New Thinking on ADHD
My latest article in the New York Times Magazine
Dear Friends and Readers,
For the last couple of years, I’ve been reporting on the science of attention. That reporting led me to a group of scientists whose research, I felt, was raising important questions about ADHD in children — about its definition, its diagnosis, and its treatment.
Yesterday, the New York Times Magazine published my reporting on their findings as the cover story in the print issue. The article went up online the previous week and so far has drawn more than 2,500 reader comments.
If you’re interested, I hope you’ll read it. If you’d like to read a shorter summary, the Times Magazine also published these Takeaways from my reporting.
And if you’d like to read more from me on the subject of attention, please stay tuned! I’m now expanding my reporting toward some broader questions: how attention works in the brain, why it often feels so hard to control, and what we might learn from science and from experts about how to improve our relationship with our own attention.
What I’ve discovered so far has changed a lot about how I think and behave. Now I’m looking forward to going deeper, and to sharing with readers everything that I learn along the way.
Thanks, as always, for your interest,
Paul
Mr. Tough, I respectfully urge you to reconsider expanding your platform on the subject of attention and ADHD until you have taken the time, as I have, to read and reflect upon the hundreds (thousands?) of critical comments on the NY Times website and across social media from patients and scientists alike calling out the glaring misunderstandings, omissions, biases, confusion and sloppy reporting in your recent cover story on ADHD. Please also consider, before you pursue writing more about this topic, imbedding yourself with adults who are living with the profound impairments of ADHD so that you can better understand their lived experience. That your article makes no mention of the problems of executive functioning and emotional dysregulation that are hallmarks of the disorder indicates a profound lack of understanding about why individuals and families seek treatment. Your writing has dangerously set back the clock on the public's understanding of the disorder and, regrettably, reads more like uninformed talking points from RFK Jr. than the sort of thoughtful, careful reporting that readers expect from the NY Times.
You were deservedly excoriated by the ADHD experts and our community for good reason. Your article is a surface-level endorsement of quackery, and deep bias against decades of research and evidence-based recognition that ADHD is a medical and neurobiological disorder, You go on to justify that position in a meandering piece riddled with manipulations of empirical studies, misleading statements, quotes taken out of context, vaguery, and outright lies.
You omitted critical information from the DSM-5, including the fact that symptoms must reflect a "persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development." You flippantly claimed only symptoms were needed for diagnosis, but failed to mention the context: those symptoms must be "maladaptive, developmentally inappropriate, persistent for at least six months, and occur in multiple settings."
Each of the criteria you omitted is defined, and every symptom listed is preceded by the word “OFTEN,” underscoring the frequency and severity required.
You also presented the idea that ADHD exists on a spectrum as if it were a revelation. The DSM-5 itself clearly outlines multiple presentations (combined, inattentive, hyperactive-impulsive), specifiers for severity (mild to severe). Within that is plenty of nuance. Sure, if you want to say it's dimensional, go right ahead. However, that’s not “new thinking.” It’s just basic diagnostic criteria.
What’s more, the DSM acknowledges comorbidities and differential diagnoses — another detail you conveniently left out:
“The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).”
Medical professionals are required to consider a wide range of possible causes — and yes, people are often misdiagnosed. If we have anyone to blame, it's the clinicians who have no expertise - give patients a questionnaire and in half an hour they've been diagnosed with ADHD. This is an indictment of their practice, not the appropriate way to perform a differential diagnosis.
Like many other neurological and psychiatric conditions, there are no definitive biomarkers, but that doesn’t mean ADHD is merely a brain difference, which is so offensive and dismissive of our very real struggles. Or your claim that stimulants aren't as effective as we think, and perhaps one's environment is the cause (sheer lunacy). We have overwhelming data that ADHD IS a medical disorder, and medication paired with therapy — can significantly reduce symptoms and improve quality of life. Not just medication, but with therapy or the like. That is the first-line approach.
You also completely ignored the role of executive dysfunction, low dopamine, and emotional dysregulation — core components of the disorder. ADHD is not a quirk that turns off and on depending on mood or setting. It’s a disorder of the brain’s regulatory systems: will, time perception, self-monitoring, and impulse control. It doesn’t vanish when we’re in quiet rooms or doing something we enjoy. It doesn’t flicker in and out like bad Wi-Fi. Stimulants don't make you smarter. There is also no cure for it. Your framing is not only false — it’s damaging.
In addition, you omitted all non-stimulant treatment options, like atomoxetine, guanfacine, and other SSRIs that are prescribed.
Your article wasn't just irresponsible — it was dangerous.
Statistically, people with ADHD are at higher risk for shorter lifespans due to impulsive behavior, addiction, legal issues, eating disorders, chronic unemployment, dysfunctional relationships, and a profound lack of self-care. ADHD can destroy potential, derail lives, and lead to unbearable suffering. You undoubtedly knew this. And yet you wrote as if this disorder were a lifestyle label instead of a serious medical condition.
Stimulant medications — the very ones you cast suspicion on — are what allow many of us to maintain basic function. They aren't for everyone, but they keep many of us employed, housed, and capable of caring for ourselves and our families.
In my case, I live with severe ADHD and a catastrophic illness. Vyvanse ensures I remember to take over 20 life-saving medications. That’s the reality of what I live with - and how critical stimulants are just to keep me alive.
The real-world consequences of your article are chilling. Stimulant shortages already make it difficult for us to access the medications we depend on. We are also living in a time where pseudoscience is ascendant, and public figures like RFK Jr. are promoting dangerous lies about stimulants, quite similar to yours. Many of us are frightened. But you're just adding fuel to a fire that threatens real lives.
But if you stand by your methodology and conclusions, defend them — then I challenge you: debate Russell Barkley and Wes Crenshaw in public. Those are experts who have spent decades researching ADHD. I guarantee you I'll bring my popcorn.
Lastly, we're real people. If you're going to use a platform like The New York Times, you have a duty to be accurate, responsible, and truthful. We live with a complicated neurobiological disorder that we did not ask for - and it makes every day feel like we're running a marathon while trapped in a bottle of glue. Stimulants are the only lifeline for many of us.
You would have known this if you were to do your journalistic due diligence and bother to interview someone with ADHD - or even the parent of a child with ADHD.
Our lives are not here for you or anyone else to delegitimize, monetize, or exploit. So kindly show some respect.
Edited for typos