By Caraline McDonnell and Sarah Tannenbaum, PsyD, ABPP
In our world filled with constant access to information, it is increasingly more challenging to decipher what is accurate and what you can trust. Oftentimes, especially as busy people and working caregivers, we tend to lean heavily on popular new stories and social media algorithms for our sources of information. While these sources often have helpful and interesting information, sometimes they get science wrong. On April 13th, 2025, the New York Times published an article on the diagnosis, prevalence, and treatment of Attention Deficit/Hyperactivity Disorder. The article took a critical look at the rates of ADHD diagnoses over the years, and the effectiveness of common medications, but it missed many important nuances in the care of ADHD that deserve attention.
Are Rates of ADHD on the Rise?
A lot of recent media around mental health challenges is focused on rising rates of different disorders. Commenting on rising rates sparks fear that there is something in our environment or society that is contributing to increased rates. While it is true that rates of ADHD diagnosis have been climbing, there are a multitude of reasons why. We only first began to understand prevalence rates of ADHD in the 1990s, and the seminal MTA study that provided baseline data for rates only included white men, limiting the generalizability of the findings. Research and clinical practice in the years since then has expanded to include people with previously under-represented or marginalized identities, like women, gender non-conforming individuals, and people of color, among others. The expansion of who gets included in studies on ADHD and who gets diagnosed with ADHD helps explain the rise in ADHD throughout the population. Similarly, much of the rise in ADHD diagnosis is a result of increased awareness of symptoms as well as environmental stressors. For instance, the pandemic years in which many children and adolescents were attending school virtually reduced access to structured supports provided by schools, exacerbated learning challenges, and provided parents more insight into learning, attentional, and behavioral challenges because of the amount of time children were at home.
How is ADHD Diagnosed?
It is important to consider how kids are getting diagnosed with ADHD, and being alert to the possibility of overdiagnosis can prevent pathologizing normal levels of restlessness, but providers should consider whether the child needs the diagnosis to get help they may genuinely need. In mental health, there is a lot of overlapping of symptoms between ADHD and other mental health disorders. Because of this, providers should take care to conduct or recommend a thorough evaluation to determine if a child has ADHD, and what interventions are appropriate.
So, what would that look like? Often, this process involves either a neuropsychological evaluation or a social-emotional-behavioral diagnostic interview including interviews with parents, the child, and teachers/school personnel, and self-report data-driven measures. It is common that pediatricians or other medical professionals may prescribe medication to a child after conducting a briefer version of this process, which could be a contributing factor to diagnosing when it may not be appropriate. If you are concerned that your child’s provider made a diagnosis without having a full understanding of the problem, it could be beneficial to seek out a thorough evaluation. However, it is also possible and common to have co-occurring diagnoses. For instance, ADHD and anxiety.
In addition, ADHD is a complex neurodevelopmental disorder that manifests in different ways across people and across the lifespan. There are three types of ADHD: predominantly inattentive, predominantly hyperactive, and combined inattentive and hyperactive. The predominately inattentive type is characterized by difficulties with attention, focus, and organization. The predominantly hyperactive type is marked by hyperactivity, impulsivity, and restlessness. The combined type involves a more even spread of symptoms from both types. While the type categorizing helps provide a framework for understanding ADHD, individuals of any type can display varying combinations and levels of intensity for all symptoms, and they can shift over time. For instance, socialization can play a large role in how ADHD manifests, and girls or people with inattentive type ADHD are often overlooked, whereas people with hyperactive type ADHD tend to be those with the highest rates of involvement in behavioral health care. This is because hyperactive type ADHD can be more problematic and harder to manage for caregivers, teachers, and others, rather than due to higher rates of prevalence. As with any mental health diagnosis, there is a range of presentation in symptoms and that can shift over time. However, because ADHD is a neurodevelopmental disorder, symptoms remain present and consistent across settings. Symptoms of ADHD can be managed through psychotherapy, environmental control, and medication, but they do not go away.
Isn’t Medication the Only Way to Treat ADHD?
Unfortunately, most children, adolescents, and adults who are diagnosed with ADHD only receive medication for treatment. While ADHD medications—typically stimulant drugs like Ritalin—can be very beneficial, they are not the only treatment, and in fact, are often not the frontline intervention according to clinical practice guidelines for ADHD.
Before even discussing medication, it is important to consider the vast and promising literature on the use of psychosocial or behavioral interventions for youth with ADHD. While the vast majority of those diagnosed with ADHD only receive medication intervention, clinical practice guidelines recommend starting with psychosocial interventions, only including medication when necessary.
Psychosocial or behavioral interventions for ADHD are ones that can be provided by a clinician (therapist, counselor), typically in an outpatient setting, but are sometimes also offered at pediatric practices by an integrated behavioral health specialist. Effective interventions for youth with ADHD include education about the brain and behavior, a set of positive reinforcement skills (one-on-one time, praise), a consistent set of consequence and disciplinary skills (selective attention, effective commands, time out), as well as strategies to enhance motivation (praise, rewards). Additionally, since inattention and impulse control are hallmark features of ADHD, these interventions are often parent-based or have a strong caregiver component. This means that the skills and strategies are taught to caregivers, and then caregivers use skills with the child, rather than engaging the youth in individual therapy, which is less effective for those with ADHD. These interventions include Parent-Child Interaction Therapy (PCIT), Behavioral Parent Training (BPT) or Parent Management Training (PMT), Summer Treatment Programs for ADHD, and Organizational Skills Training (OST) to address executive functioning challenges, among other cognitive behavioral (CBT) approaches with caregiver involvement.
These psychosocial behavioral interventions have been shown to be tremendously effective for children and teens with ADHD, and they can be individually tailored to meet the wide range of symptoms that youth present with. While all evidence-based psychosocial interventions for ADHD contain the same core components, there are age-specific adaptations that can enhance treatment efficacy. Clinical practice guidelines recommend starting with these psychosocial interventions, assessing response to treatment, and then incorporating medication to enhance treatment outcomes or to help a child better access the intervention. By using psychosocial interventions, caregivers and clinicians are teaching the child important skills that they can use throughout their life and are reducing the reliance on medication. This also helps medication prescribers be more parsimonious in the type and dosage of medication they use, because they know that there is consistent, predictable, and effective environmental and behavioral management already in place.
So, Are ADHD Medications Effective?
ADHD medications, typically stimulant drugs like Ritalin, create behavior changes in children almost overnight, and seem to be largely effective in treating externalizing symptoms of ADHD. However, there are substantial limitations to what medications can do and as with any medication, there are side effects. Many who take stimulant medications build up a tolerance, continue to present with some challenges across settings, and might struggle to consistently follow their medication regimen. Finding the right ADHD medication can also be challenging, and it is hard to find providers who have expertise in nuanced prescribing. Additionally, medication doesn’t teach skills; it can’t change the level of a child’s academic performance, nor does it teach self-regulation. At the same time, medication can help a child focus on the things they have to be doing, help them interact with peers and teachers appropriately, and help them gain confidence that they can succeed in a classroom setting. Rather than opt out of situations in which they experience challenges, medication can help kids and teens with ADHD approach situations and have a positive, corrective experience to realize that with the appropriate support, they can achieve success.
ADHD medication has been proven to reduce impulsivity, and as a result, to reduce risky behavior that could lead to substance use, motor vehicle accidents, incarceration, and unplanned pregnancies. It has also been found to reduce the rates of depression, anxiety, self-harm and suicide. Research has found that ADHD medication can reduce the risk of early death by 19%. This leads us to the question, are the risks associated with taking ADHD medications worth the tradeoff for a 19% reduction of risk of early death?
What’s Your Take?
While it may be daunting to receive an ADHD diagnosis, ADHD is highly treatable when diagnosed early and treated in a systematic and evidence-based manner. We are sharing this information to help bust some of the common myths that circulate about ADHD and to help you connect to resources and support so you can harness your child’s differences into strengths. We share this with the goal of supporting kids with ADHD and their families by providing them with all the tools that can help them thrive.