Apr. 28, 2026

Are We Treating ADHD - Or the Conditions of Modern Life?

By Alina Urriola, MD, MPH

My patient, "Lisa," spent a decade as a highly competent, reliable intensive care nurse, thriving in a setting characterized by clear roles, immediate feedback, and focused, high-stakes decision-making. When she was promoted into an administrative role requiring project management, shifting priorities, and prolonged self-directed task organization, her performance declined. She began to doubt herself and was placed on a performance improvement plan. She met criteria for attention-deficit/hyperactivity disorder, and stimulant treatment significantly improved her ability to stay on task and restored her confidence.

Diagnoses of ADHD in adults have increased substantially over the past decade. As a practicing physician, I prescribe stimulant medications regularly and—as in Lisa's case—I have seen their capacity to significantly improve patients' functioning and quality of life.

At the same time, their expanding use invites a broader professional question: What does it mean, at a societal level, when growing numbers of adults require long-term stimulant therapy to meet everyday expectations of work and productivity?

The dominant clinical narrative frames ADHD primarily as a highly hereditary neurodevelopmental disorder rooted in individual neurobiology. While this model is valid for many patients, it is incomplete. Stimulant medications improve attention, task initiation, and persistence not only in individuals diagnosed with ADHD, but in most humans. Their effectiveness alone does not establish a disease-specific deficiency. Rather, it highlights how pharmacologic agents can enhance performance in environments that demand sustained focus, rapid task-switching, and constant cognitive engagement.

Those demands have intensified. Modern professional life increasingly requires prolonged attention to abstract tasks, continuous digital availability, greater cognitive load, reduced external structure, and heightened performance pressure. For many adults, attentional strain reflects not individual failure, but the limits of human cognition under persistent load.

Adult ADHD diagnosis hinges on functional impairment, yet impairment is inherently contextual, as illustrated in Lisa's case. As expectations escalate, more individuals will meet diagnostic thresholds. This does not invalidate their distress, nor does it negate ADHD as a legitimate neurodevelopmental condition. However, it does suggest that medicine is increasingly being asked to address a mismatch between human attentional capacity and the structures in which we work and live.

The ethical concern is not whether stimulant medications should be prescribed—they often should. Rather, it lies in the broader implications of their widespread, long-term use. When pharmacologic treatment becomes the primary means by which individuals adapt to increasingly demanding systems, medicine risks unintentionally relocating structural problems into individual biology.

This is not a new tension for our profession. Medicine has long been called upon to optimize bodies for systems: hypnotics for shift work, antidepressants for burnout, beta blockers for performance anxiety. Each intervention may be clinically appropriate. Taken together, an important public health implication emerges. If large segments of the adult population require medication to function at baseline levels of productivity, that pattern suggests systemic strain rather than widespread personal pathology.

Acknowledging this tension does not mean withholding care. Patients live in the world as it is, not as it ought to be. Compassionate practice meets patients where they are and offers tools that reduce suffering and improve functioning. But ethical care also requires honesty—recognizing that benefit does not necessarily imply defect, and that treatment does not automatically validate the conditions that make it necessary.

As physicians, we are trained to think both clinically and systemically. Caring for individual patients should not preclude reflection on the broader forces shaping their health. On the contrary, maintaining that dual awareness may be essential to practicing medicine that is not only effective, but humane.

Alina Urriola, MD, MPH, is a family physician at Vera Whole Health and a volunteer physician at Lahai Health, both in Seattle.

This article was featured in the May/June 2026 issue of WSMA Reports, WSMA's print magazine.