The NYT’s ADHD Rethink is Half-Right

ADHD is not a disorder — but it IS a disability

The recent article “Have We Been Thinking About A.D.H.D. All Wrong?” (link, paywalled) by Paul Tough in The New York Times questions the standard medical model of ADHD. It suggests shifting our understanding of ADHD toward it being situational and environmental, rather than purely biological. It focuses a lot on critiquing stimulant medication as a solution, and suggests people with ADHD just have to “find their niche”.

Ok, but.

I agree that ADHD becomes more or less of a problem based on “situational and environmental” factors, but that does not preclude it being based in biological differences. And inasmuch as we can’t all change our situations and environments—he’s not really getting to the core of the issue.

What is glaringly missing from this article is a discussion of the Social Model of Disability. We live in a society and culture that demands everyone do things that ADHD people can’t do, or can barely do at great cost to themselves. So the disability lies in the gap between our needs and what society will accommodate — i.e. whose needs it meets automatically and whose it doesn’t. And we can’t change society on an individual level by making different choices.

The word “disability” doesn’t appear in the article once. This erases the entire situation ADHDers are in. Social disability arises from society’s privileging certain needs and strengths over others. Societal norms and institutions (e.g., standardized education, corporate workplaces) are inherently hostile to the way ADHDers brains work.

Without mentioning that, you’re implying that everyone could just solve their own problems within the existing society by “finding the right niche”, rather than recognizing that society has to change, because it is always going to be the wrong environment for many of us, and most people don’t have the option to opt out or completely design a custom lifestyle.

Now, I did in fact opt out of much of society and design a custom lifestyle for myself, and I can confirm, it is indeed awesome. I spend most of my time doing things that are intrinsically motivated, with very few obligations. But I was very lucky to be able to figure that out financially, and it doesn’t mean that the problems I have when I do have to interface with society have gone away.

I am free, but my house is still a mess.

I am very creative and productive on the things I want to do — but my house is a right mess and I literally just managed to do my taxes yesterday (April 12th) after having it pop up on my reminders periodically for the last 4 months. I manage my ADHD by reducing obligatory societal chores to as few things as possible.

I have no doubt that having to work a normal job would break me.

I have dedicated a lot of time to reclaiming my intrinsic motivation by eliminating extrinsic rewards or requirements from my life. I have very few demands on my time. I’ve methodically de-conditioned myself from social expectations of “having a career” or “living up to my potential”. I work for myself, and developed passive income so I mostly don’t have to work at all if I don’t feel like it. I can pursue whatever I’m interested in and do what I want, whenever I want. I spend most of my time learning new things and making websites and writing.

Consequently for a long time, I didn’t think I had ADHD. It wasn’t until I read this Substack article that talked about ADHD as a neurotype and not a disorder that I realized I definitely do have it. I just didn’t identify it as a disorder, because I’d built my environment to accommodate myself, and I didn’t think the way my brain worked was, you know, a problem. But if I compare how I live my life to the neurotypical average, my lifestyle is extremely atypical, and entirely built around the way my brain works.

Last year, I decided to try Straterra (a non-stimulent ADHD medication, which the NYT article seems to not even mention as an option). It helps me focus on the things I want to focus on. I didn’t have any purpose for taking stimulants, as it seems people take them to cope with things that I don’t have to do. I don’t have to go to work whether I feel like it or not, I don’t have to work on things other people assign me, etc. Because I’m always doing things I have internal, intrinsic motivation to do, I don’t struggle with doing things.

The only things I struggle with accomplishing are things like taking out the trash, but I have really minimized those kinds of things, so the few that are left are not a huge deal. (I still put it off ofc. 😂)

And the fact that, to get stimulants, you have to physically leave your physical house and go to the physical store and stand in line to get them, and then wait around for 1/2 hour for them to fill your order, because you can’t get them delivered by Amazon Pharmacy due to the fact that they are literally meth, was not an insignificant reason I did not even bother to try them.

So yes, I believe that if people with ADHD have an environment that supports them, then their ADHD is much less of a problem in their lives. But to accomplish that requires money, which I am very lucky to be able to manage well enough despite the ADHD.

Opting out of societal requirements is a privilege.

Our “environment” includes all of society and society’s expectations, and I had to check out of all of that to be able to truly accommodate myself.

Our “environment” includes capitalism and having to survive, and not everyone can just figure that out like I have. I feel incredibly grateful, because working at a job, or even working freelance for clients sometimes, felt like taking a cheese grater to my soul.

I am on ADHD and autism support forums a lot, and I see people all the time struggling with things I simply don’t have to do. And I know if I did have to do them, I would struggle too. Capitalism, institutionalized education, and most workplaces create barriers and burdens that most ADHD folks simply can’t opt out of.

I am very smart, I love to learn, but I struggled intensely in school. In high school, I was valedictorian, but extremely depressed. By the end of college I could barely force myself to complete the requirements to graduate.

After graduating I worked retail which also felt like death, until I started my own business and gradually worked on making my lifestyle support me instead of making me want to die.

So, my lifestyle proves the author’s general point, but it also shows that it takes extreme measures that few can accomplish to be able to create a suitable environment for ADHD, because society itself is not suitable.

I agree I don’t have a disorder, but I definitely, in this society, am disabled. And that is something that I think the author only managed to completely omit from an article of this length in this high profile of a publication because of the ableism throughout society — people just don’t want to deal with it as a reality, because it would require a radical look at how much society fails so many people and blames them for their problems instead of helping them.

I have been enormously successful at self-help, but self-help is not a solution for societal problems.

We need collective solutions. We need collective change. We need to recognize how deeply and thoroughly ableist our norms and institutions are. We need to listen to people who are struggling, not just people who are doing OK because they “found their niche”.

So yes, we have been thinking about ADHD all wrong, but the question is not environment vs biology. The question is when people will recognize that neurodivergent struggles are just the canary in the coal mine to a system that hardly works for anyone.