The anticipated MAHA Commission report released yesterday misrepresents ADHD causes and care in the U.S., misinterpreting studies and disregarding compelling new research and patient voices to suggest that ADHD is contributing to a “crisis of overdiagnosis and treatment” in American children.

The MAHA Report, spearheaded by Health and Human Service (HHS) Secretary Robert F. Kennedy, Jr., equates ADHD with obesity, heart disease, and diabetes in calling these harmful contributors to the “childhood chronic disease crisis” in the U.S. It disregards the genetic underpinnings of ADHD to suggest it is solely caused by environmental factors and foods, twists data to stoke fear over rising diagnosis rates, and excludes a wealth of studies that link stimulant medication use to improved health outcomes.

It assumes ADHD is a disease caused and cured by environmental factors. And it suggests that curing ADHD will “make America healthy again.” We disagree, and so does the research.

Should the U.S. government take a long, hard look at the impact of ultra-processed foods, environmental chemicals, and declining physical activity on American children? Absolutely. Should it invest in programs to provide healthy foods, affordable health care, and screen-free activities for all children, regardless of socioeconomic status or means? Yes. Do we support efforts to eliminate toxins from our kids’ food, water, and air? To protect them from unhealthy screen use? To help them live longer, healthier lives? 100%.

Will any of these efforts “cure” ADHD, as the MAHA Report suggests? No, the research does not support that notion. But these efforts, if undertaken by Kennedy, do stand to improve quality of life for many children, and so they should be seriously considered by HHS through investment in the FDA, CDC, and NIH.

Do you know what else improves quality of life for kids? Less stigma and shame, and more investment and solutions. The MAHA Report, sadly, increases ADHD stigma by claiming the condition is overdiagnosed and disparaging its treatment as ineffective without any credible evidence to support these claims. On the flipside, it makes no mention of the proven, life-saving benefits of ADHD treatment or the risks associated with undiagnosed, untreated ADHD. It makes no mention of behavioral parent training, cognitive behavioral therapy, dialectical behavior therapy, or classroom interventions for ADHD, all of which are shown to improve outcomes for individuals with ADHD. Instead, the report’s “solutions” for ADHD suggest more scrutiny of and restricted access to stimulant medication.

Finally, it is notable that the commission included few scientists or experts in pediatric health care. The commission conducted no new research and it apparently did not seek comment or insight from the American Professional Society of ADHD and Related Disorders (APSARD), the American Academy of Pediatrics (AAP), or the World Federation of ADHD regarding the established science on ADHD causes and treatments. No patients were interviewed for or quoted in the report.

The next steps outlined in the report are vague and we expect the commission to propose more detailed strategies in August, but here are three takeaways from the May 22 MAHA Report that may impact the ADHD community.

#1: The Report Misrepresents the Causes of ADHD

ADHD is a highly genetic condition, as confirmed by brand-new research that identified measurable genetic traits that essentially act as biomarkers for ADHD. Lifestyle factors such as nutrition, exercise, and sleep exert epigenetic changes on DNA that influence how strongly or weakly ADHD genes are expressed. However, diet, physical activity, sleep, or screen use alone do not cause — and have not been shown to “cure” — ADHD.

Scientific research has established no causal link between consumption of sugar, food additives, or food dyes and ADHD, though some studies show a heightened sensitivity among children with ADHD to these foods, which may exacerbate existing symptoms. Likewise, scientific research has established no causal link between excessive screen time, video game play, or social media use and ADHD.

Despite clear evidence to the contrary, the MAHA Report claims that ADHD is caused by all of the following, but it never mentions genetic factors:

• Antibiotics: The report cited as evidence a study that “could not disentangle the effects of antibiotics from those of the underlying conditions” and “could not verify adherence to antibiotic prescriptions.” Other recent studies have found gut microbiome alterations in children with ADHD but no causal link between antibiotic use and ADHD in humans.
• Food additives: Research shows that food dyes may worsen symptoms of inattention or hyperactivity in children with ADHD, however there is no evidence of a causal relationship.
• Environmental toxins: This article by Joel Nigg, Ph.D., contains a thorough overview of all existing research on environmental toxins and ADHD, but the bottom line is this: “Genes and environments work together to shape development of the brain and behavior throughout life, but especially — and most dramatically — in very early life. ADHD, like other complex conditions, doesn’t have a single cause. Both nature and nurture influence its development.”

#2: The Report Casts Doubt on the Validity of an ADHD Diagnosis

The MAHA Report claims that “research shows ADHD has the strongest evidence of overdiagnosis,” however no such research is cited in the report. Perhaps that is because there is no definitive evidence that ADHD is overdiagnosed in America today. ADHD diagnosis rates have increased over the last few decades, however this may be a result of any of the following, and other factors:

• The high diagnosis rate cited in the report comes from a problematic and misleading CDC study that is “terribly designed to assess the prevalence of the disorder,” says Russell Barkley, Ph.D., a leading authority on ADHD. “In this survey, there is one question about ADHD: ‘Has a doctor or other healthcare provider ever told you that this child has ADD or ADHD?’ That could be anybody associated with the healthcare profession who has no training in ADHD… and there is no effort in this study to follow up to see if these children were, in fact, diagnosed.” Barkley goes on to say that meta-analyses of better-conducted studies that apply diagnostic criteria to their research populations find that the prevalence of ADHD among children ranges from 5 to 8 percent, not 10 to 11 percent.
• Revised diagnostic criteria published in the DSM-5 changed the age of onset from 7 to 12 and added the first-ever qualifier symptoms for ADHD in adulthood
• With ongoing research and clinician training on ADHD, education and symptom recognition have improved
• Twenty years ago, ADHD was viewed as a disorder that affected young males. As research on females began to take hold, girls and women were able to secure ADHD evaluations for the first time
• Likewise, as mental health stigma dissipates within time, historically underserved populations are seeking care for the first time

The report further suggests that “the harms associated with an ADHD diagnosis may often outweigh the benefits” without naming those supposed harms or acknowledging the many health risks associated with undiagnosed ADHD. Research shows that undiagnosed and untreated individuals face a higher risk for fatal car accidents, unwanted pregnancies, serious injury and hospitalizations, job loss, academic interruptions, self-harm, anxiety, depression, eating disorders, and more. The harms associated with undiagnosed ADHD are too severe to ignore, yet the MAHA Commission does just that.

#3: The Report Misrepresents the Efficacy and Risks of ADHD Medication

The MAHA Report draws faulty conclusions from the ​​Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder (MTA) study to argue that ADHD medication use offers no benefits “in grades, relationships, achievement, behavior, or any other measure” after 14 months of use. This is untrue.

In reality, the MTA study ended after 14 months, so the control group members with ADHD who did not initially receive medication were free to seek it out after 14 months. As many of the controls began treating their ADHD symptoms with medication, the differences between the control and treatment groups faded because the control group members began to improve on medication, not because the treatment group began to do worse. It is wrong and irresponsible to suggest that no patients experienced benefits from ADHD medication use after 14 months.

“The groups became very contaminated after that 14-month follow-up,” Barkley says in a video on his YouTube channel. “Therefore, we can’t make comparisons at years 2, 3, or 4 between or among the treatment groups and draw any conclusions about them because the treatments were mixed up among all the groups.”

The report claims that stimulants, “when stopped, often lead to disabling and prolonged physical dependence and withdrawal symptoms.” This is untrue. The research cited in the report was a study of antidepressants, not stimulants. There is no evidence to support this assertion regarding stimulant medication. In addition, we know that half of teens and adults with ADHD stop taking stimulant medication within one year of starting it, often due to stigma or access problems. This suggests that it is not addictive. In fact, stimulant medication has been used safely and effectively for nearly 100 years — more than enough time for long-term adverse outcomes to come to light, yet none has.

Finally, the report’s claim that stimulant medication use does “not improve outcomes long-term” is also false.

Research dating back more than 40 years has documented the positive impact of ADHD treatment on specific symptoms like inattention and hyperactivity, and on life expectancy overall. Recently, a Swedish study, published in JAMA Network Open, documented these findings:

• ADHD medication use reduced overall risk of death by 19%. Among people with ADHD who did not receive medication, there were 48 deaths for every 10,000 people, contrasted with 39 deaths per 10,000 people within the medicated cohort.
• ADHD medication use reduced the risk of overdose by 50%. Medication use also reduced the risk of death from other unnatural causes, including accidental injuries, accidental poisoning such as drug overdoses, and suicide.
• ADHD medication use reduced the risk of death from natural causes, such as medical conditions, for women.

People with childhood ADHD are nearly twice as likely to develop a substance use disorder as are individuals without childhood ADHD. However, research suggests that patients with ADHD treated with stimulant medications experience a 60% reduction in substance use disorders compared to those who are not treated with stimulant medication. Considerable evidence also suggests that children taking ADHD medication experience improvements in academic and social functioning, which translates to improved self-esteem, lower rates of self-medication with drugs or alcohol, and decreased risk of substance abuse.

Given all of the above, it’s difficult to view the increase in stimulant medication use flagged by the MAHA Report as anything but positive. “Why isn’t that evidence of improvement in good public mental health?” Barkley asks. “The fact that there is a rise in the occurrence of a particular treatment does not provide prima facie evidence that there is something bad, wicked, evil, wrong going on here; it simply means that, over time, we are getting closer and closer to identifying conditions that produce harm in individuals, and that we try to alleviate that harm and suffering.”

The Threat to ADHD Care Access

The MAHA Commission plans to release its recommended strategies in August, but it’s easy to see the writing on the wall now. The arguments presented in Thursday’s MAHA Report, based largely on outdated or poorly interpreted research, suggest that Kennedy may seek to restrict access to ADHD care and that he’s building a foundation of doubt and misinformation now to support that action.

We fear efforts to dissuade physicians from diagnosing and treating ADHD may be forthcoming from the Drug Enforcement Administration (DEA) with support from the CDC, which Kennedy oversees. Of course, we hope we are proven wrong. We hope that, instead, HHS chooses to fully restore funding for ADHD research efforts through the National Institutes of Mental Health, for mental healthcare initiatives through the CDC, and for nationwide nutrition assistance programs through the FDA.

ADDitude supports an investment in unbiased research into the root causes of and effective treatments for ADHD to support, not ‘cure,’ individuals living with neurodivergent brains. We welcome the opportunity to engage in transparent dialog with the MAHA Commission and to introduce the voices and viewpoints of individuals and families living with ADHD, which were excluded from this report. And we hope that this administration will fund initiatives to improve food quality and access, eliminate harmful food additives, provide mental health services to all children, and crack down on the industries and companies contributing toxins to our environment.

We also stand ready to defend the legitimacy of the robust library of credible, science-backed research studies that confirm ADHD’s genetic underpinnings, that validate its diagnostic tools, and that confirm the benefits of its uninterrupted treatment.

Reactions from the ADHD Community

Mark Bertin, M.D., PLLC, of Developmental Pediatrics

“Lifestyle changes that promote child health are a wonderful idea. However, the MAHA paper ignores the reality of ADHD, a common medical disorder with genetics nearly as strong as the inherited trait of height. Undertreated ADHD is a public health concern that affects school performance, relationships, and driving; increases the risk of substance abuse; and shortens lifespans. Research and clinical experience show clear benefits to ADHD medication, which has been used for a century without evidence of chronic side effects. Supporting individuals with ADHD requires more understanding, not less, while making medical, educational, psychological, and health-related supports affordable and easily available. The MAHA document completely misrepresents ADHD in ways that are judgmental, demeaning, and will be harmful to individuals, our health care system, and society.”

Russell Barkley, Ph.D.

The ADHD Evidence Project, Founded by Stephen Faraone, Ph.D.

“ADHD is one of the most discussed neurodevelopmental disorders in the MAHA Report, but many of its claims about ADHD are misleading, oversimplified, or inconsistent with decades of scientific evidence, much of which is described in the International Consensus Statement on ADHD, and other references given here.”

Misdiagnosis is a significant barrier to care. Black children and adolescents with ADHD are more likely to be labeled with oppositional defiant disorder and to have their ADHD symptoms misunderstood as defiance. Also, cultural stigma surrounding mental health can prevent Black families from seeking care and from using ADHD medication when it is prescribed. Black parents report a preference for interventions like parent training and executive function skills training, to which their access is often limited.

One possible solution: integrated primary care, in which behavioral health services are embedded within primary care practices. When children go to a pediatrician appointment, they may also see a behavioral health care specialist for common concerns like depression, anxiety, and a range of disruptive behaviors from failing to follow caregivers’ directions to disrupting the classroom.

[Read: ADHD Clinicians Must Consider Racial Bias in Evaluation and Treatment of Black Children]

Integrated primary care can address the treatment disparities in Black youth by enabling more personalized, collaborative treatment for ADHD and its co-occurring difficulties. Parents should ask their pediatrician whether an in-office behavioral health specialist is available. Additionally, many primary care practices affiliated with academic medical centers or children’s hospitals have integrated primary care clinics.

Mental Health Stigma in ADHD Care: Next Steps

• Learn: Why We Need Clinicians of Color to Normalize ADHD in BIPOC Communities
• Read: Evaluating and Treating ADHD in African American Children: Guidance for Clinicians
• Watch: “Health Equity in ADHD: Addressing Racial Disparities in Diagnosis and Treatment” [Video Replay & Podcast #495]

Heather A. Jones, Ph.D., is an associate professor of psychology at Virginia Commonwealth University.
Alfonso L. Floyd, Ph.D., is a postdoctoral fellow in the Department of Child & Adolescent Psychiatry and Behavioral Sciences at The Children’s Hospital of Philadelphia.

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Cognitive-aerobic exercise improves working memory more than aerobic exercise alone in children and adolescents with ADHD, according to a new study¹ published in Frontiers in Psychology. 

Previous research has shown that exercise relieves ADHD symptoms by increasing endorphins and neurotransmitters in the brain. This new study is the first network meta-analysis to evaluate the efficacy of various exercise interventions on working memory in children with ADHD.

The study’s results indicate the following impacts of various types of exercise on children with ADHD:

• Cognitive-aerobic exercise demonstrates the most significant effect on working memory, or the capacity for holding and using information over a short period of time.
• Ball sports follow closely behind with a moderate to high improvement effect.
• Mindy-body exercises and interactive games display a moderate improvement in working memory.
• Simple aerobic exercise and interactive games exhibit the smallest improvement effect on children with ADHD.

“For developing children, aerobic exercise expands the growth of brain connections, the frontal cortex, and the brain chemicals (such as serotonin and dopamine) that support self-regulation and executive functioning,” said Joel Nigg, Ph.D., a clinical psychologist and a professor in the departments of psychiatry and behavioral sciences at Oregon Health & Science University. “These surprisingly specific findings in typically developing children have led to excitement about the possibility that the right kind of exercise can help ADHD.”²

Further analysis suggests that the effectiveness of cognitive-aerobic exercise in improving working memory in children with ADHD may depend on higher intervention frequency and longer cumulative intervention duration.

Cognitive-Aerobic Exercise for Working Memory

“Cognitive-aerobic exercise,” as defined by the researchers, combines physical activity with mentally stimulating tasks like decision-making and problem-solving, e.g., dual-task exercises, strategy-based games, and exergaming. It may involve activities with rules and objectives that increase the load on the prefrontal cortex, which is closely associated with working memory.

The researchers propose that cognitive-aerobic exercise is particularly powerful because it requires quick decision-making, memory retrieval, and cognitive switching in addition to physical activity, thus “working out” the working memory.

Ball Sports for Working Memory

Ball sports exert a positive impact on working memory, perhaps due to their reliance on strategy and social skills.  “Sports such as soccer or basketball typically require children to remain highly focused while also remembering and analyzing the actions of teammates and opponents, which places a high demand on task memory,” the researchers wrote. “In ball sports, children not only need to plan and execute movements but also continuously adjust strategies and predict the opponent’s actions. These multitasking and real-time adjustment characteristics directly exercise their working memory load, information storage, and response speed.”

This seems consistent with one ADDitude reader’s experience with her son, who has ADHD and plays sports like football and lacrosse.

“The strategizing required when playing these sports is helpful,” said Deborah from New York. “He is receiving many different stimuli at one time, helping him to decipher information and build his executive function skills.”

Mind-Body Exercise for Working Memory

Mind-body exercises (e.g., yoga, Tai Chi) only moderately affect working memory and “may be more significant in improving attention and emotional regulation but… may lack the high cognitive load stimulation required for direct improvements” in working memory, the researchers said.

Interactive Games for Working Memory

Sports-based interactive games primarily enhance social and cooperative skills by motivating children to engage in collaborative tasks or fun competitions in virtual environments. “Although these games have a positive impact on the social behavior and emotional regulation of children with ADHD, the cognitive challenges in these games are limited and generally do not involve high-intensity memory tasks or complex decision-making, making their direct impact on working memory relatively modest,” the researchers wrote.

Traditional Aerobic Exercise

Traditional aerobic exercise involves “repetitive and rhythmic movements, such as swimming or cycling, aimed solely at improving physical endurance and fitness.”

Due to its more straightforward physical activity format, traditional aerobic exercise had the smallest impact on working memory, the researchers proposed.

“Activities like running and skipping, while improving overall physical fitness and stimulating dopamine secretion, can help children with ADHD maintain attention in the short term,” the researchers wrote. “However, since they lack demands for memory and multitasking, they are often insufficient to activate the prefrontal cortex’s executive function areas. As a result, their direct impact on working memory is relatively small.”

The study’s overall findings suggest that “when designing exercise interventions for children with ADHD, priority should be given to exercise types with higher cognitive load,” the researchers wrote.

The meta-analysis analyzed data from 17 studies, which collectively had 419 participants with ADHD, ages 3 to 18. Studies included structured aerobic exercise (e.g., running, swimming), strength training (e.g., resistance training), cognitive exercise, and balance or coordination exercises. The intervention periods ranged from one to 13 weeks, with exercise frequency ranging from one to five times per week and lasting 10 to 90 minutes.

According to researchers, the study had several limitations, including a disproportionately small percentage of female participants. Further research is needed to explore how different kinds of exercise may impact people of various genders and why these types of exercise have different efficacy levels.

The researchers caution that their findings do not mean that children should treat their ADHD exclusively with exercise. According to the American Academy Of Pediatrics (APA), the most effective treatment for ADHD is parental behavior therapy paired with ADHD medication for children over age 6.

Sources

¹ Song, X., Hou, Y., Shi, W., Wang, Y., Fan, F., & Hong, L. (2025). Exploring the impact of different types of exercise on working memory in children with ADHD: a network meta-analysis. Frontiers in Psychology, 16. https://doi.org/10.3389/fpsyg.2025.1522944

² Best, J.R. (2010). Effects of Physical Activity on Children’s Executive Function: Contributions of Experimental Research on Aerobic Exercise. Dev Rev; (4):331-551. https://doi.org/10.1016/j.dr.2010.08.001

Calls to Action: MAHA Commission Testimony & Advocacy

• Submit your testimony to the MAHA Commission by contacting MAHA Commission Chair Robert Kennedy, Jr. at https://x.com/SecKennedy, and media@hhs.gov
• Join the advocacy efforts organized by CHADD
• Contact your national, state, and local representatives to share your testimony and the evidence-based research on ADHD below

February 26, 2025

Dear Secretary Kennedy,

As the Make America Healthy Again Commission begins its evaluation of published research on the chronic health conditions impacting American children, we urge it to consult with the esteemed clinicians associated with the American Professional Society of ADHD and Related Disorders (APSARD), the American Academy of Pediatrics (AAP), and the World Federation of ADHD regarding the established science on ADHD causes and treatments. Consensus within these groups, and among ADHD researchers worldwide, is strong and consistent regarding the following evidence-based findings:

• ADHD is a chronic neurodevelopmental condition characterized by inattention, impulsivity, executive dysfunction, and/or hyperactivity that persists into adulthood for approximately 90% of patients.¹
• ADHD is a highly genetic condition.^2,3,4 Lifestyle factors such as nutrition, exercise, and sleep exert epigenetic changes on DNA that influence how strongly or weakly ADHD genes are expressed. However, diet, physical activity, sleep, or screen use alone do not cause — and have not been shown to “cure” — ADHD.
• The 16% increase in ADHD diagnoses over the last decade is due, in large part, to revised diagnostic criteria published in the DSM-5, which changed the maximum age of onset from 7 to 12 and added the first-ever qualifier symptoms for ADHD in adulthood. This wider net, along with improved education, training, and symptom recognition, particularly in historically overlooked girls and women, account for much of the diagnostic uptick, according to studies.^{5, 6}
• Scientific research has established no causal link between excessive screen time, video game play, or social media use  and ADHD.⁷ Some studies suggest these habits may exacerbate inattention and impulsivity.^{8, 9}
• Scientific research has established no causal link between consumption of sugar, food additives, or food dyes and ADHD, though some studies show a heightened sensitivity among children with ADHD to these foods, which may exacerbate existing symptoms.¹⁰
• Scientific research shows that prenatal and/or childhood exposure to tobacco, lead, pesticides, and polychlorinated biphenyls (PCBs) may increase the odds of ADHD in some children, however the studies do not find direct causality.^{11,12, 13,14}
• Several research studies have shown that consumption of a Western diet high in processed foods, fats, sugars, and salt is associated with higher rates of ADHD, however these studies demonstrate an association rather than causality.¹⁵
• ADHD shortens an individual’s life expectancy by 7.5 years, on average.¹⁶ It is serious, potentially lethal, and associated with elevated risks for comorbid conditions ^{17, 18} including anxiety, depression,¹⁹ substance use disorder,²⁰ eating disorders,^{21, 22} obesity, and oppositional defiant disorder,²³ which commonly derails treatment plans and parenting strategies. People with ADHD are more likely to get into car accidents,²⁴ become hospitalized, and engage in self-harm than are their neurotypical peers.^{25, 26, 27}
• In patients with the condition, ADHD medication use reduces the risk of death by 19%, the risk of overdose by 50%,²⁸ the risk of substance abuse by 50%,²⁹ and the risk of motor vehicle accidents by at least 38%.³⁰ Its effective symptom management improves patients’ self-esteem and efficacy, thereby reducing the risk of self-harm and suicide, as well as negative life outcomes such as unwanted pregnancy, incarceration, unemployment, and interruption of education.
• The medications used to treat ADHD have been studied rigorously and used safely for 88 years. Amphetamine and methylphenidate safely and effectively reduce ADHD symptoms, with methylphenidate reducing symptoms by 70% to 90% in children and adults with the condition.^{31, 32} The effect sizes for ADHD medication are .8 to 1.0,³³  which are among the strongest in all of psychiatry. Clinical practice guidelines recommend medication as the first-line treatment for ADHD due to its overwhelming efficacy; for children with ADHD ages 4 to 6, parent behavior training is recommended by the AAP.³⁴
• According to the CDC, just 53.6% of all children and teens with ADHD reported they were actively treating their symptoms with medication in 2022. Because stimulant medications are classified as Schedule II drugs under the Controlled Substances Act, they are tightly regulated; supplies are limited to 30 days and prescribing clinicians must authorize monthly refills. The widely reported ADHD medication shortage has disrupted treatment for millions of patients across the country since 2022.³⁵
• Caregivers and adults with ADHD surveyed by ADDitude rate medication as the most effective treatment for ADHD, however less than half of parents report that they chose to medicate their children within 6 months of diagnosis. They report changing diet, limiting screen time, supplementing with fish oil, and increasing physical activity before ultimately using medication to achieve the symptom improvement necessary for academic and social success.
• The mild to moderate side effects associated with ADHD medication include appetite suppression, irritability or moodiness, sleep problems, and headaches. There is no evidence that ADHD medication use leads to dependency or broader substance abuse; in fact, research shows that ADHD medication use is protective against substance use disorder in individuals with ADHD.³⁶
• The non-stimulant medications used to treat ADHD, such as atomoxetine, guanfacine, and clonidine, have an effect size of .4 to .7 and are considered a second-line treatment appropriate for patients who do not tolerate or cannot take stimulants.^{37, 38, 39}
• Clinical guidelines promote the use of multimodal treatment plans that pair prescription medication with complementary approaches to ADHD management. The nonpharmacological interventions shown to be most effective at reducing ADHD symptoms in children are behavioral therapy (effect size of .5 to.8 when used on its own),⁴⁰ exercise (effect size of .4 to .6 when used on its own),⁴¹ sleep hygiene and interventions (effect size of .5 to .8 when used on their own),⁴² and dietary interventions (effect size of .2 to .5 when used on their own).⁴³
• Behavioral therapy, principally parent training, has an elevated and improved effect when used in conjunction with ADHD medication.⁴⁴ Behavioral therapy is used by just 44% of pediatric patients, in part because it’s not always covered by medical insurance and knowledgeable providers are scarce.
• One meta-analysis of randomized, placebo-controlled trials showed that supplementation with high doses of omega-3 fatty acids has a small positive impact on attention and hyperactivity in children.⁴⁵
• Research suggests that restricting the consumption of synthetic food dyes does benefit some children with ADHD, though aggregate effects are quite small.⁴⁶
• When engaging in vigorous cardiovascular exercise, the brain releases endorphins. Levels of dopamine, norepinephrine, and serotonin also increase with exercise, thus improving focus, working memory, and mood to enable better learning.
• Cognitive behavioral therapy (CBT), though more commonly prescribed to adult patients, has been shown to improve core ADHD symptoms in adolescents when used in conjunction with ADHD medication.⁴⁷
• Neurofeedback uses an electroencephalogram (EEG) to measure brain activity and train the patient to produce brain wave patterns like those of a non-ADHD brain. Neurofeedback has not shown enough effectiveness in studies to be recommended as a “stand-alone” treatment for ADHD and there is little evidence that neurofeedback reduces ADHD symptoms long-term. In addition, neurofeedback is seldom covered by insurance and involves a significant investment of time and money.^{48, 49, 50}
• According to research, brain training does not reduce ADHD symptoms. There is no evidence that a patient can train a brain to improve working memory, or any other executive function.^{51, 52, 53}

Thank you for reviewing the evidence-based research highlighted above. We welcome follow-up questions from the Commission as it devises recommendations based on science that may benefit the health and wellbeing of the 22 million Americans with ADHD, whom ADDitude has served for the last 26 years. We support their personal liberty to pursue and maintain the treatments that benefit their ADHD brains, which are a tremendous asset to this nation.

Sincerely,
Anni Rodgers
General Manager, ADDitude

Sources

¹Sibley, M., Arnold, L, Swanson, J. et.al. (13 August 2021). Variable patterns of remission from ADHD in the multimodal treatment study of ADHD. The American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.2021.21010032

²Faraone, Stephen V. et al. Molecular Genetics of Attention-Deficit/Hyperactivity Disorder, Biological Psychiatry, Volume 57, Issue 11, 1313 – 1323

³Liuyan Zhang, Suhua Chang, Zhao Li, Kunlin Zhang, Yang Du, Jurg Ott, Jing Wang, ADHDgene: a genetic database for attention deficit hyperactivity disorder, Nucleic Acids Research, Volume 40, Issue D1, 1 January 2012, Pages D1003–D1009, https://doi.org/10.1093/nar/gkr992

⁴Gizer, I.R., Ficks, C. & Waldman, I.D. Candidate gene studies of ADHD: a meta-analytic review. Hum Genet 126, 51–90 (2009). https://doi.org/10.1007/s00439-009-0694-x

⁵Mowlem, F.D., Rosenqvist, M.A., Martin, J. et al. Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment. Eur Child Adolesc Psychiatry 28, 481–489 (2019). https://doi.org/10.1007/s00787-018-1211-3

⁶Abdelnour E, Jansen MO, Gold JA. ADHD Diagnostic Trends: Increased Recognition or Overdiagnosis? Mo Med. 2022 Sep-Oct;119(5):467-473. PMID: 36337990; PMCID: PMC9616454.

⁷Nikkelen, S. W., Valkenburg, P. M., Huizinga, M., & Bushman, B. J. (2014). “Media use and ADHD-related behaviors in children and adolescents: A meta-analysis.” Developmental Psychology, 50(9), 2228-2241.

⁸Madigan S, Browne D, Racine N, Mori C, Tough S. Association Between Screen Time and Children’s Performance on a Developmental Screening Test. JAMA Pediatr. 2019;173(3):244–250. doi:10.1001/jamapediatrics.2018.5056

⁹Yifei, P, Xuechun, L,Yu, Y. (2023). Screen use and its association with ADHD symptoms among children: a systematic review. MEDS Public Health and Preventive Medicine, 3.10.23977/phpm.2023.030301

¹⁰Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry. 2012 Jan;51(1):86-97.e8. doi: 10.1016/j.jaac.2011.10.015. PMID: 22176942; PMCID: PMC4321798.

¹¹Huang L, Wang Y, Zhang L, Zheng Z, Zhu T, Qu Y, Mu D. Maternal Smoking and Attention-Deficit/Hyperactivity Disorder in Offspring: A Meta-analysis. Pediatrics. 2018 Jan;141(1):e20172465. doi: 10.1542/peds.2017-2465. PMID: 29288161.

¹²Goodlad JK, Marcus DK, Fulton JJ. Lead and Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms: a meta-analysis. Clin Psychol Rev. 2013 Apr;33(3):417-25. doi: 10.1016/j.cpr.2013.01.009. Epub 2013 Jan 29. PMID: 23419800.

¹³Nigg JT, Nikolas M, Mark Knottnerus G, Cavanagh K, Friderici K. Confirmation and extension of association of blood lead with attention-deficit/hyperactivity disorder (ADHD) and ADHD symptom domains at population-typical exposure levels. J Child Psychol Psychiatry. 2010 Jan;51(1):58-65. doi: 10.1111/j.1469-7610.2009.02135.x. Epub 2009 Nov 23. PMID: 19941632; PMCID: PMC2810427.

¹⁴Eubig PA, Aguiar A, Schantz SL. Lead and PCBs as risk factors for attention deficit/hyperactivity disorder. Environ Health Perspect. 2010 Dec;118(12):1654-67. doi: 10.1289/ehp.0901852. Epub 2010 Sep 9. PMID: 20829149; PMCID: PMC3002184.

¹⁵Howard AL, Robinson M, Smith GJ, Ambrosini GL, Piek JP, Oddy WH. ADHD is associated with a “Western” dietary pattern in adolescents. J Atten Disord. 2011 Jul;15(5):403-11. doi: 10.1177/1087054710365990. Epub 2010 Jul 14. PMID: 20631199.

¹⁶O’Nions E, El Baou C, John A, et al. Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study. The British Journal of Psychiatry. Published online 2025:1-8. doi:10.1192/bjp.2024.199

¹⁷Gnanavel S, Sharma P, Kaushal P, Hussain S. Attention deficit hyperactivity disorder and comorbidity: A review of literature. World J Clin Cases 2019; 7(17): 2420-2426 [PMID: 31559278 DOI: 10.12998/wjcc.v7.i17.2420]

¹⁸Kessler, Ronald & Adler, Lenard & Barkley, Russell & Biederman, Joseph & Conners, C & Demler, Olga & Faraone, Stephen & Greenhill, Laurence & Howes, Mary & Boye, Kristina & Spencer, Thomas & Ustun, Tevfik & Walters, Ellen & Zaslavsky, Alan. (2006). The Prevalence and Correlates of Adult ADHD in the United States: Results From the National Comorbidity Survey Replication. The American journal of psychiatry. 163. 716-23. 10.1176/appi.ajp.163.4.716.

¹⁹Babinski DE, Neely KA, Ba DM, Liu G. Depression and Suicidal Behavior in Young Adult Men and Women With ADHD: Evidence From Claims Data. J Clin Psychiatry. 2020 Sep 22;81(6):19m13130. doi: 10.4088/JCP.19m13130. PMID: 32965804; PMCID: PMC7540206.

²⁰Katelijne van Emmerik-van Oortmerssen, Geurt van de Glind, Wim van den Brink, Filip Smit, Cleo L. Crunelle, Marije Swets, Robert A. Schoevers, Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: A meta-analysis and meta-regression analysis, Drug and Alcohol Dependence, Volume 122, Issues 1–2, 2012, Pages 11-19, ISSN 0376-8716, https://doi.org/10.1016/j.drugalcdep.2011.12.007.

²¹Nazar BP, Bernardes C, Peachey G, Sergeant J, Mattos P, Treasure J. The risk of eating disorders comorbid with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Int J Eat Disord. 2016 Dec;49(12):1045-1057. doi: 10.1002/eat.22643. Epub 2016 Nov 15. PMID: 27859581.

²²Curtin, Carol & Pagoto, Sherry & Mick, Eric. (2013). The association between ADHD and eating disorders/pathology in adolescents: A systematic review. Open Journal of Epidemiology. 3. 193-202. 10.4236/ojepi.2013.34028.

²³Nock MK, Kazdin AE, Hiripi E, Kessler RC. Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: results from the National Comorbidity Survey Replication. J Child Psychol Psychiatry. 2007 Jul;48(7):703-13. doi: 10.1111/j.1469-7610.2007.01733.x. PMID: 17593151.

²⁴Curry AE, Yerys BE, Metzger KB, Carey ME, Power TJ. Traffic Crashes, Violations, and Suspensions Among Young Drivers With ADHD. Pediatrics. 2019 Jun;143(6):e20182305. doi: 10.1542/peds.2018-2305. Epub 2019 May 20. PMID: 31110164; PMCID: PMC6564068.

²⁵Ward JH, Curran S. Self-harm as the first presentation of attention deficit hyperactivity disorder in adolescents. Child Adolesc Ment Health. 2021 Nov;26(4):303-309. doi: 10.1111/camh.12471. Epub 2021 May 3. PMID: 33939246.

²⁶Hinshaw SP, Owens EB, Zalecki C, Huggins SP, Montenegro-Nevado AJ, Schrodek E, Swanson EN. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. J Consult Clin Psychol. 2012 Dec;80(6):1041-1051. doi: 10.1037/a0029451. Epub 2012 Aug 13. PMID: 22889337; PMCID: PMC3543865.

²⁷Ping-I Lin, Weng Tong Wu, Enoch Kordjo Azasu, Tsz Ying Wong, Pathway from attention-deficit/hyperactivity disorder to suicide/self-harm, Psychiatry Research, Volume 337, 2024, 115936, ISSN 0165-1781, https://doi.org/10.1016/j.psychres.2024.115936.

²⁸Li L, Zhu N, Zhang L, Kuja-Halkola R, D’Onofrio BM, Brikell I, Lichtenstein P, Cortese S, Larsson H, Chang Z. ADHD Pharmacotherapy and Mortality in Individuals With ADHD. JAMA. 2024 Mar 12;331(10):850-860. doi: 10.1001/jama.2024.0851. PMID: 38470385; PMCID: PMC10936112.

²⁹Faraone SV, Wilens T. Does stimulant treatment lead to substance use disorders? J Clin Psychiatry. 2003;64 Suppl 11:9-13. PMID: 14529324.

³⁰Chang Z, Quinn PD, Hur K, et al. Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes. JAMA Psychiatry. 2017;74(6):597–603. doi:10.1001/jamapsychiatry.2017.0659

³¹Spencer, Thomas et al. A large, double-blind, randomized clinical trial of methylphenidate in the treatment of adults with attention-deficit/hyperactivity disorder, Biological Psychiatry, Volume 57, Issue 5, 456 – 463

³²Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Leibson CL, Jacobsen SJ. Long-term stimulant medication treatment of attention-deficit/hyperactivity disorder: results from a population-based study. J Dev Behav Pediatr. 2006 Feb;27(1):1-10. doi: 10.1097/00004703-200602000-00001. PMID: 16511362.

³³Faraone, S. V., & Buitelaar, J. (2010). “Comparing the efficacy of stimulants for ADHD in children and adolescents using meta-analysis.” European Child & Adolescent Psychiatry, 19(4), 353-364.

³⁴Centers for Disease Control and Prevention. (2022, March 8). Treatment recommendations for healthcare providers. https://www.cdc.gov/adhd/hcp/treatment-recommendations/index.html.

³⁵Grossi, G. US ADHD Stimulant Shortage Highlights Growing Challenges in Adult Treatment. AJMC. 2024 Nov. https://www.ajmc.com/view/us-adhd-stimulant-shortage-highlights-growing-challenges-in-adult-treatment

³⁶Quinn PD, Chang Z, Hur K, Gibbons RD, Lahey BB, Rickert ME, Sjölander A, Lichtenstein P, Larsson H, D’Onofrio BM. ADHD Medication and Substance-Related Problems. Am J Psychiatry. 2017 Sep 1;174(9):877-885. doi: 10.1176/appi.ajp.2017.16060686. Epub 2017 Jun 29. PMID: 28659039; PMCID: PMC5581231.

³⁷Newcorn, J. H., Kratochvil, C. J., Allen, A. J., Casat, C. D., Ruff, D. D., Moore, R. J., & Michelson, D. (2008). “Atomoxetine and osmotically released methylphenidate for the treatment of attention deficit hyperactivity disorder: acute comparison and differential response.” American Journal of Psychiatry, 165(6), 721-730.

³⁸Sallee FR, McGough J, Wigal T, Donahue J, Lyne A, Biederman J; SPD503 STUDY GROUP. Guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder: a placebo-controlled trial. J Am Acad Child Adolesc Psychiatry. 2009 Feb;48(2):155-65. doi: 10.1097/CHI.0b013e318191769e. PMID: 19106767.

³⁹Connor DF, Findling RL, Kollins SH, Sallee F, López FA, Lyne A, Tremblay G. Effects of guanfacine extended release on oppositional symptoms in children aged 6-12 years with attention-deficit hyperactivity disorder and oppositional symptoms: a randomized, double-blind, placebo-controlled trial. CNS Drugs. 2010 Sep;24(9):755-68. doi: 10.2165/11537790-000000000-00000. PMID: 20806988.

⁴⁰Fabiano GA, Pelham WE Jr, Coles EK, Gnagy EM, Chronis-Tuscano A, O’Connor BC. A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clin Psychol Rev. 2009 Mar;29(2):129-40. doi: 10.1016/j.cpr.2008.11.001. Epub 2008 Nov 11. PMID: 19131150.

⁴¹Cerrillo-Urbina AJ, García-Hermoso A, Sánchez-López M, Pardo-Guijarro MJ, Santos Gómez JL, Martínez-Vizcaíno V. The effects of physical exercise in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis of randomized control trials. Child Care Health Dev. 2015 Nov;41(6):779-88. doi: 10.1111/cch.12255. Epub 2015 May 18. PMID: 25988743.

⁴²Ogundele MO, Yemula C. Management of sleep disorders among children and adolescents with neurodevelopmental disorders: A practical guide for clinicians. World J Clin Pediatr. 2022 Mar 15;11(3):239-252. doi: 10.5409/wjcp.v11.i3.239. PMID: 35663001; PMCID: PMC9134149.

⁴³Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry. 2012 Jan;51(1):86-97.e8. doi: 10.1016/j.jaac.2011.10.015. PMID: 22176942; PMCID: PMC4321798.

⁴⁴A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Arch Gen Psychiatry. 1999 Dec;56(12):1073-86. doi: 10.1001/archpsyc.56.12.1073. PMID: 10591283.

⁴⁵Richardson, A. J., Puri, B. K. (2002). “A randomized double-blind, placebo-controlled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties.” Progress in Neuro-Psychopharmacology & Biological Psychiatry, 26(2), 233-239.

⁴⁶Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry. 2012 Jan;51(1):86-97.e8. doi: 10.1016/j.jaac.2011.10.015. PMID: 22176942; PMCID: PMC4321798.

⁴⁷Ojinna BT, Parisapogu A, Sherpa ML, Choday S, Ravi N, Giva S, Shantha Kumar V, Shrestha N, Tran HH, Penumetcha SS. Efficacy of Cognitive Behavioral Therapy and Methylphenidate in the Treatment of Attention Deficit Hyperactivity Disorder in Children and Adolescents: A Systematic Review. Cureus. 2022 Dec 17;14(12):e32647. doi: 10.7759/cureus.32647. PMID: 36660538; PMCID: PMC9845961.

⁴⁸Gevensleben, H., Moll, G. H., Rothenberger, A., & Heinrich, H. (2014). Neurofeedback in attention-deficit/hyperactivity disorder – different models, different ways of application. Frontiers in human neuroscience, 8, 846. https://doi.org/10.3389/fnhum.2014.00846

⁴⁹ Arnold, L. E., Lofthouse, N., Hersch, S., Pan, X., Hurt, E., Bates, B., Kassouf, K., Moone, S., & Grantier, C. (2013). EEG neurofeedback for ADHD: double-blind sham-controlled randomized pilot feasibility trial. Journal of attention disorders, 17(5), 410–419. https://doi.org/10.1177/1087054712446173

⁵⁰Ramsay, J. R. (2010). Neurofeedback and neurocognitive training. In J. R. Ramsay, Nonmedication treatments for adult ADHD: Evaluating impact on daily functioning and well-being (pp. 109–129). American Psychological Association. https://doi.org/10.1037/12056-006

⁵¹ Gathercole S. E. (2014). Commentary: Working memory training and ADHD – where does its potential lie? Reflections on Chacko et al. (2014). Journal of child psychology and psychiatry, and allied disciplines, 55(3), 256–257. https://doi.org/10.1111/jcpp.12196

⁵² Chacko, A., Bedard, A. C., Marks, D. J., Feirsen, N., Uderman, J. Z., Chimiklis, A., Rajwan, E., Cornwell, M., Anderson, L., Zwilling, A., & Ramon, M. (2014). A randomized clinical trial of Cogmed Working Memory Training in school-age children with ADHD: a replication in a diverse sample using a control condition. Journal of child psychology and psychiatry, and allied disciplines, 55(3), 247–255. https://doi.org/10.1111/jcpp.12146

⁵³ Hulme, C., & Melby-Lervåg, M. (2012). Current evidence does not support the claims made for CogMed working memory training. Journal of Applied Research in Memory and Cognition, 1(3), 197–200. https://doi.org/10.1016/j.jarmac.2012.06.006

Donald Trump and Robert F. Kennedy, Jr., don’t understand ADHD or autism.

President Trump has a history of using the r-word. Health and Human Services Director RFK, Jr., has long maintained that vaccines cause autism, despite piles of evidence to the contrary; he’s even described autism by saying, “the brain is gone.” So it’s no shock that their new Make America Healthy Again Commission, established February 13, bristles with misunderstanding about both the rise in ADHD and autism diagnoses, and so-called “over-medication” of these and other conditions.

We’ve heard it all before. “Autism spectrum disorder now affects 1 in 36 children in the United States — a staggering increase from rates… during the 1980s,” they say. In the case of ADHD, “over 3.4 million children are now on medication for the disorder — up from 3.2 million children in 2019-2020 — and the number of children being diagnosed with the condition continues to rise.” It’s the kind of desperate handwringing we often hear from the fringes. Seeing it in an executive order from the president’s desk is admittedly scary.

The commission offers up all manner of scapegoats for this so-called rise in neurodivergence, or possibly false diagnoses. There are the usual suspects: diet, lifestyle, environmental factors. It also offers up some new boogeymen, including the “absorption of toxic material,” “medical treatments,” “electromagnetic radiation,” and “corporate influence or cronyism.” Never does this executive order grope toward the real reason: Refined diagnostic standards and outreach programs have created a wider net, which catches children before they spiral downward in adulthood. These improved standards have benefited all neurodivergent people, but particularly women and minorities.

ADHD Has Excluded Girls and Women

Back in the 1980s and 1990s, we thought attention deficit hyperactivity disorder was a condition for boys who couldn’t sit still. Millions of girls daydreamed and drifted in class. We made careless mistakes. We underperformed. We talked too much. But no one noticed. We were girls, and we didn’t cause a fuss. Now we know that those little girls also had ADHD. I was one of them. Yes, the number of children diagnosed with ADHD has risen, and thank God for it.

[Read: Why ADHD in Women is Routinely Dismissed, Misdiagnosed, and Treated Inadequately]

Every year, I see those little girls in my classroom, and I sit their parents down for the talk: Have you considered having your daughter tested? I tell them: Look, she’s 9, 10, 11. It may not seem like a big deal now, and sure, she’s doing great. But when she’s 15 or 18 or 30, that picture may look a lot different. I had all As ‘til I rage-quit a doctoral program. And every year, some parents ignore me. Others go on to get their daughters tested. Those kids go into the world armed with the help they need.

I have three boys, all with ADHD. None would have been caught in the diagnostic net of 1988 — they aren’t severe enough, troublesome enough. One has mixed-type ADHD that severely impacts his ability to concentrate on subjects he doesn’t like. He would desperately underperform without medical help. Another has inattentive ADHD, and he copes fine without medication at the moment. The youngest also has inattentive type and needs medication to function. He would have slipped through the cracks.

My husband and I both soldiered through school without ADHD diagnoses. Like most undiagnosed neurodivergent kids, we knew we weren’t like everyone else, but we didn’t know why. Therefore, we assumed something was terribly wrong with us, and it must be our fault. We blamed laziness — after all, weren’t teachers always demanding to know why we made so many careless mistakes? We blamed intellectual inferiority — we must be dumber than everyone else if we couldn’t pay attention.

Our self-esteem took a beating. This is remarkably common in the neurodivergent community. We’re trying to save our kids from it, and we’ve made remarkable headway.

With one stroke of a pen, this executive order would undo all that progress.

[Get This Free Download: A Parent’s Guide to ADHD Medications]

We’re Back to Blaming Parents for ADHD

U.S. Senator Tom Turberville (R-Alabama) lamented during RFK Jr.’s Senate confirmation hearings, “Attention deficit [ADHD], when you and I were growing up, our parents didn’t use a drug; they used a belt and whipped our butt… Nowadays, we give them Adderall and Ritalin. It’s like candy across college campuses and high school campuses.”

Then he asked Kennedy what he planned to do about the so-called over-prescription of stimulant medication for ADHD. The MAHA Commission is looking for someone to blame, and it has clearly chosen mothers. Why didn’t you feed your child organic food? Why did you vaccinate them? Why don’t you take them outside more, take away their screen? Why did you hand them a pill instead of parenting properly? It’s rife with assumptions, chief among them: This is your fault.

Once we blamed autism on cold mothers. Then we blamed it on their decision to vaccinate. Now we blame ADHD on permissive parenting.

Tuberville and Kennedy assume we give our kids pills because it’s “easier” than using an authoritarian style of parenting. We should be spanking the hyperactivity out of our kids instead of handing them Ritalin! That’ll cure the fidgets!

Clearly, none of these people have read the research: Authoritarian parenting leads to more negative outcomes, including aggression, delinquent behaviors, and anxiety. And that’s in neurotypical children. Ironically, authoritarian parenting — what Tuberville is suggesting when he tells us not to spare the rod — is shown to exacerbate ADHD symptoms.

We’re doing the best we can.

The Decision to Medicate Is Not Taken Lightly

No one gives their children medication as a first, second, or third choice. We try everything. We mess with their sleep schedules. We cut out foods and add fish oil. We give them more exercise and we modify their screen time. We try schedules. We try chore charts. We modify our parenting. We attempt everything. Ritalin scares us. And ADHD medication is hard to find — do these people really think we have the spare time to cruise different pharmacies, to try to find who has our prescription in stock? Do they think we want to obsess over side effects?

Handing your child a pill is scary. But some kids need it the way other kids need a heart medication, a diabetes medication. We should never pull a life-saving medication from a child.

Why do we think ADHD medication is optional? It’s not over-utilized. It’s not over-prescribed. It’s proven safe and effective and preventative for so many adverse outcomes.

We are doing the best we can by our children. The Make America Healthy Again Executive Order is rife with misunderstandings and assumptions about kids with ADHD and the people who parent them. Don’t blame parents — mothers, of course they mean mothers — for their kids’ brain differences. All people with ADHD and autism deserve the same respect and accommodation as other citizens, and that includes the right to medication at a doctor’s discretion. Our kids deserve better than this executive order. And so do we.

Make America Healthy Again Commission: Next Steps

• Free Download: The Ultimate Guide to ADHD Medication
• Read: “ADHD Is an Actual Condition. You Can’t Beat It Out of a Child.”
• Read: MAHA Commission Draws Swift Criticism, Condemnation

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The Trump administration’s recently established Make America Healthy Again Commission has come under fire from medical experts and patient advocacy groups for singling out autism spectrum disorder and ADHD, saying the “over-utilization of medication” for those and other conditions “pose a dire threat to the American people and our way of life.”

The commission, which will be chaired by the newly confirmed director of Health and Human Services, Robert F. Kennedy, Jr., a vocal anti-vaccine advocate, says it aims to end ADHD, autism, and other chronic health conditions with “fresh thinking on nutrition, physical activity, healthy lifestyles, over-reliance on medication and treatments, the effects of new technological habits, environmental impacts, and food and drug quality and safety.”

Almost immediately, the American Psychiatric Association (APA) and Autistic Self Advocacy Network (ASAN) condemned what it called the stigmatizing language and stated purpose of the commission, which established a 100-day mission to:

• “Assess the threat that over-utilization of medication” poses to children with chronic conditions like ADHD
• “Assess the prevalence of and threat posed by the prescription of SSRIs, antipsychotics, mood stabilizers, stimulants, and weight-loss drugs” to children
• “Identify and report on best practices for preventing childhood health issues, including through proper nutrition and the promotion of healthy lifestyles”
• “Identify and evaluate existing federal programs and funding intended to prevent and treat childhood health issues for their scope and effectiveness”
• And other tasks detailed in the full commission announcement at additu.de/maha

Over the weekend, roughly 1,200 employees of the National Institutes of Health, the nation’s top biomedical research agency, and roughly 700 staff members at the Food and Drug Administration were dismissed from their jobs, according to The New York Times. “At the Centers for Disease Control and Prevention, two prestigious training programs were gutted: one that embeds recent public health graduates in local health departments and another to cultivate the next generation of Ph.D. laboratory scientists,” the Times reported today.

“We know from the evidence and from our own clinical practice that the psychiatric drugs mentioned in the order, when prescribed and used as directed by properly trained psychiatrists, are safe, effective, and in some cases, lifesaving,” wrote APA CEO and Medical Director Marketa M. Wills, M.D., in an email to members on February 14. “APA stands for evidence-based science and will protect the treatments and practices that are so vital to many children and adolescents suffering from mental and substance use disorders.”

In its own statement, the autistic advocacy group ASAN wrote: “The proposed plan is full of attempts to research thoroughly debunked science, states goals that run counter to the actual actions taken by the administration, and spreads misinformation about autism. ASAN disapproves of the proposed plan, and will be joining efforts to push back against its harmful ideas, as well as the harmful policies proposed by the current administration…

“People with disabilities are not burdens; painting disabled people as burdens is ableist and presents disabled people as a ‘problem to be solved,’ rather than a group of people who deserve to be fully included in all aspects of society.”

Among ADDitude readers, the reaction was similarly swift and negative. Of 852 comments posted to Instagram over four days, roughly 9 out of 10 criticized the MAHA Commission and expressed worry and/or outrage. The following quotes received the greatest community reaction.

“I have so much to say about this commission as a physician, public health specialist, parenting coach and mom. I felt sick after reading it last night and enraged at the same time. Such a lack of insight. I don’t affiliate with either party, but this is a time when politics is targeting my own home and my children’s ability to thrive. I will speak up and out about that.” – @aparentlyparenting

“I’m not a child psychiatrist but have two neurodivergent kids. We limit screen time. They participate in several sports (on their schools’ sports team, practice two hours a day in the fresh sunshine and all that). We do CBT and family therapy, but meds are also necessary. This is stigmatizing medication for our kids.” – @drrupawong

“How are they supposed to study this if they cut funding to the NIH? The data will be skewed.” – @ristafarian

“Why don’t we take advice for actual physicians and pharmacists who know what they are talking about and have actually studied medicine!? I have ADHD, I take my medication, but I also work out two to three times a week running and lifting weights, I walk, I go to therapy, I journal, try mindfulness and manage the best I can. Even with all of these things (also eating healthy and have perfect bloodwork at 42), I still would struggle significantly without my meds.” – @kjacono

“Quite terrifying. If they want to MAHA, then provide affordable healthcare that includes coverage for mental health evaluation and treatment.” – @skipcoaching

“You know what would ‘Make America Healthy Again?’ Universal healthcare, livable wages, free education, bodily autonomy for women and trans folks, not removing critical information from the CDC’s website… Acting like any of this has to do with ‘health’ is preposterous!” – @stokedcoaching

“Further study is always great but using language like ‘over utilized’ and ‘threat’ is sickening. So what is the goal of this administration? First dismantle the Department of Education to limit our kids’ protections and rights to IEP and 504 services, now limit their med intake?! While also pulling out of health organizations that DO research? So who will be doing the research listed in this executive order? Who does this help? Make it make sense.” – @menagerie_mel

“I am appalled. As a late diagnosed ADHDer who relies on medication after trying to manage life without it for 35 years, doing all the healthy diet, exercise, blah blah blah stuff, and feeling completely inadequate and incapable….no.” – @katehreno

“Obviously bad news for those of us who have ADHD, but what a win for all the quacks who insist it’s made up or shouldn’t be medicated. They must be so excited to blame ADHD on vaccines or seed oils or working mothers or whatever else feeds their agenda. Maybe they can use this to promote their own unregulated supplements and turn a tidy profit.” – @theashleyclem

“You know what poses a threat to the American public? Unmedicated people with ADHD. Our jails are filled with people who could have used pharmacological interventions earlier in life.” – @skustra

“ADHD runs in my family, and I lost one cousin to ‘self-medicating’ and another to a horrific motorcycle accident due to impulsivity and thrill-seeking behaviors. Neither of them got the help they needed, and I wonder if they would still be here if they had. When my youngest started showing signs, we got him assessed and promptly medicated. He is safer now and his impulsive behaviors have drastically decreased. I am terrified that we are going to lose access to potentially life-saving medication.” – @life_is_weird4

“For decades, I was told I had anxiety and depression, and I tried every medication but nothing ever worked. I couldn’t finish college, I jumped from job to job, my emotions were constantly deregulated… Life felt overwhelming constantly. The day I started medication for ADHD my life changed. I have a job I love and thrive at, I feel in control, I have motivation, I don’t nap all day anymore, my mood swings are under control, I lost 60 pounds, and I am happier. The thought of my medication not being available to me is horrific and I can’t go back to how I was living.” – @zewingirl

“One thing. ONE THING gives me hope. Big pharma doesn’t want him to take their profits. And our meds? They’re VERY profitable.” – @eabroadbent

“I don’t see the harm in ‘assessing’ the use of medication and the possibility that dietary and lifestyle changes can also treat ADHD successfully in some cases. I don’t believe it’s an all-or-nothing situation and there’s nothing wrong with assessing how current treatments are working and if complementary or alternative treatments can be implemented to improve outcomes both from a psychological perspective as well as a financial standpoint.” – @faithology101

Read all of the ADDitude community comments posted to Instagram here.

Stimulant medication may normalize certain brain regions impacted by ADHD in children, according to a cross-sectional neuroimaging study of 7,126 children aged 9 to 10 recently published in Neuropsychopharmacology.¹

Study participants were divided into three groups. The “no-med ADHD” group included 1,002 children with severe ADHD symptoms who were not taking stimulant medication. The “stim low-ADHD” group included 273 children whose ADHD symptoms were mild and well-managed with stimulant medication. The “TDC” group included 5,378 typically developing controls.

ADHD symptoms experienced by the no-med ADHD group were associated with brain structure abnormalities not seen in the TDC or stim low-ADHD group, including:

• lower cortical thickness in the insula (INS), a brain area associated with saliency detection or the ability to prioritize information
• less grey matter volume in the nuclear accumbens (NAc), a brain area associated with reward processing and motivation

Children in the stim low-ADHD group showed no significant differences in these brain areas compared to controls. This contrast in structural MRIs suggests that stimulant medication may work to normalize some (but not all) brain regions and improve symptoms in children with ADHD.

Stimulant medication was not associated with improvement in all brain regions. Among those not impacted were the following:

• the caudate (CAU), a brain area responsible for motor control
• the amygdala (AMY), a brain area responsible for emotions

“This result is consistent with previous studies,” the researchers wrote. “Reduced volume in children with ADHD in the CAU is one of the most replicated findings in sMRI studies. No effect of stimulant medications was found in the CAU in the participants with ADHD in several cross-sectional studies. Along the same lines, longitudinal studies on children pointed to the improvement of volumes in the CAU associated with age but not stimulant medications… and two previous studies also pointed out there was no effect of stimulant medications on the AMY.”

Non-stimulant medication did not significantly impact brain structure.

A separate validation analysis included 273 participants with high ADHD symptoms who were taking stimulant medication; the results were consistent with the main study and still suggested that stimulant medication had a positive and noticeable effect on the brain structure of children in this group compared to the no-med ADHD group, even though both groups had high symptom severity at the time of the study.

“These findings are important for the treatment of children with ADHD using stimulant medication,” the researchers wrote.

Stimulant Medication & the ADHD Brain

Stimulants are the first-line treatment for ADHD in children aged 6 and older, teens, and adults. However, some people with ADHD discontinue medication due to side effects. The most common side effects reported by caregivers in ADDitude’s 2023 treatment survey were appetite suppression, irritability or moodiness, and sleep problems.

“Our current medication treatments for ADHD work quite well, but unfortunately, many children stop the treatment or stop taking medication,” said Jonathan Posner, M.D., in his 2020 ADDitude webinar, “Secrets of the ADHD Brain: How Brain Imaging Helps Us Understand and Treat Attention Deficit.” “In fact, the majority of teenagers with ADHD will stop treatment within two years.”

Understanding the parts of the brain that are impacted by stimulant medication can help refine treatment and determine “which of those changes are responsible for symptom improvement versus side effects,” Posner said.

“One of the things that brain imaging has shown is that the development of the brain in children with ADHD seems to be somewhat delayed,” Posner said. “But the overall course of development in children with ADHD versus without ADHD is very similar. It’s almost as if the ADHD brain is a couple of years behind. The very optimistic part of this is that it ultimately does catch up for most children with ADHD.”

For the majority of patients, ADHD symptoms do continue into adulthood, and the prevalence of ADHD in adults is rising. ^{2, 3} However, the present study confirmed Posner’s observations and found that children with even severe ADHD caught up developmentally for the region of the brain responsible for prioritizing information.

MRI scans showed greater cortical thickness in the INS region for the stim-low ADHD group and TDC group compared to the no-med ADHD group. However, data from a two-year follow-up analysis showed these differences were no longer present. Development of the INS is complicated, the researchers noted, but they suggested that “the No-Med group has delayed INS development at baseline, which eventually catches up to the other children.” Researchers theorize that stimulant medication may speed up this process and will continue to follow up with children over the next few years.

Limitations & Future Research

Participant data was obtained from the Adolescent Brain Cognitive Development (ABCD) study, an ongoing study since 2019 that will follow children over 10 years. Data was obtained via structural MRIs and symptom questionnaires and analyzed using linear mixed-effects models (LMM). The study included measures of cortical thickness, cortical area, cortical and subcortical volumes, and total intracranial volume.

The ABCD study lacked diagnostic information for ADHD; therefore, researchers grouped participants using latent class analysis (LCA) and 18 ADHD symptoms from the K-SADS — a moderately reliable test of affective disorders and schizophrenia. Children with bipolar disorders and anxiety disorders, oppositional defiant disorder, obsessive-compulsive disorders, and conduct disorders were excluded from the study.

Results indicate that stimulant medication may enhance brain structure and alleviate ADHD symptoms; however, this study was cross-sectional and did not establish clear causation. Information on the mean dose and duration of participants’ stimulant medication use was missing from the study. Additionally, researchers warned that the study did not fully capture the association between brain structure and ADHD severity. The stim-low ADHD group was much smaller than the other two groups, which may have hindered the study’s results. The two-year follow-up (in line with ABCD study release 4.0) included fewer participants (3,992 after exclusion criteria). Results should be interpreted with caution.

Future research should further incorporate supplemental data on stimulant use, study stimulant use by patients with severe ADHD, and include more longitudinal data.

Sources

¹Wu, F., Zhang, W., Ji, W. et al. (2024). Stimulant medications in children with ADHD normalize the structure of brain regions associated with attention and reward. Neuropsychopharmacol, 49, 1330–1340. https://doi.org/10.1038/s41386-024-01831-4

²U.S. Centers for Disease Control and Prevention. (2024, October 4). ADHD in adults: an overview.
https://www.cdc.gov/adhd/articles/adhd-across-the-lifetime.html

³American Psychiatric Association. (2019, November 15). ADHD increasing among adults.
https://www.psychiatry.org/news-room/apa-blogs/adhd-increasing-among-adults

Dialectical behavior therapy (DBT) is an evidence-based treatment designed to help individuals who struggle with emotional dysregulation, aggression, self-harm, and other problem behaviors. DBT is an intensive, highly structured program that was originally created for adults in the 1970s and has since been adapted for children and adolescents. It can be an effective treatment for ADHD because it aids in the development of skills that support emotional regulation, problem-solving, and self-acceptance.

DBT works by helping children develop skills that decrease unwanted feelings and unhelpful behaviors, as well as skills that help them to accept difficult feelings about themselves and others without judgment. DBT patients participate in one-on-one therapy, group skills training, and/or phone coaching from their therapist. Parents learn the same skills as their children so that they can reinforce those skills outside of therapy.

In this webinar, you will learn:

• About the conditions that DBT treats in children and adolescents, and who would be a good fit for this therapy
• About DBT as a treatment model and how it works
• How DBT can support children and adolescents in managing mood, impulsivity, and anxiety
• About DBT strategies to support children in distress

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DBT for ADHD: More Resources

• Download: What Is Dialectical Behavior Therapy (DBT)?
• Read: Overview of ADHD Therapies
• Q&A: Why Deficient Emotional Self-Regulation is Central to ADHD
• eBook: The Parents’ Guide to Raising a Teen with ADHD

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Meet the Expert Speaker

Lauren Allerhand, Psy.D., is Co-Director of the Dialectical Behavior Therapy Programs and a psychologist for the Mood Disorders Center at the Child Mind Institute in the San Francisco Bay Area. She specializes in the evidence-based assessment and treatment of youth struggling with depression, anxiety, trauma, eating disorders, ADHD, and oppositional defiant disorder. She has extensive training in cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). Dr. Allerhand is particularly passionate about providing DBT to improve the lives of high-risk, diagnostically complex youth who struggle with emotion dysregulation, suicidality, and self-injury.

Dr. Allerhand’s clinical practice also emphasizes supporting parents of children and teens with emotion dysregulation, oppositional behavior, or ADHD through evidence-based intervention. She has specialized trained in a DBT parenting intervention and Parent Management Training for parents of older children and teenagers. Dr. Allerhand is also certified in Parent Child Interaction Therapy (PCIT), an evidence-based intervention for families with preschool-aged children.

Listener Testimonials

“Praise to the speaker for her clarity. Excellent delivery.”

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ADHD and obsessive-compulsive disorder (OCD) are brain-based disorders that co-exist at elevated rates. Studies have found that approximately 21% of children with OCD have ADHD as well, though some clinicians estimate an even higher co-occurrence rate. For caregivers, navigating a dual diagnosis of pediatric OCD and ADHD can be confusing and counterintuitive because these conditions may seem contradictory.

Contrary to commonly held beliefs, many pediatric OCD presentations have little or nothing to do with the fear of germs. In fact, the number one compulsion for both adults and children with OCD is avoidance. For example, a child may see school as a trigger for social phobia, causing panic and anxiety.

In this one-hour webinar, caregivers and educators will deepen their understanding of OCD and learn how to identify and support this dual diagnosis in children with ADHD.

In this webinar, you will learn:

• About common misconceptions pediatric presentations of OCD, which have led to chronic underdiagnosing
• How to identify the less common presentations of OCD, using examples of common OCD presentations in neurodivergent children
• How OCD and ADHD can interfere with learning. For example, OCD can lead to and intensify school avoidance
• About the treatment of concurrent OCD and ADHD, which usually involves medication, parent training, school-based accommodations, and Exposure Response Prevention therapy
• About typical outcomes and common roadblocks to recovery

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Audacy; Spotify; Amazon Music; iHeartRADIO

OCD in Children with ADHD: More Resources

• Download: How Are Symptoms of OCD Different from ADHD?
  
• Read: Does OCD Always Come with Anxiety?
  
• Read: “I’ve Called My OCD Compulsions ‘Screaming Mimis’ Since I Was 7”
• eBook: 9 Conditions Often Diagnosed with ADHD

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Meet the Expert Speaker

Natalia Aíza, LPC, is a seasoned therapist, parent trainer, writer, and entrepreneur. Her core missions are to facilitate awareness and healing for those with OCD, and to amplify OCD competency among mental health practitioners. She is the co-founder of Kairos Wellness Collective, an innovative therapy center that specializes in OCD and anxiety disorders. In the last three years, Kairos has expanded to four locations in Colorado and has served over 2.000 families and individual clients. Natalia also advocates for OCD awareness and provides free psychoeducation on her popular instagram account @letstalk.ocd. Natalia received her BA in Literature at Harvard University, and MA in Clinical Mental Health Counseling from Palo Alto University.

Listener Testimonials

“Thank you for presenting a complex diagnosis in plain and understandable language!”

“Natalia did an excellent job introducing us to this intersectionality of ADHD and OCD.”

“She was a phenomenal speaker, and her personal life lessons were extremely helpful.”

“This training was phenomenal! I am a therapist and parent of two children with ADHD and OCD. There is so little information in the community about OCD. I learned more from this webinar than I have ever learned in the past.”

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This quote perfectly sums up the pervasive fear among adults and caregivers of children diagnosed with ADHD. And it remains as detrimental now as it was when authors Edward Hallowell, M.D., and John Ratey, M.D., first published it in their book ADHD 2.0 (#CommissionsEarned).

The first-line medications for ADHD are some of the most effective, best studied, most scrutinized, longest known, and safest drugs in all of medicine. They have been safely prescribed to children for decades. Nonetheless, no other class of medications in virtually all of medicine inspires more baseless fears, intentional disinformation, and wild beliefs as do the stimulants used to treat ADHD. Interestingly, these fears are almost entirely an American phenomenon that hardly exists elsewhere in the world.

ADHD and Stimulants: A Disinformation Campaign Begins

In the late 1970s, a public backlash against treating ADHD with stimulant medication began after groups launched nationally organized, and extraordinarily effective, disinformation campaigns. This instilled a climate of fear among physicians, parents, and educators, and sowed anxiety and confusion among the public. Moreover, it planted in the minds of Americans the otherwise nonsensical idea that it was the treatment of ADHD that was dangerous — not the untreated medical condition itself.

It is also important to make a distinction between side effects due to stimulant medications and those unpleasant experiences caused by poor clinician training and experience. Finding a good clinician is much more difficult than it should be. Establishment medical education has failed miserably to prepare clinicians to diagnose and treat ADHD at all ages.

[Free Download: The Caregiver’s Guide to ADHD Treatment]

The goals of medication treatment include:

• Rule #1: The right medication and dosage matched to the right person should be dramatically beneficial and have virtually no side effects.
• Rule #2: Finely tuned ADHD medication should help you be “the best version of you.”

The Dangers of Untreated ADHD

Clinical neuropsychologist Russell Barkley, Ph.D., has demonstrated that untreated ADHD is not just highly impairing, it can be deadly. In fact, having ADHD lowers a person’s estimated life expectancy by 12.7 years.¹ Barkley has noted that most of the contributors to this mortality are lifestyle-related and can be reversed with treatment.

Research shows that untreated ADHD, with its impulsivity and inattention, raises the risks for serious traffic accidents, addiction, unsafe sexual practices, and self-harm, as well as challenges with academic performance, relationship difficulties, financial struggles, and chronic stress for children, teens, and adults.

ADHD and Stimulants: Facts Over Fears

Baseless fears about stimulant medication have scared caregivers away from seeking proper treatment for their children diagnosed with ADHD. The benefits of ADHD medication, based on decades of research and medical practice, used in conjunction with cognitive behavioral therapy, are profound for many people. The risks stemming from untreated ADHD are equally profound.

[Read: What Are the Long-Term Effects of ADHD Medication on the Brain?]

These are the fears I hear most from caregivers about ADHD medication, and my responses:

Fear #1: Will medication change my child’s personality?

The first-line stimulant medications affect a person with ADHD differently than they do a neurotypical person. Stimulant medications calm and soothe the hyperarousal and loss of emotional control associated with ADHD. A neurotypical person on an ADHD stimulant, by contrast, becomes more agitated, jittery, irritable, and unable to slow down.

Fear #2: Are stimulants addictive?

Having ADHD increases a person’s risk of substance use disorder, regardless of whether they take medication. However, one large study of adolescents found that “current pharmacotherapy for ADHD is associated with lower risk for substance use problems as long as medication treatment is maintained, indicating that pharmacotherapy is likely to be a key part of efforts to reduce substance use risk in those with ADHD.²

Fear #3: What if my child loses weight on a stimulant and doesn’t grow?

Appetite suppression is a common side effect of stimulant medications that goes away when the medicine is taken consistently enough to develop a tolerance to it. Most children ultimately gain weight and grow just as they did before taking medication.

For a small portion of elementary school-age children, most of whom were already picky eaters, the side effect of appetite suppression does create a problem. If a child is losing weight, or just not gaining weight for more than one month, the protocol for reversing this is to:

• Lower the dose of stimulant.
• If that does not work, switch stimulant molecules
• If this is ineffective, use the lowest dose of a gentle antihistamine that is FDA-approved for children 3 years of age and older. While this is an off-label use, it often helps to maintain a very beneficial ADHD treatment until the child becomes tolerant of the medication. Antihistamines like cyproheptadine, for example, return appetite to previous levels for about six hours. They are usually taken 30 minutes before lunch and dinner.

Fear #4: What if a stimulant worsens my child’s anxiety?

ADHD shares a high comorbidity with anxiety disorder. Researchers conducted a meta-analysis of 23 studies of children diagnosed with anxiety who had started on ADHD stimulants and found that anxiety decreased significantly in almost all cases.³

Arm yourself with knowledge. Read about the findings from research studies that have investigated ADHD medication. Then you can make a rational, informed decision about what is best for your child and/or yourself.

ADHD and Stimulants: Next Steps

• Free Download: Reader Scorecard of ADHD Treatments
• Read: Treating a Child with ADHD Medication Diminishes His Future Risk of Substance Abuse
• Read: ADHD Medication Side Effects No One Should Tolerate

William W. Dodson, M.D., is a board-certified adult psychiatrist. He was named a Life Fellow of the American Psychiatric Association in 2012 in recognition of his contributions to the field of adult ADHD.

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Sources

¹ Barkley, R. A., & Fischer, M. (2019). Hyperactive child syndrome and estimated life expectancy at young adult follow-up: the role of ADHD persistence and other potential predictors. Journal of Attention Disorders, 23(9), 907–923. https://doi.org/10.1177/1087054718816164

² Schepis, T. S., Werner, K. S., Figueroa, O., McCabe, V. V., Schulenberg, J. E., Veliz, P. T., Wilens, T. E., & McCabe, S. E. (2023). Type of medication therapy for ADHD and stimulant misuse during adolescence: a cross-sectional multi-cohort national study. EClinicalMedicine, 58, 101902. https://doi.org/10.1016/j.eclinm.2023.101902

³ Coughlin, C. G., Cohen, S. C., Mulqueen, J. M., Ferracioli-Oda, E., Stuckelman, Z. D., & Bloch, M. H. (2015). Meta-Analysis: Reduced risk of anxiety with psychostimulant treatment in children with attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 25(8), 611–617. https://doi.org/10.1089/cap.2015.0075

Earlier this month, the Justice Department charged two top officers at the telehealth company Done Global with allegedly distributing Adderall and other stimulants for ADHD to patients who officials said did not merit a proper diagnosis. While health officials warned that the “disruption” to Done could affect as many as 50,000 adult patients¹, many of whom were already impacted by the ongoing ADHD medication shortage, this criminal action highlights another important issue: the limited access to clinical care for people with ADHD in the United States.

“When a company such as Done is held legally responsible and their policies are investigated, patients under clinicians’ care may lose their prescriber, leaving them abandoned without medical care,” says David Goodman, M.D., an assistant professor in psychiatry and behavioral sciences at the Johns Hopkins School of Medicine.

“The immediate need for medication is not easily resolved because changing providers typically involves a delay. Without effective medication, patients’ daily performance is compromised and may lead to conflicts at home or reduced work productivity,” Goodman says. “The negative consequences mount the longer they are off their medication.”

Rise and Fall of ADHD Telehealth

Done and other ADHD telehealth services surged in popularity during the COVID pandemic as Americans in lockdown were unable to schedule in-person doctor visits. At the same time, the Drug Enforcement Administration (DEA) loosened telemedicine rules regulating the prescription and distribution of controlled substances, including stimulants to treat ADHD.

“Done came out of real patient pain points, including access and wait times” for clinical care, says Jacob Behrens, M.D., CEO of Envision ADHD Clinic. “They expanded as they did for a number of reasons, including how poorly our health care system met the needs of this particular population. This issue is and has been real since well before the pandemic.”

Of the 30,000 to 50,000 patients who used Done and may be seeking new providers, Behrens said: “I can’t begin to imagine how the existing health care system will absorb this population. I’m just hoping that we can use this as an educational opportunity for a deeper dive/postmortem analysis of in what ways did this improve patient care and where did it go wrong?”

Maggie Sibley, Ph.D., a psychologist, researcher, and author, suggested that the Done investigation into fraudulent stimulant prescription practices might actually help alleviate the stimulant shortage for patients with ADHD.

“If many Done clients were filling Adderall prescriptions for non-medical reasons, then presumably they were taking medications that should have gone to people with ADHD,” she says. “Eliminating the non-legitimate use of stimulants might hopefully help with the demand side of the stimulant shortage. People will be able to get their medications more easily because they are reserved for people who truly have ADHD.”

ADHD Treatment Alternatives

Greg Mattingly, M.D., an associate clinical professor at Washington University School of Medicine, says he is hopeful that improved ADHD awareness and education, overall, will mean that patients ask their providers about new medications like Xelstrym, Jornay PM, and Azstarys, which are not experiencing the shortfalls that have dogged Adderall and Vyvanse. Patients who understand the full spectrum of ADHD treatment options may be more likely to access care during the ongoing stimulant shortage.

“The rising number of prescriptions during the past several years² has caught the DEA’s attention,” says Ann Childress, past president of the American Professional Society of ADHD and Related Disorders (APSARD). The DEA sets quotas for the production of controlled substances in the United States and is widely criticized for failing to allow enough production of stimulant medication to keep pace with new diagnoses.

“We are still dealing with a stimulant shortage, and I am still having to switch patients’ medications because their regular medication is not available,” Childress says. “Most clinicians that I speak with are having the same difficulties. Several medications that are not controlled substances are approved for the treatment of ADHD by the FDA. Patients may want to discuss these medications with their providers.”

Goodman advised that some hospital pharmacies may fill prescriptions for hard-to-find stimulant medications if those stimulants are ordered by an affiliated provider. He suggested that patients inquire with their providers about this option, as hospital pharmacies may experience less patient demand than neighborhood or chain pharmacies like CVS or Walgreens.

“Hospitals that have public community pharmacies can typically fill the same prescriptions that any other community pharmacy can fill,” says Aretha L. Hankinson, J.D., director of media relations for the American Society of Health-System Pharmacists. “They generally also experience the same allocations and shortages as other community pharmacies.”

Sources

¹ CDC. Disrupted Access to Prescription Stimulant Medications Could Increase Risk of Injury and Overdose. June 13, 2024. https://emergency.cdc.gov/han/2024/han00510.asp

² Danielson ML, Bohm MK, Newsome K, et al. Trends in Stimulant Prescription Fills Among Commercially Insured Children and Adults — United States, 2016–2021. MMWR Morb Mortal Wkly Rep 2023;72:327–332. DOI: http://dx.doi.org/10.15585/mmwr.mm7213a1

What I found in my research was confusing. Assessing whether a medication was effectively treating ADHD seemed heavily reliant on subjective reporting. How was I to reliably tell if my child’s ADHD medication and dose were really working as well as they should?

I was frustrated and determined to get clear results – and then I had a lightbulb moment.

The Truth Before Our Eyes

One day, I was reading with my kid. I watched as their eyes darted all over the page, the focus slipping away right in front of me. This must happen to so many people with ADHD when they try to read, I thought.

That’s when it hit me: When we read, our eyes follow a specific pattern. Unless we have ADHD, and then our wandering minds might lead to wandering eyes, making our reading patterns different and more erratic.

[Get This Free Download: How Do We Know the Medication Is Working?]

Eye movement is key; tracking it could reveal patterns and lead to a methodology for ultimately measuring focus. I brought the idea to my sister, an AI and bioinformatics expert. Together, we began to use AI to analyze reading processes and eye-movement patterns. We found that by tracking these patterns, we could develop a tool that would provide a clear, data-driven picture of how ADHD medication affects concentration and impulsivity, thus, a way to measure treatment efficacy.

Turning a Novel Idea Into Reality

Enter Ravid, my rollerblading buddy who also has ADHD and expertise in digital health product development. The three of us made this wild idea a reality. While Ravid and my sister built the product, I reached out to clinicians.

I learned in those conversations that there was no tool available that could objectively track medication efficacy for a patient outside of the clinic. Clinicians and researchers loved our approach. Reading is universal but complex enough to capture different aspects of ADHD, and eye tracking can reveal both concentration and impulse control levels.

And that’s how iFocus was born. You can log in to our site from a webcam-enabled computer and read a paragraph with and without your meds. Our tool will track your eye movement through your webcam as you read and establish a score representing your progress compared to your baseline.

[Read This Special Report: ADHD Treatments Scorecard from Readers]

Each session only takes a few minutes, but the impact, we think, can be life changing.

Putting People in Charge of Their ADHD Treatment

Recently, my kid started a new medication, and we used iFocus to find the right dose. The experience was completely different. They tested themselves, reported how they felt, and we had meaningful discussions about the results.

The dose where my child felt best was lower than I anticipated, but both my child’s report and iFocus results confirmed that the dose was working. This is just one example of how iFocus empowers people with ADHD to take control of their treatment journey.

ADHD Medication Efficacy: Next Steps

• Read: How Can I Tell If the ADHD Medication is Working?
• Read: ADHD Medications Rarely Work Perfectly on the First Try
• Read: Stimulant, Non-Stimulant, or Both? Combination Therapy for ADHD

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The comments below are a true testament to the difference a trained provider can make in your ADHD journey. These ADDitude readers recall interactions with clinicians who made them feel seen and understood… and offer hope to those adults and caregivers who are struggling to get their needs met.

Patient-Provider Relationship: Positive Interactions

“As soon as I met my current psychiatrist, we clicked. I felt like she understood my symptoms and my struggles right from the beginning. It has made it easier to trust her with details about how my meds are helping or not helping — knowing that she will believe me.” — Jenna

“We had a really great mental health/psych evaluation years ago. The provider wrote a very wonderful story for my child to help him understand his diagnosis. It was based on the animal character to which my son related best. My son, sadly, picked a Sasquatch, which just about broke my heart. He said it was because he liked to just be left alone. The provider wrote a story about how the Sasquatch elders would help him to not be so alone.” — Katie, Oregon

“When talking with my new gynecologist about hormone replacement therapy, I advised her I may need a higher dose of Estradiol due to ADHD. She was unfamiliar with the ADHD-estrogen relationship but said she was always interested in learning more. I sent her a few links to studies (the scant few available so far), and we were able to develop a few options for treatment in conjunction with my ADHD meds.” — Paulette

[Free Class: ADHD Treatment Guide for Adults]

“…My son’s psychiatrist turned to me and said, ‘Your son has a neurodivergent brain. It’s like his brain processes information in a different language.’ We had recently been in a foreign country, so it was easy to compare. That wonderful psychiatrist was the start of our journey to understanding and providing appropriate support for our burnt-out teenager.” — Karen, New Zealand

“When we connected with our new psychiatrist, it was the first time we felt ‘seen’ and understood by someone. With a complex diagnosis of ADHD and autism in an extremely bright child, it was difficult to get someone to see [my son’s] difficulties. Once we realized she got it, it was such a relief. She said, ‘We have a lot of work to do…but we’ll get there. Don’t worry.’” — Leslie, Pennsylvania

“When talking to a psychologist for stress management, he just tossed out that I had ADHD. I had suspected it for a long time, but I felt like someone had finally noticed why things were so stressful.” — Ann, California

“When I finally got to see a psychiatrist, who confirmed my suspicion that I had ADHD (at age 35), I felt very validated. My family doctor had just put me on antidepressants, which didn’t work for me at all. It was great to know I wasn’t actually crazy.” — Claire, Canada

[Read: “Here’s How I Found an ADHD Specialist Near Me.”]

“We hired an occupational therapist to help our son with self-regulation. She saw all the good things in our son that we didn’t see due to the impulsivity issues he was having at school, summer camps, etc. She really helped us to see him for the amazing child he is and opened our eyes to the curiosity behind behavior that got him into trouble.” — Tiffany, Canada

“When my son was in elementary school, the school counselor had a wonderful relationship and bond with him. During a meeting at school, she told me: “Everyone focuses on his behavior challenges, but I want to acknowledge his personality and what a bright and caring kid he is. Yes, he has lots of challenges, but he’s also a great kid. Don’t forget that.” This was after a serious incident involving my son. I felt that she was really on our side and truly cared about him. The others in the meeting were talking negatively about him; she stood up for him.” — An ADDitude reader

“For me, it was a counselor at a crisis center. This was before my ADHD diagnosis, and I was in a depression/anxiety crisis in which my significant other had called 911. The police response took me to this center, and the counselor on duty (it was after midnight and she was the only one there) happened to be the most amazing fit for me. I usually would resist speaking to counselors in these settings, but something about her had me feeling comfortable enough to be honest. She said things that ‘clicked’ and got my wheels turning, which propelled me to seek out a diagnosis. Two months later, I was finally getting the correct diagnosis of ADHD, and my life changed forever.” — Laura, Oregon

The Patient-Provider Relationship: Next Steps

• ADDitude Directory: Find an ADHD Specialist Near You
• Free Guide: 25 Things to Love About ADHD
• Deep Dive: ADHD’s Pediatrician Problem

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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.

Teens aged 18 to 19 are more likely than any other age group to stop taking prescribed medication for the treatment of attention deficit hyperactivity disorder (ADHD), according to a new study published in The Lancet.¹ The study, which sought to determine the rate of ADHD treatment discontinuation across the lifespan, found that 61% of young adults (ages 18 to 24) discontinued treatment within a year of beginning it, almost double the rate of discontinuation in kids under 12.

The retrospective, observational study analyzed population-based databases from Australia, Denmark, Hong Kong, Iceland, the Netherlands, Norway, Sweden, the UK, and the United States, to track patterns of medication initiation, persistence, and discontinuation in the five years after starting treatment. Included in the study were 1,229,972 individuals (60% males, 40% females), aged four and older.

The study revealed that one year after beginning treatment, medication was discontinued by:

• 61% of young adults (aged 18 to 24)
• 53% of adolescents (aged 12 to 17)
• 52% of adults (aged 25 and older)
• 36% of children (aged 4 to 11)

The age at which medication was most commonly discontinued was between 18 and 19 years old.

Medication Adherence Challenges

The reasons teens, adults, and children stop taking medication are plentiful and varied. According to a recent ADDitude treatment survey with more than 11,000 respondents, the top reasons cited by adults and caregivers included:

• Side effects
• Medication availability
• Comorbid conditions
• High cost
• A lack of information and metrics to gauge efficacy
• Availability of providers who understand ADHD

This last barrier to medication continuation is particularly challenging for adults, both young and old, says William Dodson, M.D., in his article “4 Reasons Adults Give Up on ADHD Medication.”

“It’s not easy for patients to find clinicians who are knowledgeable about diagnosing and treating adult ADHD,”² Dodson explains. “Limited experience with pharmacotherapy may result in difficulty gauging a patient’s response to medication and optimizing accordingly.”

The trial-and-error process, in which patients explore the efficacy of different dosages, formulations and possibly different types of ADHD medication, is essential to discovering an optimal treatment plan for ADHD, which varies widely from person to person, even within the same family. This often onerous process can be made far less confusing and stressful when patients work with a clinician who is highly knowledgeable about ADHD. Such a clinician can address the concerns that often prevent patients from starting medication, persevering through the trial-and-error process, and continuing consistent treatment.

“If people are ambivalent and fearful about trying medication, I found they commonly give up at the first sign of difficulty,” Dodson tells ADDitude. “They are often relieved that their fears have been proven correct and that the subject of medication is off the table.”

Unique Considerations for Young Adults and Teens with ADHD

The study’s key finding — that young adults aged 18 to 24 are more likely than any other age group to stop taking medication — is one that resonates with many parents and clinicians, who often find that adolescents resist ADHD medication. This causes concern because young adulthood can be a challenging time, as teens transition to more independent living, begin navigating college, and/or start a job.

Young adults can discontinue medication for a unique set of reasons that relate to their growth and development, according to Wes Crenshaw, Ph.D., and Larry Silver, M.D., in the ADDitude article titled “When Your Teen Refuses to Take ADHD Medication.” These reasons include:

• Exerting independence
• Trying to fit in with peers
• Concerns about “flattening” of personality
• Appetite suppression and sleep trouble

“The best way to sell medication to a teen or young adult is with honesty,” explain Crenshaw and Silver. “Listen to your teen’s complaints, and validate them; Managing medication is difficult, after all. For most children, teens, and adults who have been correctly diagnosed with ADHD, part of accepting the condition is to accept the implications of treatment: On one hand, ‘We can help you,’ and on the other, ‘Treatment is not a walk in the park.’”

For teens and young adults who are resistant to medication but benefit from it, Crenshaw and Silver advise suggesting to teens that they try an experiment. Teens take their ADHD medication for a week, then skip it for a week. During both periods of time, teens should take detailed notes about how they’re doing academically, emotionally and socially. For younger teens who live at home, parents can do the same, and teachers can be enlisted to offer feedback. Have the teen compare the notes from the medicated week with the notes from the non-medicated week. This may help them see the situation more objectively and can lead to treatment continuation.

Sources

¹Brikell, I. Yao, H. Li, L. Astrup, A. Gao, L. Gillies, M. (2023). ADHD medication discontinuation and persistence across the lifespan: a retrospective observational study using population-based databases. The Lancet. DOI: https://doi.org/10.1016/S2215-0366(23)00332-2

²Goodman, D. W., Surman, C. B., Scherer, P. B., Salinas, G. D., & Brown, J. J. (2012). Assessment of physician practices in adult attention-deficit/hyperactivity disorder. The primary care companion for CNS disorders, 14(4), PCC.11m01312. https://doi.org/10.4088/PCC.11m01312