Millions of children in the United States are diagnosed with attention-deficit hyperactivity disorder (ADHD), and the vast majority are prescribed stimulant medications such as Ritalin and Adderall. However, a new wave of research reported by NPR and detailed in The New York Times Magazine raises pressing questions about the effectiveness and long-term consequences of these treatments, as well as the very nature of ADHD itself (NPR, 2025).
The U.S. Centers for Disease Control and Prevention (CDC) revealed last year that more than 11% of American children had received an ADHD diagnosis—a record high, and a dramatic increase from the early 1990s figure of just 2 million. In 14-year-old boys, the rate soars to 21%. These statistics portray a nation deeply invested in identifying—and medicating—children with ADHD. But why are diagnoses rising, and are treatments truly serving those diagnosed?
This issue bears significance not only for American families but also for Thai caregivers and health educators. As rates of ADHD diagnoses steadily increase in Thailand, mirroring global trends, the Thai medical community and Ministry of Public Health must grapple with the same core question: Are stimulant medications, often seen as a first line of treatment, truly effective—and safe—in the long run?
Historically, ADHD was perceived as a clear-cut biological disorder, treatable primarily through medication. Groundbreaking studies in the 1990s, including the influential Multimodal Treatment of ADHD Study (MTA), initially concluded that stimulant medications greatly improved symptoms over a 14-month period. Children on Ritalin showed striking behavioral changes, appearing calmer, more attentive, and capable of focusing on school and homework. The perceived success of these medications led to their widespread prescription—by 1993, two-thirds of diagnosed American children were taking Ritalin.
Yet, as researchers like those leading the MTA study continued examining participants over the years, unexpected findings emerged. By 36 months, the apparent benefits of medication had faded; children on Ritalin were no longer outperforming peers who had received behavioral interventions or no specific treatment at all. This long-term analysis, spearheaded by respected academics such as a University of California, Irvine specialist in child psychiatry, revealed a troubling disconnect: while medication could offer fast, observable improvement, its advantages might not persist.
Equally salient, said the same child development experts, was the lack of attention given to these later findings. The popular narrative—that medication ‘works’ and is thus the best treatment—took firm root. But scientific understanding of ADHD itself grew less, not more, certain over time. As one prominent neuroscientist explained, hopes for discovering clear biomarkers or genetic signatures that would decisively identify ADHD have largely faded. Decades of research into brain structure, genetic markers, and neural signals resulted in a consensus: ADHD has no clear biological marker and likely arises from a blend of biological and environmental factors.
This lack of diagnostic clarity makes ADHD a difficult condition to pin down. The required Diagnostic and Statistical Manual of Mental Disorders (DSM-5) symptom checklist leaves much room for overlap with anxiety, depression, trauma, or learning disorders. Indeed, the CDC has found that approximately 75% of children diagnosed with ADHD also have another psychological or learning issue. As one expert from Oregon, a leading authority on child mental health, points out, children whose ADHD symptoms accompany intense anger or emotional dysregulation are especially at risk for future difficulties.
The spectrum-like nature of ADHD symptoms complicates the matter still further. A prominent British researcher from the UK, recognized for decades of work in developmental psychology, now posits that ADHD does not always constitute a discrete, binary disorder. Instead, he argues, these symptoms exist along a continuum; almost everyone experiences some, but their severity and impact vary widely. This perspective suggests that, for many, ADHD is not a lifelong, unchangeable brain disease, but a condition shaped by the complex interplay between an individual’s brain and their environment.
Persistent reliance on medication, therefore, also merits scrutiny. While many parents and teachers see a dramatic overnight change when children begin stimulants—improved focus, decreased disruptive behavior—the hoped-for academic gains may not materialize. Studies show that while such drugs can boost children’s abilities to sit still and complete tasks, tangible academic performance (such as test scores) may remain unchanged. An Australian experimental psychologist’s research using cognitive “knapsack” tests highlighted this paradox: medicated young adults worked more quickly and diligently, but did not actually solve problems more effectively.
Long-term use of stimulants brings additional concerns. One cornerstone MTA study observed that children regularly taking Ritalin over years tended to be about an inch shorter by age 25 compared to their peers—a difference possibly linked to the appetite-suppressant effects of these drugs during key growth periods. While addiction is rare in children taking extended-release stimulants, some report feeling emotionally “flat” or less engaged with life. This has prompted many teenagers and young adults to use medication situationally: for school exams, sports, or tasks requiring focus, rather than as a daily regimen.
Alternative treatments for ADHD remain elusive but are attracting new scientific interest. Despite a widespread desire for effective behavioral interventions—such as parent training, coaching, and classroom accommodations—few have shown consistent, measurable benefits in randomized controlled trials. However, practical adaptations, such as using organizational tools and fostering calmer home and classroom environments, have delivered modest results for particular families.
Some experts, such as a widely published American psychologist, continue to frame ADHD as a “lifelong brain disorder” akin to diabetes, arguing for steady medication to prevent downstream harms like addiction or accidents. Others, drawing on newer research, prefer a more flexible, individualized approach. The reality may be that ADHD is both a real and deeply disruptive condition for some, and a loosely defined, situational label for others.
This nuanced debate is playing out among the public, too. Parents, schools, and support organizations such as ADDitude Magazine vigorously advocate for medication as a proven treatment. Still, critics reproach such advocacy for downplaying individual children’s misgivings or the uneven clinical evidence. As rates of diagnosis and prescription continue rising—especially among adults—these questions intensify.
For Thailand, the lessons are profound. The country has witnessed a steady increase in ADHD diagnoses among schoolchildren, particularly in urban areas. As in the U.S., stimulant medications such as methylphenidate are rapidly gaining ground, often seen as the default solution within both international schools and top-tier Bangkok clinics. Thai pediatricians and child psychologists, trained in Western medical models, are now reckoning with the emerging skepticism and evolving understanding evident in U.S. research.
Moreover, the rigid structure of Thailand’s public education system, with its heavy emphasis on rote learning, obedience, and conformity, can exacerbate the challenges faced by children who struggle with attention, impulsivity, or hyperactivity. A mismatch between student needs and institutional demands can amplify symptoms and familial stress. At the same time, cultural attitudes toward mental health, academic achievement, and “face” may discourage both parents and schools from openly discussing children’s struggles, potentially leading to underdiagnosis or inappropriate reliance on medication.
As senior officials in the Thai Ministry of Public Health and Ministry of Education seek to update national guidelines, the shifting scientific consensus in the U.S. is a call to caution. Key recommendations emerging from the latest U.S. research include:
- Diagnosing ADHD cautiously, taking care to distinguish symptoms from other psychological or learning problems.
- Considering both biological and environmental contributors to symptoms—recognizing that school-related stress, trauma, or family dynamics may play a significant role.
- Prioritizing individualized, multimodal treatment plans that integrate medication, when appropriate, with behavioral interventions, family support, and classroom accommodations.
- Remaining alert to the potential long-term risks of stimulant medication, such as effects on growth and emotional well-being.
- Viewing symptoms as potentially episodic or situational, rather than fixed or lifelong, which can empower children to adapt and families to hope for improvement.
- Fostering open dialogue among parents, teachers, and healthcare providers, recognizing that “one-size-fits-all” strategies are rarely effective.
Locally, respected child psychiatrists from Chiang Mai University and Mahidol University have already begun to echo this global evolution: encouraging parents to seek second opinions, avoid overreliance on medication as a cure-all, and engage in holistic approaches tailored to each child’s realities (Thai Mental Health Department).
Thailand’s collective response must balance compassion with scientific integrity. While medications can be transformative for some—to the relief of overwhelmed families—the Thai health system should resist the temptation to simply import Western practice models wholesale. Ancient Thai values of sanook (enjoyment) and the social support offered by extended families can be assets in reducing school stress and supporting children struggling with focus and impulse control.
Looking to the future, the story of ADHD treatment is likely to become even more complex. Global researchers are now focusing on identifying subtypes of ADHD and exploring how school and home environments interact with children’s genetic and psychological profiles. As universities and medical schools around Thailand deepen their cooperation with international partners, local research will play an increasingly important role in shaping evidence-based policy and practice.
For parents, teachers, and policymakers, the take-home message is clear: there is no single “correct” way to treat or understand ADHD. Thai families should seek out reputable clinicians, question oversimplified solutions, explore both medical and environmental interventions, and advocate for their children’s unique needs. Above all, maintaining an open, supportive dialogue between families, schools, and health professionals will ensure better outcomes, improved wellbeing, and brighter futures for every child.
For those curious or concerned about ADHD, insightful resources and further reading include the NPR report (NPR, 2025), The New York Times Magazine’s coverage, and the Thai Mental Health Department’s latest guidelines on child mental health (DMH Thailand).