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ADHD is not a disorder of willpower; it is a condition of dysregulation. Decades of neurobiological research demonstrate that altered signaling in key neurotransmitter systems — particularly dopamine, norepinephrine, and serotonin — contribute to the core features of ADHD. These chemical messengers in the brain shape how we focus, prioritize, feel motivated, regulate emotions, and experience reward.

Dopamine is central to motivation, pleasure, reward processing, and goal-directed behavior. When dopamine signaling is adequate, individuals feel calm, satisfied, and capable of sustained engagement. When dopamine tone is reduced or dysregulated, as often observed in ADHD, the brain compensates by seeking novelty, urgency, or high stimulation. This contributes to distractibility, procrastination on mundane tasks, and the pursuit of immediate rewards over long-term goals.

Norepinephrine supports sustained attention, executive functioning, working memory, and impulse control. In the prefrontal cortex, the brain’s executive control center, dopamine and norepinephrine work together to optimize cognitive performance. When these systems are underactive, individuals may experience task initiation difficulties, emotional reactivity, sensory overwhelm, and mental fatigue.

While not traditionally viewed as a “core” ADHD neurotransmitter, serotonin plays a critical modulatory role in mood, sleep, emotional stability, and behavioral inhibition. Serotonergic imbalance can amplify irritability, anxiety, mood swings, impulsivity, and sleep disturbance, complicating the ADHD clinical picture.

In this engaging and scientifically grounded webinar, you will learn:

• About the neurochemical basis for ADHD and understand what is beneath the surface of symptoms
• How ADHD brains differ structurally and functionally from neurotypical brains, including altered activity in the prefrontal cortex, differences in reward circuitry, variations in cortical maturation and connectivity, and dysregulation within the networks that aid cognitive control
• Gain insight into how these neural systems interact dynamically, and how neurotransmitter balance influences real-world behavior
• How excess hormones and neurotransmitters can lead to over arousal, anxiety, and irritability while insufficient signaling affects executive function, procrastination and motivation
• How serotonin modulates emotional regulation, impulsivity, and sleep stability, with clinical examples to illustrate how neurochemical dysregulation translates to everyday functional difficulties

About evidence-based interventions and how they restore brain function, including:

• Stimulant medications that enhance dopamine and norepinephrine signaling
• Traditional non-stimulant treatments that target norepinephrine
• New and novel nonstimulants that modulate serotonin
• Behavioral interventions that leverage reward systems
• Sleep, exercise, and lifestyle strategies that support neurotransmitter balance

Have a question for our expert? There will be an opportunity to post questions for the presenter during the live webinar.

Webinar Sponsor

ADHD isn’t a lack of effort. It’s rooted in differences in how your brain regulates motivation, reward, attention, and emotions. When dopamine and other key brain chemicals fluctuate, it can affect everything from focus and consistency to mood and impulse control. Inflow gets it. Our science-backed program helps you better understand your ADHD brain and apply practical strategies to improve follow-through, emotional balance, and daily functioning. Take the free ADHD traits quiz to get started.

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

ADHD & Brain Health: Resources

• • • Free Download: Unraveling the Mysteries of Your ADHD Brain
    • Read: ADHD Neuroscience 101
    • Read: Everything You Never Knew About the ADHD Brain
    • Read: Using a Dopamine Menu to Stimulate Your ADHD Brain
      
      

Meet the Expert Speaker

Gregory W. Mattingly, M.D., has been a psychopharmacology Instructor for more than 20 years at The Washington University School of Medicine in St. Louis, Missouri. He earned his medical degree and residency at Washington University, where he received a Fulbright Scholarship. Dr. Mattingly has been a principal investigator in more than 500 clinical trials and his research has been published in numerous national and international journals. He is the CMO for ACCUMIN Neuroscience, a research insights and analytics company. In addition to his clinical and research practice, Dr. Mattingly has worked as a mental health consultant and evaluator for both the National Football League and Major League Baseball. Dr. Mattingly is the Past President for the American Professional Society of ADHD and Related Disorders, serves on the Scientific Program Committee for the World Federation for ADHD and is Co-Chair for the U.S. Psych Congress.

Certificate of Attendance: For information on how to purchase the certificate of attendance option (cost $10), register for the webinar, then look for instructions in the email you’ll receive one hour after it ends. The certificate of attendance link will also be available here, on the webinar replay page, several hours after the live webinar. ADDitude does not offer CEU credits.

Closed captions available.

The steep out-of-pocket costs of ADHD care today — on average, more than $8,500 per child and $4,700 per adult annually — are driving families to ration medication, delay or skip medical appointments, and forgo interventions they rely on to function well, according to ADDitude magazine’s new Cost of ADHD Diagnosis & Treatment survey.

Of the 1,970 survey respondents, about 25% cited out-of-pocket medical costs as a limiting or determining factor in accessing ADHD care; 21% said ongoing care is not covered by their insurance, and 16% said their ADHD medication costs are not covered at all.

“I just go without medication when I run short of money,” said one mother. “My adult child has skipped doses to be able to pay for her psychiatrist, and this has brought a lot of unsavory people into her life.”

“I never take my clinician-recommended dosage because I can’t afford it,” said another. “We are paying out-of-pocket for medication, so our kids don’t take it on weekends or vacations,” another mother commented.

[Free Report on Out-of-Pocket ADHD Costs]

ADDitude asked survey participants how they are covering or reducing the cost of ADHD care. Here’s what a few people said:

“I’ve had to take disbursements from retirement accounts to pay for psychotherapy.”

“I have two jobs at this point.”

“I switched jobs to one that is closer to home. I now bike to work. I also joined a nearby affordable community center pool. I swim and arrive at work already having exercised and feeling refreshed.”

“I’ve split the cost of ADHD coaching with another client.”

“It’s hard to pay premiums and pay for doctor visits and maintain a household.”

[ADDitude Directory: Find Affordable Care Near You]

Uneven Insurance Coverage

About half of the people surveyed said their health insurance plan partially paid for an ADHD evaluation for themselves, another adult in the household, or their child(ren). More than one in four said their insurer paid nothing toward evaluation and diagnosis; one in five said those costs were covered completely.

Many of the survey participants expressed frustration about rising health care costs — 10% said their ADHD care costs exceeded 10% of their income — and voiced deep anxiety about potentially steeper hikes and even less coverage in 2026.

The High Cost of Prescription Meds

One-quarter of survey respondents said they reluctantly switched medications because insurers dictated cheaper alternatives or covered prescriptions only partially or not at all, or because the cost of their preferred drug increased substantially.

A significant number said they had to meet their deductible, which was typically more than $1,000, before insurance would cover medication costs.

When asked if their health insurance plan covered the medications they take for ADHD:

• 19% said their prescriptions were fully covered
• 65% said their prescriptions were partially covered
• 16% said their insurer did not cover their prescriptions

Medications Covered

Regarding the medications covered:

• 32% said their insurance covered generics only
• 1% said their insurance covered brand names only
• 35% said generics and brand names were covered
• 32% said they weren’t sure

Types of Providers

Pediatricians and developmental pediatricians were the most common medical professionals seen for ongoing ADHD care (63% for children). Other providers include:

• 62% psychiatrist
• 50% other therapist or counselor
• 50% primary care provider
• 31% psychologist
• 9% occupational therapist
• 6% neurologist

Many survey respondents lamented about the shortage of psychiatrists and the impact of presumably less experienced providers who dismissed their symptoms of adult ADHD.

“I worked with an online provider to get my diagnosis because it was cheaper and quicker.”

“I had to see several different practitioners because they believed I couldn’t have ADHD as an adult since I was never diagnosed as a child.”

Finding Providers Who Take Insurance

The odds of finding a psychiatrist or therapist who accepts your insurance plan are becoming slimmer by the day.

One in four ADDitude survey respondents said that at least one of their medical providers has stopped accepting their health insurance. They voiced worry over a shrinking pool of affordable psychiatrists and therapists.

This provider shortfall was also documented in an investigation by ProPublica, which found that hundreds of mental health providers nationwide have stopped accepting insurance plans in recent years. They blamed insurance network practices that forced providers to chase down payments that were meager or late, and some reported that their services were denied coverage altogether.

The providers also criticized insurers for increasingly interfering with patients’ treatment, sometimes denying it, or pushing generic prescription medications that were cheaper but not optimal.

As the availability of mental health providers who take insurance continues to worsen, ADDitude survey participants shared their experiences.

“This has happened throughout my child’s life. His occupational therapist left the insurance network, his psychiatrist left, my therapist left, our family primary care provider left.”

“It took almost two years to find and start seeing a new therapist. The wait list was nine months long.”

“My psychiatrist is semi-retired and takes cash only. I have not found a new one who will follow my treatment plan, which was working great.”

“I had to call around and ask a bunch of psychiatrists, and it was such a pain. They think that you’re seeking medication when you just want appropriate care. It took me six months to find someone new.”

“I was referred to a nurse practitioner from a psychologist about nine months ago because the practice said my insurance didn’t reimburse them enough. I chose to stay with the practice, rather than start somewhere new, and now I pay out-of-pocket.”

ADHD Medication Cost: Next Steps

• Free Download: What to Ask Before Starting ADHD Medication
  
• Read: These Prescription Assistance Programs May Help You Save Money on ADHD Medication
• Read: How Does Health Insurance Work? A Primer for Patients with ADHD
• Watch: “Cracking the ADHD Medication Maze: How to Get, Afford, and Refill Your Prescriptions With Minimum Hassle”

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

The United States is the only first-world nation that does not provide basic health care to all its citizens. The roadmap to universal health care exists and public opinion largely supports it. However, health care is so incredibly profitable for American insurance companies and political campaigns that proposed reforms are practically guaranteed to fail time and time again.

Health insurance companies use the worst possible system to fund patient care. The only way to perpetually increase the profits demanded by shareholders is to deny legitimate claims or otherwise create obstacles that prevent or delay payments to providers. This system does not incentivize efficient care; it disincentivizes delivering care altogether.

How Insurers Dictate Physician Care

In the 1980s, as technology made the delivery of care more efficient, insurers sought ways to increase profits. This was largely accomplished by obstructing the delivery of care or denying care outright – and it changed physician behavior. If a clinician knew that a prescription for the cheapest immediate-release ADHD medication  would be approved swiftly and without question, but a superior and more expensive time-released formulation would be contested or denied, the clinician would prescribe the insurance-preferred medication, even if it were not what was in the best interest of the patient.

In Colorado, where I live, a majority of private mental health practitioners no longer accept any insurance plans largely because the insurance companies don’t pay parity rates or pay for care that was pre-authorized. It can take months for insurers to pay claims.

These insurance company practices have made access to patient care difficult, if not nearly impossible. In Colorado, few clinicians have the training and experience necessary to adequately manage ADHD in children and adults. If a patient cannot find an experienced clinician and access good care, they stop running up clinical office and pharmacy charges — a win for the insurance company and its profits, and a loss for people who go untreated.

[Download: The Soaring Cost of ADHD Care]

For every practicing clinician who still deals with insurance, there are likely one to two people in their office who do nothing but fight to get their legitimate claims submitted and paid. This extra cost gets passed on to the patient in the form of higher out-of-pocket costs at the point of service.

Being obstructive and slow to pay claims is profitable in other ways, The longer the insurance company can hold onto billions of dollars of premiums, the more investment interest those premiums will earn. Insurers also know that people with mental health conditions are much less likely to appeal a denial of care.

Life is hard enough for people with an ADHD nervous system. They can become overwhelmed by the intentional complexity and obstruction of legitimate care, A single complaint by a patient to a lawmaker or regulator is rarely noticed. A million complaints could start a revolution.

[Read: Bottom Line – Reduce the High Cost of ADHD Treatment]

Jumping Insurance Hurdles

What can patients do to fight insurance abuses?

• Contact your federal and state representatives about the problems you are having with your insurance company.
• Report issues with your insurer to your state’s Department of Insurance and copy your governor’s office.
• Report complaints about your insurance company to your human relations department, which chooses employee benefits.
• When a claim is denied, immediately demand a peer-to-peer review between your clinician and the company’s medical directors.

How can practitioners advocate for their patients?

If you are fighting to get your clients the best care you can provide (not the cheapest care that the insurance company can force you to provide), you must be aggressive. Each time you contact the insurance company, keep a log and do the following:

• Ask for a phone number to re-establish contact if the call is dropped.
• Get the person’s full name and professional licensure. Find out in which state they are licensed in case you want to make a complaint about practicing outside the scope of their license or for obstruction of appropriate care.
• As you get passed from person to person, ask each one for their credentials and what gives them the training, knowledge, and experience to make decisions about your patients’ care. How many people with ADHD have they diagnosed and treated in the last five years?

William W. Dodson, M.D., has been a board-certified adult psychiatrist for more than 27 years. He does not accept insurance.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Today, we know that ADHD affects every life domain and that medication alone is usually not sufficient. Most people need multimodal care, and the sequence of treatments matters; however, few patients benefit from these insights because ADHD care is fragmented in the following ways:

• Its quality hinges on who diagnoses the ADHD, when, and which services are available and utilized.
• How and when care is delivered.
• Untreated or undertreated ADHD is far too common.

Providing a Structured Approach

There is no one-size-fits-all approach to ADHD. An effective ADHD treatment plan for children begins with a comprehensive assessment that considers the following:

Co-occurring Conditions and Mimics

ADHD coexists with at least one psychiatric, learning, or behavioral disorder about 80% of the time. Anxiety, depression, sleep disturbance, and other conditions can imitate or amplify symptoms.

Unique Impairments

Treatment should be tailored to each child’s unique impairment and context (e.g., severity, presentation, family dynamics, parental health, care access, etc.) while simultaneously highlighting the child’s strengths. Identifying and building on a child’s talents promotes self-esteem and resilience.

💡Free Guide! Parent-Child Therapies for Better Behavior

Sleep Comes First

Sleep problems and ADHD often overlap and are mutually exacerbating; stimulants can disrupt sleep, and poor sleep can worsen ADHD symptoms. Baseline sleep history and screening for sleep disorders should precede medication trials. If sleep deteriorates, clinicians should adjust the dose or formulation, add melatonin, or reinforce sleep-hygiene routines.

Multifaceted Treatment Is Best

Research has focused extensively on monotherapy — typically medication alone — but this approach rarely suffices beyond the short term. For one, ADHD can change over time. The medication that helps a hyperactive kindergartener may not serve a high school student. Monotherapy is especially inadequate for patients with multiple symptoms, comorbidities, and residual impairments not addressed by medication, like behavioral challenges when a medication wears off.
Multimodal therapy — medication used in conjunction with new behavioral interventions — is not new. The landmark Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) study observed children assigned to different 14-month approaches:

• individually titrated medication
• intensive behavioral intervention
• combined treatment
• community care

Medications improved core symptoms, but parents and teachers rated the combined approach highest for overall functioning.

💡Free Download! A Parent’s Guide to ADHD Medication

Sequence Matters

Multimodal treatment works, but sequencing is important. In one study, children were treated during a school year and assigned to different sequences. Starting with behavioral treatment and then adding medication, if needed, produced the best outcomes, including fewer classroom rule violations and disciplinary events. Conversely, starting with medication and adding behavioral treatment later was less effective. ¹

Dosing for Non-Stimulants

For patients who do not respond to stimulants, choose not to take them, or whose comorbid conditions (e.g., tics, sleep disorders) are worsened by stimulants, non-stimulants are an option, and there are several with different mechanisms of action. Finding an optimal dose requires working closely with your provider. Often, combining stimulants with non-stimulants can improve tolerability and mitigate dose-related side effects.

What constitutes effective ADHD treatment will continue to be a central topic of research. Scientific evidence supports care that is personalized, sequenced, and measurement-based. Children respond best to treatment plans that include psychoeducation, behavioral and pharmacological interventions, and a focus on building their strengths to improve functioning not just in school but in life.

Mark A. Stein, Ph.D., is a professor of psychiatry and behavioral sciences at the University of Washington.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Source

^{1 Pelham, W.E., Jr., Fabiano, G.A., Waxmonsky, J.G., Greiner, A.R., Gnagy, E.M., et al. (2016). Treatment sequencing for childhood ADHD: a multiple-randomization study of adaptive medication and behavioral interventions. J Clin Child Adolesc Psychol. https://doi.org/ 10.1080/15374416.2015.1105138}

ADHD Medication for Adults: Article Contents

• How ADHD Medications Work
• The Benefits of ADHD Treatment
• Possible Side Effects

Nearly half of the 15.5 million American adults with ADHD were not diagnosed as children.¹ A surge in later-life diagnoses means more people are now exploring treatment options. And they have questions.

Medications, particularly stimulants, remain the most researched and effective treatments for ADHD. While questions about their efficacy, safety, and benefits should always be answered by a doctor, this guide can help you understand ADHD medications and their potential role in your treatment plan.

How ADHD Medications Work

ADHD is associated with lower dopamine and norepinephrine activity in the prefrontal cortex. These neurotransmitters modulate attention, motivation, and impulse control. Stimulant medications increase signaling by and to these neurotransmitters by boosting release of the chemicals and blocking reuptake, producing longer lasting effects.

Non-stimulants are another category of ADHD medications. These include atomoxetine, viloxazine, and off-label bupropion, which boost dopamine and norepinephrine. (Viloxazine also acts on serotonin receptors.) The non-stimulants guanfacine and clonidine don’t raise neurotransmitter levels but stimulate the alpha-2A receptors involved in impulse control, attention, and emotional regulation.

Which Medication to Choose?

Stimulants are generally more effective than non-stimulant medications for ADHD. Of the two stimulant classes, amphetamine and methylphenidate, the former shows the strongest results², while methylphenidate outperforms non-stimulants.^{3 4} Ultimately, the best medication is the one that controls your symptoms with the fewest side effects.

💡Free! ADHD Treatment Guide for Adults

When Will the Medication Start Working?

Stimulants’ effects appear within three days. Many non-stimulants take weeks to reach effective levels and start working. Some, however, particularly bupropion and atomoxetine, act on neurotransmitters right away; people taking one of these non-stimulants may notice improvements within hours.

Getting the Dose Right

In my clinical experience, many people who try stimulants for the first time experience a “honeymoon period,” during which the benefits are greater in the first few weeks than they are thereafter, even with dose adjustments. Some argue this reflects physiological “tolerance,”, but it may instead be the euphoria and relief of improvement after a lifetime of frustration. Be aware of this phenomenon and aim for a sustainable dose that works for you over time.

If the benefits of medication are minimal and side effects are low, your provider should titrate upward and monitor over three-day intervals. You can judge a medication’s efficacy through:

• ADHD symptom rating scales. These are useful, but responses should be interpreted cautiously, since they’re self-reported.
• Personal measures. You track concrete, time-based improvements (e.g., time spent answering emails or reading a book).
• Collateral information. What have your friends, family, and providers observed?

Note that small dips in attention, focus, and alertness throughout the day are normal. Attempting to medicate your way out of these lulls (i.e., siesta time) may be counterproductive.

Read: 11 Steps to Prescribing and Using ADHD Medication Effectively

The Benefits of ADHD Treatment

The benefits of the correct ADHD medication go beyond improving focus, productivity, and emotional regulation. Treating ADHD reduces other risk factors; for example, studies show that adherent treatment decreases the overall likelihood of substance use-related problems.⁵

Untreated ADHD, on the other hand, doubles the risk of developing a substance use disorder.⁶ Evidence indicates that the vast majority of individuals with ADHD do not become addicted to their prescribed medications.⁷

Is a Dose Ever Too High?

A dose is too high only if it causes problematic side effects. That said, many prescribers and insurers won’t excel labeled doses. If your doctor’s dosing decisions are driven by milligrams rather than outcomes, consider getting a second opinion.

ADHD Medications: Possible Side Effects

Short- and long-term ADHD medication side effects are typically addressed by lowering the dose. Some fade with time. Mild side effects may include:

• Anxiety
• Tremors
• Irritability and/or agitation
• Sweating
• Dry mouth
• Insomnia
• Appetite suppression
• Increased heart rate/blood pressure

Rare But Serious Side Effects of ADHD Medications

The vast majority of people on ADHD medications will never experience the following serious side effects. Nevertheless, here’s what you should know.

Cardiac Effects

Most studies find no significant adverse cardiovascular effects from ADHD medications. A recent study found a link between long-term treatment and hypertension or arterial disease⁸, but the overall risk was low. The study did not find increases in arrhythmias, heart failure, heart attacks, or strokes. Importantly, it did not prove causality.

For the average patient without serious heart problems, the benefits of ADHD medication exceed the small cardiovascular risk, as long as blood pressure and heart rate are monitored. People with pre-existing or a strong family history of heart disease or uncontrolled hypertension may need special evaluation. Lifestyle factors (e.g., smoking, inactivity, stress) can amplify risk far more than medication and should be addressed.

Psychosis

Stimulant-induced psychosis is rare, and studies have found inconsistent incidence rates. A study that followed about 222,000 teens and young adults taking ADHD stimulants found that 1 in every 660 developed psychoses.⁹ Other studies have found no link between prescribed methylphenidate use and psychosis.¹⁰

A 2025 study found no causality between stimulant use and psychosis, instead noting that their association may reflect underlying patient characteristics, not the stimulants.¹¹ People who experience psychosis on stimulants should discontinue use and take an antipsychotic, which can help resolve symptoms within days.

Optimizing ADHD Treatment

Combining short- and long-acting stimulants or adding a non-stimulant can extend coverage and reduce side effects. ADHD is managed most effectively when you combine medication with proper nutrition, exercise, adequate sleep, and therapy to support executive functioning and emotional regulation.

John Kruse, M.D., Ph.D., is a neuroscientist, psychiatrist, and author.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Staley, B. S., Robinson, L. R., Claussen, A. H., Katz, S. M., Danielson, M. L., Summers, A. D., Farr, S. L., Blumberg, S. J., & Tinker, S. C. (2024). Attention-Deficit/Hyperactivity Disorder Diagnosis, Treatment, and Telehealth Use in Adults – National Center for Health Statistics Rapid Surveys System, United States, October-November 2023. MMWR. Morbidity and Mortality Weekly Report, 73(40), 890–895. https://doi.org/10.15585/mmwr.mm7340a1

² Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., Carucci, S., Atkinson, L. Z., Tessari, L., Banaschewski, T., Coghill, D., Hollis, C., Simonoff, E., Zuddas, A., Barbui, C., Purgato, M., Steinhausen, H. C., Shokraneh, F., Xia, J., & Cipriani, A. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. The Lancet. Psychiatry, 5(9), 727–738. https://doi.org/10.1016/S2215-0366(18)30269-4

³ Faraone S. V. (2009). Using Meta-analysis to Compare the Efficacy of Medications for Attention-Deficit/Hyperactivity Disorder in Youths. P & T : a peer-reviewed journal for formulary management, 34(12), 678–694.

⁴ Bellato, A., Perrott, N. J., Marzulli, L., Parlatini, V., Coghill, D., & Cortese, S. (2025). Systematic Review and Meta-Analysis: Effects of Pharmacological Treatment for Attention-Deficit/Hyperactivity Disorder on Quality of Life. Journal of the American Academy of Child and Adolescent Psychiatry, 64(3), 346–361. https://doi.org/10.1016/j.jaac.2024.05.023

⁵ Zhang, L., Zhu, N., Sjölander, A., Nourredine, M., Li, L., Garcia-Argibay, M., Kuja-Halkola, R., Brikell, I., Lichtenstein, P., D’Onofrio, B. M., Larsson, H., Cortese, S., & Chang, Z. (2025). ADHD drug treatment and risk of suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality: emulation of target trials. BMJ (Clinical research ed.), 390, e083658. https://doi.org/10.1136/bmj-2024-083658

⁶ Wilens, T. E., Martelon, M., Joshi, G., Bateman, C., Fried, R., Petty, C., & Biederman, J. (2011). Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 50(6), 543–553. https://doi.org/10.1016/j.jaac.2011.01.021

⁷ Han B, Jones CM, Volkow ND, et al. Prescription Stimulant Use, Misuse, and Use Disorder Among US Adults Aged 18 to 64 Years. JAMA Psychiatry. 2025;82(6):572–581. doi:10.1001/jamapsychiatry.2025.0054

⁸ Zhang, L., Li, L., Andell, P., Garcia-Argibay, M., Quinn, P. D., D’Onofrio, B. M., Brikell, I., Kuja-Halkola, R., Lichtenstein, P., Johnell, K., Larsson, H., & Chang, Z. (2024). Attention-Deficit/Hyperactivity Disorder Medications and Long-Term Risk of Cardiovascular Diseases. JAMA psychiatry, 81(2), 178–187. https://doi.org/10.1001/jamapsychiatry.2023.4294

⁹ Moran, L. V., Ongur, D., Hsu, J., Castro, V. M., Perlis, R. H., & Schneeweiss, S. (2019). Psychosis with methylphenidate or amphetamine in patients with ADHD. The New England Journal of Medicine, 380(12), 1128–1138. https://doi.org/10.1056/NEJMoa1813751

¹⁰ Zarchev, M., Bouter, D. C., & Grootendorst-van Mil, N. H. (2024). No association between methylphenidate use and psychotic experiences in a population-based sample of adolescents at risk of emotional and behavioral problems. Acta Psychiatrica Scandinavica, 149(2), 168–170. https://doi.org/10.1111/acps.13630

¹¹ O’Hare, K., Byrne, J. F., Ramsay, H., Romaniuk, L., McGrath, J., Keating, D., Migone, M., O’Connor, K., Coss, N., Cannon, M., Cotter, D., Healy, C., & Kelleher, I. (2025). Stimulant medication use and risk of psychotic experiences. *Pediatrics, 155*(6), e2024069142. https://doi.org/10.1542/peds.2024-069142

Women with ADHD who report significant negative mood symptoms just before and during menstruation tend to experience similar-magnitude increases in ADHD symptoms at this time, found a new study in Journal of Attention Disorders.¹ Building upon a modest foundation of previous research that found ADHD symptoms vary across the menstrual cycle, the researchers studied women of reproductive age with ADHD treated with amphetamine salts, the most commonly used medication among members of this demographic, 60% of whom use Adderall of Mydalis.²

The 30 study participants were required to complete daily surveys measuring their ADHD symptoms as well as the severity of 17 mood symptoms. Participants reported their total daily dose of amphetamine salts, as well as use of other medications, alcohol, tobacco, or cannabis.

The study found:

• ADHD symptoms were most severe in the menstruation phase of the monthly cycle
• Negative mood symptoms were most severe in the menstruation and luteal phases
• The magnitude of increase in ADHD symptoms and negative mood was similar, leading researchers to conclude that mood and ADHD symptoms co-vary between menstrual cycle phases

These findings validate the anecdotal experience of many women with ADHD.  “Fluctuating estrogen and progesterone across the menstrual cycle invariably impact ADHD symptoms, emotions, and functioning. We know this to be true, but there is almost no research validating this relationship,” explained Lotta Skoglund Ph.D., in her recent ADDitude article, “The Menstrual Cycle Impacts ADHD Symptoms in Disparate Ways.”

“The entire week leading up to my period is where my ADHD symptoms get even more intrusive than usual,” says Chloe, an ADDitude reader. “My executive functioning dips even lower, distractibility and difficulty focusing is increased, and my mood/energy level is much lower, causing me to feel badly about all the things I’m not being successful at that week.”

Charlie, a reader in Australia, echoes this experience: “A week before I am due for my period, my brain goes to complete peanut butter. It is an utter mission to focus and stay on task. Sensory overload is at its peak. Impatience rules the days, and I get so overwhelmed.”

In addition, many women report lower efficacy of ADHD medication during the luteal and menstrual phase. One ADDitude reader shares “My ADHD meds are significantly less efficacious for about 10 days per month; two days before menstruation I am a barely functional zombie.” Norma, an ADDitude reader in Wisconsin, describes a similar experience, “The week leading up to my cycle, I might as well not even take my ADHD meds. It’s like my body overrides them.”

Based on similar anecdotal reports, the study’s researchers sought to uncover whether women with ADHD were exploring cycle syncing, increasing their dose of stimulants during the late luteal and menstruation phases to address intensified ADHD symptoms. They found, however, that women maintained constant daily medication dosing throughout their menstrual cycles.

“This may reflect prescribing practices for stimulant medications, which often do not encourage ‘flexible’ or ‘symptom-based’ dosing regimens, as well as potential inexperience of providers or patients regarding the effects of menstrual cycle phase on medication metabolism and efficacy,” the researchers reflect. The authors refer to an earlier study that found many women with ADHD were hesitant to ask doctors about the effect of their menstrual cycle on ADHD medication and often reported invalidating responses from their practitioners when they did inquire.³

Skoglund advises women to use a menstrual cycle tracking log to record and report specific data to aid these conversations with doctors: “Tracking your cycle will give you powerful insights into how hormonal fluctuations influence your ADHD symptoms, medication effectiveness, and overall functioning. With this data, you’ll be in a better position to talk to your doctor about enhancements to your treatment plan to improve your health and wellbeing.”

The study had several limitations, including its small sample size; 16 of the 46 initial participants were excluded for failure to complete daily surveys, leaving 30 participants, and the authors note it is possible the individuals who successfully completed the surveys had milder ADHD symptoms. In addition, unlike other studies,⁴ the researchers did not measure ovarian hormone levels, relying on participants’ reporting of menstruation for this information. Individuals who were taking other psychiatric medications were excluded, thus excluding women who receive medication for mood disorders and/or Premenstrual Dysphoric Disorder, both of which are significantly more likely in people with ADHD.

Sources

¹Zaritsky, R., Reed, S. C., & Evans, S. M. (2025). Changes in ADHD Symptoms and Mood Across the Menstrual Cycle in Females Treated With Stimulants: A Pilot Study. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547251400038

²Anderson K. N., Ailes E. C., Danielson M., Lind J. N., Farr S. L., Broussard C. S., Tinker S. C. (2018). Attention-deficit/hyperactivity disorder medication prescription claims among privately insured women aged 15-44 years – United States, 2003-2015. Morbidity and Mortality Weekly Report, 67(2), 66–70. https://doi.org/10.15585/mmwr.mm6702a3

³Bürger I., Erlandsson K., Borneskog C. (2024). Perceived associations between the menstrual cycle and attention deficit hyperactivity disorder (ADHD): A qualitative interview study exploring lived experiences. Sexual & Reproductive Healthcare, 40, Article 100975. https://doi.org/10.1016/j.srhc.2024.100975

⁴Roberts B., Eisenlohr-Moul T., Martel M. M. (2018). Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology, 88, 105–114. https://doi.org/10.1016/j.psyneuen.2017.11.015

Stimulant medications target brain areas that control reward and wakefulness, not attention, suggests new research in the journal Cell that challenges prior thinking about ADHD treatment.¹

For decades, doctors have prescribed stimulant medications — methylphenidate and amphetamine — under the assumption that the drugs directly improve attention and concentration in individuals with ADHD.^{2, 3, 4} However, the new study led by a team of researchers at Washington University School of Medicine in St. Louis posits that prescription stimulants increase alertness and motivation in children with ADHD.

The researchers compared the resting-state functional MRI (fMRI) data of 5,795 children aged 8 to 11 years who participated in the Adolescent Brain Cognitive Development (ABCD) Study. They found that children who took stimulants the day of the fMRI scan showed increased activity in brain regions related to arousal and reward, but no notable changes in regions connected to attention.

“Essentially, we found that stimulants pre-reward our brains and allow us to keep working at things that wouldn’t normally hold our interest — like our least favorite class in school, for example,” lead author Nico U. Dosenbach, M.D., Ph.D., said in a statement.

According to parent reports in the ABCD study, children with ADHD who took a stimulant medication received better grades in school and performed better on cognitive tests than did children with ADHD who were not taking stimulants.

The study’s findings also offer a new understanding of ADHD hyperactivity. In essence, ADHD hyperactivity may be less about having an abundance of energy and more about seeking stimulation and reward.

“Whatever kids can’t focus on — those tasks that make them fidgety — are tasks that they find unrewarding,” Dosenbach said. “On a stimulant, they can sit still because they’re not getting up to find something better to do.”

Stimulant Medications Benefit Sleep-Deprived Children

Another key finding from the study is that stimulant medications may mimic the benefits of a good night’s sleep.

“We saw that if a participant didn’t sleep enough, but they took a stimulant, the brain signature of insufficient sleep was erased, as were the associated behavioral and cognitive decrements,” Dosenbach said.

The ABCD Study reported that children who got less than the recommended nine hours or more of sleep per night and took a stimulant received better grades in school than children who got insufficient sleep and did not take a stimulant. They also received the same grades as well-rested children who did not take a stimulant.

Children with poor sleep may have shown improved academic performance when taking stimulants, but the researchers caution that stimulants do not cure the effects of chronic sleep deprivation.

“While our results appear to show that the cognitive performance of sleep-deprived children benefited from stimulants, we caution that mounting evidence points to cumulative health consequences of long-term sleep deprivation, including increased risk of depression, cellular stress, and neuronal loss,” the researchers wrote.^{5, 6}

Signs of sleep deprivation, such as difficulty paying attention or poor working memory, overlap with ADHD symptoms and may lead to children being misdiagnosed with ADHD when the actual problem is insufficient sleep.

The researchers stress that findings from the study shouldn’t undermine clinicians’ confidence in the effectiveness of stimulants for ADHD. However, it’s important to rule out factors like sleep deprivation before turning to medication.

“Sleep disturbance is a common comorbidity of ADHD and a common complication of stimulant treatment; therefore, clinicians should screen for sleep disturbance in children with ADHD both before and after prescribing a stimulant,” they wrote.⁷

Nearly three-quarters of children with ADHD experience a sleep disorder.⁸ Sleep problems last into adolescence and can aggravate ADHD symptoms during the day for many children.

“We know that teens with ADHD are more likely than their peers without ADHD to get insufficient sleep on school nights,” said Stephen Becker, Ph.D., in his ADDitude webinar, “Why Am I Always So Tired? The Latest Science on Improving Sleep in Children and Teens with ADHD.”

“We’ve also shown that poor sleep impacts academics, including academic performance, organization, and lower grades based on report cards that we’ve acquired from schools and college institutions,” Becker said. “In some of our work with young teens, even after we account for a teen’s initial levels of depressive symptoms or oppositional behaviors, those teens who had sleep problems went on to experience an increase in depressive symptoms and oppositional behaviors.”

The researchers recommend that future long-term studies evaluate whether stimulant users are less likely to get adequate sleep and measure the cumulative effects of sleep loss over the lifespan. In addition, further research is needed into the long-term effects of stimulant use on brain function and whether stimulants increase task-fMRI activation in response to smaller anticipated rewards.

“The ABCD cohort includes a mix of children taking different stimulant medications and diagnosed with different ADHD subtypes; however, it is not powered to investigate the effects of specific medications or ADHD subtypes,” they wrote. “Variability in scan duration and the lack of precise data on timing and formulation (e.g., immediate vs. delayed release) of stimulant administration limited our ability to account for pharmacokinetic effects in the ABCD cohort, potentially leading to an underestimation of stimulant effects on fMRI connectivity.”

Sources

¹Kay, B.P., Wheelock, M.D., Siegel, J.S., Barch, D.M., et al. (2025). Stimulant medications affect arousal and reward, not attention networks. Cell. https://doi.org/10.1016/j.cell.2025.11.039

²Braga, R.M., Wilson, L.R., Sharp, D.J. (et al). (2013). Separable networks for top-down attention to auditory non-spatial and visuospatial modalities. Neuroimage. https://doi.org/10.1016/j.neuroimage.2013.02.023

³Berridge, C.W., Devilbiss, D.M. (2011). Psychostimulants as cognitive enhancers: The prefrontal cortex, catecholamines, and attention-deficit/hyperactivity disorder. Biol. Psychiatry. https://doi.org/10.1016/j.biopsych.2010.06.023

⁴Farr, O.M., Zhang, S., Hu, S., et al. (2014). The effects of methylphenidate on resting-state striatal, thalamic and global functional connectivity in healthy adults. Int. J. Neuropsychopharmacol. https://doi.org/10.1017/S1461145714000674

⁵Yang, F.N., Xie, W., Wang, Z., et al. (2022). Effects of sleep duration on neurocognitive development in early adolescents in the USA: a propensity score matched, longitudinal, observational study. Lancet Child Adolesc. Health. https://doi.org/10.1016/S2352-4642(22)00188-2

⁶Jan, J.E., Reiter, R.J., Bax, M.C.O., et al. (2010). Long-term sleep disturbances in children: A cause of neuronal loss. Eur. J. Paediatr. Neurol. https://doi.org/10.1016/j.ejpn.2010.05.001

⁷Stein, M.A, Weiss, M., Hlavaty, L. (2012). ADHD treatments, sleep, and sleep problems: Complex associations. Neurotherapeutics. https://doi.org/10.1007/s13311-012-0130-0

⁸Sung, V., Hiscock, H., Sciberras, E., Efron, D. (2008). Sleep problems in children with attention-deficit/hyperactivity disorder: prevalence and the effect on the child and family. Arch. Pediatr. Adolesc. Med. https://doi.org/10.1001/archpedi.162.4.336

The afternoon slump is a real biological phenomenon driven by the body’s internal clock, which influences attention, concentration, and alertness throughout the day.

Most of us experience a big dip in energy at bedtime to promote sleep, and a surge each morning to help us initiate our day. But there’s a secondary lull, typically between 1 and 3 pm, that occurs naturally (and regardless of whether you’ve eaten a big meal). This dip is measurable and observed cross-culturally, with many parts of the world recognizing and respecting it with siesta time – a break in normal activities.

The Afternoon Slump and ADHD

Some people with ADHD may not notice this dip in alertness; issues with proprioception or awareness of bodily cues – common with neurodivergence – may make these lulls easy to miss. (Difficulty gauging sleepiness, for instance, is one reason people with ADHD may have trouble getting to bed on time.)

For many, the natural dip becomes more obvious after beginning ADHD medication. There are a few reasons for this:

[Read: The Daily Missteps That Are Sucking Away Your Energy]

• Better attention overall. When symptoms improve, heightened attention improves proprioception.
• Medication wear-off. The natural afternoon slump may overlap with waning medication coverage, especially with immediate-release formulations. For example, a 7 a.m. dose that lasts up to eight hours would taper around midday or early afternoon.
• Increased productivity. Doing more while medicated can lead to greater fatigue by the afternoon.

Is It ADHD Medication Fade or True Siesta Time?

Because the two can coincide, experiment with the timing of your morning dose. If you feel the same lull even after shifting the dose, medication likely isn’t the primary factor. If changing timing helps, consider:

• Adding a second immediate-release dose before midday
• Switching to a long-acting formulation

Siesta Time Is Natural

Fluctuating energy throughout the day is part of normal human biology. What is an issue, at least in the United States, is acknowledging this real biological phenomenon. As much as our culture tells us to power through these lulls, understanding and respecting them, I believe, is an important part of managing ADHD. Ignoring them or pretending they don’t exist is just working against your biology.

[Read: How Toxic Productivity Leads to Neurodivergent Burnout]

Acknowledging siesta time doesn’t mean abandoning responsibilities. It may mean scheduling your lunch or movement breaks around these dips, steering clear of boring tasks during the slump, and tackling your most demanding tasks earlier in the day.

What about naps? A short one – 20 minutes and no more than an hour – helps some people manage without interfering with evening sleep. But if you’re a member of the ADHD majority with sleep problems, it’s best to avoid daytime naps.

Even if ADHD medication makes you more focused and productive overall, medication won’t make the naturally occurring afternoon slump disappear. A dip in performance is still to be expected, given our biological clocks. My philosophy: Don’t try to medicate your way out of siesta time.

Afternoon Slump: Next Steps from ADDitude

• Self-Test: Am I Suffering from Hurry Sickness?
• Read: How to Tell If Your ADHD Medication Is Working
• Read: What to Do When a Prescription Wears Off

This article was derived from the ADDitude ADHD Experts Webinar, An Adult’s Guide to ADHD Treatment Considerations, with John Kruse, M.D., Ph.D., and his video “Siesta Time for Mental Health.”

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Rising costs are causing people to ration medication, delay or skip medical appointments, and forego helpful interventions, according to a new ADDitude magazine survey. Of the 1,790 survey respondents, about 25 percent cited out-of-pocket medical costs as a limiting or determining factor in accessing ADHD care; 21 percent said ongoing care is not covered by their insurance; and 16 percent said their ADHD medication costs are not covered at all.

In this download, you will learn:

• The average amount paid out-of-pocket for an ADHD evaluation
• The annual cost of ongoing care
• How much medication costs ADHD families each year
• Which non-medical interventions people are using most

Last month, Otsuka Pharmaceutical filed a New Drug Application (NDA) for centanafadine, a first-in-class non-stimulant medication that is a norepinephrine, dopamine, and serotonin reuptake inhibitor (NDSRI). The U.S. Food and Drug Administration (FDA) is now considering centanafadine for the treatment of ADHD in children, adolescents, and adults.¹

Centanafadine is a once-daily, extended-release capsule that increases the availability of three neurotransmitters involved in ADHD (norepinephrine, dopamine, and serotonin) by blocking their reabsorption. While prior research links ADHD with dopamine and norepinephrine dysregulation, rising evidence indicates that serotonin, which influences mood, impulsivity, sleep, and digestion, also contributes to ADHD symptoms and comorbidities.² An August report in Neuroscience & Biobehavioral Reviews concluded that serotonin dysregulation “is likely to generate a broad spectrum of clinical manifestations, which may account for the unique presentation of neuropsychiatric behaviors and comorbidities found in patients with ADHD.”

“Centanafadine represents a new mechanism of action among available ADHD therapies,” says John Kraus, M.D., Ph.D., executive vice president and chief medical officer at Otsuka. “By inhibiting the reuptake of these three key neurotransmitters, the mechanism is designed to address the core symptoms of ADHD and may also help with executive dysfunction and emotional dysregulation.”

Non-stimulant medications are generally considered second- or third-line treatments behind stimulant medications, which are often prescribed to patients who do not respond to or cannot tolerate stimulants. Compared to quick-acting stimulants, non-stimulant ADHD medications may take weeks or longer become fully effective. However, centanafadine demonstrated an earlier onset of action more characteristic of stimulant medications, with clinical benefits emerging by week 1 and maintained through week 6, according to clinical trials.^{3, 4, 5}

“Patients who may be particularly well-suited for centanafadine are those seeking a balanced approach to ADHD management and who may not fully benefit from or tolerate current standard therapies,” Kraus says.

Four Phase 3 clinical trials using extended-release (children and adolescents) and sustained-release (adults) formulations support the NDA submission. Across studies, centanafadine produced statistically significant and clinically meaningful improvements in ADHD symptoms compared with placebo, measured by the ADHD Rating Scale–5 (ADHD-RS-5) in youth and the Adult ADHD Investigator Symptom Rating Scale (AISRS) in adults.^{2, 3, 4}

Adolescent & Pediatric Phase 3 Trial Results

Tim Wilens, M.D., Chief of Child and Adolescent Psychiatry at Massachusetts General Hospital, and a researcher on the centanafadine pediatric and adolescent trials, presented findings from the studies at the American Professional Society of ADHD and Related Disorders (APSARD) conference in January 2025. “Centanafadine had a significant impact on ADHD symptoms,” he said. “It also improves executive functioning — time management, hierarchical thinking, organization, and start/stop/shift transitions.”

A randomized, 6-week, double-blind, placebo-controlled Phase 3 trial involving 480 children (ages 6–12) with ADHD found that high-dose centanafadine significantly improved ADHD symptoms versus placebo. (Footnote 3) Children in the study were assigned to a high-dose, low-dose, or placebo group based on weight. Among those within the high-dose group, 34% achieved an 18-point or greater reduction on the ADHD-RS-5 compared with 23% in the placebo group.

Mean ADHD-RS-5 score reductions (ages 6–12)