Rethinking ADHD: Why researchers are challenging the medical model

ADHD may reflect environment mismatch; meds help short-term, not long-term.

A growing body of research challenges the traditional medical model of ADHD, suggesting that the condition is often shaped more by environment than biology and that stimulant medications like Ritalin and Adderall offer only short-term behavioural benefits with no lasting academic or psychological improvement, the New York Times reported.

In the early 1990s, James Swanson, a research psychologist at UC Irvine, found himself in the midst of a heated debate over the rising use of Ritalin for children diagnosed with ADHD At the time, the number of children being diagnosed had doubled, and nearly two-thirds of those diagnosed were being prescribed stimulants. Swanson believed this increase was appropriate based on prevailing scientific consensus. However, many — including vocal groups like the Church of Scientology — opposed what they saw as overmedication of children.

The M.T.A. study and the short-lived promise of Ritalin

Swanson and a team of researchers launched the Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study (M.T.A.), one of the largest and most rigorous trials of its kind. It initially confirmed the effectiveness of stimulant medication like Ritalin over behavioural interventions. But three years in, the treatment advantage had vanished. All groups in the study displayed similar levels of symptoms, challenging the long-term efficacy of medication.

Growing disconnect between science and treatment

As time progressed, researchers like Swanson and Edmund Sonuga-Barke began to voice concerns. Despite explosive growth in ADHD diagnoses — reaching 11.4% of American children — new data suggested the clinical definition of ADHD no longer aligned with emerging scientific insights. Instead of a clear-cut medical disorder, ADHD appeared to be far more nuanced and variable.

The biomarker search falls short

For decades, scientists tried to find biological markers — brain structure differences, genetic links — that could decisively prove ADHD as a distinct neurological condition. But the results have been inconclusive. Major studies like those from the Enigma Consortium found brain differences between those diagnosed and those not were either minimal or nonexistent.

Rethinking the role of stimulants

Medications like Adderall and Ritalin are widely used, and often deliver short-term behavioural benefits. But researchers like F. Xavier Castellanos and William Pelham Jr. have found they don’t significantly improve academic performance or learning outcomes. One study even found that although students on stimulants worked harder, their results didn’t improve — they just felt more motivated.

A shift toward environmental understanding

Some researchers, including Sonuga-Barke, now argue that ADHD symptoms may be more about context than brain chemistry. Instead of treating ADHD as a fixed disorder, they suggest

viewing it as a mismatch between an individual's traits and their environment. This could explain why symptoms often decrease when individuals find the right educational or career setting.

Students speak out: ‘It just makes school tolerable’

Many adolescents taking stimulants describe them not as a cure, but as a tool to survive school. Some, like a student named Cap, report improvements in focus and performance but dislike how the medication makes them feel. Others, like his teammate John, say they don’t feel like they even have ADHD outside of school. For them, the condition appears situational.

A fluctuating diagnosis and new insights

The M.T.A. follow-up studies found that only 11% of diagnosed children showed consistent symptoms year after year. Symptoms in others came and went, and even some non-diagnosed children later met criteria for ADHD These findings support the idea that symptoms often reflect temporary struggles, not permanent disorders.

The new model: different, not defective

Rather than pathologizing ADHD, researchers are proposing a model that sees symptoms as traits that can be exacerbated or diminished depending on life context. Individuals thrive when they find their niche — whether in hairstyling, mechanics, or film. In this view, the goal is not to ‘fix’ brains, but to create environments where those brains can succeed.

What this means for the future of ADHD care

This rethinking of ADHD presents a challenge to the dominant medical model. For some families, a medical diagnosis provides clarity and access to treatment. But it can also bring stigma and a sense of lifelong defectiveness. The alternative model offers a more hopeful message: ADHD may not be a permanent flaw, but a call to better understand a child’s needs and environment.