I'm not at all surprised. Back when I was researching my book on music, Beethoven's Anvil, I came across a book by Russell Barkley, ADHD and the Nature of Self Control (1997) which interested me because was about executive control, which is quite important in musical behavior. Barkeley argued that ADHAD does not involved inattention as much it involves poor self-control, which Barkley argues is a failure of some central executive function. In turn, Barkley asserts that the
. . . nature of this central executive . . . is time. More specifically, it is the conjecturing of the future that arises out of reconstruction of the past and the goal-directed behaviors that are predicated on these activities. Such activities . . . permit self-regulation relative to time. (p, 202)
Barkley goes on to point out that “time is an integral, inseparable part of the physical world” (p. 204), that “our will, therefore is . . . at time’s beck and call” (p. 205) and thus that “time, timing, and timeliness . . . become important concepts in understanding . . . goal-directed behavior and in determining it” (p. 209).
Musical performances are, of course, exquisitely timed. My thinking about music, however, seems different in kind from Barkley’s thinking about ADHD (he never mentions music or music therapy in his book) and more like the various holistic points of view one finds on ADHD, especially in the popular literature. That notwithstanding, my views on music are thoroughly materialist and grounded in neurobiology and neuropsychology. Those views may not be correct, but they operate in a conceptual universe much like Barkley’s. Once my book on music was well and done I decided to take a closer look at ADHD. But let's skip that for now.
Let's look at a NYTimes article: Paul Tough, Have We Been Thinking About A.D.H.D. All Wrong? NYTimes Magazine, April 13, 2025.
I’ve spent the last year speaking with some of the leading A.D.H.D. researchers in the United States and abroad, and many of them, like Swanson, express concern over what they see as a disconnect between the emerging scientific understanding of A.D.H.D. and the way the condition is being treated in clinics and doctors’ offices. Edmund Sonuga-Barke, a researcher in psychiatry and neuroscience at King’s College London, described the situation in personal terms. “I’ve invested 35 years of my life trying to identify the causes of A.D.H.D., and somehow we seem to be farther away from our goal than we were when we started,” he told me. “We have a clinical definition of A.D.H.D. that is increasingly unanchored from what we’re finding in our science.”
Despite the questions these scientists have begun to raise, the growth of the diagnosis shows no signs of stopping or even slowing down. Last year, the Centers for Disease Control and Prevention reported that 11.4 percent of American children had been diagnosed with A.D.H.D., a record high. That figure includes 15.5 percent of American adolescents, 21 percent of 14-year-old boys and 23 percent of 17-year-old boys. Seven million American children have received an A.D.H.D. diagnosis, up from six million in 2016 and two million in the mid-1990s.
It's time to rethink things:
That ever-expanding mountain of pills rests on certain assumptions: that A.D.H.D. is a medical disorder that demands a medical solution; that it is caused by inherent deficits in children’s brains; and that the medications we give them repair those deficits. Scientists who study A.D.H.D. are now challenging each one of those assumptions — and uncovering new evidence for the role of a child’s environment in the progression of his symptoms. They don’t question the very real problems that lead families to seek treatment for A.D.H.D., but many believe that our current approach isn’t doing enough to help — and that we can do better. But first, they say, we need to rethink many of our old ideas about the disorder and begin looking at A.D.H.D. anew.
Moreover:
Now, however, some scientists have begun to argue that the traditional conception of A.D.H.D. as an unchanging, essential fact about you — something you simply have or don’t have, something wired deep in your brain — is both inaccurate and unhelpful. According to Sonuga-Barke, the British researcher, the traditional notion that there is a natural category of “people with A.D.H.D.” that clinicians can objectively measure and define “just doesn’t seem to be the case.”
Accurately diagnosing A.D.H.D. can be challenging, for a number of reasons. Unlike with diabetes, there is no reliable biological test for A.D.H.D. The diagnostic criteria in the D.S.M. often require subjective judgment, and historically those criteria have been quite fluid, shifting with each revision of the manual. The diagnosis encompasses a wide variety of behaviors. There are two main kinds of A.D.H.D., inattentive and hyperactive/impulsive, and children in one category often seem to have little in common with children in the other. There are people with A.D.H.D. whom you can’t get to stop talking and others whom you can’t get to start. Some are excessively eager and enthusiastic; others are irritable and moody.
It's hard to find ADHD in the brain:
o the surprise of many, when Hoogman and her team published their results in 2017, they claimed that the data, in fact, showed the opposite, conclusively demonstrating the biological nature of A.D.H.D.: “We confirm, with high-powered analysis, that patients with A.D.H.D. have altered brains; therefore A.D.H.D. is a disorder of the brain,” the researchers wrote. “This message is clear for clinicians to convey to parents and patients, which can help to reduce the stigma of A.D.H.D. and improve understanding of the disorder.”
When I interviewed Hoogman by email recently, I was surprised to learn that she now wishes she could have revised that statement. “Back then, we emphasized the differences that we found (although small), but you can also conclude that the subcortical and cortical volumes of people with A.D.H.D. and those without A.D.H.D. are almost identical,” she wrote. In retrospect, she added, it wasn’t fitting to conclude from her findings that A.D.H.D. is a brain disorder. “The A.D.H.D. neurobiology is so much more complex than that.”
Sonuga-Barke goes further, arguing that the entire decades-long quest for a biomarker has been “a red herring” for the field.
One prominent researcher has concluded that the standard treatment for ADHD, with stimulants, doesn't work:
After three decades of studying stimulants, Swanson differs with many of his colleagues on their value. “I don’t agree with people who say that stimulant treatment is good,” he told me. “It’s not good.” He acknowledges that medication can often produce short-term improvements in children’s behavior. But, he says, “there is no long-term effect. The only long-term effect that I know of has been the suppression of growth. If you’re honest, you should tell kids that, look, if you’re interested in next week or next month or even the next year, this is the right treatment for you. But in the long run, you’re going to be shorter. How many kids would agree to take medication? Probably none.”
Whoops!
A.D.H.D. symptoms change over time:
Last October, the M.T.A. group published a new study that explored how A.D.H.D. symptoms in M.T.A. participants changed over the course of their childhood and young adulthood. In contrast to the categorical model of A.D.H.D. — you either have it or you don’t — the researchers showed that for most subjects, their symptoms and level of impairment in fact fluctuated over the years, often quite substantially. Only about 11 percent of the children who entered the study with an A.D.H.D. diagnosis experienced the symptoms consistently year after year. More often, their symptoms would come and go; for a few years, they might stay above the D.S.M.’s symptom threshold, and then for a few years, their symptom count might dip below the cutoff, sometimes disappearing altogether.
Environment matters:
In 2016, the M.T.A. research group published a paper that suggested that for many young people, the answer is yes. At that point in the history of the study, the subjects were adults in their mid-20s, able to speak for themselves. So rather than simply collecting data on their symptoms or their height, the scientists asked them questions. They conducted long interviews with 125 of these young adults, all of whom were diagnosed with A.D.H.D. as children.
What the researchers noticed was that their subjects weren’t particularly interested in talking about the specifics of their disorder. Instead, they wanted to talk about the context in which they were now living and how that context had affected their symptoms. Subject after subject spontaneously brought up the importance of finding their “niche,” or the right “fit,” in school or in the workplace. As adults, they had more freedom than they did as children to control the parameters of their lives — whether to go to college, what to study, what kind of career to pursue. Many of them had sensibly chosen contexts that were a better match for their personalities than what they experienced in school, and as a result, they reported that their A.D.H.D. symptoms had essentially disappeared. In fact, some of them were questioning whether they had ever had a disorder at all — or if they had just been in the wrong environment as children.
Boredom is tough for some kids:
Seen through this lens, the problem for John and Cap and many other adolescents becomes a much more mundane one than a brain disorder. Their problem is the simple fact that high school can be really boring, and without medication, they have a low tolerance for boring stuff. For some children, a different school, or a different kind of school, might produce the same profound shift that the M.T.A. subjects experienced when they enrolled in film school or began studying hair styling. For others, a prescription for Ritalin or Adderall might help make school feel like a better fit. But for them and their parents, the experience of taking medication might feel quite different if it was presented to them not as a medicine to fix their defective brain but as a tool to make an inhospitable environment more tolerable.
There's much more in the story, which is quite thorough.
As I noted at the beginning, when I'd finished my book on music, I decided to take a look at ADHD. The result was a working paper: Music and the Prevention and Amelioration of ADHD: A Theoretical Perspective (2009). Here's the abstract:
Russell A. Barkley has argued that ADHD is fundamentally a disorientation in time. These notes explore the possibility that music, which requires and supports finely tuned temporal cognition, might play a role in ameliorating ADHD. The discussion ranges across cultural issues (grasshopper vs. ant, lower rate of diagnosis of ADHD among African-Americans), play, distribution of dopamine and norepinephrine in the brain, neural development, and genes in culture (studies of the distribution of alleles for dopamine receptors). Unfortunately, the literature on ADHD does not allow us to draw strong conclusions. We do not understand what causes ADHD nor do we understand how best to treat the condition. However, in view of the fact that ADHD does involve problems with temporal cognition, and that music does train one’s sense of timing, the use of music therapy as a way of ameliorating ADHD should be investigated. I also advocate conducting epidemiological studies about the relationship between dancing and music in childhood, especially in early childhood, and the incidence of ADHD.
I've published a number of posts about ADHD at New Savanna, many of them quoting from articles published in the NYTimes.
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