Episode 3: Exploring ADHD Diagnosis Trends
In this episode of ADHD Connect, Dr. Tish Taylor thoughtfully comments on Paul Tough’s recent article in The New York Times Magazine, “Have We Been Thinking About ADHD All Wrong?” and explores ADHD diagnosis trends.
With a calm, informed, and compassionate voice, Dr. Taylor unpacks the article’s central questions: Why are ADHD diagnoses increasing? Is ADHD truly neurological, or could environmental factors be playing a larger role? And how do we best understand this complex condition—especially when it doesn’t always present in obvious ways?
Speaking from her 25+ years of experience as a clinical and school psychologist, Dr. Taylor shares practical insights into how ADHD is diagnosed, what current criteria do (and don’t) capture, and how patterns of attention and behavior evolve over time. She emphasizes the importance of context, developmental history, co-occurring conditions, and environmental influences—especially in mild or borderline cases.
In This Episode, You’ll Learn:
✔ The continuum of ADHD symptoms
✔ The importance of ruling out other causes
✔ Why it’s not just about medication
✔ How to monitor symptoms over time
✔ And the role of tools like the TRAIT Tool in everyday support
🔗 Mentioned in this episode:
Episode 3 Transcript:
Hi, Dr Tish Taylor, welcome to my ADHD Connect podcast. For this episode, I wanted to comment on a recently written article by Paul Tough in the New York Times Magazine. It’s entitled, have we been thinking about ADHD all wrong and a thoughtful piece. And, you know, I have some thoughts on it.
So there’s a lot in this article. And it’s, was in April, April 2025, so, and he brought up some questions about, you know, we’re seeing higher numbers of diagnoses and ADHD, you know, and, and in turn, that means there’s, you know, higher number of medications being prescribed, and what exactly is ADHD, and you know, our current diagnostic criteria. He describes some of that on some level and talks about, you know, are there other explanations? Uses lots of sources in his article, but there are some things that I wanted to hit on, and I want to stay in my lane, if you will, being a clinical psychologist and former school psychologist.
So I’m not an academician and I’m not a researcher, so I’m not going to, you know, overstep my bounds in that way. So a lot of what I’m going to be speaking from is what I’ve understood the diagnostic criteria to be and after doing, and I can safely say, 1000s of evaluations and seeing families, children, teens and so, and some, sometimes adults, young adults, what I see in terms of the diagnostic criteria as it stands. And, you know, another question that was raised is, you know, is this neurological, or is there an environmental cause? I mean, how do we really think about this?
So I will preface it by saying that it is deemed to be a neurodevelopmental disorder. So that is the current understanding in terms of the diagnostic criteria. So the Diagnostic and Statistical Manual deems it as a neurodevelopmental disorder that begins in childhood. So essentially, what that means is there’s some lag in growth and development when you think about those areas that are targeted, when you’re trying to say, you know, does a person or child have ADHD, and so essentially it means a lot of executive functions. Is it sustained attention? Are there delays and persistent difficulties with sustained attention? Distractibility, organization on the hyperactive, impulsive side, increased levels of hyperactivity, impulsivity, and behavior regulation are more challenging, and this interferes with everyday functioning.
Part of the diagnostic criteria is also whether we see this in more than one environment. And so that can get tricky, because there are lots of variables that play, as you might imagine. So that is part of the diagnostic criteria. Another part is, have we seen it? Have we seen any of these patterns prior to age 12? A few of the pieces don’t quite fit adulthood, right? So if you look at a couple of the descriptors, there are nine descriptors for inattentive type, nine descriptors for hyperactive, impulsive type. So there’s been a slight adjustment for adulthood. Now I have heard of, you know, adult-onset ADHD, in terms of the diagnostic criteria, that is not part of the diagnostic criteria. So I can’t say I can speak a lot to that, but this idea of adult-onset ADHD, I don’t diagnose that because of the diagnostic criteria as it stands.
Another question, I think, another question that the author brought up is, you know, is there, and he was speaking to another researcher, or, you know, somebody conceptualizing this ADHD, is that, you know, we haven’t found a single biological marker and, and I, in my humble opinion, the brain is just really too dynamic for that, especially when you’re thinking about executive functions. There are so many neurons and neural pathways that are happening at any one time that I don’t know how you would find a single biological marker. So it all appears in my current understanding is that, you know, the brain is developing dynamically.
There are certainly some developmental stages that are occurring. There can be insults to that in terms of that development, and there are certainly genetic components to that that we don’t have a full handle on. As I’ve seen so many people in kids over the years, you can’t deny that there’s a strong genetic component. When you see what looks to be a pretty clear picture of ADHD, you almost always see it in the family, and there’s data and research about that as well. So you know to say it strict.
Environmental, I have a hard time grasping that one, just because of the strong genetic component that is seen. So in case after case, I see that it’s hard to say strictly environmental, because when you see children or individuals who struggle with these things, really almost day in and day out, in different environments and different circumstances, a different teacher, a different school, you know, from you know, different developmental stages. It’s hard to think it’s just environmental, that there’s something innate, or, I’ll just say, something neurological inside of them that appears present.
Now, where it gets tricky, I think, as a diagnostician and a clinician, is when it seems to be a milder case and when some of the symptoms are more subtle, or when there’s a borderline level of symptoms that seem to be reported, or they seem to be exacerbated in some circumstances and not others. Those are trickier. So I really do think about ADHD on a continuum, right? So if you think about, you know, we can all have difficulty with distractibility or doing something impulsive, but if you think about those individuals on the far end of the continuum who show those behaviors and symptoms often frequent to a more significant degree, and it’s interfering with some of their functioning, or much of their functioning, that’s when we tend to make that diagnosis, as we’ve ruled out other things as well. So but when those individuals look a little milder on that continuum, or close to that threshold on the continuum, then that gets trickier. So, what you’re trying to do is understand the entire history of the individual. Do you know if there are other things that might explain the behaviors?
For example, is there anxiety, or is there something in the environment that’s causing it? And boy, we haven’t even talked about screens and technology, but that has certainly taken us by storm, if you ask me. And so what? What role has that played in terms of attention? But I will again say, as a clinician, trying to diagnose or not diagnose, taking all those things into account. And so you’re going through a list of rule-outs, if you will. Right? I mean, would there be something else that would explain what we’re seeing, or does this appear to be innate and more neurological? So I feel like that’s a big mouthful, but I always welcome.
I think it’s really so important that we question what we’re doing, or over time, if we’re seeing trends or patterns, and you know that we’re keeping ourselves in check, right? Is there another way we need to look at this? Is there another way we need to think about this? Of course, we need to do it with solid research and data as we do it. But, you know, I thought, you know, it was thought-provoking, and I wanted to follow up with it. But thinking about, you know, is what is seen as conditional? Is it transient? In trying to uncover those patterns, in the world of mental health and psychology, you’re definitely trying to see patterns, what may be triggering those patterns, and how that may be occurring. The other thing I would say is that in my prior podcast, I talked about CO occurring conditions with ADHD, and there are many, or in many cases, you do see co-occurring conditions. And so, trying to understand all of that in context is really important as well. And I think the other thing this speaks to is really getting a good picture of what’s happening and monitoring it over time. And so, you know, do we see a change in what’s happening?
Do we see a change in the clinical presentation? Do we see a change with certain interventions, and some of those interventions may not be medication? Can we put solid structures, routines, and reinforcement systems in place that may make a difference? You know? Can we change up something in the environment that may make a difference, and see if some of those things work, and if that’s a good match for the presentation?
Again, you can access my trait tool. I know I had mentioned that in my first podcast, and that, again, is a good self-monitoring tool, a good tool to really identify, you know, what you know, how things are presenting, and what we’re seeing. So that may be a good method to help determine, you know, is this ADHD, as we understand it? Does it appear to be something innate within the child?