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

At age 49, Jan Janisch-Hanzlik’s multiple sclerosis was destroying her freedom to live the life she wanted. She gave up her active nursing job for a desk role. Frequent falls made her afraid to carry her grandchildren. She had to move to a bigger house to make room for the wheelchair she feared she might end up needing full-time.

Even the best available medication wasn’t improving Janisch-Hanzlik’s symptoms, and she worried they’d only get worse. So when she learned about a trial of CAR T cell therapy at the University of Nebraska Medical Center in Omaha, close to the city of Blair where she lives, she phoned the clinic every other month until they were ready to enroll her as the first patient.

Originally designed to target and wipe out cancer by reprogramming the patient’s immune cells, CAR T is now being offered to patients in hundreds of clinical trials for autoimmune conditions like multiple sclerosis, lupus, Graves’ disease, vasculitis, and many others. The hope is that CAR T can duplicate the success it has demonstrated in a range of blood cancers by hunting down and eliminating cells that target the self in autoimmune diseases. This would essentially reset the body’s defenses to a state like the one that existed before the disease took hold.

Read full article

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Just as micronutrients (in conjunction with stimulant medication) can help improve certain ADHD symptoms in many people, the opposite is also true: Deficiencies in key contributors to your body’s neurotransmitters and proteins can worsen your mood, concentration, and impulsivity.

The good news is that basic blood tests will reveal the imbalances that may be impeding your daily functioning. Ask your clinician to check your bloodwork for the following levels, which are based on functional medicine ranges for optimizing health and preventing disease, rather than standard reference ranges, which are designed to diagnose clinical diseases. Be sure to consult with your doctor before taking any supplements.

Vitamin D

If vitamin levels are below 40 ng/ml, which is often considered insufficient, take 5,000 IU of vitamin D, combined with K2 to help with absorption. When vitamin D levels are lower than 30 ng/ml, the bare minimum, symptoms can include chronic fatigue, poor focus, irritability, poor stress resilience, and sleep disturbances. When levels are corrected over 6 to 12 weeks, patients report improved mood stability, energy, and cognitive clarity, plus fewer PMS symptoms. Once the level is above 40, you can maintain with 2,000 IU per day.

Foods with vitamin D include fatty fish, like salmon and sardines, egg yolks, tofu, dairy and plant-based milk, orange juice, and oatmeal.

[Free Download: Brain Food: Healthy Eating Tips to Counter ADHD Symptoms]

Omega-3 Fatty Acids

The optimal omega-3 index (EPA+DHA in red blood cells is 8% or higher. This range is associated with the lowest risk for cardiovascular and inflammatory diseases. Daily intake to achieve this is typically 1,500 to 4,000 mg of combined EPA/DHA, with a 2:1 ratio of omega-6 to omega-3.

Salmon, sardines, chickpeas, walnuts, pumpkin seeds, avocado, and fish oil supplements are rich in omega-3 fatty acids.

Complete Blood Count (CBC)

This blood test analyzes your red and white blood cells, platelets, hemoglobin, and hematocrit to determine if you are anemic. Iron is essential for synthesizing dopamine, a neurotransmitter vital for powering executive functions. Low iron impairs dopamine function, exacerbating ADHD traits.
If your hemoglobin is under 13.5 g/dL for a woman and 14.0 g/dL for a man, you are deficient. If your hematocrit is below 36% for a woman and 40% for a man, you are deficient.

If this is the case for you, consider eating iron-rich goods, like spinach, lentils, tofu, red meat, and fish, and/or taking an iron supplement. Taking vitamin C with a supplement can boost absorption. The more easily absorbed iron supplements include ferrous fumerate, gluconate, and bisglycinate. Avoid ferrous sulfate, which can cause indigestion and constipation.

Vitamin B12

The optimal level for vitamin B12 is above 600 pg/ml. If you fall below this level, take a daily supplement with 2 mcg of vitamin B12 and retest your levels in six months. Symptoms of low vitamin B12 include fatigue, memory loss, mood changes, confusion, depression, and irritability.

Foods rich in B12 include beef, clams, salmon, tuna, fortified nutritional yeast, plant-based milk, and some breakfast cereals.

Magnesium Glycinate

Magnesium levels can be decreased by stimulant medications, as well as by conditions including diabetes, kidney disease, and gut issues. An RBC magnesium reference range is typically between 4.2 and 6.8 mg/dL and can be maintained by a daily intake of 360-480 mg of magnesium for adults. Research links low magnesium levels with poor concentration, irritability, depression, mood swings, fatigue, muscle cramps, and insomnia.

Green leafy vegetables, legumes, nuts, seeds, and whole grains are good sources of magnesium.

[Free Download: Top 5 Vitamins and Supplements for ADHD ]

Zinc

Optimal values are 90-120 mcg/dL. Levels below 70 mcg/dL in women and 74 mcg/dL in men are considered inadequate. If deficient, take 30 mg of zinc picolinate twice daily for 6 months, then retest. Many people are deficient in this mineral, which affects attention, energy, and mood.

Shellfish, red meat, poultry, seeds, nuts, eggs, dairy, and grains are rich in zinc.

A Blood Test for Vitamin D Deficiency: Next Steps

• Read: 10 Supplements and Vitamins for Brain Health
• Read: Do Melatonin, Omega 3 & Dietary Supplements Help ADHD?
• Free Download: The Best Vitamins and Supplements for Managing ADHD Symptoms
  

Maggie Alexander, ND, MS, PMHNP, is a psychiatric-mental health nurse practitioner and author of Shine with ADHD: Unlock Your Potential with Skills, Medicine, and Micronutrients (#CommissionsEarned). 

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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

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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

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

March 30, 2026

ADHD coaching remains an increasingly popular adjunctive approach to managing symptoms that is recommended by health care practitioners and professional practice guidelines, though most coaches operate without clinical oversight, mental health training, or a professional license, according to a new study published in JAMA Network Open.¹

An ADHD coach need not be a therapist or medical expert. Coaching provides practical, collaborative support for people with ADHD and is separate from the diagnostic and treatment roles of clinical providers. ADHD coaching evolved from the life coaching movement and grew in popularity during the COVID-19 pandemic.² Nearly two-thirds of currently active coaches (60.9%) began practicing during or after the pandemic, according to the study, which analyzed survey results from 481 ADHD coaches over a six-month period.

No licensure exists specifically for ADHD coaches; just 15% of the surveyed coaches attained a professional medical license, and 90.5% said they lacked formal clinical supervision. That said, one-third of coaches sought informal consultation from clinicians. More than half of the coaches reported referring clients to clinicians for ADHD evaluations (78.9%), medication (61%), and cognitive behavioral therapy (50.9%). A smaller percentage (21.3%) referred clients to holistic, naturopathic, or other healing arts professionals.

The ADHD Coaches Organization (ACO) says that an individual must complete a fully integrated ADHD coach training program or at least 60 hours of International Coaching Federation-compliant life coach training, plus at least 35 hours of ADHD coach training from recognized sources, to be recognized as a professional ADHD coach. Slightly more than 60% of study participants completed an ADHD coach training curriculum endorsed by the ACO.

Work experience in mental health did not appear to be a prerequisite for a career in ADHD coaching. Only 10% of participants worked in mental health prior to becoming an ADHD coach; one-third came from an education background. According to the survey, lived experience with ADHD informed most of the coaches’ practices. The majority (90.5%) emphasized their personal connections to ADHD during client sessions, which included:

• having a family member with ADHD: 77.6%
• self-identifying as either having or suspecting they have ADHD: 72.7%
• teaching or working professionally with individuals with ADHD: 66.7%
• having friends or a romantic partner with ADHD: 60.2%
• receiving a formal ADHD diagnosis: 58.9%
• receiving ADHD coaching as a client: 44.5%

Coaches tended to be self-employed, worked from home, and offered virtual one-hour weekly sessions. They charged a median rate of $150 per visit, which most clients paid out of pocket. Less than 5% of ADHD coaches accepted health insurance.

ADHD Coaching and CBT

While most ADHD coaches do not have medical or mental health training, their approaches tend to take a page out of the evidence-based cognitive behavioral therapy (CBT) playbook, including:

• executive function skills training or targeting self-motivation: 99.4%
• cognitive restructuring: 99.4%
• motivational interviewing: 96.6%,
• solution-focused approaches: 97.8%
• between sessions homework assignments: 83%

“The potential redundancy in content between ADHD coaching and CBT for ADHD could make it difficult for prospective clients and some medical clinicians to differentiate between these approaches,” the researchers wrote.

What differentiates ADHD coaching from traditional CBT is the sharing of lived experiences with ADHD and the long-term nature and support coaches offer between sessions. The researchers suggest that these features make ADHD coaching appealing to adults with ADHD, who may find CBT too rigid, generic, and short-term.

“If consumers find ADHD coaching more palatable than CBT, they may be more likely to initially engage and sustain participation,” they wrote.

ADHD Coaching Fills a Need

Many adults and caregivers cite positive experiences working with an ADHD coach. According to ADDitude’s 2023 treatment survey of more than 11,000 caregivers and adults with ADHD, nearly 1 in 5 adults and 1 in 7 children with ADHD received ADHD coaching. Among that group, the majority (93% of adults and 82% of caregivers) said they would recommend it.

The study even reported that 65% of clients received direct referrals from clinicians.^{3, 4}
ADHD coaching appears especially effective for clients seeking tailored interventions in areas, such as

• sleep management: 98%
• self-worth: 98.1%
• emotional concerns: 97%
• health behavior (e.g., nutrition, exercise, managing medical conditions): 97%
• parenting: 81.5%
• ADHD medication adherence: 77.8%
• substance use and/or addictions: 53%
• trauma: 48.7%
• suicidality, abuse, and/or harm to self or others: 41.6%

“ADHD coaching is an ongoing collaborative partnership which empowers clients to accomplish personal and professional goals with customized strategies built specifically for ADHD minds,” said David Giwerc, MCC, MCAC, founder and president of the ADD Coach Academy (ADDCA), during the ADDitude webinar “How CBT and ADHD Coaching Help Adults Manage Their Symptoms Naturally,” with J. Russell Ramsay, Ph.D.

Know Your ADHD Coach

The researchers stress that ADHD coaching should not be viewed as equivalent to evidence-based psychotherapy for ADHD, but it can augment the recommended treatment for ADHD that includes a combination of ADHD medication and psychosocial treatment.

More qualitative research is needed to clarify the safety, effectiveness, and potential cost savings of ADHD coaching. The absence of standards and regulations about who can operate as an ADHD coach increases the risk of negative outcomes.

“There are many potential drawbacks when pivoting to unsupervised, lay-practitioner treatment models,” the researchers wrote. “In addition to potential reduced efficacy if evidence-informed approaches are delivered inconsistently or incorrectly, adverse effects may include the spread of misinformation about ADHD, risk of giving harmful advice, challenges in maintaining professional boundaries, and ethical concerns such as loss of patient confidentiality.”

Questions for a Potential ADHD Coach

Clients should practice due diligence when vetting a potential ADHD coach.

“You should interview as many coaches as you can,” says Sandy Maynard, an ADHD coach and operator of Catalytic Coaching. “Make sure you leave the interview with answers and a good sense of the coach as a person and what a relationship would be like with them.”

She recommends asking the following questions during an information interview:

• How long have you been an ADHD coach?
• What percentage of your practice is devoted to individuals with ADHD? With which age groups do you work?
• What is your approach to coaching? Do you offer an introductory session, so that we can get to know one another?
• What kind of training do you have, and how extensive is it?
• I have identified (__) as one of my coaching needs. Do you have experience in this area?
• What are your fees? How and when is payment due?
• Do you coach in-person or virtually?
• What is expected of me during our coaching relationship (homework, evaluations, communication between sessions)?
• How will you monitor progress? What happens if I’m not making any?
• Will you work, or confer, with my doctor, therapist, or family?
• Can you give me the names of references?
• Can you refer me to another coach, therapist, or psychologist, if needed

Sources

¹Sibley, M.H., Graham, E.D., Brooks, J.K., et al. (2026). Demographics, services, and practices in attention-deficit/hyperactivity disorder coaching in the US.Jama Netw. Open. http://doi.org/10.1001/jamanetworkopen.2025.52407

²Sullivan Aboujaoude E. (2020). Where life coaching ends and therapy begins: toward a less confusing treatment landscape. Perspect Psychol Sci. http://doi.org/10.1177/1745691620904962

³Sullivan May, T., Birch, E., Chaves, K., et al. (2023). The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder. Aust N Z J Psychiatry. http://doi.org/10.1177/00048674231166329

⁴Sullivan Wolraich, M.L., Hagan, J.F., Jr., et al. (2019). Subcommittee on Children and Adolescents With Attention-Deficit/Hyperactive Disorder. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. http://doi.org/10.1542/peds.2019-2528

February 23, 2026

ADHD traits in childhood predict physical health problems in midlife, but early exercise interventions may offset this risk, suggest two new studies.

A cohort study of 10,930 participants published in JAMA found that adults with severe childhood ADHD traits had more physical health problems and greater physical health-related disability by age 46 compared to those with less severe ADHD symptoms by age 10.¹

The researchers reported that 42.1% of participants with higher ADHD traits in childhood developed multimorbidity (two or more co-occurring physical health conditions) by age 46. In comparison, just 37.5% of participants with fewer ADHD traits experienced the same health outcomes. Notably, the link between ADHD traits and physical health-related disability appeared much larger in women than it did in men.

Cumulative exposure to health risk factors, such as smoking, alcohol use, psychological distress, low educational attainment, and high body mass index, explains part of the association between ADHD, multimorbidity, and physical disability. However, the researchers emphasized that the direct association between ADHD and physical health outcomes remained significant.

“Clinicians should be aware of the increased rates of physical health problems and associated disability in people with ADHD and should proactively address potential contributing health risk factors,” they wrote. “Integrated interventions addressing mental health, physical health, and key health risk factors may help to reduce chronic conditions in this population.”

The JAMA study analyzed data from the population-based 1970 British Cohort Study, which included people born in England, Scotland, and Wales during the same week in 1970, with follow-up data collected over 46 years.

Increased Mortality Risk for People with ADHD

Untreated physical health problems and co-occurring conditions could reduce the life expectancy of people with ADHD at a higher rate than seen in the general population. A January 2025 study published in The British Journal of Psychiatry comparing the mortality rates of people diagnosed with ADHD to people without ADHD found that the life expectancy for women with ADHD is 8.6 years shorter than that of women without ADHD, while the life expectancy of men with ADHD is 6.8 years shorter. ²

“Adults with diagnosed ADHD are living shorter lives than they should,” the study’s authors wrote. “We believe that is likely caused by modifiable risk factors and unmet support and treatment needs in terms of both ADHD and co-occurring mental and physical health conditions.”

Exercise Interventions Improve Long-Term Mental Health

A 2023 treatment survey of 11,000 ADDitude readers reported positive benefits of exercise. About half of the respondents who exercise regularly rate this ADHD treatment as “extremely” or “very” effective. A staggering 94% of caregivers and 95% of adults recommend exercise to treat ADHD symptoms. However, only 13% said a doctor had recommended exercise to reduce symptoms, and just 37% said physical activity was part of their treatment plan.

“When I get into a good stride with routine exercise, it almost always goes hand-in-hand with better eating habits, better focus, energy levels, mental clarity, and stronger relationships and productivity,” said one adult with ADHD. “Exercise is undoubtedly a crucial piece of the (treatment) puzzle.”

“Depression can really take hold of my 10-year-old son,” one parent said. “We see great improvements after physical activity. He enjoys the elliptical, rower, spin bikes, automatic stepper, and treadmill.”

A new meta-analysis including 18 studies further explores the potential of exercise as an effective adjunctive approach for improving mental health in individuals with ADHD when it is integrated into a multimodal treatment plan that includes pharmacotherapy, behavioral therapy, or psychoeducation.
Exercise interventions produced small-to-moderate improvements in depressive symptoms, anxiety, and emotion regulation in individuals with ADHD, according to the study published in Frontiers in Psychology.

Mind-body integrated exercises, such as yoga and tai chi, significantly improved both depression and anxiety symptoms compared to physical exercises (e.g., structured fitness or sports without a mindfulness component), which did not show significant improvements across outcomes.

The researchers suggest that this advantage may stem from the “mind-body integration” of activities like yoga. By combining physical movement with breath awareness, focused attention, and present-moment acceptance, mind-body exercises directly target emotional dysregulation and attentional control, which are core components of ADHD.

Results from the meta-analysis found that adolescents with anxiety who practiced mind-body exercises experienced the greatest improvements. While children showed moderate improvement, the results were not statistically significant. These discrepancies could be due to developmental differences: Adolescents may be better able to engage with and benefit from the psychological components of exercise, while younger children may require more play-based or gamified approaches.

In addition, the most statistically significant reduction in depressive symptoms occurred from moderate-intensity exercise, whereas low-intensity and high-intensity exercises did not demonstrate measurable benefits for depression, anxiety, or emotion regulation.

While intervention length varied widely (from single sessions to 20-week programs), with no clear differences emerging across durations, single sessions demonstrated immediate short-term anxiety-reducing effects. However, to sustain benefits, longer-term participation may be necessary, the researchers suggest.

They emphasized that the study’s overall findings should be viewed as hypothesis-generating rather than definitive. “Because study designs and exercise protocols varied considerably, the results should be interpreted cautiously, and more rigorous research is needed before definitive clinical guidelines can be established,” they wrote.

Sources

¹Stott, J., O’Nions, E., Corrigan, L., Cotton, J., Donnellan, W.J., et al. (2026). Attention-Deficit/Hyperactivity Disorder Traits in Childhood and Physical Health in Midlife. JAMA Netw Open. https://doi.org/10.1001/jamanetworkopen.2025.54802

²O’Nions, E., El Baou, C., John, A., Lewer, D., Mandy, W., McKechnie, D.G.J. et al. (2025). Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study. The British Journal of Psychiatry. https://doi.org/10.1192/bjp.2024.199

³Shenning, Z., Yaoqi, H., Wenying, S., and Xiangqin, S. (2026). The effect of exercise interventions on mental health in children and adolescents with attention-deficit/hyperactivity disorder: a meta-analysis. Front. Psychol. https://doi.org/10.3389/fpsyg.2026.1748777

The average ADDitude family spends more on one child’s ADHD care than most U.S. households spend on groceries each year. For adults with ADHD, annual treatment costs exceed what many people pay for all their utilities combined.

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 magazine’s new Cost of ADHD Diagnosis & Treatment survey.

Of the 1,970 survey respondents, about 25% cited out-of-pocket medical costs as a limiting or determining factor in accessing ADHD care; 21% said ongoing care is not covered by their insurance, and 16% said their ADHD medication costs are not covered at all.

“I just go without medication when I run short of money,” said one mother. “My adult child has skipped doses to be able to pay for her psychiatrist, and this has brought a lot of unsavory people into her life.”

“I never take my clinician-recommended dosage because I can’t afford it,” said another. “We are paying out-of-pocket for medication, so our kids don’t take it on weekends or vacations,” another mother commented.

[Free Report on Out-of-Pocket ADHD Costs]

ADDitude asked survey participants how they are covering or reducing the cost of ADHD care. Here’s what a few people said:

“I’ve had to take disbursements from retirement accounts to pay for psychotherapy.”

“I have two jobs at this point.”

“I switched jobs to one that is closer to home. I now bike to work. I also joined a nearby affordable community center pool. I swim and arrive at work already having exercised and feeling refreshed.”

“I’ve split the cost of ADHD coaching with another client.”

“It’s hard to pay premiums and pay for doctor visits and maintain a household.”

[ADDitude Directory: Find Affordable Care Near You]

Uneven Insurance Coverage

About half of the people surveyed said their health insurance plan partially paid for an ADHD evaluation for themselves, another adult in the household, or their child(ren). More than one in four said their insurer paid nothing toward evaluation and diagnosis; one in five said those costs were covered completely.

Many of the survey participants expressed frustration about rising health care costs — 10% said their ADHD care costs exceeded 10% of their income — and voiced deep anxiety about potentially steeper hikes and even less coverage in 2026.

The High Cost of Prescription Meds

One-quarter of survey respondents said they reluctantly switched medications because insurers dictated cheaper alternatives or covered prescriptions only partially or not at all, or because the cost of their preferred drug increased substantially.

A significant number said they had to meet their deductible, which was typically more than $1,000, before insurance would cover medication costs.

When asked if their health insurance plan covered the medications they take for ADHD:

• 19% said their prescriptions were fully covered
• 65% said their prescriptions were partially covered
• 16% said their insurer did not cover their prescriptions

Medications Covered

Regarding the medications covered:

• 32% said their insurance covered generics only
• 1% said their insurance covered brand names only
• 35% said generics and brand names were covered
• 32% said they weren’t sure

Types of Providers

Pediatricians and developmental pediatricians were the most common medical professionals seen for ongoing ADHD care (63% for children). Other providers include:

• 62% psychiatrist
• 50% other therapist or counselor
• 50% primary care provider
• 31% psychologist
• 9% occupational therapist
• 6% neurologist

Many survey respondents lamented about the shortage of psychiatrists and the impact of presumably less experienced providers who dismissed their symptoms of adult ADHD.

“I worked with an online provider to get my diagnosis because it was cheaper and quicker.”

“I had to see several different practitioners because they believed I couldn’t have ADHD as an adult since I was never diagnosed as a child.”

Finding Providers Who Take Insurance

The odds of finding a psychiatrist or therapist who accepts your insurance plan are becoming slimmer by the day.

One in four ADDitude survey respondents said that at least one of their medical providers has stopped accepting their health insurance. They voiced worry over a shrinking pool of affordable psychiatrists and therapists.

This provider shortfall was also documented in an investigation by ProPublica, which found that hundreds of mental health providers nationwide have stopped accepting insurance plans in recent years. They blamed insurance network practices that forced providers to chase down payments that were meager or late, and some reported that their services were denied coverage altogether.

The providers also criticized insurers for increasingly interfering with patients’ treatment, sometimes denying it, or pushing generic prescription medications that were cheaper but not optimal.

As the availability of mental health providers who take insurance continues to worsen, ADDitude survey participants shared their experiences.

“This has happened throughout my child’s life. His occupational therapist left the insurance network, his psychiatrist left, my therapist left, our family primary care provider left.”

“It took almost two years to find and start seeing a new therapist. The wait list was nine months long.”

“My psychiatrist is semi-retired and takes cash only. I have not found a new one who will follow my treatment plan, which was working great.”

“I had to call around and ask a bunch of psychiatrists, and it was such a pain. They think that you’re seeking medication when you just want appropriate care. It took me six months to find someone new.”

“I was referred to a nurse practitioner from a psychologist about nine months ago because the practice said my insurance didn’t reimburse them enough. I chose to stay with the practice, rather than start somewhere new, and now I pay out-of-pocket.”

ADHD Medication Cost: Next Steps

• Free Download: What to Ask Before Starting ADHD Medication
  
• Read: These Prescription Assistance Programs May Help You Save Money on ADHD Medication
• Read: How Does Health Insurance Work? A Primer for Patients with ADHD
• Watch: “Cracking the ADHD Medication Maze: How to Get, Afford, and Refill Your Prescriptions With Minimum Hassle”

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

The United States is the only first-world nation that does not provide basic health care to all its citizens. The roadmap to universal health care exists and public opinion largely supports it. However, health care is so incredibly profitable for American insurance companies and political campaigns that proposed reforms are practically guaranteed to fail time and time again.

Health insurance companies use the worst possible system to fund patient care. The only way to perpetually increase the profits demanded by shareholders is to deny legitimate claims or otherwise create obstacles that prevent or delay payments to providers. This system does not incentivize efficient care; it disincentivizes delivering care altogether.

How Insurers Dictate Physician Care

In the 1980s, as technology made the delivery of care more efficient, insurers sought ways to increase profits. This was largely accomplished by obstructing the delivery of care or denying care outright – and it changed physician behavior. If a clinician knew that a prescription for the cheapest immediate-release ADHD medication  would be approved swiftly and without question, but a superior and more expensive time-released formulation would be contested or denied, the clinician would prescribe the insurance-preferred medication, even if it were not what was in the best interest of the patient.

In Colorado, where I live, a majority of private mental health practitioners no longer accept any insurance plans largely because the insurance companies don’t pay parity rates or pay for care that was pre-authorized. It can take months for insurers to pay claims.

These insurance company practices have made access to patient care difficult, if not nearly impossible. In Colorado, few clinicians have the training and experience necessary to adequately manage ADHD in children and adults. If a patient cannot find an experienced clinician and access good care, they stop running up clinical office and pharmacy charges — a win for the insurance company and its profits, and a loss for people who go untreated.

[Download: The Soaring Cost of ADHD Care]

For every practicing clinician who still deals with insurance, there are likely one to two people in their office who do nothing but fight to get their legitimate claims submitted and paid. This extra cost gets passed on to the patient in the form of higher out-of-pocket costs at the point of service.

Being obstructive and slow to pay claims is profitable in other ways, The longer the insurance company can hold onto billions of dollars of premiums, the more investment interest those premiums will earn. Insurers also know that people with mental health conditions are much less likely to appeal a denial of care.

Life is hard enough for people with an ADHD nervous system. They can become overwhelmed by the intentional complexity and obstruction of legitimate care, A single complaint by a patient to a lawmaker or regulator is rarely noticed. A million complaints could start a revolution.

[Read: Bottom Line – Reduce the High Cost of ADHD Treatment]

Jumping Insurance Hurdles

What can patients do to fight insurance abuses?

• Contact your federal and state representatives about the problems you are having with your insurance company.
• Report issues with your insurer to your state’s Department of Insurance and copy your governor’s office.
• Report complaints about your insurance company to your human relations department, which chooses employee benefits.
• When a claim is denied, immediately demand a peer-to-peer review between your clinician and the company’s medical directors.

How can practitioners advocate for their patients?

If you are fighting to get your clients the best care you can provide (not the cheapest care that the insurance company can force you to provide), you must be aggressive. Each time you contact the insurance company, keep a log and do the following:

• Ask for a phone number to re-establish contact if the call is dropped.
• Get the person’s full name and professional licensure. Find out in which state they are licensed in case you want to make a complaint about practicing outside the scope of their license or for obstruction of appropriate care.
• As you get passed from person to person, ask each one for their credentials and what gives them the training, knowledge, and experience to make decisions about your patients’ care. How many people with ADHD have they diagnosed and treated in the last five years?

William W. Dodson, M.D., has been a board-certified adult psychiatrist for more than 27 years. He does not accept insurance.

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ADHD is not a pathology to be cured. It is a difference to be explored and respected. This truth is self-evident but begs the question: How do we help people manage their ADHD without erasing the traits that shape who they are?

Increasingly, cognitive behavioral therapy (CBT) is being used to support executive functions and reshape environments to encourage behavioral change. At the same time, it works to reduce the shame, avoidance, and perfectionism that so often accompany ADHD.

Unlike other therapies, CBT measures patients’ outcomes in relation to their goals rather than ADHD symptom reduction. It supports patients’ time management, organization, emotional regulation, and other skills – not by encouraging them to change who they are, but by providing tools to improve functioning in ways that are meaningful to them.

CBT is most effective when it is designed collaboratively and personalized to meet a patient’s needs. For therapists, these guidelines for delivering neurodiversity-affirming care are a good place to start:

CBT Techniques for ADHD: Guidance for Therapists

💡Free Guide! 10 Things I Wish Someone Had Told Me About ADHD

1. Normalize ADHD

To aid patients in breaking unhelpful patterns, you must first understand and explain how ADHD impacts thoughts, behaviors, and emotions, Make the connection clear from a framework of difference, not deficits. Here’s an example:

PATIENT: I should be starting my report, but I keep thinking, I can’t do this. I’m a failure. I get anxious, scroll through my phone, and feel worse.

PRACTITIONER: That loop makes sense. With ADHD, large tasks demand a lot of executive functioning. When the first step isn’t clear, the brain sends an “avoid” signal. With that said, what’s a more balanced thought that still feels honest?

PATIENT: Starting is hard when the task is vague, but I’ve handed in reports before. I can begin if I make the first step tiny.

2. Follow the Patient’s Lead

When a patient tries to broadly suppress their ADHD symptoms, they end up consciously or unconsciously masking their identity. While most people mask to some degree, constant camouflaging leads to lower life satisfaction.

Abandon preconceived notions about impairing symptoms or challenges. Instead, ask your patient about their goals and the behaviors they want to change. Say:

• What would you prefer to focus on – career, health, relationships, or something else?
• What are your goals in this area?
• What tasks put you in line with your goals?

💡Read: What Makes a Life Fulfilling? Pursuing Goals Important to You, Not Others.

3. Watch Your Language

Does your patient prefer identity-first language (“ADHD person”) or person-first language (“person with ADHD”)? Do they have a preferred term for their neurotype? For example, Variable Attention Stimulus Trait (VAST), coined by Edward Hallowell, M.D., and John Ratey, M.D., is an alternative term for ADHD that has grown in popularity. Use non-pathologizing terms (also based on patient preference):

INSTEAD OF	SAY
risk	likelihood
comorbid	co-occurring
symptoms	traits, patterns, or experiences

4. Look Beyond the Individual

Is your approach centered on making individuals meet neurotypical standards? Are you exploring opportunities to reshape their environment to help them thrive? For instance, you might suggest that a patient relocate to a quieter corner of their office and schedule brief, daily check-ins with their supervisor.

5. Provide Supports

The skill-building and between-session tasks associated with CBT can be difficult for people with ADHD, possibly triggering rejection sensitivity. To address this barrier to care:

• Supply tools. Provide a timer, for example, rather than asking your patient to buy one.
• Gauge what can be done. Ask, “On a 10-point scale, with 10 being a done deal, how likely are you write in your thought journal every day?” If their answer is less than eight, adjust the task.
• Plan frequent check-ins for accountability and opportunities to troubleshoot.
• Suggest options. A paper checklist may help one patient stay organized, while a to-do list app may work better for another. Always give choices and allow patients to experiment autonomously.

Saskia Van Der Oord, Ph.D., is a professor of clinical psychology at KU Leuven in Belgium.

Michael Meinzer, Ph.D., is an associate professor of psychology at the University of Illinois, Chicago.

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When I began my academic career 40 years ago, ADHD or “hyperactivity” was considered a school disorder in children. The treatment was twice-daily immediate-release methylphenidate, designed to help children focus from 8 a.m. to 3 p.m., give or take.

Today, we know that ADHD affects every life domain and that medication alone is usually not sufficient. Most people need multimodal care, and the sequence of treatments matters; however, few patients benefit from these insights because ADHD care is fragmented in the following ways:

• Its quality hinges on who diagnoses the ADHD, when, and which services are available and utilized.
• How and when care is delivered.
• Untreated or undertreated ADHD is far too common.

Providing a Structured Approach

There is no one-size-fits-all approach to ADHD. An effective ADHD treatment plan for children begins with a comprehensive assessment that considers the following:

Co-occurring Conditions and Mimics

ADHD coexists with at least one psychiatric, learning, or behavioral disorder about 80% of the time. Anxiety, depression, sleep disturbance, and other conditions can imitate or amplify symptoms.

Unique Impairments

Treatment should be tailored to each child’s unique impairment and context (e.g., severity, presentation, family dynamics, parental health, care access, etc.) while simultaneously highlighting the child’s strengths. Identifying and building on a child’s talents promotes self-esteem and resilience.

💡Free Guide! Parent-Child Therapies for Better Behavior

Sleep Comes First

Sleep problems and ADHD often overlap and are mutually exacerbating; stimulants can disrupt sleep, and poor sleep can worsen ADHD symptoms. Baseline sleep history and screening for sleep disorders should precede medication trials. If sleep deteriorates, clinicians should adjust the dose or formulation, add melatonin, or reinforce sleep-hygiene routines.

Multifaceted Treatment Is Best

Research has focused extensively on monotherapy — typically medication alone — but this approach rarely suffices beyond the short term. For one, ADHD can change over time. The medication that helps a hyperactive kindergartener may not serve a high school student. Monotherapy is especially inadequate for patients with multiple symptoms, comorbidities, and residual impairments not addressed by medication, like behavioral challenges when a medication wears off.
Multimodal therapy — medication used in conjunction with new behavioral interventions — is not new. The landmark Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) study observed children assigned to different 14-month approaches:

• individually titrated medication
• intensive behavioral intervention
• combined treatment
• community care

Medications improved core symptoms, but parents and teachers rated the combined approach highest for overall functioning.

💡Free Download! A Parent’s Guide to ADHD Medication

Sequence Matters

Multimodal treatment works, but sequencing is important. In one study, children were treated during a school year and assigned to different sequences. Starting with behavioral treatment and then adding medication, if needed, produced the best outcomes, including fewer classroom rule violations and disciplinary events. Conversely, starting with medication and adding behavioral treatment later was less effective. ¹

Dosing for Non-Stimulants

For patients who do not respond to stimulants, choose not to take them, or whose comorbid conditions (e.g., tics, sleep disorders) are worsened by stimulants, non-stimulants are an option, and there are several with different mechanisms of action. Finding an optimal dose requires working closely with your provider. Often, combining stimulants with non-stimulants can improve tolerability and mitigate dose-related side effects.

What constitutes effective ADHD treatment will continue to be a central topic of research. Scientific evidence supports care that is personalized, sequenced, and measurement-based. Children respond best to treatment plans that include psychoeducation, behavioral and pharmacological interventions, and a focus on building their strengths to improve functioning not just in school but in life.

Mark A. Stein, Ph.D., is a professor of psychiatry and behavioral sciences at the University of Washington.

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Source

^{1 Pelham, W.E., Jr., Fabiano, G.A., Waxmonsky, J.G., Greiner, A.R., Gnagy, E.M., et al. (2016). Treatment sequencing for childhood ADHD: a multiple-randomization study of adaptive medication and behavioral interventions. J Clin Child Adolesc Psychol. https://doi.org/ 10.1080/15374416.2015.1105138}

Nearly half of the 15.5 million American adults with ADHD were not diagnosed as children.¹ A surge in later-life diagnoses means more people are now exploring treatment options. And they have questions.

Medications, particularly stimulants, remain the most researched and effective treatments for ADHD. While questions about their efficacy, safety, and benefits should always be answered by a doctor, this guide can help you understand ADHD medications and their potential role in your treatment plan.

How ADHD Medications Work

ADHD is associated with lower dopamine and norepinephrine activity in the prefrontal cortex. These neurotransmitters modulate attention, motivation, and impulse control. Stimulant medications increase signaling by and to these neurotransmitters by boosting release of the chemicals and blocking reuptake, producing longer lasting effects.

Non-stimulants are another category of ADHD medications. These include atomoxetine, viloxazine, and off-label bupropion, which boost dopamine and norepinephrine. (Viloxazine also acts on serotonin receptors.) The non-stimulants guanfacine and clonidine don’t raise neurotransmitter levels but stimulate the alpha-2A receptors involved in impulse control, attention, and emotional regulation.

Which Medication to Choose?

Stimulants are generally more effective than non-stimulant medications for ADHD. Of the two stimulant classes, amphetamine and methylphenidate, the former shows the strongest results², while methylphenidate outperforms non-stimulants.^{3 4} Ultimately, the best medication is the one that controls your symptoms with the fewest side effects.

💡Free! ADHD Treatment Guide for Adults

When Will the Medication Start Working?

Stimulants’ effects appear within three days. Many non-stimulants take weeks to reach effective levels and start working. Some, however, particularly bupropion and atomoxetine, act on neurotransmitters right away; people taking one of these non-stimulants may notice improvements within hours.

Getting the Dose Right

In my clinical experience, many people who try stimulants for the first time experience a “honeymoon period,” during which the benefits are greater in the first few weeks than they are thereafter, even with dose adjustments. Some argue this reflects physiological “tolerance,”, but it may instead be the euphoria and relief of improvement after a lifetime of frustration. Be aware of this phenomenon and aim for a sustainable dose that works for you over time.

If the benefits of medication are minimal and side effects are low, your provider should titrate upward and monitor over three-day intervals. You can judge a medication’s efficacy through:

• ADHD symptom rating scales. These are useful, but responses should be interpreted cautiously, since they’re self-reported.
• Personal measures. You track concrete, time-based improvements (e.g., time spent answering emails or reading a book).
• Collateral information. What have your friends, family, and providers observed?

Note that small dips in attention, focus, and alertness throughout the day are normal. Attempting to medicate your way out of these lulls (i.e., siesta time) may be counterproductive.

Read: 11 Steps to Prescribing and Using ADHD Medication Effectively

 

The Benefits of ADHD Treatment

The benefits of the correct ADHD medication go beyond improving focus, productivity, and emotional regulation. Treating ADHD reduces other risk factors; for example, studies show that adherent treatment decreases the overall likelihood of substance use-related problems.⁵

Untreated ADHD, on the other hand, doubles the risk of developing a substance use disorder.⁶ Evidence indicates that the vast majority of individuals with ADHD do not become addicted to their prescribed medications.⁷

Is a Dose Ever Too High?

A dose is too high only if it causes problematic side effects. That said, many prescribers and insurers won’t excel labeled doses. If your doctor’s dosing decisions are driven by milligrams rather than outcomes, consider getting a second opinion.

ADHD Medications: Possible Side Effects

Short- and long-term ADHD medication side effects are typically addressed by lowering the dose. Some fade with time. Mild side effects may include:

• Anxiety
• Tremors
• Irritability and/or agitation
• Sweating
• Dry mouth
• Insomnia
• Appetite suppression
• Increased heart rate/blood pressure

Rare But Serious Side Effects of ADHD Medications

The vast majority of people on ADHD medications will never experience the following serious side effects. Nevertheless, here’s what you should know.

Cardiac Effects

Most studies find no significant adverse cardiovascular effects from ADHD medications. A recent study found a link between long-term treatment and hypertension or arterial disease⁸, but the overall risk was low. The study did not find increases in arrhythmias, heart failure, heart attacks, or strokes. Importantly, it did not prove causality.

For the average patient without serious heart problems, the benefits of ADHD medication exceed the small cardiovascular risk, as long as blood pressure and heart rate are monitored. People with pre-existing or a strong family history of heart disease or uncontrolled hypertension may need special evaluation. Lifestyle factors (e.g., smoking, inactivity, stress) can amplify risk far more than medication and should be addressed.

Psychosis

Stimulant-induced psychosis is rare, and studies have found inconsistent incidence rates. A study that followed about 222,000 teens and young adults taking ADHD stimulants found that 1 in every 660 developed psychoses.⁹ Other studies have found no link between prescribed methylphenidate use and psychosis.¹⁰

A 2025 study found no causality between stimulant use and psychosis, instead noting that their association may reflect underlying patient characteristics, not the stimulants.¹¹ People who experience psychosis on stimulants should discontinue use and take an antipsychotic, which can help resolve symptoms within days.

Optimizing ADHD Treatment

Combining short- and long-acting stimulants or adding a non-stimulant can extend coverage and reduce side effects. ADHD is managed most effectively when you combine medication with proper nutrition, exercise, adequate sleep, and therapy to support executive functioning and emotional regulation.

John Kruse, M.D., Ph.D., is a neuroscientist, psychiatrist, and author.

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SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Staley, B. S., Robinson, L. R., Claussen, A. H., Katz, S. M., Danielson, M. L., Summers, A. D., Farr, S. L., Blumberg, S. J., & Tinker, S. C. (2024). Attention-Deficit/Hyperactivity Disorder Diagnosis, Treatment, and Telehealth Use in Adults – National Center for Health Statistics Rapid Surveys System, United States, October-November 2023. MMWR. Morbidity and Mortality Weekly Report, 73(40), 890–895. https://doi.org/10.15585/mmwr.mm7340a1

² Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., Carucci, S., Atkinson, L. Z., Tessari, L., Banaschewski, T., Coghill, D., Hollis, C., Simonoff, E., Zuddas, A., Barbui, C., Purgato, M., Steinhausen, H. C., Shokraneh, F., Xia, J., & Cipriani, A. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. The Lancet. Psychiatry, 5(9), 727–738. https://doi.org/10.1016/S2215-0366(18)30269-4

³ Faraone S. V. (2009). Using Meta-analysis to Compare the Efficacy of Medications for Attention-Deficit/Hyperactivity Disorder in Youths. P & T : a peer-reviewed journal for formulary management, 34(12), 678–694.

⁴ Bellato, A., Perrott, N. J., Marzulli, L., Parlatini, V., Coghill, D., & Cortese, S. (2025). Systematic Review and Meta-Analysis: Effects of Pharmacological Treatment for Attention-Deficit/Hyperactivity Disorder on Quality of Life. Journal of the American Academy of Child and Adolescent Psychiatry, 64(3), 346–361. https://doi.org/10.1016/j.jaac.2024.05.023

⁵ Zhang, L., Zhu, N., Sjölander, A., Nourredine, M., Li, L., Garcia-Argibay, M., Kuja-Halkola, R., Brikell, I., Lichtenstein, P., D’Onofrio, B. M., Larsson, H., Cortese, S., & Chang, Z. (2025). ADHD drug treatment and risk of suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality: emulation of target trials. BMJ (Clinical research ed.), 390, e083658. https://doi.org/10.1136/bmj-2024-083658

⁶ Wilens, T. E., Martelon, M., Joshi, G., Bateman, C., Fried, R., Petty, C., & Biederman, J. (2011). Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 50(6), 543–553. https://doi.org/10.1016/j.jaac.2011.01.021

⁷ Han B, Jones CM, Volkow ND, et al. Prescription Stimulant Use, Misuse, and Use Disorder Among US Adults Aged 18 to 64 Years. JAMA Psychiatry. 2025;82(6):572–581. doi:10.1001/jamapsychiatry.2025.0054

⁸ Zhang, 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

⁹ Moran, L. V., Ongur, D., Hsu, J., Castro, V. M., Perlis, R. H., & Schneeweiss, S. (2019). Psychosis with methylphenidate or amphetamine in patients with ADHD. The New England Journal of Medicine, 380(12), 1128–1138. https://doi.org/10.1056/NEJMoa1813751

¹⁰ Zarchev, M., Bouter, D. C., & Grootendorst-van Mil, N. H. (2024). No association between methylphenidate use and psychotic experiences in a population-based sample of adolescents at risk of emotional and behavioral problems. Acta Psychiatrica Scandinavica, 149(2), 168–170. https://doi.org/10.1111/acps.13630

¹¹ O’Hare, K., Byrne, J. F., Ramsay, H., Romaniuk, L., McGrath, J., Keating, D., Migone, M., O’Connor, K., Coss, N., Cannon, M., Cotter, D., Healy, C., & Kelleher, I. (2025). Stimulant medication use and risk of psychotic experiences. *Pediatrics, 155*(6), e2024069142. https://doi.org/10.1542/peds.2024-069142

January 29, 2026

Women with ADHD who report significant negative mood symptoms just before and during menstruation tend to experience similar-magnitude increases in ADHD symptoms at this time, found a new study in Journal of Attention Disorders.¹ Building upon a modest foundation of previous research that found ADHD symptoms vary across the menstrual cycle, the researchers studied women of reproductive age with ADHD treated with amphetamine salts, the most commonly used medication among members of this demographic, 60% of whom use Adderall of Mydalis.²

The 30 study participants were required to complete daily surveys measuring their ADHD symptoms as well as the severity of 17 mood symptoms. Participants reported their total daily dose of amphetamine salts, as well as use of other medications, alcohol, tobacco, or cannabis.

The study found:

• ADHD symptoms were most severe in the menstruation phase of the monthly cycle
• Negative mood symptoms were most severe in the menstruation and luteal phases
• The magnitude of increase in ADHD symptoms and negative mood was similar, leading researchers to conclude that mood and ADHD symptoms co-vary between menstrual cycle phases

These findings validate the anecdotal experience of many women with ADHD.  “Fluctuating estrogen and progesterone across the menstrual cycle invariably impact ADHD symptoms, emotions, and functioning. We know this to be true, but there is almost no research validating this relationship,” explained Lotta Skoglund Ph.D., in her recent ADDitude article, “The Menstrual Cycle Impacts ADHD Symptoms in Disparate Ways.”

“The entire week leading up to my period is where my ADHD symptoms get even more intrusive than usual,” says Chloe, an ADDitude reader. “My executive functioning dips even lower, distractibility and difficulty focusing is increased, and my mood/energy level is much lower, causing me to feel badly about all the things I’m not being successful at that week.”

Charlie, a reader in Australia, echoes this experience: “A week before I am due for my period, my brain goes to complete peanut butter. It is an utter mission to focus and stay on task. Sensory overload is at its peak. Impatience rules the days, and I get so overwhelmed.”

In addition, many women report lower efficacy of ADHD medication during the luteal and menstrual phase. One ADDitude reader shares “My ADHD meds are significantly less efficacious for about 10 days per month; two days before menstruation I am a barely functional zombie.” Norma, an ADDitude reader in Wisconsin, describes a similar experience, “The week leading up to my cycle, I might as well not even take my ADHD meds. It’s like my body overrides them.”

Based on similar anecdotal reports, the study’s researchers sought to uncover whether women with ADHD were exploring cycle syncing, increasing their dose of stimulants during the late luteal and menstruation phases to address intensified ADHD symptoms. They found, however, that women maintained constant daily medication dosing throughout their menstrual cycles.

“This may reflect prescribing practices for stimulant medications, which often do not encourage ‘flexible’ or ‘symptom-based’ dosing regimens, as well as potential inexperience of providers or patients regarding the effects of menstrual cycle phase on medication metabolism and efficacy,” the researchers reflect. The authors refer to an earlier study that found many women with ADHD were hesitant to ask doctors about the effect of their menstrual cycle on ADHD medication and often reported invalidating responses from their practitioners when they did inquire.³

Skoglund advises women to use a menstrual cycle tracking log to record and report specific data to aid these conversations with doctors: “Tracking your cycle will give you powerful insights into how hormonal fluctuations influence your ADHD symptoms, medication effectiveness, and overall functioning. With this data, you’ll be in a better position to talk to your doctor about enhancements to your treatment plan to improve your health and wellbeing.”

The study had several limitations, including its small sample size; 16 of the 46 initial participants were excluded for failure to complete daily surveys, leaving 30 participants, and the authors note it is possible the individuals who successfully completed the surveys had milder ADHD symptoms. In addition, unlike other studies,⁴ the researchers did not measure ovarian hormone levels, relying on participants’ reporting of menstruation for this information. Individuals who were taking other psychiatric medications were excluded, thus excluding women who receive medication for mood disorders and/or Premenstrual Dysphoric Disorder, both of which are significantly more likely in people with ADHD.

Sources

¹Zaritsky, R., Reed, S. C., & Evans, S. M. (2025). Changes in ADHD Symptoms and Mood Across the Menstrual Cycle in Females Treated With Stimulants: A Pilot Study. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547251400038

²Anderson K. N., Ailes E. C., Danielson M., Lind J. N., Farr S. L., Broussard C. S., Tinker S. C. (2018). Attention-deficit/hyperactivity disorder medication prescription claims among privately insured women aged 15-44 years – United States, 2003-2015. Morbidity and Mortality Weekly Report, 67(2), 66–70. https://doi.org/10.15585/mmwr.mm6702a3

³Bürger I., Erlandsson K., Borneskog C. (2024). Perceived associations between the menstrual cycle and attention deficit hyperactivity disorder (ADHD): A qualitative interview study exploring lived experiences. Sexual & Reproductive Healthcare, 40, Article 100975. https://doi.org/10.1016/j.srhc.2024.100975

⁴Roberts B., Eisenlohr-Moul T., Martel M. M. (2018). Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology, 88, 105–114. https://doi.org/10.1016/j.psyneuen.2017.11.015