The model is that there’s a loop of bad behavior -> worse treatment -> worse symptoms -> worse behavior. Taking the kids to a therapist interrupts that cycle. Bad behavior -> more appropriate treatment -> better symptoms -> better behavior.
Meds (& therapy—but if this miss that for a couple weeks, nothing bad immediately happens, while if they miss the meds even one day...) did the trick. Amazing. We can just tell them stuff, and they mostly listen. We can talk to them about something they just, moments ago, did that was wrong, and they know what we're talking about rather than being genuinely confused, and will not just commit to do better, but will actually try and maybe not immediately repeat the behavior, even entire minutes (LOL) later, and almost never start to just absentmindedly do it again while we're still talking to them about it. Punishments or harsh reprimands are (and were, after we caught on to those being not just ineffective, but counter-productive, even in very mild forms) reserved for immediate safety problems that can't wait for a touchy-feely approach, or many-times-repeated bad behavior, and don't usually result in hours of backlash-behavior later, as they used to, and do usually have an overall-positive effect. They notice straightforward natural-consequence-type correction and respond to it, rather than its having zero effect whatsoever.
But, yes, we can add 2 to N for worsening treatment being the opposite of helpful for (at least our) unmedicated very-ADHD kids, for sure. That was definitely something we saw.