Rethinking ADHD: A Holistic Approach to Attention, Environment, and Emotional Wellness
At The Brentwood Therapy Collective, we often sit across from individuals who have already been labeled with an ADHD diagnosis—often accompanied by a prescription, but rarely by a full understanding of their lived experience. Few have been asked the most essential questions: What interferes with your attention? When do you feel most focused? And what does your environment ask of you that your nervous system struggles to meet? As a clinical psychologist who specializes in adult ADHD testing and psychodynamic therapy, I believe healing begins when we shift from treating symptoms to understanding stories.
In a groundbreaking April 2025 article for The New York Times Magazine, journalist Paul Tough explores a quiet revolution taking place within the scientific community: an unraveling of the longstanding belief that ADHD is a fixed brain disorder best treated by medication. Tough’s synthesis of decades of research reveals a more nuanced truth—one that many clinicians have long intuited. ADHD, rather than a static neurological defect, may be better understood as a dynamic interplay between biology, emotional history, and the demands of one’s environment (NYT).
The Limits and Uses of Medication
For decades, stimulant medications like Adderall and Ritalin have been the frontline treatment for ADHD. Their short-term benefits can be striking, especially in structured environments like classrooms or offices. Children may sit still longer, adults may power through their inboxes. But a closer examination of the long-term data reveals a more sobering picture.
The Multimodal Treatment of Attention Deficit Hyperactivity Disorder (M.T.A.) study, one of the most comprehensive ADHD treatment trials ever conducted, found that while medication led to improved behavior after 14 months, those gains diminished by year three. By that point, children who received medication, behavioral therapy, or no treatment at all showed similar symptom levels. Alarmingly, children who remained on stimulants over time also experienced stunted physical growth (NIMH, 2007).
These findings do not negate the potential benefits of medication—many clients find stimulants provide vital structure during periods of high stress. But the data suggest what many of us in clinical practice have long observed: medication alone is insufficient. It may quiet the symptoms, but it rarely addresses the emotional undercurrents or systemic mismatches driving them.
The Environment Isn’t Peripheral—It’s Foundational
Perhaps the most revelatory insight from recent research is this: ADHD symptoms are not static. They fluctuate—often dramatically—in response to context. In a 2023 longitudinal study, clinical psychologist Dr. Margaret Sibley found that fewer than 11% of children diagnosed with ADHD displayed persistent, year-over-year symptoms. For the vast majority, symptoms waxed and waned depending on life stage, environmental pressures, and emotional support (American Journal of Psychiatry).
When individuals are immersed in environments that align with their cognitive and emotional rhythms, something remarkable happens. Focus returns. Regulation strengthens. Confidence blooms. A young man who struggled through public school might thrive as an automotive technician, where kinetic learning and problem-solving are daily currency. A teenager labeled as distractible in algebra class may find deep flow while editing films or designing video game levels.
In Tough’s article, participants in the M.T.A. follow-up study described this transformation vividly. One college student, once medicated for inattention, shared that his symptoms all but disappeared when he began studying film—a subject that sparked his intrinsic motivation and allowed him to hyperfocus in productive ways. “Maybe,” he reflected, “I didn’t have a disorder—I was just in the wrong environment” (NYT).
This is not to say that changing environments is a cure. Rather, it is a powerful therapeutic tool—one that should stand alongside, not behind, medication or therapy. ADHD is not simply a disorder of the brain; it is a disorder of fit.
The Quiet Epidemic of Underdiagnosis
While headlines often focus on overdiagnosis, especially in young boys, there is a quieter crisis unfolding beneath the surface: underdiagnosis. Many individuals—particularly women, BIPOC clients, and perfectionists—slip through the cracks. Their symptoms don’t conform to the stereotypical image of hyperactivity. Instead, they manifest as chronic overwhelm, emotional dysregulation, forgetfulness, or internal restlessness. These symptoms are often misread as anxiety, depression, or “just being bad at life.”
The Centers for Disease Control and Prevention reports that over 60% of individuals with ADHD have at least one additional mental health diagnosis, further muddying the waters (CDC). I have sat with many adults who tell me, often tearfully, that they’ve spent years blaming themselves for something they could never quite name. With proper evaluation—one that considers not just diagnostic checklists, but emotional context and life narrative—a different story comes into view.
From Compliance to Curiosity
If we want to truly support people with ADHD, we must create space for complexity. This is where psychodynamic therapy and mindfulness come in. Instead of simply managing behaviors, these approaches invite clients to explore the internal forces—trauma, shame, perfectionism, familial patterns—that shape their capacity for attention.
Mindfulness, in particular, helps cultivate awareness of emotional and physiological states that can mimic inattention. A racing heart, a frozen nervous system, or a wave of self-doubt can all lead to distraction. But when we learn to pause, to notice, to breathe—we interrupt that cycle. We stop trying to “fix” attention and start relating to it.
“Rather than suppressing symptoms,” I often tell clients, “let’s get curious about what they’re trying to say.”
What Holistic ADHD Care Really Looks Like
At The Brentwood Therapy Collective, our approach to ADHD testing and treatment is deeply relational. It includes:
Comprehensive assessments that explore cognitive, emotional, and relational functioning
Strengths-based interpretation of results and collaborative meaning-making
Thoughtful use of medication, when appropriate—but never as a default
Support for environmental redesign, school and workplace advocacy, executive function coaching
Integration of mindfulness, insight-oriented therapy, and emotional healing
Space to process, mourn and grieve the late in life diagnosis and impact that has on personality and defense mechanisms
The goal is not to normalize people—but to help them build lives that feel purposeful, sustainable, and self-honoring.
Toward a New Narrative of Attention
We don’t need to silence ADHD—we need to learn its language. And in doing so, we help people of all ages discover not just how to function, but how to flourish.The medical model has long treated ADHD as a binary condition—you either have it or you don’t. But emerging science suggests a more dimensional, humane view: ADHD exists on a spectrum. It is shaped by context. It changes over time. It is not a sentence—it is a signal.
If we accept this, a different kind of care becomes possible. One that prioritizes emotional depth over diagnostic speed. One that supports individual difference rather than suppressing it. One that asks not just, How do we fix this brain?, but How do we listen to what it’s telling us?
When we broaden our definition of care, we begin to see ADHD not as a flaw to be corrected, but as a call for attunement—to the nervous system, to the self, and to the environments that shape us. We shift from a model of control to one of collaboration, from rigidity to responsiveness.
This reframing empowers clients to reclaim agency in their healing journeys. It allows clinicians to hold complexity without fear. And it opens the door to a deeper truth: that attention, like emotion, is not a static trait to be managed but a living process to be understood.
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