Rethinking ADHD: A Collaborative Approach for the PM Program “ADHD Matters”
Prepared for: Psychotherapy Matters, ADHD Matters Program
Prepared by: Dr. Allan Steingart, CEO, Psychotherapy Matters
A Personal Note
In the summer of 1977, the year before I began medical school, I had the opportunity to work as a psychology student at SickKids Hospital in the laboratory of Dr. Marcel Kinsbourne and Dr. James M. Swanson—names well known to those familiar with ADHD research. As part of their “n=1” single-patient clinical trials, we administered very short-acting stimulants or placebos early in the morning and afternoon (the order was randomized and blinded) over two and a half days, then tested the children on learning tasks. We observed for side effects and assessed cognitive performance directly rather than relying on parent or teacher reports—reports that could be biased by preferences for subdued, compliant behaviour.
My own research project examined state-dependent learning—whether children could recall material learned while on stimulants after the medication had worn off. This research approach—emphasizing individualized treatment based on direct observation and patient-specific response—embodies the very principles that guide the work of Psychotherapy Matters.
That summer remains one of the most meaningful experiences of my early academic life—not only because of the intellectual excitement, but also because of the warmth and generosity shown by Dr. James Swanson as a teacher and supervisor. Dr. Swanson was an extraordinary researcher, not only for his scientific contributions but for his profound humility in the face of the complexity of ADHD. He approached each child and family with great kindness and respect, never reducing them to data points but recognizing their individuality and dignity. I was gratified to see him quoted recently in The New York Times (“Have We Been Thinking About A.D.H.D. All Wrong?” April 13, 2025), still challenging simplistic narratives around stimulant treatment. That formative experience, nearly half a century ago, continues to inform my perspective today: that ADHD assessment must be rigorous, contextual, and above all, humane.
Rationale for the PM ADHD Assessment Program
The PM program, ADHD Matters, was developed specifically to assess adults and mid-to-late adolescents (aged 16 and older), under the leadership of Dr. Natalie Erdmann—a gifted psychiatrist with extensive experience in the assessment of neurodiversity. The program was also created in response to a surge in requests for adult ADHD assessments, driven in large part by increased public awareness and enthusiasm amplified through social media.
Changing Scientific Consensus
There is a consensus that stimulants are effective for reducing core ADHD symptoms in children and adolescents, with a focus on the short-term benefits.
In adults, stimulant medications have been shown to produce clear benefits, particularly in reducing core symptoms of inattention and impulsivity. Meta-analyses report small to moderate effect sizes, with many individuals experiencing meaningful improvements in concentration, task completion, and emotional regulation. While gains in occupational functioning, academic performance, or quality of life are more variable, outcomes are often enhanced when medication is combined with psychosocial supports and individualized treatment planning. These findings underscore the importance of a comprehensive, context-sensitive approach to assessment and care.
The Diagnostic Dilemma
While the DSM-5 provides operational criteria for ADHD, recent studies indicate that these criteria often capture behaviours that are contextually triggered, developmentally transient, or better explained by comorbidities (e.g., trauma, anxiety, learning disorders). Indeed, 77% of children diagnosed with ADHD have at least one other psychiatric diagnosis (CDC, 2023). In adults, 60-80% have at least one comorbid psychiatric disorder, and 40-60% have two or more comorbid conditions (e.g. anxiety, mood, substance use and personality disorders).
Lack of Biological Markers
Efforts to identify reliable neurobiological biomarkers for ADHD have largely failed. The Enigma Consortium, one of the most comprehensive brain-imaging efforts, found only negligible structural brain differences between those with and without ADHD. This calls into question the claim that ADHD is strictly a “brain disorder.”
Implications for Treatment and Assessment
Stimulant medications may yield improvements in academic performance and broader life outcomes. However, psychotherapeutic and environmental interventions—such as adjusting expectations, strengthening organizational skills, improving family dynamics, and helping individuals identify their strengths or “niche”—often show greater potential for enhancing overall functioning and well-being. When present, comorbid conditions frequently require prioritization in treatment planning. These findings underscore the importance of a comprehensive, collaborative, and sustained model of care tailored to each patient’s needs and preferences.
PM Collaborative Assessment Model for ADHD
Key Features of ADHD Matters:
- Multidisciplinary Input: Each assessment involves a psychotherapist, psychiatrist, and, when possible, a primary care provider.
- Contextual Inquiry: Focus on environmental, educational, familial, and developmental factors.
- Dimensional Evaluation: Rather than a binary diagnosis, emphasis is placed on symptom fluctuation, functional impairment, and psychosocial context.
- Shared Decision-Making: Informed choice about treatment options—including non-pharmacological interventions—is emphasized.
- Ongoing Feedback Loop: The therapist remains involved post-assessment to implement and monitor interventions collaboratively.
Conclusion
A growing body of evidence suggests that adult ADHD is not a fixed neurobiological disorder, but rather a complex, context-dependent condition frequently accompanied by comorbid challenges. The ADHD Matters Assessment Program at Psychotherapy Matters is uniquely aligned with this evolving perspective. Our collaborative care model combines rigorous clinical standards with sustained psychotherapeutic engagement to support long-term functional outcomes.