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July 14, 2026
Language is powerful. The words we choose not only reflect our understanding of the world but also actively shape it. Recently, this truth has been at the center of a growing debate in the mental health field regarding how we talk about ADHD.
In a recent paper published in The Lancet Psychiatry titled “The Power of Words: Respectful Language in ADHD Research,” French and colleagues advocated for a shift toward "neurodiversity-affirmative language”. Rooted in the social model of disability, their proposal encourages researchers to abandon traditional medical terminology, e.g., words like disorder and deficit, in favor of more neutral terms such as condition and challenge.
My colleague, Dr. Michael Miller, and I read this with great interest. We completely agree that revising language is essential to good science and that, both as researchers and as human beings, we are ethically bound to speak respectfully. However, we felt compelled to write a response. In our new paper, we argue that while language must evolve, it must do so scientifically.
The Two Prerequisites for Language Change
If we are going to fundamentally shift our scientific lexicon, two requirements must be met:
Currently, the proposal by French and colleagues meets neither requirement. While they claim consensus is accumulating that certain terms are disrespectful, they provide zero empirical evidence that this view is shared by the community of individuals living with ADHD. Even proponents of patient-centered language admit there is surprisingly little data supporting specific language changes.
More alarmingly, the recommended changes severely dilute the scientific accuracy of our field. Let’s look at two examples.
Why a "Deficit" is Not Just a “Challenge"
French and colleagues suggest replacing the term deficit with challenge. On the surface, challenge sounds softer and more affirming. But scientifically, these words are not interchangeable.
For decades, the term deficit has been defined by a specific performance metric that falls substantially below an expected level. It is a measurable reality. A challenge, on the other hand, refers to a new or difficult task that tests someone's ability.
Every single human being is "challenged" by complex neuropsychological tests, but only some individuals who face that challenge demonstrate scientifically significant deficits. If we relabel measurable deficits as universal challenges, we sacrifice the exactness required to communicate scientific findings and accurately measure the effects of life-changing treatments.
ADHD is a Disorder, Not Just a "Condition"
Another proposal is to replace the word disorder with condition.
In mainstream psychiatry, a disorder is a clinically significant disturbance that causes distress or disability. The word purposefully separates natural human variation from the suffering (pathos) that gives pathology its meaning.
Condition is a completely neutral term. Pregnancy is a condition. Being tall is a condition. Calling ADHD a condition distances the diagnosis from the profound suffering it can cause.
French et al. argue against framing ADHD as a disorder because it exists on a spectrum without a clear cutoff, its manifestation is context-dependent, and its definition evolves. But if we apply that logic across all of medicine, the concept of disease unravels:
The Real-World Danger of Imprecise Language
This is not merely an academic debate over semantics. The language we use has real-world implications. In the United States and across the globe, our healthcare, educational, and legal systems run on precise medical language. Terms like impairment, dysfunction, and disorder are legally and administratively required to justify support services, workplace accommodations, specialized educational therapies, and medications. The language of pathology in diagnostic manuals regulates the flow of these resources.
If we reclassify ADHD as a neutral condition characterized only by challenges, we risk erecting massive bureaucratic barriers. Imprecise language could easily be used by institutions or insurance companies to deny vital care to the people who need it most.
The Need for Lexical Discipline
Attempting to characterize a clinical disorder entirely through its strengths happens in a scientific vacuum. We cannot ignore the vast body of rigorous evidence confirming that ADHD meets the long-standing criteria used by mental health science to identify clinical disorders.
As professionals, our respect for the ADHD community demands a commitment to language that is clear, correct, and evidence-based. To build genuine consensus about how we talk about ADHD, we need meaningful, collaborative dialogue that integrates compelling empirical data and rigorous theory.
This standard of "lexical discipline" is not just a technical preference. It is a vital mechanism through which science and the mental health professions uphold their duty to society.
Faraone S, Miller M Precision language in ADHD research; The Lancet Psychiatry, 2026
https://doi.org/10.1016/S2215-0366(26)00117-3
French, B ∙ Dekkers, TJ ∙ Barclay, I ∙ et al. The power of words: respectful language in ADHD research. Lancet Psychiatry. 2025; 12:876-879
Parents and teachers often ask: Does ADHD medication actually improve grades and school performance? The answer is: yes, but with important limitations. Medications are very effective at reducing inattention, hyperactivity, and impulsivity but their impact on long-term academic outcomes like grades and test scores is not as consistent.
In the Classroom
The medications for ADHD consistently: Improve attention, reduce classroom disruptions, increase time spent on-task and help children complete more schoolwork and homework. Medication can help children with ADHD access learning by improving the conditions for paying attention and persisting with work.
Does Medication Improve Test Scores and Grades?
This is where the picture gets more complicated. Medications have stronger effect on how much work is completed but a weaker effect on accuracy. Many studies show that children on medication attempt more problems in reading, math, and spelling, but the number of correct answers doesn’t always improve as much. Some studies find small but significant improvements in national exam scores and higher education entrance tests during periods when children with ADHD are medicated.
Grades improve, as well, but modestly. Large registry studies in Sweden show that students who consistently take medication earn higher grades than those who don’t. However, these gains usually do not close the achievement gap with peers who do not have ADHD.
Keep in mind that small improvements for a group as a whole mean that some children are benefiting greatly from medication and others not at all. We have no way of predicting which children will improve and which do not.
Medication Alone Isn’t Enough
Academic success depends on more than just reducing inattention, hyperactivity and impulsivity. Skills like organization, planning, studying, and managing long-term projects are also critical. Medication cannot teach these skills.
So, in addition to medication, the patient's treatment program should include educational support (tutoring, structured study skills programs), behavioral interventions (parent training, classroom management strategies), and accommodations at school (extra time, reduced distractions, organizational aids) Parents should discuss with their prescriber which of these methods would be appropriate.
Conclusions
ADHD medication is a powerful tool for reducing symptoms and supporting learning. It improves test scores and grades for some children, especially when taken consistently. But it is not a magic bullet for academic success. The best results come when medication is combined with educational and behavioral supports that help children build the skills they need to thrive in school and beyond.
A cohort study looked at over five million adults, and over 850,000 children between the ages of five and eleven, who received care at Kaiser Permanente Northern California during the ten-year period from the beginning of 2007 through the end of 2016. At any given time, KPNC serves roughly four million persons. It is representative of the population of the region, except for the highest and lowest income strata.
Among adults rates of ADHD diagnosis rose from 0.43% to 0.96%. Among children the diagnosis rates rose from 2.96% to 3.74%, ending up almost four times as high as for adults.
Non-Hispanic whites had the highest adult rates throughout, increasing from 0.67% in 2007 to 1.42% in 2016. American Indian or Alaska Native (AIAN) had the second highest rates, rising from 0.56% to 1.14%. Blacks and Hispanics had roughly comparable rates of diagnosis, the former rising from 0.22% to 0.69%, the latter from 0.25% to 0.65%. The lowest rates were among Asians (rising from 0.11% to 0.35%) and Native Hawaiian or other Pacific Islanders (increasing from 0.11% to 0.39%).
Odds of diagnosis dropped steeply with age among adults. Relative to 18-24-year-olds, 25-34-year-olds were 1/6th less likely to be diagnosed with ADHD, 35-44-year-olds 1/3rd less likely, 45-54-year-olds less than half as likely, 55-64-year-olds less than a quarter as likely, and those over 65 about a twentieth as likely. This is consistent with other studies reporting and age dependent decline in the diagnosis.
Adults with the highest levels of education were twice as likely to be diagnosed as those with the lowest levels. But variations in median household income had almost no effect. Women were marginally less likely to be diagnosed than men.
ADHD is associated with some other psychiatric disorders. Compared with normally developing adults, and adjusted for confounders, those with ADHD were five times as likely to have an eating disorder, over four times as likely to be diagnosed with bipolar disorder or depression, more than twice as likely to suffer from anxiety, but only slightly more likely to abuse drugs or alcohol.
The authors speculate that rising rates of diagnosis could reflect increasing recognition of ADHD in adults by physicians and other clinicians as well as growing public awareness of ADHD during the decade under study. Turning to the strong differences among ethnicities, they note, Racial/ethnic differences could also reflect differential rates of treatment seeking or access to care. Racial/ethnic background is known to play an important role in opinions on mental health services, health care utilization, and physician preferences. In addition, rates of diagnosis- seeking to obtain stimulant medication for nonmedical use may be more common among white vs nonwhite patients. They conclude, greater consideration must be placed on cultural influences on health care seeking and delivery, along with an increased understanding of the various social, psychological, and biological differences among races/ethnicities as well as culturally sensitive approaches to identify and treat ADHD in the total population.
But the main take home message of this work is that most cases of ADHD in adults are not being diagnosed by clinicians. We know from population studies, worldwide, that about three percent of adults suffer from the disorder. This study found that less than 1 percent are diagnosed by their doctors. Clearly, more education is needed to teach clinicians how to identify, diagnose and treat ADHD in adults.
The diagnosis of ADHD should only be done by a licensed clinician, and that clinician should have one goal in mind: to plan a safe and effective course of evidence-based treatment. The infographic gives a summary of this diagnostic approach which my colleagues and I prepared for our "Primer" about ADHD,http://rdcu.be/gYyV. A key point that parents of ADHD youth and adults with ADHD should keep in mind is that there is only one way to diagnose ADHD.An expert clinician must document the criteria for the disorder as specified by either the Diagnostic and Statistical Manual of the American Psychiatric Association, which is now in its fifth edition (DSM-5), or the World Health Organization's International Classification of Diseases (ICD-10). The two sets of criteria are nearly identical. These criteria are most commonly applied by a clinician asking questions of the parent (for children) and/or patient (for adolescents and adults).For children, information from the teacher can be useful. Some clinicians get this information by having the parent ask the teacher to fill out a rating scale. This information can be very useful if it is available. When diagnosing adults, it is also useful to collect information from a significant other, which can be a parent for young adults or a spouse for older adults. But when such informants are not available, diagnosing ADHD based on the patient's self-report is valid. As the infographic indicates, any diagnosis of ADHD should also assess for comorbid psychiatric disorders, as these have implications for which ADHD medications will be safe and effective. And because a prior history of cardiovascular disease or seizures frequently contraindicate stimulants. These must also be assessed.
The Background:
Motor vehicle crashes remain one of the most significant public health challenges in the United States. In 2022 alone, nearly 44,000 people died on American roads, and more than 2.6 million crash-related injuries required emergency care. Most people are familiar with the usual suspects: drunk driving, speeding, and distracted driving from phones. These risks are well-documented and the focus of ongoing public safety campaigns.
But a serious risk factor has been flying under the radar: untreated ADHD. Despite receiving little attention from the public, policymakers, or transportation safety agencies, it may belong in the same conversation as these better-known dangers.
ADHD is not currently recognized by the National Highway Traffic Safety Administration as a driving risk factor; yet inattention and impulsivity, two of its defining features, are consistently cited as common contributors to crashes. Beyond these core symptoms, adults with ADHD may also experience emotional dysregulation, which can further impair driving behavior.
The Research:
Prior studies on ADHD and crash risk have produced estimates ranging from a 5% to a 70% increase. This massive heterogeneity has made it difficult to draw firm conclusions. This new meta-analysis set out to offer some clarity on these numbers.
Researchers focused specifically on adults aged 18 to 65 with a formal ADHD diagnosis who were not receiving treatment, comparing them to controls without ADHD. Four studies met these criteria, collectively covering more than 2.75 million people.
The Results:
The findings were striking: untreated ADHD was associated with a 93% increase in crash risk (95% confidence interval: 88%–99%). There was no evidence of publication bias. Although there was meaningful variation across studies, most of it stemmed from the smallest study (just 36 participants) which reported an outlier estimate of a 16-fold increase.
To put the 93% figure in context: a separate meta-analysis found that alcohol use is associated with a 150% increase in crash risk. Another way to understand just how significant this risk really is, untreated ADHD raises crash risk by more than half as much as alcohol does.
The analysis also found a dose-response relationship between ADHD symptom severity and crash risk: each incremental increase in symptom severity corresponded to a 5–6% higher crash risk. At the highest severity levels, crash risk approached that associated with alcohol use. This gradient reinforces that we're not looking at a binary distinction between “has ADHD” and “doesn’t” — the worse the symptoms, the greater the danger on the road.
The Takeaway:
These findings have practical implications for patients, families, clinicians, and policymakers alike. Untreated ADHD is not a minor footnote in the driving safety literature; rather, it is a substantial, measurable, and potentially modifiable risk factor. The question of whether and how it should be factored into licensing policy, clinical practice, and public health messaging deserves serious attention.
As populations grow, more children are growing up surrounded by traffic noise and polluted air. In most cities, these two factors tend to go hand-in-hand; yet, most previous research has examined these exposures separately. Many reviews focused on a single pollutant (such as fine particulate matter, PM2.5), or on a single developmental window, such as pregnancy or early childhood. Few have asked how noise and air pollution compare as risk factors, or how prenatal and postnatal exposures differ in their effects.
A new meta-analysis set out to address those gaps. It examined evidence on both environmental noise and several major air pollutants in relation to ADHD, compared exposures before versus after birth, and pooled data across countries and regions. Eligible studies involved children and adolescents under 18, used objective measures of environmental exposure, and assessed ADHD using either clinical diagnosis or standardized rating scales.
Noise
Nine studies, combining data from over 100,000 children and adolescents (all in European countries and Canada) found that high noise exposure was associated with 3% greater odds of ADHD. Prenatal noise exposure showed no effect; childhood exposure alone drove the association, at 4% greater odds. This is a negligible effect size that could easily reflect unmeasured confounding factors rather than a true causal relationship.
Nitrogen dioxide
Thirteen studies covering nearly one million children and adolescents in Europe, Canada, China, and South Korea found that nitrogen dioxide (NO₂) exposure was associated with 11% greater odds of ADHD. As with noise, prenatal exposure showed no independent effect. When the analysis was restricted to the five studies that used clinical diagnoses alone — generally considered the most reliable measure — the estimated odds rose to between 20% and 80% higher. The wide range reflects substantial variation across studies.
Pollutants with no significant effect
Four studies (97,500 participants) examining nitric oxide (NO), three studies (over 63,000 participants) on ozone, and three studies (over 28,000 participants) on sulfur dioxide found no significant associations with ADHD.
Particulate matter
The strongest associations emerged for particulate matter. Twelve studies involving nearly 160,000 participants in China, the US, Canada, and Europe found that exposure to fine particles (PM2.5, 2.5 microns in diameter) was associated with 30% greater odds of ADHD. Ten studies covering more than a quarter of a million participants in India, China, South Korea, and Europe found that coarser particles (PM10, 10 microns) were associated with 50% greater odds. In both cases, prenatal exposure showed no association, which is consistent with the fact that fetuses do not breathe air through developed lungs. When restricted to clinically diagnosed ADHD, PM2.5 was associated with roughly 50% greater odds, and PM10 with more than double the odds.
The Results
Across all exposures examined, particulate matter showed the clearest and strongest associations with ADHD, followed by nitrogen dioxide. Noise reached statistical significance but at a trivially small effect size. Nitric oxide, ozone, and sulfur dioxide showed no significant associations.
The authors found no evidence of publication bias which strengthens confidence in the overall pattern. However, there was marked heterogeneity across individual studies: results varied considerably, which urges caution in treating any single estimate as definitive. These are associations, not proven causal relationships, and the possibility that unmeasured factors explain part of the signal cannot be ruled out.
The Background:
Over the past two decades, diagnostic rates for adult ADHD have roughly doubled, and stimulant prescriptions in the United States skyrocketed by more than 50% between 2012 and 2023, particularly among girls and women. While these medications help many individuals manage their symptoms, a landmark 2026 article published in European Neuropsychopharmacology tackles an important question that is rarely discussed: When should doctors and patients consider stopping them?
The Discussion:
To answer this, the American Society of Clinical Psychopharmacology (ASCP) gathered a task force of 45 international experts spanning 12 countries. Through a rigorous evaluation process, they reached an overwhelming agreement on a framework for "deprescribing", the planned, supervised reduction or cessation of a medication. Here are the core insights from these ground-breaking guidelines and what they mean for adults navigating long-term ADHD treatment.
When the Treatment Isn’t Yielding Benefits
One of the most straightforward reasons to consider stopping a stimulant is if it simply isn’t doing its job. The task force agreed that if a patient does not experience an optimal response, measured by actual symptom reduction, improved daily functioning, and a better quality of life, even after trying a high, optimized dose, it may be time to step back and look at alternative options.
Sometimes, the issue goes back to the initial evaluation. The criteria for diagnosing ADHD have expanded over the years, and brief psychiatric evaluations can occasionally lead to diagnostic inaccuracies. If a thorough reevaluation reveals that the original ADHD diagnosis was incorrect, the expert consensus is clear: stimulant deprescribing is appropriate unless another stimulant-responsive condition is evident. Furthermore, if a patient develops a persistent tolerance to the drug that cannot be resolved by safe dose adjustments, a temporary taper or drug holiday may be recommended.
When the Risks to Health Outweigh the Rewards
Our bodies and health needs naturally shift over time, meaning a medication that worked safely years ago might pose a threat to your health today. The experts concluded that deprescribing should be heavily considered if stimulants exacerbate a concurrent medical or psychiatric illness. For example, although rare, stimulants can unintentionally trigger mania or psychosis in adults with unstable or unrecognized comorbid bipolar disorder.
Physical health developments are equally critical. If an adult develops a newly arising or unstable cardiovascular condition, such as a cardiac arrhythmia, ischemia, or cardiomyopathy, the risk-benefit balance changes dramatically. Additionally, if severe side effects occur that cannot be managed by reducing the dosage, or if dangerous new drug-drug interactions emerge, stopping the medication under medical supervision protects the patient's long-term well-being.
Addressing Misuse and the Complex Role of Cannabis
Because stimulant medications target brain reward and wakefulness circuitry, they can foster a propensity for misuse. Studies indicate that more than 1 in 5 adults prescribed stimulants have misused them, and 1 in 6 have diverted their medication to others. The task force emphasizes that deprescribing is warranted if a patient persistently takes doses higher than prescribed against medical advice, uses the medication purely for unauthorized performance enhancement, or has an untreated, coexisting substance use disorder.
And what about cannabis? This topic sparked the most debate among the experts, falling just short of an official consensus with 71% agreement that regular cannabis use alone shouldn't automatically trigger a stimulant stoppage. Recognizing the complexity, such as how chronic cannabis use can overlap with ADHD executive function deficits, the task force proposed a structured monitoring approach instead of an immediate cutoff. Clinicians are encouraged to track the patient every 1 to 3 months using standardized symptom tools and random urine drug screens to verify whether cannabis use is actively neutralizing the stimulant's therapeutic benefits.
The Path Forward: Safe Tapering and Lifestyle Support
If you and your doctor decide that stopping a stimulant is the right path, it shouldn’t happen overnight. The task force strongly recommends that medications be gradually tapered off at a rate tailored to the individual to minimize potential disruptions and distinguish between transient withdrawal and a true return of ADHD symptoms.
Crucially, stopping a medication doesn't mean stopping treatment. The experts highlight that the success of any deprescribing plan is significantly enhanced when patients focus on optimizing modifiable lifestyle factors. Prioritizing sleep hygiene, staying physically active, and implementing structured behavioral strategies can support executive functioning and help sustain your cognitive gains even as the medication is reduced or eliminated.
The Takeaway:
The decision to continue or stop an ADHD medication is a deeply personal one that requires balancing real-world efficacy, safety, and individual health changes. These new consensus recommendations provide an essential roadmap to help adults navigate their long-term mental health journeys safely and effectively.
Are you or a loved one currently evaluating your long-term relationship with ADHD medication? Consider scheduling a check-in with your healthcare provider to discuss whether your current treatment plan still perfectly matches your health needs today.
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