ADHD is classified as a neurodevelopmental disorder characterised by deficits in attention and executive function. Fifty years of research have been conducted under this classification. A synthesis of the evidence produced in that time suggests the classification may not be consistent with the findings. The same cognitive profile constitutes 31.6% of surgical trainees while being eleven times more likely to leave its bearer in neither work nor education. Its depression is fully mediated by loneliness. Its cardiovascular risk is substantially comorbidity-mediated. Its violence perpetration disappears after comorbidity control. Every adverse outcome depends on environmental conditions — none requires the architecture. The standard biological fitness test the field applies to comparable conditions has never been applied to ADHD — this monograph applies it. The population-genetic values are without parallel in the literature: assortative pair-bonding within the architecture runs at 13 times baseline, the architecture returns the only positive fertility ratio identified in any heritable condition tested (FR ≈ 1.13), and has persisted despite continuous negative selection for forty-five thousand years. Four original contributions are advanced: a unified two-parameter neurocognitive model that deductively generates the full DSM-5 criterion set; a three-stage pipeline failure presenting clinically as affective impermanence, formally defined and mechanistically grounded here for the first time; characterisation of the cognitive profile as an Exploratory-Salience Obligate-Collective Architecture (ESOCA) — obligate-social, optimised for collective coordination at the expense of individual regulatory capacity, evolved for conditions that no longer exist at population scale; and reframing of the field's piecemeal nutritional findings as metabolic consequences of elevated catecholamine throughput operating on a post-agricultural nutritional supply. Thirty-six falsifiable predictions follow. Stimulant medication remains the most effective first-line treatment for ADHD. The reasoning for the prescription changes; the efficacy does not.
J Blake (Sat,) studied this question.