Management of attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder management options are evidence-based practices with established treatment efficacy for ADHD. Approaches that have been evaluated in the management of ADHD symptoms include FDA-approved pharmacologic treatment and other pharmaceutical agents, psychological or behavioral approaches, combined pharmacological and behavioral approaches, cognitive training, neurofeedback, neurostimulation, physical exercise, nutrition and supplements, integrative medicine, parent support, and school interventions.^[1] Based on two 2024 systematic reviews of the literature, FDA-approved medications and to a lesser extent psychosocial interventions have been shown to improve core ADHD symptoms compared to control groups (e.g., placebo).^[1][2]

The American Academy of Pediatrics (AAP) recommends different treatment paradigms depending on the age of the person being treated. For those aged 4–5, the AAP recommends evidence-based parent- and/or teacher-administered behavioral interventions as first-line treatment, with the addition of methylphenidate if there is continuing moderate-to-severe functional disturbances. For those aged 6–11, the use of medication in combination with behavioral therapy is recommended, with the evidence for stimulant medications being stronger than that for other classes. For adolescents aged 12–17, use of medication along with psychosocial interventions are recommended.^[3] Clinical picture of ADHD can be corrected if rehabilitation interventions are started from the early preschool age, when the compensatory capabilities of the brain are great and a persistent pathological stereotype has not yet formed. If symptoms persist at a later age, as the child grows, defects in the development of higher brain functions and behavioral problems worsen, which subsequently lead to difficulties in schooling.^{[citation needed]}

There are a number of stimulant and non-stimulant medications indicated for the treatment of ADHD. The most commonly used stimulant medications include methylphenidate (Ritalin, Concerta), dexmethylphenidate (Focalin, Focalin XR), Serdexmethylphenidate/dexmethylphenidate (Azstarys), mixed amphetamine salts (Adderall, Mydayis), dextroamphetamine (Dexedrine, ProCentra), dextromethamphetamine (Desoxyn), and lisdexamfetamine (Vyvanse). Non-stimulant medications with a specific indication for ADHD include atomoxetine (Strattera), viloxazine (Qelbree), guanfacine (Intuniv), and clonidine (Kapvay). Other medicines which may be prescribed off-label include bupropion (Wellbutrin), tricyclic antidepressants, SNRIs, or MAOIs.^[4][5][6] The presence of comorbid (co-occurring) disorders can make finding the right treatment and diagnosis much more complicated, costly, and time-consuming. So it is recommended to assess and simultaneously treat any comorbid disorders.^[7]

A variety of psychotherapeutic and behavior modification approaches to managing ADHD including psychotherapy and working memory training may be used. Improving the surrounding home and school environment with parent management training and classroom management can improve behavior and school performance of children with ADHD.^[8][9] Specialized ADHD coaches provide services and strategies to improve functioning, like time management or organizational suggestions.^[10] Self-control training programs have been shown to have limited effectiveness.^{[citation needed]}