What are the recommended treatments for Attention Deficit Hyperactivity Disorder (ADHD)?

Recommended Treatments for Attention Deficit Hyperactivity Disorder (ADHD)

For the treatment of ADHD, FDA-approved medications combined with behavioral interventions provide the most effective outcomes for reducing core symptoms and improving functioning across all age groups. 1

Age-Specific Treatment Recommendations

Preschool Children (4-5 years)

• Evidence-based parent-administered behavior therapy should be prescribed as first-line treatment 1
• Methylphenidate may be prescribed if behavioral interventions do not provide significant improvement and there is moderate-to-severe continuing functional impairment 1
• When weighing medication use in this age group, consider that preschoolers may experience increased mood lability and dysphoria with stimulant medications 1

Elementary and Middle School-Aged Children (6-11 years)

• Combination of FDA-approved medications AND behavioral interventions (preferably both parent training/behavioral management and classroom interventions) is strongly recommended 1
• Stimulant medications have the strongest evidence for effectiveness (effect size 1.0), followed by atomoxetine, extended-release guanfacine, and extended-release clonidine (effect size 0.7) 1
• Educational interventions and individualized instructional supports are necessary components of any treatment plan 1

Adolescents (12-18 years)

• FDA-approved medications with the adolescent's assent is strongly recommended 1
• Evidence-based training interventions and/or behavioral interventions should be included when available 1
• School-based training interventions focusing on functioning skills have shown consistent benefits for adolescents 1
• The greatest benefits from training interventions occur with extended treatment duration, frequent constructive feedback, and direct application to daily functioning 1

Adults

• Combination of medication and psychosocial treatment is recommended 1
• Cognitive-behavioral therapy (CBT) has shown effectiveness for ADHD in adults, particularly when combined with medication 1, 2, 3
• CBT helps develop executive functioning skills, time management, organization, planning, and emotional self-regulation 1

Medication Options

Stimulant Medications

• First-line pharmacological treatment with strongest immediate effect on core ADHD symptoms 1
• Approximately 70-80% of people with ADHD respond to stimulants 1
• Include methylphenidate and amphetamine-based medications (amphetamine, dexamphetamine, lisdexamfetamine) 1, 4
• Individual response to methylphenidate versus amphetamine is idiosyncratic 1

Non-Stimulant Medications

• Atomoxetine (Strattera) - FDA-approved for children and adults with ADHD 5, 6
• Extended-release guanfacine and extended-release clonidine - alpha-2 adrenergic receptor agonists 1, 4
• Viloxazine - selective noradrenaline reuptake inhibitor 4
• Non-stimulants may take several weeks to achieve full therapeutic effect 6
• Atomoxetine carries a warning for increased risk of suicidal ideation in children and adolescents 5

Behavioral and Psychosocial Interventions

Behavioral Parent Training

• Well-established treatment for children with ADHD 1, 7
• Teaches parents to influence environmental contingencies to improve child behavior 1
• Effects tend to persist after treatment ends, unlike medication effects 1
• Parents often report higher satisfaction with behavioral therapy than with medication alone 1

School-Based Interventions

• Classroom behavioral management improves attention to instruction, compliance with rules, and work productivity 1, 7
• Educational accommodations often include Individualized Education Programs (IEP) or rehabilitation plans (504 plans) 1

Training Interventions

• Target skill development with repeated practice and performance feedback 1
• Effective for addressing disorganization of materials and time management 1
• Social skills training alone has not been shown to be effective for children with ADHD 1

Cognitive-Behavioral Therapy (CBT)

• Particularly beneficial for adolescents and adults 1, 2
• Helps develop executive functioning skills, time management, and emotional regulation 1
• Low-quality evidence suggests CBT may improve common secondary disturbances such as depression and anxiety 3

Ineffective or Insufficient Evidence Treatments

• The following treatments have insufficient evidence or have been found to have little to no benefit: 1
  • Mindfulness (except in adults where evidence is emerging) 1
  • Cognitive training
  • Diet modification
  • EEG biofeedback
  • Supportive counseling
  • Cannabidiol oil (evidence is anecdotal only)
  • External trigeminal nerve stimulation (eTNS) has limited evidence 1

Important Clinical Considerations

• The positive effects of behavioral therapies tend to persist, while medication effects cease when medication stops 1
• Optimal care is likely to occur when both medication and behavioral therapies are used together 1
• Treatment decisions should consider family preferences and feasibility, as these factors predict engagement and persistence with treatment 1
• For adolescents, behavioral family approaches may be helpful, but responses to behavioral contingencies are more varied than in younger children 1
• Regular monitoring for adverse effects of medications is essential, particularly for stimulants 5
• ADHD should be recognized as a chronic condition requiring ongoing management following principles of the chronic care model 1