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.”

ADHD and schizophrenia are distinct neurodevelopmental disorders with some overlapping symptoms, such as inattention, impulsivity, weak working memory, and emotional dysregulation. Symptoms of schizophrenia may also include hallucinations, delusions, and paranoia. Understanding how ADHD fits into this diagnostic picture, and untangling overlapping symptoms, leads to better treatment approaches and outcomes.

While most people with ADHD will never develop schizophrenia, these factors increase risk: family history of schizophrenia, adverse childhood experiences or trauma, and abuse of psychoactive substances, such as marijuana that contains elevated levels of THC.

Schizophrenia typically emerges in the late teens through early thirties. ADHD can be diagnosed at any age, though it usually emerges in the early grade school years.

[Watch: “Understand How ADHD and Schizophrenia Overlap”]

ADHD and Schizophrenia: Treatment Options

When treating comorbid schizophrenia and ADHD, a priority must be to treat any psychosis with first-generation antipsychotics such as Haldol and Trilafon, or second-generation antipsychotics such as Abilify and Risperdal. Antipsychotics can be taken orally in the form of daily pills or as injectables. Recent innovations have yielded exciting new medications, such as injectables effective for as long as three months, and other promising new interventions are on the horizon. Antidepressants, mood stabilizers, or anti-anxiety drugs may also help in treating associated symptoms of schizophrenia, as do adjunctive therapies such as cognitive behavioral therapy and family therapy.

Only after the psychosis is under control can clinicians clearly identify symptoms associated with ADHD and prescribe treatment. ADHD is associated with low dopamine levels in the brain, and most ADHD medications are intended to increase these. Patients with schizophrenia tend to have high dopamine levels, so doctors must exercise caution when prescribing stimulants to them. If medication increases dopamine levels further, this may exacerbate schizophrenia by worsening psychosis.

[Read: Why ADHD Brains Crave Stimulation]

Under the consistent care of a clinician, patients with schizophrenia who adhere to their medication regimen tend to do very well. No matter a condition’s treatment challenges, I understand a patient and their symptoms more fully every time I see them. I learn from what we’ve tried, bringing us closer to getting a medication combination just right. This kind of treatment takes trial and error, thoughtfulness, and time spent with a doctor.

ADHD and Schizophrenia: Next Steps

• Read: When It’s Not Just ADHD – Symptoms of Comorbid Conditions
• Read: ADHD Comorbidity – An Overview of Dual Diagnoses
• Read: A Clinician’s Guide to Impulsive Aggression

Napoleon B. Higgins, Jr., M.D., is a child, adolescent, and adult psychiatrist in Houston, Texas. He is the owner of Bay Pointe Behavioral Health Services and Kaleidoscope Clinical Research.

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Stimulant medications (amphetamine or methylphenidate) reduce ADHD symptoms better than non-pharmacological interventions, according to a meta-analysis published in The Lancet Psychiatry, which included 113 randomized clinical trials (RCTs) and 14,887 participants aged 19 to 44. ¹

The researchers analyzed self-reports and clinician-reported rating scales submitted at 12, 26, and 52 weeks regarding the efficacy of medication and non-medication treatment for ADHD.

“Stimulants were the only intervention supported by evidence of efficacy in the short term (i.e., at time points closest to 12 weeks) for core symptoms of ADHD in adults (both self-reported and clinician-reported) and were associated with good acceptability (all-cause discontinuation),” they said. (Amphetamines and methylphenidate showed no notable difference in effectiveness.)

Atomoxetine, a selective norepinephrine reuptake inhibitor (SNRI), benefited adults with ADHD during the measured time periods, but atomoxetine had worse overall acceptability compared to placebo.

A small body of evidence suggested that non-medication treatment [i.e., cognitive behavioral therapy (CBT), neurofeedback, and relaxation therapy] benefited people with ADHD over longer periods. However, those studies, the researchers noted, had inconsistent results with variations depending on whether the individual with ADHD or their clinician rated the core symptoms.

“Our findings highlight how both individuals with ADHD and clinicians should be considered as sources of evidence, with ratings of symptoms by both groups measured in RCTs,” the researchers said. “Participants in RCTs might report positive effects of the active intervention to please the interviewer (the Hawthorne effect), or might not correctly report the perceived effects of interventions (especially when they feel under pressure from the clinicians and have difficulties with executive function, as is often the case in people with ADHD).”

Neurofeedback Therapy for ADHD Not Effective

A separate meta-analysis published in JAMA Psychiatry examined the results of neurofeedback treatment in 2,472 people with ADHD aged 5 to 40 years from 38 RCTs. ²

The review, led by the University of Southampton, King’s College London, and the University of Zurich, found insufficient evidence to recommend neurofeedback as a front-line treatment for ADHD. According to the researchers, neurofeedback did not significantly reduce ADHD symptoms of inattention, hyperactivity, and impulsivity, and it did not improve cognitive performance in adults. Their findings did show that adults who used neurofeedback gained a slight improvement in their processing speed.

In addition, the researchers did not identify any differences between neurofeedback and other non-pharmacological treatments, such as physical exercise or cognitive training. Newer neurofeedback techniques, such as functional magnetic resonance imaging (fMRI) and functional near-infrared spectroscopy (fNIRS), also lack the evidence to support their efficacy at treating ADHD symptoms.

Neurofeedback is a distinct form of biofeedback that uses electroencephalography (EEG) to help patients train their brains to improve focus, impulse control, and executive function.

“The effects of neurofeedback don’t really last in the long term,” Stephanie Sarkis, Ph.D., said during the ADDitude webinar “Dispelling Myths About Supplements for ADHD.” “I know people who have used it say they felt more focused after sessions, but then they returned to baseline quickly. Neurofeedback is expensive to get that kind of a result, and insurance doesn’t cover it.”

A 2023 ADDitude survey of more than 11,000 caregivers and adults with ADHD found that 9% of adults and 14% of children have tried neurofeedback for ADHD. Of those respondents, caregivers rated the efficacy of neurofeedback as 2.9, and adults rated it as 2.88, on a five-point scale. In contrast, medication was rated 3.57 by caregivers and 3.52 by adults who responded to the ADDitude survey.

Indeed, the formal effect sizes for ADHD medication are .8 to 1.0, which are among the strongest in all of psychiatry.³ 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 American Academy of Pediatrics (AAP). ⁴

“Despite continuing progress in our scientific understanding of ADHD, little has changed for decades in terms of treatment,” said Edmund Sonuga-Barke, a professor of developmental psychology, psychiatry and neuroscience at King’s College London and joint senior author on the JAMA Psychiatry report. “Effective alternatives to medication as the front-line treatment for core symptoms are still lacking. The development of new, science-driven, and more effective non-pharmacological approaches for the treatment of ADHD, therefore, remains a priority for our field.”

Sources

¹ Ostinelli, E.G., Schulze, M., Zangani, C., Farhat, L.C., Tomlinson, A., Del Giovane, C., et al. (2025). Comparative efficacy and acceptability of pharmacological, psychological, and neurostimulatory interventions for ADHD in adults: a systematic review and component network meta-analysis. Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(24)00360-2

² Westwood, S.J., Aggensteiner, P., Kaiser, A., Nagy, P., Donno, F. et al. (2025). Neurofeedback for attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2024.3702

³Faraone, S. V., & Buitelaar, J. (2010). Comparing the efficacy of stimulants for ADHD in children and adolescents using meta-analysis. European Child & Adolescent Psychiatry.  https://doi.org/10.1007/s00787-009-0054-3

⁴Centers for Disease Control and Prevention. (2022, March 8). Treatment recommendations for healthcare providers. https://www.cdc.gov/adhd/hcp/treatment-recommendations/index.html

April 16, 2025

Every few years, the ADHD community must endure another skeptic – an author, a journalist, a contrarian mental health provider, quite frequently a chiropractor – recycling claims like “ADHD is overdiagnosed,” “stimulants don’t work,” or, most remarkably in one case, “ADHD does not exist.”

In every instance, including Paul Tough’s recent New York Times Magazine feature, the articles serve only to obfuscate the conversation about ADHD because:

• They attempt a critique of the diagnosis based mostly on thought experiments and persuasion rather than qualitative or quantitative analysis.
• They focus almost exclusively on the medical aspects of ADHD and not on the behavioral change that integrates with and complements it, providing a wholly reductive understanding of treatment.
• They neglect to spend sufficient time with any of the millions of children, teens, and adults who are immensely helped by an integrative treatment for ADHD, including medication management. If they interview anyone, they cherry-pick folks who decided they didn’t want or like treatment for ADHD.

Invariably, in such analyses, clients of ADHD services are portrayed as hapless dupes of a psychiatric industrial complex hellbent on profiting from a made-up affliction that is really just the same thing that everyone else experiences but somehow handles quite nobly and with aplomb. In reality, almost no one seeking help for ADHD feels hoodwinked. Why would they? The work they do to overcome ADHD is certainly difficult. I have found that anyone benefiting from stimulant medication typically has a love-hate relationship with it; if it weren’t working, nobody anywhere any time would pay their hard-earned dollars each month to receive it.

The Truth About ADHD Medication Efficacy

In his article, Tough retreads a very old tire of ADHD tropes dating back to the genesis of my career in doctoral school in the late 1980s. To do so, he latches onto the Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) study, without any meaningful clinical understanding of its nuances.

In my book, ADD and Zombies, I point out that a major problem with the MTA study is that it does not account for stimulant tolerance – the problem that, with prolonged usage, people adjust to medication and need more and more to get the same results. While stimulant tolerance somehow remains controversial among some prescribers, it is not controversial among the clients who take these medications. For them, it’s obvious.

As is often the case when laypeople storm the ADHD castle, the author misstates the recommended treatment as stimulant medication alone. Nearly all professional organizations recommend a combination of therapy and medication management, or what we call “integrative treatment.” As I say in my books, “If you are taking meds only for ADHD, it’s like putting gas in your car and driving around and around the parking lot.” The MTA study is simply a study of stimulants over time and, therefore, not a true reflection of real-world results for patients undergoing integrative treatment.

The Truth About ADHD Diagnoses

The author points out, somewhat ham-handedly, that the process of diagnosing ADHD is problematic. He is correct, largely because that process is mostly conducted in primary care offices, and not in collaboration with psychiatric providers and/or in tandem with a longer-term relationship with a therapist. However, he is incorrect that there is no test for ADHD. There are several.

It’s true that ADHD has no genetic marker test, but this is true also of depression, anxiety, and just about every other psychiatric condition. But, somehow, very few skeptics write articles about how “depression is overdiagnosed” or maybe “doesn’t exist.” Almost nobody claims that anxiety is a trick diagnosis to lure people into taking medication. No one disavows bipolar disorder.

As mental health providers, we don’t diagnose people with ADHD to stigmatize or pathologize them; we do so to describe their experiences and behavior so that we might, with their most enthusiastic consent, bill their insurance and devise treatment plans to reduce those symptoms. And if we do it right, we do it well.

To make these diagnoses, we use norm-referenced psychological testing, alongside a good psychiatric interview and history taking. At our office, this process takes a minimum of five sessions and is quite good at predicting who does and does not have ADHD. And contrary to Tough’s supposition in quoting me in his article, a diagnosis really is just that, a categorical variable. You either qualify for it or you don’t. And if you do, you either are impaired by it or you are not. That’s the essence of every psychiatric diagnosis in the DSM-5. Love it or hate it, it is not unique to ADHD.

If Tough wants to complain about the quality of diagnosis rendered in various medical offices, he might actually read my book and find in me a willing ally. I have that same concern, not because prescribers lack the tools or resources to do better diagnoses, but because they are not paid to use them. Had Tough asked or read beyond the popular press or the low-hanging MTA fruit, he’d have found a much more interesting story there – one that describes how to get a good ADHD diagnosis and why so many people don’t pursue that path and yet end up on stimulants.

Instead, he leans on a highly reductive approach, as evidenced in this quote: “That ever-expanding mountain of pills rests on certain assumptions: that ADHD is a medical disorder that demands a medical solution; that it is caused by inherent deficits in children’s brains; and that the medications we give them repair those deficits.”

There’s a lot to unpack here.

Yes, ADHD is a medical disorder because we have decided it is a medical disorder and because we have found that integrative treatment brings tremendous improvement to people’s lives, and people want to use their insurance to get that treatment. I know this because I, unlike the Times author, have spent thousands of hours over 32 years talking to those folks.

Wouldn’t it be great if stimulants “repaired those deficits” of attention and concentration, as Tough laments, they do not? Does Mounjaro reverse my diabetes? Does a beta-blocker repair my high blood pressure? Of course not. I got those from my mom, just as most folks with ADHD inherited it from their parents or grandparents, which is well demonstrated in the literature ignored by Tough. All we can do is treat the symptoms of most chronic health conditions with medication and lifestyle changes. That’s integrative treatment.

Far less amusing is Tough’s next quote, another tired and rather offensive supposition that ADHD is caused by some environmental bugaboo. He notes, “Scientists who study ADHD are… uncovering new evidence for the role of a child’s environment in the progression of his symptoms. They don’t question the very real problems that lead families to seek treatment for ADHD, but many believe that our current approach isn’t doing enough to help — and that we can do better. But first, they say, we need to rethink many of our old ideas about the disorder and begin looking at ADHD anew.”

While Tough doesn’t flesh out this idea, most of us recognize it as the “bad parenting” theory of ADHD that is far from new. As I point out in my books, the diathesis-stress model best explains how predisposition and environment work together to produce the actual symptoms and behavior of any given psychiatric diagnosis and many medical ones.

Tough is correct to wonder if environmental factors might also impact ADHD, but to propose it as an astounding new development that dislodges genetic predisposition as a primary contributor to ADHD is no more accepted in the field than the false belief that autism is caused by vaccines.

I could wax on responding to Tough’s analysis, but I will close my remarks, content in the understanding that people will continue to seek and receive services for ADHD, regardless of his words, because they like how the treatment impacts their lives. And if they do not, they are free not to be treated. At our clinic, that’s true regardless of one’s age or status. If children do not want to be treated, we do not treat them. We invite them to be part of our team, and most are happy to do so. Those who are not, we respect equally.

As Tough notes in the article, we do help parents encourage their children to receive treatment by pointing out how difficult their kids’ lives are in school, among friends, and at home. I saw several such teens today. But, in the end, we are radical believers in informed consent.

What is disappointing is not the return of these old saws, repackaged as new news, but the fact that too few clients receive the benefits of integrative treatment. The medical folks hand out prescriptions. The traditional therapists eschew them. And diagnosis is often eyeballed rather than scrupulously tested. There is much to critique in these bifurcated treatment models. Tough could have made that a central point of his article had he stepped a little farther into our world and shown a bit more empathy for the millions of folks who are in no way hapless dupes, and who might not appreciate the implication that they are.

ADHD Article Corrections: Next Steps

• Read: Setting the Record Straight on ADHD and Its Treatments
• Free Download: The Ultimate Guide to ADHD Medication
• Reader Reactions: MAHA Commission Means Fear, Stigma, Health Threats for Two-Thirds of ADDitude Readers
• Read: Is ADHD Real? Yes — and Still Heavily Stigmatized

Wes Crenshaw, PhD is Board Certified in Couple and Family Psychology (ABPP) and the author of I Always Want to Be Where I’m Not: Successful Living with ADD and ADHD and coauthor with Kelsey Daugherty, DNP of ADD and Zombies: Fearless Medication Management for ADD and ADHD.

Since its publication last Sunday, The New York Times Magazine article “Have We Been Thinking About ADHD All Wrong?” has been called provocative and controversial. We would like to add a few adjectives: misrepresentative, biased, and dangerous.

In his 8,800-word article, writer Paul Tough used cherry-picked bits of decades-old data, very small studies, and interviews with three patients (all men) to exhume long-debunked ideas about ADHD and its treatment with prescription stimulant medication. Tough dismissed the lifelong work of esteemed ADHD researcher Russell Barkley, Ph.D., and suggested that the diagnosis of ADHD was unreliable or subjective because it relies not on a biomarkers or genetic tests, but on a trained clinician’s careful review of patients’ self-reported and observed symptoms in several settings.

To be clear, identifiable biomarkers do not yet exist for many psychiatric, neurodevelopmental, and neurodegenerative disorders. In the case of ADHD, medical experts use rating scales, neuroimaging studies, and/or criteria in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) to assess whether patients meet the threshold for a diagnosis.

“There’s no genetic marker for most psychiatric illness, but there is very clear heritability, as Dr. Russell Barkley has pointed out for years,” says Wes Crenshaw, Ph.D., a licensed psychologist and author. “I wonder if the Times author doubts depression? Or autism? Or anxiety? Or bipolar disorder?”

Though he was also quoted in the Times article, Crenshaw says he was never interviewed by the reporter, who pulled quotes out of context from his ADDitude articles.

ADHD Biases Divorced from Fact

Tough cited findings from the Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) Study to suggest that the benefits of stimulant medication wear off after 36 months. In arguing that Ritalin’s “advantage had completely faded,” Tough failed to report that long-term medication adherence among the MTA subjects was inconsistent — an important fact that undermines the author’s contradictory argument that stimulant medication is somehow both ineffective and “powerfully addictive,” as he claims in the article. (If it were addictive, wouldn’t the MTA subjects have taken it every day without fail? We know that half of teens and adults with ADHD stop taking stimulant medication within one year of starting it, suggesting that it is not addictive and shining a light on how woefully irresponsible it is to claim the ineffectiveness of a medication that is not taken consistently.)

Tough was guilty of biased reporting, or a deep misunderstanding of the subject he was covering, when he suggested that the increase in ADHD diagnosis rates — from 3 percent nearly 40 years ago to up to 11.4 percent of American children today, according to the CDC — represents a medical crisis or evidence of overdiagnosis. In truth, this uptick is is due, in large part, to a revised set of diagnostic criteria for ADHD in the DSM-5, a dramatic improvement in both clinician and patient understanding of ADHD, and critical research on its manifestations, especially in girls, women, and people of color — populations that have been historically overlooked and underserved, with serious consequences.

Perhaps the Times reporter was unaware of the basic fact that, 40 years ago, the scientific community screened almost exclusively only boys for symptoms of ADHD. It did not acknowledge the inattentive subtype of ADHD that many girls and women exhibit. And it insisted that symptoms only caused impairment in school settings. We now know much better.

Sloppy Reporting, Inaccurate Conclusions

Tough did Times readers a disservice by choosing not to interview more esteemed physicians, researchers, and clinical psychologists at the forefront of ADHD care. Instead, he plucked their quotes from the pages of ADDitude, stripped them of context, and did not pursue conversations with authors, like Crenshaw, or patients they suggested. [Crenshaw told ADDitude that, prior to the article’s publication, he offered “the author (through fact checker) a chance to interview an almost infinite number of ADHD people whose lives have been radically changed by integrative treatment.” No interviews were granted.]

For example, Tough quoted a feature from the Fall 2021 issue of ADDitude magazine in which Crenshaw addressed parents’ top concerns regarding ADHD medication. In the article, Crenshaw used established, evidence-based research to suggest that, if your child has ADHD, then stimulant medication paired with behavioral parent training and/or cognitive behavior therapy is shown to produce the greatest results in symptom management. Tough took Crenshaw’s words out of context to make it seem that he was arguing that ADHD exists as a binary, on-off diagnosis without any heterogeneity or symptom fluctuation. This is contrary to Crenshaw’s views and contradicts ADDitude‘s own recent reporting.

In its Spring 2025 issue, ADDitude magazine published a cover story titled “ADHD’s Vanishing (and Reappearing) Act,” in which author Maggie Sibley, Ph.D., explained her recent research into the sometimes unpredictable ebbs and flows of ADHD symptoms over a lifetime. Rather than acknowledge ADDitude‘s work to cover the scientific community’s evolving understanding of ADHD, Tough’s reporting painted ADDitude and its contributors as outdated. This is an unfair depiction.

He manipulated ADDitude content again in quoting an article published in 2020 and written by Roberto Olivardia, Ph.D., a clinical psychologist and Harvard Medical School lecturer. Tough did not interview Olivardia. Instead, he pulled a quote from Olivardia regarding the ways in which stimulant medication may quell a child’s social impulsivity. Tough deliberately omitted this vital precursor to the quoted statement in the ADDitude article: “Clinicians should assure parents that any medication that appears to mute the child’s positive aspects and core personality is indicative of an unsuccessful medical trial. Another medication should be tried.”

Olivardia didn’t mince words in his response to the Times article. “The suggestion that I and other ADHD clinicians would uniformly placate parental concerns with a canned response is insulting,” he says. “This is not the first time this has happened within the ADHD community, and it’s so frustrating. Some things in the article are accurate, but they are mixed in with very inaccurate, overly simplistic information.”

Unraveling a Dangerous Narrative About Medication

Of perhaps greatest concern is Tough’s inaccurate and harmful portrayal of stimulant medication as an ineffective Band-Aid that fails to improve students’ academic test scores and, therefore, must be unnecessary. He cited limited research casting doubt on ADHD medication’s ability to make kids score higher on timed tests, sort specific puzzles more efficiently, or excel in summer school. “If these studies are accurate, stimulant medications don’t do much to improve cognitive ability or academic performance,” Tough wrote. “And yet millions of young Americans (and their parents) feel that the pills are essential to their success in school. Why?”

Inexplicably, Tough did not report that ADHD medication has been shown to reduce impulsivity and, by extension, the risks of car accidents, substance abuse, unplanned pregnancy, comorbid depression and anxiety, incarceration, self-harm, and suicide. In fact, research has found that stimulant medication use among individuals with ADHD reduces the risk of premature death by a staggering 19%.

In a study published in The British Journal of Psychiatry in 2025, the life expectancy for adults with ADHD was found to be 7.5 years shorter than it was for those without the condition. Women with ADHD live 8.6 years fewer years than women without ADHD, while the life expectancy of men with ADHD was 6.8 years shorter than that of their peers. ADHD is a serious condition, and to willfully misrepresent its proven treatments is dangerous at best.

Research has documented the positive impact of ADHD treatment on life expectancy. A Swedish study, published in JAMA Network Open, followed nearly 150,000 adults and adolescents for two years after they received their ADHD diagnoses. The researchers shared the following insights about the use of stimulant medication — amphetamine or methylphenidate — which is effective for roughly 70% of patients with ADHD:

• 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.

What’s more, researchers at the University of Michigan and Massachussets General Hospital studied 40,000 high school seniors, more than 4,000 of whom had ADHD. The research team compared the risk for marijuana abuse — the most common drug misused by this age group—among teens with ADHD to the overall population. They found that the students with the lowest incidence of substance abuse started ADHD treatment with stimulants before 9 years of age. When treatment began between ages 10 and 14, it was helpful, but the students still had a significantly higher likelihood of smoking marijuana. The highest risk of marijuana use was found among students with ADHD who started medication after age 15.

The late Joseph Biederman, M.D., the former Chief of the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD at Massachusetts General Hospital, along with researchers at the hospital and at Massachusetts Institute of Technology, conducted a study in which teens with ADHD were separated into two groups, then tasked with driving through a virtual roadway featuring surprise events, including oncoming traffic. The teens in the first group received stimulant medication (lisdexamfetamine: brand name Vyvanse) while the teens in the second group did not. Compared with the group of non-medicated ADHD teens, the medicated group was 67% less likely to have a collision during these events.

“For families that stop ADHD treatment on weekends and during ‘downtime,’ I emphasize the importance of driving only while medication is active,” Dr. Biederman had said. “A short-acting medication taken about half an hour before hitting the road may just be lifesaving.”

Why Ignore Patients’ Real-World Experiences?

Indeed, ADHD treatment with medication is lifesaving for many children, adolescents, and adults with ADHD for many reasons beyond the decreased risks for car accidents, illegal drug use, unprotected sex, and the other dangers outlined above.

ADDitude readers write to us daily about the social, emotional, professional, and psychological benefits they experience while using prescription stimulant medication to treat their ADHD symptoms. By excluding these patient perspectives, Tough’s reporting could place lives at risk by telling a story that may scare caregivers and adult patients away from the ADHD treatments that are shown to safely, effectively improve and protect lives.

On that note, let us leave you with a few quotes from ADDitude readers explaining, in their own words, the benefits of stimulant medication and the threats they feel in 2025.

“Adderall is literally the difference between crippling depression due to executive function disorder and not. If my access to my much-needed medication goes away, the impact will be exponential.”

“If they mess with my stimulants or access to stimulants, I could lose my job and even my marriage. I rely on it to maintain focus as a design engineer. It also helps communication with my wife when I have my stimulants.”

“ADHD medication has huge benefits. It’s frustrating that the discourse is being steered from the top by someone so willfully ignorant, bringing out everyone who has totally misinformed ‘reckons’ about ADHD.”

Rebuttal from Russell Barkley, Ph.D.

More NYTimes Rebuttals

• 4-Part Video Response from Russell Barkley, Ph.D.
• The Child Mind Institute
• The ADHD Evidence Project

ADHD Article Corrections: Next Steps

• Free Download: The Ultimate Guide to ADHD Medication
• Reader Reactions: MAHA Commission Means Fear, Stigma, Health Threats for Two-Thirds of ADDitude Readers
• Read: Is ADHD Real? Yes — and Still Heavily Stigmatized

Corrections

This article was updated on April 25, 2025, to reflect the following:

• Wes Crenshaw, Ph.D., reported to ADDitude that he invited the author to interview several ADHD patients, not himself, and that invitation was not accepted
• The CDC’s 2022 estimate for the prevalence of ADHD in American children aged 3-17 years, which is 11.4 percent, not 5 to 7 percent
• Author Paul Tough did not directly describe the ADHD diagnosis process as “arbitrary,” but rather his quoted source, Edmund Sonuga-Barke, did. This quotation was removed.
• The full quote from Tough’s text was included: “If these studies are accurate, stimulant medications don’t do much to improve cognitive ability or academic performance. And yet millions of young Americans (and their parents) feel that the pills are essential to their success in school. Why?”
• This phrase was removed, “…and then questioned why American parents and students would accept the ‘risks inherent in taking prescription stimulants.'” The original article stated: “Researchers acknowledge that there are other risks inherent in taking prescription stimulants.”

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In 44 days, the Make America Healthy Again (MAHA) Commission says it will deliver to President Trump a report — based on existing research, public hearings, roundtables, and meetings but not new studies — on the scope, causes, and treatments related to childhood chronic disease. In its founding documents, the MAHA Commission, chaired by Health and Human Services Secretary Robert F. Kennedy, Jr., singled out autoimmune diseases, autism, and ADHD, which it said “pose a dire threat to the American people and our way of life” and “harm us, our economy, and our security.”

Medical professionals and advocates were swift to condemn the commission’s stigmatizing portrayal of ADHD and autism as “a dire threat,” and challenged its suggestion that chronic conditions like these may be caused by “over-utilization of medication, certain food ingredients, certain chemicals and other exposures” — claims not supported by accepted scientific knowledge and research.

Of greatest concern to caregivers and patients with ADHD was the commission’s vow to “assess the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, stimulants, and weight-loss drugs.” As countless ADDitude readers have said to us: Stimulants are not a threat; they are an essential and effective treatment that mitigates threats to our wellbeing. Many expressed fear that the commission’s actions could restrict access to their prescription medication.

While the commission said it would rely on “transparency and open-source data,” it has not held any reported public hearings or meetings with ADHD experts since it was established in February. News outlets have reported only one closed-door gathering on March 11 with no public invitation or known agenda.

Secretary Kennedy has not responded to ADDitude’s open letter, urging him to consult with ADHD experts and researchers regarding evidence-based findings to effectively treat the condition. However, more than 400 ADDitude readers shared their opinions of the MAHA Commission and its anticipated assessment and final recommendations, which are expected to be delivered to President Trump on August 12.

• 66% of readers said they feel fearful, angry, and/or skeptical of the MAHA Commission
• 23% of readers said they are reserving judgment, feel torn, or are unfamiliar with the MAHA Commission
• 10% expressed excitement or hopefulness about the commission’s work

[New Class! ADHD Treatment Guide for Adults]

Here are some of those opinions, sent to ADDitude in response to the question: What do you think the MAHA Commission assessment, and subsequent recommendations, might mean for your family and others with ADHD, depression, and other related conditions?

Those Who Oppose the MAHA Commission

“I am deeply concerned by this resolution and its negative bias against the medication that has been life-changing for so many people and families. I also find it misaligned with the opinions of the respected researchers like Dr. Russell Barkley who have worked so hard to destigmatize ADHD medication and help people understand that dangerous consequences can come from living without any treatment. I am concerned that this resolution is misrepresenting itself as trying to improve health, when it is actually an effort to restrict treatment options that are already heavily researched and proven.” — an ADDitude reader in Florida

“Health insurance companies will use the commission’s recommendations to make it harder for us to undergo ADHD testing and treatment in every form. They will use it to justify denying requests to receive all types of therapy, medications, etc., and/or increase our payments to receive them. They will use it to justify denying coverage for pre-existing conditions that they no longer feel need to be treated.” — an ADDitude reader in Florida

[Reader Essay: “We Should Never Pull a Life-Saving Medication from a Child.”]

“One assessment by non-experts devoted to a political cause will be wasteful and biased. It will certainly not be worth throwing out an entire body of scientific dispassionate inquiry and knowledge that has accumulated over decades of ADHD research and practice. I can’t imagine what his motive is except to humiliate and dehumanize us.” — an ADDitude reader in Virginia

“This sets us back at least 10 years in mental health care. Referring to any therapeutic treatment as a potential ‘threat’ not only worsens stigma but propagates complete misinformation.” — an ADDitude reader in Colorado

“It is significantly concerning when those without medical knowledge or an understanding of how to look at and critically assess research are making decisions about how to treat health concerns. We are already seeing the impact of unsound decision-making, as previously eradicated illnesses and diseases are making an unwanted comeback. Without informed decision-makers, people will suffer.” — an ADDitude reader in Pennsylvania

“MAHA will probably limit which medications are covered by insurance or Medicaid, making life unaffordable and unbearable for many neurodivergent people who are relying on them just to get through each day. Each person’s body chemistry handles different drug formulas differently, and often it takes trial and error to find the correct med for each person. Taking many of these medications off the table will greatly impact so many.” — an ADDitude reader in North Carolina

“I see a huge threat in this MAHA initiative. It sounds like segregating or eliminating ‘mutants’ at the beginning of a sci-fi movie. Add in the attack on Section 504, and it would seem that anyone who is not physically or neurologically ‘typical’ is not worth helping/saving/protecting. It’s absolutely horrific. I think it could go way beyond limiting treatment, and I believe it would be a massive disservice to our people, and our public health, setting a terrible precedent for who is ‘valuable enough.'” — an ADDitude reader in California

“The very wording of the statement reflects their bias against these vital tools. Their intent is to restrict access and convince people that they don’t work. This will only further harm marginalized communities that already receive care at lower rates.” — an ADDitude reader in Arkansas

“I am terrified of the outcome of this so-called assessment. For several years we’ve tried to find the right drug combination for my daughter. Now we seem to have it, and I’m afraid it will be stripped away in a couple of months. We both have ADHD, take stimulants, as well as meds for anxiety and depression. If they are no longer available to us, I will attempt to migrate to Canada, seeking asylum based on the fact that living in the U.S. would put our health severely at risk.” — an ADDitude reader in Texas

“No different than a Type-1 diabetic who needs insulin to lower blood sugar levels, my son’s brain needs these medications to help balance its chemistry. Without them, I’m certain he would not be able to attend school. Our insurance company makes me fight every month for the medication he has. I can’t imagine more limitations!” — an ADDitude reader in Oregon

“If the recommendations lead to stricter limitations on the prescribing of medications, it may force individuals with ADHD, depression, and other mental health conditions to turn to less effective or more dangerous treatment options. Additionally, limiting prescribed medications could reinforce the stigma surrounding mental health, making it harder for individuals with ADHD and depression to seek help as their treatment options are limited.” — an ADDitude reader

“I exercise, eat healthy, meditate, blah blah blah, and only the meds make my brain work better. I can feel the moment it turns on. Take the meds away, and you have mayhem at work, and at home. It’s mind-bending to ponder the consequences.” — an ADDitude reader in New Mexico

“I can’t even think about this without feeling ill. On the surface, I look like a normal, functioning professional with an advanced degree. I am fortunate to have landed a job with a six-figure salary, but I can’t tell you how many nights I spent curled up crying during the stimulant shortages because I was terrified that I would lose my job if I couldn’t function without my medication. Not to mention how hopeless and embarrassed I felt having to desperately call every local pharmacy to see if they had medication in stock. We need to broaden access — not limit it.”- an ADDitude reader in Michigan

“Politicians should not be interfering with medication access or making decisions on what is or isn’t safe. That’s what the FDA is for. These headlines make me extremely anxious and, in a way, feel less than — like those who want to ban SSRIs and other medications do not care about those of us who need them.” — an ADDitude reader in Michigan

“They are targeting medications that truly make a difference in the day-to-day lives of ADHD brains and their parents. If some of these medications get taken off the market, there will increases in suicides. Taking away what works without viable alternative solutions is a huge mistake. As a scientist, I’m scared of people who are not accepting of scientific proof.” — an ADDitude reader

“Based on the anti-science rhetoric from this new administration, I am afraid they may act to limit the usage of these medications based on their motivated reasoning. They will disregard the body of evidence, and use false-cause, anecdotal, and Texas sharpshooter fallacies to do real harm to Americans who need these medications to function or even survive.” — an ADDitude reader

Those Who Support the MAHA Commission

“I’m hoping for a broad, holistic, ground-up approach where our treatment options outside of medications are expanded and supported and made more financially accessible to make needed medications and prescriptions more effective.” — an ADDitude reader in Georgia

“I want to know that what my kids are taking is actually safe, actually healthy, and actually doing what it should be doing. We should not be afraid of that. If they find that pharmaceutical companies are lying to us, then please, by all means, take the medications out of production and find us alternatives that really do help! I say this as a mother of four children on ADHD and depression/anxiety medications.” — an ADDitude reader in Minnesota

“I tend to be more conservative when it comes to diagnosing and medication management, so I think we need an assessment of the system with new recommendations from a new perspective. In the 30 years I have been a social worker, I have seen many over-diagnosed and over-medicated clients. I think we need to go to a more holistic approach. I feel that meds are often prescribed in isolation, when they should be in combination with therapy or other forms of counseling/support groups. Mental health is a huge crisis, but even more so is the over-medication of the U.S. population. I welcome the oversight.” — an ADDitude reader in Maryland

“Healthcare in the U.S. needs to be reformed and the only way to do that is to shake things up. It would mean we can get rid of things that aren’t working and implement new policies and ideas that will work. It might mean we have to fight harder for the things that matter but when we work together anything is possible!” — an ADDitude reader

Those Undecided on the MAHA Commission

“My initial reaction was fear and disbelief — wondering why this was being investigated and whether I might have trouble accessing my medications. But once I engaged my professional mindset, I realized the potential harm of prescribing antidepressants and other psychiatric medications too freely. When these medications are used as a quick fix rather than addressing underlying issues — such as biological conditions, illnesses, or nutritional deficiencies — it can be dangerous.” — an ADDitude reader in Texas

“I think it’s important for scientists and doctors to continuously assess and research all medications to ensure they’re effective and safe, but the language of referring to these as a potential ‘threat’ is harmful and potentially dangerous. It could increase stigma, reduce access to medications for those who need them, and contribute to a broader uptick in ableism especially toward mental health disorders. I also think that it sets a dangerous precedent of politicizing health issues, which could further contribute toward not only stigma but misinformation from politicians who are not medically trained or certified, harmful policies and legislation targeting people with mental and physical disabilities, and a cultural shift away from accommodations, accessibility, and legal protections for people affected by mental health disorders.” — an ADDitude reader in Colorado

“A review of these medications may lead to more informed prescribing practices, ensuring that treatments are effective and necessary. This could improve patient outcomes and tailor treatment to individual needs, which is crucial for managing conditions like ADHD and depression. However, there are potential risks associated with the recommendations that could affect access to treatment. If the assessment finds that certain medications are being overprescribed or misused, it might result in stricter regulations or guidelines that could limit access for those who genuinely need these medications. Moreover, increased examination and discussion around these medications may inadvertently contribute to stigma.” — an ADDitude reader in Australia

MAHA Commission: Next Steps

• Free Download: The Ultimate Guide to ADHD Medication
• Read: “Disability Is DEI.”
• Reader Reactions: “I’m Truly Scared for What This Could Mean”

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Access to prescription ADHD medication continues to burden — and preoccupy — patients with ADHD.

The prescription stimulant shortage that first disrupted treatment for millions of patients with ADHD two years ago lingers for many. And now, ADDitude readers and others in the mental-health community are worried about losing access to “lifesaving” medication as the Make America Healthy Again (MAHA) Commission investigates the state of “childhood chronic disease.”

The MAHA Commission will “assess the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors (SSRIs), antipsychotics, mood stabilizers, stimulants, and weight-loss drugs” and deliver a recommendation on May 25. Some within the mental-health community are expressing concern that the commission could force the withdrawal of Federal Drug Administration (FDA) approval for these drugs.

According to an article published last week by Medscape, rescinding the FDA’s authorization for these medications would be “very difficult,” requiring years of public meetings and evidence that the medications are unsafe.

Research has long established the safety and efficacy of the stimulant medications used to treat ADHD. Amphetamine (brand name: Adderall) and methylphenidate (brand name: Ritalin), two main stimulants used to treat ADHD, have been found to reduce ADHD symptoms by 70% to 90% in children^1,2.

[Get This Free Download: The Ultimate Guide to ADHD Medication]

SSRIs are often used as a first-line pharmacological option for treating anxiety and depression, as they have fewer side effects than older classes of antidepressants³.

Despite the proven safety and efficacy of these medications, ADDitude readers say they are largely feeling uneasy and anxious as they await the commission’s report. Here is what they told us on Facebook last week:

“I never thought I’d see such craziness here in our country. I’m truly scared for what this could mean for my child, who needs his medication to function. Natural aids can only do so much.” — Martha

“Exercise and what we eat are powerful, but it’s not enough to help my ADHD and AuDHD family members… Removing ADHD meds would make it darn near impossible for my AuDHD kid to learn.” — Laura

[Get This Free Download: Comparison Chart of Stimulants & Non-Stimulants]

“My kids and I are all on medication for ADHD. I am also a therapist specializing in the ADHD population. I wish people outside of this world would take a moment to realize that none of us go on these medications for funsies…we do so because they are incredibly helpful and enable us to live normal, healthy, and productive lives.” — Megan

“I applaud people who can find a natural way to treat their symptoms. However, for me, it’s like a completely new life with stimulants. It’s so odd that anyone would want to take something life-changing away from someone. It’s cruel.” — Jenna

“As an individual with ADHD and a public school educator, I hope and pray they don’t do anything to make meds even harder to get. That will wreck the quality of life for a lot of people.” — Martha

“Just because something didn’t work for your child, doesn’t mean it’s not a lifesaver for another. It’s up to each parent and their child’s doctors and therapist to decide what’s best for them, including the use of medication.” — Amanda

“The issues treated by the drugs the commission might target are all long-perceived by Boomers as flaws of character, something you can pray or willpower away, with enough discipline.”  — Heather

“ADHD meds are effective and helpful for me and two of our children. We also know that we need daily exercise and a diet…I am all for pulling back the curtain and working to make people healthy…It’s time for a change.” — Terri

Make America Healthy Again Commission: Next Steps

• Read: Dear Mr. Kennedy
• Free Download: A Parent’s Guide to ADHD Medications
• Read: “We Should Never Pull a Life-Saving Medication from a Child”

Sources

¹ Spencer, 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(5), 456-463https://doi.org/10.1016/j.biopsych.2004.11.043

² Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Leibson CL, Jacobsen SJ. (2006). Long-term stimulant medication treatment of attention-deficit/hyperactivity disorder: results from a population-based study. J Dev Behav Pediatr. 27(1):1-10. https://psycnet.apa.org/doi/10.1097/00004703-200602000-00001

³ Chu A, Wadhwa R. (2025). Selective Serotonin Reuptake Inhibitors. In: StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK554406/

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

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

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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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Narcissistic personality traits are curbed, and empathy improved, by the use of stimulant medication in adults who have ADHD, according to a small study published in Alpha Psychiatry.¹ The study is the first to explore the impact of ADHD medication on narcissistic personality traits and empathy in adult patients with ADHD, building on past research that established a high prevalence of narcissistic personality disorder (NPD) in this population.

The study involved 75 participants (54% male, 46% female). Of those, 44% received extended-release methylphenidate, 50% received short-acting methylphenidate, and 6% received atomoxetine for three months. Levels of ADHD symptoms, empathy, and pathological narcissism — both grandiose and vulnerable/covert subtypes — were assessed before and after three months of treatment. Researchers found significant changes in three areas among patients taking stimulant medication: reductions in narcissistic traits, increases in empathy levels, and improvements in ADHD symptoms.

Pathological narcissism is marked by impairment in self-esteem regulation; intense shame, anger, or envy leads individuals to employ maladaptive strategies to restore self-esteem in situations where it is perceived as threatened.² The subtype of grandiose narcissism is marked by exhibitionism, aggression, and self-assurance; the subtype of vulnerable narcissism is marked by distrustfulness, fear of rejection, introversion, and negative emotionality.

Deficits in empathy are central to narcissism and can lead to myriad challenges over the lifespan including problems with communication and interpersonal relationships. While previous research, including a systematic review published in 2021, found that treatment with methylphenidate increased empathy in children with ADHD, research focusing on adults had been scarce.^{3, 4} As such, the study helps to fill in a gap in the research landscape.

Narcissistic Personality Traits Linked to Hyperactivity and Impulsivity

This research comes just months after another small study, published in Journal of Psychiatric Research, explored the link between pathological narcissism and ADHD by gathering data on a group of 164 adults with ADHD.⁵ The study’s findings confirmed previous research that demonstrated a significantly increased prevalence of narcissistic traits among adults with ADHD; it found that narcissistic personality disorder (NPD) occurs in 25% of adults with ADHD⁶ compared to 6% of all adults.⁷

The Journal of Psychiatric Research article offered further insight into the link between ADHD and narcissism, revealing that narcissistic traits tied to both grandiose and vulnerable subtypes were associated with symptoms of hyperactivity and impulsivity, but not with inattention.

In addition, narcissistic traits in ADHD adults were linked to higher levels of anxiety and depression. Traits of vulnerable narcissism, specifically, were associated with more significant emotion dysregulation and a history of hospitalization, suicide attempts, and non-suicidal self-injury, even after adjusting for the presence of borderline personality disorder. The study’s findings “suggest that narcissistic vulnerability has a unique impact on the clinical severity of ADHD,” write the study’s authors.

Narcissistic Personality Traits Lower Adherence to ADHD Treatment

Multiple studies have demonstrated that people with ADHD and comorbid personality disorders, including NPD, have lower adherence rates to ADHD treatment than do people with ADHD alone, making treatment for these individuals both variable and challenging.^{8, 9}

“An omission in the consideration of [narcissistic] traits may be the reason for inadequate improvement in areas [of ADHD] such as social interaction, social functioning, and interpretation of events. This, in turn, may lead to sub-optimal treatment of ADHD,” write the authors of the Alpha Psychiatry study. “New approaches are needed to mitigate comorbid personality traits in order to enhance treatment adherence and response rates.”

Limitations of both studies include the small sample size, lack of longitudinal follow-up, and potential confounding factors. The authors of both studies call for further research.

Sources

¹Takım U, Belli H, Gökçay H, Köse H, Arslan Akgül H, Çakır A. Examination of Changes in Levels of Empathy and Narcissistic Pathology After Treatment of Adult with Attention-Deficit/Hyperactivity Disorder. Alpha Psychiatry. 2024 Sep 1;25(5):598-603. doi: 10.5152/alphapsychiatry.2024.241630. PMID: 39553487; PMCID: PMC11562234.

²Duarte M, Blay M, Hasler R, Pham E, Nicastro R, Jan M, Debbané M, Perroud N. Adult ADHD and pathological narcissism: A retrospective-analysis. J Psychiatr Res. 2024 Jun;174:245-253. doi: 10.1016/j.jpsychires.2024.04.032. Epub 2024 Apr 21. PMID: 38670059.

³Fantozzi, P., Sesso, G., Muratori, P., Milone, A., & Masi, G. (2021). Biological Bases of Empathy and Social Cognition in Patients with Attention-Deficit/Hyperactivity Disorder: A Focus on Treatment with Psychostimulants. Brain Sciences, 11(11), 1399. https://doi.org/10.3390/brainsci11111399

⁴Groen, Y., den Heijer, A.E., Fuermaier, A.B.M. et al. Reduced emotional empathy in adults with subclinical ADHD: evidence from the empathy and systemizing quotient. ADHD Atten Def Hyp Disord 10, 141–150 (2018). https://doi.org/10.1007/s12402-017-0236-7

⁵Duarte M, Blay M, Hasler R, Pham E, Nicastro R, Jan M, Debbané M, Perroud N. Adult ADHD and pathological narcissism: A retrospective-analysis. J Psychiatr Res. 2024 Jun;174:245-253. doi: 10.1016/j.jpsychires.2024.04.032. Epub 2024 Apr 21. PMID: 38670059.

⁶Bernardi S, Faraone SV, Cortese S, Kerridge BT, Pallanti S, Wang S, Blanco C. The lifetime impact of attention deficit hyperactivity disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Psychol Med. 2012 Apr;42(4):875-87. doi: 10.1017/S003329171100153X. Epub 2011 Aug 16. PMID: 21846424; PMCID: PMC3383088.

⁷Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, Ruan WJ, Pulay AJ, Saha TD, Pickering RP, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2008 Jul;69(7):1033-45. doi: 10.4088/jcp.v69n0701. PMID: 18557663; PMCID: PMC2669224.

⁸Gift TE, Reimherr FW, Marchant BK, Steans TA, Wender PH. Personality disorder in adult attention-deficit/hyperactivity disorder: attrition and change during long-term treatment. J Nerv Ment Dis. 2016;204(5):355 363. ( 10.1097/NMD.0000000000000470) [DOI]

⁹Robison RJ, Reimherr FW, Gale PD, et al. Personality disorders in ADHD Part 2: The effect of symptoms of personality disorder on response to treatment with oros methylphenidate in adults with ADHD. Ann Clin Psychiatry. 2010;22(2):94 102. [PubMed]

We make time for everything and everyone but ourselves. We consistently prioritize the needs of others. We feel guilty erecting boundaries. And this struggle to carve out space for our own wellbeing is the biggest barrier to mental and emotional health for more than half of adults with ADHD, according to a new survey of 1,898 ADDitude readers.

“I have a hard time putting myself first. I worry about others to my own detriment.”

“I really want to journal but, when I remember to, I spend an hour writing and then find myself thinking, ‘I don’t have time for this!’”

On a 10-point scale, where 10 is extremely satisfied, ADDitude readers rated their mental and emotional health a 5.2. Additional barriers to mental health care cited by readers include the following:

• Defining effective self-care strategies: 45%
• Sticking with a routine: 45%
• Practicing mindful meditation and/or gratitude: 38%
• Affording a mental-health practitioner: 23%

“Insurance makes things impossible sometimes. Also, I’ve had to switch mental healthcare doctors many times due to clashes of ideals and personality. One actually said ADHD wasn’t real and that I just needed discipline to work through my ‘laziness’.”

“I have not found a single counselor who is highly familiar with adult ADHD and its nasty companions.”

[Get This Free Download: Make Mindfulness Work for You]

Top Mental Health Apps and Tools

Following are the top apps, websites, podcasts, books, and other resources recommended by ADDitude readers for improving mental and emotional health.

Self-Care Apps

• Insight Timer: Guided meditation sessions, music, and courses for mindfulness and relaxation
• Balance: Personalized meditation that adapts sessions to your goals and progress
• Gratitude: Foster daily gratitude and positivity via journaling
• Happify: Activities and games to boost happiness and reduce stress
• Headspace: Mindfulness and meditation tools, sleep sounds, mindful movement, and exercise.
• Calm: Sleep stories and music, meditation and inspirational stories, mood tracking, and relaxation tools
• Healthy Minds: Unlock wellbeing my practicing four skills — awareness, connection, insight, and purpose
• Finch: Nurture a virtual pet by completing daily wellness and self-care tasks

Self-Care YouTube Channels, Podcasts, and Websites

• How to ADHD: A YouTube channel created by Jessica McCabe that offers practical tools and insights for living with ADHD.
• The Happiness Lab: A podcast by Laurie Santos, Ph.D., that explores science-backed strategies for a happier life.
• The Teen Anxiety Maze : A podcast by Cynthia Coufal, a teen anxiety coach.
• Therapy in a Nutshell : A mental health and strategies podcast, YouTube channel, and website by Emma McAdam, LMFT.
• Something Shiny: A podcast by therapists David Kessler and Isabelle Richards that tackles ADHD and relationships with humor and authenticity.
• ADDitude ADHD Experts: Leading experts in ADHD and mental health share the latest research and proven strategies.

Self-Care Books

• ADHD 2.0 (#CommissionsEarned)by Edward M. Hallowell, M.D., and John Ratey, M.D.
• Your Brain Is Not Broken (#CommissionsEarned) by Tamara Rosier, Ph.D.
• The Gift of Imperfection (#CommissionsEarned) by Brené Brown
• Get Out of Your Mind and Into Your Life (#CommissionsEarned) by Steven C. Hayes and Spencer Smith

Daily Self-Care Approaches

To prioritize self-care, many ADDitude readers incorporate small practices and routines into daily life. Here is their advice.

“Take three deep breaths a few times a day. Connect it to something you are doing anyway; do it after going to the bathroom first thing in the morning or when you get into your car.”

“I have a ‘blow off steam’ playlist that I listen to when I feel wired or hostile. (I also have calming playlists!)”

“As weird as it sounds, I find ChatGPT great for journaling. It asks me questions about what I’ve written and helps me develop a deeper understanding of my thoughts.”

“Exercise is the magic medicine for my mental health. I notice a difference in my energy, focus, attitude, and motivation to get things done when I exercise. I try to walk three days a week and attend a class at my local YMCA three days a week.”

“I write about three good things every morning. It gives me a sense of achievement and agency and calms my anxiety.”

“I have set aside Fridays after work as ‘nothing needs to get done’ time.”

“I try to have 30 minutes of ‘me’ time every day. I take a bath, listen to an audiobook, or watch a show.”

[Read: 31 Ways to Work Out the Kinks in Your Workout Plan]

The Power of Therapy and Medication for Mental Health

Readers report that taking prescribed medications and working with mental health professionals do wonders for their health, and assigned the following “helpfulness” ratings to each tool (on a 5-point scale where 5 is extremely helpful):

• Therapist (in-person or online): 4.11
• Medication for ADHD: 3.91
• Medication for another condition: 3.88
• Psychiatrist: 3.67

“ADHD meds have helped so much with emotional regulation that I’m quite upset I didn’t have access to them earlier!”

“Medication for anxiety has largely cleared up my ADHD mess, so much that I’m able to handle other sides that come up (time blindness, forgetfulness, etc.)”

“Accessing a therapist is paramount to understanding your emotions, triggers, and boundaries.”

“Medication can be so helpful, but it can take a while to figure out what works for you. Try some stuff and don’t be afraid to try something else if it is not working or if side effects make life unfun. Also, know that medication is a helpful tool, but it doesn’t do the work for you. It helps you do the work of setting up systems, finding coping skills and accommodations, and looking honestly at how your current patterns are helping or hurting you as you seek to be the best you.”

More Recommended Mental Health Supports

What other supports are helpful for improving mental and emotional health? ADDitude readers contributed the following “helpfulness” ratings:

• ADHD coach: 3.67
• Yoga or meditation class: 3.50
• Spouse, family member, friend: 3.38
• Anger-management training: 2.75
• Journaling: 3.08

“Get a good yoga teacher who focuses on the emotional benefits of yoga as well as the physical benefits. It is so much more than exercise and is really beneficial for all sorts of ADHD symptoms, too.”

“Find safe spaces to talk about your feelings, even if it is just an online community of strangers. Communities of people with ADHD are great to engage with because they have empathy for what you are experiencing and often really great advice for ways to better your daily life.”

“There is something therapeutic about writing on paper while curled up in a chair. It clears my mind and gets the chaos out of my head.”

“My most helpful experiences come from seeing others with similar struggles and finding that I am normal.”

How to Improve Mental Health: Next Steps

• Celebrate Every Step: Join the Small Wins Appreciation Network!
• Read: 11 Self Care Strategies for ADHD Brains
• Read: “Your ADHD Self-Improvement Plan — 6 Steps to a Better You”
• Join Us! ADHD Support Group for Adults

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

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

The diagnostic criteria for ADHD are largely based on studies of young white boys — and do not reflect the lived experiences of many adults with the condition. This gap between clinical guidance and real-life symptoms has contributed to a decades-long problem with misdiagnosis, missed diagnoses, and inadequate treatment for individuals who slipped under the ADHD radar in childhood.

ADHD persists into adulthood for up to 90% of children with the condition, however, only 33% of pediatricians, 30% of family practitioners, 25% of nurse practitioners, and 22% of internists said that they received adequate training on ADHD in medical school, according to data presented by the American Professional Society of ADHD and Related Disorders (APSARD) at its 2024 conference. APSARD is now working to remedy this obstacle to care with the first-ever guidelines for the diagnosis and treatment of ADHD in adults. In 2023, it established a 27-member task force that is devising clinical practice guidelines for the diagnosis and treatment of ADHD in adults. According to David Goodman, M.D., who is leading the medical subcommittee for the task force, the adult ADHD guidelines have the greatest chance at widespread adoption if they are research-based, clinically informed, and patient-focused. APSARD hopes to publish the guidelines in 2025.

Continue reading “The State of Adult ADHD Today” to learn more.

2. ADHD Medication Use Lowers the Risk of Death, Hospitalization

Treating ADHD with medication can lower the overall risk of mortality by 19% and overdose by 50%. It also reduces hospitalizations, both psychiatric and non-psychiatric, according to two large-scale Swedish studies.^{1, 2} These findings highlight the importance of ADHD medication use for long-term health and longevity, underscoring the urgent need to end the stimulant shortage that has prevented U.S. patients with ADHD from consistently accessing medication since the Fall of 2022.

Continue reading “ADHD Medication Use Lowers the Risk of Death, Hospitalization” to learn more.

3. Massive Study Ties Leaded Gasoline Exposure to 150 Million Mental Health Diagnoses in U.S.

Leaded gasoline and exposure to its exhaust may help explain an estimated 151 million U.S. cases of psychiatric disorders, including ADHD, depression, and anxiety, according to a new cross-sectional study spanning the last 75 years.

Exposure to leaded gasoline from car exhaust was tied to population-wide cases of mental health disorders from 1940 to 2015 in the study, published in December in the Journal of Child Psychology and Psychiatry.³ It estimated that more than half of the current U.S. population was exposed to harmful levels of lead in childhood, resulting in profound effects on their mental health, personality traits, and overall well-being. People born between 1966 and 1986 (referred to as Generation X) experienced the highest rate of lead exposure and are at the greatest risk for anxiety, depression, ADHD, and personality changes.

Continue reading “Massive Study Ties Leaded Gasoline Exposure to 150 Million Mental Health, ADHD Diagnoses in U.S.” to learn more.

4. High and Low Estrogen Exacerbate ADHD Symptoms in Females

The impact of rising and falling hormone levels on ADHD symptoms is compounded for females beginning in puberty, according to the multiple hormone sensitivity theory explained in a review article published in January in Hormones and Behavior.⁴ The theory offers valuable insight into how hormones — namely, high and low estrogen levels — may influence ADHD symptoms in females across the lifespan, including during the menstrual cycle, puberty, pregnancy, and menopause.

Per the theory, females may be more likely to engage in risk-taking and reward-seeking behaviors in the days leading up to ovulation. These behaviors coincide with a steady rise in estrogen levels that drops off during ovulation. In contrast, withdrawal and/or depletion of estrogen at a cycle’s end may be characterized by increased negative affect, avoidant behaviors, and reduced executive functioning.

Continue reading “High and Low Estrogen Exacerbate ADHD Symptoms in Females: New Theory.” to learn more.

5. ADHD Medication Costs Soar

ADHD medication costs have nearly doubled or tripled for doses of Ritalin, Concerta, and Focalin since the Adderall shortage began in October 2022, according to a report published in USA Today in late 2023. The newspaper analyzed the prices that retail community pharmacies pay for common ADHD prescriptions. For specific dosages of methylphenidate (i.e., Ritalin and Concerta), the average price paid by small to mid-sized independent and chain pharmacies nearly doubled from late 2022 to December 2023. The average cost of certain versions of dexmethylphenidate (Focalin) more than doubled during that period.

Continue reading “ADHD Medication Costs Soar: Price Report” to learn more.

6. ADHD Traits May Have Provided an Evolutionary Advantage

ADHD traits such as distractibility and impulsivity may have benefited our ancestors as they foraged for food, and they continue to play a crucial role in how people with ADHD adapt and survive, suggests research published in February in the journal Proceedings of the Royal Society B Biological Sciences.⁵

“We speculate that ADHD serves as an adaptive specialization for foraging, thus explaining its widespread prevalence and continued persistence in the human population,” the researchers said. “This tendency to explore while foraging might extend to other behaviors such as cycling more frequently between information sources in the classroom or sources of stimulation in the home environment.”

Continue reading “ADHD Traits May Have Provided an Evolutionary Advantage” to learn more.

7.

In June, 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 patients⁶, 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.

Continue reading “Done ADHD Investigation Sparks Worry of Inadequate Care” to learn more.

8. Boredom Triggers High Stress Response in Impulsive People

Boredom causes a heightened stress response in impulsive people, as evidenced by the elevated cortisol levels documented in research published in Physiology & Behavior in October.⁷ The research deepens the scientific community’s understanding of the interplay between impulsivity and boredom, suggesting that this relationship may be mediated by the hypothalamic-pituitary-adrenal (HPA) axis.

“This research suggests that the lived experience of boredom feels more intense and aversive for people who are highly impulsive, transforming into an overwhelming need to escape that boredom,” explained Matt Parker, Ph.D., the study’s senior author and a neuroscientist at the University of Surrey.

Continue reading “Boredom Triggers High Stress Response in Impulsive People: New Study” to learn more.

9. DEA OKs Expanded Production of the ADHD Medication Vyvanse

Vyvanse and its generic equivalents (lisdexamfetamine dimesylate) became more readily available at pharmacies following a decision in September by the Drug Enforcement Administration (DEA) to allow expanded production of the stimulant medication used to treat ADHD and moderate-to-severe binge-eating disorder (BED) in adults. The DEA approved a 24% production increase in response to the ongoing stimulant shortage.

“These adjustments are necessary to ensure that the United States has an adequate and uninterrupted supply of lisdexamfetamine to meet legitimate patient needs both domestically and globally,” the DEA said in a letter on September 5.

Continue reading “Vyvanse Shortage Update: DEA OKs Expanded Production of the ADHD Medication” to learn more.

10. ADHD Medication Prescriptions Spiked Ahead of Adderall Shortage

Prescriptions for ADHD medications increased significantly during the COVID-19 pandemic, especially for women and for adults aged 20-39, according to a study published in January in JAMA Psychiatry. The most significant increases were found among prescriptions for adults aged 20-39, up 81% for non-stimulants and 30% for stimulants; and for women, up 59% for non-stimulants and 25% for stimulants.⁸ By contrast, researchers found a decrease or no change in rates of prescriptions during the pandemic for medications used to treat other behavioral health disorders, including anxiety, depression, and opioid use disorders.

Continue reading “ADHD Medication Prescriptions Spiked Ahead of Adderall Shortage: New Report” to learn more.

Sources

¹Li, L., Zhu, N., Zhang, L., et al. (2024). ADHD Pharmacotherapy and Mortality in Individuals With ADHD. JAMA. https://doi.org/10.1001/jama.2024.0851

²Tipale, H., Bergström, J., Gèmes, K., et al. (2024). Attention-Deficit/Hyperactivity Disorder Medications and Work Disability and Mental Health Outcomes. JAMA Netw Open. 7(3):e242859. https://doi.org/10.1001/jamanetworkopen.2024.2859

³McFarland, M.J., Reuben, A. and Hauer, M. (2024). Contribution of Childhood Lead Exposure to Psychopathology in the US Population Over the Past 75 Years. J Child Psychol Psychiatr.https://doi.org/10.1111/jcpp.14072

⁴Eng, A.G., Nirjar, U., Elkins, A.R., Sizemore, Y.J., Monticello, K.N., Petersen, M.K., Miller, S.A., Barone, J., Eisenlohr-Moul, T.A., & Martel, M.M. (2024). Attention-Deficit/Hyperactivity Disorder and the Menstrual Cycle: Theory and Evidence. Hormones and Behavior. 158(105466).https://doi.org/10.1016/j.yhbeh.2023.105466

⁵Barack, D.L., Ludwig, V.U., Parodi, F., Ahmed, N., Brannon, E.M., Ramakrishnan, A.M., and Platt, M.L. (2024). Attention Deficits Linked with Proclivity to Explore While Foraging. Proceedings of the Royal Society B Biological Sciences. https://doi.org/10.1098/rspb.2022.2584

⁶CDC. Disrupted Access to Prescription Stimulant Medications Could Increase Risk of Injury and Overdose. June 13, 2024. https://emergency.cdc.gov/han/2024/han00510.asp

⁷ Clay, J.M., Badariotti, J.I., Kozhushko, N., Parker, M.O. (2024). HPA Activity Mediates the Link Between Trait Impulsivity and Boredom. Physiology & Behavior. 284, 114637. https://doi.org/10.1016/j.physbeh.2024.114637

⁸Chai, G., Xu, J., Goyal S, et al. (2024). Trends in Incident Prescriptions for Behavioral Health Medications in the US, 2018-2022. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2023.5045

In this final installment of ADDitude magazine’s two-part series, “The Future of ADHD” (the first part appeared in the Winter 2023 issue), I’ll explain each of the developments poised to revolutionize ADHD understanding and treatment.

New Pharmacologic Interventions for ADHD

Development of pharmacologic interventions for ADHD has mushroomed over the last two decades. Though researchers have made progress in developing non-stimulant treatment options (i.e., long-acting forms of clonidine and guanfacine, as well as atomoxetine and viloxazine), most of the FDA-approved agents are simply tweaks of methylphenidate and amphetamine compounds.

There are now more choices available to prescribers and patients, offering stimulant preparations of varying durations, delivery formats (patch, liquid, tablet, capsule), and pharmacokinetic profiles. It should be noted that both older and newer preparations are exceptionally effective for most patients and, when comparing them to non-stimulants in head-to-head trials and in clinical practice, the psychostimulants generally win hands-down. However, the various forms of psychostimulants differ in their rate of onset, duration of coverage, convenience (once daily vs. multiple doses daily), and cost.

Psychostimulants, however, are not effective for everyone; about 30% of patients may not have a satisfactory response.¹ As a result, researchers are increasingly exploring the benefits of combining psychostimulant treatment with other compounds (e.g., methylphenidate paired with atomoxetine, or a dextroamphetamine compound plus guanfacine).

[Get This Free Download: 2024 Scorecard of ADHD Treatments]

The robust effectiveness of psychostimulants in treating ADHD has somewhat slowed the development of alternatives. However, researchers are exploring newer agents that target different neurotransmitter systems, including:

• Solriamfetol (used to treat excessive daytime drowsiness)
• Tipepidine (used as a cough suppressant)
• Amantadine (used to treat Parkinson’s disease)
• Dasotraline (used to treat depression and other disorders)

Not yet FDA-approved for ADHD, these compounds face two main challenges: matching the effectiveness of psychostimulants and effectively targeting symptoms not currently treated by psychostimulants.

ADHD and the Gut-Brain Axis

Emerging research suggests a significant, but underappreciated, relationship between the gut biome — a diverse community of microorganisms living in the digestive tract — and behavior and emotions. The gut and the brain communicate through the gut-brain axis, allowing gut microbiota to influence brain function and vice versa.

Multiple studies have now shown that abnormalities in the gut microbiome can affect mood, anxiety, and stress levels.² Certain gut bacteria can even produce neurotransmitters like serotonin and gamma-aminobutyric acid (GABA), which play a crucial role in regulating emotions.³ Other gut bacteria can produce toxins, inflammatory molecules, and other metabolites that can cross the blood-brain barrier to adversely impact brain health and cognitive function.⁴

[Get This Free Download: Lifestyle Changes for Adults with ADHD]

Imbalances in the gut microbiome can be caused by diet, stress, and even antibiotic use during the prenatal period or during infancy.^{5 6} Longitudinal studies have shown that these gut factors can be linked to mental health disorders, including ADHD, in later childhood.⁷ Multiple studies also suggest that restoring a healthy gut balance through probiotics, prebiotics, or dietary changes might improve emotional wellbeing.⁸ Research involving the microbiome’s impact on human behavior and emotions is still emerging.

ADHD and Gene-Environment Interactions

ADHD is highly heritable; however, environmental influences are exceptionally important in determining whether, when, and how a set of genes will manifest in ADHD symptoms. Environments determine whether a particular illness or disease manifests. This area of research — how certain genes are differentially expressed due to differences in environments — is in its infancy.

A major challenge: Because there are so many genes and possible environmental factors unfolding over time, there are literally trillions of possible gene-environment interactions that could affect the timing, severity, and persistence of ADHD. Due to the likely number and complexity of these interactions, multiple replications across independent studies will be essential.

Several studies have already shown that the severity and persistence of ADHD can be a function of parent-child interactions and supervision across different settings.⁹ This is not a “blame the parents” finding, but, instead, suggests that certain interventions from caregivers (and possibly teachers, coaches, and other adults) may mitigate a child’s symptom severity and persistence. For example, teaching parents how to remain neutral, or even express warmth in the face of difficult behaviors, is likely an important area of intervention. Related findings indicate that parental rejection¹⁰ can affect a child’s outcomes, as can the level of household disorganization¹¹, overall life stress¹², and other factors. Attention to such challenges offers an opportunity for targeted interventions.

Many different factors contribute to ADHD’s etiology, timing of onset, and severity, as well as possibilities for prevention and person-specific treatment. Our research to date, and our research programs unfolding over the next decades, will continue to lead to advances in the way we diagnose and treat ADHD in childhood and in adults.

ADHD Research: Next Steps

• Read: The Evolution of ADHD — Examining the Last 25 Years and the Future
• Read: Prenatal and Early Life Risk Factors of ADHD
• Watch: Epigenetics — Understanding Its Role in ADHD and Future Applications
• Hub: ADHD News & Research

Peter S. Jensen, M.D., is the founder of The REACH Institute, which trains providers in interventions for children’s mental health care.

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

Sources

¹ Spencer, T., Biederman, J., & Wilens, T. (2004). Nonstimulant treatment of adult attention-deficit/hyperactivity disorder. The Psychiatric clinics of North America, 27(2), 373–383. https://doi.org/10.1016/j.psc.2003.12.001

² Xiong, R. G., Li, J., Cheng, J., Zhou, D. D., Wu, S. X., Huang, S. Y., Saimaiti, A., Yang, Z. J., Gan, R. Y., & Li, H. B. (2023). The Role of Gut Microbiota in Anxiety, Depression, and Other Mental Disorders as Well as the Protective Effects of Dietary Components. Nutrients, 15(14), 3258. https://doi.org/10.3390/nu15143258

³ Chen, Y., Xu, J., & Chen, Y. (2021). Regulation of Neurotransmitters by the Gut Microbiota and Effects on Cognition in Neurological Disorders. Nutrients, 13(6), 2099. https://doi.org/10.3390/nu13062099

⁴ Parker, A., Fonseca, S., & Carding, S. R. (2020). Gut microbes and metabolites as modulators of blood-brain barrier integrity and brain health. Gut microbes, 11(2), 135–157. https://doi.org/10.1080/19490976.2019.1638722

⁵ Madison, A., & Kiecolt-Glaser, J. K. (2019). Stress, depression, diet, and the gut microbiota: human-bacteria interactions at the core of psychoneuroimmunology and nutrition. Current opinion in behavioral sciences, 28, 105–110. https://doi.org/10.1016/j.cobeha.2019.01.011

⁶ Fish-Williamson, A., Hahn-Holbrook, J., Hobbs, M., Wallander, J., & Morton, S. M. B. (2022). Prenatal antibiotic exposure in pregnancy and early childhood socioemotional development. JCPP advances, 2(2), e12066. https://doi.org/10.1002/jcv2.12066

⁷ Cassidy-Bushrow, A. E., Sitarik, A. R., Johnson, C. C., Johnson-Hooper, T. M., Kassem, Z., Levin, A. M., Lynch, S. V., Ownby, D. R., Phillips, J. M., Yong, G. J. M., Wegienka, G., & Straughen, J. K. (2023). Early-life gut microbiota and attention deficit hyperactivity disorder in preadolescents. Pediatric research, 93(7), 2051–2060. https://doi.org/10.1038/s41390-022-02051-6

⁸ Bistas, K. G., & Tabet, J. P. (2023). The Benefits of Prebiotics and Probiotics on Mental Health. Cureus, 15(8), e43217. https://doi.org/10.7759/cureus.43217

⁹Haack, L. M., Villodas, M. T., McBurnett, K., Hinshaw, S., & Pfiffner, L. J. (2016). Parenting Mediates Symptoms and Impairment in Children With ADHD-Inattentive Type. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 45(2), 155–166. https://doi.org/10.1080/15374416.2014.958840

¹⁰ Brinksma, D. M., Hoekstra, P. J., de Bildt, A., Buitelaar, J. K., van den Hoofdakker, B. J., Hartman, C. A., & Dietrich, A. (2023). Parental rejection in early adolescence predicts a persistent ADHD symptom trajectory across adolescence. European child & adolescent psychiatry, 32(1), 139–153. https://doi.org/10.1007/s00787-021-01844-0

¹¹ Agnew-Blais, J. C., Wertz, J., Arseneault, L., Belsky, D. W., Danese, A., Pingault, J. B., Polanczyk, G. V., Sugden, K., Williams, B., & Moffitt, T. E. (2022). Mother’s and children’s ADHD genetic risk, household chaos and children’s ADHD symptoms: A gene-environment correlation study. Journal of child psychology and psychiatry, and allied disciplines, 63(10), 1153–1163. https://doi.org/10.1111/jcpp.13659

¹² Hartman, C. A., Rommelse, N., van der Klugt, C. L., Wanders, R. B. K., & Timmerman, M. E. (2019). Stress Exposure and the Course of ADHD from Childhood to Young Adulthood: Comorbid Severe Emotion Dysregulation or Mood and Anxiety Problems. Journal of clinical medicine, 8(11), 1824. https://doi.org/10.3390/jcm8111824

Onyda XR (clonidine hydrochloride), the first and only liquid non-stimulant ADHD medication approved in the U.S., and the only such medication with nighttime dosing, became available nationwide for the treatment of attention deficit hyperactivity disorder (ADHD) on October 1. ¹

The U.S. Food and Drug Administration (FDA) approved Onyda XR on May 24 as a monotherapy ADHD treatment or as an adjunctive therapy to approved central nervous system (CNS) stimulant medications in pediatric patients six years and older.

Tris Pharma developed Onyda XR with its proprietary LiquiXR® technology, which converts immediate-release drugs into extended-release formulations for once-daily dosing. Onyda XR is considered a centrally acting alpha2-adrenergic agonist medication that belongs to the same class of drugs as Guanfacine (Intuniv) and clonidine (Kapvay).

Patients with ADHD who experience adverse side effects from stimulants or who respond poorly to stimulant medications may find symptom relief in a non-stimulant medication. A systematic review and meta-analysis published in May by Neuroscience & Biobehavioral Reviews reported that non-stimulant medication is nearly as effective as stimulant medication at improving executive function in children, adolescents, and adults with ADHD. ²

Combination Therapy for ADHD

In addition, clinicians may prescribe Onyda XR along with a stimulant to treat ADHD symptoms. Combination therapy is becoming an increasingly popular option for patients who need longer durations of drug coverage than a stimulant dose can provide on its own or who hope to avoid common stimulant side effects.

“Most of the medicines we use for ADHD are safe in combination with other medications,” said Timothy E. Wilens, M.D., chief of child and adolescent psychiatry and co-director of the Center for Addiction Medicine at Massachusetts General Hospital, during the ADDitude webinar “Combination Therapy: Medication Strategies for Hard-to-Treat Complex ADHD.” “Certain combinations, such as stimulants plus clonidine or guanfacine, are FDA approved, and they wouldn’t be unless they were deemed effective and safe.”

Guanfacine ER (Intuniv) and clonidine ER (Kapvay), received FDA approval for the treatment of ADHD in patients 6 to 17 years old as monotherapy and as adjunctive therapy to stimulant medications in 2009 and 2010, respectively.

If a stimulant does not address symptoms at standard dosages, “it usually makes more sense to treat remaining symptoms with a second medication,” said Oren Mason, M.D., a physician at Attention MD in Grand Rapids, Michigan.

“Most adult patients in my practice who take extended-release stimulants need average to high dosages to achieve optimal symptom reduction,” Mason said. “They typically report 8 to 10 hours of medication benefit, and most require short-acting supplements to treat their evening symptoms. In contrast, most patients on combination therapy take low- to moderate stimulant dosages and report a duration of benefits of more than 12 hours.”

Mason said he finds that many adult patients using combination therapy decrease their stimulant dosages and experience fewer side effects than do patients taking only stimulants. “Waking up was less torturous, and getting ready for school was smoother,” he said. “Family life was better, without the meltdowns that many families accept as ‘normal’ as stimulants wear off.”

Anthony Rostain, M.D., M.A., professor of psychiatry and pediatrics at the Perelman School of Medicine at the University of Pennsylvania, recommends that clinicians consider several factors before prescribing combination therapy.

“The important thing to keep in mind if you’re combining agents,” he said, “is to be sure that the patient understands how to use each one and how to dose each one. They need to understand the inherent challenges they’re going to face, and make sure you’re paying attention to the side effects that might emerge from the combination of stimulant and non-stimulant.”

The FDA based its approval for Onyda XR on studies of clonidine hydrochloride extended-release tablets, including two 8-week, placebo-controlled trials evaluating 256 patients, as well as a 40-week, placebo-controlled, randomized-withdrawal study evaluating the drug in 135 pediatric patients aged 6 to 17 years. ³, ⁴

According to Onyda XR prescribing information, the most common adverse reactions with the medication’s use as monotherapy include somnolence, fatigue, irritability, nightmares, insomnia, constipation, and dry mouth. The most common adverse reactions with its use as an adjunct therapy include somnolence, fatigue, decreased appetite, and dizziness. ⁵

Sources

¹Tris Pharma’s Once-Daily ADHD Medication, ONYDA XR (clonidine hydrochloride) Extended-Release Oral Suspension, Now Available in the United States. News Release. Tris Pharma. October 1, 2024. Accessed October 2, 2024. https://www.businesswire.com/news/home/20241001522635/en/Tris-Pharma–Once-Daily-ADHD-Medication-ONYDA-XR-clonidine-hydrochloride-Extended-Release-Oral-Suspension-Now-Available-in-the-United-States

²Isfandnia, F., Masri, S.E., Radua, J., & Rubia, K. (2024) The Effects of Chronic Administration of Stimulant and Non-Stimulant Medications on Executive Functions in ADHD: A Systematic Review and Meta-Analysis. Neuroscience & Biobehavioral Reviews; 162. https://doi.org/10.1016/j.neubiorev.2024.105703

³Jain, R., Segal, S., Kollins, S.H., Khayrallah, M. (2011). Clonidine Extended-Release Tablets for Pediatric Patients with Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry. https://doi.org/10.1016/j.jaac.2010.11.005

⁴Kollins, S.H., Jain, R., Brams, M., Segal, S., Findling, R.L., Wigal, S.B., Khayrallah, M. (2011). Clonidine Extended-Release Tablets as Add-On Therapy to Psychostimulants in Children and Adolescents with ADHD. Pediatrics. https://doi.org/10.1542/peds.2010-1260

⁵ Highlights of Prescribing Information. Onyda XR. FDA. Accessed May 29, 2024. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/217645s000lbl.pdf

Relexxii (generic name: methylphenidate HCI ER) is a once-daily, extended-release, central nervous system (CNS) stimulant indicated for the treatment of attention deficit hyperactivity disorder (ADHD) in adults up to the age of 65 and pediatric patients six years of age and older. The safety and effectiveness of Relexxii for pediatric patients under age six are unknown.

According to the U.S. Food and Drug Administration (FDA), Relexxii is a federally controlled substance. “Schedule II Stimulants” are believed to have a high potential for abuse and misuse, which can lead to the development of a substance use disorder, including addiction.

What Ingredients Are in Relexxii?

Relexxii contains methylphenidate hydrochloride salt, the same active ingredient as ADHD medications, such as Ritalin, Daytrana, Concerta, and Aptensio XR. Relexxii contains the following inactive ingredients: cellulose acetate, colloidal silicon dioxide, ferrosoferric oxide, hypromellose, iron oxide black, lactose monohydrate, magnesium stearate, phosphoric acid, polyethylene glycol, polyethylene oxide, sodium chloride, succinic acid, titanium dioxide, and triacetin.

How Does Relexxii Work?

Relexxii uses osmotic delivery technology, releasing the medication at a controlled rate throughout the day. Relexxii comes in tablet form and has a semipermeable membrane with an immediate-release drug overcoat, an osmotically active bilayer core containing the drug and excipients, and a push layer containing osmotically active components. The immediate-release drug overcoat dissolves within one hour, providing an initial dose of medication. The push layer in the tablet’s core expands and pushes the drug through a laser-drilled orifice at a controlled release rate throughout the day for 6 to 7 hours. The Relexxii tablet releases medication without dissolving its outer shell. The outer shell passes through the digestive tract and out of the body without being digested.

How Do You Use Relexxii?

Relexxii tablets should be taken orally once daily in the morning, with or without food, and must be swallowed whole with a full glass of water or another liquid. Never cut, crush, or chew the tablets because this would destroy the time-release mechanism.

What Is the Typical Dosage for Relexxii?

Relexxii is available in flexible dosing options that support targeted titration and eliminate the need for multiple pills. Daily dosages above 54 mg in pediatric patients 6 to 12 years and above 72 mg in pediatric patients 13 to 17 years have not been studied and are not recommended. Daily dosages above 72 mg are not recommended in adults.

The optimal dosage varies from patient to patient. Your doctor may adjust your daily dosage by small increments until you or your child experiences the greatest improvement in symptoms without side effects.

For updated information about dosages, interactions, and precautions, see the Relexxii drug monograph on WebMD.

Relexxii vs. Concerta

Relexxii and Concerta are both brand names for methylphenidate HCI. Relexxii and Concerta both use osmotic delivery technology, which releases the medication at a controlled rate throughout the day. In a study of 60 healthy volunteers, a once-daily dose of Relexxii 72-mg demonstrated bioequivalence to a twice-daily dose of Concerta (methylphenidate HCI) 36-mg tablets. ¹, ²

On June 23, 2022, the FDA approved Vertical Pharmaceuticals’ Relexxii for ADHD in adults (up to 65 years old) and pediatric patients six years of age and older.

Concerta received FDA approval for treating ADHD on August 1, 2000.

What Side Effects Are Associated with Relexxii?

As with all ADHD medications, follow your Relexxii prescription instructions exactly. Taking Relexxii late in the day can disrupt sleep.
The most common side effects of Relexxii reported by adults include:

• decreased appetite
• headache
• dry mouth
• nausea
• insomnia
• anxiety
• dizziness
• weight loss
• irritability
• increased sweating

Less common side effects of Relexxii include:

• priapism (an erection that does not subside)
• circulation problems in fingers and toes, including Raynaud’s Phenomenon
• eyesight changes or blurred visions

The most common side effect reported in pediatric patients taking Relexxii was upper abdominal pain. There has been some concern that stimulants may cause a slowing of growth in children and adolescents. However, research findings revealed mixed results. Some studies show no impact on growth at all ³, while others find what is considered a “negligible” slowing of growth. ⁴ Talk to your doctor if you find evidence of suppressed growth or weight in your child.

If side effects are bothersome or do not disappear, talk to your doctor. Most people taking this medication do not experience any of these side effects. See the full list of possible Relexxii side effects here.

What Precautions Are Associated with Relexxii?

Patients with known structural cardiac abnormalities, cardiomyopathy, severe heart rhythm abnormalities, coronary artery disease, and other serious heart problems should avoid using Relexxii. Patients should monitor their heart rate and blood pressure regularly while taking Relexxii, as increases may occur. Patients with a personal or family history of high blood pressure, heart problems, or heart defects should share this with their HCP.

Relexxii may exacerbate symptoms of behavior disturbance and thought disorder in patients with a preexisting psychotic disorder or induce a manic or mixed episode in patients with bipolar disorder. Before initiating treatment, screen patients for risk factors for developing a manic episode (e.g., comorbid or history of depression, a family history of suicide, and bipolar disorder). If new psychotic or manic symptoms occur, consider discontinuing Relexxii.

Before initiating Relexxii, healthcare providers should assess the family history and clinically evaluate patients for tics or Tourette’s syndrome. They should also regularly monitor patients for the emergence or worsening of tics or Tourette’s syndrome and discontinue treatment if clinically appropriate.

Because the Relexxii tablet is nondeformable and does not appreciably change in shape in the GI tract, Relexxii should not be administered to patients with preexisting severe gastrointestinal narrowing (e.g., esophageal motility disorders, small bowel inflammatory disease, “short gut” syndrome due to adhesions or decreased transit time, peritonitis, cystic fibrosis, chronic intestinal pseudo-obstruction, or Meckel’s diverticulum).

An ophthalmologist should evaluate any Relexxii-treated patients at risk for acute angle closure glaucoma (e.g., patients with significant hyperopia).

The effects of Relexxii on an unborn child are not yet clear. Tell your doctor if you plan to become pregnant, are pregnant, or are breastfeeding before taking Relexxii. Women exposed to Relexxii during pregnancy or breastfeeding may participate in the National Pregnancy Registry for Psychiatric Medications to improve existing safety information.

What Interactions Are Associated with Relexxii

You should not take Relexxii if you have any of the following conditions:

• allergy or hypersensitivity to methylphenidate HCI or any of the ingredients in methylphenidate medications
• anxiety/agitation
• glaucoma
• tics or history of Tourette’s syndrome
• circulation problems
• esophagus, stomach, or intestine problems
• if you are taking monoamine oxidase inhibitors (MAOIs) or within 14 days after discontinuing MAOI treatment
• if you are taking risperidone.

Share a list of all vitamin or herbal supplements and prescription and non-prescription medications you take with the pharmacist when you fill your prescription. Inform all doctors and physicians that you are taking Relexxii before surgery or laboratory tests. Relexxii can have a dangerous interaction with certain anesthetics.

For a complete list of all possible drug interactions, refer to Relexxii’s drug label information for consumers and healthcare professionals.

Sources

¹ Relexxii (methylphenidate hydrochloride extended-release tablets) package insert. Vertical Pharmaceuticals, LLC; 2023.
²Data on file, Osmotica Pharmaceuticals US LLC.
³Harstad, E., Weaver, A., Katusic, S., Colligan, R.C., Kumar, S., Chan, E., Voigt, R., Barbaresi, W. (2014.) ADHD, Stimulant Treatment, and Growth: A Longitudinal Study. Pediatrics. https://doi.org/10.1542/peds.2014-0428
⁴Greenhill, L., Swanson, J., Hechtman, L., Waxmonsky, J., Arnold, L., Molina, B., Hinshaw, S., Jensen, P., Abikoff, H., Wigal, T., Stehli, A., Howard, A., Hermanussen, M., Hanć, T. (2020). Trajectories of Growth Associated With Long-Term Stimulant Medication in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child & Adolescent Psychiatry. v. 59, Issue 8. 978-989. https://www.jaacap.org/article/S0890-8567(19)31443-1/fulltext/