You might have heard of Prof Edmund Sonuga-Barke from the NYT article titled ‘Have We Been Thinking About ADHD All Wrong?’ that went viral earlier this year.

Since we’re both based at King’s College London, I thought it would be fun to bring him together with Prof Ellie Dommett, head of our ADHD Research Lab.

Science is often seen as serious, even austere, but we have a lot of fun at the lab and I think that comes across in this conversation.

Actually, based on the number of times we laughed (many of which I had to cut), I’m pretty hopeful you’ll find it both entertaining and insightful.

We talked about:

• How the medical model of ADHD may be limiting scientific progress

• The dubious benefits of long-term medication

• How exercise might help with ADHD symptoms

• Why we need personalized approaches

• How changing your relationship with ADHD symptoms might be as important as reducing them

As for my takeaways:

1. It’s time to move beyond the medical model. We all agreed about the need to embrace multiple pathways, multimodal interventions, and multiple approaches to understanding ADHD. In addition, strength-based research is lacking and there aren’t enough studies looking into leveraging the positive aspects that come with ADHD traits.

2. Non-drug interventions need more attention. While medication can help some people, we desperately need more robust research into alternatives like exercise, mindfulness, and lifestyle interventions.

3. Personalization + agency are key. We need to build tools and protocols that recognize that ADHD manifests differently in each person and that they may be seeking different solutions. Ultimately, this is about helping people feel empowered and valued rather than simply trying to “fix” them.

What about you, what are your takeaways? Please let me know in the comments.

P.S. I’m not starting a podcast (this is way too much work!) but I really enjoyed recording this conversation so we might have some more video editions of the newsletter in the future. Stay tuned!

Papers mentioned in our conversation if you’d like to dig deeper:

Dinu, L. M., Singh, S. N., Baker, N. S., Georgescu, A. L., Singer, B. F., Overton, P. G., & Dommett, E. J. (2023). The effects of different exercise approaches on attention deficit hyperactivity disorder in adults: A randomised controlled trial. Behavioral Sciences, 13(2), 129. https://doi.org/10.3390/bs13020129

Le Cunff, A. L. (2024). Distractibility and impulsivity in ADHD as an evolutionary mismatch of high trait curiosity. Evolutionary Psychological Science, 10(3), 282-297. https://doi.org/10.1007/s40806-024-00400-8

Ramji, A. V., Dommett, E. J., & Runswick, O. R. (2024). “I Found Comfort in Exercising”: Exploring Experiences With Exercise for Adults With Attention-Deficit/Hyperactivity Disorder. Adapted Physical Activity Quarterly, 42(1), 1-18. https://doi.org/10.1123/apaq.2023-0175

Sonuga-Barke, E. J. S., Stoilova, M., Kostyrka-Allchorne, K., Bourgaize, J., Murray, A., Tan, M. P. J., ... & Livingstone, S. (2024). Pathways between digital activity and depressed mood in adolescence: outlining a developmental model integrating risk, reactivity, resilience and reciprocity. Current Opinion in Behavioral Sciences, 58, 101411. https://doi.org/10.1016/j.cobeha.2024.101411

Swanson, J. M., Arnold, L. E., Molina, B. S., Sibley, M. H., Hechtman, L. T., Hinshaw, S. P., ... & Stern, K. (2017). Young adult outcomes in the follow‐up of the multimodal treatment study of attention‐deficit/hyperactivity disorder: Symptom persistence, source discrepancy, and height suppression. Journal of Child Psychology and Psychiatry, 58(6), 663-678. https://doi.org/10.1111/jcpp.12684

When I was diagnosed with ADHD, I was told one of the most effective treatments was medication, and I was offered a prescription right there on the spot. I distinctly remember the immediate resistance I felt in my body.

Of course, I knew from my academic research that pharmacological treatment is indicated as a first-line option for ADHD, and I have friends who’ve expressed how grateful they are for their ADHD medication. But, somehow, it felt wrong when it happened to me.

Looking back, I understand my resistance better now. I was never asked how impairing my symptoms actually were considering my current circumstances (job, relationships etc) and what coping mechanisms I’d already developed. The focus was purely on symptom checklist → medication.

In the UK, where I live, prescriptions for ADHD have risen 18% year on year since the pandemic, while in the US dispensing of stimulants for ADHD increased by 60% over the past ten years or so. Which begs the question: is medication really the best option? And what are the risks and moral considerations?

First, let’s have a look at how we got there.

A little history of ADHD interventions

I’m deliberately using the word interventions and not treatments here, because many of these don’t actually “treat” ADHD – they partially alleviate or mask certain symptoms. And, as I’ll touch on later, medication is not the only way to support people with ADHD. So, here’s a quick timeline:

• 1937: Dr. Charles Bradley first reported that Benzedrine (racemic amphetamine originally marketed in the 1930s as a decongestant inhaler) improved behavior and school performance in children with behavioral issues. This is the earliest record of stimulants being used for what we now call ADHD.

• 1950s–1960s: Methylphenidate (Ritalin) was introduced in the 1950s and became widely used in the 1960s for “hyperkinetic reaction of childhood,” the precursor term for ADHD. Diagnostic criteria were still vague, focused mainly on hyperactivity.

• 1970s–1980s: Diagnostic definitions shifted. DSM-III introduced ADD with or without hyperactivity, and DSM-III-R renamed it ADHD. Stimulant use broadened but was debated.

• 1990s: ADHD subtypes (inattentive, hyperactive-impulsive, combined) were formalized in DSM-IV. Extended-release stimulant formulations were developed to improve adherence and reduce stigma of taking multiple daily doses. First major non-stimulant explored. Concerns about overdiagnosis and misuse surfaced.

• 2000s: Atomoxetine (Strattera) approved as the first non-stimulant specifically for ADHD, and Guanfacine XR (Intuniv) and Clonidine XR (Kapvay) approved for pediatric ADHD. Debate intensified about rising diagnoses.

• 2010s: Lisdexamfetamine (Vyvanse) gained popularity, marketed as longer-lasting and with lower misuse potential. Recognition of adult ADHD increased and treatment expanded beyond children.

• 2020s: ADHD diagnoses and prescribing rose sharply during and after the pandemic, linked to the expansion of telemedicine and increased recognition in adults. Viloxazine XR (Qelbree) approved in 2021 as a novel non-stimulant. Growing attention on shortages (e.g., Adderall) and concerns about misuse/diversion.

Although these days guidelines emphasize multimodal treatment (behavioral interventions + meds), stimulants remain first-line in many cases. Non-stimulants are options for people who don’t tolerate or respond to stimulants.

There are many issues with this meds-first approach. Some people experience side effects which include appetite suppression, insomnia, increased heart rate and blood pressure, and mood changes. Tolerance may develop and effectiveness can wane during the day, leading to a “crash” when the drug wears off. Misuse is a real concern, particularly among adolescents and young adults.

Long-term, the picture is even less clear. Safety questions remain about decades-long effects on brain development and cardiovascular health. And there are of course moral and ethical concerns as reliance on medication may obscure systemic contributors such as school and work environments, and frame ADHD primarily as a pathology.

Perhaps fortunately, that’s not the entire picture.

What the timeline misses

People with ADHD didn’t passively wait for medical interventions to arrive. Just like with any other condition, people with ADHD will seek ways to cope. And most of the time, they’ll find one.

Forms of coping include stimulating substances like coffee and tobacco, exercise or physically demanding work to help channel their restless energy, creative and entrepreneurial pursuits that accommodate hypercuriosity and reward novelty-seeking, and structured rituals to self-impose a form of external order.

These strategies exist on a spectrum. Some are beneficial: regular exercise, creative outlets, careers that play to ADHD strengths. Some are in the middle and highly context-dependent: workaholic tendencies, relying on caffeine to stay focused, rigid scheduling systems.

And some are actively harmful: alcohol, nicotine, and any ways to cope that provide temporary dopamine hits at significant cost.1

For instance, I started smoking when I was 11. I loved how it helped me feel less restless and more focused. By 18, I was going through a pack a day. Throughout my twenties and into my thirties, I struggled with alcohol abuse, which calmed my racing mind.

This was textbook undiagnosed ADHD brain seeking dopamine regulation through whatever was available.

(I’m not alone in this pattern: research consistently shows that people with ADHD have significantly higher rates of substance use disorders, and many describe feeling “normal” for the first time when using certain substances, which isn’t coincidence as both ADHD and addiction involve dopaminergic dysregulation)

Whether it’s alcohol, prescribed amphetamines, or even exercise, anything that helps regulate executive function and mood carries the potential for dependency: you can absolutely become addicted to exercise, to work, to the rush of constant crisis.

The pattern is the same: you find something that makes your brain feel ‘right’, and you chase it.

Still, the problem isn’t that people with ADHD are seeking regulation – they are, inevitably. It’s whether we’re doing so consciously, safely, and with the appropriate kind of support.

And this is exactly what should be assessed during diagnosis. A clinician should be asking: What are you already using to cope? What’s working? What patterns of dependency exist?

But that’s not what happened to me.

What else works?

I’m not saying medication is intrinsically wrong. For some people, in some contexts, it genuinely is life-changing. My concern is that medication offered reflexively at diagnosis isn’t just inadequate, it might be actively harmful.

We suspect that ADHD traits likely evolved in environments vastly different from modern life, and the “disorder” might emerge from the mismatch between our neurology and today’s demands: sedentary work, arbitrary deadlines, sedentary work, constant digital stimulation.

Shouldn’t we be assessing whether the environment is the problem and lifestyle changes might help before medicating the person?

Researchers (including in my lab) have been exploring other interventions: exercise (we know physical activity has positive effects on attention and executive function), mindfulness practices (like meditation), dietary approaches (including omega-3 fatty acid supplementation), digital therapeutics (such as video game cognitive training programs), neurofeedback…

This is what bothers me most about my diagnostic experience: none of these were mentioned. Not as alternatives, not as complements to medication, not even as questions about what I was already doing.

I decided to turn down medication. Instead, I turned to movement and mindfulness – mostly ecstatic dance, meditation, and journaling. And I unwittingly built a career that rewards hypercuriosity, encourages nonlinear thinking, and gives me tons of autonomy over how I manage my time and energy. I’m not a fan of the word ‘superpowers’ but it’s undeniable that in this context many of my ADHD traits have actually become pretty useful.

I recognize this path required privileges many people don’t have: education, savings from my first job at Google, risk tolerance, and work in fields that value my particular cognitive style.

For someone without the option to restructure their environment (and I recognize that’s most people given current economic realities) the situation is more complex. But that doesn’t mean medication should be automatic; it means we need better questions about what environmental changes are possible, even small ones.

I do remain open to medication if ADHD becomes unmanageable through other means in the future. However, I suspect that with the right environmental fit and support systems, only a small subset of people with ADHD truly require pharmacological intervention – though that’s unfortunately not the world we live in yet.

Now, the uncomfortable question this raises is: how many people are being medicated to function in environments fundamentally incompatible with their neurobiology, when restructuring those environments might address the root cause?

Sure, not everyone can become self-employed or redesign their career. But asking the question challenges our reflexive reach for the prescription pad.

TLDR: ADHD interventions should assess the whole person in their full context – their current coping strategies, their environment, their ambitions, their resources – not just check symptom boxes and prescribe medication. Until we do that, we’re just trying to fix the person rather than addressing the mismatch.

As usual, I’d love to hear your thoughts in the comments!

You’ve probably heard someone say, “Everyone has ADHD these days.”

In the U.S., diagnoses more than doubled since the early 1990s. I know it’s tempting to dismiss this as overdiagnosis or a cultural fad, but the reality is more complex.

First, let’s get a couple of things out of the way. We know what ADHD isn’t. It’s not a product of too much sugar, bad parenting, or laziness. It involves real differences in brain function and development.

But do we know what it actually is? Ask most researchers, and they’ll give you something like this:

“a polygenic neurodevelopmental condition that affects attention, impulse control, and regulation of activity and emotion”

It’s a neat definition, but underneath lies a patchwork of competing theories that looks like complete mayhem. In the course of my own research, I’ve identified 19 distinct models of ADHD described in the scientific literature!1

So why is ADHD so hard to pin down with one theory?

How ADHD works (and why it’s complicated)

In the 1990s, researchers thought they had cracked the code. Russell Barkley’s theory proposed an elegant hierarchical model: a single core deficit in behavioral inhibition could explain the cascade of problems seen in ADHD by disrupting executive functions like working memory and self-regulation.

But then, the plot thickened. New findings showed that not all people with ADHD had inhibition problems. Some also struggled with delay, motivation, emotion, or timing.

If you think of the brain like a busy airport with planes (thoughts, actions, emotions) that need to take off and land on schedule, scientists have identified several domains where the air traffic control can go awry in ADHD, leading to delays, sudden takeoffs, or forgotten landings:

• Executive function: Planning, working memory, automatic responses.

• Reward and motivation: Preference for immediate over delayed rewards.

• Arousal and alertness: Trouble maintaining steady effort or focus.

• Timing and regulation: Difficulty with time perception and transitions.

• Emotion and mood: Intense emotions and difficulty regulating them.

That’s why you’ve probably noticed some people can’t sit still while others are daydreaming. Some speak non-stop; others barely talk at all. They can be impulsive or overwhelmed by emotion. And some don’t seem obviously different until their environment changes.

This variability is part of why ADHD is so hard to pin down.2 Despite decades of research, there’s no blood test. No scan that confirms it. Diagnosis is currently based on patterns of behavior that disrupt daily life and persist across settings, but not everybody agrees as to what those patterns of behavior actually look like.

As a result, the field began to fracture into specialized theories. You can roughly place these theories of ADHD into four buckets :

1. Executive dysfunction. One of the earliest and most enduring views. ADHD involves difficulty managing internal control systems like planning, remembering what to do next, or stopping an automatic response. This explains impulsivity and disorganization, but not motivation issues or mood swings.

2. Delay aversion. This view proposes that some symptoms of ADHD arise not just from difficulties with cognitive control, but from how people react emotionally to waiting. Delays don’t just feel boring but can be unbearable. This can lead to choices that prioritize immediate relief, like quitting a task early or avoiding anything that involves waiting.

3. Default mode interference. The brain has a default mode network that becomes active when we’re not focused on the outside world. In ADHD, this system seems to stay active even during tasks, creating interference – like background noise interrupting a conversation. This might help explain those mid-sentence lapses or zoning out during simple tasks.

4. Dopamine models. ADHD has been linked to how the brain handles dopamine, a chemical involved in reward and motivation. In many people with ADHD, the brain appears less able to anticipate rewards or maintain interest over time. This can make long-term goals feel flat and distant.

And to complicate things further, theories of ADHD operate at different levels of explanation:

• Genetic: ADHD has a strong inherited component. No single gene causes it, but many genes each with small effects seem to contribute to it.

• Neurobiological: Brain networks involved in attention, timing, and reward seem to behave differently in ADHD, sometimes more variable, less connected, or slower to mature.

• Cognitive-behavioral: ADHD traits affect how people think, learn, respond to feedback, and regulate effort.

• Environmental: Stress, trauma, classroom and work demands, sleep, and parenting style might all interact with ADHD traits.

• Evolutionary: ADHD traits such as hyperfocus, hypervigilance and hypercuriosity might have once been adaptive in nomadic, high-stimulus environments, and might have become mismatched to modern life.

Today, most researchers agree that ADHD isn’t explained by any single mechanism. Instead, we see integrative frameworks that suggest ADHD arises from multiple interacting systems, shaped by genetics, brain development, and environment.

So... is ADHD a thing? Yes and no.

Rethinking what ADHD is

ADHD is real in the sense that it describes a consistent pattern of difficulties that cause genuine problems for millions of people. But it’s not a single thing with a single cause.

Rather than a fixed medical condition you either have or don’t, ADHD might be better understood as an umbrella term for a spectrum of traits3 that appear together more often than by chance, and that seem to share common roots in brain development, genetics, and our environment.

This helps explain a puzzle: ADHD diagnoses have increased sharply over the past 30 years. That’s partly due to better recognition and reduced stigma, but it also reflects how the category has stretched to capture a broader range of behaviors and struggles.

That also helps explain why different treatments help different people, why individuals with ADHD can look so different from one another, and why the condition has been so hard to pin down with a single theory.

At a practical level, this suggests that cookie-cutter approaches whether in treatment, education, or support are likely to miss the mark. Some people might benefit most from medication, others from environmental changes, and still others from strategies that work with their natural curiosity rather than against it.

It means parents and teachers might need different approaches for different kids, and that self-advocacy becomes about understanding your own particular constellation of traits instead of trying to figure out how you fit into a predetermined “ADHD box.”

The good news is that new research directions are moving beyond the binary diagnostic category toward more nuanced approaches. Emerging research includes:

• Brain networks. Tracking how large-scale brain systems interact in real time to reveal the moment-to-moment patterns behind ADHD symptoms.

• Genetic profiling. Mapping how combinations of small genetic risks shape brain development differently in different people.

• Individualized treatments. Matching interventions to each person’s profile of strengths and challenges instead of applying standard protocols.

• Environmental factors: Recognizing environments as part of the solution, including how we structure schools, workplaces, and daily life.

Some scientists, myself included, are also exploring how traits like novelty-seeking and curiosity – which are linked to dopamine function – might tie together the cognitive, motivational, and emotional sides of ADHD, and how people with ADHD can better harness their unique strengths.

In the future, what we now call “ADHD” might be broken down into more biologically distinct subtypes or reframed dimensionally to measure levels of impulsivity, distractibility, curiosity, and emotional regulation, rather than using a single catch-all diagnosis. That shift could help make support more personalized.

The bottom line

So yes, ADHD is a thing. But it’s likely not one thing. It’s currently a useful label for multiple, interacting processes that vary from person to person, giving clinicians a way to support patients, educators a lens to support students, and researchers a map to explore.

The explosion of theories isn’t a failure of science but a sign of a complicated, deeply human condition we’re still working to understand.

The real question isn’t whether ADHD is “real.” The question is: can we get comfortable with that complexity so people can find what actually works for them?

At fourteen, I was effectively kicked out of school. Not for bad grades, but for being too disruptive. The headmaster was sympathetic but clear with my parents: if I tried to re-enroll the following term, they wouldn’t accept me.

In their defense, I wasn’t exactly making life easy for them. I created a magazine with friends featuring fictional love stories about our teachers and illustrated poems about our classmates (some of which I still feel guilty about). I figured out how to temporarily disable the fire exit alarm for sneaky smoke breaks. I even organized a petition to relax the dress code.

Looking back, all that creative mischief was probably a way to channel something deeper. I’d always had trouble sitting still (except when reading a great book), my attention pulled in multiple directions, curious about so many tangential topics and unable to stay focused on the linear curriculum we were supposed to follow.

It was shortly after I joined the ADHD Research Lab at King’s College London that a colleague casually asked: “Have you been diagnosed?” The question caught me off guard.

I thought I knew what ADHD looked like, and it wasn’t me. I had degrees, a career, and felt functional enough.

Yet, the question stayed with me, until I eventually went through the hours of clinical assessment. At thirty-two, I was diagnosed with ADHD. The doctor offered medication, which I declined.

The diagnosis was three years ago now and I kept it quiet, telling only my family and closest friends. Part of me feared making it part of my public identity. An ADHD researcher diagnosed with ADHD! I didn’t want for this to take over my life.

But the diagnosis did help me understand patterns I’d noticed but never connected. Like how I could lose myself in research for hours but struggle to begin the simplest admin task. Or how I’d procrastinate on a time-sensitive project while juggling three side projects at once. How I’d develop an intense but short-lived obsession with the most random topics, then blame myself for not sticking with anything long enough to see it through.

As well as the low moods, the dark thoughts, the addictions, the racing mind that refused to rest at night.

Despite these challenges, I was fortunate. Without realizing it, I had designed a life that aligned with the way my brain worked: flexible hours, ideas I was truly curious about, challenges that kept me on my toes, and the freedom to explore a wide range of unrelated projects.

In many ways, curiosity has been my lifeline. I didn’t know where it would lead, but following it gave shape to my days. And often, that was enough. It gave me something to reach for, a way to move forward even when I couldn’t find a reason to.

Then, a couple of years ago, I stumbled upon an amazing paper exploring the relationship between curiosity and impulsivity at a neurological level.

Because of my personal experience, I had always been convinced of the crucial role curiosity plays in human flourishing. But now I started wondering specifically about its role in ADHD. Soon I kept noticing breadcrumbs of evidence everywhere: studies describing ADHD as linked to novelty-seeking and exploratory drive, and personal accounts of people with ADHD (including clinicians) seeing their impulsive curiosity as both a strength and a struggle.

Unlike typical curiosity, the kind described by people with ADHD often involves an urgent, almost compulsive drive to explore new information and pursue novel experiences.

You might recognize it as opening 27 browser tabs while chasing an idea, getting lost in Wikipedia rabbit holes for hours, impulsively signing up for a pottery class because you saw one video on Instagram, or deep-diving into quantum physics podcasts for a week before moving on to your next obsession.

I call it hypercuriosity: an intensified, impulsive desire to know and explore. This trait may have been adaptive in ancestral environments, but it can create friction in today’s world with its endless distractions, information overload, and pressure to follow linear paths that don’t align with how hypercurious minds work.1

I believe hypercuriosity isn’t inherently good or bad. Like many traits, it can manifest in ways that serve us or derail us. For example, a hypercurious mind might feel focused when exploring a personally meaningful question, but fall into doomscrolling when overwhelmed by information designed to capture our attention.

However, three interconnected forces might be conspiring to push hypercuriosity toward its maladaptive expressions:

1) Social media is designed to trigger but never satisfy our information-seeking drives. Algorithms exploit our curiosity gaps (the space between what we know and want to know) and deliver just enough novelty to keep us scrolling. For hypercurious minds, this creates an endless loop of stimulation.

2) Nonlinear exploration is discouraged in educational institutions. Traditional education rewards sustained attention to predetermined tasks. The result is that many hypercurious kids feel miserable suppressing their natural curiosity rather than learn how to leverage it.

3) Most modern workplaces measure value based on efficient output. In high productivity + low creativity work environments, hypercurious employees might burn out and/or leave to become self-employed (which might be why there is an association between ADHD and entrepreneurship).

So how do we fix this? I believe solving this requires three fundamental shifts:

1. Rewilding education. We need to redesign learning environments to support hypercuriosity. This means welcoming neurodivergent thinking, embracing experimental learning, and encouraging nonlinear paths.

2. Reclaiming attention. The attention economy hijacks hypercuriosity. We must treat attention as a precious resource worth protecting both individually and culturally by resisting algorithmic distraction and setting boundaries around our focus.

3. Reimagining technology. Digital tools should support hypercuriosity, not exploit it. We need interfaces (including AI) that help us ask better questions, discover new information, connect ideas, and integrate knowledge.

I’m still early in my research. This article is the start of a tiny experiment. Over the next six months, I’ll share research notes and reflections as I explore what it would take to build a world where hypercuriosity is supported rather than suppressed.

Hypercurious minds deserve better systems and better stories. If this resonates, I’d love for you to subscribe.