In 1937, a Rhode Island psychiatrist named Charles Bradley ran an experiment on 30 child patients who had complained of headaches. He gave them an amphetamine, that is a stimulant, called Benzedrine, which was popular at the time among jazz musicians and college students. The experiment failed, in one sense. The headaches persisted. But he noted that half of the children responded in what he called spectacular fashion, as teachers said these children seemed instantly transformed by the drug. Rather than being bored by their homework, they were interested in it. Rather than being hyperactive, they became more “placid and easygoing.” Rather than complaining to parents about chores, they would make comments like: “I start to make my bed, and before I know it, it is done.” Bradley published the results in The American Journal of Insanity, and it marks perhaps the origins of our treatment model for ADHD.

Attention-deficit/hyperactivity disorder, or ADHD, has always been hard to define. It’s harder still in an age when everybody feels like modern entertainment and the omnipresence of our screens make it hard for anybody to concentrate and sit still. But clearly, some people struggle with concentration and stillness more than others. ADHD has many classic symptoms, but it is typically marked by patterns of inattentiveness—frequently losing items, failing to follow multistep instructions—or by hyperactivity: say, fidgeting, or, for some children, being literally incapable of sitting in one place for more than half a second. In a way, I’ve always disliked the phrase "attention-deficit disorder," because ADHD is not about a deficit of ordinary attention but a surplus of feral attention—an overflowing of raw, uncontrollable noticing.

Last week, the journalist Paul Tough published a long, 9,000-word essay in The New York Times Magazine about ADHD called "Have We Been Thinking About ADHD All Wrong?" Tough asked hard questions about why diagnoses are soaring. Is this evidence of an epidemic? Or is it evidence of overdiagnosis? Paul is today’s guest. We talk about his blockbuster essay, what its loudest critics said about it, what its loudest advocates said about it, and why they both might be wrong.

If you have questions, observations, or ideas for future episodes, email us at [email protected].

Host: Derek Thompson

Guest: Paul Tough

Producer: Devon Baroldi

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