Opinion

Let’s Talk About ADHD With Science, Compassion, and Common Sense
By Dr. Tina Narayan
For forty years, I have worked with children struggling with ADHD, autism spectrum
disorders, and other neurobehavioral and learning challenges. I’ve sat with over 40,000
families, listened to their stories, and helped them navigate the complex and often
confusing world of childhood attention and behavior issues. That’s why I feel compelled
to speak now.

A recent opinion essay by Paul Tough in The New York Times sparked widespread
debate, questioning whether we’ve misunderstood ADHD. The responses — from
clinicians, educators, parents, and researchers — have ranged from thoughtful agreement
to strong rebuttals. Some praised Tough for raising important questions; others criticized
the piece as oversimplified and potentially harmful. As someone deeply immersed in this
field, I believe the path forward lies not in division, but in grounding our understanding
of ADHD on three essential pillars: science, common sense, and compassion.

Let’s begin with science. ADHD is not a cultural invention. It is a well-documented,
genetically influenced neurodevelopmental condition. Brain imaging studies, longitudinal
research, and genetic analyses all support the reality of ADHD as a biological difference
in brain function — especially in how attention, impulse control, and executive function
are regulated. But science doesn’t offer us final answers; it evolves. And we must remain
open to new data while continuing to rely on the evidence we already have.

At the same time, we must apply common sense. Today’s children grow up in a
hyperstimulating, fast-paced, screen-saturated world. Long hours indoors, fragmented
schedules, poor sleep, and highly processed diets can all worsen attention and regulation
— in children with and without ADHD. Recognizing these influences doesn’t negate the
legitimacy of the diagnosis; it enhances our ability to tailor solutions. It reminds us that
ADHD doesn’t exist in a vacuum, and environment matters.

And finally, we must lead with compassion. Every child is unique. Every family has its
own story. We must understand what’s happening at school, at home, in their health, and
in their relationships. Anxiety, trauma, sleep disturbances, learning differences, and
family stress are not footnotes — they are central to understanding the child in front of
us. Real care begins with real listening.

When we use every tool in our toolbox — behavioral strategies, mindfulness, structured
routines, nutrition, natural supplements, training for parents and educators, and when needed, medication — we give children their best chance to thrive. Not every child needs every intervention. The key is individualized, thoughtful, integrated care.

The conversation Paul Tough started is an important one. But we must be careful not to
trade understanding for oversimplification, or evidence for narrative. ADHD is real. And
so are the challenges families face every day.

If we center our approach on science, common sense, and compassion, we will not only
manage ADHD more effectively — we will raise happier, healthier, more successful
children.

Dr. Tina Narayan is a pediatric neurologist who has spent four decades working with
children with ADHD, autism spectrum disorders, neurobehavioral, and learning
challenges. She has supported more than 40,000 families in her clinical career.

Cover Note
Dear Editors,

Please find attached my opinion essay, “Let’s Talk About ADHD With Science,
Compassion, and Common Sense,” submitted for consideration in your Opinion section.
As a pediatric neurologist with four decades of experience and over 40,000 families
served, I bring a deeply personal and professional perspective to this discussion,
particularly in response to the recent op-ed by Paul Tough.

Thank you for your time and consideration.
Sincerely,
Dr. Tina Narayan