By Dr. Ryan Sultan, Assistant Professor of Clinical Psychiatry, Columbia University | Updated February 2026
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ADHD is one of the most scientifically validated psychiatric disorders, with structural brain differences visible on MRI, 70-80% heritability, and consistent findings across 50+ years of research involving millions of patients worldwide. |
"ADHD isn't real. It's just lazy kids and Big Pharma making money."
I hear some version of this at every party when people find out I'm a psychiatrist who specializes in ADHD.
And I get it. I understand the skepticism.
Unlike diabetes (check blood sugar) or a broken bone (X-ray shows it), you can't run a simple blood test for ADHD. There's no scan you can do in 10 minutes that definitively says "yes" or "no."
This makes ADHD feel subjective. Invented. A convenient label for behavior problems.
But here's what the person at the party doesn't know:
ADHD is one of the most researched conditions in all of psychiatry. We have more scientific evidence for ADHD than we do for many "accepted" medical conditions.
Let me show you the data.
Let's start with the most direct evidence: You can literally see ADHD on brain scans.
Multiple large-scale neuroimaging studies have found consistent structural differences in ADHD brains:
These aren't subtle differences. They're measurable, reproducible, and found consistently across thousands of scans in multiple countries.
It's not just structure - ADHD brains work differently:
Study after study shows: ADHD brains activate different regions and show different connectivity patterns.
This isn't speculation. We can see these differences with specialized imaging.
Translation: The brain differences in ADHD are as well-established as brain differences in stroke, Alzheimer's, or traumatic brain injury.
If ADHD were "just bad parenting" or "modern society," it wouldn't run in families the way it does.
But it does. Dramatically.
We've identified multiple genetic variants associated with ADHD:
2019 Study in Nature Genetics: Analyzed DNA from 20,183 people with ADHD and 35,191 controls. Found 12 independent genetic variants significantly associated with ADHD.
If you have ADHD:
This is consistent with a neurodevelopmental disorder with genetic basis, not a "made-up" condition.
Bottom Line: ADHD is more heritable than height. Nobody argues that height isn't "real" because it runs in families. Neither should ADHD.
Let's talk about the sheer volume of scientific evidence.
There is literally not a single major medical organization that disputes the validity of ADHD.
If ADHD were "an American invention" or "Big Pharma marketing," you'd expect it to vary wildly by country.
It doesn't.
Polanczyk et al. (2007) reviewed 102 studies from around the world. Conclusion: ADHD prevalence is remarkably consistent globally.
Here's something critics can't explain away: ADHD medications work. Consistently. Predictably. Measurably.
For context: An effect size of 0.5 is considered "medium," 0.8 is "large." ADHD stimulants consistently show effects of 0.9-1.0.
Some people claim: "Stimulants calm ADHD kids down, so ADHD must be real."
Actually, stimulants improve focus in everyone - people with and without ADHD. The difference is:
The fact that stimulants work predictably for a specific constellation of symptoms supports a biological basis.
If ADHD weren't real, why would treating it have such dramatic, measurable effects on life outcomes?
Let me address the specific claims I hear.
Response: There's no blood test for Alzheimer's either, but nobody claims Alzheimer's isn't real. Psychiatric diagnoses are based on clinical presentation, which is standard medical practice for many conditions (migraines, fibromyalgia, irritable bowel syndrome, etc.).
Also - we can see ADHD on advanced brain imaging. We just don't use $5,000 MRI scans for routine diagnosis when clinical assessment works fine.
Response: True. And everyone feels sad sometimes - that doesn't mean clinical depression isn't real. ADHD is diagnosed when symptoms are:
The difference between "sometimes distracted" and ADHD is like the difference between "sometimes sad" and major depression.
Response: Actually, ADHD is underdiagnosed in most populations:
Yes, some regions may overdiagnose. But globally, the bigger problem is underdiagnosis.
Response: ADHD symptoms are found in every generation and every culture studied, including in historical records before ADHD had a name. What's changed is our ability to recognize and treat it - not its existence.
Also: ADHD adults significantly underperform their intellectual potential, earn less money, have more accidents, higher divorce rates, and increased mortality. This is not "normal."
Response: ADHD was first described in medical literature in 1902 - decades before ADHD medications existed. Stimulants weren't used for ADHD until the 1930s, and widespread medication use didn't begin until the 1960s-1990s.
Also: Many ADHD medications are now generic (cheap), yet the condition continues to be studied intensively. If this were a pharmaceutical conspiracy, why would thousands of independent researchers in non-profit universities worldwide continue finding consistent results?
Response: If ADHD were caused by parenting:
Parenting style can worsen or improve ADHD symptoms, but it doesn't cause ADHD.
Response: ADHD has been documented in every decade since the early 1900s, long before screens and processed sugar were widespread. If modern life caused ADHD, we'd see:
Screens and sugar can worsen symptoms in people with ADHD, but they don't cause it.
If the evidence is this strong, why do people still claim ADHD isn't real?
People trust what they can see. A broken bone shows up on X-ray. High cholesterol shows up in bloodwork.
ADHD requires clinical assessment. This feels "subjective" even though the evidence base is massive.
Everyone experiences distraction, impulsivity, and restlessness sometimes. This makes people think "That's just life, not a disorder."
But severity matters. Everyone feels sad sometimes - that doesn't mean depression isn't real.
Drug companies have aggressively marketed ADHD medications. This creates (legitimate) skepticism.
But pharmaceutical marketing doesn't erase 50 years of independent research from universities worldwide.
ADHD diagnosis rates have increased significantly since the 1990s. Critics see this as evidence of "overdiagnosis."
But: Most of this increase reflects better recognition (especially in girls, adults, inattentive type) - not actual increase in prevalence.
Some people resist the idea that behavior and personality can have biological underpinnings. It challenges notions of free will and personal responsibility.
But neuroscience doesn't care about ideology. The brain differences are real whether we're comfortable with them or not.
Here's the thing: All psychiatric diagnoses are descriptive categories.
"Depression" describes a cluster of symptoms. So does "ADHD." So does "anxiety."
These categories are useful because:
Is ADHD a "disease" like cancer? No. It's a neurodevelopmental variant with genetic basis that causes functional impairment.
Is it "real"? Absolutely. As real as dyslexia, autism, or any other condition defined by behavioral and cognitive differences with neurobiological underpinnings.
The question isn't "Is ADHD real?"
The question is: "Do some people have persistent attention regulation problems that cause significant impairment and respond to treatment?"
The answer to that question is unequivocally yes. Whether we call it "ADHD" or something else is just semantics.
Learn more about ADHD:
Struggling with ADHD but worried about stigma or misdiagnosis? I provide comprehensive, science-based evaluations in my Manhattan practice.
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