Althouse: "The failure to find a clear biomarker doesn’t mean that there is no biological basis for A.D.H.D.; most scientists I spoke to..."

April 13, 2025

"The failure to find a clear biomarker doesn’t mean that there is no biological basis for A.D.H.D.; most scientists I spoke to..."

"... agreed that the condition is produced by some combination of biological and environmental forces, though there is little consensus about the relative importance of each. But it does have certain implications for the field, including for the question of medication. If we’re no longer confident that A.D.H.D. has a purely biological basis, does it make sense that our go-to treatment is still rooted in biology?... Adderall, now the leading treatment for the disorder, is a type of amphetamine.... A significant part of the A.D.H.D. establishment does, in fact, promote the message that children and adolescents who resist medication don’t know what’s good for them...."

I'm reading "Have We Been Thinking About A.D.H.D. All Wrong? With diagnoses at a record high, some experts have begun to question our assumptions about the condition — and how to treat it" (NYT)(free-access link).

30 comments:

gilbar said...: ADHD is an acronym that means: Boys will be Boys..
Prove me wrong; 4/13/25, 8:09 PM
gilbar said...: if you're a rowdy boy.. ADHD and Adderall
if you're a quiet boy.. HRT and puberty blockers
if you're a rowdy girl.. HRT and puberty blockers
if you're a quiet girl.. SSRI and SNRI

better living through chemistry?; 4/13/25, 8:18 PM
Oso Negro said...: A decades long experiment to demonstrate that people on amphetamine-like substances get amphetamine-like results. As Scott Adams like to say, they could have just asked me.; 4/13/25, 8:22 PM
wild chicken said...: I read that whole thing. It didn't mention the discovery of "adult ADHD" usually diagnosed just in time for grad school or residency.

Apparently the drugs don't really help performance but they make you feel great!; 4/13/25, 8:25 PM
walter said...: Abstract
Special Education Financing and ADHD Medications: A Bitter Pill to Swallow
Melinda Sandler Morrill. J Policy Anal Manage. 2018.
Accurate diagnosis of attention deficit/hyperactivity disorder (ADHD) in children is difficult because the major symptoms, inattentiveness and hyperactivity, can be exhibited by any child. This study finds evidence of systematic differences in diagnosis and treatment of ADHD due to third party financial incentives. In some states, due to the financing mechanism for special education, schools face a financial incentive to facilitate the identification of children with ADHD. Using variation in special education funding policies across states, we find that children living in states with financial incentives are about 15 percent more likely to report having ADHD and are about 22 percent more likely to be taking medication for ADHD. We provide support that these findings are causal by leveraging variation from two states that implemented policy changes during the time period studied.; 4/13/25, 8:28 PM
Aggie said...: If you define a medical condition that is arguably on the edges of the 'normal' behavioral bell curve, on arbitrary and shaky grounds, and then start prescribing permanent prescriptions to treat it, then Yes - you're doing it wrong. The public education system in the United States is toxic to children, and it's high time it was called to account and reformed from the bottom up, starting with the top.; 4/13/25, 8:29 PM
Ampersand said...: Had I been born 50 years later, I would have been diagnosed ADHD. I outgrew it.; 4/13/25, 8:35 PM
MikeD said...: I recall when I was 7 or 8 (late 40's) my Dad offered me $1 if I could sit still for 5 minutes. I didn't get the dollar. BTW, that was 10 times my weekly allowance for doing my minor chores.; 4/13/25, 9:49 PM
Smilin' Jack said...: “If we’re no longer confident that A.D.H.D. has a purely biological basis, does it make sense that our go-to treatment is still rooted in biology?”

That question makes no sense. A broken leg doesn’t have a purely biological cause; does that mean you should treat it with talk therapy?; 4/13/25, 10:02 PM
BG said...: My grandson was in a public school for first grade. His teacher (who should have retired five years before then) wanted him to go on drugs. What did he do, for example? He came out of the bathroom before all the rest of the kids, went over to where coats were hung, found an empty hanger and started swinging on it. (Yeah, I laughed to myself.)
The next year, second grade, he was in a Lutheran school. That teacher said, "No way does he need to be medicated." When he showed signs of inattention and restlessness, she told him to run around the gym a few times. He'd come back and was fine. She was a great teacher - she had other "natural" methods she used with kids. No drugs involved.; 4/13/25, 10:03 PM
reader said...: Teachers need to accept that the majority of little boys aren’t going to act like the majority of little girls. I was not impressed by my son’s third grade teacher at the beginning of the year. She didn’t seem organized in the way she structured the kids day or as focused on academics. By the end of the year I had tremendous respect for her. She had a majority of boys in her classroom and I think that was intentional. During class when she was going to transition from one subject to another she had everyone stand in the aisle and do some form of calisthenics (jumping jacks, burpees, etc.) for a few minutes. She also added in an extra recess every day during class time, but the kids had to walk, jog, or run. The boys loved being in her class, the girls not so much. My son did very well that year and enjoyed it.; 4/13/25, 10:22 PM
Mrs. X said...: This comment has been removed by the author.; 4/14/25, 12:14 AM
Mrs. X said...: From the article: “While the medications can have a powerful effect on how children behave in the classroom, they do little to improve how they learn.”
Silly scientists, the point isn’t to get them to learn. The majority of today’s teachers are too uneducated to teach, so behavior is all that matters. What’s been done to schoolchildren, particularly boys but some girls too, is criminal.; 4/14/25, 12:16 AM
Saint Croix said...: We overmedicate, as a society. Way too many pills. I've long-thought that ADHD was a control mechanism, not a healthcare mechanism.

The medical establishment that thinks it's healthcare to stab babies and castrate little boys is not one that I trust. I don't know how many health issues are caused by doctors and their mistakes, but it's a lot more than we think.

Our universities, including our medical universities, are controlled by leftists, who themselves are obsessed with controlling others, and keeping people in line. No thanks.; 4/14/25, 2:19 AM
Saint Croix said...: "First, do no harm"

has been replaced with

"First, prescribe drugs and charge them money"; 4/14/25, 2:23 AM
Mark said...: These diagnoses come in handy wi4h standardized tests like the ACT as they often mean having 50% more time on the test, whether you decide to medicate or not.

Plenty of parents doing this for a leg up there.; 4/14/25, 3:00 AM
Money Manger said...: "We overmedicate, as a society. Way too many pills."

You should look at France.; 4/14/25, 3:58 AM
BUMBLE BEE said...: A friend mentioned her son was pointed out by his teacher as ADHD and was recommending meds. Being a nurse, she had her son evaluated by a professional. He was determined to be "just a busy boy".
He's an adult now, an engineer, with three "busy" boys of his own. Hey teacher, leave those kids alone.; 4/14/25, 5:06 AM
Lucien said...: The phrase “most scientists . . . agree” doesn’t have the heft it used to. But is there Anything that most scientists would agree isn’t caused by “a combination of biological and environmental factors”?; 4/14/25, 6:19 AM
Bitter Clinger said...: Mark is correct. Part of this is to get advantage in school and it's not just ACT/SAT/MCAT. College students can get additional time (I've seen up to double the allowed time), access to notes for exams that are closed book/notes, and access to a computer. There may be other allowances; these are the allowances I've seen. The ADA is one of factors that are destroying education.; 4/14/25, 7:16 AM
Scott Patton said...: Reminiscent of the fantastic question ("What is your sound?") in the lyrics of "What Does the Fox Say", we could begin greeting people with, "What is your pill?"; 4/14/25, 8:05 AM
Leslie Graves said...: That's a fascinating article, especially the material about how although taking Ritalin/Adderrall causes those who take it to feel that it is much, much easier to attend to (what is otherwise very boring and un-attendable to them), it doesn't actually improve their performance on the material they are attending to, either in short-term tests or over the long haul. That's really surprising.; 4/14/25, 8:09 AM
Tina848 said...: There is a well know biomarker for Autism, about 30-40% of the cases have a genetic abnormality. I find it shocking there is not one know for ADHD. That almost always means 1 or 2 things, behavioral issues or environmental issues. Is it the teaching methodologies in the schools or home environment? These become very uncomfortable conversations.; 4/14/25, 8:55 AM
bagoh20 said...: I wonder if Adderall had been available throughout human history if that would be a net positive?; 4/14/25, 10:25 AM
Anthony said...: I too would probably have been diagnosed with ADHD as a kid. I still have trouble settling down on one thing for an extended period of time. I've basically structured my time to allow for it. I'd thought about looking into adderall or something, as I have a friend who went on it and said it allowed her to concentrate on things for the first time in her life. Since I'm old now it probably doesn't make much difference anyway.; 4/14/25, 10:36 AM
Bill R said...: This comment has been removed by the author.; 4/14/25, 11:05 AM
Bill R said...: Bill R said...
I certainly had ADHD as a child in the 1950's. Sister Mary Redempta kept it under control with her pointer. It hurt, but it was infinitely kinder than keeping me stupefied with drugs all day.

Oh, and my wife says I STILL have it. Hmmmph.; 4/14/25, 11:06 AM
Deirdre Mundy said...: I find it fascinating that the article completely missed an obvious stimulant that many non-medicated ADHD people use long term--- coffee. The happy unmedicated college kid is often consuming 2-3 pots of the stuff a day-- they're not unmedicated, they're just controlling the dose hour by hour.

I'm a lifelong ADHDer, but wasn't medicated until recently. Why the change? Old age means I can no longer drink coffee in the amounts I once consumed, I get heartburn if I drink it too late at night now. The meds have fewer systemic side effects than "Two pots of coffee plus some espresso.

Also, coffee makes me better at interesting things that require focus, ADHD meds make me better at "Cleaning the kitchen without wandering off to read" ..... Unfortunately at my current phase in life "chores and paying bills" is more essential than "reading deeply and writing about it".....; 4/14/25, 1:30 PM
walter said...: I work on school promos and observe the high carb and sugar meals being handed out for breakfast and lunch and wonder about all the posters and stuff all over the classroom walls. Every once in a while theres a classroom with less of that and it feels much less chaotic and distracting.; 4/14/25, 2:41 PM
Blair said...: People are so ignorant about ADHD. Yes it is a real thing, possibly overdiagnosed, but that doesn't stop it being real. It's not just something that boys get, it has nothing to do with good or bad behavior, and it has nothing to do with intelligence. That latter fact is why it's completely understandable that medication doesn't improve academic outcomes. Why would it?! The problem with ADHD is not what's in the brain, it's the noise. Stimulants don't make me smarter, they just help me regulate my dopamine levels to filter out the noise so I can focus long enough to do basic boring but necessary tasks that most people take for granted. The goal is just to be normal.; 4/14/25, 9:35 PM