ADHD? UNDER THE MICROSCOPE.
ADHD: A Response to a Changing World
The early years of life, particularly the first seven, are critical for brain and nervous system development. During this period, we are highly receptive, absorbing information from our environment, experiences, and relationships.
Neuroplasticity—the brain’s ability to organise and reorganise itself based on lived experience—means that our earliest interactions shape us profoundly.
While ‘ADHD’ type symptoms may have some distinct neurobiological markers: including but not limited to, weaker function and structure in the brain’s pre-frontal cortex, especially in the right hemisphere, smaller total brain volume and reduced volumes in specific brain areas, as well as increased activity in other areas, these changes don’t just spontaneously emerge in a vacuum.
Instead, they’re the result of an interplay of intergenerational, relational, and sociological influences. This is where society meets neuroplastictity.
And this is the point that I think we often overlook, instead preferring to pathologise individuals. Its also the deep-dive this blog invites you to join me on.
I’ve tried to include a real abundance of rich links to educational institutes, further reading, and wider learning, to help you along the way, or to allow you to divert along any trail of further reading that takes your interest. I’ve also included a link to some pretty passionate criticism of my point of view at the bottom of this article, in case you want the other side of the coin.
With all that said, lets jump in…
Attachment theory, pioneered by John Bowlby and expanded by Mary Main and Peter Fonagy, highlights how early relationships shape emotional and cognitive development. Research on mentalization—the ability to understand our own and others’ mental states—further reinforces the significance of attuned caregiving in shaping a child’s capacity for self-regulation. The importance of strong primary attachment is thoroughly researched and well understood. The strong link between unpredictable and unstable early attachments and poor outcomes later is life is well established.
Modern society, however, is increasingly structured in ways that disrupt these foundational attachments. Economic pressures, shifting parenting roles, increased screen exposure, and the erosion of slow, attuned caregiving all influence how children’s nervous systems develop. Unlike previous generations, for good or for bad, today’s children are growing up in an environment that fosters very different patterns of attention, regulation, and emotional processing.
Yet, our education system remains frozen in time, largely unchanged since the industrial era, when schools were designed to produce compliant workers for factory-based economies. Children are still expected to sit still for extended periods, follow rigid structures, and conform to standardised learning models.
But the world we inhabit demands entirely different cognitive and emotional skills — self-regulation in the face of constant digital stimulation, independence in learning, and more complex social-emotional navigation. Instead of questioning whether our outdated systems still serve children’s evolving needs, we are increasingly pathologising them.
More and more children are being labelled with ‘ADHD’ and other regulatory disorders, when in reality, they are struggling to function within a framework that no longer aligns with their neurological and social realities. Rather than addressing these systemic mismatches, we reinforce medicalised solutions—an approach that conveniently serves the interests of the pharmaceutical industry.
ADHD and Autism: A Misguided AND FRANKLY OFFENSIVE Conflation
Lately, I’ve come across articles that lazily conflate ADHD and autism under a banner of ‘neurodiversity’. (Deliberately not inserting links, so as not to encourage sloppy thinking, just google the two keywords together and you’ll find plenty.)
Autism and ‘ADHD’ are two entirely distinct diagnoses. Autism is characterised by identifiable, clearly diagnosable, and irreversible neurodevelopmental difference.
‘ADHD’, on the other hand, is often a manifestation of social misattunement, misalignment, or even attachment disruption rather than an inherent neurological condition. To conflate the two is not only inaccurate but also dismissive of the complexity of each.
Gabor Maté challenges the mainstream view of ADHD as a fixed, genetically determined disorder. He argues that ADHD is not an inherent disease but an adaptive response to early relational and environmental stressors—particularly a lack of attuned, present caregiving in a world that increasingly fragments human connection. As he puts it:
“The human brain does not develop on its own. It develops in interaction with the environment. And the essential environment is the relationship with caregivers.”
From this perspective, ADHD is not a neurobiological deficit but a survival adaptation. Children who experience inconsistent, dysregulated, or distracted caregiving may develop coping mechanisms—such as hypervigilance, impulsivity, and difficulty sustaining attention—that later get labelled as ADHD. Maté describes this as a "tuning out" response: when a child does not receive the necessary level of engaged, regulating attention, they learn to disconnect as a protective measure. What we call ‘ADHD’ is often a reflection of disrupted attachment and chronic stress, not an inherent disorder.
This shifts the focus away from individual pathology and rather inconveniently towards societal responsibility. If ‘ADHD’ is largely shaped by social conditions—disrupted attachment, chronic stress, the widespread use of screens as ‘childminders’, and the erosion of deep relational attunement— then the solution is not simply medication, but a reassessment of how we structure childhood, education, and society itself.
ADHD & Attachment in Societal Context
Neurobiological development is deeply influenced by our early relationships. While ‘ADHD’ has neurobiological components, these are not fixed; they are dynamically shaped by relational patterns, stress, and trauma. Bessel van der Kolk’s work has shown how early adversity alters brain development, particularly in areas governing attention and emotional regulation. This means that what is often seen as a ‘disorder’ may instead be an adaptation to early experiences.
John Bowlby’s attachment theory provides a framework for understanding how different societies cultivate attachment and regulation. Mary Main’s research, including her work in Uganda, highlights that multiple caregivers can be beneficial in societies where this model is embedded in cultural structures. However, in Western contexts—where education systems, work demands, and social expectations are built around nuclear family structures—applying these models without adaptation can create challenges. The issue is not the attachment model itself, but the societal framework in which it operates.
Failing to account for these contextual differences risks pathologising children rather than addressing the broader systemic issues at play. The rising rates of ADHD diagnoses, for example, may reflect a mismatch between how children are being raised and the demands placed upon them, rather than an increase in neurodevelopmental disorders.
The Cost of Pathologising OUR Children (AND THE VULNERABLE MEMBERS OF OUR SOCIETY)
This trend towards medicalising certain behaviour is, at its core, a political and economic issue. Governments and institutions have long been reluctant to fund the social changes necessary to support child development. Instead of investing in better parental leave policies, improved education models, or more flexible working arrangements that allow for greater parental presence, the default response has been to individualise and medicalise the issue.
This benefits the psychopharmaceutical industry, which thrives on the increasing reliance on stimulant medications rather than systemic reform. As Maté and others have pointed out, these medications may provide short-term relief, but they do not address the root causes of attention and regulation difficulties. The current psychiatric model often ignores alternative interventions—many of which are free but require time, commitment, and a willingness to rethink the way we structure childhood.
While it’s crucial to acknowledge the wider societal factors influencing ADHD, we must also be realistic about the pressures modern parents face. Economic constraints, the necessity to work, and the structure of our education and employment systems cannot simply be wished away. It’s not about placing blame on individual parents (see criticism below) but recognising that we have built a system that is increasingly incompatible with healthy child development.
If we are serious about addressing what we call ‘ADHD’, we need to stop looking for quick fixes and start asking bigger questions.
How do we create environments that support children's natural attentional rhythms?
How do we build education systems that reflect contemporary neurodevelopmental realities rather than outdated industrial models?
And how do we shift the conversation from individual pathology to collective responsibility?
Until we start answering these questions, we will continue to misdiagnose systemic dysfunction as personal disorder—and in doing so, we fail the very people we claim to be helping.
Bibliography, Further Reading, A Deeper Dive…..
Bowlby, J. (1969) Attachment and Loss: Volume 1 - Attachment. London: Hogarth Press and the Institute of Psycho-Analysis.
Fonagy, P., Gergely, G., Jurist, E. and Target, M. (2002) Affect Regulation, Mentalization, and the Development of the Self. London: Karnac Books.
Gaskin, I.M. (2011) Birth Matters: A Midwife’s Manifesta. New York: Seven Stories Press.
Gaskin, I.M. (2003) Ina May’s Guide to Childbirth. New York: Bantam Books.
Kolb, B. and Gibb, R. (2011) ‘Brain plasticity and behaviour in the developing brain’, Journal of the Canadian Academy of Child and Adolescent Psychiatry, 20(4), pp. 265–276.
Maté, G. (2000) Scattered Minds: The Origins and Healing of Attention Deficit Disorder. Toronto: Vintage Canada.
Maté, G. (2022) The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture. London: Penguin Life.
Main, M. and Solomon, J. (1986) ‘Discovery of an insecure disorganized/disoriented attachment pattern’, in Brazelton, T.B. and Yogman, M.W. (eds.) Affective Development in Infancy. Norwood, NJ: Ablex, pp. 95-124.
Main, M., Hesse, E. and Kaplan, N. (2005) ‘Predictability of attachment behaviour and representations across the lifespan’, in Grossman, K.E., Grossmann, K. and Waters, E. (eds.) Attachment from Infancy to Adulthood: The Major Longitudinal Studies. New York: Guilford Press, pp. 245-304.
Porges, S.W. (2011) The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. New York: W.W. Norton & Company.
Van der Kolk, B. (2014) The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. London: Penguin Books.
Yehuda, R. and Lehrner, A. (2018) ‘Intergenerational transmission of trauma effects: putative role of epigenetic mechanisms’, World Psychiatry, 17(3), pp. 243–257.
For balance, and transparency, here’s a link to a Reddit post criticism of Komisar’s postion (and mine). I don’t consider myself a ‘social conservative’, (I’m sure that would give a lot of people who know me a real laugh) or expect women to ‘stare at their children all day’ (My children would object in the strongest terms).
I acknowledge that patterns are intergenerational, societal, complex, i.e not all on the shoulders of ‘mothers’. I hope I’ve made that clear, because God knows I have enough maternal guilt to be getting on with.
https://www.reddit.com/r/Parenting/comments/1j3mu6g/i_cant_believe_that_erica_komisar_is_popular/
