Cookie Preferences
By clicking, you agree to store cookies on your device to enhance navigation, analyze usage, and support marketing. More Info
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
May 28, 2025
.png)
The U.S. government released a sweeping document titled The MAHA Report: Making Our Children Healthy Again, developed by the President’s “Make America Healthy Again” Commission. Chaired by public figures and physicians with ties to the current administration, the report presents a broad diagnosis of what it calls a national health crisis among children. It cites rising rates of obesity, diabetes, allergies, mental illness, neurodevelopmental disorders, and chronic disease as signs of a generation at risk.
The report's overarching goal is to shift U.S. health policy away from reactive, pharmaceutical-based care and toward prevention, resilience, and long-term well-being. It emphasizes reforming the food system, reducing environmental chemical exposure, addressing lifestyle factors like physical inactivity and screen overuse, and rethinking what it calls the “overmedicalization” of American children.
While some of the report’s arguments are steeped in political rhetoric and controversial claims—particularly around vaccines and mental health diagnoses—others are rooted in well-established public health science. This blog aims to highlight where the MAHA Report gets the science right, especially as it relates to childhood health and ADHD.
Although the MAHA Report contains several debatable assertions, it also outlines six key public health priorities that are well-supported by decades of research. If implemented thoughtfully, these recommendations might make a meaningful difference in the health of American children:
Reduce Ultra-Processed Food (UPF) Consumption
UPFs now make up nearly 70% of children’s daily calories. These foods are high in added sugars, refined starches, unhealthy fats, and chemical additives, but low in nutrients. Studies—including a 2019 NIH-controlled feeding study—show that UPFs promote weight gain, overeating, and metabolic dysfunction. What can help: Tax incentives for fresh food retailers, improved school meals, front-of-pack labeling, and food industry regulation.
Promote Physical Activity and Limiting Sedentary Time
Most American children don’t get the recommended 60 minutes of physical activity per day. This contributes to obesity, cardiovascular risk, and even mental health issues. Physical activity is known to improve attention, mood, sleep, and self-regulation. What can help: Mandatory daily PE, school recess policies, walkable community infrastructure, and screen-time education.
Addressing Sleep Deprivation
Teens today sleep less than they did a decade ago, in part due to screen use and early school start times. Sleep loss is linked to depression, suicide risk, poor academic performance, and metabolic problems. What can help: Later school start times, family education about sleep hygiene, and limits on evening screen exposure.
Improving Maternal and Early Childhood Nutrition
The report indirectly supports actions that are backed by strong evidence: encouraging breastfeeding, supporting maternal whole-food diets, and improving infant nutrition. These are known to reduce chronic disease risk later in life.
ADHD is one of the most discussed neurodevelopmental disorders in the MAHA Report, but many of its claims about ADHD are misleading, oversimplified, or inconsistent with decades of scientific evidence, much of which is described in the International Consensus Statement on ADHD, and other references given below.
This is true. Diagnosis rates have risen over the past two decades, due in part to better recognition, broadened diagnostic criteria, and changes in healthcare access. Diagnosis rates in some parts of the country are too high, but we don’t know why. That should be addressed and investigated. MAHA attributes increasing diagnoses to ‘overmedicalization’. That is a hypothesis worth testing but not a conclusion we can draw from available data.
These have been associated with ADHD but have not been documented as causes. ADHD is highly heritable, with genetic factors accounting for 70–80% of the risk. Unlike genetic studies, environmental risk studies are compromised by confounding variables. There are good reasons to address these issues but doing so is unlikely to reduce diagnostic rates of ADHD.
❌ Inaccurate: ADHD medications don’t work long-term.
The report criticizes stimulant use but fails to note that ADHD medications are among the most effective psychiatric treatments, especially when consistently used. They cite the MTA study’s long term outcome study of kids assigned to medication vs. placebo as showing medications don’t work in the long term. But that comparison is flawed because during the follow-up period, many kids on medication stopped taking them and many on placebo started taking medications. Many studies document that medications for ADHD protect against many real-world outcomes such as accidental injuries, substance abuse and even premature death.
Despite the issues discussed above, the MAHA Report can indirectly help children and adults with ADHD by pushing for systemic changes that reduce ultra-processed food consumption, increase physical activity, and motivate better sleep practices.
In other words, you don’t need to reject the diagnosis of ADHD to support broader changes in how we feed, educate, and care for children. A more supportive, less toxic environment benefits everyone—including those with ADHD.
The MAHA Report; https://www.whitehouse.gov/wp-content/uploads/2025/05/WH-The-MAHA-Report-Assessment.pdf
The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neuroscience and Biobehavioral Reviews, Sept 2021, Issue 128, pages 789-818. doi: 10.1016/j.neubiorev.2021.01.02
Faraone SV, Bellgrove MA, Brikell I, et al. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 2024; 10(1): 11.
Faraone SV. Understanding Environmental Exposures and ADHD: a Pathway Forward. Prev Sci 2024.
Perfluoroalkylated substances (PFASs), commonly known as "forever chemicals" in the media, are pollutants that do not break down in the environment. Their chemical structure includes fluorine atoms bonded to carbon, which makes them effective at repelling water. This property has led to their use in water-repellent clothing, stain-resistant carpets and furniture, and nonstick cookware.
However, the same chemical structure that makes PFASs useful also makes them a concern for human and animal health, as there are no natural biological processes to remove them from the body. Once ingested, they accumulate and become more concentrated at each level of the food chain. PFASs can also cross the placental barrier, raising concerns about potential harm to developing embryos and fetuses.
A Chinese research team conducted a systematic review of the medical literature to examine if there is a link between maternal exposure to PFASs and an increased risk of ADHD in children. They analyzed data from several studies:
- A meta-analysis of five studies involving 2,513 mother-child pairs found no increase in ADHD risk from exposure to PFOA (perfluorooctanoate) or PFOS (perfluorooctane sulfonate). The consistency across these studies was high, with little variation and no evidence of publication bias.
- Another meta-analysis of three studies with 995 mother-child pairs also showed no increase in ADHD risk from exposure to PFNA (perfluorononanoate) or PFHxS (perfluorohexane sulfonate), with similarly negligible variation between studies and no publication bias.
- In an analysis comparing the highest and lowest quartiles of maternal exposure, a slight increase in ADHD risk was observed with PFOA exposure, while a slight decrease was noted with PFOS exposure. Both findings were marginally significant and may be due to the small sample sizes.
The researchers concluded that more studies are needed to confirm these findings due to the limited evidence available.
This New York Times article, “5 Takeaways from New Research about ADHD”, earns a poor grade for accuracy. Let’s break down their (often misleading and frequently inaccurate) claims about ADHD.
The Claim: A.D.H.D. is hard to define/ No ADHD Biomarkers exist
The Reality: The claim that ADHD is hard to define “because scientists haven’t found a single biological marker” is misleading at best. While it is true that no biomarker exists, decades of rigorous research using structured clinical interviews and standardized rating scales show that ADHD is reliably diagnosed. Decades of validation research consistently show that ADHD is indeed a biologically-based disorder. One does not need a biomarker to draw that conclusion and recent research about ADHD has not changed that conclusion.
Additionally, research has in fact confirmed that genetics do play a role in the development of ADHD and several genes associated with ADHD have been identified.
The Claim: The efficacy of medication wanes over time
The Reality: The article’s statement that medications like Adderall or Ritalin only provide short-term benefits that fade over time is wrong. It relies almost entirely on one study—the Multimodal Treatment Study of ADHD (MTA). In the MTA study, the relative advantage of medication over behavioral treatments diminished after 36 months. This was largely because many patients who had not initially been given medication stopped taking it and many who had only been treated with behavior therapy suddenly began taking medication. The MTA shows that patients frequently switched treatments. It does not overturn other data documenting that these medications are highly effective. Moreover, many longitudinal studies clearly demonstrate sustained benefits of ADHD medications in reducing core symptoms, psychiatric comorbidity, substance abuse, and serious negative outcomes, including accidents, and school dropout rates. A study of nearly 150,000 people with ADHD in Sweden concluded “Among individuals diagnosed with ADHD, medication initiation was associated with significantly lower all-cause mortality, particularly for death due to unnatural causes”. The NY Times’ claim that medications lose their beneficial effects over time ignores compelling evidence to the contrary.
The Claim: Medications don’t help children with ADHD learn
The Reality: ADHD medications are proven to reliably improve attention, increase time spent on tasks, and reduce disruptive behavior, all critical factors directly linked to better academic performance.The article’s assertion that ADHD medications improve only classroom behavior and do not actually help students learn also oversimplifies and misunderstands the research evidence. While medication alone might not boost IQ or cognitive ability in a direct sense, extensive research confirms significant objective improvements in academic productivity and educational success—contrary to the claim made in the article that the medication’s effect is merely emotional or perceptual, rather than genuinely educational.
For example, a study of students with ADHD who were using medication intermittingly concluded “Individuals with ADHD had higher scores on the higher education entrance tests during periods they were taking ADHD medication vs non-medicated periods. These findings suggest that ADHD medications may help ameliorate educationally relevant outcomes in individuals with ADHD.”
The Claim: Changing a child’s environment can change his or her symptoms.
The Reality: The Times article asserts that ADHD symptoms are influenced by environmental fluctuations and thus might not have their roots in neurobiology. We have known for many years that the symptoms of ADHD fluctuate with environmental demands. The interpretation of this given by the NY Times is misleading because it confuses symptom variability with underlying causes. Many disorders with well-established biological origins are sensitive to environmental factors, yet their biology remains undisputed.
For example, hypertension is unquestionably a biologically based condition involving genetic and physiological factors. However, it is also well-known that environmental stressors, dietary
habits, and lifestyle factors can significantly worsen or improve hypertension. Similarly, asthma is biologically rooted in inflammation and airway hyper-reactivity, but environmental triggers such as allergens, pollution, or even emotional stress clearly impact symptom severity. Just as these environmental influences on hypertension or asthma do not negate their biological basis, the responsiveness of ADHD symptoms to environmental fluctuations (e.g., improvements in classroom structure, supportive home life) does not imply that ADHD lacks neurobiological roots. Rather, it underscores that ADHD, like many medical conditions, emerges from the interplay between underlying biological vulnerabilities and environmental influences.
Claim: There is no clear dividing line between those who have A.D.H.D. and those who don’t.
The Reality: This is absolutely and resoundingly false. The article’s suggestion that ADHD diagnosis is arbitrary because ADHD symptoms exist on a continuum rather than as a clear-cut, binary condition is misleading. Although it is true that ADHD symptoms—like inattention, hyperactivity, and impulsivity—do vary continuously across the population, the existence of this continuum does not make the diagnosis arbitrary or invalidate the disorder’s biological basis. Many well-established medical conditions show the same pattern. For instance, hypertension (high blood pressure) and hypercholesterolemia (high cholesterol) both involve measures that are continuously distributed. Blood pressure and cholesterol levels exist along a continuum, yet clear diagnostic thresholds have been carefully established through decades of clinical research. Their continuous distribution does not lead clinicians to question whether these conditions have biological origins or whether diagnosing an individual with hypertension or hypercholesterolemia is arbitrary. Rather, it underscores that clinical decisions and diagnostic thresholds are established using evidence about what levels lead to meaningful impairment or increased risk of negative health outcomes. Similarly, the diagnosis of ADHD has been meticulously defined and refined over many decades using extensive empirical research, structured clinical interviews, and validated rating scales. The diagnostic criteria developed by experts carefully delineate the point at which symptoms become severe enough to cause significant impairment in an individual’s daily functioning. Far from being arbitrary, these thresholds reflect robust scientific evidence that individuals meeting these criteria face increased risks for the serious impairments in life including accidents, suicide and premature death.
The existence of milder forms of ADHD does not undermine the validity of the diagnosis; rather, it emphasizes the clinical reality that people experience varying degrees of symptom severity.
Moreover, acknowledging variability in severity has always been a core principle in medicine. Clinicians routinely adjust treatments to meet individual patient needs. Not everyone diagnosed with hypertension receives identical medication regimens, nor does everyone with elevated cholesterol get prescribed the same intervention. Similarly, people with ADHD receive personalized treatment plans tailored to the severity of their symptoms, their specific impairments, and their individual circumstances. This personalization is not evidence of arbitrariness; it is precisely how evidence-based medicine is practiced. In sum, the continuous nature of ADHD symptoms is fully compatible with a biologically-based diagnosis that has substantial evidence for validity, and acknowledging symptom variability does not render diagnosis arbitrary or diminish its clinical importance.
In sum, readers seeking a balanced, evidence-based understanding of ADHD deserve clearer, more careful reporting. By overstating diagnostic uncertainty, selectively interpreting research about medication efficacy, and inaccurately portraying the educational benefits of medication, this article presents an overly simplistic, misleading picture of ADHD.
Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder that significantly impacts children’s academic performance, social interactions, and overall quality of life (QoL). While medication is the standard treatment, it often comes with side effects and may not always provide sufficient benefits. A new systematic review and meta-analysis aims to investigate whether physical activity can offer a viable and effective alternative or complement to medication.
About the Study
This protocol, developed in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines, focuses on randomized clinical trials involving children and adolescents (ages 3–18) diagnosed with ADHD or hyperkinetic disorder. The study's goal is to evaluate the effects of physical activity on:
Unlike earlier reviews, which often included non-randomized trials or imposed limits on activity types, this analysis takes a more robust and inclusive approach. It is the first of its kind to examine QoL as an outcome while also incorporating trial sequential analysis—a method to assess evidence strength over time.
Why Physical Activity?
Physical activity is believed to impact the same brain systems targeted by ADHD medications, particularly the catecholaminergic system. This overlap suggests that exercise could play a key role in managing symptoms, potentially reducing reliance on medication or enhancing its effects.
Methodology Highlights
Significance and Dissemination
The results of this systematic review will provide critical insights into how physical activity could improve outcomes for children and adolescents with ADHD. It is also notable as the first review in this field to prioritize quality of life—a crucial, often-overlooked measure of treatment success.
The findings will be published in peer-reviewed journals and presented at relevant conferences to inform clinicians, educators, and families.
Conclusion
As concerns about the limitations of ADHD medication grow, exploring alternatives like physical activity becomes increasingly important. This systematic review has the potential to shape future treatment strategies, offering children with ADHD a chance for better symptom management and a higher quality of life.
.png)
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.
For many ADHD patients, getting properly diagnosed and starting meds is only half the battle. The next step is figuring out the exact right dose. Historically, clinical guidelines have provided scant guidance on this critical step. This lack of direction can inadvertently foster two extremes in clinical practice: therapeutic inertia (settling for a subtherapeutic dose that leaves symptoms undertreated) or uncritical escalation (driving doses higher and higher beyond licensed limits without meaningful benefit).
To clear up this pharmacological gray area, an international team of researchers published the first comprehensive dose-effect network meta-analysis of ADHD medications in The Lancet Psychiatry. By pulling together a massive vault of clinical trial data, they mapped out exactly how efficacy and tolerability shift as doses increase.
Traditional meta-analyses evaluate head-to-head, pairwise data, comparing one drug at a specific dose directly against a placebo. However, this study utilized an advanced Bayesian hierarchical network model using restricted cubic splines.
This mathematical framework allowed the researchers to combine both direct trial data and indirect evidence simultaneously across 113 double-blind randomized controlled trials (RCTs). In total, the study evaluated data from 14,138 children/adolescents and 11,016 adults. By standardizing various formulations into basic equivalents (e.g., converting amphetamines to dextroamphetamine equivalents), they created a clear, unified map of dose ranges.
The study yielded distinct dose-response curves depending on the patient's age and the specific medication class. Rather than a linear trend in which "more medicine equals more benefit," most treatments reach a clear statistical plateau or ceiling.
For Children and Adolescents (under 18)
In the pediatric population, medications hit clear peak efficacy boundaries:
For both amphetamines and guanfacine, escalating the dosage past these points resulted in U-shaped curves, meaning further dose hikes yielded diminishing group-level symptom reduction.
For Adults (18 and older)
Adult profiles showed slightly different trajectories:
The ultimate goal of this landmark analysis is to guide shared decision-making between clinicians, patients, and families. The results send a dual message to the medical community:
A medication's true efficacy hinges on its tolerability, typically measured by how often patients discontinue treatment due to severe side effects. For amphetamines, this dropout risk scales linearly with dosage, notably exceeding placebo in children above 25 mg/day and becoming prominent in adults past 50 mg/day. In contrast, methylphenidate shows no clear dose-dependent dropout risk in pediatric patients, whereas adults face a steep risk curve: increasing the dose from 60 mg/day to 90 mg/day raises the dropout risk from 7.3% to 10.0% for only modest symptom relief. Finally, youth taking guanfacine experience a sharp climb in discontinuation risks, reaching a 9.8% median risk at 4 mg/day before data limitations obscure further trends.
The authors strongly emphasize that these findings represent group averages. Because individual metabolism, genetics, and comorbidities vary widely, some specific patients may legitimately require and tolerate higher off-label doses. However, if an unusually high dose is needed, the study suggests it should prompt a careful clinical pause, either to reassess for co-occurring conditions (like anxiety, autism, or sleep disorders) or to manage realistic expectations regarding what the medication can achieve.
The persistent shortage of ADHD medications has been more than a simple annoyance for patients at the pharmacy; the inconsistent availability of these medications has had deep impacts on the daily lives of those struggling without them. While public discourse has pointed fingers at over-prescribing or at restrictive DEA quotas, a recent economic evaluation in JAMA Health Forum suggests we’ve been looking in the wrong direction for an answer to what is causing this.
The reality of the shortage is less about increased demand and more about a fragile, globalized supply chain that snapped at a critical link.
Debunking the "Quota Myth":
The prevailing narrative suggested that the Drug Enforcement Administration (DEA) was stifling production by refusing to raise quotas. However, the data tells a different story. In 2022, manufacturers collectively met only about 70% of their allotted production quotas.
So we know that the problem wasn't that this DEA quota ceiling was too low. In fact, most manufacturers couldn't even reach it. Even when accounting for exports and domestic retail, production remained significantly below the legal limit. Even if the DEA had doubled its quotas, these medications still likely wouldn't have magically appeared on pharmacy shelves.
The most striking finding in the study is the correlation between the shortage and a sharp decline in the import of raw Active Pharmaceutical Ingredients (APIs). For the past decade, Germany has accounted for over 85% of US amphetamine imports. In 2022, these imports dropped by approximately 36.7%. When the API doesn't arrive at the factory, production for medium and small manufacturers grinds to a halt. Unlike larger pharmaceutical giants, these smaller players often lack the inventory cushion or flexibility to quickly pivot to a new supplier.
When the primary supply of amphetamine-based stimulants (like Adderall) faltered, it triggered a secondary crisis. Patients and clinicians, seeking alternatives, shifted toward lisdexamfetamine (Vyvanse) and methylphenidate (Ritalin/Concerta).
If we view this shortage purely through a regulatory or clinical lens, we miss the underlying cause of the crisis. The pharmaceutical industry has become a victim of its reliance on "just-in-time manufacturing” and highly concentrated sourcing. Because over 30% of APIs for the US market are produced in just one or two facilities globally, the system isn't just inefficient; it’s brittle. We are, in a sense, trapped in a system that prioritizes cost-reduction over the resilience required for public health.
The researchers suggest several policy shifts to prevent a repeat of this supply chain failure:
The ADHD medication shortage wasn't a failure of clinical oversight or a sudden surge in "TikTok-driven diagnoses”, as many have suggested. It was a failure of logistics. It reminds us that the path from a lab in Germany to a patient's hand in the US is far more precarious than we realized.
_logo%201.svg)
