Originally written in 2015. Revised and updated in 2025. Looking for the latest reflections? Read Part 3: Ten Years Later for updates on neurodiversity, hormone-related symptom changes, stimulant safety, and more.
During my four years of residency in Psychiatry, it was pretty rare for me to come across an adult with ADHD (Attention Deficit Hyperactivity Disorder) so I understand the skepticism that some people have (including some mental health professionals) regarding the validity of ADHD. Skeptics often argue that ADHD is a manufactured condition—a product of pharmaceutical marketing and the pathologizing of normal human responses to a changing, stimulation-seeking society.
There’s also evidence of concerning consequences from both the diagnosis and its primary treatments. For example, CDC data show that stimulants (the primary class of ADHD medications) are being prescribed to toddlers for behavioral issues—especially among lower-income and minority populations.
Stimulant misuse is another. One survey found that 20% of college students had used someone else’s prescription stimulant at least once. This is troubling, especially since stimulants belong to a class of medications with a known potential for abuse. ADHD diagnoses among school-aged children have continued to rise over the past two decades, and with that, stimulant prescriptions have increased as well.
There are even for-profit clinics that charge thousands of dollars for proprietary evaluations using brain scans to diagnose ADHD—and determine which of six “subtypes” you have. And that’s just the cost of the evaluation; treatment is extra.
But despite all of the above, now with over 20 years in practice, I’ve evaluated and helped many people with ADHD. What’s been affirmed through that experience is this: ADHD is real, exists outside the context of “normal” distractibility, and causes genuine impairment. Thankfully, evaluating for ADHD is straightforward and typically involves a careful and reliable history. Further confirmation can come from standardized psychological and educational testing. No other tests are required. Brain scans, in particular, are not currently validated as reliable diagnostic tools.
What Is ADHD?
The core symptoms of ADHD are:
- Situational challenges maintaining attention
- Distractibility
- Impulsivity
- Poor working memory—the kind used for real-time, short-term processing (not long-term recall)
These symptoms are persistent (not episodic), and they’ve been present since early childhood.
This consistent symptom profile—persistent, developmental, and impairing—makes ADHD distinguishable from other conditions. Fortunately, treatment is often straightforward, generally safe, and can lead to meaningful, often immediate benefits for both individuals and families.
But why so much controversy then?
Why Prescribe Medication? And Specifically, Why Stimulants?
One reason for controversy is that the most common treatment for ADHD is a daily medication—and for many, that means daily medication for children. And not just any medication: it’s an amphetamine, a controlled substance regulated by the DEA because of its abuse potential.
By contrast, conditions like Depression or Anxiety often start with psychotherapy as the first line of treatment. So why is medication often first for ADHD?
First: Because it works—and quickly. About 80% of individuals with ADHD show meaningful improvement with stimulant medication.
Although stimulants affect dopamine and norepinephrine, the prevailing theory is that they help regulate the neurotransmitter glutamate in two key brain areas: one for sustaining attention, and another for filtering distractions. So instead of “stimulating a bored brain,” they function more like neuromodulators, balancing activity in the prefrontal cortex to help coordinate focus and task switching.
At the doses typically prescribed, the amount of medication that reaches the brain is too modest to cause noticeable ‘stimulation.’
Second: Research consistently shows that medication strategies are significantly more effective than non-medication approaches.
This was first shown in 1970s studies comparing methylphenidate (Ritalin) to behavioral strategies. It was confirmed decades later in the landmark MTA Cooperative Group study, which compared medication, behavioral therapy, combined treatment, and standard community care. Medication outperformed all other options.
Unlike in Depression and Anxiety—where medication and therapy are often equally effective—ADHD responds best to medication, particularly in the short term.
Third: Despite theoretical concerns, stimulant medications are generally well tolerated.
There’s over 40 years of real-world use. Common side effects include appetite suppression and sleep disruption. Some individuals experience irritability when the medication wears off. These effects can be challenging, but they’re usually mild and improve over time. Missing a daily dose can cause fatigue or drowsiness, but there are no serious withdrawal symptoms.
Concerns about growth suppression have not been supported long term. Nor has the worry that stimulants cause addiction.
In fact, long-term studies show that untreated ADHD carries a higher risk of substance abuse—and that this risk is meaningfully reduced with proper stimulant treatment (Wilens et al., Pediatrics, 2003).
So why don’t stimulants cause addiction when prescribed appropriately? It comes down to dose and delivery. Our bodies can manage low, steady exposures to many substances—but react poorly to overwhelming doses.
For example, a healthy diet allows the body to regulate blood sugar. A high-sugar diet overwhelms that system, leading to cravings, fat storage, and Type 2 Diabetes.
Even water—essential for life—can be toxic if consumed in excess (a condition called psychogenic polydipsia).
In the same way, the small doses of stimulants prescribed for ADHD optimize brain function without overwhelming it. These medications are designed to regulate activity—not flood the brain with stimulation. Only when taken in high, misused doses do they cause harmful changes in brain chemistry.
In fact, the brain activity produced by therapeutic doses of stimulants closely resembles what we see during normal stress (through norepinephrine) or healthy excitement (through dopamine)—but without the emotional intensity. In that sense, the medication supports brain function within the natural range, not beyond it.
This may also explain why most people don’t need ever-increasing doses. Effective therapeutic use doesn’t overwhelm the brain’s reward systems. Unlike substances of abuse—which trigger spikes in dopamine and create tolerance through overstimulation—prescribed stimulants work by tuning brain function, not overriding it. That’s why dependence and addiction are far less likely when used as intended.
Is ADHD a Made Up Diagnosis?
The next controversy is the belief held by some that ADHD is a modern invention—meant to explain away the natural consequences of a fast-paced, overstimulating society. One where children are especially exposed to digital media and devices, often at the expense of free play and time outdoors.
This critique suggests we’ve pathologized what used to be considered ordinary childhood behavior: restlessness, distractibility, exuberance. From this perspective, ADHD isn’t a disorder—it’s just how kids respond to environments that no longer allow them to move freely, focus gradually, or develop at their own pace.
As a father of two children, I don’t entirely disagree with concerns about overstimulation and under-play. But as a clinician, I push back against the idea that ADHD is a recent cultural fabrication.
Take this excerpt from a medical textbook written in 1798 by physician Sir Alexander Crichton:
The morbid alterations to which attention is subject, may all be reduced under the two following heads: First—the incapacity of attending with a necessary degree of constancy to any one object; Second—a total suspension of its effects on the brain.
The incapacity of attending with a necessary degree of constancy to any one object, almost always arises from an unnatural or morbid sensibility of the nerves, by which means this faculty is incessantly withdrawn from one impression to another. It may be either born with a person, or it may be the effect of accidental diseases.
When born with a person it becomes evident at a very early period of life, and has a very bad effect, inasmuch as it renders him incapable of attending with constancy to any one object of education. But it seldom is in so great a degree as totally to impede all instruction; and what is very fortunate, it is generally diminished with age.
Crichton goes on to note that this condition can be present from birth, is evident in early life, and tends to make school difficult—though not impossible.
Sound familiar? That’s ADHD. And this was written over 200 years ago—long before smartphones or pharmaceutical companies.
His account also reinforces that diagnosis is possible through a detailed, developmental history. ADHD isn’t new. It’s just newly recognized.
Some people with ADHD outgrow their symptoms entirely by their mid-20s. Others improve but retain residual challenges. And a third group continues to experience symptoms throughout adulthood. That breakdown—one-third resolving, one-third improving, one-third persisting—mirrors prevalence rates: about 9.8% of school-aged children, and about 6.2% of adults.
So, ADHD isn’t fake. It’s real, impairing, and sometimes invisible. And yes, modern life can make living with ADHD even harder. That’s the topic I’ll explore in depth in Part 2. If I still have your attention, please read on.
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