Is Attention Deficit Hyperactivity Disorder (ADHD) a disorder?

Spoiler alert: It's complicated.

I work with a lot of people who have a diagnosis of ADHD. Some have had it from childhood and are looking for a better understanding of their condition as well as a more holistic and comprehensive approach to treating their symptoms. Others have come seeking a new diagnosis as adults when, after decades of struggling with the responsibilities of school, work, family, or simply adulting, they feel as though they can no longer manage their lives.

ADHD can be an elegant explanation for life-long challenges; people are clearly suffering from a mis-match between the way their brain works and the demands of their lives. Unfortunately, receiving a diagnosis comes with shame and the perception of stigma that sometimes creates emotional distress as well as frustration that the primary tools for addressing their symptoms are based on pharmacological interventions.

During my intitial sessions with individuals who have attention and concentration challenges, I like to reflect about the meaning of the second D - Disorder in the diagnosis of Attention Deficit Hyperactivity Disorder. In this conversation, my hope is to shift the narrative from one of ADHD being a problem with the way their brain works, to one of being a problem with the way our society works. Though the conversation may not change the decision to diagnose or how we choose to treat, it can be helpful to know that things are more nuanced than they first appear to be.

The Problem with "Disorder"

Here's the thing – calling it Attention Deficit Hyperactivity Disorder suggests that having ADHD traits is inherently problematic. Like there's something fundamentally wrong with brains that work this way. What I've noticed in my practice is that ADHD symptoms are only "disordered" when we try to fit ADHD brains into systems that weren't designed with neurodiversity in mind.

Think about it. We've created a world of 8-hour workdays, sitting still at desks, paying attention to one thing at a time, following rigid schedules, and completing tasks in predetermined sequences. These systems work well enough for many people. But when anyone struggles with this highly specific way of organizing learning and work, we label them as having a "disorder."

But what if the challenge isn't the brain? What if it's simply a mismatch between different types of minds and the environments we've created?

The Context Question

Let me paint you a picture. It's 1823, and you're a farmer. You wake up when the sun rises, work with your hands, move your body all day, switch between different tasks as seasons and weather demand, and solve problems creatively as they arise.

In that world, ADHD traits aren't disordered – they're essential. The ability to hyperfocus when needed? That's an advantage. The tendency to notice everything in your environment? You're the one who spots changes first. The drive to seek novelty and take risks? You're the explorer, the innovator, the one who finds new solutions.

Fast forward to today. Sit still for 6+ hours. Pay attention to one person talking. Don't fidget. Follow the schedule. Complete this worksheet. Raise your hand before speaking.

Suddenly, those same traits that served people well in different contexts become challenges in our current educational and work environments.

The Mismatch Problem

Our modern world – especially schools and many workplaces – tends to favor certain ways of thinking and learning. Everything is often standardized, scheduled, and systematized. We've created environments that work beautifully for only some brains.

But that's not how all brains work. And it's definitely not how ADHD brains work best.

ADHD brains often excel with variety, novelty, movement, and interest-driven focus. They're entrepreneurial brains, artist brains, problem-solver brains. They're the brains that built companies, wrote symphonies, and figured out innovations we all benefit from.

The challenge isn't in the brain. The challenge is in the gap between these incredible minds and systems that weren't designed to accommodate different ways of thinking and learning.

What the Research Actually Shows

Studies consistently show that people with ADHD traits excel in certain environments: entrepreneurship, creative fields, emergency services, jobs requiring multitasking and problem-solving under pressure. They're well-represented among CEOs, artists, inventors, and first responders.

In other words, when the environment matches the brain, ADHD traits become strengths.

The same "distractibility" that makes it hard to focus on routine tasks allows someone to notice patterns and connections others miss. The same "impulsivity" that creates challenges in rigid settings becomes the willingness to take creative risks. The same "hyperactivity" that feels disruptive in quiet environments becomes the energy that powers innovation.

So What Should We Call It?

Some researchers prefer terms like "Attention Regulation Difference" or "Executive Function Variation." Others like "Variable Attention Stimulus Trait" (VAST).

But my favorite reframe comes from thinking about it as a trait that our human genome has preserved throughout time - one that is necessary to our survival as a human species.

The Bottom Line

Is the second D in ADHD correct? I'd argue it's more complicated than that. These aren't disordered brains – they're differently wired brains navigating systems designed primarily for a different type of mind.

The real question isn't "How do we fix ADHD?" It's "How do we create more environments where different types of brains can thrive?"

That might mean flexible work arrangements, movement breaks, project-based learning, or jobs that harness ADHD strengths. It definitely means expanding our understanding of what successful thinking and learning can look like.

ADHD brains aren't broken. Our systems work well for some people, but they weren't designed with neurodiversity in mind. And maybe it's time we started making space for different kinds of minds to flourish.

Dr. Ben Bregman is a psychiatrist specializing in integrative mental health. If you're looking for support understanding ADHD or creating environments where different brains can thrive, consider reaching out to Washington Integrative Mental Health Services. Our clinic is located in Takoma Park, MD