Many people are surprised to learn that a medical diagnosis does not always explain why something is happening. Often, it simply describes what is being observed.
ADHD is a clear example of this problem.
A group of behaviors - difficulty sustaining attention, impulsivity, restlessness, emotional reactivity - are observed together. These behaviors are then given a name. Once named, that label is treated as the cause of the very symptoms it was created to describe. Attention problems are explained by ADHD, even though ADHD itself is defined by attention problems.
This is circular reasoning, and it quietly shapes how patients understand themselves.
The “disease delusion”
This term was introduced in Jeffrey Bland’s 2014 book The Disease Delusion, a book that challenges the way modern medicine often turns symptom patterns into standalone diseases. The concern is not that symptoms aren’t real - they are. The concern is that naming a pattern can prematurely end the search for cause.
When a descriptive label replaces curiosity, the diagnosis becomes a stopping point instead of a starting point.
A question that changed how I think about ADHD
Years ago, while calling in a prescription for an amphetamine-based medication, a pharmacist paused and asked, “Why is everyone on amphetamines these days?”
It was an honest question. Amphetamines are powerful nervous system stimulants. We now prescribe them broadly to children and adults so they can focus, regulate emotions, and function day to day.
Human neurobiology has not changed dramatically in one generation. When a growing percentage of people require stimulant medication just to meet baseline expectations, it makes sense to ask what pressures are shaping the nervous system in this direction.
ADHD as a common downstream pattern
In patients with chronic illness, attention problems often arise alongside other physiologic stressors. These may include chronic infection, immune activation that does not resolve, disrupted sleep, nutrient depletion, gut dysregulation, autonomic instability, or toxic exposure.
Within the IACIRS framework - infection-associated chronic inflammatory response syndrome - this pattern is predictable. When the immune system remains chronically activated, the brain adapts. Energy is conserved. Regulatory bandwidth narrows. Executive function becomes inconsistent.
The behaviors fit ADHD criteria, but the driver lies upstream.
Why stimulant medications can help - and why they often fall short
Stimulant medications increase dopamine and norepinephrine signaling. This can improve focus and impulse control, sometimes dramatically. For many patients, this support is meaningful, especially early on.
What these medications do not do is explain why the brain needed pharmacologic stimulation in the first place. When inflammation, sleep disruption, folate or iron abnormalities, gut-driven immune signaling, or chronic infection remain active, medication compensates for an ongoing problem rather than resolving it.
This helps explain why side effects, tolerance, emotional flattening, sleep disturbance, and difficulty tapering are so common. The nervous system is still under load.
What I see when root causes are addressed
This is where circular reasoning begins to unravel.
I have worked with many patients who initially met criteria for ADHD and later found they no longer needed stimulant medication once key drivers were identified and treated. The pathways were different.
One patient had evidence of impaired cerebral folate availability. After starting folinic acid, which bypasses common folate transport and conversion barriers, attention and emotional regulation improved steadily. Over time, stimulant medication was reduced and eventually stopped.
(That physiology is explored in more depth here:
https://www.restorativemedcenter.com/blogs/folinic-acid-the-unsung-hero-for-iacirs-recovery)
Another patient’s attention improved as Candida overgrowth was addressed and gut-driven immune activation settled.
In a different case, significant ADHD symptoms softened only after Bartonella was identified and treated. Cognitive noise and internal restlessness improved in parallel with infectious burden.
These patients did not share a single cause. What they shared was a symptom pattern that made sense once the underlying physiology was uncovered.
Many pathways, one familiar label
There is no single root cause for ADHD-type symptoms. Nutrient handling, immune signaling, gut ecology, infections, sleep quality, and stress physiology can all converge on the same outward presentation.
When we stop at the diagnostic label, those pathways remain hidden. When we look upstream, they become addressable.
A more useful place to begin
Rather than asking whether someone meets criteria for ADHD, I find it more helpful to explore questions like:
- When did attention problems begin?
- What else was happening in the body at that time?
- Do symptoms fluctuate with sleep, illness, inflammation, or treatment?
- What improves attention indirectly?
These questions almost always reveal a story. That story matters more than the label.
Stepping out of the loop
ADHD describes a pattern. It does not explain why that pattern developed. When we treat the description as the cause, we stay stuck in a loop. When we ask what is driving the nervous system into this state, we open the door to real change.
For many patients, attention problems are not a permanent trait or a fixed identity. They are a reflection of physiology under strain. As that strain eases, attention often follows.
That shift - from naming symptoms to understanding causes - is when real healing begins.