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

A history of substance abuse often precludes a young patient with ADHD from receiving a prescription for stimulant medication. It’s a common precaution, but new research suggests withholding treatment may do more harm than good. In fact, withholding ADHD treatment may put young people at greater risk of health problems and other adverse outcomes.

A national study led by researchers at the Penn State College of Medicine found a striking treatment deficit among adolescents and young adults diagnosed with both ADHD and substance abuse disorder (SUD). Published in the Journal of the American Academy of Child and Adolescent Psychiatry, the study analyzed medical records from more than 1.2 million people ages 15 to 25 diagnosed with ADHD. Of those, nearly one in four also had an SUD.

When a young person with ADHD received an SUD diagnosis, they were significantly less likely to be prescribed ADHD medication, the study found. Ongoing stimulant prescriptions dropped by roughly 15% among this group, and new stimulant prescriptions fell by more than 17%.

Young people who continued receiving ADHD treatment had meaningfully better outcomes, with fewer emergency room visits, fewer hospitalizations, fewer accidental overdoses, and fewer suicidal thoughts and attempts. They were also more likely to continue with psychiatric care. Most strikingly, ADHD treatment was associated with an approximately 30% lower risk of death over five years.

[Watch: ADHD Treatment and Substance Use Problems – The Latest Research on Stimulants & SUD]

Benefits were seen with both central nervous system stimulants (e.g., Adderall, Ritalin) and non-stimulants (e.g., Strattera), though stimulants were associated with even greater reductions in certain adverse outcomes.

These findings directly challenge the assumption that stimulant treatment worsens substance use-related problems.

The ADHD-SUD Connection

Research suggests that up to half of people with ADHD may develop a substance use disorder at some point in their lives due to genetics and neurobiology. Impulsivity, poor emotional regulation, and difficulty thinking through consequences can increase vulnerability to substance use. Without effective treatment, some young people discover that substances temporarily quiet the mental restlessness or emotional pain that ADHD can cause.

When ADHD and SUD occur together, the stakes are significantly higher: We see elevated rates of emergency room visits, hospitalizations, accidental overdose, suicidal thoughts, suicide attempts, and higher mortality risk. Effective treatment is not optional. It is urgent.

[Self-Test: Could You Have a Substance Use Disorder?]

The Risks of Withholding Medication

Stimulants typically produce significant symptom improvement. However, they are also controlled substances with documented potential for misuse and dependence, a concern that becomes even more significant when substance use is already in the picture. Many families and clinicians share this unease, and it helps to explain why providers often hesitate to prescribe stimulants once substance use is diagnosed.

However, when ADHD goes untreated, serious consequences may follow. Untreated ADHD can drive academic failure, emotional dysregulation, and low self-esteem, all of which can fuel substance misuse. Effective ADHD treatment interrupts that cycle. Better symptom control helps young people make safer decisions, stay engaged in school or work, and participate more consistently in recovery programs. For some, ADHD medication may also reduce the urge to self-medicate.

The Bottom Line

While any controlled substance should be prescribed with caution to patients struggling with substance use, an SUD diagnosis should not automatically end access to evidence-based ADHD treatment. Every patient is different, and the right approach depends on the individual. What matters most is that the conversation between doctor and patient remains open, treatment is actively monitored, and care is coordinated across mental health and addiction specialists when needed.

Questions to ask a treatment team include:

• What are the risks and benefits of each medication option?
• How will treatment be monitored safely?
• What warning signs should we heed?

The goal is not just symptom control; it is promoting safety, restoring functioning, and giving young people a genuine chance at a healthier future. If you have questions about your own treatment or your child’s, bring them to your clinicians. Advocate for comprehensive care. The evidence is on your side.

When Drug Testing Is Routine

Some ADDitude readers have told us that they were required to submit to regular drug testing as a condition of continuing to receive their ADHD stimulant medication prescription. Among the reasons: to monitor adherence, prevent misuse, or comply with controlled-substance monitoring guidelines.

Here are a few of the comments they shared:

“The policy from my doctor was that I had to sign an agreement before she would prescribe medication, and if she ever felt that I was abusing it, she would give me a test. I haven’t been asked to take a test and it’s been three years since I signed on.”

“It costs $150 every time they ask me for a urine test. It’s ridiculous.”

“I have to do a drug screen once a year in order to refill my Adderall prescription.”

“As an adult, this policy has been required by my doctor to confirm that I am, in fact, taking my medicine. However, when I was younger and seeing a pediatrician, it was never required for me.”

Stimulant Treatment and SUD : Next Steps

• Watch: Substance Use Disorder and ADHD – Safe, Effective Treatment Options
• Read: The Damaging Effects of Cannabis on the ADHD Brain
• Read: Substance Use Disorders and ADHD – 5 Key Facts and Additional Resources

Raman Baweja, M.D., is a professor of psychiatry and behavioral health and public health sciences at the Penn State College of Medicine in Hershey, Pennsylvania.

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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

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.

Does stimulant medication increase risk for substance use disorder and developing an addiction?

The question is valid. People with ADHD are at greater risk, after all, for using substances and for developing dependence. And stimulant medication — the first-line treatment for ADHD — is classified by the FDA as a Schedule II controlled substances due to its high potential for misuse, abuse, and dependence. So it’s not surprising that some people worry stimulant medications may inadvertently increases risk for addiction in ADHD brains.

But mounting research shared during the July 2026 ADDitude webinar “ADHD Treatment and Substance Use Problems: The Latest Research on Stimulants & SUD” paints a reassuring picture.

“We’re not showing, on average, that stimulants increase risk for substance use disorder,” said Brooke Molina, Ph.D., Professor of Psychiatry, Psychology, Pediatrics, and Clinical and Translational Science at the University of Pittsburgh, during her joint webinar with Brian D’Onofrio, Ph.D.

Here are their webinar’s main takeaways on ADHD, substance use, and the impact of ADHD medication treatment on substance use-related outcomes.

The Factors That Link ADHD to Substance Use

From inherited family risk and symptom severity to altered reward processing, multiple factors help explain why people with ADHD face an elevated risk for substance use and substance use disorders.

[Overview: Substance Use Disorders — Signs, Symptoms, and Links to ADHD]

“There’s variation in the way that people with ADHD respond to drugs and things that are potentially rewarding,” Molina said. “This does go back to the dopamine differences in the brain.”

Difficulty translating knowledge into action — a common challenge associated with ADHD — is another factor. In this case, awareness of negative effects does not always translate to reduced substance use.

“This is really important for clinicians to be aware of,” Molina said regarding the treatment of people with ADHD and active substance use issues. “You can’t just take a standard treatment developed for something like substance use disorder and drop it on a person with ADHD. [The treatment plan] needs to consider the particular issues that go along with ADHD.”

Stimulants Do Not Increase Risk for Later Substance Use

Multiple long-scale and longitudinal studies show that stimulant treatment in childhood does not increase risk for harmful substance use later on.

One study that looked at onset and duration of stimulant treatment for ADHD found that people who started treatment before the age of 9 or who were receiving treatment for longer (i.e., six or more years compared to less than one year) were less likely to use substances.

[Read: Treating a Child with ADHD Medication Diminishes Future Risk of Substance Abuse]

Stimulants Protect Against Adverse Outcomes

It’s widely recognized that stimulants don’t increase risk for substance use, however some studies have found that stimulant medication actually protects against serious outcomes, like hospitalization, crime, and even substance-related death in patients with ADHD, regardless of age. “There is a roughly 30% reduction in the risk for these serious outcomes,” said D’Onofrio, the Sharon Stephens Brehm Endowed Professor in the Department of Psychological and Brain Sciences at Indiana University.

Even among people with ADHD and a history of substance use, initiating ADHD medication treatment reduces risk for these events, D’Onofrio said.

ADHD and SUD: Implications

Well-respected research overwhelmingly shows that stimulants do not increase risk for substance problems. Still, many people with ADHD, and many clinicians, are slow to accept the evidence.

“We have an enormous number of practitioners out there who just really are very uncomfortable treating ADHD, and they’re scared of dealing with stimulant medications,” said Molina, who noted that upcoming U.S. Guidelines for the Diagnosis and Treatment of ADHD in Adulthood will aim to help clinicians become more familiar with treating complex ADHD.

D’Onofrio added other treatment options exist if stimulant abuse is a concern. “There are extended-release rather than short-acting [meds], and then there are specific types of stimulant medications, different formulations that are harder to abuse,” he said, adding that therapy and other approaches can also help.

Researchers also need to further understand why many youth with ADHD stop taking medication and what effects this trend may have on health outcomes, he said.

For more insights on ADHD, stimulants, substance use-related outcomes, and the studies highlighted during the webinar, watch the replay.

SUD and ADHD Treatment: Next Steps

• Read: SUD Risk Is Elevated by ADHD
• Study: Prescription Stimulants Do Not Increase the Risk of Illicit Drug Use in Adolescents
• Read: No, Stimulants Don’t Cause Brain Damage

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 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

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

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