Dr. Drew Collins, a naturopathic doctor who has run a cash-pay practice for 41 years, returned to Great Minds of Today for a conversation on ADHD that host Mark Anthony framed bluntly: with so much conflicting information circulating online, he wanted to get to "the truth about ADHD that no one is talking about." Collins, who practices at ProActiveChoice.com, spent the episode making one central argument — that ADHD and the broader category of neurodivergence aren't a new phenomenon so much as a newly and rapidly expanding diagnostic one.
His framing: what gets labeled ADHD today has always existed in some form — he called it the "artist's dilemma" or the "inconvenient genius," the person in the village who noticed the sunrise and wrote poetry while everyone else chopped wood. What's changed, he argued, is the diagnostic apparatus itself. The DSM (the manual psychiatric diagnoses are built on) has grown edition over edition, from DSM-1 through DSM-5, and each new diagnostic code tends to arrive with an insurance-approved drug attached to it.
Key Takeaways
- Dr. Collins frames ADHD and neurodivergence as long-standing human variation, not a new phenomenon — what's expanded is the diagnostic system, including a fast-growing adult ADHD category, especially in women.
- He discussed genetic testing (a cheek swab or blood test) for SNPs tied to methylation — markers he said appear in an estimated 40 to 50 percent of the population and correlate with ADHD, anxiety, and other neurodivergent symptoms.
- Some patients genetically lack the enzyme needed to break down the same neurotransmitters stimulant medication targets, meaning the same drug can help one person and make another feel measurably worse.
- Dr. Collins was direct that medication can help short term but doesn't fix the underlying biochemistry, and that long-term stimulant use carries a real risk of receptor downregulation — a mechanism he compared to addiction.
- He prioritizes exercise, sleep, nutrition, food allergy testing, art and music enrichment, and pet therapy as lower-cost, non-toxic first steps before or alongside medication.
ADHD Isn't New — the Diagnosis Landscape Is
Collins traced the rise in ADHD diagnoses to a combination of social and diagnostic shifts rather than a sudden explosion of the underlying condition. Families are more economically stressed, more households run on two working parents (or one on their own), and diagnostic categories have simply multiplied — each DSM revision adds more finely divided codes, he said, and "if you go to the DSM5s and you go to a diagnosis number... then there's also an approved drug for that diagnosis." He also pointed to autism-diagnosis trends as part of the same broader story, citing figures moving from roughly one in 10,000 decades ago to around one in 30 today.
Adult ADHD, he said, is a newer and rapidly growing category on top of that — particularly in women. His explanation: research and clinical literature have historically underrepresented women, and girls with ADHD traits are often socialized to sit quietly and play alone, so symptoms don't surface diagnostically until the social stress of middle school or hormonal changes bring them out.
"It's not getting more understood. It's just getting more described."
— Dr. Drew CollinsThe Genetic Testing Piece: SNPs, Methylation, and Predicting Bad Reactions
Where conventional ADHD diagnosis is purely observational — clinicians matching behavior to DSM-5 criteria — Collins pointed to a lab-based alternative: a cheek swab or blood test screening for single nucleotide polymorphisms (SNPs), genetic markers tied to methylation. He said these mutations show up in an estimated 40 to 50 percent of the population and correlate with ADHD, anxiety, depression, and other conditions grouped under neurodivergence. The test doesn't require drawing blood from young children — he noted a two-year-old can do it with a cheek swab — and he described the panel as costing a few hundred dollars, generally not covered by Medicare and inconsistently covered by other insurance unless the diagnosis code lines up with the test.
More specifically, he described certain genetic markers as predictive of how a patient will tolerate stimulant medication: some children lack the enzyme needed to break down neurotransmitters like epinephrine (adrenaline) once the body releases them. Without that enzyme, he said, the chemical doesn't clear the way it does for most people — "you'd be like your whole life" stuck in a heightened, agitated state — which can show up as the kind of behavior that gets kids flagged, medicated, or in some cases pushed toward the juvenile justice system before anyone tests for the underlying genetics.
What Stimulant Medication Does — and What It Doesn't Fix
Collins walked through the biology in plain terms: dopamine, norepinephrine, and epinephrine (the "monoamines") drive focus and reward in the prefrontal cortex. People with ADHD, in his description, don't get the same dopamine payoff from routine tasks that most people do — but they can focus intensely on whatever does light up that reward system. Stimulant medication is chemically shaped like dopamine, which is why it can help patients get satisfaction from a broader range of tasks, not just their one area of intense interest.
But he was equally direct about the tradeoff. Chronic stimulation of a neurotransmitter pathway can cause the body's own receptors for that chemical to downregulate — a mechanism he likened directly to addiction, whether the substance in question is a prescribed stimulant, alcohol, or a drug of abuse. He also raised a real example from his own community: a local physician colleague who describes herself as an "undermedicated ADHD adult." She tried medication earlier in her career and, in Collins's account, found that it dulled her — she went off it, calls her intensity her "superpower," and continues to run multiple businesses.
"The medicine is problematic in that it's not curing anything. It's not fixing anything. It's making them more socially acceptable."
— Dr. Drew CollinsThe Non-Drug Interventions Dr. Collins Prioritizes First
Asked what isn't being talked about enough, Collins listed a set of lower-cost, non-toxic interventions he tries before or alongside medication: daily exercise (he called it the cheapest and most effective single intervention, noting kids need to move roughly every 20 minutes rather than sit still for hours); consistent sleep (he said children need about 10 hours nightly until roughly age 27, since the brain is still developing, and pushed for getting screens out of kids' hands at bedtime); nutrition; and food allergy testing for common triggers like corn and gluten.
He also pointed to enrichment programs — art, music, and pet therapy — as underrated tools, citing a local example: when the Redmond school district's elementary schools lost their art programs entirely, a community arts association raised roughly $60,000 to send artists back into the schools. Pets, he said, build empathy and give kids with ADHD or anxiety a sense of responsibility and self-regulation that's hard to replicate elsewhere.
Collins closed by returning to his core message: he doesn't dispute that some children and adults are genuinely struggling, or that medication has a place — but he wants families to know testing exists that goes beyond observation, and that the differences behind an ADHD diagnosis are, in his words, something to accommodate rather than something to be ashamed of.
