This is really useful. My 36 year old son was recently diagnosed. When I first read the descriptions and the diagnostic questions, I was sceptical. It read like most horoscopes read to me. My reaction was "this applies to me and just about all my friends".
He had a great comeback: "That's probably because you have it, and you've therefore easily connected and been attracted to others with ADHD traits as friends.
So since then I have reconsidered. I've also realised that if I do have it, I'm very lucky because I don't suffer from the negative emotional aspects. I like having a drifting, magpie curiosity-following mind. It has lots of downsides, but I've managed to find a career that rewards most of the traits. I don't say that with arrogance and price, just gratitude that I've mostly avoided the downside.
So your point about it being "a lot of things" is very helpful. Looking forward to learning more.
Thanks so much for sharing, Paul. ADHD is highly hereditary, so it wouldn't be too surprising that both you and your son fit the diagnosic criteria (although we know those diagnostic tools are far from perfect).
"I've managed to find a career that rewards most of the traits" - to me this is one of the keys. Some people like you and I are lucky to stumble into the right career and don't struggle as much. What we call "symptoms" are really mismatched traits.
I wasn’t diagnosed until I was sixty. It brought a lot of understanding to the way I’d led my life. Structure was the biggest thing that kept me going at work. Now that I’m retired, that structure of work is gone and I’m just beginning to get my bearings once again.
I had that response the first time I took an ADHD test (just an online one) - that it was pandering the way astrology does, that the statements are just describing the human condition.
I tested this theory by having a bunch of friends take the same test. And that is how I learned that what I believed was the universal human condition was in fact not how life is for everyone else. (Some other friends did score highly - but they were later diagnosed)
When I told my mum, she said "don't be silly, you don't have ADHD, you've just always been a sensitive child" - but "you've always been like this" is of course greater evidence that it's ADHD. (She has since been diagnosed and it has been transformational for her)
Paul, firstly thanks for sharing your initial comment.
About your reaction hearing about ADHD from your son…It wasn’t until a couple years ago that I started to consider that I might have ADHD myself (now 24yo). Having reached a certain level of certainty about a year ago, I decided to open up to my mum (now 50yo) about it - and her reaction was strikingly similar to yours and McKinley’s mum. Of course, my reaction was similar to your son’s “It’s because you have it too!!”. She was incredibly reticent. The argument was “everyone struggles with these things”
Fast forward one year, my instagram DMs are filled with ADHD memes and reels from my mum. We both feel so comfortable talking about it now and sharing our struggles - but also “superpowers”. Not only did she she come to terms with how likely it is that I have ADHD (I’m not diagnosed but at the moment myself, my diagnosed partner, diagnosed friends and therapist are certain about I fall under the umbrella - though ofc my therapist keeps assuring me she can’t diagnose) but also realised that she might be on the spectrum herself.
I can’t be more thankful for this! For context, we come from a country where there is a lot of stigma and discrimination around disabilities, queerness, women etc. It’s not a welcoming place when it comes to these topics, and this hate is deeply rooted in most of the people born and raised there (fear, that is). While I’m privileged to be part of a more “woke” generation, and having lived in the western world for the past 6 years (since I was 18yo), it’s been easier to change these mental patterns. Whereas for my mum, the situation is a little different. Despite many aspects of her life being so different from mine, she remained patient, understanding and, well, curious!
It requires a certain level of honesty and strength to be able to drop your guard and truly listen to yourself and your child.
Last but not least, some of the heaviest work is done by Anne Laure and other researchers and scientists as such. All is left for us is to educate ourselves and love each other.
Thanks for sharing Rux. I'm very glad to hear you're managing the realisation well.
My son is doing much better as a result of his diagnosis. As a father, my main regret is that I didn't even think that he had a problem when he was a kid. We just thought that he was a bit socially awkward at times, and just put that down to the human condition.
The way I am thinking my way through this these days is very similar to Anne Laure's "mismatched traits" approach. My experience has mostly been having a very wide-ranging, but often fickle and impulsive curiosity. Like almost everything powerful in life it can be a strength or a weakness. The challenge seems to be to harness the power of it and avoid the dangers.
The challenge is made greater in the context of educational and cultural institutions that were designed for a very different type of personality. I still resist calling it a medical condition or disability though. Not out of pride and shame, but it just doesn't seem accurate or helpful. It seems it's only appropriate in those circumstances where it's in the way of someone being able to live well, and therefore they need serious help.
Thank you, Mike! Selfishly, those posts are also a great way for me to consolidate and better articulate my current knowledge. I'm glad this resonates with you, especially coming from a practitioner.
Brilliant research. Thank you. I myself suffer from ADHD. And there is a surprising amount of it present in the executive clients I coach. I’m excited to read more of your findings.
This was an interesting read. I come from a family where all the neurodivergencies (?) and mental illnesses seem to have been thrown into a blender and distributed amongst each of us. Is it autism? Is it ADHD? Maybe PTSD, or CPTSD. Or maybe rapid cycling bipolar disorder or on the spectrum of schizophrenia with autism. It’s a long list. Even the family members with adult onset of serious mental illness at one point had symptoms of ADHD, autism and dyslexia or dysgraphia. It’s also interesting to me that we seem to have differences that are similar and seem like a family trait.
I imagine it’s hard to untangle as far as research goes! More like whack a mole than any steady target.
I'm mostly on board with all that's written here, as it's become the standard viewpoint on the issue, but there's one thing I've been thinking about:
"It's not a product of too much sugar..."
How can we be so sure this is true? After all, Americans eat a LOT of sugar. And high consumption of refined sugar is linked to the exact symptoms ADHD describes. Furthermore, ADHD is diagnosed purely based on patient's descriptions of symptoms, there's no brain scan or any other more objective markers of the syndrome, and therefore, there's no true ability to distinguish if a symptoms is caused by an underlying syndrome or consumption of something like sugar.
If you go to a doctor to get an ADHD diagnosis, they will NOT ask you - how much refined sugar do you consume? And if you do consume a lot of refined sugar, they will not say - let's first track how much refined sugar you're consuming, get it down to a very low number, then track whether these symptoms still appear.
So given they're not doing this, I don't know how anyone can in good faith truly say it can't be a product of too much sugar.
There's also several other lifestyle factors that could contribute to ADHD symptoms such as excessive social media, video games, pornography usage or other compulsive behavior that could impact baseline dopamine levels as well-covered in the book Dopamine Nation by Anna Lembke. If you look at what ADHD meds likes Adderall and Vyvanse actually do, they mostly just boost your dopamine levels. But the need for that might be because our baseline levels are too low after they've been artificially triggered by highly stimulating behavior. And once again, doctors do not take the time to investigate this when diagnosing and prescribing.
All of the above problems are exacerbated even further by the profit motive of pharmaceuetical companies, as clearly evidenced by the rise of Venture Capital backed companies like Done which promote "same day, telemedicine ADHD diagnosis". We've established that given how ADHD is diagnosed, we can't truly separate the underlying condition from confounding factors without a doctor spending a lot of time and energy on a patient, but the profit motive of pharmaceuticals has created the exact opposite incentive. Lastly but certainly not least, pharmaceutical drugs that boost your dopamine have an element of making you feel good, boosting your productivity, and can be habit-forming and slightly addictive, making patients more inclined to seek out these drugs regardless of true underlying need. Given that, I find it incredibly hard to believe that ADHD is not over-diagnosed and over-prescribed in this country. And the viewpoint "it's not just sugar, it's an underlying condition" is almost a "overly dismissive to the person being overly dismissive" reaction because there's no strong evidence that it simply isn't "just sugar" (or doom scrolling, or both combined).
Thanks for raising these points. I agree lifestyle factors aren’t adequately screened for in typical ADHD evaluations and that many clinicians don’t systematically assess diet, screen time, or other dopamine-affecting behaviors before diagnosis, and that’s a real problem with current diagnostic practices.
However, the evidence against sugar as a primary cause comes from controlled studies where researchers actually did what you’re suggesting doctors should do. Multiple randomized controlled trials have given children high-sugar vs. low-sugar diets while observers (blinded to which diet the child was on) rated their behavior. These studies suggest no significant differences in hyperactivity or attention: https://pubmed.ncbi.nlm.nih.gov/7474248/
Some observational and meta-analytic studies do report a correlation between higher sugar intake and ADHD symptoms or hyperactivity, but these do not establish causality and often cannot account for confounding factors. So “the higher sugar consumption by children with ADHD is possibly a consequence rather than a determinant of the disorder” - https://pmc.ncbi.nlm.nih.gov/articles/PMC6193136/
That said, poor diet, excessive screen time, and other modern lifestyle factors can absolutely play a role and should be considered when supporting people with ADHD. Personally, like many people, I turn to sugar and doomscrolling when my mental health isn’t too good. Others turn to alcohol. Really, we could all benefit from a healthier lifestyle.
I also agree the rise of telehealth ADHD mills is genuinely alarming, and the financial incentives are problematic. The fact that stimulants can make anyone feel more focused and productive creates obvious potential for misuse (that’s a big reason why I turned down medication when it was offered to me).
However, we also have to consider that ADHD was historically severely underdiagnosed, particularly in girls, adults, and people of color. Some of the increase likely reflects better recognition rather than pure overdiagnosis, and lots of people are seeking help because they do struggle, whether you want to label it ADHD or not. And some research labs, like mine, are looking into non-medication interventions such as exercise, which doesn’t have the same problematic incentives.
All that being said, yes, we shouldn’t rule out environmental and lifestyle causes before diagnosing a neurodevelopmental condition, and a responsible evaluation should include comprehensive assessment of sleep, diet, exercise, screen time, stress, etc. Many don’t and I agree that’s a problem with how ADHD is currently diagnosed in practice. But based on the current scientific evidence we’re pretty sure sugar doesn’t cause ADHD. That can change, that’s the nature of scientific evidence.
I sympathize with the points you bring up, Bill, and I have to admit, I do still question the research on if this is a product of our biology or a mis-match of our environment with the additional inputs. As somebody who grew up running around on a farm eating the food we grew, no refined sugar, homeschooled, and spent relatively little time sitting, but was still able to perform when I got to college, I have a different perspective. I went from never attending a school to working as a Special Education teacher, and I still to this day wonder if the environment we've created where people are supposed to sit still for 8 hours a day and are given these additional inputs and stimulants might not be a huge factor. I wrote about my experiences here, if it's of interest: https://fieldnotesofawhimsic.substack.com/p/confessions-of-a-peculiar-person
Thanks for chimming in, Liz! You’ve hit on something really important here - the biology vs environment mismatch you describe isn’t actually contradictory to ADHD being ‘real.’ Your experience growing up on a farm with lots of movement, varied tasks, and minimal sitting actually suggests that ADHD traits might be better suited to certain environments.
This aligns with what researchers call the ecological mismatch theory - that traits we now label as ADHD (like need for movement, novelty-seeking, rapid attention shifting) might have been adaptive in more dynamic, unpredictable environments but clash with modern sedentary, rule-bound settings like traditional classrooms.
Genetic studies suggest these aren’t universal traits - the DRD4-7R gene variant linked to ADHD is more common in historically nomadic populations and research shows it might be advantageous in some environments but not others. This suggests the variant may have been selected for in contexts requiring more novelty-seeking and exploration. I wrote about it here: https://link.springer.com/article/10.1007/s40806-024-00400-8
So it's not really biology OR environment - it’s that certain biological variations in attention, need for physical activity, curiosity, self-regulation, and reward processing interact differently with different environments. The 8-hour sitting requirement you mention might be incompatible with how some brains are wired, regardless of sugar intake or screen time.
This is why I think supporting people with ADHD shouldn’t be focused on ‘fixing’ people (I’ll write a post about medication later and how I don’t think ADHD is overdiagnosed but ADHD meds are overprescribed) and more in the three shifts I describe at the bottom of this post: https://hypercurious.com/p/hello-world
Thanks for replying and sharing this resource! These studies are all super interesting and I have read them and think they are great! I guess I also wasn’t clear in my comment, but the article I wrote and shared speaks to exactly what you are articulating with this research - that there are evolutionary advantages of these traits. My problem is with calling it a deficit and disorder while conducting studies to label it that use and compare against a population that have all been subjected to screens, tv, sugar, movement limiting environments all their life, all things I didn’t have. What I wrote about was my experience getting a degree in special education and becoming a teacher for brains like mine and observing how much children like me were struggling and exasperated by their situations and stimulants. If you had an opportunity to read what I wrote I would be very interested to know your thoughts since I have a unique set of experiences around my brain from that lens, and I think it’s a problem that we are labeling it the way that we are and trying to change it vs understanding the environment and stimulants that have made it a problem.
I can only say this as a parent with ADHD and a daughter with ADHD/anxiety that was diagnosed by the time she was under 4: for what it's worth, my daughter hadn't even had fruit juice by the time she was diagnosed, generally one or two popsicles during summer, definitely no soda. I was always very vigilant as my side of the family has truly terrible dental enamel and decay, and so delayed the introduction of processed sugar in our daughter's life. She still turned out to have the same social, emotional, sensory and executive function issues as me. I don't doubt that sugar does a lot of damage to society, and would of course change my hypothesis if I saw something supporting this in the literature, but anecdotally sugar has had zero impact on my child with the exception of being an impulse control sticking point as she entered the preteens.
I’m 32 and only recently started suspecting I might have ADHD. Looking back, a lot of things suddenly make sense—why certain parts of life have always felt harder than they “should,” or why I’ve had to work so hard to create systems that others seem to handle effortlessly. I haven’t gotten a formal diagnosis yet (my therapist recommended it, but she’s not qualified to make one), and I’m still unsure why I’ve put it off.
What I have been doing is intentionally building a lifestyle that suits how my brain works—though that often means choosing a different path than what’s considered “normal” or expected.
Curious if others here have found value in getting a formal diagnosis? And are there any resources or practices you’d recommend for better understanding and supporting yourself when building an ADHD-friendly lifestyle?
Hi Pete - I was diagnosed in 2019 with inattentive ADHD by a psychologist using psychometric testing and brain scans (EEG) and underwent 1 year of neurofeedback which I found helpful (2 x's a week then tapered to 1X a week). I am not on medication.
The diagnosis was helpful to me because it explained a lot of issues I experience that I would often dismiss or feel shame about: time optimism & time blindness causing lateness, executive function (overwhelm, difficulty starting, procrastination) low frustration threshold to name a few.
I was then able to figure out that my late father also suffered from ADHD. He died before I figured out why he was placed on academic probation twice in University and almost didn't get his degree as a teacher: clearly he valued education but he struggled academically.
A lot of the chaos I experienced growing up was likely due to family ADHD which also drove addiction (self-medication?) in the family. I later discovered I am 2E with moderate giftedness which probably accounted for my good grades and social skills. It also masked my symptoms and I've struggled with feeling super competent in some areas of life and very low-functioning in others.
I follow a carnivore diet (8 years Sept 1) which has been helpful in managing my energy especially as I navigate the onslaught of menopause (probably the reason my ADHD was driving me mad 6 years ago - seems to be the window of discovery for many women). I also bought a mini-trampoline 2 years ago to help me with energy slumps mid-day. I have done body doubling co-working sessions on Zoom to help me tackle stuff I avoid. I also have used alarms (Time Timer is a visual alarm you might like), ADHD binaural music, bullet journalling, and gamification to get stuff done.
All that being said, it's a personal decision to be diagnosed and "book diagnosis" aka self-diagnosis is viewed as legit in many online circles because of the paucity of diagnosticians globally.
https://www.youtube.com/@HowtoADHD might be a place to explore as a resource to get ideas to create an ADHD-friendly lifestyle for yourself. AMA :-)
Great article. The ending, about how depth of our minds and psychology and complexity involved, was excellent too:
"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?"
Thank you for this! I was diagnosed years ago at 37. I’m still unpacking what it means to me and how it shows up in me. The nuance you bring here is important. Much appreciated.
One of the most thoughtful and well-researched pieces I’ve read on ADHD. I was diagnosed recently and saw myself in so much of it — especially the part about shaping a career choices around curiosity. Thank you, Thank you
Enlightening article! I’ve never heard hyperfocus, hypervigilance and hypercuriosity characterized as an evolutionary ADHD cause…but I have enjoyed these traits in abundance my whole life. I hope the rest of the series will explore these “superpower” traits in more depth, and also how ADHD traits manifest differently across the lifespan. Post-menopausally I am struggling much more with motivation, energy and executive function issues and I’d love to understand more about that.
I just hope AI can solve some of the problems resulting from executive dysfunction. Like I want someone to structure my life and remind me what to do next.
Presented very well, thank you. Adult male here with firmly diagnosed ADHD several years ago. Have been through it all, and childhood behaviors come into better focus and understanding now. Thanks for illuminating the variability of the symptoms. I'm still trying to understand me. Thank you for tackling and sharing this.
This is a thoughtful piece that's in keeping with your thoughtful Substack. And, I’d like to suggest that the core problem with the “Is ADHD a real thing?” debate isn’t the word "real", but the word "thing."
Calling ADHD a “thing” implies a bounded, stable, internally caused, test-identifiable entity. Something with crisp edges, predictive value, and mechanistic ties to a definable number of causes and consequences. But ADHD doesn’t behave like that. Despite decades of research across every level of analysis, we still haven’t found that kind of entity.
What we have found is a recognizable pattern of symptoms — real ones! — that occur (together and separately) in some people, under some circumstances, to varying degrees, across time. In that way, ADHD is better understood not as an entity, but as a transdiagnostic symptom configuration, not unlike fatigue.
Fatigue is a great analog: it’s real, it’s widespread, and it’s often impairing. AND, it can be caused or shaped by thousands of interacting factors. It can point to a biological issue. Or an environmental mismatch. Or a behavioral loop. Or a trade-off the body is making to balance real constraints within the person and the resources available to them. Or just a normal response to effort, or transition, or a season of life. Or any combination of these factors! But we don’t tend to treat fatigue as a “thing” you either have, or don’t have. We know that it's a thing most people have some experience with, and that some people have a lot of really uncomfortable experience with, and that can only be understood and addressed within the whole and holistic context of the person's unique biology, history, current life circumstances, changing needs, and enduring values. In other words, we treat fatigue as a signal, a phenomenon, a symptom worth understanding in context.
When we try to force symptoms (like inattention, impulsivity, or emotional lability) into an entity-shaped box, we end up creating a tangle of problems. We get overgeneralized “solutions”, fruitless searches for biomarkers, rigid identity claims, and a culture of diagnosis that over-focuses on whether a person “has the thing” instead of how to support them in a specific context. We lose out on rich understandings of what is happening for this individual, at this time. It also becomes harder to advocate for systemic changes, because the burden of change gets individualized. And ironically, it becomes harder for people to take agentic steps toward managing their symptoms, because doing so feels like a threat to the “reality” of the diagnosis.
So yes, ADHD is "real"..... just not in the way we usually mean when we call something a “thing.” The more we can hold onto that nuance, the more room we’ll have to explore complexity, contextual variation, and person-specific strategies, which is where real progress happens.
We might very well benefit from the diagnostic model of "an umbrella" for many hard-to-define conditions such as ADHD. There is comirbidity aplenty underlying these difficulties. I'm sure as we progress further with our instrumentation, we will come to greater answers. One must always "cling" to a reserve of hope. Peachy 🍑 keen horizons to you all on your journey, for the next generation and beyond...🐝.
This is really useful. My 36 year old son was recently diagnosed. When I first read the descriptions and the diagnostic questions, I was sceptical. It read like most horoscopes read to me. My reaction was "this applies to me and just about all my friends".
He had a great comeback: "That's probably because you have it, and you've therefore easily connected and been attracted to others with ADHD traits as friends.
So since then I have reconsidered. I've also realised that if I do have it, I'm very lucky because I don't suffer from the negative emotional aspects. I like having a drifting, magpie curiosity-following mind. It has lots of downsides, but I've managed to find a career that rewards most of the traits. I don't say that with arrogance and price, just gratitude that I've mostly avoided the downside.
So your point about it being "a lot of things" is very helpful. Looking forward to learning more.
Thanks so much for sharing, Paul. ADHD is highly hereditary, so it wouldn't be too surprising that both you and your son fit the diagnosic criteria (although we know those diagnostic tools are far from perfect).
"I've managed to find a career that rewards most of the traits" - to me this is one of the keys. Some people like you and I are lucky to stumble into the right career and don't struggle as much. What we call "symptoms" are really mismatched traits.
I'm excited to share more!
I wasn’t diagnosed until I was sixty. It brought a lot of understanding to the way I’d led my life. Structure was the biggest thing that kept me going at work. Now that I’m retired, that structure of work is gone and I’m just beginning to get my bearings once again.
I had that response the first time I took an ADHD test (just an online one) - that it was pandering the way astrology does, that the statements are just describing the human condition.
I tested this theory by having a bunch of friends take the same test. And that is how I learned that what I believed was the universal human condition was in fact not how life is for everyone else. (Some other friends did score highly - but they were later diagnosed)
When I told my mum, she said "don't be silly, you don't have ADHD, you've just always been a sensitive child" - but "you've always been like this" is of course greater evidence that it's ADHD. (She has since been diagnosed and it has been transformational for her)
Uncannily similar to my reaction to my son's diagnosis. Thanks.
Paul, firstly thanks for sharing your initial comment.
About your reaction hearing about ADHD from your son…It wasn’t until a couple years ago that I started to consider that I might have ADHD myself (now 24yo). Having reached a certain level of certainty about a year ago, I decided to open up to my mum (now 50yo) about it - and her reaction was strikingly similar to yours and McKinley’s mum. Of course, my reaction was similar to your son’s “It’s because you have it too!!”. She was incredibly reticent. The argument was “everyone struggles with these things”
Fast forward one year, my instagram DMs are filled with ADHD memes and reels from my mum. We both feel so comfortable talking about it now and sharing our struggles - but also “superpowers”. Not only did she she come to terms with how likely it is that I have ADHD (I’m not diagnosed but at the moment myself, my diagnosed partner, diagnosed friends and therapist are certain about I fall under the umbrella - though ofc my therapist keeps assuring me she can’t diagnose) but also realised that she might be on the spectrum herself.
I can’t be more thankful for this! For context, we come from a country where there is a lot of stigma and discrimination around disabilities, queerness, women etc. It’s not a welcoming place when it comes to these topics, and this hate is deeply rooted in most of the people born and raised there (fear, that is). While I’m privileged to be part of a more “woke” generation, and having lived in the western world for the past 6 years (since I was 18yo), it’s been easier to change these mental patterns. Whereas for my mum, the situation is a little different. Despite many aspects of her life being so different from mine, she remained patient, understanding and, well, curious!
It requires a certain level of honesty and strength to be able to drop your guard and truly listen to yourself and your child.
Last but not least, some of the heaviest work is done by Anne Laure and other researchers and scientists as such. All is left for us is to educate ourselves and love each other.
Thanks for sharing Rux. I'm very glad to hear you're managing the realisation well.
My son is doing much better as a result of his diagnosis. As a father, my main regret is that I didn't even think that he had a problem when he was a kid. We just thought that he was a bit socially awkward at times, and just put that down to the human condition.
The way I am thinking my way through this these days is very similar to Anne Laure's "mismatched traits" approach. My experience has mostly been having a very wide-ranging, but often fickle and impulsive curiosity. Like almost everything powerful in life it can be a strength or a weakness. The challenge seems to be to harness the power of it and avoid the dangers.
The challenge is made greater in the context of educational and cultural institutions that were designed for a very different type of personality. I still resist calling it a medical condition or disability though. Not out of pride and shame, but it just doesn't seem accurate or helpful. It seems it's only appropriate in those circumstances where it's in the way of someone being able to live well, and therefore they need serious help.
Great post and series. We need fresh eyes like yours on ADHD.
I treat ADHD teens.
You write: "Parents and teachers might need different approaches for different kids." So true.
Low SES kids often deemed "lazy" and written off.
High SES kids often dispatched on journey of neuropsych, meds, therapy, EF coaching, accommodations....but still struggle.
Thank you, Mike! Selfishly, those posts are also a great way for me to consolidate and better articulate my current knowledge. I'm glad this resonates with you, especially coming from a practitioner.
Merci beaucoup pour cette initiative et ce post très documenté.
Merci, Martin !
As someone who suspects they are ND this was such an interesting read, thank you so much and look forward to seeing the follow ups 🥰
Thank you, Sarah! I'm excited to share more.
Brilliant research. Thank you. I myself suffer from ADHD. And there is a surprising amount of it present in the executive clients I coach. I’m excited to read more of your findings.
Thanks so much, Will - I'm so glad it resonates!
This was an interesting read. I come from a family where all the neurodivergencies (?) and mental illnesses seem to have been thrown into a blender and distributed amongst each of us. Is it autism? Is it ADHD? Maybe PTSD, or CPTSD. Or maybe rapid cycling bipolar disorder or on the spectrum of schizophrenia with autism. It’s a long list. Even the family members with adult onset of serious mental illness at one point had symptoms of ADHD, autism and dyslexia or dysgraphia. It’s also interesting to me that we seem to have differences that are similar and seem like a family trait.
I imagine it’s hard to untangle as far as research goes! More like whack a mole than any steady target.
I'm mostly on board with all that's written here, as it's become the standard viewpoint on the issue, but there's one thing I've been thinking about:
"It's not a product of too much sugar..."
How can we be so sure this is true? After all, Americans eat a LOT of sugar. And high consumption of refined sugar is linked to the exact symptoms ADHD describes. Furthermore, ADHD is diagnosed purely based on patient's descriptions of symptoms, there's no brain scan or any other more objective markers of the syndrome, and therefore, there's no true ability to distinguish if a symptoms is caused by an underlying syndrome or consumption of something like sugar.
If you go to a doctor to get an ADHD diagnosis, they will NOT ask you - how much refined sugar do you consume? And if you do consume a lot of refined sugar, they will not say - let's first track how much refined sugar you're consuming, get it down to a very low number, then track whether these symptoms still appear.
So given they're not doing this, I don't know how anyone can in good faith truly say it can't be a product of too much sugar.
There's also several other lifestyle factors that could contribute to ADHD symptoms such as excessive social media, video games, pornography usage or other compulsive behavior that could impact baseline dopamine levels as well-covered in the book Dopamine Nation by Anna Lembke. If you look at what ADHD meds likes Adderall and Vyvanse actually do, they mostly just boost your dopamine levels. But the need for that might be because our baseline levels are too low after they've been artificially triggered by highly stimulating behavior. And once again, doctors do not take the time to investigate this when diagnosing and prescribing.
All of the above problems are exacerbated even further by the profit motive of pharmaceuetical companies, as clearly evidenced by the rise of Venture Capital backed companies like Done which promote "same day, telemedicine ADHD diagnosis". We've established that given how ADHD is diagnosed, we can't truly separate the underlying condition from confounding factors without a doctor spending a lot of time and energy on a patient, but the profit motive of pharmaceuticals has created the exact opposite incentive. Lastly but certainly not least, pharmaceutical drugs that boost your dopamine have an element of making you feel good, boosting your productivity, and can be habit-forming and slightly addictive, making patients more inclined to seek out these drugs regardless of true underlying need. Given that, I find it incredibly hard to believe that ADHD is not over-diagnosed and over-prescribed in this country. And the viewpoint "it's not just sugar, it's an underlying condition" is almost a "overly dismissive to the person being overly dismissive" reaction because there's no strong evidence that it simply isn't "just sugar" (or doom scrolling, or both combined).
Thanks for raising these points. I agree lifestyle factors aren’t adequately screened for in typical ADHD evaluations and that many clinicians don’t systematically assess diet, screen time, or other dopamine-affecting behaviors before diagnosis, and that’s a real problem with current diagnostic practices.
However, the evidence against sugar as a primary cause comes from controlled studies where researchers actually did what you’re suggesting doctors should do. Multiple randomized controlled trials have given children high-sugar vs. low-sugar diets while observers (blinded to which diet the child was on) rated their behavior. These studies suggest no significant differences in hyperactivity or attention: https://pubmed.ncbi.nlm.nih.gov/7474248/
Some observational and meta-analytic studies do report a correlation between higher sugar intake and ADHD symptoms or hyperactivity, but these do not establish causality and often cannot account for confounding factors. So “the higher sugar consumption by children with ADHD is possibly a consequence rather than a determinant of the disorder” - https://pmc.ncbi.nlm.nih.gov/articles/PMC6193136/
That said, poor diet, excessive screen time, and other modern lifestyle factors can absolutely play a role and should be considered when supporting people with ADHD. Personally, like many people, I turn to sugar and doomscrolling when my mental health isn’t too good. Others turn to alcohol. Really, we could all benefit from a healthier lifestyle.
I also agree the rise of telehealth ADHD mills is genuinely alarming, and the financial incentives are problematic. The fact that stimulants can make anyone feel more focused and productive creates obvious potential for misuse (that’s a big reason why I turned down medication when it was offered to me).
However, we also have to consider that ADHD was historically severely underdiagnosed, particularly in girls, adults, and people of color. Some of the increase likely reflects better recognition rather than pure overdiagnosis, and lots of people are seeking help because they do struggle, whether you want to label it ADHD or not. And some research labs, like mine, are looking into non-medication interventions such as exercise, which doesn’t have the same problematic incentives.
All that being said, yes, we shouldn’t rule out environmental and lifestyle causes before diagnosing a neurodevelopmental condition, and a responsible evaluation should include comprehensive assessment of sleep, diet, exercise, screen time, stress, etc. Many don’t and I agree that’s a problem with how ADHD is currently diagnosed in practice. But based on the current scientific evidence we’re pretty sure sugar doesn’t cause ADHD. That can change, that’s the nature of scientific evidence.
Very interesting points I'll be sure to dig into the links provided, thanks
I sympathize with the points you bring up, Bill, and I have to admit, I do still question the research on if this is a product of our biology or a mis-match of our environment with the additional inputs. As somebody who grew up running around on a farm eating the food we grew, no refined sugar, homeschooled, and spent relatively little time sitting, but was still able to perform when I got to college, I have a different perspective. I went from never attending a school to working as a Special Education teacher, and I still to this day wonder if the environment we've created where people are supposed to sit still for 8 hours a day and are given these additional inputs and stimulants might not be a huge factor. I wrote about my experiences here, if it's of interest: https://fieldnotesofawhimsic.substack.com/p/confessions-of-a-peculiar-person
Thanks for chimming in, Liz! You’ve hit on something really important here - the biology vs environment mismatch you describe isn’t actually contradictory to ADHD being ‘real.’ Your experience growing up on a farm with lots of movement, varied tasks, and minimal sitting actually suggests that ADHD traits might be better suited to certain environments.
This aligns with what researchers call the ecological mismatch theory - that traits we now label as ADHD (like need for movement, novelty-seeking, rapid attention shifting) might have been adaptive in more dynamic, unpredictable environments but clash with modern sedentary, rule-bound settings like traditional classrooms.
Genetic studies suggest these aren’t universal traits - the DRD4-7R gene variant linked to ADHD is more common in historically nomadic populations and research shows it might be advantageous in some environments but not others. This suggests the variant may have been selected for in contexts requiring more novelty-seeking and exploration. I wrote about it here: https://link.springer.com/article/10.1007/s40806-024-00400-8
So it's not really biology OR environment - it’s that certain biological variations in attention, need for physical activity, curiosity, self-regulation, and reward processing interact differently with different environments. The 8-hour sitting requirement you mention might be incompatible with how some brains are wired, regardless of sugar intake or screen time.
This is why I think supporting people with ADHD shouldn’t be focused on ‘fixing’ people (I’ll write a post about medication later and how I don’t think ADHD is overdiagnosed but ADHD meds are overprescribed) and more in the three shifts I describe at the bottom of this post: https://hypercurious.com/p/hello-world
Thanks for replying and sharing this resource! These studies are all super interesting and I have read them and think they are great! I guess I also wasn’t clear in my comment, but the article I wrote and shared speaks to exactly what you are articulating with this research - that there are evolutionary advantages of these traits. My problem is with calling it a deficit and disorder while conducting studies to label it that use and compare against a population that have all been subjected to screens, tv, sugar, movement limiting environments all their life, all things I didn’t have. What I wrote about was my experience getting a degree in special education and becoming a teacher for brains like mine and observing how much children like me were struggling and exasperated by their situations and stimulants. If you had an opportunity to read what I wrote I would be very interested to know your thoughts since I have a unique set of experiences around my brain from that lens, and I think it’s a problem that we are labeling it the way that we are and trying to change it vs understanding the environment and stimulants that have made it a problem.
I can only say this as a parent with ADHD and a daughter with ADHD/anxiety that was diagnosed by the time she was under 4: for what it's worth, my daughter hadn't even had fruit juice by the time she was diagnosed, generally one or two popsicles during summer, definitely no soda. I was always very vigilant as my side of the family has truly terrible dental enamel and decay, and so delayed the introduction of processed sugar in our daughter's life. She still turned out to have the same social, emotional, sensory and executive function issues as me. I don't doubt that sugar does a lot of damage to society, and would of course change my hypothesis if I saw something supporting this in the literature, but anecdotally sugar has had zero impact on my child with the exception of being an impulse control sticking point as she entered the preteens.
I’m 32 and only recently started suspecting I might have ADHD. Looking back, a lot of things suddenly make sense—why certain parts of life have always felt harder than they “should,” or why I’ve had to work so hard to create systems that others seem to handle effortlessly. I haven’t gotten a formal diagnosis yet (my therapist recommended it, but she’s not qualified to make one), and I’m still unsure why I’ve put it off.
What I have been doing is intentionally building a lifestyle that suits how my brain works—though that often means choosing a different path than what’s considered “normal” or expected.
Curious if others here have found value in getting a formal diagnosis? And are there any resources or practices you’d recommend for better understanding and supporting yourself when building an ADHD-friendly lifestyle?
Hi Pete - I was diagnosed in 2019 with inattentive ADHD by a psychologist using psychometric testing and brain scans (EEG) and underwent 1 year of neurofeedback which I found helpful (2 x's a week then tapered to 1X a week). I am not on medication.
The diagnosis was helpful to me because it explained a lot of issues I experience that I would often dismiss or feel shame about: time optimism & time blindness causing lateness, executive function (overwhelm, difficulty starting, procrastination) low frustration threshold to name a few.
I was then able to figure out that my late father also suffered from ADHD. He died before I figured out why he was placed on academic probation twice in University and almost didn't get his degree as a teacher: clearly he valued education but he struggled academically.
A lot of the chaos I experienced growing up was likely due to family ADHD which also drove addiction (self-medication?) in the family. I later discovered I am 2E with moderate giftedness which probably accounted for my good grades and social skills. It also masked my symptoms and I've struggled with feeling super competent in some areas of life and very low-functioning in others.
I follow a carnivore diet (8 years Sept 1) which has been helpful in managing my energy especially as I navigate the onslaught of menopause (probably the reason my ADHD was driving me mad 6 years ago - seems to be the window of discovery for many women). I also bought a mini-trampoline 2 years ago to help me with energy slumps mid-day. I have done body doubling co-working sessions on Zoom to help me tackle stuff I avoid. I also have used alarms (Time Timer is a visual alarm you might like), ADHD binaural music, bullet journalling, and gamification to get stuff done.
All that being said, it's a personal decision to be diagnosed and "book diagnosis" aka self-diagnosis is viewed as legit in many online circles because of the paucity of diagnosticians globally.
https://www.youtube.com/@HowtoADHD might be a place to explore as a resource to get ideas to create an ADHD-friendly lifestyle for yourself. AMA :-)
Great article. The ending, about how depth of our minds and psychology and complexity involved, was excellent too:
"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?"
Thank you for this! I was diagnosed years ago at 37. I’m still unpacking what it means to me and how it shows up in me. The nuance you bring here is important. Much appreciated.
One of the most thoughtful and well-researched pieces I’ve read on ADHD. I was diagnosed recently and saw myself in so much of it — especially the part about shaping a career choices around curiosity. Thank you, Thank you
Enlightening article! I’ve never heard hyperfocus, hypervigilance and hypercuriosity characterized as an evolutionary ADHD cause…but I have enjoyed these traits in abundance my whole life. I hope the rest of the series will explore these “superpower” traits in more depth, and also how ADHD traits manifest differently across the lifespan. Post-menopausally I am struggling much more with motivation, energy and executive function issues and I’d love to understand more about that.
I just hope AI can solve some of the problems resulting from executive dysfunction. Like I want someone to structure my life and remind me what to do next.
Presented very well, thank you. Adult male here with firmly diagnosed ADHD several years ago. Have been through it all, and childhood behaviors come into better focus and understanding now. Thanks for illuminating the variability of the symptoms. I'm still trying to understand me. Thank you for tackling and sharing this.
This is a thoughtful piece that's in keeping with your thoughtful Substack. And, I’d like to suggest that the core problem with the “Is ADHD a real thing?” debate isn’t the word "real", but the word "thing."
Calling ADHD a “thing” implies a bounded, stable, internally caused, test-identifiable entity. Something with crisp edges, predictive value, and mechanistic ties to a definable number of causes and consequences. But ADHD doesn’t behave like that. Despite decades of research across every level of analysis, we still haven’t found that kind of entity.
What we have found is a recognizable pattern of symptoms — real ones! — that occur (together and separately) in some people, under some circumstances, to varying degrees, across time. In that way, ADHD is better understood not as an entity, but as a transdiagnostic symptom configuration, not unlike fatigue.
Fatigue is a great analog: it’s real, it’s widespread, and it’s often impairing. AND, it can be caused or shaped by thousands of interacting factors. It can point to a biological issue. Or an environmental mismatch. Or a behavioral loop. Or a trade-off the body is making to balance real constraints within the person and the resources available to them. Or just a normal response to effort, or transition, or a season of life. Or any combination of these factors! But we don’t tend to treat fatigue as a “thing” you either have, or don’t have. We know that it's a thing most people have some experience with, and that some people have a lot of really uncomfortable experience with, and that can only be understood and addressed within the whole and holistic context of the person's unique biology, history, current life circumstances, changing needs, and enduring values. In other words, we treat fatigue as a signal, a phenomenon, a symptom worth understanding in context.
When we try to force symptoms (like inattention, impulsivity, or emotional lability) into an entity-shaped box, we end up creating a tangle of problems. We get overgeneralized “solutions”, fruitless searches for biomarkers, rigid identity claims, and a culture of diagnosis that over-focuses on whether a person “has the thing” instead of how to support them in a specific context. We lose out on rich understandings of what is happening for this individual, at this time. It also becomes harder to advocate for systemic changes, because the burden of change gets individualized. And ironically, it becomes harder for people to take agentic steps toward managing their symptoms, because doing so feels like a threat to the “reality” of the diagnosis.
So yes, ADHD is "real"..... just not in the way we usually mean when we call something a “thing.” The more we can hold onto that nuance, the more room we’ll have to explore complexity, contextual variation, and person-specific strategies, which is where real progress happens.
We might very well benefit from the diagnostic model of "an umbrella" for many hard-to-define conditions such as ADHD. There is comirbidity aplenty underlying these difficulties. I'm sure as we progress further with our instrumentation, we will come to greater answers. One must always "cling" to a reserve of hope. Peachy 🍑 keen horizons to you all on your journey, for the next generation and beyond...🐝.