A wealth of detailed, data-driven information on the efficacy and side effects of ADHD interventions now exists in a free, interactive platform called Evidence Based Interventions-ADHD (EBI-ADHD), the product of a massive umbrella review published in the British Medical Journal.¹

EBI-ADHD was created to satisfy the need for accessible information about a wide array of ADHD interventions, and its findings were drawn from 221 meta-analyses of randomized controlled trials that explore ADHD treatments in adults and kids, as well as from the ADHD community itself.

“The platform is made to be user-friendly, and to help people make informed choices about what they really care about,” said Samuele Cortese, M.D., Ph.D., senior author on the study, in a recent ADDitude webinar titled “Heart Health and ADHD Treatment: Implications of Stimulant Use for Adults.” “It is based on a huge analysis of the literature — we analyzed data from more than 50,000 people — but it is also based on the experience and the recommendation of people with lived experience.”

Information on the EBI-ADHD platform is extensive and can be sorted according to various filters, including the following:

• Age group
  • Preschoolers
  • Children
  • Adults
• Treatment type
  • Medication (12 types, including stimulants and non-stimulants)
  • Psychosocial (8 types)
  • Lifestyle (9 types)
  • Brain stimulation (3 types)

The platform contains data on the impact of the various treatment types on ADHD symptoms, as rated by:

• Clinicians
• Teachers
• Parents
• Patients
• A combination of the above

The database also contains information about side effects such as:

• Sleep disruption
• Appetite suppression

Also included are measures of:

• Acceptability (discontinuation for any reason)
• Tolerability (discontinuation due to side effects)

For each measurement, evidence quality (very low to high) is given.

Most Effective ADHD Medication: Findings

Most Effective ADHD Medication for Children

The researchers found moderate- to high-certainty evidence that the following medications had medium to large effect sizes for ADHD symptoms in children:

• Alpha-2 agonists
• Amphetamines
• Atomoxetine
• Methylphenidate
• Viloxazine

On average, methylphenidate was found to be the most tolerable for children (better than placebo). Amphetamine showed worse tolerability than placebo, with moderate-certainty evidence.

This finding was supported by another recent study which focused on the efficacy and mechanism of action of methylphenidate.² Participants were stimulant-naïve 8- to 12-year-old children with ADHD. They received an MRI while completing tasks that measured attentional control and impulsivity — once without medication and once after a dose of methylphenidate. The MRIs revealed that methylphenidate decreased variability and increased stability in the brain.

“We found that whole brain flexibility decreased on methylphenidate,” the study’s authors wrote. “Further, individuals with greater decreases in whole brain flexibility on methylphenidate exhibited greater improvements in task performance.”

According to the most recent ADDitude treatment survey, which recorded responses from more than 11,000 participants:

• 52% of children taking medication for ADHD use methylphenidate, and their caregivers rate it 3.09 out of 5 for efficacy
• 34% take a form of amphetamine and their caregivers rated it 3.06 out of 5

Most Effective ADHD Medication for Adults

The researchers found moderate-certainty evidence of medium effect sizes for the following ADHD treatments for adults:

• Atomoxetine
• Methylphenidate

Though other medications, including alpha 2 agonists, showed large effect sizes, the evidence was low or very low certainty.

The ADDitude treatment survey found that, among adults taking medication for ADHD symptoms:

• 30% take a form of methylphenidate, and they rate it 2.96 out of 5 for efficacy
• 62% take a form of amphetamine, and they rate it 2.96 out of 5

Most Effective Non-Medication Interventions

Only one non-medication intervention, cognitive behavioral therapy, had moderate-certainty evidence of efficacy in managing ADHD symptoms in adults, according to clinicians.

The ADDitude survey found that 46% of adults have tried cognitive behavioral therapy, and 81% of those recommend it to others.

Acupuncture, mindfulness, and physical training showed large effect sizes on both ADHD symptoms and secondary outcomes, such as academic performance and quality of life, however the evidence certainty was low or very low, because of small sample sizes, trial limitations, and lack of data on acceptability, tolerability, and side effects. Mindfulness was the only intervention to show large effects at extended follow-up; the efficacy of all other interventions was short term.

Effect of Interventions on Other Outcomes

In children and adolescents, moderate-certainty evidence found that

• Amphetamines showed medium improvements in academic performance
• Atomoxetine showed small to medium improvements on quality of life

In adults, moderate- or high-certainty evidence found that:

• Atomoxetine showed small improvements on emotional dysregulation
• Methylphenidate showed small improvements on executive functions

The international team of researchers behind EBI-ADHD hopes the free, user-friendly tool will empower patients with information about the diverse breadth of treatment options available today, so they can actively participate in shared decision making with their providers.

“Long waiting lists for mental health services are a major issue. Having incorrect information about treatments can make people’s journeys even more difficult, by wasting time and money on non-evidence-based approaches,” said Corentin Gosling, Ph.D., an associate professor at the Paris Nanterre University and first lead author of the study, in a press release. “Taking the time to review all treatment options within a shared decision-making process using the web app we developed can empower people with ADHD, leading to better treatment adherence, improved outcomes, and an overall better patient experience.”

Sources

¹Gosling C J, Garcia-Argibay M, De Prisco M, Arrondo G, Ayrolles A, Antoun S et al. Benefits and harms of ADHD interventions: umbrella review and platform for shared decision making BMJ 2025; 391 :e085875 doi:10.1136/bmj-2025-085875

²Nugiel, T., Fogleman, N.D., Lyons, M.G. et al. Methylphenidate stabilizes dynamic brain network organization during tasks probing attention and reward processing in stimulant-naïve children with ADHD. Transl Psychiatry 15, 488 (2025). https://doi.org/10.1038/s41398-025-03694-9

Onyda XR (clonidine hydrochloride) is a liquid non-stimulant ADHD medication approved for the treatment of ADHD symptoms in pediatric patients aged 6 and older. As of December 2025, it is the only liquid non-stimulant ADHD medication with nighttime dosing.

Onyda XR became available for the treatment of attention-deficit hyperactivity disorder (ADHD) in the United States on October 1, 2024.¹

The U.S. Food and Drug Administration (FDA) approved Onyda XR on May 24, 2024, as a monotherapy treatment for ADHD or as an adjunctive therapy to approved central nervous system (CNS) stimulant medications in pediatric patients 6 years of age and older. The safety and effectiveness of Onyda XR in children under 6 years of age are unknown.

What Is the Active Ingredient in Onyda XR?

Clonidine hydrochloride (HCL)

How Does Onyda XR Work?

Tris Pharma developed Onyda XR with its proprietary LiquiXR® technology, which converts immediate-release drugs into extended-release formulations for once-daily dosing.¹

LiquiXR® technology works by attaching the active ingredient in Onyda XR to ion-exchange resins, small carrier particles that temporarily “hold onto” the medicine. The extended-release particles are coated with polymer films of varying thicknesses. After Onyda XR is swallowed, naturally occurring positively charged GI exchange ions in the stomach and intestines pass through the polymer coating, releasing the medicine. The thickness of the polymer coating controls how fast the drug is released and extends its duration of action. This method allows for a single, once-daily dose of Onyda XR to be released in a gradual, continuous, and extended-release profile over 24 hours.

By taking Onyda XR at night, patients experience its main therapeutic effects the following day. Dosing at bedtime may help manage potential side effects, such as somnolence and sedation, as any initial drowsiness occurs while the patient is already asleep.

Onyda XR is considered a centrally acting alpha2-adrenergic agonist medication that belongs to the same class of drugs as alpha-2 agonists, such as guanfacine (Intuniv) and clonidine (Kapvay).

How Do You Use Onyda XR?

Onyda XR is taken by mouth once daily at bedtime, with or without food. It is supplied in 30 mL, 60 mL, or 120 mL bottles and includes one oral dosing dispenser and one press-in bottle adapter.

To use, shake the bottle gently for at least 10 seconds before each dose. Carefully measure the dose using the oral syringe that comes with the medication. Rinse the syringe with water after each use.

Do not stop taking Onyda XR without talking to your healthcare provider. If you miss a dose of Onyda XR, skip the missed dose and take the next dose at its regular scheduled time. Do not take more Onyda XR in 24 hours than your healthcare provider prescribed for your daily dose.

For the 30 mL and 60 mL bottles, throw away any unused Onyda XR remaining 30 days after first opening the bottle. For the 120 mL bottle, throw away any unused Onyda XR remaining 60 days after first opening the bottle.

What Does Onyda XR Taste Like?

Onyda XR is orange-flavored.

Who Should Take Onyda XR?

Onyda XR is an extended-release oral suspension non-stimulant option for pediatric patients 6 years and older who have difficulty swallowing pills. It is also suitable for patients with ADHD who experience adverse side effects from stimulants or who respond poorly to stimulant medications.

In addition, clinicians may prescribe Onyda XR along with a stimulant to treat ADHD symptoms in patients who require a longer-acting therapy. Combination therapy is an option for patients who need longer durations of drug coverage than a stimulant dose can provide on its own.

What Is the Typical Dosage for Onyda XR?

The recommended starting dose for Onyda XR is 0.1 mg daily at bedtime. Clinicians may titrate the dose of Onyda XR in increments of 0.1 mg per day at weekly intervals, up to the maximum recommended dosage of 0.4 mg once daily at bedtime.

*For updated information about dosages, interactions, and precautions, see the Onyda XR drug monograph on WebMD.

What Side Effects Are Associated with Onyda XR?

According to Onyda XR prescribing information,² the most common adverse reactions associated with the medication’s use as monotherapy include:

• somnolence
• fatigue
• irritability
• nightmares
•  insomnia
• constipation
• dry mouth

The most common adverse reactions with its use as an adjunct therapy include:²

• somnolence
• fatigue
• decreased appetite
• dizziness

These are not all the possible side effects of Onyda XR. For a complete list of potential side effects, refer to the Safety & Side of Effects of Onyda XR.

What Precautions Are Associated with Onyda XR?

Before taking Onyda XR, tell your healthcare provider about any medical conditions, including kidney problems, low or high blood pressure, heart problems, including slow heart rate or other heart rhythm problems, or if you have ever had a stroke or stroke symptoms.

Treatment with Onyda XR can cause dose-related decreases in blood pressure and heart rate, which can increase your risk of fainting. If you have a history of passing out or have other medical problems, your risk is higher. Your healthcare provider should check your heart rate and blood pressure before starting treatment and regularly during treatment with Onyda XR. Do not become dehydrated or too hot (overheated) to decrease your chance of passing out during treatment with Onyda XR.

Taking Onyda XR with alcohol or medicines may cause or worsen sleepiness or dizziness, which could cause slow reaction times (sedation and somnolence). Do not drive, operate heavy machinery, or do other dangerous activities until you know how Onyda XR affects you. Do not drink alcohol or take other medicines that make you sleepy or dizzy during treatment with Onyda XR until you talk with your healthcare provider.

Suddenly stopping Onyda XR can cause high blood pressure to return if you have a history of high blood pressure. Suddenly stopping Onyda XR may also cause withdrawal symptoms, including headache, increased heart rate, nausea, flushing or warm feeling, lightheadedness, chest tightness, and nervousness or anxiety. Tell your healthcare provider if you have been vomiting and cannot take Onyda XR, as you may be at risk for rebound hypertension.

What Drug Interactions Are Associated with Onyda XR?

You should not take Onyda XR if you are allergic to clonidine.

Avoid concomitant use of CNS depressants with Onyda XR. Clonidine may potentiate the CNS-depressive effects of alcohol, barbiturates, or other sedating drugs.

Avoid concomitant use of antihypertensive drugs, as clonidine potentiates the hypotensive effects of clonidine.

Concomitant use of tricyclic antidepressants with clonidine can increase blood pressure and may counteract the hypotensive effects of clonidine.

Avoid use of Onyda XR with agents known to affect sinus node function or AV nodal conduction (e.g., digitalis, calcium channel blockers, and beta-blockers) due to a potential for additive effects such as bradycardia and AV block.

According to Onyda XR prescribing information, prolonged experience with clonidine in women over several decades, based on published literature — including controlled trials, a retrospective cohort study, and case reports — has not identified a drug-associated risk of major congenital disabilities, miscarriage, and adverse maternal or fetal outcomes.

Patients should consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for Onyda XR and any potential adverse effects on the breastfed child from Onyda XR or from the underlying maternal condition.

Share a list of all vitamins or herbal supplements and prescription and non-prescription medications you take with the pharmacist when you fill your prescription. Inform all doctors and physicians that you are taking Onyda XR before surgery or laboratory tests.

For a complete list of all possible drug interactions, side effects, and precautions, refer to Onyda’s drug label information for consumers and healthcare professionals.

What Studies Are Associated with Onyda XR?

The FDA based its approval of Onyda XR on two 8-week studies of clonidine hydrochloride extended-release tablets in pediatric patients aged 6 to 17 years who met DSM-IV criteria for ADHD.^{3, 4}

Monotherapy Study:
In the first placebo-controlled monotherapy trial, 256 pediatric patients were assigned to either a group where they were given .02 mg of clonidine XR daily, .o4 mg of clonidine XR daily, or a placebo.³ By week 5, patients receiving clonidine XR showed significantly greater improvements in ADHD symptoms from baseline compared with the placebo group (as measured by the ADHD-RS-IV total score). The most common adverse reactions included somnolence, fatigue, irritability, insomnia, nightmares, constipation, and dry mouth.

Adjunctive Therapy Study:
A second 8-week study evaluated clonidine XR as an adjunctive therapy in 198 children who had an inadequate response to prior stimulant treatment (methylphenidate or amphetamine).⁴ In this randomized, double-blind, placebo-controlled trial, patients received either clonidine XR plus a stimulant or a stimulant plus a placebo. By week 5, those treated with clonidine XR in combination with a stimulant showed statistically significant improvements in ADHD symptoms (measured by the ADHD-RS-IV total score) compared with the stimulant-only group. The most common adverse reactions included somnolence, fatigue, decreased appetite, and dizziness.

Refer to Onyda XR’s study results for more information.

Sources

¹Tris Pharma’s Once-Daily ADHD Medication, ONYDA XR (clonidine hydrochloride) Extended-Release Oral Suspension, Now Available in the United States. News Release. Tris Pharma. October 1, 2024. Accessed October 2, 2024. https://www.businesswire.com/news/home/20241001522635/en/Tris-Pharma–Once-Daily-ADHD-Medication-ONYDA-XR-clonidine-hydrochloride-Extended-Release-Oral-Suspension-Now-Available-in-the-United-States

²Highlights of Prescribing Information. Onyda XR. FDA. Accessed May 29, 2024. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/217645s000lbl.pdf

³Jain, R., Segal, S., Kollins, S.H., Khayrallah, M. (2011). Clonidine extended-release tablets for pediatric patients with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. https://doi.org/10.1016/j.jaac.2010.11.005

⁴Kollins, S.H., Jain, R., Brams, M., Segal, S., Findling, R.L., Wigal, S.B., Khayrallah, M. (2011). Clonidine extended-release tablets as add-on therapy to psychostimulants in children and adolescents with ADHD. Pediatrics. https://doi.org/10.1542/peds.2010-1260

Music strikes a powerful chord with ADHD brains, which light up like a stadium full of Zippos when following a melody, processing lyrics, noodling on an instrument, or linking songs to distant memories. In short, songs make our brains sing.

Music Sparks Joy

The positive effects of music have real neurochemical underpinnings. Research shows that playing or listening to music lowers cortisol, which decreases stress and anxiety levels and turns up dopamine release. Active participation in group singing, dancing, or instrument playing sparks a release of oxytocin and endorphins, the feel-good chemicals linked to bonding, community, and connection.¹

The effects of music can be measured in blood samples. In one study, youth taking medication for ADHD and depression were guided to freely play rhythmic instruments (no skill required) and visualize positive images and words while listening to music. Compared to children in the control group, who were only given medication, those in the music therapy group showed much higher serotonin levels and significantly lower cortisol levels after treatment.²

Music Is Grounding

Music helps fine-tune our emotional responses. Teens with ADHD who listened to songs as part of a combined cognitive behavioral therapy and music-based intervention saw better symptom control and better cognitive reappraisal — the critical ability to evaluate a situation from a different perspective — after treatment.³

[Get This Free Guide: Music for Healthy ADHD Brains]

Musicians with ADHD may benefit the most. Research shows that experienced guitar or piano players with ADHD score better on measures of sustained and selective attention, working memory, impulse control, and other cognitive domains compared to non-musicians with ADHD.⁴

Music Promotes Focus

If you use background music to get stuff done, know that your behavior is backed by science. In one study, preteens with and without ADHD completed reading tasks with and without background music. ⁵ Regardless of whether it was calm or energetic, background music boosted reading comprehension scores significantly for the ADHD group and, interestingly, worsened them for the non-ADHD group.

What type of music works best? That’s highly individual. But research suggests some musical elements may resonate more in ADHD brains. Music with fast, pulsing beats improves sustained attention in adults with ADHD symptoms, according to one study. As one of the researchers said, “The ADHD brain needs strong stimulation to really kick it into gear.”⁶

Music Creates Structure

Music training improves executive functioning overall, with notable effects on inhibitory control—important for those who struggle with impulsivity. Dancing, clapping to a rhythm, or learning to play an instrument all engage and strengthen parts of the brain responsible for motor coordination and timing.

[Free Webinar Replay: “Some Kind of Wonderful: How Music Affects the ADHD Brain”]

But music goes deeper, orchestrating changes in breathing patterns, heart rate, and the sympathetic nervous system. (Ever felt goosebumps during a powerful chorus?) Its effect on the body makes it a useful tool for emotional regulation. In fact, music’s ability to lower stress makes it a powerful pain reliever that can also boost immunity.

How to Harness Good Vibrations

Try these ideas for infusing your life with music to ground you, get in the zone, sleep, stay on track, and work through ADHD-related challenges.

• Tune in, turn on. Experiment with genres. Do you focus better with classical music? What about EDM? What if the lyrics are in a foreign language? Does pop music motivate you to wash the dishes but not to study?
• Create playlists. Do you lose track of time in the shower? Create a bathroom playlist where each song cues you to the next task. Does your child struggle with transitions? An activity playlist can help them track the passage of time in a novel way. Hate chores? Only clean until your “Mops ‘n’ Hoses” playlist ends.
• Can’t sleep? Lullabies aren’t just for children! Play a song on repeat at a low volume to encourage slumber.
• Mindful minutes. For a different type of mindful meditation, play a favorite song and focus on a single aspect of the composition, like the backing vocals, drum beat, or baseline. Tune in to how you feel, physically and emotionally, when you listen to music.
• Does that ring a bell? Set important information to jingles for easier recall.
• Songwriting can provide an outlet for intense emotions when talking feels like “too much.”
• A personal anthem. Nervous about an upcoming social gathering? Beating yourself up over a recent slip-up? Identify go-to songs that speak to the positive mindset you want to channel.
• Just dance. Like music, movement and exercise offer tremendous benefits for ADHD brains. Dancing is a physical release, and it delivers an assertive signal: “Here I am!”
• Talk tracks. Form stronger bonds by asking new acquaintances or old friends about their top songs or albums. Parents: Be curious about the music your child likes and never disparage a teen’s favorite artists or tracks.

ADDitude’s Desert Island Playlist

If you were stranded on a desert island with just one album (and a record player, of course), which one would you choose and why? Read the ADDitude team’s responses below.

“Vs. by Pearl Jam is one of the truly great rock albums of my lifetime and a time machine that transports me back to the delirious, live-out-loud days of being 17 and driving a hot Mustang with the windows down.” — Anni Layne Rodgers, General Manager

“Exile in Guyville by Liz Phair was so gutsy and empowering. It captured the essence of how I felt being a young woman in my early 20s in a way that is still relevant. Depending on your mood, it can be cool and playful or thought-provoking and somber.” — Melanie Wolkoff Wachsman, Senior Consumer Health Editor

“Dónde Están los Ladrones? by Shakira is fun blend of sounds, from heartfelt ballads to rock with Middle Eastern influences, that’s been with me since childhood! — Nathaly Pesantez, Senior Editor

“I started listening to music in earnest in middle school, and Nirvana was the defining band of that era for me. Decades later, blasting Nirvana’s album, Nevermind, and other favorites from that period makes driving around to run errands just a little more fun.” — Eve Gilman, Managing Editor

“I was a kid when I stumbled upon Carole King’s Tapestry in my dad’s vinyl collection. I put on the record because the picture on the cover seemed warm and inviting; her bare feet in the window seat, the cat looking at the camera. What hooked me back then, and now, is the raw realness of King’s voice — not glossy, not perfect, not even always pretty but always honest.” — Nicole Cavacco Kear, Consumer Health Editor

“I like Melophobia by Cage the Elephant because it illustrates how heart-wrenching relationships can be, especially when communication just isn’t working to bring people closer together. The song ‘Come a Lil Closer’ is about poverty and inequality that no one wants to see. The lyrics and music just really resonated with me.” — Carole Fleck, Editor in Chief, ADDitude Magazine

“Starting my professional music career in high school, tracks from Stevie Wonder’s Songs in the Key of Life, were among the first songs I learned thoroughly, and they shaped my harmonic and melodic development.” — Ted Cruz, Editorial Specialist, Webinars

“My fave albums would be Heard It in a Past Life by Maggie Rogers or After It All by Delta Rae. I was introduced to these musicians during the pandemic, and they helped get me through that dark time.” — Hope Goodrich, Web & Social Media Assistant

Listen to ADDitude’s Desert Island Playlist on the ADDitude Spotify channel http://additu.de/desert-island.

ADHD Music Playlist: Next Steps

• Download: Focus Your ADHD Brain With 5 Helpful Hacks
• Read: “The Minor Falls, the Major Lifts:” Why Music Matters to ADHD Brains
• Read: “How Hardcore Feminist Punk Rock Unlocked My AuDHD Brain”

Roberto Olivardia, Ph.D., is a clinical instructor of psychology at Harvard Medical School. He maintains a private psychotherapy practice in Lexington, Massachusetts.

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Sources

¹Chanda, M.L., Levitin, D.J. (2013). The neurochemistry of music. Trends Cogn Sci. https://doi.org/10.1016/j.tics.2013.02.007

²Park, J.I., Lee, I.H., Lee, S.J. et al. (2023). Effects of music therapy as an alternative treatment on depression in children and adolescents with ADHD by activating serotonin and improving stress coping ability. BMC Complement Med Ther. https://doi.org/10.1186/s12906-022-03832-6

³Madjar, N., Gazoli, R., Manor, I., Shoval, G. (2020). Contrasting effects of music on reading comprehension in preadolescents with and without ADHD. Psychiatry Res. https://doi.org/10.1016/j.psychres.2020.113207

⁴Rodrigues, A.C., Loureiro, M.A., Caramelli, P. (2013). Long-term musical training may improve different forms of visual attention ability. Brain Cogn. https://doi.org/10.1016/j.bandc.2013.04.009

⁵Lachance, K., & Gosselin, N. (2025). Listening habits and subjective effects of background music in young adults with and without ADHD. Frontiers in Psychology. https://doi.org/10.1016/j.tics.2013.02.007

⁶Woods, K.J.P., Sampaio, G., James, T. et al. (2024). Rapid modulation in music supports attention in listeners with attentional difficulties. Commun Biol. https://doi.org/10.1016/j.tics.2013.02.007

Mind–body practices like dance, yoga, exercise, and music actually change the brain and provide powerful benefits for neurodivergent people. Research shows that a body in motion engages a diverse network of brain regions, and the results are undeniable: Movement, and dance in particular, improves mood, focus, emotional regulation, social connections, and decreases social anxiety and depression.

Neuroscientist Julia C. Basso, who heads up the Embodied Brain Laboratory at Virginia Tech, will discuss the research findings in her lab that underscore how meditation practices, along with physical movement, uniquely affect health and wellness in people with ADHD and autism — and may even create a flexible nervous system that helps people to respond more calmly to difficult situations.

In this webinar, you will learn:

• About the latest research on how movement benefits neurodivergent individuals and why movement is uniquely effective.
• How movement interventions can strengthen attention, emotional regulation, and social functioning
• About real-world examples of how dance and group practices foster lasting social connection.
• About simple routines you can do at home to boost focus, mood, and social skills at for both children and adults.

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Spotify; Amazon Music; iHeartRADIO

Movement and the Neurodivergent Brain: Resources

• • • Free Download: Your Free Guide to Music for Focus
    • Read: The Activities That Activate Neurodivergent Brains
    • Read: Somatic Therapy: Understanding the ADHD Brain, Body, & Trauma
    • Read: Say Yes to Yoga for Kids with ADHD
      
      

Obtain a Certificate of Attendance

If you attended the live webinar on November 12, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Julia C. Basso, Ph.D., is an Assistant Professor in the Department of Human Nutrition, Foods, and Exercise at Virginia Tech, a Scientific Wellness Consultant, and Director of The Embodied Brain Laboratory. She also holds affiliate faculty positions in the Virginia Tech School of Neuroscience and is a Fellow at both the Institute for Creativity, Arts, and Technology and the Center for Health Behaviors Research at the Fralin Biomedical Research Institute at Virginia Tech Carilion.

With a Ph.D. in Behavioral and Neural Science, a B.A. in Dance, and certification as a yoga teacher, Dr. Basso’s work bridges the fields of art and science, focusing on the body–brain connection and the use of movement to enhance brain function and physiology. Her research includes pioneering studies on neurodivergent populations, exploring how dance and other movement-based practices can improve attention, emotion regulation, social connection, and overall well-being in individuals with ADHD and autism.

A Renée Fleming Neuroarts Investigator, Dr. Basso’s research has been featured in prominent outlets such as The New York Times, Dance Magazine, Psychology Today, Virginia Living, and National Public Radio. In addition to her scientific work, she creates dance performances and artistic installations that visualize and sonify brain activity, extending her commitment to understanding and sharing the embodied mind through both research and art.

Learn more at www.embodiedbrainlab.com.

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
Apple Podcasts | Spotify | Google Play | Amazon Music | RadioPublic | Pocket Casts | iHeartRADIO | Audacy

Do current cognitive behavioral therapy (CBT) approaches inadvertently promote masking and conformity for individuals with ADHD? Or do evidence-based CBT strategies support real-world functioning, self-efficacy, and quality of life for neurodivergent clients? Does CBT encourage denial of identity? Or does it promote authenticity? In this webinar, two leading psychotherapists will discuss the efficacy of CBT for ADHD and how modern approaches should move from treating ADHD behaviors and impairments to empowering individuals. Michael Meinzer, Ph.D., and Saskia Van der Oord, Ph.D., will discuss and underscore the need for evidence-based strategies that support functioning and respect neurodivergent identities without pathologizing their differences.

In this webinar, you will learn:

•  How CBT is evolving, and what challenges it can effectively address for people with ADHD and where it might miss the mark
• How traditional (non-adapted) CBT approaches may inadvertently encourage masking and conformity to neurotypical norms
• How CBT for ADHD can help you adapt your lifestyle to your environment and improve situations involving your job, relationships, and more
• How to assess whether CBT is working for you
• What people should know in choosing and working with a therapist

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Audacy; Spotify; Amazon Music; iHeartRADIO

Webinar Sponsor

Play Attention: Research conducted at Tufts University School of Medicine demonstrates that Play Attention improves attention, behavior, executive function, and overall performance. Harnessing cutting-edge NASA-inspired technology, Play Attention offers a customized program for both children and adults. Your dedicated Focus Coach will tailor a plan for each family member to improve executive function and self-regulation. Home and professional programs are available. Visit our calendar to schedule a consultation or learn more at www.playattention.com.

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

Behavioral Therapy for ADHD: Resources

• • • Free Download: Everything You Need to Know About CBT
    • Read: ADHD Therapy Comparison: CBT vs. ADHD Coaching
    • Read: Why the ADHD Brain Chooses the Less Important Task — and How CBT Improves Prioritization Skills
    • Read: Adult ADHD Treatment Options — An Overview

Obtain a Certificate of Attendance

If you attended the live webinar on October 16, 2025, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speakers

Michael Meinzer, Ph.D., is an Associate Professor of Psychology at the University of Illinois, Chicago (UIC). He directs UIC’s Young Adult & Adolescent ADHD Services research lab and the SUCCEEDS College ADHD Clinic. He recently published Mastering the Transition to College: The Ultimate Guidebook for Parents of Teens with ADHD (#CommissionsEarned)  based on his research and clinical experience.

Saskia Van der Oord, Ph.D., is a professor of clinical psychology at the Faculty of Psychology and Educational Sciences at KU Leuven (Belgium). She is a clinical psychologist and behavior therapist, co-director of the faculty’s ADHD clinic, and head of the postgraduate training program in cognitive behavior therapy for children and adolescents. Her research work is focused on the development, evaluation and adaptation of non-pharmacological interventions for ADHD. Her research work is fueled by the perspectives of people with lived experience.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

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FREE WEBINAR ON AUGUST 13
Click here to register for “Combined Treatment Options for Pediatric ADHD: Sequencing Your Child’s Care” with Mark A. Stein, Ph.D., ABPP, on August 13 at 1 pm ET.

Chronic pain is more common in autistic children and teens with and without ADHD than it is in neurotypical youth. Conditions such as migraines, gastrointestinal pain, and musculoskeletal pain occur at significantly higher rates in neurodivergent populations, yet these symptoms are often overlooked or misunderstood by medical professionals and caregivers.

Emerging research suggests that autistic children and teens with and without ADHD may be more susceptible to developing chronic pain, perhaps because differences in sensory processing, emotional regulation, and communication shape how they experience and express pain. These unique factors can make it challenging for caregivers and health care professionals to recognize and address chronic pain in neurodivergent individuals.

If left unaddressed, chronic pain can profoundly impact a child’s daily life — affecting academic performance, physical function, social relationships, and emotional well-being.

In this webinar, experts in autism, ADHD, and chronic pain will provide insights into the science and lived experiences of children navigating these overlapping challenges. In this webinar, caregivers and professionals will learn:

• Why chronic pain is more common in autistic children with and without ADHD: How sensory differences, stress, and co-occurring conditions like anxiety may contribute to pain.
• How pain presents in unique ways: Why autistic children with and without ADHD may express or experience pain differently — and how this can make it harder to recognize.
• The impact on daily life: How chronic pain affects school, social interactions, and emotional health, and how pain-related distress may show up as irritability, withdrawal, or other behaviors.
• Strategies to reduce pain’s impact: Evidence-based approaches for caregivers, including medical interventions, coping tools, sensory supports, and environmental adjustments.
• How to communicate with doctors and teachers: Tips for navigating the healthcare and school systems and advocating for appropriate supports.

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 Chronic Pain, Autism, and ADHD: Resources

• Free Download: The ADHD-Autism Link in Children
• Read: Autism in Girls: Why Signs of Neurodivergence are Overlooked
• Read: How ADHD Can Intensify Physical Health Conditions
• Read: Comorbid ADHD Complicates Most Diagnoses and Treatment Plans
  

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Meet the Expert Speakers

Gloria T. Han, Ph.D., is an Assistant Professor in the Department of Anesthesiology, Division of Pain Medicine, at Vanderbilt University Medical Center. She also serves as a pediatric pain psychologist in the pediatric pain clinic at Monroe Carell Jr. Children’s Hospital at Vanderbilt, where she collaborates with physicians, physical therapists, and occupational therapists to support a high proportion of children and teens navigating autism, ADHD, and pain-related challenges. Dr. Han’s clinical and research efforts focus on the intersection of autism and chronic pain, particularly how features of autism — such as differences in sensory, emotional, and social information processing — may contribute to an increased vulnerability for chronic pain. By identifying these developmental pathways, she hopes to expand upon current evidence-based strategies for managing chronic pain and develop effective interventions tailored to the specific needs of neurodivergent youth facing these overlapping challenges.

Anna C. Wilson, Ph.D., is a Professor of Pediatrics at Oregon Health & Science University (OHSU). She is also a pediatric psychologist at the Pediatric Pain Management Clinic at OHSU/Doernbecher Children’s Hospital, which provides multidisciplinary care for children and teens with a variety of chronic pain conditions. Dr. Wilson’s research has focused on the prevention of chronic pain in children and adolescents, with a focus on studying how parents and parenting influence children’s pain experiences. She has also recently conducted work on how pain experiences in young people relate to ADHD symptoms. Her work has been supported by the National Institutes of Health, the Medical Research Foundation of Oregon, and the Friends of Doernbecher Children’s Hospital. Together with health journalist Rachel Rabkin Peachman, Dr. Wilson authored When Children Feel Pain: From Everyday Aches to Chronic Conditions (Harvard University Press, 2022). (#CommissionsEarned) This book tells the story of pain in childhood, why it has been poorly understood even by doctors and nurses, and how we can better support all children and reduce the negative impact of chronic pain.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

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Cognitive-aerobic exercise improves working memory more than aerobic exercise alone in children and adolescents with ADHD, according to a new study¹ published in Frontiers in Psychology. 

Previous research has shown that exercise relieves ADHD symptoms by increasing endorphins and neurotransmitters in the brain. This new study is the first network meta-analysis to evaluate the efficacy of various exercise interventions on working memory in children with ADHD.

The study’s results indicate the following impacts of various types of exercise on children with ADHD:

• Cognitive-aerobic exercise demonstrates the most significant effect on working memory, or the capacity for holding and using information over a short period of time.
• Ball sports follow closely behind with a moderate to high improvement effect.
• Mindy-body exercises and interactive games display a moderate improvement in working memory.
• Simple aerobic exercise and interactive games exhibit the smallest improvement effect on children with ADHD.

“For developing children, aerobic exercise expands the growth of brain connections, the frontal cortex, and the brain chemicals (such as serotonin and dopamine) that support self-regulation and executive functioning,” said Joel Nigg, Ph.D., a clinical psychologist and a professor in the departments of psychiatry and behavioral sciences at Oregon Health & Science University. “These surprisingly specific findings in typically developing children have led to excitement about the possibility that the right kind of exercise can help ADHD.”²

Further analysis suggests that the effectiveness of cognitive-aerobic exercise in improving working memory in children with ADHD may depend on higher intervention frequency and longer cumulative intervention duration.

Cognitive-Aerobic Exercise for Working Memory

“Cognitive-aerobic exercise,” as defined by the researchers, combines physical activity with mentally stimulating tasks like decision-making and problem-solving, e.g., dual-task exercises, strategy-based games, and exergaming. It may involve activities with rules and objectives that increase the load on the prefrontal cortex, which is closely associated with working memory.

The researchers propose that cognitive-aerobic exercise is particularly powerful because it requires quick decision-making, memory retrieval, and cognitive switching in addition to physical activity, thus “working out” the working memory.

Ball Sports for Working Memory

Ball sports exert a positive impact on working memory, perhaps due to their reliance on strategy and social skills.  “Sports such as soccer or basketball typically require children to remain highly focused while also remembering and analyzing the actions of teammates and opponents, which places a high demand on task memory,” the researchers wrote. “In ball sports, children not only need to plan and execute movements but also continuously adjust strategies and predict the opponent’s actions. These multitasking and real-time adjustment characteristics directly exercise their working memory load, information storage, and response speed.”

This seems consistent with one ADDitude reader’s experience with her son, who has ADHD and plays sports like football and lacrosse.

“The strategizing required when playing these sports is helpful,” said Deborah from New York. “He is receiving many different stimuli at one time, helping him to decipher information and build his executive function skills.”

Mind-Body Exercise for Working Memory

Mind-body exercises (e.g., yoga, Tai Chi) only moderately affect working memory and “may be more significant in improving attention and emotional regulation but… may lack the high cognitive load stimulation required for direct improvements” in working memory, the researchers said.

Interactive Games for Working Memory

Sports-based interactive games primarily enhance social and cooperative skills by motivating children to engage in collaborative tasks or fun competitions in virtual environments. “Although these games have a positive impact on the social behavior and emotional regulation of children with ADHD, the cognitive challenges in these games are limited and generally do not involve high-intensity memory tasks or complex decision-making, making their direct impact on working memory relatively modest,” the researchers wrote.

Traditional Aerobic Exercise

Traditional aerobic exercise involves “repetitive and rhythmic movements, such as swimming or cycling, aimed solely at improving physical endurance and fitness.”

Due to its more straightforward physical activity format, traditional aerobic exercise had the smallest impact on working memory, the researchers proposed.

“Activities like running and skipping, while improving overall physical fitness and stimulating dopamine secretion, can help children with ADHD maintain attention in the short term,” the researchers wrote. “However, since they lack demands for memory and multitasking, they are often insufficient to activate the prefrontal cortex’s executive function areas. As a result, their direct impact on working memory is relatively small.”

The study’s overall findings suggest that “when designing exercise interventions for children with ADHD, priority should be given to exercise types with higher cognitive load,” the researchers wrote.

The meta-analysis analyzed data from 17 studies, which collectively had 419 participants with ADHD, ages 3 to 18. Studies included structured aerobic exercise (e.g., running, swimming), strength training (e.g., resistance training), cognitive exercise, and balance or coordination exercises. The intervention periods ranged from one to 13 weeks, with exercise frequency ranging from one to five times per week and lasting 10 to 90 minutes.

According to researchers, the study had several limitations, including a disproportionately small percentage of female participants. Further research is needed to explore how different kinds of exercise may impact people of various genders and why these types of exercise have different efficacy levels.

The researchers caution that their findings do not mean that children should treat their ADHD exclusively with exercise. According to the American Academy Of Pediatrics (APA), the most effective treatment for ADHD is parental behavior therapy paired with ADHD medication for children over age 6.

Sources

¹ Song, X., Hou, Y., Shi, W., Wang, Y., Fan, F., & Hong, L. (2025). Exploring the impact of different types of exercise on working memory in children with ADHD: a network meta-analysis. Frontiers in Psychology, 16. https://doi.org/10.3389/fpsyg.2025.1522944

² Best, J.R. (2010). Effects of Physical Activity on Children’s Executive Function: Contributions of Experimental Research on Aerobic Exercise. Dev Rev; (4):331-551. https://doi.org/10.1016/j.dr.2010.08.001

Spravato (generic name: esketamine) is the first and only FDA-approved nasal spray used for adults with treatment-resistant depression. Depression is considered “treatment-resistant” when individuals have tried at least two different oral anti-depressant medications and symptoms persist. An estimated 30% of people with major depressive disorder have treatment-resistant depression¹.

In 2019, the U.S. Food & Drug Administration approved Spravato for use alongside an oral antidepressant; in early 2025, the spray was authorized as a standalone treatment. A recent Phase 4 clinical trial¹ found that, four weeks after starting Spravato, 22.5% of participants with major depressive disorder who took the nasal spray alongside an oral antidepressant achieved remission from depression symptoms, compared to 7.6% of participants achieving relief on an oral antidepressant and placebo spray.

It is not known whether SPRAVATO® is safe and effective in children.

How Does Spravato Work?

Spravato works by blocking a receptor in the brain activated by glutamate, a chemical messenger. This mechanism is similar to that found in other antidepressants, which target receptors for chemical messengers like seratonin and dopamine.

What Ingredients Are in Spravato?

The main active ingredient in Spravato is esketamine, which is conventionally used as an anesthetic similar to its parent compound, ketamine. Esketamine is more concentrated than ketamine, requiring a lower dose for efficacy.

Inactive ingredients include citric acid monohydrate, edetate disodium, sodium hydroxide, and water.

How Do You Use Spravato?

The medication is an intranasal spray that is self-administered under the supervision of a healthcare provider at a certified SPRAVATO® treatment center. Patients are required to remain for at least two hours after administration, so healthcare providers can monitor any side effects.

To prevent nausea, it is recommended that patients do not eat at least two hours before receiving the drug and not drink at least 30 minutes before.

What Is the Dosage for Spravato?

The optimal dosage of Spravato varies by patient. The typical dose is 28 mg (two sprays), administered biweekly.

For updated information about dosages, interactions, and precautions, see the Spravato (Esketamine) drug monograph on WebMD.

What Side Effects Are Associated with Spravato?

The most common side effects include:

• Disassociation (feeling disconnected from yourself, thoughts, feelings, and surroundings)
• Dizziness/spinning sensation
• Nausea/vomiting
• Sedation, sleepiness, lack of energy
• Decreased feeling of sensitivity
• Anxiousness
• Increased blood pressure
• Feeling intoxicated
• Headache
• Feeling very excited or happy

Side effects will typically occur 40 minutes after taking the drug and tend to go away within two hours.

Spravato also may have serious side effects, including:

• Allergic reactions: breathing problems, racing heart, fever, stomach cramps
• Memory or thinking problems: unusual changes in judgment/decision-making, trouble concentrating or paying attention, and remembering things
• Bladder problems
• Breathing problems: slow or shallow breathing
• May increase the risk of suicidal thoughts or actions

Consult your healthcare provider about these possible side effects before beginning Spravato.

Visit the Spravato website to see the full list of side effects.

What Precautions Are Associated with Spravato?

You should not take Spravato if you have a history of blood vessel disease or brain bleeding, an abnormal connection between your veins and arteries, or are allergic to esketamine, ketamine, or any other ingredients in Spravato.

Taking Spravato can lead to physical and psychological dependence. If you have a history of drug or alcohol abuse, make sure to discuss it with your doctor before taking Spravato.

This spray has not yet been proven safe and effective for children or for reducing and preventing suicidal thoughts.

Does Spravato Interact with ADHD Stimulants?

Spravato may increase blood pressure and heart rate, a side effect also common with stimulant medications used to treat ADHD, like Adderall and Ritalin. Thus, taking both medications may increase risk of high blood pressure. This is one reason healthcare providers monitor patients’ heart rate and blood pressure in the two hours after medication is administered.

Can You Take Spravato with Another Antidepressant?

According to the label, SPRAVATO® can be used:

• “with or without an antidepressant taken by mouth, to treat adults with treatment-resistant depression”
• “with an antidepressant taken by mouth, to treat depressive symptoms in adults with major depressive disorder (MDD) with suicidal thoughts or actions.”

What Else Does Spravato Interact With?

When taken with central nervous system depressants, like opioids and benzodiazepines, patients may experience excessive drowsiness and dizziness. The risk of experiencing dizziness and sleepiness may increase with alcohol consumption while taking Spravato.

There are no known interactions between Spravato and foods, herbs, and vitamins. Cannabis use may increase risk of side effects. Patients should discuss these and any other interactions with their healthcare providers.

Limitations of Use

SPRAVATO® is not for use as a medicine to prevent or relieve pain (anesthetic). It is not known if SPRAVATO® is safe or effective as an anesthetic medicine or if it is safe and effective for use in preventing suicide or in reducing suicidal thoughts or actions.

Spravato Nasal Spray and Other Depression Medications: Next Steps

• Read: Treatments for Depression and ADHD: New and Forthcoming Approaches
• Read: What to Expect When You Start Depression Medication
• Self-Test: Depression in Adults
• Free Download: Understanding Depression in Teens
• Read: How to Treat Depression

Sources

¹ Mayes, S.D., Becker, S.P. & Johnson & Johnson pivotal study of seltorexant shows statistically significant and clinically meaningful improvement in depressive symptoms and sleep disturbance outcomes. (2024, May 29). JNJ.com. https://www.jnj.com/media-center/press-releases/johnson-johnson-pivotal-study-of-seltorexant-shows-statistically-significant-and-clinically-meaningful-improvement-in-depressive-symptoms-and-sleep-disturbance-outcomes

Onyda XR (clonidine hydrochloride), the first and only liquid non-stimulant ADHD medication approved in the U.S., and the only such medication with nighttime dosing, became available nationwide for the treatment of attention deficit hyperactivity disorder (ADHD) on October 1. ¹

The U.S. Food and Drug Administration (FDA) approved Onyda XR on May 24 as a monotherapy ADHD treatment or as an adjunctive therapy to approved central nervous system (CNS) stimulant medications in pediatric patients six years and older.

Tris Pharma developed Onyda XR with its proprietary LiquiXR® technology, which converts immediate-release drugs into extended-release formulations for once-daily dosing. Onyda XR is considered a centrally acting alpha2-adrenergic agonist medication that belongs to the same class of drugs as Guanfacine (Intuniv) and clonidine (Kapvay).

Patients with ADHD who experience adverse side effects from stimulants or who respond poorly to stimulant medications may find symptom relief in a non-stimulant medication. A systematic review and meta-analysis published in May by Neuroscience & Biobehavioral Reviews reported that non-stimulant medication is nearly as effective as stimulant medication at improving executive function in children, adolescents, and adults with ADHD. ²

Combination Therapy for ADHD

In addition, clinicians may prescribe Onyda XR along with a stimulant to treat ADHD symptoms. Combination therapy is becoming an increasingly popular option for patients who need longer durations of drug coverage than a stimulant dose can provide on its own or who hope to avoid common stimulant side effects.

“Most of the medicines we use for ADHD are safe in combination with other medications,” said Timothy E. Wilens, M.D., chief of child and adolescent psychiatry and co-director of the Center for Addiction Medicine at Massachusetts General Hospital, during the ADDitude webinar “Combination Therapy: Medication Strategies for Hard-to-Treat Complex ADHD.” “Certain combinations, such as stimulants plus clonidine or guanfacine, are FDA approved, and they wouldn’t be unless they were deemed effective and safe.”

Guanfacine ER (Intuniv) and clonidine ER (Kapvay), received FDA approval for the treatment of ADHD in patients 6 to 17 years old as monotherapy and as adjunctive therapy to stimulant medications in 2009 and 2010, respectively.

If a stimulant does not address symptoms at standard dosages, “it usually makes more sense to treat remaining symptoms with a second medication,” said Oren Mason, M.D., a physician at Attention MD in Grand Rapids, Michigan.

“Most adult patients in my practice who take extended-release stimulants need average to high dosages to achieve optimal symptom reduction,” Mason said. “They typically report 8 to 10 hours of medication benefit, and most require short-acting supplements to treat their evening symptoms. In contrast, most patients on combination therapy take low- to moderate stimulant dosages and report a duration of benefits of more than 12 hours.”

Mason said he finds that many adult patients using combination therapy decrease their stimulant dosages and experience fewer side effects than do patients taking only stimulants. “Waking up was less torturous, and getting ready for school was smoother,” he said. “Family life was better, without the meltdowns that many families accept as ‘normal’ as stimulants wear off.”

Anthony Rostain, M.D., M.A., professor of psychiatry and pediatrics at the Perelman School of Medicine at the University of Pennsylvania, recommends that clinicians consider several factors before prescribing combination therapy.

“The important thing to keep in mind if you’re combining agents,” he said, “is to be sure that the patient understands how to use each one and how to dose each one. They need to understand the inherent challenges they’re going to face, and make sure you’re paying attention to the side effects that might emerge from the combination of stimulant and non-stimulant.”

The FDA based its approval for Onyda XR on studies of clonidine hydrochloride extended-release tablets, including two 8-week, placebo-controlled trials evaluating 256 patients, as well as a 40-week, placebo-controlled, randomized-withdrawal study evaluating the drug in 135 pediatric patients aged 6 to 17 years. ³, ⁴

According to Onyda XR prescribing information, the most common adverse reactions with the medication’s use as monotherapy include somnolence, fatigue, irritability, nightmares, insomnia, constipation, and dry mouth. The most common adverse reactions with its use as an adjunct therapy include somnolence, fatigue, decreased appetite, and dizziness. ⁵

Sources

¹Tris Pharma’s Once-Daily ADHD Medication, ONYDA XR (clonidine hydrochloride) Extended-Release Oral Suspension, Now Available in the United States. News Release. Tris Pharma. October 1, 2024. Accessed October 2, 2024. https://www.businesswire.com/news/home/20241001522635/en/Tris-Pharma–Once-Daily-ADHD-Medication-ONYDA-XR-clonidine-hydrochloride-Extended-Release-Oral-Suspension-Now-Available-in-the-United-States

²Isfandnia, F., Masri, S.E., Radua, J., & Rubia, K. (2024) The Effects of Chronic Administration of Stimulant and Non-Stimulant Medications on Executive Functions in ADHD: A Systematic Review and Meta-Analysis. Neuroscience & Biobehavioral Reviews; 162. https://doi.org/10.1016/j.neubiorev.2024.105703

³Jain, R., Segal, S., Kollins, S.H., Khayrallah, M. (2011). Clonidine Extended-Release Tablets for Pediatric Patients with Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry. https://doi.org/10.1016/j.jaac.2010.11.005

⁴Kollins, S.H., Jain, R., Brams, M., Segal, S., Findling, R.L., Wigal, S.B., Khayrallah, M. (2011). Clonidine Extended-Release Tablets as Add-On Therapy to Psychostimulants in Children and Adolescents with ADHD. Pediatrics. https://doi.org/10.1542/peds.2010-1260

⁵ Highlights of Prescribing Information. Onyda XR. FDA. Accessed May 29, 2024. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/217645s000lbl.pdf

Relexxii (generic name: methylphenidate HCI ER) is a once-daily, extended-release, central nervous system (CNS) stimulant indicated for the treatment of attention deficit hyperactivity disorder (ADHD) in adults up to the age of 65 and pediatric patients six years of age and older. The safety and effectiveness of Relexxii for pediatric patients under age six are unknown.

According to the U.S. Food and Drug Administration (FDA), Relexxii is a federally controlled substance. “Schedule II Stimulants” are believed to have a high potential for abuse and misuse, which can lead to the development of a substance use disorder, including addiction.

What Ingredients Are in Relexxii?

Relexxii contains methylphenidate hydrochloride salt, the same active ingredient as ADHD medications, such as Ritalin, Daytrana, Concerta, and Aptensio XR. Relexxii contains the following inactive ingredients: cellulose acetate, colloidal silicon dioxide, ferrosoferric oxide, hypromellose, iron oxide black, lactose monohydrate, magnesium stearate, phosphoric acid, polyethylene glycol, polyethylene oxide, sodium chloride, succinic acid, titanium dioxide, and triacetin.

How Does Relexxii Work?

Relexxii uses osmotic delivery technology, releasing the medication at a controlled rate throughout the day. Relexxii comes in tablet form and has a semipermeable membrane with an immediate-release drug overcoat, an osmotically active bilayer core containing the drug and excipients, and a push layer containing osmotically active components. The immediate-release drug overcoat dissolves within one hour, providing an initial dose of medication. The push layer in the tablet’s core expands and pushes the drug through a laser-drilled orifice at a controlled release rate throughout the day for 6 to 7 hours. The Relexxii tablet releases medication without dissolving its outer shell. The outer shell passes through the digestive tract and out of the body without being digested.

How Do You Use Relexxii?

Relexxii tablets should be taken orally once daily in the morning, with or without food, and must be swallowed whole with a full glass of water or another liquid. Never cut, crush, or chew the tablets because this would destroy the time-release mechanism.

What Is the Typical Dosage for Relexxii?

Relexxii is available in flexible dosing options that support targeted titration and eliminate the need for multiple pills. Daily dosages above 54 mg in pediatric patients 6 to 12 years and above 72 mg in pediatric patients 13 to 17 years have not been studied and are not recommended. Daily dosages above 72 mg are not recommended in adults.

The optimal dosage varies from patient to patient. Your doctor may adjust your daily dosage by small increments until you or your child experiences the greatest improvement in symptoms without side effects.

For updated information about dosages, interactions, and precautions, see the Relexxii drug monograph on WebMD.

Relexxii vs. Concerta

Relexxii and Concerta are both brand names for methylphenidate HCI. Relexxii and Concerta both use osmotic delivery technology, which releases the medication at a controlled rate throughout the day. In a study of 60 healthy volunteers, a once-daily dose of Relexxii 72-mg demonstrated bioequivalence to a twice-daily dose of Concerta (methylphenidate HCI) 36-mg tablets. ¹, ²

On June 23, 2022, the FDA approved Vertical Pharmaceuticals’ Relexxii for ADHD in adults (up to 65 years old) and pediatric patients six years of age and older.

Concerta received FDA approval for treating ADHD on August 1, 2000.

What Side Effects Are Associated with Relexxii?

As with all ADHD medications, follow your Relexxii prescription instructions exactly. Taking Relexxii late in the day can disrupt sleep.
The most common side effects of Relexxii reported by adults include:

• decreased appetite
• headache
• dry mouth
• nausea
• insomnia
• anxiety
• dizziness
• weight loss
• irritability
• increased sweating

Less common side effects of Relexxii include:

• priapism (an erection that does not subside)
• circulation problems in fingers and toes, including Raynaud’s Phenomenon
• eyesight changes or blurred visions

The most common side effect reported in pediatric patients taking Relexxii was upper abdominal pain. There has been some concern that stimulants may cause a slowing of growth in children and adolescents. However, research findings revealed mixed results. Some studies show no impact on growth at all ³, while others find what is considered a “negligible” slowing of growth. ⁴ Talk to your doctor if you find evidence of suppressed growth or weight in your child.

If side effects are bothersome or do not disappear, talk to your doctor. Most people taking this medication do not experience any of these side effects. See the full list of possible Relexxii side effects here.

What Precautions Are Associated with Relexxii?

Patients with known structural cardiac abnormalities, cardiomyopathy, severe heart rhythm abnormalities, coronary artery disease, and other serious heart problems should avoid using Relexxii. Patients should monitor their heart rate and blood pressure regularly while taking Relexxii, as increases may occur. Patients with a personal or family history of high blood pressure, heart problems, or heart defects should share this with their HCP.

Relexxii may exacerbate symptoms of behavior disturbance and thought disorder in patients with a preexisting psychotic disorder or induce a manic or mixed episode in patients with bipolar disorder. Before initiating treatment, screen patients for risk factors for developing a manic episode (e.g., comorbid or history of depression, a family history of suicide, and bipolar disorder). If new psychotic or manic symptoms occur, consider discontinuing Relexxii.

Before initiating Relexxii, healthcare providers should assess the family history and clinically evaluate patients for tics or Tourette’s syndrome. They should also regularly monitor patients for the emergence or worsening of tics or Tourette’s syndrome and discontinue treatment if clinically appropriate.

Because the Relexxii tablet is nondeformable and does not appreciably change in shape in the GI tract, Relexxii should not be administered to patients with preexisting severe gastrointestinal narrowing (e.g., esophageal motility disorders, small bowel inflammatory disease, “short gut” syndrome due to adhesions or decreased transit time, peritonitis, cystic fibrosis, chronic intestinal pseudo-obstruction, or Meckel’s diverticulum).

An ophthalmologist should evaluate any Relexxii-treated patients at risk for acute angle closure glaucoma (e.g., patients with significant hyperopia).

The effects of Relexxii on an unborn child are not yet clear. Tell your doctor if you plan to become pregnant, are pregnant, or are breastfeeding before taking Relexxii. Women exposed to Relexxii during pregnancy or breastfeeding may participate in the National Pregnancy Registry for Psychiatric Medications to improve existing safety information.

What Interactions Are Associated with Relexxii

You should not take Relexxii if you have any of the following conditions:

• allergy or hypersensitivity to methylphenidate HCI or any of the ingredients in methylphenidate medications
• anxiety/agitation
• glaucoma
• tics or history of Tourette’s syndrome
• circulation problems
• esophagus, stomach, or intestine problems
• if you are taking monoamine oxidase inhibitors (MAOIs) or within 14 days after discontinuing MAOI treatment
• if you are taking risperidone.

Share a list of all vitamin or herbal supplements and prescription and non-prescription medications you take with the pharmacist when you fill your prescription. Inform all doctors and physicians that you are taking Relexxii before surgery or laboratory tests. Relexxii can have a dangerous interaction with certain anesthetics.

For a complete list of all possible drug interactions, refer to Relexxii’s drug label information for consumers and healthcare professionals.

Sources

¹ Relexxii (methylphenidate hydrochloride extended-release tablets) package insert. Vertical Pharmaceuticals, LLC; 2023.
²Data on file, Osmotica Pharmaceuticals US LLC.
³Harstad, E., Weaver, A., Katusic, S., Colligan, R.C., Kumar, S., Chan, E., Voigt, R., Barbaresi, W. (2014.) ADHD, Stimulant Treatment, and Growth: A Longitudinal Study. Pediatrics. https://doi.org/10.1542/peds.2014-0428
⁴Greenhill, L., Swanson, J., Hechtman, L., Waxmonsky, J., Arnold, L., Molina, B., Hinshaw, S., Jensen, P., Abikoff, H., Wigal, T., Stehli, A., Howard, A., Hermanussen, M., Hanć, T. (2020). Trajectories of Growth Associated With Long-Term Stimulant Medication in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child & Adolescent Psychiatry. v. 59, Issue 8. 978-989. https://www.jaacap.org/article/S0890-8567(19)31443-1/fulltext/

EndeavorOTC is an over-the-counter digital therapeutic authorized by the Food and Drug Administration (FDA) for the treatment of adults 18 and older with primarily inattentive or combined-type ADHD. In the U.S., it is indicated to improve attention and functioning as measured by computer-based testing. It is available without a prescription.

EndeavorOTC is not intended to be used as a stand-alone therapeutic and is not a substitution for ADHD medication.

Developed by Akili Interactive, EndeavorOTC is the first FDA-authorized over-the-counter digital therapeutic treatment for adult ADHD. It uses the same proprietary technology as EndeavorRx, an FDA-approved digital therapeutic for the treatment of children ages 8 to 12 with primarily inattentive or combined-type ADHD.

EndeavorOTC is available in the U.S. in the Apple App Store for iOS and the Google Play Store for Android mobile devices.

How Does EndeavorOTC Work?

Through its immersive video game experience, EndeavorOTC presents specific sensory stimuli and simultaneous motor challenges designed to alter pathways in the brain related to focus.

Adults typically interact with EndeavorOTC on mobile devices for 25 minutes daily, five days a week.

The EndeavorOTC games, which challenge players to simultaneously target and navigate through a series of obstacles, are designed to boost cognitive functions related to attention, focus, multitasking, and prioritization.

How Long Does EndeavorOTC Take to Work?

The clinical study supporting EndeavorOTC’s FDA clearance found that, after six weeks of EndeavorOTC use, 83% of participants saw clinical improvements in their ability to focus as measured by the TOVA attentional control score. Nearly three-quarters (72.5%) of participants reported some quality-of-life improvements as measured by the Adult ADHD Quality of Life Scale (AAQoL), and roughly half (45.8%) of adults met a prespecified threshold for clinically meaningful improvement.¹

What are the Side Effects of EndeavorOTC?

The clinical trial for EndeavorOTC reported no lasting or serious side effects. Of the 221 adults who received EndeavorOTC for six weeks in the trial, 11 (5%) reported a treatment-emergent adverse device event, most commonly nausea (1.8%) and headache (1.4%).¹

What Precautions are Associated with EndeavorOTC?

EndeavorRx may not be appropriate for patients with photosensitive epilepsy, color blindness, or physical limitations that stop a patient from comfortably holding a device.

To learn more about EndeavorOTC, visit EndeavorOTC.com.

What is EndeavorRX?

EndeavorRx, a version of EndeavorOTC designed for children ages 8 to 12 with ADHD, was approved by the FDA in June 2020. Through its immersive video game experience, EndeavorRx presents specific sensory stimuli and simultaneous motor challenges designed to target neural systems in the brain related to attentional control. Children interact with EndeavorRx on mobile devices and typically play for 25 minutes per day, five days a week. It is available by prescription from a licensed healthcare provider.

Learn more about EndeavorRx at www.endeavorrx.com/

Source

¹ Stamatis, C.A., Mercaldi, C., Kollins, S.H. (2023). A Single-Arm Pivotal Trial to Assess the Efficacy of Akl-T01, a Novel Digital Intervention for Attention, in Adults Diagnosed With ADHD. Journal of the American Academy of Child & Adolescent Psychiatry. https://doi.org/10.1016/j.jaac.2023.09.510

One trademark of ADHD is low levels of dopamine, a neurotransmitter released by the brain that makes kids feel good and helps them focus. Increasing dopamine in the brain through medication is an effective treatment for ADHD. However, more than a year into a nationwide stimulant shortage, parents still struggle to fill prescriptions for their kids.

As the shortage stretches on, many caregivers are working to implement ADHD treatment tactics without medication. Here are some gut health strategies to consider.

Don’t Skip Meals

The way your child’s brain works is influenced by what they eat, and good nutrition is essential. Eating unhealthy, non-nutritious foods may contribute to inattention and problematic behaviors, while a diet with a variety of healthy foods nourishes the brain to pay attention and function optimally.

[Free Download: 5 Rules for an ADHD-Friendly Diet]

A study in Cell Metabolism found that dopamine release in the brain can occur at two different times: when food is swallowed and once the food reaches the stomach.¹ Skipping a meal robs the body of two potential releases of dopamine. If your child is not hungry, try to keep them on a regular meal schedule to help regulate opportunities for dopamine release. Healthy snacks help, too. A protein-rich diet, including fish, poultry, eggs, and legumes (e.g., beans, lentils, peas, etc.), can help increase dopamine levels.

Introduce Variety

Many kids with ADHD want to eat the same things every day, but doing so may mean they miss out on producing more of that feel-good hormone. Research has also found a strong connection between gut health and mental health. ² A healthy gut is best described as having a diverse microbiome, consisting of different types of microorganisms (bacteria, fungi, viruses, etc.) that coexist harmoniously in the digestive tract. Increasing the diversity of your child’s gut microbiome with a protein-rich diet, including fish, poultry, eggs, and legumes (e.g., beans, lentils, peas, etc.), ensures that dopamine can be adequately synthesized.

Introduce new foods slowly and in a variety of ways. For example, pick a vegetable your child usually eats and connect it to another vegetable or legume. So if your child eats raw carrots, pair them with a dip made of puréed red peppers or smooth refried beans. If your child prefers crunchy foods, make crunchy cooked veggies in the oven or air fryer. Experiment with spices, too. Offering your child small tastes (repeatedly) will build their acceptance of new foods. Kids are more likely to expand their taste and preference for new foods when given multiple chances to learn about and experience new food.

[Free Download: Meal-Planning Guide for ADHD Families]

Mindful Eating

Young children, especially those with ADHD, may be easily distracted during mealtimes. Make it a point to give your child a heads-up on what’s for dinner and when it will be served. Kids with ADHD do best when they know what to expect and follow a schedule. Then, turn off all electronic devices, including the TV, while eating to limit distractions. If possible, sit and eat together at the table. This lets your child know that during meals, it’s time to pause (even for a minute) and focus on eating. This is also a great time to share a moment with your child.

Gut Health Strategies for Treating ADHD: Next Steps

• Read: The ADHD Diet Plan: Healthy Foods and Supplements for Kids & Adults 
• Read: Food Therapy: The Right Nutrition for ADHD Symptoms
• Download: ADHD Brain Food: What to Eat, What to Avoid
• Watch: “What to Eat, What to Avoid: The ADHD Guide to Food and Nutrition for Children”

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The opinions expressed in ADDitude Guest Blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of ADDitude. Blogs are not reviewed by an ADDitude physician or any member of the ADDitude editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. ADDitude does not endorse any specific product, service or treatment.

Do not consider ADDitude Blogs as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on ADDitude. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. ADDitude understands that reading individual, real-life experiences can be a helpful resource, but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately.

Sources

¹Thanarajah, S.E., Backes, H., DiFeliceantonio, A.G., Albus, K., Cremer, A.L., Hanssen, R., Lippert, R.N., Cornely, O.A., Small, D.M., Brüning, J.C., Tittgemeyer, M. (2018) Food Intake Recruits Orosensory and Post-ingestive Dopaminergic Circuits to Affect Eating Desire in Humans. Cell Metabolism. https://doi.org/10.1016/j.cmet.2018.12.006

²Chen, Y., Xu, J., Chen, Y. (2021). Regulation of Neurotransmitters by the Gut Microbiota and Effects on Cognition in Neurological Disorders. Nutrients. https://doi.org/10.3390/nu13062099