/10.1176/appi.ajp.2021.21010032

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.

Since its publication last Sunday, The New York Times Magazine article “Have We Been Thinking About ADHD All Wrong?” has been called provocative and controversial. We would like to add a few adjectives: misrepresentative, biased, and dangerous.

In his 8,800-word article, writer Paul Tough used cherry-picked bits of decades-old data, very small studies, and interviews with three patients (all men) to exhume long-debunked ideas about ADHD and its treatment with prescription stimulant medication. Tough dismissed the lifelong work of esteemed ADHD researcher Russell Barkley, Ph.D., and suggested that the diagnosis of ADHD was unreliable or subjective because it relies not on a biomarkers or genetic tests, but on a trained clinician’s careful review of patients’ self-reported and observed symptoms in several settings.

To be clear, identifiable biomarkers do not yet exist for many psychiatric, neurodevelopmental, and neurodegenerative disorders. In the case of ADHD, medical experts use rating scales, neuroimaging studies, and/or criteria in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) to assess whether patients meet the threshold for a diagnosis.

“There’s no genetic marker for most psychiatric illness, but there is very clear heritability, as Dr. Russell Barkley has pointed out for years,” says Wes Crenshaw, Ph.D., a licensed psychologist and author. “I wonder if the Times author doubts depression? Or autism? Or anxiety? Or bipolar disorder?”

Though he was also quoted in the Times article, Crenshaw says he was never interviewed by the reporter, who pulled quotes out of context from his ADDitude articles.

ADHD Biases Divorced from Fact

Tough cited findings from the Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) Study to suggest that the benefits of stimulant medication wear off after 36 months. In arguing that Ritalin’s “advantage had completely faded,” Tough failed to report that long-term medication adherence among the MTA subjects was inconsistent — an important fact that undermines the author’s contradictory argument that stimulant medication is somehow both ineffective and “powerfully addictive,” as he claims in the article. (If it were addictive, wouldn’t the MTA subjects have taken it every day without fail? We know that half of teens and adults with ADHD stop taking stimulant medication within one year of starting it, suggesting that it is not addictive and shining a light on how woefully irresponsible it is to claim the ineffectiveness of a medication that is not taken consistently.)

Tough was guilty of biased reporting, or a deep misunderstanding of the subject he was covering, when he suggested that the increase in ADHD diagnosis rates — from 3 percent nearly 40 years ago to up to 11.4 percent of American children today, according to the CDC — represents a medical crisis or evidence of overdiagnosis. In truth, this uptick is is due, in large part, to a revised set of diagnostic criteria for ADHD in the DSM-5, a dramatic improvement in both clinician and patient understanding of ADHD, and critical research on its manifestations, especially in girls, women, and people of color — populations that have been historically overlooked and underserved, with serious consequences.

Perhaps the Times reporter was unaware of the basic fact that, 40 years ago, the scientific community screened almost exclusively only boys for symptoms of ADHD. It did not acknowledge the inattentive subtype of ADHD that many girls and women exhibit. And it insisted that symptoms only caused impairment in school settings. We now know much better.

Sloppy Reporting, Inaccurate Conclusions

Tough did Times readers a disservice by choosing not to interview more esteemed physicians, researchers, and clinical psychologists at the forefront of ADHD care. Instead, he plucked their quotes from the pages of ADDitude, stripped them of context, and did not pursue conversations with authors, like Crenshaw, or patients they suggested. [Crenshaw told ADDitude that, prior to the article’s publication, he offered “the author (through fact checker) a chance to interview an almost infinite number of ADHD people whose lives have been radically changed by integrative treatment.” No interviews were granted.]

For example, Tough quoted a feature from the Fall 2021 issue of ADDitude magazine in which Crenshaw addressed parents’ top concerns regarding ADHD medication. In the article, Crenshaw used established, evidence-based research to suggest that, if your child has ADHD, then stimulant medication paired with behavioral parent training and/or cognitive behavior therapy is shown to produce the greatest results in symptom management. Tough took Crenshaw’s words out of context to make it seem that he was arguing that ADHD exists as a binary, on-off diagnosis without any heterogeneity or symptom fluctuation. This is contrary to Crenshaw’s views and contradicts ADDitude‘s own recent reporting.

In its Spring 2025 issue, ADDitude magazine published a cover story titled “ADHD’s Vanishing (and Reappearing) Act,” in which author Maggie Sibley, Ph.D., explained her recent research into the sometimes unpredictable ebbs and flows of ADHD symptoms over a lifetime. Rather than acknowledge ADDitude‘s work to cover the scientific community’s evolving understanding of ADHD, Tough’s reporting painted ADDitude and its contributors as outdated. This is an unfair depiction.

He manipulated ADDitude content again in quoting an article published in 2020 and written by Roberto Olivardia, Ph.D., a clinical psychologist and Harvard Medical School lecturer. Tough did not interview Olivardia. Instead, he pulled a quote from Olivardia regarding the ways in which stimulant medication may quell a child’s social impulsivity. Tough deliberately omitted this vital precursor to the quoted statement in the ADDitude article: “Clinicians should assure parents that any medication that appears to mute the child’s positive aspects and core personality is indicative of an unsuccessful medical trial. Another medication should be tried.”

Olivardia didn’t mince words in his response to the Times article. “The suggestion that I and other ADHD clinicians would uniformly placate parental concerns with a canned response is insulting,” he says. “This is not the first time this has happened within the ADHD community, and it’s so frustrating. Some things in the article are accurate, but they are mixed in with very inaccurate, overly simplistic information.”

Unraveling a Dangerous Narrative About Medication

Of perhaps greatest concern is Tough’s inaccurate and harmful portrayal of stimulant medication as an ineffective Band-Aid that fails to improve students’ academic test scores and, therefore, must be unnecessary. He cited limited research casting doubt on ADHD medication’s ability to make kids score higher on timed tests, sort specific puzzles more efficiently, or excel in summer school. “If these studies are accurate, stimulant medications don’t do much to improve cognitive ability or academic performance,” Tough wrote. “And yet millions of young Americans (and their parents) feel that the pills are essential to their success in school. Why?”

Inexplicably, Tough did not report that ADHD medication has been shown to reduce impulsivity and, by extension, the risks of car accidents, substance abuse, unplanned pregnancy, comorbid depression and anxiety, incarceration, self-harm, and suicide. In fact, research has found that stimulant medication use among individuals with ADHD reduces the risk of premature death by a staggering 19%.

In a study published in The British Journal of Psychiatry in 2025, the life expectancy for adults with ADHD was found to be 7.5 years shorter than it was for those without the condition. Women with ADHD live 8.6 years fewer years than women without ADHD, while the life expectancy of men with ADHD was 6.8 years shorter than that of their peers. ADHD is a serious condition, and to willfully misrepresent its proven treatments is dangerous at best.

Research has documented the positive impact of ADHD treatment on life expectancy. A Swedish study, published in JAMA Network Open, followed nearly 150,000 adults and adolescents for two years after they received their ADHD diagnoses. The researchers shared the following insights about the use of stimulant medication — amphetamine or methylphenidate — which is effective for roughly 70% of patients with ADHD:

• ADHD medication use reduced overall risk of death by 19%. Among people with ADHD who did not receive medication, there were 48 deaths for every 10,000 people, contrasted with 39 deaths per 10,000 people within the medicated cohort.
• ADHD medication use reduced the risk of overdose by 50%. Medication use also reduced the risk of death from other unnatural causes, including accidental injuries, accidental poisoning such as drug overdoses, and suicide.
• ADHD medication use reduced the risk of death from natural causes, such as medical conditions, for women.

People with childhood ADHD are nearly twice as likely to develop a substance use disorder as are individuals without childhood ADHD. However, research suggests that patients with ADHD treated with stimulant medications experience a 60% reduction in substance use disorders compared to those who are not treated with stimulant medication. Considerable evidence also suggests that children taking ADHD medication experience improvements in academic and social functioning, which translates to improved self-esteem, lower rates of self-medication with drugs or alcohol, and decreased risk of substance abuse.

What’s more, researchers at the University of Michigan and Massachussets General Hospital studied 40,000 high school seniors, more than 4,000 of whom had ADHD. The research team compared the risk for marijuana abuse — the most common drug misused by this age group—among teens with ADHD to the overall population. They found that the students with the lowest incidence of substance abuse started ADHD treatment with stimulants before 9 years of age. When treatment began between ages 10 and 14, it was helpful, but the students still had a significantly higher likelihood of smoking marijuana. The highest risk of marijuana use was found among students with ADHD who started medication after age 15.

The late Joseph Biederman, M.D., the former Chief of the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD at Massachusetts General Hospital, along with researchers at the hospital and at Massachusetts Institute of Technology, conducted a study in which teens with ADHD were separated into two groups, then tasked with driving through a virtual roadway featuring surprise events, including oncoming traffic. The teens in the first group received stimulant medication (lisdexamfetamine: brand name Vyvanse) while the teens in the second group did not. Compared with the group of non-medicated ADHD teens, the medicated group was 67% less likely to have a collision during these events.

“For families that stop ADHD treatment on weekends and during ‘downtime,’ I emphasize the importance of driving only while medication is active,” Dr. Biederman had said. “A short-acting medication taken about half an hour before hitting the road may just be lifesaving.”

Why Ignore Patients’ Real-World Experiences?

Indeed, ADHD treatment with medication is lifesaving for many children, adolescents, and adults with ADHD for many reasons beyond the decreased risks for car accidents, illegal drug use, unprotected sex, and the other dangers outlined above.

ADDitude readers write to us daily about the social, emotional, professional, and psychological benefits they experience while using prescription stimulant medication to treat their ADHD symptoms. By excluding these patient perspectives, Tough’s reporting could place lives at risk by telling a story that may scare caregivers and adult patients away from the ADHD treatments that are shown to safely, effectively improve and protect lives.

On that note, let us leave you with a few quotes from ADDitude readers explaining, in their own words, the benefits of stimulant medication and the threats they feel in 2025.

“Adderall is literally the difference between crippling depression due to executive function disorder and not. If my access to my much-needed medication goes away, the impact will be exponential.”

“If they mess with my stimulants or access to stimulants, I could lose my job and even my marriage. I rely on it to maintain focus as a design engineer. It also helps communication with my wife when I have my stimulants.”

“ADHD medication has huge benefits. It’s frustrating that the discourse is being steered from the top by someone so willfully ignorant, bringing out everyone who has totally misinformed ‘reckons’ about ADHD.”

Rebuttal from Russell Barkley, Ph.D.

More NYTimes Rebuttals

• 4-Part Video Response from Russell Barkley, Ph.D.
• The Child Mind Institute
• The ADHD Evidence Project

ADHD Article Corrections: Next Steps

• 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

Corrections

This article was updated on April 25, 2025, to reflect the following:

• Wes Crenshaw, Ph.D., reported to ADDitude that he invited the author to interview several ADHD patients, not himself, and that invitation was not accepted
• The CDC’s 2022 estimate for the prevalence of ADHD in American children aged 3-17 years, which is 11.4 percent, not 5 to 7 percent
• Author Paul Tough did not directly describe the ADHD diagnosis process as “arbitrary,” but rather his quoted source, Edmund Sonuga-Barke, did. This quotation was removed.
• The full quote from Tough’s text was included: “If these studies are accurate, stimulant medications don’t do much to improve cognitive ability or academic performance. And yet millions of young Americans (and their parents) feel that the pills are essential to their success in school. Why?”
• This phrase was removed, “…and then questioned why American parents and students would accept the ‘risks inherent in taking prescription stimulants.'” The original article stated: “Researchers acknowledge that there are other risks inherent in taking prescription stimulants.”

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In 44 days, the Make America Healthy Again (MAHA) Commission says it will deliver to President Trump a report — based on existing research, public hearings, roundtables, and meetings but not new studies — on the scope, causes, and treatments related to childhood chronic disease. In its founding documents, the MAHA Commission, chaired by Health and Human Services Secretary Robert F. Kennedy, Jr., singled out autoimmune diseases, autism, and ADHD, which it said “pose a dire threat to the American people and our way of life” and “harm us, our economy, and our security.”

Medical professionals and advocates were swift to condemn the commission’s stigmatizing portrayal of ADHD and autism as “a dire threat,” and challenged its suggestion that chronic conditions like these may be caused by “over-utilization of medication, certain food ingredients, certain chemicals and other exposures” — claims not supported by accepted scientific knowledge and research.

Of greatest concern to caregivers and patients with ADHD was the commission’s vow to “assess the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, stimulants, and weight-loss drugs.” As countless ADDitude readers have said to us: Stimulants are not a threat; they are an essential and effective treatment that mitigates threats to our wellbeing. Many expressed fear that the commission’s actions could restrict access to their prescription medication.

While the commission said it would rely on “transparency and open-source data,” it has not held any reported public hearings or meetings with ADHD experts since it was established in February. News outlets have reported only one closed-door gathering on March 11 with no public invitation or known agenda.

Secretary Kennedy has not responded to ADDitude’s open letter, urging him to consult with ADHD experts and researchers regarding evidence-based findings to effectively treat the condition. However, more than 400 ADDitude readers shared their opinions of the MAHA Commission and its anticipated assessment and final recommendations, which are expected to be delivered to President Trump on August 12.

• 66% of readers said they feel fearful, angry, and/or skeptical of the MAHA Commission
• 23% of readers said they are reserving judgment, feel torn, or are unfamiliar with the MAHA Commission
• 10% expressed excitement or hopefulness about the commission’s work

[New Class! ADHD Treatment Guide for Adults]

Here are some of those opinions, sent to ADDitude in response to the question: What do you think the MAHA Commission assessment, and subsequent recommendations, might mean for your family and others with ADHD, depression, and other related conditions?

Those Who Oppose the MAHA Commission

“I am deeply concerned by this resolution and its negative bias against the medication that has been life-changing for so many people and families. I also find it misaligned with the opinions of the respected researchers like Dr. Russell Barkley who have worked so hard to destigmatize ADHD medication and help people understand that dangerous consequences can come from living without any treatment. I am concerned that this resolution is misrepresenting itself as trying to improve health, when it is actually an effort to restrict treatment options that are already heavily researched and proven.” — an ADDitude reader in Florida

“Health insurance companies will use the commission’s recommendations to make it harder for us to undergo ADHD testing and treatment in every form. They will use it to justify denying requests to receive all types of therapy, medications, etc., and/or increase our payments to receive them. They will use it to justify denying coverage for pre-existing conditions that they no longer feel need to be treated.” — an ADDitude reader in Florida

[Reader Essay: “We Should Never Pull a Life-Saving Medication from a Child.”]

“One assessment by non-experts devoted to a political cause will be wasteful and biased. It will certainly not be worth throwing out an entire body of scientific dispassionate inquiry and knowledge that has accumulated over decades of ADHD research and practice. I can’t imagine what his motive is except to humiliate and dehumanize us.” — an ADDitude reader in Virginia

“This sets us back at least 10 years in mental health care. Referring to any therapeutic treatment as a potential ‘threat’ not only worsens stigma but propagates complete misinformation.” — an ADDitude reader in Colorado

“It is significantly concerning when those without medical knowledge or an understanding of how to look at and critically assess research are making decisions about how to treat health concerns. We are already seeing the impact of unsound decision-making, as previously eradicated illnesses and diseases are making an unwanted comeback. Without informed decision-makers, people will suffer.” — an ADDitude reader in Pennsylvania

“MAHA will probably limit which medications are covered by insurance or Medicaid, making life unaffordable and unbearable for many neurodivergent people who are relying on them just to get through each day. Each person’s body chemistry handles different drug formulas differently, and often it takes trial and error to find the correct med for each person. Taking many of these medications off the table will greatly impact so many.” — an ADDitude reader in North Carolina

“I see a huge threat in this MAHA initiative. It sounds like segregating or eliminating ‘mutants’ at the beginning of a sci-fi movie. Add in the attack on Section 504, and it would seem that anyone who is not physically or neurologically ‘typical’ is not worth helping/saving/protecting. It’s absolutely horrific. I think it could go way beyond limiting treatment, and I believe it would be a massive disservice to our people, and our public health, setting a terrible precedent for who is ‘valuable enough.'” — an ADDitude reader in California

“The very wording of the statement reflects their bias against these vital tools. Their intent is to restrict access and convince people that they don’t work. This will only further harm marginalized communities that already receive care at lower rates.” — an ADDitude reader in Arkansas

“I am terrified of the outcome of this so-called assessment. For several years we’ve tried to find the right drug combination for my daughter. Now we seem to have it, and I’m afraid it will be stripped away in a couple of months. We both have ADHD, take stimulants, as well as meds for anxiety and depression. If they are no longer available to us, I will attempt to migrate to Canada, seeking asylum based on the fact that living in the U.S. would put our health severely at risk.” — an ADDitude reader in Texas

“No different than a Type-1 diabetic who needs insulin to lower blood sugar levels, my son’s brain needs these medications to help balance its chemistry. Without them, I’m certain he would not be able to attend school. Our insurance company makes me fight every month for the medication he has. I can’t imagine more limitations!” — an ADDitude reader in Oregon

“If the recommendations lead to stricter limitations on the prescribing of medications, it may force individuals with ADHD, depression, and other mental health conditions to turn to less effective or more dangerous treatment options. Additionally, limiting prescribed medications could reinforce the stigma surrounding mental health, making it harder for individuals with ADHD and depression to seek help as their treatment options are limited.” — an ADDitude reader

“I exercise, eat healthy, meditate, blah blah blah, and only the meds make my brain work better. I can feel the moment it turns on. Take the meds away, and you have mayhem at work, and at home. It’s mind-bending to ponder the consequences.” — an ADDitude reader in New Mexico

“I can’t even think about this without feeling ill. On the surface, I look like a normal, functioning professional with an advanced degree. I am fortunate to have landed a job with a six-figure salary, but I can’t tell you how many nights I spent curled up crying during the stimulant shortages because I was terrified that I would lose my job if I couldn’t function without my medication. Not to mention how hopeless and embarrassed I felt having to desperately call every local pharmacy to see if they had medication in stock. We need to broaden access — not limit it.”- an ADDitude reader in Michigan

“Politicians should not be interfering with medication access or making decisions on what is or isn’t safe. That’s what the FDA is for. These headlines make me extremely anxious and, in a way, feel less than — like those who want to ban SSRIs and other medications do not care about those of us who need them.” — an ADDitude reader in Michigan

“They are targeting medications that truly make a difference in the day-to-day lives of ADHD brains and their parents. If some of these medications get taken off the market, there will increases in suicides. Taking away what works without viable alternative solutions is a huge mistake. As a scientist, I’m scared of people who are not accepting of scientific proof.” — an ADDitude reader

“Based on the anti-science rhetoric from this new administration, I am afraid they may act to limit the usage of these medications based on their motivated reasoning. They will disregard the body of evidence, and use false-cause, anecdotal, and Texas sharpshooter fallacies to do real harm to Americans who need these medications to function or even survive.” — an ADDitude reader

Those Who Support the MAHA Commission

“I’m hoping for a broad, holistic, ground-up approach where our treatment options outside of medications are expanded and supported and made more financially accessible to make needed medications and prescriptions more effective.” — an ADDitude reader in Georgia

“I want to know that what my kids are taking is actually safe, actually healthy, and actually doing what it should be doing. We should not be afraid of that. If they find that pharmaceutical companies are lying to us, then please, by all means, take the medications out of production and find us alternatives that really do help! I say this as a mother of four children on ADHD and depression/anxiety medications.” — an ADDitude reader in Minnesota

“I tend to be more conservative when it comes to diagnosing and medication management, so I think we need an assessment of the system with new recommendations from a new perspective. In the 30 years I have been a social worker, I have seen many over-diagnosed and over-medicated clients. I think we need to go to a more holistic approach. I feel that meds are often prescribed in isolation, when they should be in combination with therapy or other forms of counseling/support groups. Mental health is a huge crisis, but even more so is the over-medication of the U.S. population. I welcome the oversight.” — an ADDitude reader in Maryland

“Healthcare in the U.S. needs to be reformed and the only way to do that is to shake things up. It would mean we can get rid of things that aren’t working and implement new policies and ideas that will work. It might mean we have to fight harder for the things that matter but when we work together anything is possible!” — an ADDitude reader

Those Undecided on the MAHA Commission

“My initial reaction was fear and disbelief — wondering why this was being investigated and whether I might have trouble accessing my medications. But once I engaged my professional mindset, I realized the potential harm of prescribing antidepressants and other psychiatric medications too freely. When these medications are used as a quick fix rather than addressing underlying issues — such as biological conditions, illnesses, or nutritional deficiencies — it can be dangerous.” — an ADDitude reader in Texas

“I think it’s important for scientists and doctors to continuously assess and research all medications to ensure they’re effective and safe, but the language of referring to these as a potential ‘threat’ is harmful and potentially dangerous. It could increase stigma, reduce access to medications for those who need them, and contribute to a broader uptick in ableism especially toward mental health disorders. I also think that it sets a dangerous precedent of politicizing health issues, which could further contribute toward not only stigma but misinformation from politicians who are not medically trained or certified, harmful policies and legislation targeting people with mental and physical disabilities, and a cultural shift away from accommodations, accessibility, and legal protections for people affected by mental health disorders.” — an ADDitude reader in Colorado

“A review of these medications may lead to more informed prescribing practices, ensuring that treatments are effective and necessary. This could improve patient outcomes and tailor treatment to individual needs, which is crucial for managing conditions like ADHD and depression. However, there are potential risks associated with the recommendations that could affect access to treatment. If the assessment finds that certain medications are being overprescribed or misused, it might result in stricter regulations or guidelines that could limit access for those who genuinely need these medications. Moreover, increased examination and discussion around these medications may inadvertently contribute to stigma.” — an ADDitude reader in Australia

MAHA Commission: Next Steps

• Free Download: The Ultimate Guide to ADHD Medication
• Read: “Disability Is DEI.”
• Reader Reactions: “I’m Truly Scared for What This Could Mean”

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In reality, there is no crisis.

The rise in diagnoses reflects a long-overdue recognition of neurodivergence — particularly among girls, women, and people of color who were historically overlooked — rather than a sudden explosion in neurodivergent individuals.

Neurodivergence Overlooked: A Well-Documented Pattern

My own neurodivergence was overlooked for many years. As a child, the only label my brain was ever given was “gifted.” At the same time, I struggled with sensory overload, social exhaustion, and the inability to complete simple tasks despite excelling in areas that schools valued. Yet, like many high-achieving girls, my difficulties were attributed to personality quirks rather than neurological differences.

It wasn’t until adulthood, while seeking evaluations for my own children, that I saw myself in the screening questions and research, leading to my own diagnoses of ADHD and autism. Like many women, I only began to understand my brain after fighting for my children to be understood.

[Take This Free Screening Test: Autism in Women]

What Explains Rising Rates of ADHD and Autism?

At first glance, rising autism and ADHD diagnoses may seem like evidence of a true increase. But research points to three other drivers: changes in diagnostic criteria, greater awareness, and increased access to evaluations.

Decades ago, autism was largely understood in terms of its most visible and disabling presentations, meaning that countless individuals — especially women, people of color, and those with high-masking traits — were overlooked. Research shows, for instance, that autistic females often camouflage their autistic traits, leading to delayed or missed diagnoses.

Similarly, ADHD was historically viewed as a disorder affecting only young boys. We understand today that women with ADHD often exhibit internalized symptoms, such as inattentiveness and emotional dysregulation, which deviate from the hyperactive, disruptive stereotypes commonly associated with the condition.

Increasing awareness of neurodiversity in general has made many people more likely to recognize signs of autism and ADHD that may have gone unnoticed in previous generations. The availability of evaluations has expanded as well, making it somewhat easier to obtain a diagnosis. And since a formal diagnosis is often required to access educational accommodations or workplace protections, many individuals have a stronger incentive to pursue assessment than in the past.

It’s also possible that neurodivergence itself has increased slightly over time due to environmental or societal influences. Some researchers have investigated whether prenatal exposures — such as pollution, maternal stress, or certain medications — could play a role, though no consensus has emerged. Others speculate that modern life, with its increasing reliance on digital stimulation, structured schooling, and high cognitive demands, may be making traits associated with autism and ADHD more noticeable or challenging.

[Watch: An Open Conversation with Temple Grandin – Autism Expert, Author, and Scientist”]

However, there is no clear evidence that these conditions are becoming more biologically prevalent, only that we are finally recognizing and understanding them on a broader scale. It’s not that more people have suddenly become neurodivergent, but that more of those who were always neurodivergent are now being identified.

Celebration, Not Alarm

Some worry that broadened diagnostic criteria has blurred important distinctions, grouping together individuals with vastly different experiences and needs. They argue this could make it harder for neurodivergent people to secure the right support, especially if those with lower support needs are seen as “using up” resources meant for those with greater needs.

But from what I’ve seen, the opposite seems to be happening. The increase in diagnoses is driving greater awareness and acceptance of varied neurodivergent experiences and that, in turn, is fueling a more unified and politically powerful advocacy movement.

The fact that more people are receiving diagnoses should be cause for celebration, not alarm. It means that more of us are gaining access to self-understanding, accommodations, and community. Autistic adults who receive a formal diagnosis report higher self-esteem and overall psychological well-being, attributing their improved mental health to better self-understanding and acceptance. Many autistic adults describe their newfound understanding of their neurodivergent mind as transformative, giving them a greater sense of identity.

The rise in diagnoses is a sign that we are finally beginning to recognize and support the diversity of human minds. Rhetoric to the contrary reflects a fundamental misunderstanding of what is happening in the neurodiversity space, and threatens to roll back progress, reinforce stigma, and making it harder for people to seek the support they need.

The answer isn’t to reduce diagnoses by retreating to outdated ideas about neurological differences. The answer is to build a neurodiversity-affirming world — one where fewer people need a diagnosis just to be seen, heard, and supported.

ADHD and Autism: Next Steps

• Take our self-tests:
  • Adult ADHD
  • Adult autism
  • ADHD in women
  • Autism in women
• Learn: How to get evaluated for autism as an adult
• Free Download: Bring this checklist to your autism evaluation
• Learn: Autism and ADHD in adults
• Understand: The auDHD experience

Charlotte Hill, Ph.D., is a policy analyst and neurodiversity educator in Oakland, California. 

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Calls to Action: MAHA Commission Testimony & Advocacy

• Submit your testimony to the MAHA Commission by contacting MAHA Commission Chair Robert Kennedy, Jr. at https://x.com/SecKennedy, and media@hhs.gov
• Join the advocacy efforts organized by CHADD
• Contact your national, state, and local representatives to share your testimony and the evidence-based research on ADHD below

February 26, 2025

Dear Secretary Kennedy,

As the Make America Healthy Again Commission begins its evaluation of published research on the chronic health conditions impacting American children, we urge it to consult with the esteemed clinicians associated with the American Professional Society of ADHD and Related Disorders (APSARD), the American Academy of Pediatrics (AAP), and the World Federation of ADHD regarding the established science on ADHD causes and treatments. Consensus within these groups, and among ADHD researchers worldwide, is strong and consistent regarding the following evidence-based findings:

• ADHD is a chronic neurodevelopmental condition characterized by inattention, impulsivity, executive dysfunction, and/or hyperactivity that persists into adulthood for approximately 90% of patients.¹
• ADHD is a highly genetic condition.^2,3,4 Lifestyle factors such as nutrition, exercise, and sleep exert epigenetic changes on DNA that influence how strongly or weakly ADHD genes are expressed. However, diet, physical activity, sleep, or screen use alone do not cause — and have not been shown to “cure” — ADHD.
• The 16% increase in ADHD diagnoses over the last decade is due, in large part, to revised diagnostic criteria published in the DSM-5, which changed the maximum age of onset from 7 to 12 and added the first-ever qualifier symptoms for ADHD in adulthood. This wider net, along with improved education, training, and symptom recognition, particularly in historically overlooked girls and women, account for much of the diagnostic uptick, according to studies.^{5, 6}
• Scientific research has established no causal link between excessive screen time, video game play, or social media use  and ADHD.⁷ Some studies suggest these habits may exacerbate inattention and impulsivity.^{8, 9}
• Scientific research has established no causal link between consumption of sugar, food additives, or food dyes and ADHD, though some studies show a heightened sensitivity among children with ADHD to these foods, which may exacerbate existing symptoms.¹⁰
• Scientific research shows that prenatal and/or childhood exposure to tobacco, lead, pesticides, and polychlorinated biphenyls (PCBs) may increase the odds of ADHD in some children, however the studies do not find direct causality.^{11,12, 13,14}
• Several research studies have shown that consumption of a Western diet high in processed foods, fats, sugars, and salt is associated with higher rates of ADHD, however these studies demonstrate an association rather than causality.¹⁵
• ADHD shortens an individual’s life expectancy by 7.5 years, on average.¹⁶ It is serious, potentially lethal, and associated with elevated risks for comorbid conditions ^{17, 18} including anxiety, depression,¹⁹ substance use disorder,²⁰ eating disorders,^{21, 22} obesity, and oppositional defiant disorder,²³ which commonly derails treatment plans and parenting strategies. People with ADHD are more likely to get into car accidents,²⁴ become hospitalized, and engage in self-harm than are their neurotypical peers.^{25, 26, 27}
• In patients with the condition, ADHD medication use reduces the risk of death by 19%, the risk of overdose by 50%,²⁸ the risk of substance abuse by 50%,²⁹ and the risk of motor vehicle accidents by at least 38%.³⁰ Its effective symptom management improves patients’ self-esteem and efficacy, thereby reducing the risk of self-harm and suicide, as well as negative life outcomes such as unwanted pregnancy, incarceration, unemployment, and interruption of education.
• The medications used to treat ADHD have been studied rigorously and used safely for 88 years. Amphetamine and methylphenidate safely and effectively reduce ADHD symptoms, with methylphenidate reducing symptoms by 70% to 90% in children and adults with the condition.^{31, 32} The effect sizes for ADHD medication are .8 to 1.0,³³  which are among the strongest in all of psychiatry. Clinical practice guidelines recommend medication as the first-line treatment for ADHD due to its overwhelming efficacy; for children with ADHD ages 4 to 6, parent behavior training is recommended by the AAP.³⁴
• According to the CDC, just 53.6% of all children and teens with ADHD reported they were actively treating their symptoms with medication in 2022. Because stimulant medications are classified as Schedule II drugs under the Controlled Substances Act, they are tightly regulated; supplies are limited to 30 days and prescribing clinicians must authorize monthly refills. The widely reported ADHD medication shortage has disrupted treatment for millions of patients across the country since 2022.³⁵
• Caregivers and adults with ADHD surveyed by ADDitude rate medication as the most effective treatment for ADHD, however less than half of parents report that they chose to medicate their children within 6 months of diagnosis. They report changing diet, limiting screen time, supplementing with fish oil, and increasing physical activity before ultimately using medication to achieve the symptom improvement necessary for academic and social success.
• The mild to moderate side effects associated with ADHD medication include appetite suppression, irritability or moodiness, sleep problems, and headaches. There is no evidence that ADHD medication use leads to dependency or broader substance abuse; in fact, research shows that ADHD medication use is protective against substance use disorder in individuals with ADHD.³⁶
• The non-stimulant medications used to treat ADHD, such as atomoxetine, guanfacine, and clonidine, have an effect size of .4 to .7 and are considered a second-line treatment appropriate for patients who do not tolerate or cannot take stimulants.^{37, 38, 39}
• Clinical guidelines promote the use of multimodal treatment plans that pair prescription medication with complementary approaches to ADHD management. The nonpharmacological interventions shown to be most effective at reducing ADHD symptoms in children are behavioral therapy (effect size of .5 to.8 when used on its own),⁴⁰ exercise (effect size of .4 to .6 when used on its own),⁴¹ sleep hygiene and interventions (effect size of .5 to .8 when used on their own),⁴² and dietary interventions (effect size of .2 to .5 when used on their own).⁴³
• Behavioral therapy, principally parent training, has an elevated and improved effect when used in conjunction with ADHD medication.⁴⁴ Behavioral therapy is used by just 44% of pediatric patients, in part because it’s not always covered by medical insurance and knowledgeable providers are scarce.
• One meta-analysis of randomized, placebo-controlled trials showed that supplementation with high doses of omega-3 fatty acids has a small positive impact on attention and hyperactivity in children.⁴⁵
• Research suggests that restricting the consumption of synthetic food dyes does benefit some children with ADHD, though aggregate effects are quite small.⁴⁶
• When engaging in vigorous cardiovascular exercise, the brain releases endorphins. Levels of dopamine, norepinephrine, and serotonin also increase with exercise, thus improving focus, working memory, and mood to enable better learning.
• Cognitive behavioral therapy (CBT), though more commonly prescribed to adult patients, has been shown to improve core ADHD symptoms in adolescents when used in conjunction with ADHD medication.⁴⁷
• Neurofeedback uses an electroencephalogram (EEG) to measure brain activity and train the patient to produce brain wave patterns like those of a non-ADHD brain. Neurofeedback has not shown enough effectiveness in studies to be recommended as a “stand-alone” treatment for ADHD and there is little evidence that neurofeedback reduces ADHD symptoms long-term. In addition, neurofeedback is seldom covered by insurance and involves a significant investment of time and money.^{48, 49, 50}
• According to research, brain training does not reduce ADHD symptoms. There is no evidence that a patient can train a brain to improve working memory, or any other executive function.^{51, 52, 53}

Thank you for reviewing the evidence-based research highlighted above. We welcome follow-up questions from the Commission as it devises recommendations based on science that may benefit the health and wellbeing of the 22 million Americans with ADHD, whom ADDitude has served for the last 26 years. We support their personal liberty to pursue and maintain the treatments that benefit their ADHD brains, which are a tremendous asset to this nation.

Sincerely,
Anni Rodgers
General Manager, ADDitude

Sources

¹Sibley, M., Arnold, L, Swanson, J. et.al. (13 August 2021). Variable patterns of remission from ADHD in the multimodal treatment study of ADHD. The American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.2021.21010032

²Faraone, Stephen V. et al. Molecular Genetics of Attention-Deficit/Hyperactivity Disorder, Biological Psychiatry, Volume 57, Issue 11, 1313 – 1323

³Liuyan Zhang, Suhua Chang, Zhao Li, Kunlin Zhang, Yang Du, Jurg Ott, Jing Wang, ADHDgene: a genetic database for attention deficit hyperactivity disorder, Nucleic Acids Research, Volume 40, Issue D1, 1 January 2012, Pages D1003–D1009, https://doi.org/10.1093/nar/gkr992

⁴Gizer, I.R., Ficks, C. & Waldman, I.D. Candidate gene studies of ADHD: a meta-analytic review. Hum Genet 126, 51–90 (2009). https://doi.org/10.1007/s00439-009-0694-x

⁵Mowlem, F.D., Rosenqvist, M.A., Martin, J. et al. Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment. Eur Child Adolesc Psychiatry 28, 481–489 (2019). https://doi.org/10.1007/s00787-018-1211-3

⁶Abdelnour E, Jansen MO, Gold JA. ADHD Diagnostic Trends: Increased Recognition or Overdiagnosis? Mo Med. 2022 Sep-Oct;119(5):467-473. PMID: 36337990; PMCID: PMC9616454.

⁷Nikkelen, S. W., Valkenburg, P. M., Huizinga, M., & Bushman, B. J. (2014). “Media use and ADHD-related behaviors in children and adolescents: A meta-analysis.” Developmental Psychology, 50(9), 2228-2241.

⁸Madigan S, Browne D, Racine N, Mori C, Tough S. Association Between Screen Time and Children’s Performance on a Developmental Screening Test. JAMA Pediatr. 2019;173(3):244–250. doi:10.1001/jamapediatrics.2018.5056

⁹Yifei, P, Xuechun, L,Yu, Y. (2023). Screen use and its association with ADHD symptoms among children: a systematic review. MEDS Public Health and Preventive Medicine, 3.10.23977/phpm.2023.030301

¹⁰Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry. 2012 Jan;51(1):86-97.e8. doi: 10.1016/j.jaac.2011.10.015. PMID: 22176942; PMCID: PMC4321798.

¹¹Huang L, Wang Y, Zhang L, Zheng Z, Zhu T, Qu Y, Mu D. Maternal Smoking and Attention-Deficit/Hyperactivity Disorder in Offspring: A Meta-analysis. Pediatrics. 2018 Jan;141(1):e20172465. doi: 10.1542/peds.2017-2465. PMID: 29288161.

¹²Goodlad JK, Marcus DK, Fulton JJ. Lead and Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms: a meta-analysis. Clin Psychol Rev. 2013 Apr;33(3):417-25. doi: 10.1016/j.cpr.2013.01.009. Epub 2013 Jan 29. PMID: 23419800.

¹³Nigg JT, Nikolas M, Mark Knottnerus G, Cavanagh K, Friderici K. Confirmation and extension of association of blood lead with attention-deficit/hyperactivity disorder (ADHD) and ADHD symptom domains at population-typical exposure levels. J Child Psychol Psychiatry. 2010 Jan;51(1):58-65. doi: 10.1111/j.1469-7610.2009.02135.x. Epub 2009 Nov 23. PMID: 19941632; PMCID: PMC2810427.

¹⁴Eubig PA, Aguiar A, Schantz SL. Lead and PCBs as risk factors for attention deficit/hyperactivity disorder. Environ Health Perspect. 2010 Dec;118(12):1654-67. doi: 10.1289/ehp.0901852. Epub 2010 Sep 9. PMID: 20829149; PMCID: PMC3002184.

¹⁵Howard AL, Robinson M, Smith GJ, Ambrosini GL, Piek JP, Oddy WH. ADHD is associated with a “Western” dietary pattern in adolescents. J Atten Disord. 2011 Jul;15(5):403-11. doi: 10.1177/1087054710365990. Epub 2010 Jul 14. PMID: 20631199.

¹⁶O’Nions E, El Baou C, John A, et al. Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study. The British Journal of Psychiatry. Published online 2025:1-8. doi:10.1192/bjp.2024.199

¹⁷Gnanavel S, Sharma P, Kaushal P, Hussain S. Attention deficit hyperactivity disorder and comorbidity: A review of literature. World J Clin Cases 2019; 7(17): 2420-2426 [PMID: 31559278 DOI: 10.12998/wjcc.v7.i17.2420]

¹⁸Kessler, Ronald & Adler, Lenard & Barkley, Russell & Biederman, Joseph & Conners, C & Demler, Olga & Faraone, Stephen & Greenhill, Laurence & Howes, Mary & Boye, Kristina & Spencer, Thomas & Ustun, Tevfik & Walters, Ellen & Zaslavsky, Alan. (2006). The Prevalence and Correlates of Adult ADHD in the United States: Results From the National Comorbidity Survey Replication. The American journal of psychiatry. 163. 716-23. 10.1176/appi.ajp.163.4.716.

¹⁹Babinski DE, Neely KA, Ba DM, Liu G. Depression and Suicidal Behavior in Young Adult Men and Women With ADHD: Evidence From Claims Data. J Clin Psychiatry. 2020 Sep 22;81(6):19m13130. doi: 10.4088/JCP.19m13130. PMID: 32965804; PMCID: PMC7540206.

²⁰Katelijne van Emmerik-van Oortmerssen, Geurt van de Glind, Wim van den Brink, Filip Smit, Cleo L. Crunelle, Marije Swets, Robert A. Schoevers, Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: A meta-analysis and meta-regression analysis, Drug and Alcohol Dependence, Volume 122, Issues 1–2, 2012, Pages 11-19, ISSN 0376-8716, https://doi.org/10.1016/j.drugalcdep.2011.12.007.

²¹Nazar BP, Bernardes C, Peachey G, Sergeant J, Mattos P, Treasure J. The risk of eating disorders comorbid with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Int J Eat Disord. 2016 Dec;49(12):1045-1057. doi: 10.1002/eat.22643. Epub 2016 Nov 15. PMID: 27859581.

²²Curtin, Carol & Pagoto, Sherry & Mick, Eric. (2013). The association between ADHD and eating disorders/pathology in adolescents: A systematic review. Open Journal of Epidemiology. 3. 193-202. 10.4236/ojepi.2013.34028.

²³Nock MK, Kazdin AE, Hiripi E, Kessler RC. Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: results from the National Comorbidity Survey Replication. J Child Psychol Psychiatry. 2007 Jul;48(7):703-13. doi: 10.1111/j.1469-7610.2007.01733.x. PMID: 17593151.

²⁴Curry AE, Yerys BE, Metzger KB, Carey ME, Power TJ. Traffic Crashes, Violations, and Suspensions Among Young Drivers With ADHD. Pediatrics. 2019 Jun;143(6):e20182305. doi: 10.1542/peds.2018-2305. Epub 2019 May 20. PMID: 31110164; PMCID: PMC6564068.

²⁵Ward JH, Curran S. Self-harm as the first presentation of attention deficit hyperactivity disorder in adolescents. Child Adolesc Ment Health. 2021 Nov;26(4):303-309. doi: 10.1111/camh.12471. Epub 2021 May 3. PMID: 33939246.

²⁶Hinshaw SP, Owens EB, Zalecki C, Huggins SP, Montenegro-Nevado AJ, Schrodek E, Swanson EN. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. J Consult Clin Psychol. 2012 Dec;80(6):1041-1051. doi: 10.1037/a0029451. Epub 2012 Aug 13. PMID: 22889337; PMCID: PMC3543865.

²⁷Ping-I Lin, Weng Tong Wu, Enoch Kordjo Azasu, Tsz Ying Wong, Pathway from attention-deficit/hyperactivity disorder to suicide/self-harm, Psychiatry Research, Volume 337, 2024, 115936, ISSN 0165-1781, https://doi.org/10.1016/j.psychres.2024.115936.

²⁸Li L, Zhu N, Zhang L, Kuja-Halkola R, D’Onofrio BM, Brikell I, Lichtenstein P, Cortese S, Larsson H, Chang Z. ADHD Pharmacotherapy and Mortality in Individuals With ADHD. JAMA. 2024 Mar 12;331(10):850-860. doi: 10.1001/jama.2024.0851. PMID: 38470385; PMCID: PMC10936112.

²⁹Faraone SV, Wilens T. Does stimulant treatment lead to substance use disorders? J Clin Psychiatry. 2003;64 Suppl 11:9-13. PMID: 14529324.

³⁰Chang Z, Quinn PD, Hur K, et al. Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes. JAMA Psychiatry. 2017;74(6):597–603. doi:10.1001/jamapsychiatry.2017.0659

³¹Spencer, Thomas et al. A large, double-blind, randomized clinical trial of methylphenidate in the treatment of adults with attention-deficit/hyperactivity disorder, Biological Psychiatry, Volume 57, Issue 5, 456 – 463

³²Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Leibson CL, Jacobsen SJ. Long-term stimulant medication treatment of attention-deficit/hyperactivity disorder: results from a population-based study. J Dev Behav Pediatr. 2006 Feb;27(1):1-10. doi: 10.1097/00004703-200602000-00001. PMID: 16511362.

³³Faraone, S. V., & Buitelaar, J. (2010). “Comparing the efficacy of stimulants for ADHD in children and adolescents using meta-analysis.” European Child & Adolescent Psychiatry, 19(4), 353-364.

³⁴Centers for Disease Control and Prevention. (2022, March 8). Treatment recommendations for healthcare providers. https://www.cdc.gov/adhd/hcp/treatment-recommendations/index.html.

³⁵Grossi, G. US ADHD Stimulant Shortage Highlights Growing Challenges in Adult Treatment. AJMC. 2024 Nov. https://www.ajmc.com/view/us-adhd-stimulant-shortage-highlights-growing-challenges-in-adult-treatment

³⁶Quinn PD, Chang Z, Hur K, Gibbons RD, Lahey BB, Rickert ME, Sjölander A, Lichtenstein P, Larsson H, D’Onofrio BM. ADHD Medication and Substance-Related Problems. Am J Psychiatry. 2017 Sep 1;174(9):877-885. doi: 10.1176/appi.ajp.2017.16060686. Epub 2017 Jun 29. PMID: 28659039; PMCID: PMC5581231.

³⁷Newcorn, J. H., Kratochvil, C. J., Allen, A. J., Casat, C. D., Ruff, D. D., Moore, R. J., & Michelson, D. (2008). “Atomoxetine and osmotically released methylphenidate for the treatment of attention deficit hyperactivity disorder: acute comparison and differential response.” American Journal of Psychiatry, 165(6), 721-730.

³⁸Sallee FR, McGough J, Wigal T, Donahue J, Lyne A, Biederman J; SPD503 STUDY GROUP. Guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder: a placebo-controlled trial. J Am Acad Child Adolesc Psychiatry. 2009 Feb;48(2):155-65. doi: 10.1097/CHI.0b013e318191769e. PMID: 19106767.

³⁹Connor DF, Findling RL, Kollins SH, Sallee F, López FA, Lyne A, Tremblay G. Effects of guanfacine extended release on oppositional symptoms in children aged 6-12 years with attention-deficit hyperactivity disorder and oppositional symptoms: a randomized, double-blind, placebo-controlled trial. CNS Drugs. 2010 Sep;24(9):755-68. doi: 10.2165/11537790-000000000-00000. PMID: 20806988.

⁴⁰Fabiano GA, Pelham WE Jr, Coles EK, Gnagy EM, Chronis-Tuscano A, O’Connor BC. A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clin Psychol Rev. 2009 Mar;29(2):129-40. doi: 10.1016/j.cpr.2008.11.001. Epub 2008 Nov 11. PMID: 19131150.

⁴¹Cerrillo-Urbina AJ, García-Hermoso A, Sánchez-López M, Pardo-Guijarro MJ, Santos Gómez JL, Martínez-Vizcaíno V. The effects of physical exercise in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis of randomized control trials. Child Care Health Dev. 2015 Nov;41(6):779-88. doi: 10.1111/cch.12255. Epub 2015 May 18. PMID: 25988743.

⁴²Ogundele MO, Yemula C. Management of sleep disorders among children and adolescents with neurodevelopmental disorders: A practical guide for clinicians. World J Clin Pediatr. 2022 Mar 15;11(3):239-252. doi: 10.5409/wjcp.v11.i3.239. PMID: 35663001; PMCID: PMC9134149.

⁴³Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry. 2012 Jan;51(1):86-97.e8. doi: 10.1016/j.jaac.2011.10.015. PMID: 22176942; PMCID: PMC4321798.

⁴⁴A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Arch Gen Psychiatry. 1999 Dec;56(12):1073-86. doi: 10.1001/archpsyc.56.12.1073. PMID: 10591283.

⁴⁵Richardson, A. J., Puri, B. K. (2002). “A randomized double-blind, placebo-controlled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties.” Progress in Neuro-Psychopharmacology & Biological Psychiatry, 26(2), 233-239.

⁴⁶Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry. 2012 Jan;51(1):86-97.e8. doi: 10.1016/j.jaac.2011.10.015. PMID: 22176942; PMCID: PMC4321798.

⁴⁷Ojinna BT, Parisapogu A, Sherpa ML, Choday S, Ravi N, Giva S, Shantha Kumar V, Shrestha N, Tran HH, Penumetcha SS. Efficacy of Cognitive Behavioral Therapy and Methylphenidate in the Treatment of Attention Deficit Hyperactivity Disorder in Children and Adolescents: A Systematic Review. Cureus. 2022 Dec 17;14(12):e32647. doi: 10.7759/cureus.32647. PMID: 36660538; PMCID: PMC9845961.

⁴⁸Gevensleben, H., Moll, G. H., Rothenberger, A., & Heinrich, H. (2014). Neurofeedback in attention-deficit/hyperactivity disorder – different models, different ways of application. Frontiers in human neuroscience, 8, 846. https://doi.org/10.3389/fnhum.2014.00846

⁴⁹ Arnold, L. E., Lofthouse, N., Hersch, S., Pan, X., Hurt, E., Bates, B., Kassouf, K., Moone, S., & Grantier, C. (2013). EEG neurofeedback for ADHD: double-blind sham-controlled randomized pilot feasibility trial. Journal of attention disorders, 17(5), 410–419. https://doi.org/10.1177/1087054712446173

⁵⁰Ramsay, J. R. (2010). Neurofeedback and neurocognitive training. In J. R. Ramsay, Nonmedication treatments for adult ADHD: Evaluating impact on daily functioning and well-being (pp. 109–129). American Psychological Association. https://doi.org/10.1037/12056-006

⁵¹ Gathercole S. E. (2014). Commentary: Working memory training and ADHD – where does its potential lie? Reflections on Chacko et al. (2014). Journal of child psychology and psychiatry, and allied disciplines, 55(3), 256–257. https://doi.org/10.1111/jcpp.12196

⁵² Chacko, A., Bedard, A. C., Marks, D. J., Feirsen, N., Uderman, J. Z., Chimiklis, A., Rajwan, E., Cornwell, M., Anderson, L., Zwilling, A., & Ramon, M. (2014). A randomized clinical trial of Cogmed Working Memory Training in school-age children with ADHD: a replication in a diverse sample using a control condition. Journal of child psychology and psychiatry, and allied disciplines, 55(3), 247–255. https://doi.org/10.1111/jcpp.12146

⁵³ Hulme, C., & Melby-Lervåg, M. (2012). Current evidence does not support the claims made for CogMed working memory training. Journal of Applied Research in Memory and Cognition, 1(3), 197–200. https://doi.org/10.1016/j.jarmac.2012.06.006