Part 3 in a series originally written in 2015, revised and updated in 2025
When I first wrote about ADHD in 2015, I had been in practice for over a decade and had already begun seeing the patterns that shape lives. Now, with over 20 years of clinical experience, I still stand by what I said then—but I see it all more clearly. The science has matured, and so has the conversation. What hasn’t changed is the core reality: ADHD is real, impairing, and persistent. But how we talk about it, how we frame it, and how we treat it—those are all areas where reflection is not only warranted, but necessary.
This third installment isn’t a correction of the earlier two. I explained in Part 1 that ADHD is a condition defined by persistent, developmental, and functionally impairing symptoms—not just everyday distractibility. In Part 2, I challenged the misleading naming conventions and showed how societal expectations complicate what gets labeled as dysfunction. All of that remains true. But time gives perspective, and some things deserve nuance, clarification, or greater emphasis. Ten years later, here’s what I would add.
1. Neurodiversity Matters
In 2015, the word “neurodiversity” was gaining traction in education and advocacy circles, but it hadn’t yet reshaped the mainstream clinical narrative. Today, it has. And that shift matters.
Yes, ADHD causes disability. Yes, it impairs functioning. Yes, it meets criteria for a psychiatric disorder. But that framing—disorder first, identity second—is increasingly being challenged. And rightly so.
People with ADHD do not have broken brains. They have differently tuned brains. Brains that struggle with executive function but may excel in innovation, intuition, or nonlinear thinking. In Part 2, I described how ADHD is not a constant attention deficit, but a situational mismatch—where context dictates capacity. The deficits are real, but so are the adaptations and strengths. That doesn’t mean ADHD is easy. But it does mean we need to move beyond a purely deficit-based framework.
The neurodiversity movement has helped reframe ADHD not as a disease to be fixed, but as a cognitive difference to be supported. It hasn’t invalidated the diagnosis; it has simply humanized it. And that’s a good thing.
2. Medication and Height: What the Data Now Shows
In 2015, I wrote that concerns about long-term growth suppression in children taking stimulants had not been shown to be true. At the time, that was a fair summary. But longer-term data have since shown that there is a small but observable impact on height.
A 2023 PRISMA-style meta-analysis of 29 studies reported a statistically significant reduction in height z-scores among children treated with methylphenidate. The standardized mean difference was –0.40, translating roughly to a 1–2 cm difference in final adult height. Importantly, the review concluded that while the effect was real, it was small and not clinically significant in most cases (link.springer.com).
This doesn’t change my overall stance on treatment. The benefits of appropriate stimulant use still outweigh the risks for most people. But the evidence now calls for transparency: parents deserve to know that a small reduction in growth ispossible, even if it’s not dangerous or typically impactful.
3. Hormones and Efficacy: Sex Differences Matter
We’ve also learned more about how stimulant medications affect women, particularly in relation to hormonal cycles.
A growing body of research and clinical observation now shows that ADHD symptoms can worsen during the premenstrual phase of the menstrual cycle. What’s more, stimulant medications often become less effective during that time. Estrogen appears to enhance dopamine signaling, so when estrogen levels drop, the efficacy of stimulant medication can drop too.
A 2023 clinical commentary from the MGH Center for Women’s Mental Health suggests that premenstrual changes in estrogen may reduce the efficacy of stimulant medications, and that temporary dosage adjustments during this window may improve functioning for some patients (womensmentalhealth.org). While empirical studies are still limited, clinicians and patients increasingly report that cyclical variability is real—and actionable.
For women and girls, this matters. It may explain why some days feel harder for reasons that previously felt invisible. And it underscores the need for more personalized approaches to ADHD care that take hormonal variation into account.
4. Recognition Has Grown—But ADHD Hasn’t Spread
One of the biggest changes in the last ten years has been the surge in adult ADHD diagnoses. Some of this is due to increased awareness—especially among women—and some came as a downstream effect of parents getting evaluated after their children were diagnosed. But the COVID era added a new layer. Remote work and disrupted routines made executive dysfunction more visible. The usual scaffolding—commutes, calendars, external structure—fell away. What had once been manageable for many adults suddenly became disabling. That prompted a lot of long-overdue evaluations.
Importantly, this doesn’t mean more people are “getting” ADHD. In Part 1, I shared a passage from a 1798 medical textbook that sounded uncannily like a modern ADHD diagnosis. The condition has always existed—what’s changed is who gets seen, who gets heard, and who gets labeled. Recognition has caught up to reality.
Rates of diagnosis have gone up—especially in adult women, people of color, and those historically left out of the mental health system. That’s not overpathologizing. That’s catching up. Just as autism, depression, and anxiety are better recognized today than in past generations, so too is ADHD. We’re not inventing new disorders. We’re acknowledging old patterns that were previously missed, masked, or misdiagnosed.
5. Online Prescribing and the Addiction Myth
Telemedicine platforms like Cerebral, Done, and others came under fire in the early 2020s for aggressive advertising and potentially lax diagnostic standards. Some of that criticism was warranted. But one of the fears that surfaced—that wide access to stimulants would trigger an addiction epidemic—has not been supported by evidence.
As with in-person care, when stimulant medications are prescribed appropriately, the risk of addiction remains very low. Research continues to show that treated ADHD carries lower risk of later substance abuse than untreated ADHD. For example, a 2024 national cohort study found that early and sustained stimulant treatment was associated with reduced rates of prescription stimulant misuse and illicit drug use in adolescence (mghpsychnews.org). Another large-scale analysis using registry data confirmed that appropriate stimulant treatment in childhood and adolescence did not increase—and may even reduce—the likelihood of developing substance use disorders in adulthood (sciencedirect.com). A 2017 population study tracking over 38,000 individuals found that those treated with ADHD medication had approximately 31% fewer substance-related adverse outcomes over a three-year period (psychiatryonline.org).
That doesn’t mean the online prescribing boom was benign. There were real problems: poor documentation, rushed assessments, inconsistent follow-up. But those are issues of quality control, not medication danger.
The lesson here is that access matters, and so does oversight. We can’t go back to a world where people suffer without diagnosis or treatment. But we do need to make sure that care is delivered responsibly.
Looking Ahead
Ten years ago, I wrote that ADHD was real, that it caused meaningful impairment, and that treatment worked. I explained then how diagnosis is best made through reliable history, not expensive scans or one-size-fits-all checklists. All of that remains true.
What has changed is the lens. We see ADHD now not only as a disorder, but as a difference—one that intersects with biology, society, gender, and history. Our tools have improved. So has our compassion.
And maybe, with enough time and care, so will our systems.
This concludes the ADHD series originally written during Mental Health Month 2015. Revised and updated in 2025 to reflect new evidence and enduring experience.
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