“Have We Been Thinking About A.D.H.D. All Wrong?” article is largely WRONG.

Apr 26

Written By Dave

Dr. Russell Barkley Rebuts New York Times' ADHD Article: “Not Thinking About ADHD Wrong — Writing About It Wrong”

In a sweeping, four-part video series, renowned ADHD expert Dr. Russell Barkley offered a scathing critique of The New York Times Magazine's recent article, “Have We Been Thinking About A.D.H.D. All Wrong?” by journalist Paul Tough. According to Barkley, the article is riddled with errors, omissions, and misleading interpretations of scientific research that could severely misinform the public about ADHD. I’ve already heard the author interviewed on media outlets that continue spreading this misinformation at a precarious time.

Rather than offering a groundbreaking reassessment, Barkley argues that Tough recycles debunked ideas that echo critiques from fringe groups like the Church of Scientology in the 1980s and 1990s. Barkley methodically dismantles the article’s claims, revealing how they distort decades of research, clinical practice, and lived experience.

Misrepresenting Landmark ADHD Research

At the heart of Tough’s article is a discussion of the Multimodal Treatment Study of Children with ADHD (MTA Study), one of the most important long-term studies on ADHD treatment. Barkley clarifies several crucial points that Tough misrepresents:

Selective Treatment Narratives: While the article suggests medication benefits “dissipate” after a few years, Barkley reminds readers that after the initial 14-month controlled treatment phase, families were free to seek additional treatments, contaminating the original study groups. Medication effects were never expected to show lasting changes after discontinuation — just as stopping insulin wouldn’t create lasting improvements in a diabetic.
Exaggerated Role of Experts: The article portrays Dr. James Swanson, an MTA investigator, as a major architect of the study, but Barkley points out he was one of many collaborators — not its leader.
Flawed Premises About Medication: Contrary to the article's implication that ADHD medication was used based on unfounded assumptions about brain deficits, Barkley emphasizes that stimulants were adopted because they worked — decades before neuroimaging or genetic studies could explain why.

Misleading Use of ADHD Prevalence and Diagnosis Data

Barkley sharply criticizes Tough’s reliance on the CDC’s parent-reported survey data, which he describes as deeply flawed for estimating ADHD prevalence.

Survey Weakness: The CDC asks if a doctor ever told a parent their child had ADHD — without verification, clinical interviews, or standardized assessments. Better-designed epidemiological studies show that ADHD prevalence is much more stable, affecting 5–7% of children and 3–5% of adults, not the higher figures often cited to spark fear.
Rising Diagnosis Rates: Tough portrays the increased use of ADHD medications as alarming. Barkley counters that expanded diagnosis reflects long-overdue recognition of ADHD in groups previously overlooked — such as girls, teens, and adults — not evidence of overdiagnosis or pharmaceutical overreach.

Recycling Old and Debunked Arguments

Dr. Barkley notes the deep irony that Tough’s supposed “rethinking” of ADHD mirrors the discredited arguments made by Scientology-aligned groups decades ago:

No Biomarker Fallacy: Tough claims that the lack of a definitive biomarker undermines ADHD’s legitimacy. Barkley retorts that no mental disorder — depression, anxiety, bipolar disorder — has a simple biological test. Validity comes from observable impairments across life domains, not a blood test.
Dimensionality Misunderstanding: ADHD traits are dimensional — meaning they exist along a spectrum — but that doesn't negate the reality of the disorder. Many conditions (e.g., blood pressure, IQ, depression) are dimensional yet classified into diagnostic categories when symptoms cause significant impairment.
Normal Behaviors Argument: The article implies that because ADHD behaviors (like distraction or impulsivity) occur in everyone sometimes, they cannot define a disorder. Barkley calls this claim absurd, comparing it to washing hands: normal behavior becomes pathological in obsessive-compulsive disorder only when it becomes excessive, distressing, and impairing.

Ignoring Major Advances in ADHD Research and Treatment

Tough’s article suggests ADHD treatment has stagnated since the 1930s. Barkley calls this "utter nonsense," highlighting major advances:

Medication Delivery: Innovations include extended-release formulations, transdermal patches, prodrugs like Vyvanse, and nighttime-activated medications.
Non-Stimulant Options: Non-stimulant medications (e.g., atomoxetine) and alpha-2 agonists (e.g., guanfacine) have expanded treatment choices.
Behavioral Interventions: Evidence-based behavioral parent training, classroom management strategies, social skills training, ADHD coaching, mindfulness practices, and exercise interventions have flourished.
Long-Term Benefits: Barkley points to abundant research showing that stimulant medication improves not only ADHD symptoms but also reduces accidents, substance use, risky sexual behavior, teen pregnancies, driving crashes, and even premature mortality.
Brain Growth Evidence: Recent studies show that children with ADHD who remain on stimulant medication experience better brain growth outcomes over time — a fact conveniently omitted from the article.

Twisting the Discussion of Risk Factors

The article raises concerns about stimulant medications causing reduced adult height and rare psychosis risk:

Height Reduction: Barkley acknowledges a very small reduction in adult height for a minority of patients but stresses that these minor risks pale compared to untreated ADHD's risks — including academic failure, addiction, injuries, incarceration, and early death.
Psychosis Risk: The article exaggerates the psychosis risk from stimulant use. Barkley notes the absolute risk remains extremely low (less than 1%), and patients with family histories of psychotic disorders can be carefully screened.

The Fallacy of "Environmental Solutions" Alone

Tough advocates shifting focus away from medical treatment toward broad societal changes to accommodate ADHD — essentially redesigning schools, workplaces, and society itself.

Barkley agrees that local accommodations (like school supports and work adjustments) are vital — but calls the idea of restructuring society impractical and utopian. ADHD is a chronic disorder affecting 5–7% of children and 3–5% of adults. It demands individualized supports, evidence-based interventions, and, when appropriate, medication.

Not a Bold New Thesis, But an Old Misunderstanding

Ultimately, Barkley accuses The New York Times Magazine of "journalism by omission": cherry-picking outdated critiques, ignoring mountains of contrary evidence, and misleading readers under the guise of raising thoughtful questions.

"We don't need to rethink ADHD," Barkley concludes. "The author of this article does."

Good science journalism clarifies; bad science journalism sows confusion. Barkley’s comprehensive rebuttal reminds us that when it comes to ADHD, thoughtful evidence must prevail over sensationalism — for the sake of millions of individuals and families affected by this lifelong, serious, and manageable disorder.

TLDR Summary

1. Point: MTA Study shows medication benefits dissipate over time
Barkley's Rebuttal: Post-14 months, study groups sought their own treatments, contaminating the results. Medication benefits didn’t naturally dissipate.

2. Point: Rising ADHD diagnoses and stimulant prescriptions are bad
Barkley's Rebuttal: Rising diagnosis reflects better identification, especially among girls, teens, and adults — not overdiagnosis or harm.

3. Point: CDC prevalence surveys show an ADHD "epidemic"
Barkley's Rebuttal: CDC surveys are unreliable. Better studies show ADHD prevalence is stable at 5–7% in children and 3–5% in adults.

4. Point: Stimulants were prescribed based on faulty medical assumptions
Barkley's Rebuttal: Stimulants were prescribed because they worked, even before brain-based theories were developed.

5. Point: No ADHD biomarker undermines ADHD validity
Barkley's Rebuttal: No mental disorder has a simple biomarker. Disorder validity is based on impairment, not the existence of a biological test.

6. Point: ADHD traits are common in normal children, so it’s not a disorder
Barkley's Rebuttal: Severity, frequency, and impairment separate a disorder from normal behavior; DSM criteria ensure this.

7. Point: ADHD is dimensional, so it’s not a true disorder
Barkley's Rebuttal: Many disorders (e.g., anxiety, depression) are dimensional. Extreme traits causing impairment still define a disorder.

8. Point: Medications don’t improve long-term academic achievement
Barkley's Rebuttal: Short studies miss long-term benefits. Medications improve classroom behavior, grades, peer relations, and safety.

9. Point: Stimulant use stunts growth significantly
Barkley's Rebuttal: Height reduction is minimal for most. Large studies (e.g., Swedish population study) found no significant height difference due to medication.

10. Point: Stimulant use triples risk of psychosis
Barkley's Rebuttal: Psychosis risk is extremely rare (<1%). The risk was known for 70+ years and can be managed by careful screening.

11. Point: Children should decide about taking medication
Barkley's Rebuttal: Children lack the cognitive maturity for such decisions. Treatment decisions are a parental and clinical responsibility.

12. Point: Environmental changes can replace the need for medication
Barkley's Rebuttal: Local accommodations help individuals, but broad societal restructuring is impractical and unnecessary.

13. Point: The field hasn't advanced much since the 1930s
Barkley's Rebuttal: Enormous advances have been made: new medications, delivery systems, behavioral therapies, brain research, and more.