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.

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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}

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

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
      
      

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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.

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Vitamin D supplementation is associated with decreased ADHD symptoms, including lower levels of hyperactivity and inattention in children, finds a new meta-analysis.¹ The research builds on previous studies that found relatively lower levels of vitamin D in children with ADHD than in their neurotypical peers.

The meta-analysis reviewed six studies of children with ADHD who received vitamin D supplements or placebos. The children treated with vitamin D exhibited decreased ADHD symptoms (SMD=-0.59), including lower scores of hyperactivity (SMD=-0.64) and inattention (SMD=-0.6) with no significant side effects. Standardized Mean Difference (SMD) was used to measure the effect of the supplementation.

The researchers concluded that vitamin D should be pursued as an adjuvant to methylphenidate for children with ADHD. “Given the robust evidence and well-structured, randomized controlled trials, we strongly advocate for the integration of vitamin D supplementation with ADHD treatment,” wrote the authors of the review.

Low Vitamin D in Kids with ADHD

On his YouTube channel, Russell Barkley, Ph.D., reviewed the research findings and said, “A significant subset of children with ADHD have lower vitamin D levels than typical children and this group especially might be the ones most targeted for this kind of supplementation.”

Abnormally low levels of vitamin D have been linked to ADHD in several studies, among them a meta-analysis of eight trials. All of the trials reviewed found significantly lower serum concentrations of vitamin D in individuals with an ADHD diagnosis compared to controls (SMD = − 0.73).²

As vitamin D is largely sourced from sunlight and increasing latitude decreases sunlight, the researchers further tested the association by completing a meta-regression analysis to explore the impact of latitude on the study findings. They discovered a significant correlation; the latitude gradient influenced the difference in vitamin D levels between the ADHD group and the control group.

Later studies have confirmed that locations with greater sunlight report lower-than-average ADHD prevalence, further supporting a possible connection between ADHD and vitamin D.³ The association was further investigated in a study published earlier this year in Frontiers in Psychology, which found that Vitamin D insufficiency worsens sleep problems in children with ADHD, impairing sleep quality and worsening sleep-disordered breathing.⁴

The new finding that vitamin D supplements can improve core ADHD symptoms has clinical implications for pediatric patients and may merit further research on the topic. In a recent ADDitude webinar titled, “The Surprising Association Between ADHD & Inflammation,” James Kustow, BMedSci, BMBS, MRCPsych, discussed how the correlation of vitamin D deficiency with ADHD may be a clue to help scientists understand the role of inflammation in ADHD.

“Vitamin D has anti-inflammatory properties, and we know levels are lower in ADHD,” Kustow said. “So, vitamin D deficiency serves, really, as a marker for inflammation.”

Sources

¹Latorre, C. G. & Mañalac, A. S. (2025). Effects of Vitamin D supplementation on Pediatric Attention Deficit Hyperactivity Disorder: a meta-analysis and systematic review. The PCMC Journal, 21(1), 42-55.

²Kotsi, E., Kotsi, E., Perrea, D.N. (2019). Vitamin D levels in children and adolescents with attention-deficit hyperactivity disorder (ADHD): a meta-analysis. Attention deficit hyperactivity Disord. https://doi.org/10.1007/s12402-018-0276-7

³Miller, M.C., Pan, X. Eugene Arnold, L. et al (2021). Vitamin D levels in children with attention deficit hyperactivity disorder: Association with seasonal and geographical variation, supplementation, inattention severity, and theta:beta ratio. Biological Psychology. https://doi.org/10.1016/j.biopsycho.2021.108099

⁴Zhang, P., Liu, Y., Yan, M. et al. (2025). Vitamin D insufficiency and sleep disturbances in children with ADHD: a case-control study. Frontiers in Psychology. https://doi.org/10.3389/fpsyt.2025.1546692

No practical, modern protocol exists regarding how to efficiently adjust stimulants to optimize their performance in managing ADHD symptoms and mitigating side effects. The only guidance available stems from the Multimodal Treatment of ADHD (MTA) Study, published in 1999, but the MTA’s research methodology often took as long as eight months to determine each subject’s optimal medication and dose.

This is completely impractical in the real world, where insurance coverage pays for only two or three sessions of clinical assessment and medication adjustments. As such, I developed a method for optimizing ADHD stimulant medications that I have used successfully in my own practice for 30 years.

Choosing the Right ADHD Medication

Two molecules comprise the first-line stimulants prescribed to most people with ADHD: methylphenidate (brand names include Ritalin and Concerta) and amphetamine (brand names include Vyvanse and Adderall). More than 39 different brand name medications are made from these two molecules, and they all provide a comparable level of benefits, side effects, and response rates, according to large group studies. One molecule is not intrinsically better than the other.

That said, nothing (including genetics) predicts which molecule will work best for any individual. Patients may need to try both kinds of stimulants to arrive at optimal ADHD treatment — a process that takes time and collaboration with their clinicians.

Roughly 30% of people with ADHD either do not respond to or tolerate the first stimulant they try. When that happens, we stop the first molecule and try the other one. When both are tried sequentially, the combined response rate is about 85%; the remaining 15% of people do not respond to or tolerate either medication.

[Read: Complete ADHD Medication List for Comparing Popular Meds]

No single factor, such as weight, age, gender, ethnic background, or severity of impairments, predicts any individual’s optimal dose. That is discovered by adjusting the dose through trial and error. Only about half of people achieve their optimal response within the range of dosages approved by the FDA. In my practice, more than 40% of patients required doses higher than the FDA-approved doses, and about 6 to 8% optimized below the lowest dose manufactured, underscoring the need to give feedback to your clinician to guide the fine-tuning process.

3 Rules of Medication Titration

Three general rules should guide your medication expectations and adjustments:

1. You shouldn’t feel medicated.

Once you find your optimal dose, you should experience “the very best version of you.” ADHD medications should not change your personality. If you feel dulled or like a zombie, the dose is too high.

[Free Resource: ADHD Medication Tracking Log]

2. Benefits should outweigh stimulant side effects.

With the right medication at the right dose, you should achieve life-changing benefits without meaningful or lasting side effects. A measure called “effect size” tells us how well any medical treatment works compared to the other available treatments. Almost everything in medicine has an effect size of 0.4 (barely but consistently detectable benefits) up to 1.0 (a very robust level of benefits). When stimulants are fine-tuned to suit a unique individual, the effect size can fall in the range of 1.6 to 1.8 – better than almost any other treatment in all of medicine.

In other words, the right stimulant will deliver very noticeable benefits. If you have tried a full range of doses and have not experienced an “oh, wow” level of response, this was not the right molecule for you and you need to try the other molecule. If a medication is not dramatically effective, don’t settle for it.

Often, intolerable side effects mean this was the wrong molecule for you or the dose was too high. More is not better.

3. You must commit to treatment.

Medication doesn’t work if you stop taking it. The first-line stimulant medications are completely effective as soon as they reach the brain, which takes about an hour (except in the case of backloaded methylphenidate formulations, like Concerta, which gradually increase to their full blood level). Most people will see all the benefits and side effects of a medication within about 90 minutes of taking it. It may take a clinician a week to determine whether a dose adjustment is needed for a child because they often lack self-appraisal and feedback skills; also, it may take this long to collect observations from parents and teachers.

The biggest obstacle to success is failing to accept that you have a lifelong condition. Virtually every patient with whom I have ever worked has stopped taking their medication at times “to see if I still need it.” Science confirms that the impairments of ADHD are always present, and that stimulant medications can reliably work for a lifetime without significant adjustments in dose after adolescence.

Getting Started with ADHD Medication

Create a list of symptoms that you would like to ease, then work with your clinician to fine-tune medications according to how well they relieve these symptoms. Impairments that respond particularly well to medication are:

• Procrastination
• Distractibility
• Poor reading speed, comprehension, and retention
• Poor emotional control
• Restlessness; fidgeting
• Impulsiveness
• Misplacing things; forgetfulness
• Blurting without thinking

With each dose increase of your newly prescribed medication, jot down the improvements and side effects that you experience. At some point, a dose increase will bring no further symptom improvement. If that dose and its predecessor seem to equally relieve the impairments of your ADHD, then the lower dose is your optimal one.

For children younger than 16, the American Academy of Pediatrics recommends refining the dose once a year because it commonly fluctuates in childhood. This readjustment is usually done in August before the new school year begins.

Citric Acid and Adderall, Ritalin, Other ADHD Meds

Some soft drinks, artificial juices, and cereal bars contain high levels of citric acid, a preservative, which can interfere with stimulant medication efficacy. Foods high in citric acid and ascorbic acid (Vitamin C) prevent stimulants from being absorbed, and should be avoided one hour before and after taking a stimulant to achieve its full benefit.

Adderall Dosage & Medication Titration: Next Steps

• Read: 10 Things Your Doctor May Not Have Told You About ADHD Medications
• Download: How Do We Know the Medication is Working?
• Watch: Combination Therapy: Medication Strategies for Hard-to-Treat Complex ADHD

William M. Dodson, M.D., is a board-certified psychiatrist.

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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.

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.

Watch the Video Replay

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Download or Stream the Podcast Audio

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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. Take our online ADHD assessment or schedule a consultation | www.playattention.com

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

 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
  

Obtain a Certificate of Attendance

If you attended the live webinar on September 9, 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

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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What do we know about combining and sequencing ADHD treatments for children? Are more interventions better and, if so, when? Treating ADHD in children can include stimulant medication, non-stimulants, and psychosocial interventions such as behavioral parent training, and school- and peer-based interventions, including summer treatment programs.

In this webinar, Mark A. Stein, Ph.D., will explain ADHD heterogeneity, the need to personalize treatment, and what we have learned in the last 30 years on combining and sequencing ADHD treatment for optimal care.

In this webinar, you will learn about:

• • • ADHD heterogeneity and a precision medicine approach to treatment
    • The data on combining treatments for ADHD, including psychosocial, pharmacological, and family based treatments.
    • The challenges and strategies for optimizing multimodal treatment
    • Sequencing treatments — when to start, and when to add more.
    • When treatment is excessive based on impairing side effects.

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, inspired by NASA technology and backed by Tufts University research, helps strengthen executive function — a key piece of the puzzle for kids with ADHD. It works well with other treatments like therapy or medication and helps improve focus, self-regulation, and follow-through. Each family gets unlimited support from a personal Focus Coach, so you’re never on your own.

Schedule your consultation to discuss your specific needs or visit www.playattention.com to take our ADHD test. Home and Professional Programs available.

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

ADHD Treatments for Children: Resources

• • • Free Download: Take Charge of Your Child’s Medication
    • Read: ADHD Treatment Options for Children
    • Read: What Is Complex ADHD? Symptoms, Diagnosis & Treatment
    • Read: How a Physician Treats ADHD with Combination Therapy

Obtain a Certificate of Attendance

If you attended the live webinar on August 13, 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 Speaker

Mark A. Stein Ph.D., ABPP, is a professor of psychiatry and behavioral sciences and adjunct professor of pediatrics at the University of Washington. He also is the founder  of the Program to Enhance Attention, Regulation, and Learning  (PEARL Clinic) at Seattle Children’s Hospital. Previously, Dr. Stein was professor of psychiatry and pediatrics at the University of Illinois at Chicago. He also was chair of psychology and developmental pediatrics at Children’s National Medical Center in Washington, D.C. Dr. Stein is a fellow of the American Psychological Association and the past president of the American Professional Society for ADHD and Related Disorders (APSARD). In 2017, he received the Lifetime Achievement Award from Children and Adults with ADHD (CHADD). Dr. Stein has written more than 150 peer-reviewed articles and conducted numerous studies of ADHD treatment in children, adolescents, and adults. His interests are in the relationship between ADHD and sleep, and in personalizing ADHD treatment.

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The anticipated MAHA Commission report released yesterday misrepresents ADHD causes and care in the U.S., misinterpreting studies and disregarding compelling new research and patient voices to suggest that ADHD is contributing to a “crisis of overdiagnosis and treatment” in American children.

The MAHA Report, spearheaded by Health and Human Service (HHS) Secretary Robert F. Kennedy, Jr., equates ADHD with obesity, heart disease, and diabetes in calling these harmful contributors to the “childhood chronic disease crisis” in the U.S. It disregards the genetic underpinnings of ADHD to suggest it is solely caused by environmental factors and foods, twists data to stoke fear over rising diagnosis rates, and excludes a wealth of studies that link stimulant medication use to improved health outcomes.

It assumes ADHD is a disease caused and cured by environmental factors. And it suggests that curing ADHD will “make America healthy again.” We disagree, and so does the research.

Should the U.S. government take a long, hard look at the impact of ultra-processed foods, environmental chemicals, and declining physical activity on American children? Absolutely. Should it invest in programs to provide healthy foods, affordable health care, and screen-free activities for all children, regardless of socioeconomic status or means? Yes. Do we support efforts to eliminate toxins from our kids’ food, water, and air? To protect them from unhealthy screen use? To help them live longer, healthier lives? 100%.

Will any of these efforts “cure” ADHD, as the MAHA Report suggests? No, the research does not support that notion. But these efforts, if undertaken by Kennedy, do stand to improve quality of life for many children, and so they should be seriously considered by HHS through investment in the FDA, CDC, and NIH.

Do you know what else improves quality of life for kids? Less stigma and shame, and more investment and solutions. The MAHA Report, sadly, increases ADHD stigma by claiming the condition is overdiagnosed and disparaging its treatment as ineffective without any credible evidence to support these claims. On the flipside, it makes no mention of the proven, life-saving benefits of ADHD treatment or the risks associated with undiagnosed, untreated ADHD. It makes no mention of behavioral parent training, cognitive behavioral therapy, dialectical behavior therapy, or classroom interventions for ADHD, all of which are shown to improve outcomes for individuals with ADHD. Instead, the report’s “solutions” for ADHD suggest more scrutiny of and restricted access to stimulant medication.

Finally, it is notable that the commission included few scientists or experts in pediatric health care. The commission conducted no new research and it apparently did not seek comment or insight from the American Professional Society of ADHD and Related Disorders (APSARD), the American Academy of Pediatrics (AAP), or the World Federation of ADHD regarding the established science on ADHD causes and treatments. No patients were interviewed for or quoted in the report.

The next steps outlined in the report are vague and we expect the commission to propose more detailed strategies in August, but here are three takeaways from the May 22 MAHA Report that may impact the ADHD community.

#1: The Report Misrepresents the Causes of ADHD

ADHD is a highly genetic condition, as confirmed by brand-new research that identified measurable genetic traits that essentially act as biomarkers for ADHD. Lifestyle factors such as nutrition, exercise, and sleep exert epigenetic changes on DNA that influence how strongly or weakly ADHD genes are expressed. However, diet, physical activity, sleep, or screen use alone do not cause — and have not been shown to “cure” — ADHD.

Scientific research has established no causal link between consumption of sugar, food additives, or food dyes and ADHD, though some studies show a heightened sensitivity among children with ADHD to these foods, which may exacerbate existing symptoms. Likewise, scientific research has established no causal link between excessive screen time, video game play, or social media use and ADHD.

Despite clear evidence to the contrary, the MAHA Report claims that ADHD is caused by all of the following, but it never mentions genetic factors:

• Antibiotics: The report cited as evidence a study that “could not disentangle the effects of antibiotics from those of the underlying conditions” and “could not verify adherence to antibiotic prescriptions.” Other recent studies have found gut microbiome alterations in children with ADHD but no causal link between antibiotic use and ADHD in humans.
• Food additives: Research shows that food dyes may worsen symptoms of inattention or hyperactivity in children with ADHD, however there is no evidence of a causal relationship.
• Environmental toxins: This article by Joel Nigg, Ph.D., contains a thorough overview of all existing research on environmental toxins and ADHD, but the bottom line is this: “Genes and environments work together to shape development of the brain and behavior throughout life, but especially — and most dramatically — in very early life. ADHD, like other complex conditions, doesn’t have a single cause. Both nature and nurture influence its development.”

#2: The Report Casts Doubt on the Validity of an ADHD Diagnosis

The MAHA Report claims that “research shows ADHD has the strongest evidence of overdiagnosis,” however no such research is cited in the report. Perhaps that is because there is no definitive evidence that ADHD is overdiagnosed in America today. ADHD diagnosis rates have increased over the last few decades, however this may be a result of any of the following, and other factors:

• The high diagnosis rate cited in the report comes from a problematic and misleading CDC study that is “terribly designed to assess the prevalence of the disorder,” says Russell Barkley, Ph.D., a leading authority on ADHD. “In this survey, there is one question about ADHD: ‘Has a doctor or other healthcare provider ever told you that this child has ADD or ADHD?’ That could be anybody associated with the healthcare profession who has no training in ADHD… and there is no effort in this study to follow up to see if these children were, in fact, diagnosed.” Barkley goes on to say that meta-analyses of better-conducted studies that apply diagnostic criteria to their research populations find that the prevalence of ADHD among children ranges from 5 to 8 percent, not 10 to 11 percent.
• Revised diagnostic criteria published in the DSM-5 changed the age of onset from 7 to 12 and added the first-ever qualifier symptoms for ADHD in adulthood
• With ongoing research and clinician training on ADHD, education and symptom recognition have improved
• Twenty years ago, ADHD was viewed as a disorder that affected young males. As research on females began to take hold, girls and women were able to secure ADHD evaluations for the first time
• Likewise, as mental health stigma dissipates within time, historically underserved populations are seeking care for the first time

The report further suggests that “the harms associated with an ADHD diagnosis may often outweigh the benefits” without naming those supposed harms or acknowledging the many health risks associated with undiagnosed ADHD. Research shows that undiagnosed and untreated individuals face a higher risk for fatal car accidents, unwanted pregnancies, serious injury and hospitalizations, job loss, academic interruptions, self-harm, anxiety, depression, eating disorders, and more. The harms associated with undiagnosed ADHD are too severe to ignore, yet the MAHA Commission does just that.

#3: The Report Misrepresents the Efficacy and Risks of ADHD Medication

The MAHA Report draws faulty conclusions from the ​​Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder (MTA) study to argue that ADHD medication use offers no benefits “in grades, relationships, achievement, behavior, or any other measure” after 14 months of use. This is untrue.

In reality, the MTA study ended after 14 months, so the control group members with ADHD who did not initially receive medication were free to seek it out after 14 months. As many of the controls began treating their ADHD symptoms with medication, the differences between the control and treatment groups faded because the control group members began to improve on medication, not because the treatment group began to do worse. It is wrong and irresponsible to suggest that no patients experienced benefits from ADHD medication use after 14 months.

“The groups became very contaminated after that 14-month follow-up,” Barkley says in a video on his YouTube channel. “Therefore, we can’t make comparisons at years 2, 3, or 4 between or among the treatment groups and draw any conclusions about them because the treatments were mixed up among all the groups.”

The report claims that stimulants, “when stopped, often lead to disabling and prolonged physical dependence and withdrawal symptoms.” This is untrue. The research cited in the report was a study of antidepressants, not stimulants. There is no evidence to support this assertion regarding stimulant medication. In addition, we know that half of teens and adults with ADHD stop taking stimulant medication within one year of starting it, often due to stigma or access problems. This suggests that it is not addictive. In fact, stimulant medication has been used safely and effectively for nearly 100 years — more than enough time for long-term adverse outcomes to come to light, yet none has.

Finally, the report’s claim that stimulant medication use does “not improve outcomes long-term” is also false.

Research dating back more than 40 years has documented the positive impact of ADHD treatment on specific symptoms like inattention and hyperactivity, and on life expectancy overall. Recently, a Swedish study, published in JAMA Network Open, documented these findings:

• ADHD medication use reduced overall risk of death by 19%. Among people with ADHD who did not receive medication, there were 48 deaths for every 10,000 people, contrasted with 39 deaths per 10,000 people within the medicated cohort.
• ADHD medication use reduced the risk of overdose by 50%. Medication use also reduced the risk of death from other unnatural causes, including accidental injuries, accidental poisoning such as drug overdoses, and suicide.
• ADHD medication use reduced the risk of death from natural causes, such as medical conditions, for women.

People with childhood ADHD are nearly twice as likely to develop a substance use disorder as are individuals without childhood ADHD. However, research suggests that patients with ADHD treated with stimulant medications experience a 60% reduction in substance use disorders compared to those who are not treated with stimulant medication. Considerable evidence also suggests that children taking ADHD medication experience improvements in academic and social functioning, which translates to improved self-esteem, lower rates of self-medication with drugs or alcohol, and decreased risk of substance abuse.

Given all of the above, it’s difficult to view the increase in stimulant medication use flagged by the MAHA Report as anything but positive. “Why isn’t that evidence of improvement in good public mental health?” Barkley asks. “The fact that there is a rise in the occurrence of a particular treatment does not provide prima facie evidence that there is something bad, wicked, evil, wrong going on here; it simply means that, over time, we are getting closer and closer to identifying conditions that produce harm in individuals, and that we try to alleviate that harm and suffering.”

The Threat to ADHD Care Access

The MAHA Commission plans to release its recommended strategies in August, but it’s easy to see the writing on the wall now. The arguments presented in Thursday’s MAHA Report, based largely on outdated or poorly interpreted research, suggest that Kennedy may seek to restrict access to ADHD care and that he’s building a foundation of doubt and misinformation now to support that action.

We fear efforts to dissuade physicians from diagnosing and treating ADHD may be forthcoming from the Drug Enforcement Administration (DEA) with support from the CDC, which Kennedy oversees. Of course, we hope we are proven wrong. We hope that, instead, HHS chooses to fully restore funding for ADHD research efforts through the National Institutes of Mental Health, for mental healthcare initiatives through the CDC, and for nationwide nutrition assistance programs through the FDA.

ADDitude supports an investment in unbiased research into the root causes of and effective treatments for ADHD to support, not ‘cure,’ individuals living with neurodivergent brains. We welcome the opportunity to engage in transparent dialog with the MAHA Commission and to introduce the voices and viewpoints of individuals and families living with ADHD, which were excluded from this report. And we hope that this administration will fund initiatives to improve food quality and access, eliminate harmful food additives, provide mental health services to all children, and crack down on the industries and companies contributing toxins to our environment.

We also stand ready to defend the legitimacy of the robust library of credible, science-backed research studies that confirm ADHD’s genetic underpinnings, that validate its diagnostic tools, and that confirm the benefits of its uninterrupted treatment.

Reactions from the ADHD Community

Mark Bertin, M.D., PLLC, of Developmental Pediatrics

“Lifestyle changes that promote child health are a wonderful idea. However, the MAHA paper ignores the reality of ADHD, a common medical disorder with genetics nearly as strong as the inherited trait of height. Undertreated ADHD is a public health concern that affects school performance, relationships, and driving; increases the risk of substance abuse; and shortens lifespans. Research and clinical experience show clear benefits to ADHD medication, which has been used for a century without evidence of chronic side effects. Supporting individuals with ADHD requires more understanding, not less, while making medical, educational, psychological, and health-related supports affordable and easily available. The MAHA document completely misrepresents ADHD in ways that are judgmental, demeaning, and will be harmful to individuals, our health care system, and society.”

Russell Barkley, Ph.D.

The ADHD Evidence Project, Founded by Stephen Faraone, Ph.D.

“ADHD is one of the most discussed neurodevelopmental disorders in the MAHA Report, but many of its claims about ADHD are misleading, oversimplified, or inconsistent with decades of scientific evidence, much of which is described in the International Consensus Statement on ADHD, and other references given here.”

Misdiagnosis is a significant barrier to care. Black children and adolescents with ADHD are more likely to be labeled with oppositional defiant disorder and to have their ADHD symptoms misunderstood as defiance. Also, cultural stigma surrounding mental health can prevent Black families from seeking care and from using ADHD medication when it is prescribed. Black parents report a preference for interventions like parent training and executive function skills training, to which their access is often limited.

One possible solution: integrated primary care, in which behavioral health services are embedded within primary care practices. When children go to a pediatrician appointment, they may also see a behavioral health care specialist for common concerns like depression, anxiety, and a range of disruptive behaviors from failing to follow caregivers’ directions to disrupting the classroom.

[Read: ADHD Clinicians Must Consider Racial Bias in Evaluation and Treatment of Black Children]

Integrated primary care can address the treatment disparities in Black youth by enabling more personalized, collaborative treatment for ADHD and its co-occurring difficulties. Parents should ask their pediatrician whether an in-office behavioral health specialist is available. Additionally, many primary care practices affiliated with academic medical centers or children’s hospitals have integrated primary care clinics.

Mental Health Stigma in ADHD Care: Next Steps

• Learn: Why We Need Clinicians of Color to Normalize ADHD in BIPOC Communities
• Read: Evaluating and Treating ADHD in African American Children: Guidance for Clinicians
• Watch: “Health Equity in ADHD: Addressing Racial Disparities in Diagnosis and Treatment” [Video Replay & Podcast #495]

Heather A. Jones, Ph.D., is an associate professor of psychology at Virginia Commonwealth University.
Alfonso L. Floyd, Ph.D., is a postdoctoral fellow in the Department of Child & Adolescent Psychiatry and Behavioral Sciences at The Children’s Hospital of Philadelphia.

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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

February 26, 2025

Dear Secretary Kennedy,

As the Make America Healthy Again Commission begins its evaluation of published research on the chronic health conditions impacting American children, we urge it to consult with the esteemed clinicians associated with the American Professional Society of ADHD and Related Disorders (APSARD), the American Academy of Pediatrics (AAP), and the World Federation of ADHD regarding the established science on ADHD causes and treatments. Consensus within these groups, and among ADHD researchers worldwide, is strong and consistent regarding the following evidence-based findings:

• ADHD is a chronic neurodevelopmental condition characterized by inattention, impulsivity, executive dysfunction, and/or hyperactivity that persists into adulthood for approximately 90% of patients.¹
• ADHD is a highly genetic condition.^2,3,4 Lifestyle factors such as nutrition, exercise, and sleep exert epigenetic changes on DNA that influence how strongly or weakly ADHD genes are expressed. However, diet, physical activity, sleep, or screen use alone do not cause — and have not been shown to “cure” — ADHD.
• The 16% increase in ADHD diagnoses over the last decade is due, in large part, to revised diagnostic criteria published in the DSM-5, which changed the maximum age of onset from 7 to 12 and added the first-ever qualifier symptoms for ADHD in adulthood. This wider net, along with improved education, training, and symptom recognition, particularly in historically overlooked girls and women, account for much of the diagnostic uptick, according to studies.^{5, 6}
• Scientific research has established no causal link between excessive screen time, video game play, or social media use  and ADHD.⁷ Some studies suggest these habits may exacerbate inattention and impulsivity.^{8, 9}
• Scientific research has established no causal link between consumption of sugar, food additives, or food dyes and ADHD, though some studies show a heightened sensitivity among children with ADHD to these foods, which may exacerbate existing symptoms.¹⁰
• Scientific research shows that prenatal and/or childhood exposure to tobacco, lead, pesticides, and polychlorinated biphenyls (PCBs) may increase the odds of ADHD in some children, however the studies do not find direct causality.^{11,12, 13,14}
• Several research studies have shown that consumption of a Western diet high in processed foods, fats, sugars, and salt is associated with higher rates of ADHD, however these studies demonstrate an association rather than causality.¹⁵
• ADHD shortens an individual’s life expectancy by 7.5 years, on average.¹⁶ It is serious, potentially lethal, and associated with elevated risks for comorbid conditions ^{17, 18} including anxiety, depression,¹⁹ substance use disorder,²⁰ eating disorders,^{21, 22} obesity, and oppositional defiant disorder,²³ which commonly derails treatment plans and parenting strategies. People with ADHD are more likely to get into car accidents,²⁴ become hospitalized, and engage in self-harm than are their neurotypical peers.^{25, 26, 27}
• In patients with the condition, ADHD medication use reduces the risk of death by 19%, the risk of overdose by 50%,²⁸ the risk of substance abuse by 50%,²⁹ and the risk of motor vehicle accidents by at least 38%.³⁰ Its effective symptom management improves patients’ self-esteem and efficacy, thereby reducing the risk of self-harm and suicide, as well as negative life outcomes such as unwanted pregnancy, incarceration, unemployment, and interruption of education.
• The medications used to treat ADHD have been studied rigorously and used safely for 88 years. Amphetamine and methylphenidate safely and effectively reduce ADHD symptoms, with methylphenidate reducing symptoms by 70% to 90% in children and adults with the condition.^{31, 32} The effect sizes for ADHD medication are .8 to 1.0,³³  which are among the strongest in all of psychiatry. Clinical practice guidelines recommend medication as the first-line treatment for ADHD due to its overwhelming efficacy; for children with ADHD ages 4 to 6, parent behavior training is recommended by the AAP.³⁴
• According to the CDC, just 53.6% of all children and teens with ADHD reported they were actively treating their symptoms with medication in 2022. Because stimulant medications are classified as Schedule II drugs under the Controlled Substances Act, they are tightly regulated; supplies are limited to 30 days and prescribing clinicians must authorize monthly refills. The widely reported ADHD medication shortage has disrupted treatment for millions of patients across the country since 2022.³⁵
• Caregivers and adults with ADHD surveyed by ADDitude rate medication as the most effective treatment for ADHD, however less than half of parents report that they chose to medicate their children within 6 months of diagnosis. They report changing diet, limiting screen time, supplementing with fish oil, and increasing physical activity before ultimately using medication to achieve the symptom improvement necessary for academic and social success.
• The mild to moderate side effects associated with ADHD medication include appetite suppression, irritability or moodiness, sleep problems, and headaches. There is no evidence that ADHD medication use leads to dependency or broader substance abuse; in fact, research shows that ADHD medication use is protective against substance use disorder in individuals with ADHD.³⁶
• The non-stimulant medications used to treat ADHD, such as atomoxetine, guanfacine, and clonidine, have an effect size of .4 to .7 and are considered a second-line treatment appropriate for patients who do not tolerate or cannot take stimulants.^{37, 38, 39}
• Clinical guidelines promote the use of multimodal treatment plans that pair prescription medication with complementary approaches to ADHD management. The nonpharmacological interventions shown to be most effective at reducing ADHD symptoms in children are behavioral therapy (effect size of .5 to.8 when used on its own),⁴⁰ exercise (effect size of .4 to .6 when used on its own),⁴¹ sleep hygiene and interventions (effect size of .5 to .8 when used on their own),⁴² and dietary interventions (effect size of .2 to .5 when used on their own).⁴³
• Behavioral therapy, principally parent training, has an elevated and improved effect when used in conjunction with ADHD medication.⁴⁴ Behavioral therapy is used by just 44% of pediatric patients, in part because it’s not always covered by medical insurance and knowledgeable providers are scarce.
• One meta-analysis of randomized, placebo-controlled trials showed that supplementation with high doses of omega-3 fatty acids has a small positive impact on attention and hyperactivity in children.⁴⁵
• Research suggests that restricting the consumption of synthetic food dyes does benefit some children with ADHD, though aggregate effects are quite small.⁴⁶
• When engaging in vigorous cardiovascular exercise, the brain releases endorphins. Levels of dopamine, norepinephrine, and serotonin also increase with exercise, thus improving focus, working memory, and mood to enable better learning.
• Cognitive behavioral therapy (CBT), though more commonly prescribed to adult patients, has been shown to improve core ADHD symptoms in adolescents when used in conjunction with ADHD medication.⁴⁷
• Neurofeedback uses an electroencephalogram (EEG) to measure brain activity and train the patient to produce brain wave patterns like those of a non-ADHD brain. Neurofeedback has not shown enough effectiveness in studies to be recommended as a “stand-alone” treatment for ADHD and there is little evidence that neurofeedback reduces ADHD symptoms long-term. In addition, neurofeedback is seldom covered by insurance and involves a significant investment of time and money.^{48, 49, 50}
• According to research, brain training does not reduce ADHD symptoms. There is no evidence that a patient can train a brain to improve working memory, or any other executive function.^{51, 52, 53}

Thank you for reviewing the evidence-based research highlighted above. We welcome follow-up questions from the Commission as it devises recommendations based on science that may benefit the health and wellbeing of the 22 million Americans with ADHD, whom ADDitude has served for the last 26 years. We support their personal liberty to pursue and maintain the treatments that benefit their ADHD brains, which are a tremendous asset to this nation.

Sincerely,
Anni Rodgers
General Manager, ADDitude

Sources

¹Sibley, M., Arnold, L, Swanson, J. et.al. (13 August 2021). Variable patterns of remission from ADHD in the multimodal treatment study of ADHD. The American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.2021.21010032

²Faraone, Stephen V. et al. Molecular Genetics of Attention-Deficit/Hyperactivity Disorder, Biological Psychiatry, Volume 57, Issue 11, 1313 – 1323

³Liuyan Zhang, Suhua Chang, Zhao Li, Kunlin Zhang, Yang Du, Jurg Ott, Jing Wang, ADHDgene: a genetic database for attention deficit hyperactivity disorder, Nucleic Acids Research, Volume 40, Issue D1, 1 January 2012, Pages D1003–D1009, https://doi.org/10.1093/nar/gkr992

⁴Gizer, I.R., Ficks, C. & Waldman, I.D. Candidate gene studies of ADHD: a meta-analytic review. Hum Genet 126, 51–90 (2009). https://doi.org/10.1007/s00439-009-0694-x

⁵Mowlem, F.D., Rosenqvist, M.A., Martin, J. et al. Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment. Eur Child Adolesc Psychiatry 28, 481–489 (2019). https://doi.org/10.1007/s00787-018-1211-3

⁶Abdelnour E, Jansen MO, Gold JA. ADHD Diagnostic Trends: Increased Recognition or Overdiagnosis? Mo Med. 2022 Sep-Oct;119(5):467-473. PMID: 36337990; PMCID: PMC9616454.

⁷Nikkelen, S. W., Valkenburg, P. M., Huizinga, M., & Bushman, B. J. (2014). “Media use and ADHD-related behaviors in children and adolescents: A meta-analysis.” Developmental Psychology, 50(9), 2228-2241.

⁸Madigan S, Browne D, Racine N, Mori C, Tough S. Association Between Screen Time and Children’s Performance on a Developmental Screening Test. JAMA Pediatr. 2019;173(3):244–250. doi:10.1001/jamapediatrics.2018.5056

⁹Yifei, P, Xuechun, L,Yu, Y. (2023). Screen use and its association with ADHD symptoms among children: a systematic review. MEDS Public Health and Preventive Medicine, 3.10.23977/phpm.2023.030301

¹⁰Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry. 2012 Jan;51(1):86-97.e8. doi: 10.1016/j.jaac.2011.10.015. PMID: 22176942; PMCID: PMC4321798.

¹¹Huang L, Wang Y, Zhang L, Zheng Z, Zhu T, Qu Y, Mu D. Maternal Smoking and Attention-Deficit/Hyperactivity Disorder in Offspring: A Meta-analysis. Pediatrics. 2018 Jan;141(1):e20172465. doi: 10.1542/peds.2017-2465. PMID: 29288161.

¹²Goodlad JK, Marcus DK, Fulton JJ. Lead and Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms: a meta-analysis. Clin Psychol Rev. 2013 Apr;33(3):417-25. doi: 10.1016/j.cpr.2013.01.009. Epub 2013 Jan 29. PMID: 23419800.

¹³Nigg JT, Nikolas M, Mark Knottnerus G, Cavanagh K, Friderici K. Confirmation and extension of association of blood lead with attention-deficit/hyperactivity disorder (ADHD) and ADHD symptom domains at population-typical exposure levels. J Child Psychol Psychiatry. 2010 Jan;51(1):58-65. doi: 10.1111/j.1469-7610.2009.02135.x. Epub 2009 Nov 23. PMID: 19941632; PMCID: PMC2810427.

¹⁴Eubig PA, Aguiar A, Schantz SL. Lead and PCBs as risk factors for attention deficit/hyperactivity disorder. Environ Health Perspect. 2010 Dec;118(12):1654-67. doi: 10.1289/ehp.0901852. Epub 2010 Sep 9. PMID: 20829149; PMCID: PMC3002184.

¹⁵Howard AL, Robinson M, Smith GJ, Ambrosini GL, Piek JP, Oddy WH. ADHD is associated with a “Western” dietary pattern in adolescents. J Atten Disord. 2011 Jul;15(5):403-11. doi: 10.1177/1087054710365990. Epub 2010 Jul 14. PMID: 20631199.

¹⁶O’Nions E, El Baou C, John A, et al. Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study. The British Journal of Psychiatry. Published online 2025:1-8. doi:10.1192/bjp.2024.199

¹⁷Gnanavel S, Sharma P, Kaushal P, Hussain S. Attention deficit hyperactivity disorder and comorbidity: A review of literature. World J Clin Cases 2019; 7(17): 2420-2426 [PMID: 31559278 DOI: 10.12998/wjcc.v7.i17.2420]

¹⁸Kessler, Ronald & Adler, Lenard & Barkley, Russell & Biederman, Joseph & Conners, C & Demler, Olga & Faraone, Stephen & Greenhill, Laurence & Howes, Mary & Boye, Kristina & Spencer, Thomas & Ustun, Tevfik & Walters, Ellen & Zaslavsky, Alan. (2006). The Prevalence and Correlates of Adult ADHD in the United States: Results From the National Comorbidity Survey Replication. The American journal of psychiatry. 163. 716-23. 10.1176/appi.ajp.163.4.716.

¹⁹Babinski DE, Neely KA, Ba DM, Liu G. Depression and Suicidal Behavior in Young Adult Men and Women With ADHD: Evidence From Claims Data. J Clin Psychiatry. 2020 Sep 22;81(6):19m13130. doi: 10.4088/JCP.19m13130. PMID: 32965804; PMCID: PMC7540206.

²⁰Katelijne van Emmerik-van Oortmerssen, Geurt van de Glind, Wim van den Brink, Filip Smit, Cleo L. Crunelle, Marije Swets, Robert A. Schoevers, Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: A meta-analysis and meta-regression analysis, Drug and Alcohol Dependence, Volume 122, Issues 1–2, 2012, Pages 11-19, ISSN 0376-8716, https://doi.org/10.1016/j.drugalcdep.2011.12.007.

²¹Nazar BP, Bernardes C, Peachey G, Sergeant J, Mattos P, Treasure J. The risk of eating disorders comorbid with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Int J Eat Disord. 2016 Dec;49(12):1045-1057. doi: 10.1002/eat.22643. Epub 2016 Nov 15. PMID: 27859581.

²²Curtin, Carol & Pagoto, Sherry & Mick, Eric. (2013). The association between ADHD and eating disorders/pathology in adolescents: A systematic review. Open Journal of Epidemiology. 3. 193-202. 10.4236/ojepi.2013.34028.

²³Nock MK, Kazdin AE, Hiripi E, Kessler RC. Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: results from the National Comorbidity Survey Replication. J Child Psychol Psychiatry. 2007 Jul;48(7):703-13. doi: 10.1111/j.1469-7610.2007.01733.x. PMID: 17593151.

²⁴Curry AE, Yerys BE, Metzger KB, Carey ME, Power TJ. Traffic Crashes, Violations, and Suspensions Among Young Drivers With ADHD. Pediatrics. 2019 Jun;143(6):e20182305. doi: 10.1542/peds.2018-2305. Epub 2019 May 20. PMID: 31110164; PMCID: PMC6564068.

²⁵Ward JH, Curran S. Self-harm as the first presentation of attention deficit hyperactivity disorder in adolescents. Child Adolesc Ment Health. 2021 Nov;26(4):303-309. doi: 10.1111/camh.12471. Epub 2021 May 3. PMID: 33939246.

²⁶Hinshaw SP, Owens EB, Zalecki C, Huggins SP, Montenegro-Nevado AJ, Schrodek E, Swanson EN. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. J Consult Clin Psychol. 2012 Dec;80(6):1041-1051. doi: 10.1037/a0029451. Epub 2012 Aug 13. PMID: 22889337; PMCID: PMC3543865.

²⁷Ping-I Lin, Weng Tong Wu, Enoch Kordjo Azasu, Tsz Ying Wong, Pathway from attention-deficit/hyperactivity disorder to suicide/self-harm, Psychiatry Research, Volume 337, 2024, 115936, ISSN 0165-1781, https://doi.org/10.1016/j.psychres.2024.115936.

²⁸Li L, Zhu N, Zhang L, Kuja-Halkola R, D’Onofrio BM, Brikell I, Lichtenstein P, Cortese S, Larsson H, Chang Z. ADHD Pharmacotherapy and Mortality in Individuals With ADHD. JAMA. 2024 Mar 12;331(10):850-860. doi: 10.1001/jama.2024.0851. PMID: 38470385; PMCID: PMC10936112.

²⁹Faraone SV, Wilens T. Does stimulant treatment lead to substance use disorders? J Clin Psychiatry. 2003;64 Suppl 11:9-13. PMID: 14529324.

³⁰Chang Z, Quinn PD, Hur K, et al. Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes. JAMA Psychiatry. 2017;74(6):597–603. doi:10.1001/jamapsychiatry.2017.0659

³¹Spencer, Thomas et al. A large, double-blind, randomized clinical trial of methylphenidate in the treatment of adults with attention-deficit/hyperactivity disorder, Biological Psychiatry, Volume 57, Issue 5, 456 – 463

³²Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Leibson CL, Jacobsen SJ. Long-term stimulant medication treatment of attention-deficit/hyperactivity disorder: results from a population-based study. J Dev Behav Pediatr. 2006 Feb;27(1):1-10. doi: 10.1097/00004703-200602000-00001. PMID: 16511362.

³³Faraone, S. V., & Buitelaar, J. (2010). “Comparing the efficacy of stimulants for ADHD in children and adolescents using meta-analysis.” European Child & Adolescent Psychiatry, 19(4), 353-364.

³⁴Centers for Disease Control and Prevention. (2022, March 8). Treatment recommendations for healthcare providers. https://www.cdc.gov/adhd/hcp/treatment-recommendations/index.html.

³⁵Grossi, G. US ADHD Stimulant Shortage Highlights Growing Challenges in Adult Treatment. AJMC. 2024 Nov. https://www.ajmc.com/view/us-adhd-stimulant-shortage-highlights-growing-challenges-in-adult-treatment

³⁶Quinn PD, Chang Z, Hur K, Gibbons RD, Lahey BB, Rickert ME, Sjölander A, Lichtenstein P, Larsson H, D’Onofrio BM. ADHD Medication and Substance-Related Problems. Am J Psychiatry. 2017 Sep 1;174(9):877-885. doi: 10.1176/appi.ajp.2017.16060686. Epub 2017 Jun 29. PMID: 28659039; PMCID: PMC5581231.

³⁷Newcorn, J. H., Kratochvil, C. J., Allen, A. J., Casat, C. D., Ruff, D. D., Moore, R. J., & Michelson, D. (2008). “Atomoxetine and osmotically released methylphenidate for the treatment of attention deficit hyperactivity disorder: acute comparison and differential response.” American Journal of Psychiatry, 165(6), 721-730.

³⁸Sallee FR, McGough J, Wigal T, Donahue J, Lyne A, Biederman J; SPD503 STUDY GROUP. Guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder: a placebo-controlled trial. J Am Acad Child Adolesc Psychiatry. 2009 Feb;48(2):155-65. doi: 10.1097/CHI.0b013e318191769e. PMID: 19106767.

³⁹Connor DF, Findling RL, Kollins SH, Sallee F, López FA, Lyne A, Tremblay G. Effects of guanfacine extended release on oppositional symptoms in children aged 6-12 years with attention-deficit hyperactivity disorder and oppositional symptoms: a randomized, double-blind, placebo-controlled trial. CNS Drugs. 2010 Sep;24(9):755-68. doi: 10.2165/11537790-000000000-00000. PMID: 20806988.

⁴⁰Fabiano GA, Pelham WE Jr, Coles EK, Gnagy EM, Chronis-Tuscano A, O’Connor BC. A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clin Psychol Rev. 2009 Mar;29(2):129-40. doi: 10.1016/j.cpr.2008.11.001. Epub 2008 Nov 11. PMID: 19131150.

⁴¹Cerrillo-Urbina AJ, García-Hermoso A, Sánchez-López M, Pardo-Guijarro MJ, Santos Gómez JL, Martínez-Vizcaíno V. The effects of physical exercise in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis of randomized control trials. Child Care Health Dev. 2015 Nov;41(6):779-88. doi: 10.1111/cch.12255. Epub 2015 May 18. PMID: 25988743.

⁴²Ogundele MO, Yemula C. Management of sleep disorders among children and adolescents with neurodevelopmental disorders: A practical guide for clinicians. World J Clin Pediatr. 2022 Mar 15;11(3):239-252. doi: 10.5409/wjcp.v11.i3.239. PMID: 35663001; PMCID: PMC9134149.

⁴³Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry. 2012 Jan;51(1):86-97.e8. doi: 10.1016/j.jaac.2011.10.015. PMID: 22176942; PMCID: PMC4321798.

⁴⁴A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Arch Gen Psychiatry. 1999 Dec;56(12):1073-86. doi: 10.1001/archpsyc.56.12.1073. PMID: 10591283.

⁴⁵Richardson, A. J., Puri, B. K. (2002). “A randomized double-blind, placebo-controlled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties.” Progress in Neuro-Psychopharmacology & Biological Psychiatry, 26(2), 233-239.

⁴⁶Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry. 2012 Jan;51(1):86-97.e8. doi: 10.1016/j.jaac.2011.10.015. PMID: 22176942; PMCID: PMC4321798.

⁴⁷Ojinna BT, Parisapogu A, Sherpa ML, Choday S, Ravi N, Giva S, Shantha Kumar V, Shrestha N, Tran HH, Penumetcha SS. Efficacy of Cognitive Behavioral Therapy and Methylphenidate in the Treatment of Attention Deficit Hyperactivity Disorder in Children and Adolescents: A Systematic Review. Cureus. 2022 Dec 17;14(12):e32647. doi: 10.7759/cureus.32647. PMID: 36660538; PMCID: PMC9845961.

⁴⁸Gevensleben, H., Moll, G. H., Rothenberger, A., & Heinrich, H. (2014). Neurofeedback in attention-deficit/hyperactivity disorder – different models, different ways of application. Frontiers in human neuroscience, 8, 846. https://doi.org/10.3389/fnhum.2014.00846

⁴⁹ Arnold, L. E., Lofthouse, N., Hersch, S., Pan, X., Hurt, E., Bates, B., Kassouf, K., Moone, S., & Grantier, C. (2013). EEG neurofeedback for ADHD: double-blind sham-controlled randomized pilot feasibility trial. Journal of attention disorders, 17(5), 410–419. https://doi.org/10.1177/1087054712446173

⁵⁰Ramsay, J. R. (2010). Neurofeedback and neurocognitive training. In J. R. Ramsay, Nonmedication treatments for adult ADHD: Evaluating impact on daily functioning and well-being (pp. 109–129). American Psychological Association. https://doi.org/10.1037/12056-006

⁵¹ Gathercole S. E. (2014). Commentary: Working memory training and ADHD – where does its potential lie? Reflections on Chacko et al. (2014). Journal of child psychology and psychiatry, and allied disciplines, 55(3), 256–257. https://doi.org/10.1111/jcpp.12196

⁵² Chacko, A., Bedard, A. C., Marks, D. J., Feirsen, N., Uderman, J. Z., Chimiklis, A., Rajwan, E., Cornwell, M., Anderson, L., Zwilling, A., & Ramon, M. (2014). A randomized clinical trial of Cogmed Working Memory Training in school-age children with ADHD: a replication in a diverse sample using a control condition. Journal of child psychology and psychiatry, and allied disciplines, 55(3), 247–255. https://doi.org/10.1111/jcpp.12146

⁵³ Hulme, C., & Melby-Lervåg, M. (2012). Current evidence does not support the claims made for CogMed working memory training. Journal of Applied Research in Memory and Cognition, 1(3), 197–200. https://doi.org/10.1016/j.jarmac.2012.06.006

Donald Trump and Robert F. Kennedy, Jr., don’t understand ADHD or autism.

President Trump has a history of using the r-word. Health and Human Services Director RFK, Jr., has long maintained that vaccines cause autism, despite piles of evidence to the contrary; he’s even described autism by saying, “the brain is gone.” So it’s no shock that their new Make America Healthy Again Commission, established February 13, bristles with misunderstanding about both the rise in ADHD and autism diagnoses, and so-called “over-medication” of these and other conditions.

We’ve heard it all before. “Autism spectrum disorder now affects 1 in 36 children in the United States — a staggering increase from rates… during the 1980s,” they say. In the case of ADHD, “over 3.4 million children are now on medication for the disorder — up from 3.2 million children in 2019-2020 — and the number of children being diagnosed with the condition continues to rise.” It’s the kind of desperate handwringing we often hear from the fringes. Seeing it in an executive order from the president’s desk is admittedly scary.

The commission offers up all manner of scapegoats for this so-called rise in neurodivergence, or possibly false diagnoses. There are the usual suspects: diet, lifestyle, environmental factors. It also offers up some new boogeymen, including the “absorption of toxic material,” “medical treatments,” “electromagnetic radiation,” and “corporate influence or cronyism.” Never does this executive order grope toward the real reason: Refined diagnostic standards and outreach programs have created a wider net, which catches children before they spiral downward in adulthood. These improved standards have benefited all neurodivergent people, but particularly women and minorities.

ADHD Has Excluded Girls and Women

Back in the 1980s and 1990s, we thought attention deficit hyperactivity disorder was a condition for boys who couldn’t sit still. Millions of girls daydreamed and drifted in class. We made careless mistakes. We underperformed. We talked too much. But no one noticed. We were girls, and we didn’t cause a fuss. Now we know that those little girls also had ADHD. I was one of them. Yes, the number of children diagnosed with ADHD has risen, and thank God for it.

[Read: Why ADHD in Women is Routinely Dismissed, Misdiagnosed, and Treated Inadequately]

Every year, I see those little girls in my classroom, and I sit their parents down for the talk: Have you considered having your daughter tested? I tell them: Look, she’s 9, 10, 11. It may not seem like a big deal now, and sure, she’s doing great. But when she’s 15 or 18 or 30, that picture may look a lot different. I had all As ‘til I rage-quit a doctoral program. And every year, some parents ignore me. Others go on to get their daughters tested. Those kids go into the world armed with the help they need.

I have three boys, all with ADHD. None would have been caught in the diagnostic net of 1988 — they aren’t severe enough, troublesome enough. One has mixed-type ADHD that severely impacts his ability to concentrate on subjects he doesn’t like. He would desperately underperform without medical help. Another has inattentive ADHD, and he copes fine without medication at the moment. The youngest also has inattentive type and needs medication to function. He would have slipped through the cracks.

My husband and I both soldiered through school without ADHD diagnoses. Like most undiagnosed neurodivergent kids, we knew we weren’t like everyone else, but we didn’t know why. Therefore, we assumed something was terribly wrong with us, and it must be our fault. We blamed laziness — after all, weren’t teachers always demanding to know why we made so many careless mistakes? We blamed intellectual inferiority — we must be dumber than everyone else if we couldn’t pay attention.

Our self-esteem took a beating. This is remarkably common in the neurodivergent community. We’re trying to save our kids from it, and we’ve made remarkable headway.

With one stroke of a pen, this executive order would undo all that progress.

[Get This Free Download: A Parent’s Guide to ADHD Medications]

We’re Back to Blaming Parents for ADHD

U.S. Senator Tom Turberville (R-Alabama) lamented during RFK Jr.’s Senate confirmation hearings, “Attention deficit [ADHD], when you and I were growing up, our parents didn’t use a drug; they used a belt and whipped our butt… Nowadays, we give them Adderall and Ritalin. It’s like candy across college campuses and high school campuses.”

Then he asked Kennedy what he planned to do about the so-called over-prescription of stimulant medication for ADHD. The MAHA Commission is looking for someone to blame, and it has clearly chosen mothers. Why didn’t you feed your child organic food? Why did you vaccinate them? Why don’t you take them outside more, take away their screen? Why did you hand them a pill instead of parenting properly? It’s rife with assumptions, chief among them: This is your fault.

Once we blamed autism on cold mothers. Then we blamed it on their decision to vaccinate. Now we blame ADHD on permissive parenting.

Tuberville and Kennedy assume we give our kids pills because it’s “easier” than using an authoritarian style of parenting. We should be spanking the hyperactivity out of our kids instead of handing them Ritalin! That’ll cure the fidgets!

Clearly, none of these people have read the research: Authoritarian parenting leads to more negative outcomes, including aggression, delinquent behaviors, and anxiety. And that’s in neurotypical children. Ironically, authoritarian parenting — what Tuberville is suggesting when he tells us not to spare the rod — is shown to exacerbate ADHD symptoms.

We’re doing the best we can.

The Decision to Medicate Is Not Taken Lightly

No one gives their children medication as a first, second, or third choice. We try everything. We mess with their sleep schedules. We cut out foods and add fish oil. We give them more exercise and we modify their screen time. We try schedules. We try chore charts. We modify our parenting. We attempt everything. Ritalin scares us. And ADHD medication is hard to find — do these people really think we have the spare time to cruise different pharmacies, to try to find who has our prescription in stock? Do they think we want to obsess over side effects?

Handing your child a pill is scary. But some kids need it the way other kids need a heart medication, a diabetes medication. We should never pull a life-saving medication from a child.

Why do we think ADHD medication is optional? It’s not over-utilized. It’s not over-prescribed. It’s proven safe and effective and preventative for so many adverse outcomes.

We are doing the best we can by our children. The Make America Healthy Again Executive Order is rife with misunderstandings and assumptions about kids with ADHD and the people who parent them. Don’t blame parents — mothers, of course they mean mothers — for their kids’ brain differences. All people with ADHD and autism deserve the same respect and accommodation as other citizens, and that includes the right to medication at a doctor’s discretion. Our kids deserve better than this executive order. And so do we.

Make America Healthy Again Commission: Next Steps

• Free Download: The Ultimate Guide to ADHD Medication
• Read: “ADHD Is an Actual Condition. You Can’t Beat It Out of a Child.”
• Read: MAHA Commission Draws Swift Criticism, Condemnation

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The Trump administration’s recently established Make America Healthy Again Commission has come under fire from medical experts and patient advocacy groups for singling out autism spectrum disorder and ADHD, saying the “over-utilization of medication” for those and other conditions “pose a dire threat to the American people and our way of life.”

The commission, which will be chaired by the newly confirmed director of Health and Human Services, Robert F. Kennedy, Jr., a vocal anti-vaccine advocate, says it aims to end ADHD, autism, and other chronic health conditions with “fresh thinking on nutrition, physical activity, healthy lifestyles, over-reliance on medication and treatments, the effects of new technological habits, environmental impacts, and food and drug quality and safety.”

Almost immediately, the American Psychiatric Association (APA) and Autistic Self Advocacy Network (ASAN) condemned what it called the stigmatizing language and stated purpose of the commission, which established a 100-day mission to:

• “Assess the threat that over-utilization of medication” poses to children with chronic conditions like ADHD
• “Assess the prevalence of and threat posed by the prescription of SSRIs, antipsychotics, mood stabilizers, stimulants, and weight-loss drugs” to children
• “Identify and report on best practices for preventing childhood health issues, including through proper nutrition and the promotion of healthy lifestyles”
• “Identify and evaluate existing federal programs and funding intended to prevent and treat childhood health issues for their scope and effectiveness”
• And other tasks detailed in the full commission announcement at additu.de/maha

Over the weekend, roughly 1,200 employees of the National Institutes of Health, the nation’s top biomedical research agency, and roughly 700 staff members at the Food and Drug Administration were dismissed from their jobs, according to The New York Times. “At the Centers for Disease Control and Prevention, two prestigious training programs were gutted: one that embeds recent public health graduates in local health departments and another to cultivate the next generation of Ph.D. laboratory scientists,” the Times reported today.

“We know from the evidence and from our own clinical practice that the psychiatric drugs mentioned in the order, when prescribed and used as directed by properly trained psychiatrists, are safe, effective, and in some cases, lifesaving,” wrote APA CEO and Medical Director Marketa M. Wills, M.D., in an email to members on February 14. “APA stands for evidence-based science and will protect the treatments and practices that are so vital to many children and adolescents suffering from mental and substance use disorders.”

In its own statement, the autistic advocacy group ASAN wrote: “The proposed plan is full of attempts to research thoroughly debunked science, states goals that run counter to the actual actions taken by the administration, and spreads misinformation about autism. ASAN disapproves of the proposed plan, and will be joining efforts to push back against its harmful ideas, as well as the harmful policies proposed by the current administration…

“People with disabilities are not burdens; painting disabled people as burdens is ableist and presents disabled people as a ‘problem to be solved,’ rather than a group of people who deserve to be fully included in all aspects of society.”

Among ADDitude readers, the reaction was similarly swift and negative. Of 852 comments posted to Instagram over four days, roughly 9 out of 10 criticized the MAHA Commission and expressed worry and/or outrage. The following quotes received the greatest community reaction.

“I have so much to say about this commission as a physician, public health specialist, parenting coach and mom. I felt sick after reading it last night and enraged at the same time. Such a lack of insight. I don’t affiliate with either party, but this is a time when politics is targeting my own home and my children’s ability to thrive. I will speak up and out about that.” – @aparentlyparenting

“I’m not a child psychiatrist but have two neurodivergent kids. We limit screen time. They participate in several sports (on their schools’ sports team, practice two hours a day in the fresh sunshine and all that). We do CBT and family therapy, but meds are also necessary. This is stigmatizing medication for our kids.” – @drrupawong

“How are they supposed to study this if they cut funding to the NIH? The data will be skewed.” – @ristafarian

“Why don’t we take advice for actual physicians and pharmacists who know what they are talking about and have actually studied medicine!? I have ADHD, I take my medication, but I also work out two to three times a week running and lifting weights, I walk, I go to therapy, I journal, try mindfulness and manage the best I can. Even with all of these things (also eating healthy and have perfect bloodwork at 42), I still would struggle significantly without my meds.” – @kjacono

“Quite terrifying. If they want to MAHA, then provide affordable healthcare that includes coverage for mental health evaluation and treatment.” – @skipcoaching

“You know what would ‘Make America Healthy Again?’ Universal healthcare, livable wages, free education, bodily autonomy for women and trans folks, not removing critical information from the CDC’s website… Acting like any of this has to do with ‘health’ is preposterous!” – @stokedcoaching

“Further study is always great but using language like ‘over utilized’ and ‘threat’ is sickening. So what is the goal of this administration? First dismantle the Department of Education to limit our kids’ protections and rights to IEP and 504 services, now limit their med intake?! While also pulling out of health organizations that DO research? So who will be doing the research listed in this executive order? Who does this help? Make it make sense.” – @menagerie_mel

“I am appalled. As a late diagnosed ADHDer who relies on medication after trying to manage life without it for 35 years, doing all the healthy diet, exercise, blah blah blah stuff, and feeling completely inadequate and incapable….no.” – @katehreno

“Obviously bad news for those of us who have ADHD, but what a win for all the quacks who insist it’s made up or shouldn’t be medicated. They must be so excited to blame ADHD on vaccines or seed oils or working mothers or whatever else feeds their agenda. Maybe they can use this to promote their own unregulated supplements and turn a tidy profit.” – @theashleyclem

“You know what poses a threat to the American public? Unmedicated people with ADHD. Our jails are filled with people who could have used pharmacological interventions earlier in life.” – @skustra

“ADHD runs in my family, and I lost one cousin to ‘self-medicating’ and another to a horrific motorcycle accident due to impulsivity and thrill-seeking behaviors. Neither of them got the help they needed, and I wonder if they would still be here if they had. When my youngest started showing signs, we got him assessed and promptly medicated. He is safer now and his impulsive behaviors have drastically decreased. I am terrified that we are going to lose access to potentially life-saving medication.” – @life_is_weird4

“For decades, I was told I had anxiety and depression, and I tried every medication but nothing ever worked. I couldn’t finish college, I jumped from job to job, my emotions were constantly deregulated… Life felt overwhelming constantly. The day I started medication for ADHD my life changed. I have a job I love and thrive at, I feel in control, I have motivation, I don’t nap all day anymore, my mood swings are under control, I lost 60 pounds, and I am happier. The thought of my medication not being available to me is horrific and I can’t go back to how I was living.” – @zewingirl

“One thing. ONE THING gives me hope. Big pharma doesn’t want him to take their profits. And our meds? They’re VERY profitable.” – @eabroadbent

“I don’t see the harm in ‘assessing’ the use of medication and the possibility that dietary and lifestyle changes can also treat ADHD successfully in some cases. I don’t believe it’s an all-or-nothing situation and there’s nothing wrong with assessing how current treatments are working and if complementary or alternative treatments can be implemented to improve outcomes both from a psychological perspective as well as a financial standpoint.” – @faithology101

Read all of the ADDitude community comments posted to Instagram here.

Stimulant medication may normalize certain brain regions impacted by ADHD in children, according to a cross-sectional neuroimaging study of 7,126 children aged 9 to 10 recently published in Neuropsychopharmacology.¹

Study participants were divided into three groups. The “no-med ADHD” group included 1,002 children with severe ADHD symptoms who were not taking stimulant medication. The “stim low-ADHD” group included 273 children whose ADHD symptoms were mild and well-managed with stimulant medication. The “TDC” group included 5,378 typically developing controls.

ADHD symptoms experienced by the no-med ADHD group were associated with brain structure abnormalities not seen in the TDC or stim low-ADHD group, including:

• lower cortical thickness in the insula (INS), a brain area associated with saliency detection or the ability to prioritize information
• less grey matter volume in the nuclear accumbens (NAc), a brain area associated with reward processing and motivation

Children in the stim low-ADHD group showed no significant differences in these brain areas compared to controls. This contrast in structural MRIs suggests that stimulant medication may work to normalize some (but not all) brain regions and improve symptoms in children with ADHD.

Stimulant medication was not associated with improvement in all brain regions. Among those not impacted were the following:

• the caudate (CAU), a brain area responsible for motor control
• the amygdala (AMY), a brain area responsible for emotions

“This result is consistent with previous studies,” the researchers wrote. “Reduced volume in children with ADHD in the CAU is one of the most replicated findings in sMRI studies. No effect of stimulant medications was found in the CAU in the participants with ADHD in several cross-sectional studies. Along the same lines, longitudinal studies on children pointed to the improvement of volumes in the CAU associated with age but not stimulant medications… and two previous studies also pointed out there was no effect of stimulant medications on the AMY.”

Non-stimulant medication did not significantly impact brain structure.

A separate validation analysis included 273 participants with high ADHD symptoms who were taking stimulant medication; the results were consistent with the main study and still suggested that stimulant medication had a positive and noticeable effect on the brain structure of children in this group compared to the no-med ADHD group, even though both groups had high symptom severity at the time of the study.

“These findings are important for the treatment of children with ADHD using stimulant medication,” the researchers wrote.

Stimulant Medication & the ADHD Brain

Stimulants are the first-line treatment for ADHD in children aged 6 and older, teens, and adults. However, some people with ADHD discontinue medication due to side effects. The most common side effects reported by caregivers in ADDitude’s 2023 treatment survey were appetite suppression, irritability or moodiness, and sleep problems.

“Our current medication treatments for ADHD work quite well, but unfortunately, many children stop the treatment or stop taking medication,” said Jonathan Posner, M.D., in his 2020 ADDitude webinar, “Secrets of the ADHD Brain: How Brain Imaging Helps Us Understand and Treat Attention Deficit.” “In fact, the majority of teenagers with ADHD will stop treatment within two years.”

Understanding the parts of the brain that are impacted by stimulant medication can help refine treatment and determine “which of those changes are responsible for symptom improvement versus side effects,” Posner said.

“One of the things that brain imaging has shown is that the development of the brain in children with ADHD seems to be somewhat delayed,” Posner said. “But the overall course of development in children with ADHD versus without ADHD is very similar. It’s almost as if the ADHD brain is a couple of years behind. The very optimistic part of this is that it ultimately does catch up for most children with ADHD.”

For the majority of patients, ADHD symptoms do continue into adulthood, and the prevalence of ADHD in adults is rising. ^{2, 3} However, the present study confirmed Posner’s observations and found that children with even severe ADHD caught up developmentally for the region of the brain responsible for prioritizing information.

MRI scans showed greater cortical thickness in the INS region for the stim-low ADHD group and TDC group compared to the no-med ADHD group. However, data from a two-year follow-up analysis showed these differences were no longer present. Development of the INS is complicated, the researchers noted, but they suggested that “the No-Med group has delayed INS development at baseline, which eventually catches up to the other children.” Researchers theorize that stimulant medication may speed up this process and will continue to follow up with children over the next few years.

Limitations & Future Research

Participant data was obtained from the Adolescent Brain Cognitive Development (ABCD) study, an ongoing study since 2019 that will follow children over 10 years. Data was obtained via structural MRIs and symptom questionnaires and analyzed using linear mixed-effects models (LMM). The study included measures of cortical thickness, cortical area, cortical and subcortical volumes, and total intracranial volume.

The ABCD study lacked diagnostic information for ADHD; therefore, researchers grouped participants using latent class analysis (LCA) and 18 ADHD symptoms from the K-SADS — a moderately reliable test of affective disorders and schizophrenia. Children with bipolar disorders and anxiety disorders, oppositional defiant disorder, obsessive-compulsive disorders, and conduct disorders were excluded from the study.

Results indicate that stimulant medication may enhance brain structure and alleviate ADHD symptoms; however, this study was cross-sectional and did not establish clear causation. Information on the mean dose and duration of participants’ stimulant medication use was missing from the study. Additionally, researchers warned that the study did not fully capture the association between brain structure and ADHD severity. The stim-low ADHD group was much smaller than the other two groups, which may have hindered the study’s results. The two-year follow-up (in line with ABCD study release 4.0) included fewer participants (3,992 after exclusion criteria). Results should be interpreted with caution.

Future research should further incorporate supplemental data on stimulant use, study stimulant use by patients with severe ADHD, and include more longitudinal data.

Sources

¹Wu, F., Zhang, W., Ji, W. et al. (2024). Stimulant medications in children with ADHD normalize the structure of brain regions associated with attention and reward. Neuropsychopharmacol, 49, 1330–1340. https://doi.org/10.1038/s41386-024-01831-4

²U.S. Centers for Disease Control and Prevention. (2024, October 4). ADHD in adults: an overview.
https://www.cdc.gov/adhd/articles/adhd-across-the-lifetime.html

³American Psychiatric Association. (2019, November 15). ADHD increasing among adults.
https://www.psychiatry.org/news-room/apa-blogs/adhd-increasing-among-adults

Dialectical behavior therapy (DBT) is an evidence-based treatment designed to help individuals who struggle with emotional dysregulation, aggression, self-harm, and other problem behaviors. DBT is an intensive, highly structured program that was originally created for adults in the 1970s and has since been adapted for children and adolescents. It can be an effective treatment for ADHD because it aids in the development of skills that support emotional regulation, problem-solving, and self-acceptance.

DBT works by helping children develop skills that decrease unwanted feelings and unhelpful behaviors, as well as skills that help them to accept difficult feelings about themselves and others without judgment. DBT patients participate in one-on-one therapy, group skills training, and/or phone coaching from their therapist. Parents learn the same skills as their children so that they can reinforce those skills outside of therapy.

In this webinar, you will learn:

• About the conditions that DBT treats in children and adolescents, and who would be a good fit for this therapy
• About DBT as a treatment model and how it works
• How DBT can support children and adolescents in managing mood, impulsivity, and anxiety
• About DBT strategies to support children in distress

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DBT for ADHD: More Resources

• Download: What Is Dialectical Behavior Therapy (DBT)?
• Read: Overview of ADHD Therapies
• Q&A: Why Deficient Emotional Self-Regulation is Central to ADHD
• eBook: The Parents’ Guide to Raising a Teen with ADHD

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Meet the Expert Speaker

Lauren Allerhand, Psy.D., is Co-Director of the Dialectical Behavior Therapy Programs and a psychologist for the Mood Disorders Center at the Child Mind Institute in the San Francisco Bay Area. She specializes in the evidence-based assessment and treatment of youth struggling with depression, anxiety, trauma, eating disorders, ADHD, and oppositional defiant disorder. She has extensive training in cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). Dr. Allerhand is particularly passionate about providing DBT to improve the lives of high-risk, diagnostically complex youth who struggle with emotion dysregulation, suicidality, and self-injury.

Dr. Allerhand’s clinical practice also emphasizes supporting parents of children and teens with emotion dysregulation, oppositional behavior, or ADHD through evidence-based intervention. She has specialized trained in a DBT parenting intervention and Parent Management Training for parents of older children and teenagers. Dr. Allerhand is also certified in Parent Child Interaction Therapy (PCIT), an evidence-based intervention for families with preschool-aged children.

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