Management of attention deficit hyperactivity disorder
Attention deficit hyperactivity disorder management options are evidence-based practices with established treatment efficacy for ADHD. Approaches that have been evaluated in the management of ADHD symptoms include FDA-approved pharmacologic treatment and other pharmaceutical agents, psychological or behavioral approaches, combined pharmacological and behavioral approaches, cognitive training, neurofeedback, neurostimulation, physical exercise, nutrition and supplements, integrative medicine, parent support, and school interventions. Based on two 2024 systematic reviews of the literature, FDA-approved medications and to a lesser extent psychosocial interventions have been shown to improve core ADHD symptoms compared to control groups.
The American Academy of Pediatrics recommends different treatment paradigms depending on the age of the person being treated. For those aged 4–5, the AAP recommends evidence-based parent- and/or teacher-administered behavioral interventions as first-line treatment, with the addition of methylphenidate if there is continuing moderate-to-severe functional disturbances. For those aged 6–11, the use of medication in combination with behavioral therapy is recommended, with the evidence for stimulant medications being stronger than that for other classes. For adolescents aged 12–17, use of medication along with psychosocial interventions are recommended. While non-pharmacological therapy and medical therapy are two accepted treatment plans, it remains unclear what the most effective course of treatment would be.
There are a number of stimulant and non-stimulant medications indicated for the treatment of ADHD. The most commonly used stimulant medications include methylphenidate, dexmethylphenidate, Serdexmethylphenidate/dexmethylphenidate, mixed amphetamine salts, dextroamphetamine, dextromethamphetamine, and lisdexamfetamine. Non-stimulant medications with a specific indication for ADHD include atomoxetine, viloxazine, guanfacine, and clonidine. Other medicines which may be prescribed off-label include bupropion, tricyclic antidepressants, SNRIs, or MAOIs. The relative efficacy of stimulant vs non-stimulant medication is still contested, and under active study. The presence of comorbid disorders can make finding the right treatment and diagnosis much more complicated, costly, and time-consuming. So it is recommended to assess and simultaneously treat any comorbid disorders.
A variety of psychotherapeutic and behavior modification approaches to managing ADHD including psychotherapy and working memory training may be used. Improving the surrounding home and school environment with parent management training and classroom management can improve behavior and school performance of children with ADHD. Specialized ADHD coaches provide services and strategies to improve functioning, like time management or organizational suggestions. Self-control training programs have been shown to have limited effectiveness.
Psychosocial
There are a variety of psychotherapeutic approaches employed by psychologists and psychiatrists; the one used depends on the patient and the patient's symptoms. The approaches include psychotherapy, cognitive-behavior therapy, support groups, school-based interventions, parent training, meditation, mindfulness, neurofeedback, and social skills training. In a 2019 review the effectiveness of social skills training was evaluated in children aged 5 to 18 years. At the time there was little evidence to support or refute this type of training for the treatment of ADHD in this age group.Parents and classroom
Improving the surrounding home and school environment can improve the behavior of children with ADHD. Parents of children with ADHD often show similar deficits themselves, and thus may not be able to sufficiently help the child with his or her difficulties. Improving the parents' understanding of the child's behavior and teaching them strategies to improve functioning and communication and discourage unwanted behavior has measurable effect on the children with ADHD. The different educational interventions for the parents are jointly called Parent Management Training. Techniques include operant conditioning: a consistent application of rewards for meeting goals and good behavior and punishments such as time-outs or revocation of privileges for failing to meet goals or poor behavior. It is important to note that Parent Management Training is recommended as the first-line treatment for preschool-aged children when available and appropriate. Classroom management is similar to parent management training; educators learn about ADHD and techniques to improve behavior applied to a classroom setting. Strategies utilized include increased structuring of classroom activities, daily feedback, and token economy. In order for Token Economy to benefit students with ADHD, all staff must be consistent in rewarding the same behaviors. Additionally, establishing classroom routines will help to ensure that students with ADHD remain focused throughout the day.Cognitive training
Cognitive trainings can be delivered in a number of methods, including at home or hospital based programs. A 2013 paper published by two researchers from the University of Oslo concluded that working memory training provides short term improvements, but that there was limited evidence that these improvements were sustained or that they were generalized to improved verbal ability, mathematical skills, attention, or word decoding. A 2014 paper published by a group of researchers from the University of Southampton presented the result of meta analysis study of 14 recently published randomized controlled trials. The authors concluded that "more evidence from well-blinded studies is required before cognitive training can be supported as a frontline treatment of core ADHD symptoms". A more recent 2023 meta-analysis of RCTs examined the efficacy of computerized cognitive training in reducing ADHD symptoms through computer programs. In addition to finding short-term working memory improvements, they also found some evidence of long-term verbal working memory effects. However, the results were limited to the study's settings, and the authors highlighted the need for more targeted intervention strategies.Medications
Stimulants
are the most commonly prescribed medications for ADHD. The stimulant medications indicated to treat ADHD are methylphenidate, dexmethylphenidate, Serdexmethylphenidate/dexmethylphenidate, mixed amphetamine salts, dextroamphetamine, lisdexamfetamine, and in rare cases dextromethamphetamine. Controlled-release pharmaceuticals may allow once daily administration of medication in the morning. This is especially helpful for children who do not like taking their medication in the middle of the school day. Several controlled-release methods are used.Stimulants used to treat ADHD raise the extracellular concentrations of the neurotransmitters dopamine and norepinephrine, which increases cellular communication between neurons that utilize these compounds. Stimulants increase the availability of synaptic dopamine, reduce the overactivity, impulsivity, and inattention characteristics of patients with ADHD, and improve associated behaviors, including on-task behavior, academic performance, and social functioning.
The therapeutic benefits are due to noradrenergic effects at the locus coeruleus and the prefrontal cortex and dopaminergic effects at the ventral tegmental area, nucleus accumbens, and prefrontal cortex. This elevation of catecholamines, predominantly in the prefrontal cortex, preferentially activates dopamine D1 and norepinephrine α2 receptors, both of which are crucial for mediating cognitive processes including attention, inhibitory control, and working memory. Neuroimaging studies have shown that stimulants act to modulate activity in the right inferior frontal cortex and insula—regions implicated in attention and inhibition—and regulate fronto-striato-parietal networks, which are often dysregulated in ADHD. These effects are manifested in correlated clinical improvements in attention, reduced distractibility, and decreased hyperactivity and impulsivity.
Stimulant medications are considered safe when used under medical supervision. Nonetheless, there are concerns that the long term safety of these drugs has not been adequately documented, as well as social and ethical issues regarding their use and dispensation. The U.S. FDA has added black-box warnings to some ADHD medications, warning that abuse can lead to psychotic episodes, psychological dependence, and that severe depression may occur during withdrawal from abusive use. Studies consistently show that most students report using stimulant medications, legally or illegally to improve academic performance, specifically to increase concentration, organization, and the ability to stay up longer and study. The abuse of this drug has made prescribing it much more meticulous.
Stimulants are some of the most effective medications available for the treatment of ADHD. Seven different formulations of stimulants have been approved by the U.S. Food and Drug Administration for the treatment of ADHD: four amphetamine-based formulations, two methylphenidate-based formulations, and dextromethamphetamine hydrochloride. Atomoxetine, viloxazine, guanfacine, and clonidine are the only non-controlled, non-stimulant FDA approved drugs for the treatment of ADHD.
Short-term clinical trials have shown medications to be effective for treating ADHD, but the trials usually use exclusion criteria, meaning knowledge of medications for ADHD is based on a small subset of the typical patients seen in clinical practice. They have not been found to improve school performance and data is lacking on long-term effectiveness and the severity of side effects. Stimulants, however, may reduce the risk of unintentional injuries in children with ADHD.
This class of medicines is generally regarded as one unit; however, they affect the brain differently. Some investigations are dedicated to finding the similarities of children who respond to a specific medicine. The behavioral response to stimulants in children is similar regardless of whether they have ADHD or not.
Stimulant medication is an effective treatment for adult attention-deficit hyperactivity disorder although the response rate may be lower for adults than children. A 2025 meta-analytic systematic review of 113 randomized controlled trials demonstrated that stimulant medications significantly improved core ADHD symptoms in adults over a three-month period, with good acceptability compared to other pharmacological and non-pharmacological treatments.
Some physicians may recommend antidepressant drugs as the first line treatment instead of stimulants although antidepressants have much lower treatment effect sizes than stimulant medication.