September 18, 2026

Long-term stimulant use for ADHD negligibly affects adult height, according to a new cohort study published in Pediatric Research that tracked 64,775 children for up to 28 years.¹

Parents making ADHD treatment decisions commonly worry that prescription stimulants will stunt their child’s growth. In a 2024 ADDitude survey of 11,000 readers, less than half (42%) of parents chose to medicate their children in the months following an ADHD diagnosis. Those respondents cited side effects like appetite suppression or sleep disruption — both possible impediments to growth — as influences on their decision.

Murky or conflicting findings from previous studies have done little to ease caregivers’ worries.

“Many prior studies either did not follow participants to adult height, so reported effects may reflect delayed maturation rather than true adult height deficits, or they did not account for genetic height potential, which may confound results,” the study’s authors wrote.^{2, 3}

The Pediatric Research study followed a different methodology. It measured the impact of ADHD and stimulant treatment on an individual’s adult height relative to their expected genetic height potential, based on their parents’ heights. Taking an individual-level normalization approach accounted for familial genetic height potential, reducing uncertainty from delayed maturation and group-level bias.

The researchers used health records from a nationwide provider to assemble a retrospective cohort of 17,517 children with treated and untreated ADHD, plus 47,258 in a control group, all born between 1995 and 2003. (Of those with ADHD, 11,846 received stimulant treatment, and 5,671 did not.) They followed the children through 2023 to ensure they reached adult height, defined as at least age 17 for girls and age 19 for boys.

When they compared adult heights across the three groups using an ANOVA (analysis of variance), they found statistically detectable but clinically negligible effect sizes in adult height for girls with ADHD taking stimulant medication and non-significant differences in adult height for boys with ADHD who were treated with stimulants.

“The large sample size increases the likelihood of detecting statistically significant but trivial differences; therefore, effect size analysis is essential for interpreting practical relevance,” the study’s authors wrote.

The effect sizes were consistently very small, and the physical difference measured between the groups was less than a centimeter, which is below the typical range considered clinically meaningful and within the range of routine measurement error.

“Given the very small effect sizes and sub-centimeter absolute differences, clinicians and families can be reassured that decisions regarding stimulant therapy need not be driven primarily by concerns about potential reductions in adult height,” the study’s authors wrote.

Sources

¹Gabbay, M., Gabbay, U. and Carmi, D. (2026). The impact of ADHD and neurostimulant treatment on normalized height deviance after accounting for genetic height potential. Pediatric Research. https://doi.org/10.1038/s41390-026-04929-1
²Spencer, T.J. et al. (1996). Growth deficits in ADHD children revisited: evidence for disorder-associated growth delays. J. Am. Acad. Child Adolesc. Psychiatry.  https://doi.org/10.1097/00004583-199611000-00014
³Biederman, J. et al. (2003). Growth deficits and attention-deficit/hyperactivity disorder revisited: impact of gender, development, and treatment. Pediatrics. https://doi.org/10.1542/peds.111.5.1010

September 17, 2026

Methylphenidate (brand name: Ritalin) use is associated with real-time improvements in both ADHD symptoms and daily functioning at work, which continue to strengthen over time in adults with ADHD, according to a new exploratory study published in the Journal of Attention Disorders.¹

Of participants with ADHD who received methylphenidate:

• 39.6% showed improvement in both symptoms and functioning
• 33.8 % showed improvement in symptoms but not functioning
• 4.3% showed improvement in functioning but not symptoms

Within the placebo group, symptoms and functioning improved in 26% of participants, and 43.8% demonstrated no improvement on either measure.

The findings suggest that evaluating symptom improvement alone isn’t enough to determine whether a patient is receiving optimal treatment. Clinicians should also consider how ADHD medication impacts a patient’s daily functioning, such as their ability to arrive at work on time, perform job functions reliably, and meet productivity goals at work.

“The evaluation of symptoms alone may be a relatively weak method of determining if a patient is actually being optimally treated,” the study’s authors wrote. “Symptom change may be more immediate and more sensitive to medication treatment, but robust symptom change is associated with the functional response that is the more meaningful target of treatment.”

The study included a four-week double-blind clinical trial followed by a six-month open-label (OL) follow-up phase. The researchers measured symptoms and functional changes before and after the study period using the ADHD Rating Scale-5 (ADHD-5-RS), the Clinical Global Impressions Improvement scale (CGI-I), and the Weiss Functional Impairment Rating Scale—Self Report (WFIRS-S). (The WFIRS-S evaluates how the patient feels their emotional and behavioral symptoms impact their level of functioning in the following domains: Family, Work, School, Life Skills, Self-Concept, Social, and Risky Activities.)

For the clinical trial, 351 adults with ADHD aged 18 and older took extended-release methylphenidate ranging from 25 mg to 100 mg or placebo once daily. At the end of the four weeks, 40% of those taking methylphenidate showed significant functional improvement, and 47.5% were rated as “improved” or “very much improved” on the CGI-I. Symptoms continued to improve, with 14% of improvement occurring in the last four months of the six-month OL phase.

Clinicians titrated methylphenidate doses to the point of optimal improvement during the OL phase. By the sixth month, 66.7% of the 124 participants achieved both symptomatic and functional improvement across all WFIRS-S domains.

Stimulant Treatment Associated with Improvements in Job Performance

Work was the only WFIRS-S domain in which participants taking methylphenidate showed significant improvements compared with the placebo group during the double-blind clinical trial and the OL follow-up. (The Work domain assessed job performance, punctuality, job retention, productivity, and work potential.)

The association between methylphenidate treatment and improved work-related functioning may offer hope for adults with ADHD, who face a substantially higher risk of career instability and unemployment.^{2, 3}

In 2024, a longitudinal study of nearly 7,000 participants in the Journal of Attention Disorders found that individuals with comorbid ADHD and oppositional defiant disorder symptoms face higher unemployment rates, lower overall income, and more frequent sick days in adulthood compared to their neurotypical peers.⁴

Many ADDitude readers have experienced firsthand how ADHD symptoms can impact employment status and job performance.

“I have lost plenty of jobs due to my ADHD symptoms,” wrote Tim, from North Carolina. “However, I was unmedicated for many years and didn’t realize that I was struggling because of my ADHD.”

“I left my most recent job because I couldn’t handle all the details in the paperwork,” said Dawn from Virginia. “I just kept missing things. It wasn’t a good fit.”

“I suffered from severe burnout from a job that wasn’t suited for my ADHD brain,” another reader said. “It resulted in severe exhaustion and depression and became so serious that I lost the ability to continue employment. I’ve been surviving on disability benefits since.”

While more research is needed to determine which parts of an adult’s daily life respond best to stimulants, and how doctors can fine-tune ADHD medication doses for each patient, the study’s authors are encouraged by their findings.

“The take-home message for clinicians is that stimulant treatment of adults with ADHD can be anticipated to lead to functional improvement in most patients and optimized functional impairment over time in more than half of patients,” they wrote.

Sources

¹Weiss, M.D., Newcorn, J.H., Donnelly, G.A.E. et al. (2026). An exploratory study of functional outcome in stimulant treatment of ADHD in adults. Journal of Attention Disorders. https://doi.org/10.1177/10870547261440452

² Jangmo, A., Kuja-Halkola, R., Pérez-Vigil, A., et al. (2021). Attention-deficit/hyperactivity disorder and occupational outcomes: the role of educational attainment, comorbid developmental disorders, and intellectual disability. PLoS One. https://doi.org/10.1371/journal.pone.0247724

³Jervan, B., Torgersen, T., Nordahl, H.M., & Rasmussen, K. (2012). Functional impairment and occupational outcome in adults with ADHD. J Atten Disord. https://doi.org/10.1177/1087054711413074

⁴ Seppä, S., Huikari, S., Korhonen, M., Nordström, T., Hurtig, T., & Halt, A.-H. (2024). Associations of symptoms of ADHD and oppositional defiant disorder (ODD) in adolescence with occupational outcomes and incomes in adulthood. Journal of Attention Disorders. https://doi.org/10.1177/10870547241259329

August 26, 2026

ADHD medications decrease antidepressant usage and reduce symptoms of depression and anxiety in people diagnosed with attention deficit, suggest findings from three new studies.

Antidepressant and psychotropic medication use in adults often precedes an ADHD diagnosis; however, a new landmark study published in Acta Psychiatrica Scandinavica152 found that use of selective serotonin reuptake inhibitors (SSRIs) and other antidepressants decreased substantially after adults received an ADHD diagnosis and began treatment with a stimulant or non-stimulant medication.1

Women received antidepressant prescriptions prior to an ADHD diagnosis much more often than did men, according to the Finnish cohort study of 322,416 adults (66,146 with ADHD and 256,270 without). The researchers attribute this to clinicians misinterpreting or misdiagnosing ADHD symptoms as anxiety or depression in women. Depression and anxiety can also result from living with untreated ADHD. As many as 80% of adults with ADHD have at least one coexisting psychiatric disorder; the most common are generalized anxiety, social anxiety, and depression. 2

“ADHD is often associated with coexisting psychiatric conditions,” the researchers wrote. “Differential diagnosis between other conditions and ADHD is not always clear, and patients are sometimes initially treated for another disorder instead.”

Findings from the study support this: At the second-year follow-up, the use of SSRIs, benzodiazepine derivatives, diazepines, oxazepines, thiazepines and oxepines, and other antidepressants decreased in the ADHD cohort. However, SSRI and other antidepressant usage increased in the non-ADHD group during the same period.

Following an ADHD diagnosis, most patients were motivated to try ADHD medication: 95% of patients filled the prescribed medication; 80% of those bought the medication within 10 days. More than half of patients (56.5%) purchased extended-release methylphenidate (brand name: Ritalin).

Just one quarter of late-diagnosed adult patients with ADHD maintained continuous ADHD medication for five years or more.

“This indicates that ADHD drugs were not massively misused, as large purchases would be indicative of [abuse],” the researchers said. “Discontinuation may stem from symptom alleviation, adverse effects, or refinement of diagnoses.”

The study, which analyzed data from Finnish national registers between 2015 and 2020, also found that children and adolescents diagnosed later with ADHD used more antibiotics and anti-inflammatory drugs than did matched controls. After the children began ADHD treatment, the use of these drugs decreased more than it did in controls.

The researchers wrote that “future research is needed, for example, about possible anti-inflammatory effectiveness of ADHD medications, like that of selective serotonin reuptake inhibitors and serotonin and noradrenaline reuptake inhibitors.”

While the Finnish study broadly evaluated how an ADHD diagnosis and subsequent treatment influences antidepressant usage, two new clinical trials took a deeper look into whether a single-medication approach could treat ADHD and co-occurring depression and/or anxiety.

Stimulant Treatment for Co-Occurring Anxiety

During an 8-week Phase 3b clinical trial, centanafadine (brand name: Simtriyo), a first-in-class norepinephrine, dopamine, serotonin reuptake inhibitor (NDSRI) and central nervous system (CNS) stimulant, delivered statistically significant, clinically relevant improvements in both ADHD and anxiety symptoms.3 Centanafadine received FDA approval for the treatment of ADHD in adults and pediatric patients aged 6 years and older on July 24, 2026.

The trial included 315 adults, aged 18 to 65 years, with ADHD and coexisting generalized or social anxiety disorder. Study participants received either centanafadine XR 280mg or placebo once daily. The study analyzed symptom improvements using the Adult Investigator Symptom Rating Scale (AISRS) and the Hamilton Anxiety Rating Scale (HAM-A).

Non-Stimulant Treatment for Coexisting Depression and Anxiety

Another recent clinical trial published in The Journal of Clinical Psychiatry that adults with ADHD and coexisting depression and/or anxiety symptoms experienced substantial improvement in all three conditions while taking the non-stimulant viloxazine ER (brand name: Qelbree) extended-release capsules alone or in addition to existing treatments.4

During the open-label Phase 4 trial, 150 participants received 200mg of viloxazine ER once daily, with doses increasing up to 600mg. At week 14, the AISRS results showed improved ADHD symptoms and a significant reduction in total baseline AISRS scores. Depression and anxiety rating scales also showed significant improvement in symptoms from baseline to week 14: 71.8% of participants achieved a 30% reduction in AISRS total score, and half of the participants reduced their AISRS total score by 45.6%.

This was the first clinical trial of viloxazine ER in adults with ADHD to include participants with coexisting depression and/or anxiety and to allow concurrent medication use. In addition to viloxazine ER,

• 28.6% of participants used stimulant medications
• 44.7% of participants used antidepressants
• 14.9% of participants used anxiolytic and/or hypnotic medications

Viloxazine ER is an FDA-approved non-stimulant medication for children, ages 6 years or older, and adults with ADHD. 5 It is not approved as an antidepressant in the U.S. However, studies from the 1970s found viloxazine demonstrated antidepressant effects 6 In Europe, viloxazine was approved and used as an immediate-release drug for depression for approximately 30 years before being discontinued for commercial reasons unrelated to efficacy or safety. 7

Clinical Implications

More research is needed to determine whether ADHD medications effectively treat coexisting depression and/or anxiety or if symptom reduction is related to improvements in ADHD symptoms. However, one consistent takeaway from all these studies is the utility of ADHD medications.

The potential benefits of using one medication to treat both ADHD and coexisting depression and/or anxiety could improve safety and medication adherence issues for patients who already have executive function deficits.

“Simultaneous treatment of ADHD and depression and/or anxiety symptoms can be challenging, partly due to safety concerns about combining medications,” the authors of The Journal of Clinical Psychiatry article wrote.

Fewer prescription medications could also translate to greater cost savings for patients.

The steep out-of-pocket costs of ADHD care today — on average, more than $8,500 per child and $4,700 per adult annually — are driving families to ration medication, delay or skip medical appointments, and forgo interventions they rely on to function well, according to ADDitude’s Cost of ADHD Diagnosis & Treatment survey. Of the 1,970 survey respondents, 10% said their ADHD care costs exceeded 10% of their income.

“I just go without medication when I run short of money,” a respondent said.

“I never take my clinician-recommended dosage because I can’t afford it,” another survey respondent said.

“We are paying out-of-pocket for medication, so our kids don’t take it on weekends or vacations,” another mother commented.

“As with any treatment, the best approach to treating depression and/or anxiety and ADHD depends on the patient’s individual needs,” says Roberto Olivardia, Ph.D., who recommends clinicians consider both psychological and psychopharmacological treatments when treating patients with ADHD and coexisting anxiety and/or depression.

“Dealing with ADHD symptoms is challenging enough,” Olivardia says. “Dealing with depression or anxiety, too, is debilitating. Only with proper assessment and diagnosis can treatment for both, or either, be possible.”

Sources

¹Westman, E., Prami, T., Kallio, A. et al. (2025). Use of antidepressants decreased after initiation of ADHD treatment in adults — a Finnish nationwide register study describing use of ADHD and non-ADHD medication in people with and without ADHD. Acta Psychiatrica Scandinavica152. https://doi.org/10.1111/acps.70007

²Katzman, M.A., Bilkey, T.S., Chokka, P.R., Fallu, A., & Klassen, L.J. (2017). Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry. https://doi.org/10.1186/s12888-017-1463-3

³P3b short-term study of CTN in patients with ADHD and comorbid anxiety. ClinicalTrials.gov. May 6, 2026. Accessed July 1, 2026. https://clinicaltrials.gov/study/NCT06973577

⁴Adler, L.A., Lieberman, V.R., Brijbasi, L., Mattingly, G.W., et al. (2026). Viloxazine extended release in adults with attention-deficit/hyperactivity disorder and depression and/or anxiety symptoms: results from a decentralized, open-label, phase 4 trial. J Clin Psychiatry. https://doi.org/10.4088/JCP.25m16234

⁵Qelbree (viloxazine extended-release capsules). Prescribing information. In: Supernus Pharmaceuticals. Inc.; 2025. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/211964s013lbl.pdf

⁶Greenwood D. (1975). Animal pharmacology of viloxazine (Vivalan). J Int Med Res.

⁷Findling, R.L., Candler, S.A., Nasser, A.F., et al. (2021). Viloxazine in the management of CNS disorders: a historical overview and current status. CNS Drugs. https://doi.org/10.1007/s40263-021-00825-w

The following is a personal essay that reflects the opinion of its author.

Too often, a parent with a quiet child who has attention problems will leave the doctor’s office feeling frustrated, ignored, dismissed, or misunderstood.

Did the doctor really understand our concerns? Was there any medical gaslighting?

Indeed, medicine still has blind spots about how ADHD is diagnosed and treated, and this is especially true for females and people from racial and ethnic minority groups. After more than 20 years of practicing child and adolescent psychiatry, I still find it helpful to pause and consider what might be influencing me to not get it right.

Maybe it’s because of my medical training. In the medical school classroom and on patient rounds, I was encouraged to think about a differential diagnosis, the full range of possibilities. On tests and in real-life practice, however, I was taught to identify key symptoms, move quickly toward a diagnosis, and begin treatment, often with medication.

The Flip Side of Efficiency

I was encouraged to recognize the “classic” ADHD patient: a hyper and inattentive young boy. But such diagnostic efficiency can lead me to miss the quiet child who is merely inattentive or to mislabel the deeper issue of trauma that might be causing the restlessness.

[Webinar Replay: “When Willful Ignorance Causes Doctors to Dismiss Your ADHD Concerns.”]

Trauma, anxiety, depression, sleep problems, learning differences, and autism all have overlapping symptoms with ADHD. I often find elementary-age, adolescent, or young adult students feeling overwhelmed and suffering from anxiety and depression as well, which leads me to question which came first: the ADHD or the emotional struggles.

An adult who has spent years compensating for their ADHD may present as anxious or burned out. Of course, not every distracted or overwhelmed person has ADHD. Sometimes, what looks like ADHD is instead the result of chronic stress, language barriers, learning challenges, excessive screen use, or another condition that deserves a different response.

I’m also aware of how time and billing pressures influence my ability to feel confident in a diagnosis or treatment. In both busy primary care and mental health practices, clinicians are often expected to move quickly. An ADHD diagnosis usually requires a wider lens and more unbillable time to gather input from parents, teachers, partners, rating scales, developmental history, and examples from work, school, and home.

Stereotypes and bias also taint proper diagnoses. Girls and women are often overlooked because their ADHD may show up as disorganization, perfectionism, emotional exhaustion, or shame. Black, Latino, and other minority children are more likely to receive punishment instead of the support they need.

[Free Download: What Every Thorough ADHD Diagnosis Includes]

This is also true for children learning in their second language. I often receive referrals for a child who can’t pay attention in school because they don’t understand the English language, not because they have ADHD. Unfortunately, stereotypes and bias affect even the best clinicians. Slowing down and considering all angles is especially important so as not to mislabel or mistreat patients in these circumstances.

We, clinicians, need to keep learning by investing in continuing education, practicing cultural awareness and humility, and being good listeners. Ultimately, the best ADHD care is collaborative, curious, and committed to a patient’s wellbeing.

Medical Gaslighting Prevention: Next Steps

• Free Download: How to Talk to Your Doctor About Medical Research
• Read: “Medical Gaslighting Convinced Me That I Didn’t Have ADHD”
• Read: A Clinicians’ Guide to Better Patient Communication

Luke Smith, M.D., is a psychiatrist and the director of El Futuro in Durham, North Carolina.

What does gut health have to do with ADHD?

More than you might think. Emerging research points to surprising connections between the gut microbiome, neurodivergence, and overall health.

“When [gut microbiota] eat the food you’re eating — when they digest the fiber you’re eating, the healthy oils you’re eating — they produce certain molecules that will be beneficial for the whole body, including for ADHD,” said Dr. Miguel Toribio-Mateas, a clinical neuroscientist, applied microbiologist, and nutrition researcher, during his August 2026 webinar, “How Gut Health Impacts ADHD Symptoms.”

Here are our takeaways from his presentation on the link between the brain and body, and what people with ADHD can do to support their gut health.

A Primer on the Gut-Brain Connection

The brain and gut communicate constantly, and most of that information travels from the gut to the brain. The vagus nerve is an important pathway in this communication. Food acts as information; it influences gut-brain signaling, which affects appetite, energy, mood, stress, and body cues.

“What happens in the gut does not stay in the gut,” Toribio-Mateas said. “The gut will contribute to conditions such as ADHD as well as other coexisting conditions… in the neurosphere, anxiety, depression, and so on. Food is one of the factors that affect the risk of developing these conditions.”

[Free Download: ADHD Brain Food]

Gut-Brain Axis and ADHD: What’s Known

Research on ADHD and the gut-brain connection is still in its early stages. Some studies suggest that people with ADHD have different gut bacteria profiles than do neurotypical people. These differences may explain in part why rates of gastrointestinal issues are higher in people with ADHD. “The gut cannot really be disentangled from the immune system,” he said, noting that what gut microbes do with the food we eat can help support the body and may affect inflammatory processes.

It’s also known that gut microbes can influence neurotransmitters implicated in ADHD, such as dopamine, which affects focus and mood.

“It’s not that they are going to give us more dopamine,” Toribio-Mateas said. “It’s going to make dopamine work better.” In other words, a healthier gut may help support brain functions relevant to ADHD.

What to Eat

There is no “magical ADHD diet” that can control symptoms outright, Toribio-Mateas said, warning that “the science is not there.” Nutrition can support a healthier lifestyle, but it cannot and should not replace ADHD medication.

[Read: 5 Foundational Habits That Benefit ADHD Brains]

“I’d like to step away from all-or-nothing thinking, that it has to be meds only or nutrition only,” he said. “They can very well be combined.”

That said, foods that support a healthier gut microbiome — and may benefit people with ADHD — include plants and vegetables, which provide microbiota-accessible carbohydrates, or MACs. MACs help microbes produce short-chain fatty acids, which support neurotransmitter balance and the immune system.

“They are like fertilizer for the good bugs that you have in your gut that will help you to stay healthy, active, and keep your nervous system ticking,” Toribio-Mateas said.

Fiber-rich and fermented foods can also help, though individuals with IBS or inflammatory conditions may need to monitor their intake. Ultra-processed foods may disrupt the gut microbiome and worsen health over time.

Kefir, which supports gut health, may be beneficial for people with ADHD, though not necessarily for symptom control. In his study, Toribio-Mateas found that children with ADHD who drank kefir slept better than those who did not, suggesting that nutrition may be a supportive part of ADHD care rather than a stand-alone treatment.

So while the gut-brain axis matters, nutrition is only one piece of the puzzle. Environment, genetics, and other factors also play a role in ADHD and overall health.

For more insights on the gut-brain connection and foods that may support ADHD brain function, watch the full webinar at additu.de/082526.

Gut Health and ADHD: Next Steps

• Read: “How to Unlock the Power of the Food-Dopamine Connection”
• Read: Build a Better Relationship with Food to Benefit Your Brain
• Read: Can Eating Healthy Improve ADHD Symptoms?

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July 29, 2026

Centanafadine (brand name: Simtriyo), the first and only norepinephrine, dopamine, serotonin reuptake inhibitor (NDSRI) and central nervous system (CNS) stimulant has received U.S. Food and Drug Administration (FDA) approval for the treatment of ADHD in adults and pediatric patients aged 6 years and older. The once-daily, extended-release capsule increases the availability of three neurotransmitters involved in ADHD by blocking their reabsorption, according to the drug’s manufacturer, Otsuka.¹

The FDA based its approval on the results of four Phase 3 clinical trials that showed centanafadine produced statistically significant and clinically meaningful improvements in ADHD symptoms compared with placebo, as measured by the ADHD Rating Scale–5 (ADHD-RS-5) in children and adolescents and the Adult ADHD Investigator Symptom Rating Scale (AISRS) in adults. Clinical benefits emerged as early as Week One in both pediatric and adult patients.

Simtriyo is expected to become available later this year following scheduling by the U.S. Drug Enforcement Administration (DEA), according to Otsuka.

Results of Phase 3 Clinical Trials

A set of randomized, double-blind, placebo-controlled trials analyzed centanafadine’s efficacy in 480 children and 459 adolescents. Over six weeks, adolescent participants received either high-dose centanafadine (328.8 mg), low-dose centanafadine (164.4 mg), or placebo; children were similarly assigned to a high-dose, low-dose, or placebo group, with doses based on their weight.

About half of the adolescents who received high-dose centanafadine and a third of children in the high-dose centanafadine group demonstrated an 18-point or greater reduction on the ADHD-RS-5 compared with 23% in the placebo group. (Adolescents and children who received low-dose centanafadine did not experience statistically significant improvements.)^{2, 3}

Adults with ADHD also demonstrated statistically significant improvements, according to two randomized trials evaluating sustained-release (SR) centanafadine. A double-blind, placebo-controlled Phase 3 trial involving 859 adults with ADHD between the ages of 18 and 55 randomly assigned participants to high-dose centanafadine (400 mg), low-dose centanafadine (200 mg), or placebo twice daily for six weeks. At the end of the trial, one quarter of adults taking either low- or high-dose centanafadine achieved an 18-point or greater reduction on the AISRS, compared with 15.4% of the placebo group.⁴

Symptom improvement is sustained with centanafadine, according to a 52-week extension study involving 662 adults. According to the study, AISRS total scores increased up to 57% in adults who used 400 mg centanafadine SR twice daily. The study’s authors concluded that the medication is safe and effective for long-term treatment of adults with ADHD.⁵

Simtriyo was generally well-tolerated in pediatric and adult patient populations. The most common side effects were rash and decreased appetite in children 6 to 12 years of age; decreased appetite, nausea, rash, headache, and abdominal pain in adolescents 13 to 17 years of age; and headache, decreased appetite, insomnia, nausea, dry mouth, and diarrhea in adults.

Potential Future Uses for Centanafadine

The new ADHD medication shows promise for treating co-occurring conditions, as well. A recent eight-week, Phase 3b randomized, double-blind, placebo-controlled trial involving 315 adults (aged 18 to 65 years) with ADHD and generalized or social anxiety disorder found that taking a 280 mg dose of centanafadine once daily significantly improved symptoms of both conditions compared to placebo.⁵ Otsuka stated that complete results will be presented at a future scientific meeting.

“Centanafadine is another way to get serotonin and was shown to help anxiety and mood in people with ADHD since it kind of has an SSRI built in,” said Greg Mattingly, M.D., during the ADDitude webinar “The Brain Chemistry of ADHD: Understanding Dopamine, Serotonin & Norepinephrine.”

Sources

¹Otsuka receives FDA approval for first-in-class SIMTRIYO® (centanafadine) for the treatment of attention-deficit hyperactivity disorder (ADHD) in adults and pediatric patients aged 6 years and older. Press release. July 24, 2026. Accessed July 24, 2026. https://www.otsuka-us.com/otsuka-shares-fda-review-update-for-centanafadine

²Ward, C.L., Wilens, T.E., Jin, N., et al. (2025). Efficacy and safety of centanafadine for ADHD treatment in children: A randomized clinical trial. Pediatrics Open Science. https://doi.org/10.1542/pedsos.2024-000349

³Ward, C.L., Childress, A.C., Jin, N., et al (2025). Centanafadine for attention-deficit/hyperactivity disorder in adolescents: A randomized clinical trial. Journal of the American Academy of Child & Adolescent Psychiatry. https://doi.org/10.1016/j.jaac.2025.06.023

⁴Adler, L.A., Madera-McDonough, J., et al. (2022). Efficacy, safety, and tolerability of centanafadine sustained-release tablets in adults with attention-deficit/hyperactivity disorder. Journal of Clinical Psychopharmacology. https://doi.org/10.1097/jcp.0000000000001575

⁵Mattingly, G.W., Turkoglu, O., Chang, D., Ward, C., Skubiak, T., Zhang, Z., Cutler, A.J. (2025). 52-week open-label safety and tolerability study of centanafadine sustained release in adults with attention-deficit/hyperactivity disorder. J Clin Psychopharmacol. https://doi.org/10.1097/JCP.0000000000002020

⁶P3b short-term study of CTN in patients with ADHD and comorbid anxiety. ClinicalTrials.gov. May 6, 2026. Accessed July 1, 2026. https://clinicaltrials.gov/study/NCT06973577

ADHD is the second most prevalent psychiatric diagnosis among adults, but few, if any, clinicians receive training in the evaluation and treatment of this dimensional condition. Critically left behind are women and people over 60 — two underrepresented groups in ADHD care — given the field’s persistent focus on young boys.

This is why more than half of women with ADHD received their diagnosis in adulthood, despite the condition having a childhood onset. Likewise, we know very little about seniors with ADHD, as most longitudinal studies on ADHD stop in early adulthood. That said, studies put diagnosis rates at 2% in people over 60, though the share is likely much higher.

How can clinicians better identify ADHD in these groups? Russell Ramsay, Ph.D., outlined professional recommendations in his July 2026 ADDitude webinar, “Recognizing ADHD in Women and Older Adults: Differentiating and Diagnosing Mature Symptoms.” Here are our main takeaways:

ADHD in Seniors: Consider Persistence

To account for confounding factors like cognitive decline, menopause, and other age-related conditions, Ramsay recommends looking for continuation of symptoms and executive functioning issues over time — one of the clearest indicators of ADHD.

That said, symptoms rarely cause consistent impairment across time. “ADHD is a dimensional syndrome,” he said, noting that people who present in the senior years for an evaluation may have had subthreshold ADHD in childhood and adulthood. That is, they may have shown core, clinically significant symptoms of the condition while not meeting the full diagnostic count outlined by the Diagnostic and Statistical Manual of Mental Disorders(DSM).

[Read: Distinct Diagnostic and Treatment Considerations for ADHD in Older Adults]

The clinical interview is key for establishing persistence, including self and observer forms as well as school records and work evaluations. Other tools and strategies for professionals include:

• The Barkley Quick-Check for Adult ADHD — a nine-item screening tool that identifies highly predictive symptoms. Seniors need only endorse five symptoms instead of the typical six recommended for adults.
• Mental state examinations (e.g., working memory tests) to assess for cognitive impairments. Severe neurological decline, not ADHD, is associated with more errors in responses.

ADHD in Women: Reverse Diagnosis Often Tells the Story

Many women are only diagnosed with ADHD after first seeking help for another condition or issue, like an eating disorder, anxiety, depression, fatigue, or overwhelm. Ramsay suggests that clinicians who specialize in these areas should screen female patients for ADHD practically by default.

In clinical interviews, masking of executive functioning challenges and the degree to which women try to “hold it all together” should also be assessed. “Even if someone is high achieving, I want to hear how they achieved it, Ramsay said. “Behind the scenes, what were the compensatory mechanisms?”

[Read: “Women Need Better, More Accurate Diagnostic Tools for ADHD”]

Telling ADHD Apart From Everything Else

Given ADHD’s overlap with other conditions and high comorbidity rates, clinicians can tell if ADHD is present by considering the persistence of executive functioning challenges. That is, is executive dysfunction present even during fluctuations of other issues?

A granular review of symptoms can also help tease apart conditions. A person may say they’re distracted, for example, but it may be because of intrusive thoughts related to OCD, not because of inattention rooted in ADHD. Patients themselves can also be great discerners of their symptoms.

For more insights on identifying ADHD in women and older adults, including what makes for a comprehensive evaluation, watch the full webinar at additu.de/072826

Signs of ADHD: Next Steps

• Read: ADHD Does Not Diminish with Age. Its Diagnostic Clarity Does.
• Read: The State of Adult ADHD Today
• Read: How the DSM-5 Fails People with ADHD — and a Better Way to Diagnose
  

ADDITUDE IS HUMAN
Artificial intelligence does not create or edit any written content published by ADDitude. Our editorial team is 100% human, and our mission is simple: listen to and serve our readers with hand-crafted, expert-informed resources. To support ADDitude, please consider subscribing. Your readership and support help make our commitment possible. Thank you.

Stimulant medications are the undisputed heavyweights of ADHD treatment, reliably reducing symptoms and impairments. The two stimulant classes – methylphenidate and amphetamine – are prescribed as a first-line treatment and providers only look to other options if that approach fails.

But as millions of families navigate persistent pharmacy shortages, regulatory red tape, and anxieties around taking controlled substances, we ask: Does the decades-long “stimulant-first” approach serve everyone’s best interests?

Efficacy Data and Comparisons

Current guidelines from major medical organizations, including the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry, favor stimulants as the primary treatment for children and teens? Non-stimulants have a backup role, reserved for those with specific issues, like substance use disorders or tics, or for patients who do not respond to or tolerate stimulants.

Real-world prescription data illustrate a stark result of these guidelines. An analysis of nearly 80 million U.S. prescriptions for ADHD medications found that a staggering 90 percent were for stimulants, and 10 percent were for non-stimulants.

When we peel back the layers of data, the clinical superiority of stimulants falls out of focus. For example, colleagues at the forefront of ADHD research published a network meta-analysis, which uses complex statistical methods to compare the efficacy of treatments across many studies. They found that stimulants had a modest statistical edge over non-stimulants.

[Read: New Insight Into ADHD Stimulants – Optimal Doses by Age, Deprescribing Guidance]

From that data, we calculated that a doctor must prescribe stimulants instead of non-stimulants to eight patients just to see one additional patient do better than they would have if they had taken a non-stimulant.

These views are not to dispute the outstanding record of stimulant medication for youth with ADHD. Rather, we ask whether the advantage stimulants hold over non-stimulants is sufficient to reserve first-line status among providers.

The “Average Patient” Illusion

Statistical comparisons between drugs rely on average differences between treatments. Using averages, however, ignores a crucial fact: Not all patients react to any given medication in the same way. When one of us (JN) looked closely at atomoxetine date from a placebo controlled clinical trial, he found that the “average benefit” data hid a deep split: 47 percent of children and teens had an excellent response to atomoxetine, 40 percent had a poor response, and only 13 percent fell into the middle. For nearly half the patients taking it, the non-stimulant worked very well – likely about as well as a stimulant would have.

So, by always prescribing stimulants first, doctors are withholding from a large group of patients a highly effective treatment that may have fewer side effects than first-line stimulant medications.

[Read: Stimulant, Non-Stimulant, or Both? Combination Therapy for ADHD]

The debate isn’t just about efficacy; it’s about the practical and societal tolls associated with stimulants. Because they are controlled substances, stimulants are tightly regulated. This means no automatic refills, mandatory in-person evaluations, and complex telemedicine restrictions.

Parents of children with ADHD, and adults with ADHD, already struggle with the organization and planning skills required to navigate logistical hurdles. The situation is worsened by stimulant shortages that force patients to ration doses, switch brains, or endure gaps in treatment. The effects lead to less adequate symptom control, work and academic struggles, and emotional distress.

There is also a darker side to the dominance of stimulants: Rates of diversion, misuse, and abuse are alarming among adolescents and young adults, who sometimes use prescription stimulants to pull all-nighters, enhance academic performance, or party. A national survey found that more than 25 percent of people using prescription stimulants reported misusing them – and many divert them to family members and friends, a practice entirely hidden from doctors. Diversion and misuse are especially prevalent on college campuses.

The Trade-Offs of a New Approach

To be clear, a “non-stimulant-first” strategy isn’t without challenges; most notably, time. Stimulants work quickly; non-stimulants can take several weeks to reach full effectiveness. If a child is actively failing classes and needs rapid symptom relief to save their school year, waiting weeks for a non-stimulant to kick in could be detrimental.

Advocates for the stimulant-first approach also correctly point out that risks of abuse can be managed by properly educating families and carefully screening out high-risk patients.

Ultimately the goal isn’t to demonize stimulants or render them even more difficult to obtain. Instead, the evidence strongly suggests that medical guidelines should abandon a rigid “one-size-fits-all” strategy in favor of parallel first-line pathways.

The shift toward truly personalized prescribing requires hard data. To help prescribers, parents, and adolescents with ADHD navigate the stimulant vs. non-stimulant questions, we are conducting a clinical trial funded by the Patient-Centered Outcomes Research Institute that will put these two strategies to the test.

By presenting both classes of medication as equally valid starting points, doctors and patients can make informed, personalized decisions based on an individual’s unique needs, psychiatric history, and personal values. In the complex world of ADHD treatment, giving patients more than one option might just be the most effective prescription of all.

Stimulant vs. Non-Stimulant ADHD Meds: Next Steps

• Read: Unraveling a Tangle of Confusion Over ADHD Medication
• Q&A: “Why Are There So Many Different ADHD Medications?”
• Read: Stimulants vs. Non-Stimulants – Understanding ADHD Medications

Stephen V. Faraone, Ph.D., is a distinguished professor in the Department of Psychiatry at SUNY Upstate Medical University and the founder of www.ADHDevidence.org

Jeffrey Newcorn, M.D., is a professor of psychiatry and pediatrics at the Icahn School of Medicine at Mount Sinai.

ADDITUDE IS HUMAN
Artificial intelligence does not create or edit any written content published by ADDitude. Our editorial team is 100% human, and our mission is simple: listen to and serve our readers with hand-crafted, expert-informed resources. To support ADDitude, please consider subscribing. Your readership and support help make our commitment possible. Thank you.

July 9, 2026

Adolescent boys with ADHD may exhibit lower self-esteem, more narcissistic traits, and greater aggression than do boys without ADHD. However, narcissistic tendencies and low self-esteem do not directly influence aggressive behaviors, according to a new study published in the International Journal of Developmental Neuroscience that examines the link between aggressive behavior and ADHD in children.¹

These findings refute earlier research suggesting that low self-esteem combined with narcissistic traits, such as perceived superiority and a heightened sensitivity to criticism, contribute to aggressiveness in children with ADHD.², ³

The study included 80 boys aged 9 to 14 years who had been diagnosed with ADHD and 41 age-matched boys without ADHD. Participants and their caregivers completed several rating scales and questionnaires on self-esteem, narcissistic traits, and aggressive behaviors, which revealed the following findings:

• On the Strengths and Difficulties Questionnaire (SDQ), boys with ADHD scored significantly higher than did the control group across all aggression scales and subscales, including verbal aggression, aggression toward objects and animals, provoked physical aggression, and unprovoked physical aggression.
• On the Rosenberg Self-Esteem Scale, the ADHD group exhibited significantly lower self-esteem scores than did the control group. The researchers also found that children with lower self-esteem scores tended to exhibit greater aggression toward objects and animals, though no causation was established.
• The researchers also observed a weak but statistically significant negative correlation between self-esteem and symptoms of ADHD, oppositional defiant disorder (ODD), and conduct disorder based on diagnostic criteria in the Turgay DSM-5 Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S).

“While ODD has an estimated prevalence of 10%, it occurs in about half of children with ADHD, making it one of the most common disorders occurring with ADHD,” said William Dodson, M.D.-LF-APA, during the ADDitude webinar “How Oppositional Defiant Disorder Ruptures Families — and How You Can Learn to Manage It.”⁴

Narcissistic Traits in Children with ADHD

Study participants also completed The Childhood Narcissism Scale (CNS), which measures grandiose and entitled traits in children aged 8 to 14. The ADHD group scored significantly higher on the CNS than did the control group, a finding that aligns with previous studies on narcissistic traits.

Individuals diagnosed with ADHD in childhood have an increased risk of being diagnosed in late adolescence with a personality disorder, particularly narcissistic personality disorder (NPD), which occurs in 25% of adults with ADHD compared to 6% of adults without ADHD.⁵

Though mental health providers do not diagnose NPD before age 18, the researchers noted that younger children may show early signs of the personality disorder. “Narcissistic individuals may react to threats to their idealized self-image with intense emotions, such as shame, anger, or envy, often resorting to maladaptive strategies to regulate self-esteem,” they wrote.

Many symptoms of NPD and ODD overlap, such as a lack of empathy or accountability for actions, severe sensitivity to criticism, noncompliance, and manipulation of others. Though similar, these symptoms may manifest in different ways. For example, an individual with NPD often possesses an inflated sense of self-importance and entitlement that serves as justification for their actions.

“People with ODD typically do not regard themselves as oppositional or defiant,” Dodson said. “They often justify their behaviors as a response to unreasonable demands or provocation from the person in authority. As such, there is often no remorse or discomfort involved with these disruptive behaviors.”

Though symptoms of narcissism and ODD may mimic one another, the study found no correlation between high narcissistic trait scores and high scores of aggression.

This finding adds color to the picture painted by a 2025 study published in the Journal of Psychiatric Research that linked narcissistic traits in adults with ADHD with higher levels of anxiety and depression. Traits of vulnerable narcissism, specifically, were associated with more significant emotional dysregulation and a history of hospitalization, suicide attempts, and non-suicidal self-injury.⁶

How Emotional Dysregulation Influences Aggression

Missing from the study was a look at how emotional dysregulation influences aggressive or disruptive behaviors in children with ADHD. This omission may stem from the fact that emotional dysregulation is not included in the diagnostic criteria for ADHD, though many individuals describe it as the most impairing aspect of the condition.

“Emotional dysregulation is a defining characteristic of ADHD, which explains why so many children and teens with ADHD are easily swept away by intense emotions — resulting in explosive, aggressive, sometimes frightening reactions that disrupt the entire family,” said Dodson.

Joel Nigg, Ph.D., discussed the relationship between ADHD, emotional dysregulation, and anger in the ADDitude webinar titled, “You’re So Emotional: Why ADHD Brains Wrestle with Emotional Regulation.” “Individuals with ADHD experience disproportionate problems with anger, irritability, and managing other emotions,” he said.

“These problems walk in lock step with the general difficulties in self-regulation that characterize ADHD.”

Sources

¹Öcal, G.K., Önder, A., Adanır, A.S., Çoban, Ö.G. (2026). Narcissistic traits, self-esteem and aggression symptoms in children and adolescents with attention-deficit/hyperactivity disorder. Int J Dev Neurosci. https://doi.org/10.1002/jdn.70143

²Barry, C.T., Frick, P.J., and Killian, A.L. (2003). The relation of Narcissism and self-esteem to conduct problems in children: a preliminary investigation. Journal of Clinical Child & Adolescent Psychology. https://doi.org/10.1207/S15374424JCCP3201_13

³Hiemstra, W., Verhulp, E.E., Thomaes, S., and Orobio de Castro, B. (2020). Self-views and aggression in boys referred for disruptive behavior problems: self-esteem, narcissism, and their interaction. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-019-01347-z

⁴Eskander, N. (2020). The psychosocial outcome of conduct and oppositional defiant disorder in children with attention deficit hyperactivity disorder. Cureus. https://doi.org/10.7759/cureus.9521

⁵Stinson, F.S., Dawson, D.A., Goldstein, R.B., Chou, S.P., et al. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. https://doi.org/10.4088/jcp.v69n0701

⁶Duarte, M., Blay, M., Hasler, R., Pham, E., Nicastro, R. et al. (2024). Adult ADHD and pathological narcissism: A retrospective-analysis. J Psychiatr Res. https://doi.org/10.1016/j.jpsychires.2024.04.032

June 25, 2026

Less than one-third of people with ADHD find effective, efficient symptom relief with the first medication they try. According to a 2023 survey, ADDitude readers try 2.6 medications, on average, before settling on one and getting to work finding a dosage ‘sweet spot’ that balances efficacy against side effects. It’s an arduous process of trial-and-error that may benefit from new research on optimal dosing of ADHD medication by patient age.

According to a recent study of more than 25,000 individuals with ADHD aged 5 years and older, the optimal dose of medication varies by drug type and across age groups.¹

Published in The Lancet Psychiatry, the systematic review of 164 studies and dose–effect network meta-analysis of 113 double-blind randomized controlled trials identified the most effective dose thresholds for several ADHD medications.

In children and adolescents with ADHD:

• Methylphenidate (brand name: Ritalin) reached peak efficacy at approximately 45 mg/day.
• Amphetamines (brand name: Adderall) reached peak efficacy at approximately 25 mg/day.
• Lisdexamfetamine (brand name: Vyvanse) reached peak efficacy at approximately 55 mg/day.
• Guanfacine (brand name: Intuniv) reached peak efficacy at approximately 4 mg/day.

In adults with ADHD:

• Amphetamines reached peak efficacy at approximately 50 mg/day.
• Methylphenidate efficacy increased without evidence of a plateau.

The U.K. research team, led by Samuele Cortese, M.D., Ph.D., of the National Institute for Health and Care Research (NIHR), found no evidence that exceeding FDA-licensed maximum doses improved any drug’s overall efficacy for any age group. The researchers did acknowledge, however, that some individuals with ADHD do require higher-than-licensed doses of medication.

They also found an association between medication discontinuation and doses at or slightly above peak efficacy. For example, the risk of medication discontinuation increased when amphetamine doses were above 25 mg/day for children and adolescents, and 50 mg/day for adults.

Among adults with ADHD, methylphenidate discontinuation risk increased when doses rose above 50 mg/day. However, taking higher doses of methylphenidate did not increase the likelihood that children or adolescents would stop taking the drug due to side effects.

The researchers emphasized that the study’s results are population-level benchmarks and not prescriptive recommendations.

“Our results are valid at the group level but cannot inform decision-making at the individual level,” they wrote. “Our evidence needs to be complemented by personalized considerations for each patient, with cautious dose titration, as well as implementation of a broader multimodal approach to improve both effectiveness and tolerability of ADHD treatment, ideally in a shared decision-making process.”

If a patient, particularly a child or adolescent, does not experience symptom benefit from an ADHD medication, clinicians are encouraged to titrate up from the minimum dose.

“Evidence from real-world studies shows that a substantial proportion of children and adolescents receive low doses of medication without appropriate upward titration,” the researchers wrote. “This is particularly concerning, as timely and adequate dose adjustment has been associated with improved adherence, probably by facilitating earlier symptom improvement and reinforcing engagement with treatment.”^{2, 3}

Stimulants are considered the first-line treatment for ADHD, but not all children and adults respond to or tolerate stimulant medications; others may prefer to take a non-stimulant. According to the ADDitude treatment survey of more than 11,000 adults and caregivers:

• 52% of children taking medication for ADHD use methylphenidate, and their caregivers rate it an average of 3.15 out of 5 for efficacy
• 34% take a form of amphetamine, and their caregivers rated it an average of 2.97 out of 5
• 16% of children treat their ADHD with non-stimulants, and their caregivers rate it an average of 2.45 out of 5 for efficacy

Among adults taking ADHD medication:

• 63% use a form of amphetamine, and they rated it an average of 3.31 out of 5 for efficacy
• 29% use a form of methylphenidate, and they rate it an average of 2.8 out of 5 for efficacy
• 8% use a non-stimulant, and they rate it an average of 2.3 out of 5 for efficacy

“Gauging whether a medication is working as well as it should, or whether it’s the right medication at all, requires consistent self-appraisal and ongoing communication with your clinician regarding symptom control — or lack thereof,” said William Dodson, M.D., LF-APA, in the ADDitude webinar “Optimizing ADHD Medication: Strategies for Achieving Better Symptom Management.” “It also requires patience as the clinician works to potentially adjust or switch medications before settling on the right combination.”

A new consensus statement developed by the American Society of Clinical Psychopharmacology (ASCP) aims to support clinicians in determining when stimulants are an appropriate treatment and when they should be reconsidered.⁴

The first-ever formal guidelines identified clinical scenarios for deprescribing stimulant medications in adults with ADHD, including when:

• A patient is misdiagnosed with ADHD.
• A patient receives no benefit from the medication.
• A patient develops tolerance for the medication.
• Stimulants exacerbate a patient’s co-occurring condition(s).
• Side effects cannot be managed by reducing the dose of the stimulants.
• A change in medical status shifts the risk-benefit ratio.
• A patient persistently exceeds their prescribed dose.
• A patient diverts their medication to others.
• A patient uses their medication for enhancement beyond ADHD treatment.

To reach a consensus, at least 75% of the panelists needed to “strongly agree” or “moderately agree” with each statement. The one statement that did not reach a consensus involved cannabis use; 71% of panelists felt that regular cannabis use was an insufficient reason to deprescribe stimulant medication in adults with ADHD.

The guidelines do not provide specific medication tapering schedules, but they do recommend a gradual, personalized taper that emphasizes “sleep hygiene, physical activity, and structured behavioral strategies that support executive functioning.”

Findings from The Lancet Psychiatry study and the consensus statement could inform the forthcoming adult ADHD clinical practice guidelines from the American Professional Society of ADHD and Related Disorders (APSARD), expected later this year.

Sources

¹ Nourredine, M., Jurek, L., Hamza, T. et al. (2026). Pharmacological interventions for ADHD: a systematic review and dose–effect network meta-analysis. The Lancet Psychiatry. https://doi.org/10.1016/j.euroneuro.2026.112863

² Olfson, M., Marcus, S., Wan, G. (2009). Stimulant dosing for children with ADHD: a medical claims analysis. J Am Acad Child Adolesc Psychiatry. https://doi.org/10.1097/CHI.0b013e31818b1c8f

³ Xu, Y., Chung, H., Shu, M., et al. (2023). Dose titration of osmotic release oral system methylphenidate in children and adolescents with attention-deficit hyperactivity disorder: a retrospective cohort study. BMC Pediatr. https://doi.org/10.1186/s12887-023-03850-4

⁴ Goodman, D., Mago, R., Citrome, L., Swartz, H.A., McIntyre, R.S., et al. (2026). The American Society of Clinical Psychopharmacology task force consensus statement on the deprescribing of stimulant medications in adults with ADHD. European Neuropsychopharmacology. https://doi.org/10.1016/j.euroneuro.2026.112863

Allow us to spotlight yet another overlooked topic in women’s health: the safety of ADHD medication use in the perinatal period.

Though ADHD medication use among pregnant women is increasing, unequivocal information its risks and benefits is lacking. In her June 2026 webinar, “ADHD in Pregnancy: Navigating Risk, Evidence, and Clinical Decision-Making,” clinician and researcher Allison S. Baker, M.D., invited us to look at these decisions within a “risk-risk” framework that considers tradeoffs between maternal functioning and health, and fetal-infant outcomes.

“It’s a lengthy process to walk through these discussions with our patients,” Baker said.

Find our takeaways on ADHD treatment in the perinatal period from Dr. Baker’s webinar below.

Pregnancy Stresses Coping Capacity

As with other hormonal transitions, pregnancy is a vulnerable period for women with ADHD. Hormonal, physical, and emotional shifts in this time alter dopamine signaling and cognitive reserves, changing how ADHD symptoms emerge, intensify, or are recognized.

[Read: Treating for Two – ADHD Meds in Pregnancy]

“One of the things we are evaluating in the perinatal consultation is…whether pregnancy has exposed the degree to which a woman’s functioning had depended on enormous compensatory effort that she is no longer able to sustain,” Baker said.

The postpartum period is also extraordinarily challenging. Women with ADHD are at greater risk for mood and anxiety disorders after birth. High levels of ADHD symptoms are also linked to having a less positive parenting experience, feeling less in control, and attending perinatal examinations.

“This can be a painful loop for women,” Baker said, emphasizing that overwhelm often leads to shame for new parents. “Shame is that gasoline on the fire of perinatal mood and anxiety vulnerability.”

Discontinuing ADHD Meds in Pregnancy May Worsen Maternal Health

Most data on stimulant use during pregnancy focuses on its effects on developing fetuses and infants. While some studies have shown increased adverse effects among infants exposed to maternal ADHD medications, most have not — reassuring data for parents-to-be.

[Read: A Guide to Postpartum Care for Mothers with ADHD]

We know less about stimulant use during pregnancy and its impact on maternal health. But in one study (the first of its kind), Baker and her colleagues found that stimulant discontinuation during pregnancy may worsen ADHD symptoms and functioning for some women. The researchers also found that those that discontinued medication were at risk for co-occurring mood disorder or for an elevated postnatal depression score.

ADHD Medication Should Not Be “Panic Stopped”

Baker’s findings challenge current perinatal treatment practices and the many clinicians who automatically recommend stimulant discontinuation from preconception through breastfeeding.

“Treatment with medication should not be reflexively or panic stopped, especially if it is required for daily functioning of the pregnant and breast-feeding person,” Baker said.

A more nuanced, thoughtful approach is required for perinatal care. Clinical guidelines published in the American Journal of Obstetrics & Gynecology include the following:

• At preconception, consider trialing off medication to determine functioning. Continue with medication if needed or change the prescription to the lowest effective dose.
• During pregnancy, talk to the patient about the risks and benefits of continuing their meds and provide options, like intermittent use.
• After birth, discuss breastfeeding safety if the patient is on an amphetamine derivative. (Methylphenidate exposure through milk appears very low.)
• Monitor fetal and infant development carefully in the perinatal period

Baker emphasizes that ADHD treatment should always be multimodal. The biggest risk for patients in the perinatal period, she said, is abruptly stopping current treatment with no monitoring or supports provided.

“When we talk about stopping medication…we need to ask, ‘What are we asking this person to give up and what supports are we using to replace it?’”

For more insights on ADHD in the perinatal period, watch the full webinar at additu.de/062326

ADHD Meds and Pregnancy: Next Steps

• Take This Test: Signs of Postpartum Depression
• Read: Methylphenidate, Atomoxetine Safe to Use in Pregnancy
• Read: Discontinuing Stimulant Medication Negatively Impacts Pregnant Women with ADHD

ADDITUDE IS HUMAN
Artificial intelligence does not create or edit any written content published by ADDitude. Our editorial team is 100% human, and our mission is simple: listen to and serve our readers with hand-crafted, expert-informed resources. To support ADDitude, please consider subscribing. Your readership and support help make our commitment possible. Thank you.

June 18, 2026

An authoritative, consistent, and noncoercive parenting style is the most effective for children with ADHD. However, a recent meta-analysis published in Child & Adolescent Psychiatry found that parents of neurodiverse children are more likely to use negative parenting practices.¹

According to the study, parents of children with ADHD displayed higher levels of hostility, inconsistent discipline, family conflict, and abuse. They were less likely than parents of neurotypical children to exhibit warmth, expressive encouragement, and structure.

Parents of children with ADHD were also more likely to practice authoritarian parenting, which emphasizes obedience through harsh discipline and strict rule enforcement.

“Authoritarian parenting and its techniques, we now know, can cause distress and are linked to maladaptive behaviors,” said Caroline Mendel, Psy.D., in the ADDitude webinar “Parenting Styles That Work for Neurodivergent Children.”  “Children, especially neurodivergent children, do not respond well to this form of parenting.

“On the other hand, permissive parenting, characterized by high levels of warmth and little to no limit setting, isn’t what our children need either, as this can also lead to negative outcomes,” she continued.

However, the study found permissive parenting practices and parental withdrawal to be comparatively more pronounced in parents of children with ADHD.

“The most effective parenting style balances warmth and clear limits,” Mendel said. “Experts call it ‘authoritative parenting.’ It’s a dynamic that fosters the parent-child relationship while also providing children with the structure they need for positive development.”

The researchers suggest that authoritative parenting may be significantly more beneficial than warmth alone. “Although warm parenting may foster a supportive emotional environment, in the absence of structure and boundaries, it may often fail to address the behavioral regulation challenges characteristic of ADHD,” they wrote. “On the other hand, rigid rule enforcement without emotional attunement, typical of authoritarian parenting, is associated with negative outcomes, including increased conflict, reduced emotional security, and heightened ADHD symptom severity.”

Despite the benefits of authoritative parenting, caregivers of children with ADHD were significantly less likely to use this approach and less likely to grant autonomy or encourage their child to express themselves directly and openly, the study found.

The systematic review and meta-analysis included 62 studies from 19 countries involving 13,105 children and adolescents aged 2 to 18 years (6,543 with ADHD, and 6,562 without ADHD).

The study’s authors recommend more research using larger, methodologically robust samples, as “the evidence for some parenting factors is limited and should be interpreted as preliminary until confirmed by further high-quality research.”

In addition, most of the findings were based on self-reports, which may be subject to bias.

“Our results underscore the need to educate parents and professionals not only about the differential effects that various parenting practices may have on children, but also about the ways that children’s ADHD symptoms can shape parental responses,” the researchers wrote.

What Influences Negative Parenting Practices?

Reduced parental warmth and increased hostility may develop in a parent-child relationship in response to ADHD behaviors, sex, or developmental stage. Co-occurring conditions in both children and parents, as well as a parent’s educational level, socioeconomic status, and societal characteristics, can shape parenting styles as well.

A parent’s upbringing and experience with trauma may also have an effect. The study suggests that self-perpetuating cycles tend to emerge in families where parents of children with ADHD experienced childhood abuse themselves.

Parenting Interventions for ADHD Families

“The moderate effects of abuse and family conflict highlight the critical need not only for a careful assessment of the family environment in which children with ADHD are raised, but also for tailored and enhanced support for parents who may be more at risk for engaging in harmful parenting practices,” the researchers wrote. “When necessary, measures should be taken to reduce such harmful practices.”

Interventions to address maladaptive parenting techniques may include the following:

Behavioral Parent Training (BPT)

The American Academy of Pediatrics recommends behavioral parent training (BPT) as a first-line ADHD treatment for children younger than 6, and as an adjunct to medication for older children. BPT programs use evidence-based interventions to teach caregivers effective strategies for managing their emotions and their child’s behavior.

“This type of training helps parents learn to be proactive rather than reactive,” says Sharon Saline, Psy.D., author of What Your ADHD Child Wishes You Knew (#CommissionsEarned). “BPT focuses on positive reinforcement, setting effective boundaries, and providing scaffolding to increase positive connections, reduce negativity, and enhance a child’s successes.”

According to an ADDitude survey, 57% of parents reported participating in parent training. Of those, an astounding 93% recommended it.

Internal Family Systems (IFS)

Internal Family Systems (IFS) is a form of therapy that helps individuals heal from wounds created by trauma from criticism, child abuse, or rigid or authoritarian approaches used by parents.

“A goal of IFS therapy is to help individuals access compassion, curiosity, and patience. These qualities help us grow and heal,” said Susan Bauerfeld, Ph.D., during the ADDitude webinar “How to Heal from Trauma Using Internal Family Systems.”

Neurodivergent Parenting Tips

“Parenting is hard, especially if you are a neurodivergent parent raising a neurodivergent child and using different approaches than your parents used on you,” Mendel said. “As a psychologist who helps parents manage ADHD in their children, please hear me when I say that you are not alone, and that you are doing a wonderful job. Acknowledge the progress that you’ve made and are making. Set small goals for yourself and celebrate the small wins. Build and rely upon your support network and take care of yourself — one of the most important behaviors you can model for your child.”

Members of ADDitude’s reader panel shared the following neurodivergent parenting tips:

“Never respond to anger with anger (or frustration with frustration),” shared Dena from California. “Sometimes love, patience, and acceptance are needed to soothe the other.”

“Keep instructions to one or maybe two at a time,” said Olivia from Texas. “Praise the accomplished step, then provide the next instruction. This ensures success and builds confidence.”

“Your child(ren) will teach you just as much as you teach them,” another reader said. “Approach your child and yourself with curiosity, compassion, and love.”

Source

¹ Văidean, T., Dobrean, A., Predescu, E., et al. (2025). Meta-analysis: parenting children and adolescents with attention-deficit/hyperactivity disorder compared to healthy controls. Journal of the American Academy of Child & Adolescent Psychiatry. http://doi.org/10.1016/j.jaac.2025.12.016

May 21, 2026

Adults with ADHD and a coexisting substance use disorder (SUD) are nearly twice as likely to discontinue treatment with medication compared to their peers with ADHD only, according to a new study published in BMJ Mental Health.¹

The Swedish cohort study found that almost half (44%) of adults with ADHD and substance use disorder stopped medication within one year of diagnosis or first SUD-related event, compared to 25% in the ADHD-only group. (The study defined medication discontinuation as a treatment gap of 90 days or more without medication, calculated based on the estimated duration of the previous prescription.) Individuals with a history of abuse of stimulants, cannabis, and/or multiple SUDs experienced significantly higher risks for treatment discontinuation.

Though many patients eventually resumed treatment, those with ADHD and SUD did so at a much lower rate. Notably, individuals with substance-related criminal justice involvement were the least likely to reinitiate ADHD treatment.

“ADHD is often overlooked in prison populations and seldom treated appropriately,” the researchers wrote.² “Whether this is due to patients experiencing difficulties engaging and adhering to treatment regimens or whether healthcare providers are reluctant to prescribe stimulants to patients with ADHD and SUD in the presence of criminal history, or consider treating this patient group riskier and therefore more often discontinue treatment, is unclear. It is, however, increasingly clear that healthcare services need to be adapted to the specific needs of patients with ADHD, SUD, and criminality to reach more patients and improve long-term outcomes.”³

Though guidelines recommend stimulants as the first-line treatment for ADHD in adults, some clinicians remain wary of using stimulant medication to treat patients with coexisting SUD. Concerns often center on the abuse potential of stimulants; however, ADHD treatment with stimulant medication does not cause future drug misuse or addiction, explained Timothy E. Wilens, M.D., during the ADDitude webinar, “Substance Use Disorder and ADHD: Safe, Effective Treatment Options.”

“In fact, the opposite appears to be true,” Wilens said. “Studies show that early treatment of ADHD and its continued treatment across the lifespan reduce risk for substance use and SUDs.”⁴

Some clinicians prescribe lower doses of ADHD medication for SUD populations out of caution. However, findings showed lower doses did not improve adherence; higher doses did.

This finding suggests that patients who tolerate stimulants well are more likely to continue treatment, which could prevent criminal behaviors. Patients with ADHD, early onset SUD, and coexisting conduct disorder are at a higher risk for criminality, but those who adhere to their ADHD treatment are better able to avoid it, according to a 2012 population-based Swedish study involving 26,000 adults with ADHD who had criminal convictions. The study, published in the New England Journal of Medicine, found that the crime rate decreased by 32% for men who had taken their ADHD medication. The drop in crime was even bigger for women: 41%.⁵

A 2025 BMJ study found that ADHD medication use is significantly associated with lower rates of first-time and recurring suicidality, criminal behaviors, vehicular accidents, and substance misuse.⁶

“This may be because people with multiple occurrences of such events typically have more severe ADHD, making them more likely to benefit from drug treatment,” the study’s authors wrote. “Additionally, the cumulative effect of ADHD drug treatment may lead to additive improvements over time, whereas negative consequences may accumulate the longer an individual goes untreated.”

Factors Influencing Treatment Discontinuation and Reinitiation

The researchers on the BMJ Mental Health study stressed the need to improve medication continuity for individuals with ADHD and SUD. They recommended that treatment providers consider the specific needs of individuals with ADHD and SUD to improve outcomes, especially in young males, who were more likely to discontinue treatment compared to females.

Study results showed those with ADHD and SUD were more likely than those with ADHD only to change providers and medication type between discontinuation and reinitiation of treatment.

“SUD patients, especially those with more severe SUD, have difficulties accessing and engaging with the healthcare system, due to stigma and low health literacy,” the researchers wrote. “Such factors, although impossible to explore using register data, may contribute to the increased risk of treatment discontinuation and lower reinitiation.”

Age also influenced treatment discontinuation and reinitiation. In the ADHD and SUD group, young adults between the ages of 18 and 24 years or younger at the time of their first SUD event were more likely to stop and less likely to restart treatment compared to those with only ADHD.

“Given that treatment adherence has been associated with positive outcomes in both ADHD and SUD, it is important to improve treatment access and continuity of care, especially in the susceptible period during the transition between adolescence and adulthood, a period marked by heightened vulnerability for both SUD onset and for treatment discontinuation,” the researchers wrote.

The study included a total of 55,684 people between the ages of 16 and 26 from Swedish national registers (9,283 people with ADHD and SUD and 46,401 with ADHD only), who had ongoing ADHD medication treatment.

According to Wilens, about one in two adolescents and one in four adults with an SUD has co-occurring ADHD; the risk for SUD is even higher among adolescents and adults with untreated ADHD.^{7, 8}

“Given the known links between ADHD and SUD, adolescents and adults with SUDs or problematic substance use should be screened for ADHD,” he said. “For individuals with both SUDs and ADHD, structured therapies such as cognitive behavioral therapy (CBT) and pharmacological approaches appear most effective. Treatment may start, for example, with CBT that focuses initially on SUD than on the ADHD. Throughout treatment, providers may alternate between focusing on the SUD and ADHD, helping patients understand and identify their thoughts and feelings around substance cravings and urges, and managing symptoms and other ADHD-related issues that may interfere with substance use treatment. Patients also learn how to keep themselves out of high-risk situations.”

Sources

¹Capusan AJ, Zhang L, Larsson H, et al. (2026). Discontinuation and reinitiation of pharmacological treatment for ADHD among individuals with ADHD and substance use disorder. BMJ Ment Health. https://mentalhealth.bmj.com/content/29/1/e302138

²Retz, W., Ginsberg, Y., Turner, D., et al. (2021). Attention-deficit/hyperactivity disorder (ADHD), antisociality, and delinquent behavior over the lifespan. Neurosci Biobehav Rev. https://doi.org/10.1016/j.neubiorev.2020.11.025

³Mariani, J.J., Levin, F.R. (2007). Treatment strategies for co-occurring ADHD and substance use disorders. Am J Addict. https://doi.org/10.1080/10550490601082783

⁴Boland, H., DiSalvo, M., Fried, R., Woodworth, K.Y., Wilens, T., Faraone, S.V., & Biederman, J. (2020). A literature review and meta-analysis on the effects of ADHD medications on functional outcomes. Journal of psychiatric research. https://doi.org/10.1016/j.jpsychires.2020.01.006

⁵Lichtenstein, P., Halldner, L., Zetterqvist, J., Sjölander, A., Serlachius, E., Fazel, S., Långström, N., & Larsson, H. (2012). Medication for attention deficit-hyperactivity disorder and criminality. The New England Journal of Medicine. https://doi.org/10.1056/NEJMoa1203241

⁶Zhang. L., Zhu, N., Sjölander, A., Nourredine, M., Li, L., Garcia-Argibay, M. et al. (2025). ADHD drug treatment and risk of suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality: emulation of target trials. BMJ. https://doi.org/10.1136/bmj-2024-083658

⁷van Emmerik-van Oortmerssen, K., van de Glind, G., van den Brink, W., Smit, F., Crunelle, C. L., Swets, M., & Schoevers, R. A. (2012). Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: a meta-analysis and meta-regression analysis. Drug and alcohol dependence. https://doi.org/10.1016/j.drugalcdep.2011.12.007

⁸Wilens, T.E., & Morrison, N.R. (2012). Substance-use disorders in adolescents and adults with ADHD: focus on treatment. Neuropsychiatry. https://doi.org/10.2217/npy.12.39

May 18, 2026

Symptoms of inattention appear in both ADHD and anxiety, but new research suggests that distinct brain mechanisms are associated with this behavior in each condition. A study published in the Journal of Attention Disorders found that children with ADHD and those with anxiety notice or focus on information at the very beginning of a task in similar ways; however, they behave differently after realizing they have made a mistake.¹

Determining whether a symptom of inattention is explained by underlying ADHD or anxiety can be challenging for clinicians. Distractibility, poor concentration, and forgetfulness are core traits of inattentive ADHD. Though inattention is not a clinical symptom of an anxiety disorder, children with anxiety may appear distracted and forgetful.

“ADHD and anxiety disorder symptoms overlap,” says William Dodson, M.D. “Both cause restlessness. An anxious child can be highly distracted because they are thinking about their anxiety or their obsessions. Both can lead to excessive worry and trouble settling down enough to fall asleep. It takes time to do a comprehensive history to determine whether a patient is struggling with one or both conditions.” About half of children with ADHD also meet the diagnostic criteria for a co-existing anxiety disorder.¹, ¹

For the study, researchers examined distinct stages of the attentional process — from initial focus to error correction — to chart differing behaviors among 111 children, ages 7 to 11. The participants were divided into four groups: ADHD-only, anxiety-only, ADHD-and-anxiety, and typically developing (TD). Electroencephalography (EEG) recorded the participants’ brain activity as they completed three computerized attention tasks of various difficulty.

The study found that children with ADHD, anxiety, or both conditions exhibited similar early attention and arousal regulation difficulties when they began a task. More specifically, the groups showed weaker neural responses to important cues, in deciding what to pay attention to, and in adjusting alertness levels based on task demands, compared with the TD group. The TD group’s brains shifted into a more activated, “ready” state before starting difficult tasks, while the other groups’ brains did not.

Distinct patterns emerged between the ADHD-only, anxiety-only, and ADHD-and-anxiety groups at the attentional engagement, performance monitoring, and performance evaluation phases of the study.

Children with Anxiety and Inattention

Children with anxiety showed signs of heightened error monitoring. Their brains reacted more harshly when mistakes occurred, indicating that they were hypersensitive to errors and potential failure. At the same time, they showed reduced conscious processing of those mistakes afterward. In other words, anxious children appeared to overreact automatically to errors without learning from them.

The researchers suggest that this anxiety-related inattention may stem partly from excessive self-monitoring and worry. The anxious brain may become so focused on avoiding mistakes and rumination that it remains mentally “stuck” on the error and is unable to redirect. This cycle of heightened error sensitivity combined with inefficient conscious evaluation could contribute to the distractibility and difficulty with sustaining attention seen in children with anxiety.

Children with Inattentive ADHD

In contrast, the ADHD-only group was less likely to recognize mistakes or practice post-error slowing (immediately slowing down after making an error to improve performance on the next attempt). This finding suggests that attention issues in children with ADHD are caused by a reduced ability to monitor performances and use feedback from the environment to adjust behaviors.

Children with ADHD and Anxiety

Findings from the study showed evidence of two types of attention issues working in tandem among the ADHD-and-anxiety group. Anxious behaviors, such as hypervigilance or worrying about making a mistake, appeared to act as a compensatory mechanism that offset typical ADHD symptoms. The anxious behaviors paradoxically reduced ADHD symptoms, such as impulsivity, and improved focus, but in doing so created a different attention issue (getting stuck, careless mistakes). In this case, when children are inattentive, it is not only because of their ADHD but because their anxiety prevents them from moving on and focusing on the task at hand.

Understanding the different neural mechanisms underlying inattentive symptoms could help clinicians more accurately distinguish between ADHD-related and anxiety-related inattention.

“Inaccurate or incomplete diagnoses can delay appropriate treatment, potentially leading to greater functional impairment and worsening symptoms,” the researchers wrote. “The attentional processes identified in the present study as differing between ADHD and anxiety symptom profiles may represent promising candidate targets for objective assessment to support clinical characterization.”

Source

¹ Pranjić, M., Peisch, V., Li, Y., Troxel, M., Lee, K., & Arnett, A.B. (2026). Inattention in pediatric attention-deficit/hyperactivity disorder and anxiety: Neurophysiological evidence for distinct and overlapping cognitive Mechanisms. Journal of Attention Disorders. https://doi.org/10.1177/10870547261445680

¹Bowen R., Chavira D.A., Bailey K., Stein M.T., Stein M.B. (2008). Nature of anxiety comorbid with attention deficit hyperactivity disorder in children from a pediatric primary care setting. Psychiatry Research. https://doi.org/10.1016/j.psychres.2004.12.015

¹Reimherr F.W., Marchant B.K., Gift T. E., Steans T. A. (2017). ADHD and anxiety: clinical significance and treatment implications. Current Psychiatry Reports. https://doi.org/10.1007/s11920-017-0859-6

When I started my Ph.D. program years ago, I arrived confident. I had two master’s degrees, decades of management experience, and a solid sense of myself as a capable professional. Then I found myself surrounded by people who seemed effortlessly brilliant, and my gaps in knowledge and experience felt enormous. Before long, a quiet but persistent doubt crept in: What if I don’t actually belong here?

That experience surprised me, but I now recognize it as imposter syndrome.

This feeling is especially common among adults with ADHD due to a lifetime of being told they’re “not enough,” or simply doing things wrong. When you combine that history with the demands of modern workplaces — constant evaluation, comparison, and self-promotion — imposter syndrome isn’t a personal failing. It’s a predictable response.

3 Factors Drive Imposter Syndrome

Up to 70% of people experience imposter syndrome — feeling like a fraud and doubting their abilities, even when evidence suggests otherwise. Researchers and clinicians say these feelings appear to be more persistent and disruptive for adults with ADHD for three reasons:

1. The inconsistency gap.

Because ADHD affects executive function, performance can be highly variable — brilliant one day, struggling with basic tasks the next. This makes it easy to distrust success and dismiss accomplishments as flukes.

[Self-Test: Do You Suffer From Imposter Syndrome?]

2. Working memory challenges.

These create what researchers call “success amnesia.” Failures remain vivid, while accomplishments are fleeting. Without a stable internal record of competence, every new challenge can feel like starting from scratch.

3. Masking.

Many adults with ADHD develop elaborate coping strategies to appear neurotypical. When praise comes, they may feel that people are complimenting their mask, not who they really are. Rejection sensitive dysphoria, an intense emotional response to perceived or real criticism, can amplify this fear of being “found out.”

The result is a familiar cycle: You work twice as hard to compensate. You succeed. But because the effort seemed chaotic or last-minute, the success feels undeserved. Anxiety follows, along with the fear that, next time, you’ll be exposed.

Is Imposter Syndrome Harmful or Helpful?

Imposter syndrome causes harm when it leads to burnout, chronic over-preparation, or under-advocating for yourself. It can also keep you stuck, turning down opportunities because you’re convinced that you’ll be found out.

[Watch: How to Interrupt the Cycle of Self-Sabotage]

At times, it can masquerade as helpful, prompting conscientiousness, humility, or thoroughness. But when doubt becomes a primary motivator, it is not serving you. The cost is simply too high.

Moving Forward

Imposter syndrome can resurface at any time throughout your career, especially during transitions or high-stakes moments. That’s to be expected. But confidence isn’t a personality trait that you either have or you don’t. It’s a skill built through practice, systems, and support. You don’t overcome imposter syndrome by becoming perfect; you do it by recognizing that belonging is earned by showing up as yourself.

5 Strategies for ADHD Brains

Name the Pattern but Don’t Argue with the Feeling

You don’t have to feel confident to be competent. When imposter thoughts show up, identify them: “This is imposter syndrome talking.” You’re not debating or validating the thought, just recognizing it as a pattern.

Build an External Evidence File

Because working memory challenges and strong emotions can create an unreliable narrator, keep a tangible record. Save emails with positive feedback, compliments, or successful outcomes. When your brain won’t cooperate, let the facts speak.

Separate Performance from Self-Worth

ADHD brains often fuse mistakes with identity. A missed deadline becomes “I’m a failure,” instead of “I missed a deadline.” Try shifting your thinking to “This skill is still developing.” That small change creates critical distance between what you do and who you are.

Stop Trying to Be Good at Everything

I stopped struggling with imposter syndrome when I accepted the fact that I didn’t need to excel at everything. For many adults with ADHD, this means designing roles and workflows that lean into strengths like creativity, problem-solving, relationship-building, or strategic thinking — and letting go of the idea that you must also excel at detail-heavy or administrative work that conflicts with the way your brain operates.

Get Curious Instead of Critical

Self-doubt often stems from uncertainty. Instead of asking, “What’s wrong with me?” try “What kind of support, structure, or clarity would help me here?” Curiosity moves you from shame to problem-solving — a far more productive place.

How to Overcome Imposter Syndrome: Next Steps

• Free Download: Emotional Regulation & Anger Management Scripts
• Read: You Are Enough: How to Counteract ADHD Imposter Syndrome
• Read: You Are Not the Sum of Your ADHD Challenges
• Watch: “Perfectionism and ADHD: Making ‘Good Enough’ Work for You”

Eric Zackrison, Ph.D., is a leadership consultant and organizational communication scholar who teaches in the Department of Technology Management at UC Santa Barbara.

ADDITUDE IS HUMAN
Artificial intelligence does not write or edit any content published by ADDitude. Our team is 100% human, and our mission is simple: listen to and serve our readers with hand-crafted, expert-informed resources. To support ADDitude, please consider subscribing. Your readership and support help make our commitment possible. Thank you.

ADHD medications, particularly stimulants, are the most effective treatments in all of psychiatry. In the short term, they significantly reduce ADHD symptoms; in the long term, they protect against a multitude of negative outcomes.

While these medications deliver clear benefits, concerns remain about their possible side effects – among them, potential cardiovascular issues associated with long-term use. There is high-quality research on stimulants and heart health, and here I will place these findings in context.

ADHD Meds and Heart Health

Most ADHD medications – stimulants and non-stimulants – have small average effects on blood pressure and heart rate after weeks or a few months of use.¹ These findings are based on the results of more than 100 randomized controlled trials, the most rigorous type of clinical study. Blood pressure in medicated individuals appears elevated mainly during the daytime, suggesting that the cardiovascular system isn’t continuously stressed and may recover at night when the medication has worn off.²

[Read: Heart Health and ADHD – On Cardiovascular Risks and Treatments]

To clarify the connection between cardiovascular disease and extended use of stimulant or non-stimulant medication for ADHD, a comprehensive study followed more than 278,000 people with ADHD over 14 years.³ Three findings stand out from this research:

• People who take ADHD medication long-term face a slightly increased risk for hypertension compared to those who do not take these medications.
• Hypertension risk is dose-dependent; the higher the dose of medication, the greater the risk for high blood pressure.
• Taking ADHD medication long-term does not increase risk for arrhythmia, heart attacks, or thromboembolism.

Guidelines for Professionals

High quality, rigorous research indicates that, at a group level, ADHD medication use may slightly increase the risk for high blood pressure, but not for other cardiovascular events. Given the clear benefits these medications provide – from improved academic function and protection against injury to reduced mortality – the risk-benefit ratio is reassuring for people who take ADHD medications.

That said, all decisions regarding ADHD medication use should consider the individual’s pre-existing or familial cardiac conditions and be made in consultation with a cardiovascular specialist. Other guidelines include the following:

• Monitor blood pressure and pulse before and during ADHD treatment with all medications, not just stimulants.
• Use the minimum effective dose of ADHD medication.
• High blood pressure is not an absolute contraindication to ADHD medication, If hypertension is observed after starting medication, decrease the dose or stop the medication and refer the patient to a specialist who can check for and treat hypertension. The patient may be able to resume the ADHD medication after treatment. Hypertension can also be treated before starting ADHD medication.
• Taking medication for high blood pressure is not a contraindication for ADHD medication. It is acceptable to take medication for ADHD in addition to medication for hypertension so long as blood pressure is stabilized and monitored.

ADHD and Heart Health: Next Steps

• Free Download: Healthy Lifestyle Changes for Adults with ADHD
• Read: Understanding Cardiovascular Disease in Women with ADHD
• Read: Can I Take ADHD Medications If I Have a Heart Condition?

Samuele Cortese, M.D, Ph.D., is a professor at the University of Southampton in the United Kingdom and an adjunct professor at New York University. He was part of a team that created a platform on the latest ADHD research and evidence-based interventions at ebiadhd-database.org

ADDITUDE IS HUMAN
Artificial intelligence does not write or edit any content published by ADDitude. Our team is 100% human, and our mission is simple: listen to and serve our readers with hand-crafted, expert-informed resources. To support ADDitude, please consider subscribing. Your readership and support help make our commitment possible. Thank you.

Sources

¹ Farhat, L. C., Lannes, A., Del Giovane, C., Parlatini, V., Garcia-Argibay, M., Ostinelli, E. G., Tomlinson, A., Chang, Z., Larsson, H., Fava, C., Montastruc, F., Cipriani, A., Revet, A., & Cortese, S. (2025). Comparative cardiovascular safety of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. The Lancet. Psychiatry, 12(5), 355–365. https://doi.org/10.1016/S2215-0366(25)00062-8

²Buitelaar, J. K., van de Loo-Neus, G. H. H., Hennissen, L., Greven, C. U., Hoekstra, P. J., Nagy, P., Ramos-Quiroga, A., Rosenthal, E., Kabir, S., Man, K. K. C., Ic, W., Coghill, D., & ADDUCE consortium (2022). Long-term methylphenidate exposure and 24-hours blood pressure and left ventricular mass in adolescents and young adults with attention deficit hyperactivity disorder. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 64, 63–71. https://doi.org/10.1016/j.euroneuro.2022.09.001

³Zhang, L., Li, L., Andell, P., Garcia-Argibay, M., Quinn, P. D., D’Onofrio, B. M., Brikell, I., Kuja-Halkola, R., Lichtenstein, P., Johnell, K., Larsson, H., & Chang, Z. (2024). Attention-Deficit/Hyperactivity Disorder Medications and Long-Term Risk of Cardiovascular Diseases. JAMA psychiatry, 81(2), 178–187. https://doi.org/10.1001/jamapsychiatry.2023.4294

Perimenopause is the most impairing phase of life for women with ADHD. From worsening ADHD symptoms to mood changes and sleep issues to brain fog, fluctuating and decreasing estrogen levels wreak havoc on the lives of women with ADHD, whose brains are far more sensitive to hormonal changes. (In an ADDitude survey, 94% of women said their ADHD symptoms grew more severe during perimenopause and menopause.) Despite this, many neurodivergent women going through this transition still aren’t getting adequate care.

“Perimenopause is when you need the most help, the most support,” said Patricia O. Quinn, M.D., during her May 6 ADDitude webinar, “Perimenopause in Women with ADHD.” “You need to take care of yourself during this time.”

Here’s what all women with ADHD and their health care providers should know about the perimenopausal transition.

Perimenopause Occurs Earlier in Women with ADHD

Perimenopause begins up to 10 years earlier for women with ADHD, who report in one study that their more severe perimenopause symptoms occurred between the ages of 35 and 39, compared to ages 45 and 49 for neurotypical women.

What’s more, women with ADHD report more severe perimenopause symptoms across all categories — somatic (e.g., hot flashes), psychological (e.g., depressive mood), and urogenital (e.g., vaginal dryness) — compared to women without ADHD.

[Read: Let’s Talk About Perimenopause and ADHD]

“This is something that needs to be addressed in women with ADHD in addition to their ADHD symptoms,” Quinn said.

Estrogen and Medication Changes May Be Warranted

Research on the most effective treatments for ADHD during perimenopause is limited, but available data and observational evidence suggest that many women benefit from estrogen supplementation and increased stimulant dosages during this phase.

“Estrogen… makes your stimulant more effective,” Quinn said, emphasizing that all treatment decisions must be made in consultation with a doctor who considers the patient’s family medical history and individual risk factors.

HRT or HST?

Most of us have heard of hormone replacement therapy (HRT) to treat symptoms associated with postmenopause — that is, after periods have stopped completely and estrogen and progesterone stabilize at a low level.

But in perimenopause, when periods are irregular due to rapidly shifting and unpredictable hormones, the term “hormone stabilization therapy” (HST) better describes the treatment’s focus. Like HRT, HST uses estrogen, or estrogen and progesterone, to steady and elevate hormone levels. Birth control pills, which can help stabilize hormones, are often recommended, as are antidepressants for mood and hot flashes.

[Read: Falling Estrogen, Soaring ADHD]

Treatment Efficacy Depends on Several Factors

An individual’s response to perimenopause treatments depends on factors such as age, activity level, prior estrogen therapy use, the form of HRT used, and even socioeconomic status. “Exercise is really important. Estrogen is more effective — HRT is more effective — if you exercise,” Quinn said. “Start HRT and HST as early as possible. We want to start it as close to when the problems are occurring.”

For more insights on perimenopause and ADHD, watch the full webinar at additu.de/050626

Perimenopause and ADHD: Next Steps

• Free Download: How to Talk to Your Doctor About ADHD Research
• Research: Sex Hormones in Women Impact ADHD Symptoms, Medication Efficacy
• Read: “ADHD and Menopause Is the Perfect Storm No One Warned Us About”

ADDITUDE IS HUMAN
Artificial intelligence does not write or edit any content published by ADDitude. Our team is 100% human, and our mission is simple: listen to and serve our readers with hand-crafted, expert-informed resources. To support ADDitude, please consider subscribing. Your readership and support help make our commitment possible. Thank you.

April 29, 2026

The distinct symptom profiles of ADHD — namely, inattention and hyperactivity-impulsivity — follow their own unique behavioral and developmental pathways, and they may benefit from targeted interventions and treatment, suggests a new study published in Frontiers in Psychology.¹

Findings from the study show that ADHD symptoms arise not from a single deficit, but from different underlying brain systems involved in attention, behavioral control, emotional regulation, and sleep.

The research team found that symptoms of hyperactivity and impulsivity typically decrease as children age and are more commonly observed in boys, whereas inattention remains stable throughout development and affects boys and girls at similar rates. Overall, symptoms of inattention were found to be more severe than symptoms of hyperactivity and/or impulsivity.

Learning challenges appeared to be the strongest predictor of inattention, according to the study. Children with more severe inattentive symptoms showed greater difficulty sustaining focus, filtering out distractions, and managing mental effort. “These deficits directly impact classroom learning and explain the strong association [of inattention] with academic difficulties,” the researchers wrote.

The researchers also found strong associations between symptoms of hyperactivity-impulsivity and oppositional or conduct-related behaviors, emotional dysregulation, as well as specific sleep disruptions, such as restless sleep, nightmares, or unusual nighttime movements.

Sleep emerged as an important factor across both symptom clusters, but in different ways. While general sleep difficulties were loosely connected to inattention, disturbances in sleep–wake transitions, specifically restless sleep, nightmares, or sleep talking were a significant predictor of hyperactivity-impulsivity.

“Poor sleep may impair brain regulation systems, especially those tied to impulse control and emotional reactivity,” the researchers wrote.

“Sleep problems in youth with ADHD are associated with several negative outcomes,” said Stephen P. Becker, Ph.D., in the ADDitude webinar “Why Am I Always So Tired? The Latest Science on Improving Sleep in Children and Teens with ADHD.” “They impact functioning during the day, be it at school or at home, and they are associated with mental health problems over time. Sleep problems in adolescents with ADHD are tied to poorer quality of life, as well as poor academic performance and lower grades.”

Low-Anxiety, High-Impulsivity Subtype

Interestingly, children with lower levels of anxiety tended to show higher levels of hyperactivity and impulsivity, leading researchers to infer that anxious behaviors may suppress overt hyperactive behaviors. Children with anxiety may be more cautious, self-aware, or responsive to consequences, while children with low anxiety may be more prone to risk-taking and impulsive actions and less responsive to threat cues.

This finding points to a possible “low-anxiety, high-impulsivity” subtype of ADHD.

The recognition that different ADHD symptom profiles are driven by different neurological mechanisms could reshape how clinicians diagnose and treat the condition and its many subtypes.

For example, children with primarily inattentive symptoms may benefit most from academic support, cognitive interventions, and strategies that strengthen attention and information processing. Children with more pronounced hyperactivity and impulsivity may respond best to behavioral therapy, emotional regulation support, and interventions that address sleep quality.

This cross-sectional study was conducted at the outpatient Cognitive Center of Guangxi Zhuang Autonomous Region People’s Hospital, between December 2020 and December 2022. It included a sample of 331 children aged 6 to 12 years with ADHD.

Source

¹Fu Y, Qin Z, Qin L, Zhang H, Liu H, Huang S and Li D (2025) Multidimensional factors associated with ADHD core symptoms in children: cognition, sleep, behavior, and demographics. Front. Psychiatry. https://doi.org/10.3389/fpsyt.2025.1658202

April 22, 2026

Pediatric ADHD treatment with the stimulant medication methylphenidate may reduce future risk of adverse outcomes and provide a protective effect against adult psychiatric disorders, according to two new studies that should quell unfounded fears that stimulants may trigger psychosis and exacerbate post-traumatic stress disorder (PTSD) symptoms.^{1, 2}

Patients with ADHD who are treated with stimulant medications experience fewer hospitalizations, emergency department visits, motor vehicle accidents, and subsequent prescriptions of antipsychotics and mood stabilizers than do similar patients treated with non-stimulants and antidepressants, a recent study published in the Journal of Attention Disorders found.³ The study also found that youth treated with stimulants had a significantly lower risk of an eventual PTSD diagnosis compared to youth treated with non-stimulants, though no causality was established.

Despite the evidence of positive outcomes, the researchers identified a shift away from prescribing methylphenidate to children with ADHD following a PTSD diagnosis. One possible explanation: Older studies have suggested a potential link between stimulant use and the onset or exacerbation of PTSD symptoms in adults with ADHD.^{4, 5}

“These shifts may reflect clinician concerns that stimulants could exacerbate trauma-related symptoms, such as hyperarousal,” the researchers wrote, “although the evidence on this risk remains limited and mixed.”

The Journal of Attention Disorders study analyzed electronic health record data from the TriNetX Research Network of more than 714,000 children (aged 6 to 18 years) who were diagnosed with either ADHD or ADHD and PTSD between the years of 2010 and 2024.

Results from the study showed that stimulants were prescribed less often to adolescents (aged 12 to 18 years) in the ADHD-PTSD cohort compared to adolescents in the ADHD cohort, and stimulants were prescribed more frequently to males in both cohorts. Female adolescents in the ADHD-PTSD cohort were the least likely to receive stimulants. Overall, new prescriptions for methylphenidate decreased by 7% for children with ADHD following a PTSD diagnosis.

Non-Stimulants Used to Treat ADHD and PTSD

Youth with co-occurring ADHD and PTSD were more likely to be prescribed non-stimulant medications, including alpha-2 agonists and atomoxetine (a selective norepinephrine reuptake inhibitor), antidepressants, antipsychotics, mood stabilizers, and psychotherapy compared to children with ADHD alone. Guanfacine (brand name: Intuniv) was the most prescribed non-stimulant in both cohorts, though it was prescribed slightly more in the ADHD cohort (55%) compared to the ADHD-PTSD cohort (49%).

Clonidine (brand name: Catapres) prescriptions were significantly higher among youth in the ADHD-PTSD cohort (39%) than they were in the ADHD group (20%). Clonidine, a blood pressure medication, is also used to treat sleep disturbances in children.

“Its elevated use in youth with PTSD, even after adjusting for diagnosed sleep disorders, suggests clinicians select it for other reasons, possibly such as reducing hyperarousal, which is a core symptom of PTSD though such off-label prescribing warrants careful clinical oversight,” the researchers wrote about clonidine.

Atomoxetine (brand name: Strattera) made up about 20% of the non-stimulant prescriptions.

Antidepressants, Antipsychotics, & Other Treatments for ADHD and PTSD

Among non-ADHD medications in the study, antidepressants were prescribed the most often across both cohorts, with a 29% relative increase in the PTSD-ADHD cohort.

Antipsychotics and mood stabilizers are typically reserved for treatment-resistant or clinically complex cases, the researchers noted. However, “These medications were frequently initiated early in the treatment course despite a lack of evidence to support their selection as initial treatment options,” they wrote.

Stimulants and Psychotherapy

Not all patients use their prescribed medications. The longitudinal analysis of sequential treatment stages within the ADHD-PTSD cohort showed that stimulant medications and psychotherapy were the most frequently used, with psychotherapy use gradually increasing over time.

“While rates of antipsychotic and mood stabilizer prescriptions increased following a PTSD diagnosis, it is encouraging that stimulants and psychotherapy remained the most commonly used treatments,” the researchers wrote. Behavioral therapy along with use of ADHD stimulants, such as methylphenidate and amphetamine, are considered first-line treatments for ADHD in children ages six and older.

Protective Effect of Methylphenidate

The potential protective effect of methylphenidate was the focus of one of the most comprehensive investigations to date on the long-term mental health outcomes associated with ADHD treatment.

The cohort study published in JAMA Psychiatry found that children with ADHD who were treated with methylphenidate before age 13, and who sustained treatment for at least 3 to 4 years, experienced significantly lower risk of psychosis and psychotic disorders, such as schizophrenia, in adulthood, compared to their unmedicated ADHD peers. In addition, children with ADHD who used methylphenidate were no more likely to be diagnosed with psychosis than were unmedicated patients with ADHD.⁶

“The observation that treating ADHD with methylphenidate specifically in childhood was associated with a reduced risk of nonaffective psychosis may point toward a sensitive developmental window in which methylphenidate could affect the trajectory of brain development,” the researchers wrote.

The researchers used advanced statistical modeling to analyze health data from 678,546 people born in Finland, from 1987 to 1997, who were diagnosed with ADHD before age 18 and after January 1, 2003.

How Stimulants Impact Developing Brains

Findings from the JAMA Psychiatry study build on the results from a 2025 longitudinal magnetic resonance imaging (MRI) study published in Progress in Neuro-Psychopharmacology & Biological Psychiatry, which showed that early and consistent use of methylphenidate influences frontal lobe development in the brains of children with ADHD.⁷

The study divided the participants into three groups: early-exposure (methylphenidate exposure before age 12), late-exposure (methylphenidate exposure after age 12), and control. When the researchers compared baseline MRI scans with scans taken five years later, they found brain growth in the early-exposure group but no change in brain volume in the late-exposure group.

“The findings suggest that initiating methylphenidate treatment earlier, particularly before the age of 12, may be more effective in driving structural brain changes and potentially normalizing the atypical brain development associated with ADHD,” the authors wrote.

During the ADDitude webinar “ADHD Medication Options and Benefits for Children,”
Walt Karniski, M.D., explained that three regions of the ADHD brain differ from neurotypical brains.

“If a child is not treated with ADHD medication, these brain differences persist into adulthood,” he said. “Adults with ADHD who were treated with stimulant medication as children no longer exhibit these brain differences.”

In other words, early and long-term ADHD medication use changes the brain, resulting in positive outcomes.

“There is now data out there… that treatment isn’t just about the symptoms now; it’s about preventing damage in the brain so you don’t develop secondary issues like anxiety, depression, emotional dysregulation, and insomnia,” said Greg Mattingly, M.D., during his April 2026 ADDitude webinar titled, “The Brain Chemistry of ADHD.”

While the JAMA Psychiatry study provides new insights for psychosis prediction and prevention in children with ADHD, it did not rule out the possibility of an increased risk of psychotic disorders in individuals diagnosed with ADHD in adolescence or older. More studies are needed to evaluate the effects of treatment in those populations.

Sources

¹Mosholder, A.D., Gelperin, K., Hammad, T.A., Phelan, K., Johann-Liang, R. (2009). Hallucinations and other psychotic symptoms associated with the use of attention-deficit/hyperactivity disorder drugs in children. Pediatrics. https://doi.org/10.1542/peds.2008-0185

²Moran, L.V., Ongur, D., Hsu, J., Castro, V.M., Perlis, R.H., Schneeweiss, S. (2019). Psychosis with methylphenidate or amphetamine in patients with ADHD. N Engl J Med. https://doi.org/10.1056/NEJMoa1813751

³Baweja, R., Lopes, F., Padilla, F.M., Baweja, R., Amaya-Jackson, L., Waschbusch, D.A., & Waxmonsky, J.G. (2026). Treatment patterns and clinical outcomes in youth with comorbid ADHD and PTSD: insights from real-world data. Journal of Attention Disorders. https://doi.org/ 10.1177/10870547261416173

⁴Crum-Cianflone, N.F., Frasco, M.A., Armenta, R.F., Phillips, C.J., Horton, J., Ryan, M.A., Russell, D.W., Leard Mann, C. (2015). Prescription stimulants and PTSD among US military service members. Journal of Traumatic Stress. https://doi.org/10.1002/jts.22052

⁵Houlihan D.J. (2011). Psychostimulant treatment of combat-related posttraumatic stress disorder. Journal of Psychopharmacology. https://doi.org/10.1177/0269881110385600

⁶Healy, C., O’Hare, K., Lång, U., et al. (2026). Methylphenidate treatment and risk of psychotic disorder. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2026.0152

⁷Chang, J., Lin, H., & Gau, S.S.F. (2025). Age-dependent effects of cumulative methylphenidate exposure on brain structure and symptom amelioration in youth with ADHD: A longitudinal MRI study. Progress in Neuro-Psychopharmacology and Biological Psychiatry. https://doi.org/10.1016/j.pnpbp.2025.111429