Management of attention deficit hyperactivity disorder
[1] Based on two 2024 systematic reviews of the literature, FDA-approved medications and to a lesser extent psychosocial interventions have been shown to improve core ADHD symptoms compared to control groups (e.g., placebo).
[1][2] The American Academy of Pediatrics (AAP) recommends different treatment paradigms depending on the age of the person being treated.
For those aged 4–5, the AAP recommends evidence-based parent- and/or teacher-administered behavioral interventions as first-line treatment, with the addition of methylphenidate if there is continuing moderate-to-severe functional disturbances.
[3] Clinical picture of ADHD can be corrected if rehabilitation interventions are started from the early preschool age, when the compensatory capabilities of the brain are great and a persistent pathological stereotype has not yet formed.
If symptoms persist at a later age, as the child grows, defects in the development of higher brain functions and behavioral problems worsen, which subsequently lead to difficulties in schooling.
Non-stimulant medications with a specific indication for ADHD include atomoxetine (Strattera), viloxazine (Qelbree), guanfacine (Intuniv), and clonidine (Kapvay).
[9][10] Specialized ADHD coaches provide services and strategies to improve functioning, like time management or organizational suggestions.
The authors concluded that "more evidence from well-blinded studies is required before cognitive training can be supported as a frontline treatment of core ADHD symptoms".
[23][24] Stimulants used to treat ADHD raise the extracellular concentrations of the neurotransmitters dopamine and norepinephrine, which increases cellular communication between neurons that utilize these compounds.
[9] Nonetheless, there are concerns that the long term safety of these drugs has not been adequately documented,[28][29][30][31] as well as social and ethical issues regarding their use and dispensation.
[43] A 2025 meta-analytic systematic review of 113 randomized controlled trials demonstrated that stimulant medications significantly improved core ADHD symptoms in adults over a three-month period, with good acceptability compared to other pharmacological and non-pharmacological treatments.
[61] Five different amphetamine-based pharmaceuticals are currently used in ADHD treatment: racemic amphetamine, dextroamphetamine, lisdexamfetamine, and two mixed enantiomer products (Adderall and Dyanavel XR).
[62][63][64] Methamphetamine, prescribed as its dextrorotatory enantiomer dextromethamphetamine under the brand name Desoxyn, is a second-line psychostimulant for ADHD in the United States.
[21][67] Like amphetamine, methylphenidate (MPH) is a chiral compound which is composed of two isomers: d-threo-methylphenidate (also known as dexmethylphenidate, d-methylphenidate, or d-MPH) and l-threo-methylphenidate (also known as l-methylphenidate or l-MPH).
[citation needed] Atomoxetine,[85] viloxazine, guanfacine, and clonidine are drugs approved for the treatment of ADHD that have been classified as "non-stimulant".
[109][110] Canadian clinical practice guidelines only support the use of dopaminergic antipsychotics with selectivity for D2-type dopamine receptors, particularly risperidone, as a third-line treatment for both disorders following the failure of stimulant monotherapy and psychosocial interventions.
[109] There is no evidence to support the use of any subclass of antipsychotics for the treatment of the core symptoms of ADHD (i.e., inattention and hyperactivity) without comorbid behavioral disorders.
[187] Evidence suggests that careful assessment and highly individualized behavioural interventions significantly improve both social and academic skills,[190] while medication only treats the symptoms of the disorder.
"[191] Central nervous system stimulants such as lisdexamfetamine may be associated with occurrences of constipation, diarrhea, nausea, and stomach pain.
[213][214] One review highlighted a nine-month randomized controlled trial of amphetamine in children that found an average increase of 4.5 IQ points and continued improvements in attention, disruptive behaviors, and hyperactivity.
[218] Stimulant withdrawal or rebound reactions can occur and can be minimised in intensity via a gradual tapering off of medication over a period of weeks or months.
[223] Charles Bradley in Providence, Rhode Island, reported that a group of children with behavioral problems improved after being treated with the stimulant Benzedrine.
While an effective agent for managing the symptoms, the development of liver failure in 14 cases over the next 27 years would result in the manufacturer withdrawing this medication from the market.
[227] In March 2019, a Purdue Pharma subsidiary received approval from the FDA for Adhansia XR, a methylphenidate medication to treat ADHD.
[235] Preliminary studies have supported the idea that playing video games is a form of neurofeedback, which helps those with ADHD self-regulate and improve learning.
[240] Children who spend time outdoors in natural settings, such as parks, seem to display fewer symptoms of ADHD, which has been dubbed "Green Therapy".
[244] Results of studies regarding the effect of eliminating artificial food coloring from the diet of children with ADHD have been very varied.
It has been found that it might be effective in some children but as the published studies have been of low quality results can be more related to research problems such as publication bias.
[262] Based on a 2024 systematic literature review and meta analysis commissioned by the Patient-Centered Outcomes Research Institute (PCORI), seven randomized control trials were identified that report on the effectiveness of physical exercise for treating ADHD symptoms.
[269] Controversy remains, and the PDR continues to carry a warning that stimulants should not be used in the presence of tic disorders, so physicians may be reluctant to use them.
