Have We Been Thinking About A.D.H.D. All Wrong?

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In the years since the consensus statement was published, however, the evidence for each of these A.D.H.D. biomarkers has faltered. Attempts to replicate the studies that showed differences in brain electrical activity came up empty. And though scientists have identified complex collections of genes that together may be signs of greater risk for A.D.H.D., they have failed to find a specific gene that predicts the disorder. “There is no single-gene story,” John Gabrieli, an M.I.T. neuroscientist, told me recently. “Fifteen years ago, there was incredible optimism, and now we realize how far away we are.”

Compared with other psychiatric medications, Gabrieli explained, Ritalin and Adderall (and the many similar formulations on the market today) are relatively safe and effective. They don’t help everyone, but in the short term, at least, they provide significant symptom control in most of the children who take them. Clinicians generally consider them easy to prescribe, in part because they’re usually easy for patients to quit. Unlike antidepressants or many anti-anxiety medications, they don’t linger in the bloodstream for more than a day, which means that even with the extended-release versions, they don’t require a weaning process. You can just stop taking them. “At some level,” Gabrieli told me, “these stimulants are not that far from Red Bull.”

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