ADHD Medications

ADHD medicines are prescription medicines used where attention deficit hyperactivity disorder is causing real difficulty in daily life. They fall into two broad groups, stimulant and non-stimulant. This page explains what the guidelines ask of prescribers, so you can bring better questions to whoever prescribes for you or for your child.

What these medicines are, and what this page is for

Starting any of these medicines is a specialist decision. The guideline for England and Wales asks that ADHD medication be started only by a professional with training and expertise in diagnosing and managing ADHD.¹

Medication is one part of a plan, not the whole of it

The guideline asks for a comprehensive, holistic shared treatment plan. That plan should address psychological, behavioural and occupational or educational needs.²

Before any treatment starts, the benefits and harms of non-pharmacological and pharmacological treatments should be discussed with you.² So should the benefits of a healthy lifestyle, including exercise.

Your preferences and concerns are then recorded in the treatment plan.²

People should be reassured that they can revisit decisions about treatments.² A choice made this year is not binding forever.

What should happen before medication is considered

Medication is not the automatic first move, and the threshold differs by age. For a child under five, an ADHD-focused group parent-training programme comes first.³ It is named as the first-line treatment for that age group.

Medication for a child under five is treated as a step needing extra care. It should not be offered without a second specialist opinion from a service with expertise in young children.³

For a child of five or over, medication is offered only where symptoms are still causing a persistent significant impairment in at least one domain.³ That is after environmental modifications have been implemented and reviewed.

The same threshold applies to adults. Medication is offered where symptoms are still causing a significant impairment after environmental modifications have been implemented and reviewed.⁴

Environmental modifications are changes made to the physical environment to reduce the impact of a person's ADHD on daily life.⁵

If none of that was tried before medication was raised, that is a fair thing to ask about.

The groups of medicine, and how they are thought to work

The stimulant group divides into methylphenidate-based and amphetamine-based medicines.⁶

Methylphenidate blocks the reuptake of the neurotransmitters noradrenaline and dopamine. Noradrenaline is also called norepinephrine. Blocking that reuptake increases the concentration of dopamine and noradrenaline in the synaptic cleft,⁷ the small gap between nerve cells where signals pass.

Atomoxetine is different again. It is a selective noradrenaline reuptake inhibitor, and it also inhibits dopamine reuptake in specific brain regions such as the prefrontal cortex.⁸

Within the non-stimulants there is a second kind, the alpha agonists, which include clonidine and guanfacine.⁶

What the sources describe is action at receptors and transporters, which is not the same as correcting a brain.

What the guideline asks prescribers to try, and in what order

Guidelines differ between countries. What follows is what NICE asks of prescribers in England and Wales, so your country may order things differently.

For children aged five and over and young people, methylphenidate is offered as the first line pharmacological treatment. For adults, the first-line choice is lisdexamfetamine or methylphenidate.⁹

The non-stimulants come after the stimulants, not alongside them. Atomoxetine or guanfacine is offered to children and young people who cannot tolerate methylphenidate or lisdexamfetamine,⁹ or whose symptoms have not responded to them. For adults in the same position, atomoxetine is the option named.

If symptoms are unresponsive to one or more stimulants and one non-stimulant, the guideline asks for a second opinion or referral to a tertiary service.⁹

That sequence describes ordinary practice rather than a set of options for you to choose between, and which medicine suits a particular person is a prescribing decision.

The checks that come before a first prescription

A first prescription should follow a full assessment.

It starts with a review to confirm the person continues to meet the criteria for ADHD and needs treatment. Then mental health and social circumstances, including a risk assessment for substance misuse and drug diversion. The physical side covers a medical history, current medication, height and weight, pulse and blood pressure, and a cardiovascular assessment.¹

An electrocardiogram is not needed before starting stimulants, atomoxetine or guanfacine, unless particular cardiac features are present or another condition is being treated with a medicine that may pose an increased cardiac risk.¹

Those features include a history of congenital heart disease or previous cardiac surgery. They also include fainting on exertion or in response to fright, chest pain suggesting cardiac origin, and a murmur heard on cardiac examination. If any of those apply, the guideline asks for a cardiology opinion before medication for ADHD is started.¹

Side effects, named plainly

These medicines have real side effects. For methylphenidate, insomnia and nervousness are the most commonly reported adverse effects.¹⁰ Others group into recognisable families.

Growth retardation, meaning reduced height and weight, is observed when methylphenidate is prescribed to children long-term.¹⁰

There is a cardiac risk too, and it is the reason the baseline heart checks exist. Sudden death has been reported in children and adults with a pre-existing structural cardiac abnormality.¹⁰

Because of that, the advice is to avoid methylphenidate where there is a structural cardiac abnormality, cardiomyopathy or arrhythmia.¹⁰ This is one reason the medical history is taken first.

Someone taking a monoamine oxidase inhibitor should not be given methylphenidate,¹⁰ so your prescriber needs to know everything else you take.

In the United States, atomoxetine's labelling carries a boxed warning for suicidal ideation in children and adolescents.¹¹

Children and adolescents starting atomoxetine need close monitoring for suicidal ideation and unusual changes in behaviour.¹¹ That is a reason to stay in contact with the prescriber early on, not a reason to panic.

NICE also asks that young people and adults be monitored for sexual dysfunction as a potential adverse effect of atomoxetine.¹² It is an awkward thing to bring up, and it is a legitimate thing to raise.

Clonidine and guanfacine are associated with cardiovascular effects such as lowering blood pressure, with sedation, weight gain and dizziness.⁶

What good monitoring looks like

Being on one of these medicines should come with ongoing monitoring.

Effectiveness and adverse effects are monitored and documented in the person's notes. Review and follow-up should happen according to the severity of the condition. That holds regardless of whether or not the person is taking medication.¹³

Height is measured every 6 months in children and young people, and height and weight are plotted on a growth chart.¹³

For children and young people the interval varies with age, and for adults weight is measured every 6 months.¹³

Heart rate and blood pressure are monitored and compared with the normal range for age every 6 months.¹³

Routine blood tests, including liver function tests, and routine electrocardiograms are not offered to people taking ADHD medication unless there is a clinical indication.¹³

Where a child or young person's height over time is significantly affected by medication, a planned break in treatment over school holidays may be considered to allow catch-up growth.¹³

That is a clinical decision, and it belongs to the prescriber, made because growth has actually been affected. It is not a routine summer habit, and not something to start on your own.

Misuse, diversion and dependence

Stimulants are controlled drugs, and prescribers are expected to know the controlled drug legislation that governs how stimulants are prescribed and supplied. Prescribers are asked to be cautious about prescribing stimulants where there is a risk of diversion for cognitive enhancement or appetite suppression.¹⁴

Where that risk is present, they are asked not to offer preparations that are easier to misuse.¹⁴ This is a prescribing judgement, made case by case.

Professionals, parents and carers are all asked to watch for changes in the potential for misuse and diversion.¹⁵ That risk can shift as circumstances shift, and as a child grows up.

The amounts prescribed for ADHD are described as not enough to activate the reward system in the central nervous system.⁷

Much higher amounts are a different matter, and that is where the mechanism of addiction applies.⁷ The distinction is between a prescribed medicine and a misused one.

Because stimulants are controlled substances, prescribers are often hesitant to use them.⁶

The caution is reasonable, and so is the difficulty it creates for people who would benefit.

What the evidence does not support

Some widely repeated claims are not supported.

The guideline asks prescribers to tell people that medication does not change personality.¹⁵

For children and young people, the guideline advises against cutting out artificial colouring and additives as a generally applicable treatment. Fatty acid supplementation is addressed directly too. It should not be advised or offered for treating ADHD in children and young people.¹⁶

Restrictive diets are not dismissed outright, and the few food diet limits eating to a small range of foods. Families should be told that its long-term effectiveness and potential harms are unevidenced, with only limited evidence of short-term benefits.¹⁶

None of that is an argument against eating well. Healthcare professionals are asked to stress the value of a balanced diet, good nutrition and regular exercise.¹⁶ The distinction is between general good health and a claimed treatment for ADHD.

Review, and thinking about stopping

Being on an ADHD medicine is not a one-off decision, and it is also not a decision to unmake on your own.

Medication should be reviewed at least once a year by a professional with training and expertise in managing ADHD.¹⁷ The review covers your preference, the benefits, adverse effects, and the impact on education and employment.

You are meant to be part of that. The guideline asks that people be encouraged to raise a wish to stop or change a medicine, and to share in any decision about stopping.¹⁷

Trial periods of stopping medication may be considered where the overall balance of benefits and harms suggests it is appropriate.¹⁷

Stopping, switching or changing an ADHD medicine is a conversation with your prescriber, not a decision to take alone. If side effects are the reason you want to stop, say that directly; it is a clinical problem with possible answers.

One practical point is easily missed. The symptoms of ADHD themselves may make it hard to stick to a treatment plan, including remembering to order and collect medication.¹⁵ That is worth saying out loud in the appointment, and it is a feature of the condition, not a character flaw.

Availability is not the same everywhere

Whether you can get a particular ADHD medicine depends on where you live. That is a fact about health systems and law, not about you.

Stimulants are controlled internationally, by treaty. The 1971 Convention on Psychotropic Substances was adopted to limit the diversion and abuse of certain substances, among them central nervous stimulants.¹⁸

That Convention has a dual aim. It limits the use of psychotropic substances to medical and scientific purposes, and it works to ensure their availability for those purposes.¹⁸

Methylphenidate is listed among the substances in Schedule II of the Convention.¹⁹

The Green List records prohibitions and restrictions on export and import made under article 13 of the Convention.²⁰

Methylphenidate appears there, against a list of notifying countries. Belize, Nigeria, Senegal, Togo, Türkiye and Yemen are the ones recorded.²¹

So a medicine that is first-line in one country may be legally barred from crossing the border into another.

None of that is a reason to seek a medicine outside the system that governs it. Where your options look narrower than what you read online, international control is one reason among several, alongside cost and local supply.

Where therapy and other support fit

For every child of five or over and every young person with ADHD, information about ADHD and additional support for parents and carers should be offered. That support can be group based and as few as 1 or 2 sessions.³ It covers education and information on the causes and impact of ADHD, and advice on parenting strategies. With consent, it includes liaison with school, college or university.

Where a child or young person also has symptoms of oppositional defiant disorder or conduct disorder, a parent-training programme should be offered alongside that ADHD-focused support. For young people who have benefited from medication but whose symptoms still cause significant impairment, a course of cognitive behavioural therapy may be considered.³ It addresses social skills with peers, problem-solving, self-control, active listening and dealing with feelings.

The guideline names three situations for adults. Non-pharmacological treatment should be considered for adults who have made an informed choice not to have medication, who have difficulty adhering to it, or who have found it ineffective or cannot tolerate it.⁴

Choosing not to take medication is treated as a legitimate informed choice with its own pathway, not as non-compliance.

Non-pharmacological treatment alongside medication should be considered for adults who have benefited from medication but whose symptoms still cause significant impairment.⁴

Where non-pharmacological treatment is indicated for adults, the minimum offer is named. It is a structured supportive psychological intervention focused on ADHD, with regular follow-up in person or by phone.⁴

Our guide on how to find the right therapist covers choosing someone alongside medical care. For the wider medicine picture, see our page on psychiatric medications.

Questions worth taking to your prescriber

These are prompts, not demands.

• What is this medicine meant to help with, and how will we know if it is working?
• What was tried before medication, and should anything else be in place alongside it?
• Which side effects should I watch for, and which would you want to hear about quickly?
• What baseline checks will you do before I start, and is a heart check needed in my case?
• How will growth, weight and blood pressure be monitored, and how often?
• When will we review this, and what happens if it is not helping?
• If I ever want to try without it, how would we go about that safely?
• What support is available for me or my family alongside the medicine?

If a prescriber cannot answer these, that is useful information too.

This article is for general information and is not a substitute for professional assessment or care. If this is affecting your life, consider reaching out to a qualified mental health professional.

References

1. [1] National Institute for Health and Care Excellence (NICE). NG87 Attention deficit hyperactivity disorder: diagnosis and management, recommendations 1.7.2 to 1.7.6, baseline assessment and cardiology referral (England and Wales). nice.org.uk.
2. [2] National Institute for Health and Care Excellence (NICE). NG87 Attention deficit hyperactivity disorder: diagnosis and management, recommendations 1.5.2 to 1.5.6, planning treatment (England and Wales). nice.org.uk.
3. [3] National Institute for Health and Care Excellence (NICE). NG87 Attention deficit hyperactivity disorder: diagnosis and management, recommendations 1.5.7 to 1.5.14, children under 5 and children aged 5 and over (England and Wales). nice.org.uk.
4. [4] National Institute for Health and Care Excellence (NICE). NG87 Attention deficit hyperactivity disorder: diagnosis and management, recommendations 1.5.15 to 1.5.18, adults (England and Wales). nice.org.uk.
5. [5] National Institute for Health and Care Excellence (NICE). NG87 Attention deficit hyperactivity disorder: diagnosis and management, Terms used in this guideline: environmental modifications (England and Wales). nice.org.uk.
6. [6] Magnus W, Anilkumar AC, Shaban K. Attention Deficit Hyperactivity Disorder. StatPearls Publishing. Treatment / Management. ncbi.nlm.nih.gov/books/NBK441838.
7. [7] Verghese C, Patel P, Abdijadid S. Methylphenidate. StatPearls Publishing. Mechanism of Action, including dependence. ncbi.nlm.nih.gov/books/NBK482451.
8. [8] Fedder D, Patel H, Saadabadi A. Atomoxetine. StatPearls Publishing. Mechanism of Action. ncbi.nlm.nih.gov/books/NBK493234.
9. [9] National Institute for Health and Care Excellence (NICE). NG87 Attention deficit hyperactivity disorder: diagnosis and management, recommendations 1.7.7 to 1.7.16, medication choice (England and Wales). nice.org.uk.
10. [10] Verghese C, Patel P, Abdijadid S. Methylphenidate. StatPearls Publishing. Adverse Effects and drug-drug interactions. ncbi.nlm.nih.gov/books/NBK482451.
11. [11] Fedder D, Patel H, Saadabadi A. Atomoxetine. StatPearls Publishing. Adverse Effects, including the United States boxed warning for suicidal ideation. ncbi.nlm.nih.gov/books/NBK493234.
12. [12] National Institute for Health and Care Excellence (NICE). NG87 Attention deficit hyperactivity disorder: diagnosis and management, recommendations 1.8.13 to 1.8.15, tics and sexual dysfunction (England and Wales). nice.org.uk.
13. [13] National Institute for Health and Care Excellence (NICE). NG87 Attention deficit hyperactivity disorder: diagnosis and management, recommendations 1.8.1 to 1.8.12, maintenance and monitoring: height and weight, and cardiovascular monitoring (England and Wales). nice.org.uk.
14. [14] National Institute for Health and Care Excellence (NICE). NG87 Attention deficit hyperactivity disorder: diagnosis and management, recommendations 1.7.20 to 1.7.25, considerations when prescribing (England and Wales). nice.org.uk.
15. [15] National Institute for Health and Care Excellence (NICE). NG87 Attention deficit hyperactivity disorder: diagnosis and management, recommendations 1.8.19 to 1.9.5, stimulant diversion and adherence to treatment (England and Wales). nice.org.uk.
16. [16] National Institute for Health and Care Excellence (NICE). NG87 Attention deficit hyperactivity disorder: diagnosis and management, recommendations 1.6.1 to 1.6.5, dietary advice (England and Wales). nice.org.uk.
17. [17] National Institute for Health and Care Excellence (NICE). NG87 Attention deficit hyperactivity disorder: diagnosis and management, recommendations 1.10.1 to 1.10.3, review of medication and discontinuation (England and Wales). nice.org.uk.
18. [18] International Narcotics Control Board (INCB). Psychotropic Substances: the 1971 Convention on Psychotropic Substances and its dual aim. incb.org/incb/en/psychotropics/index.html.
19. [19] International Narcotics Control Board (INCB). Green List: List of Psychotropic Substances under International Control, 2026 edition, Part one, Substances in Schedule II (methylphenidate, IDS code PM 007). incb.org.
20. [20] International Narcotics Control Board (INCB). Green List: List of Psychotropic Substances under International Control, 2026 edition, structure of Parts one to three. incb.org.
21. [21] International Narcotics Control Board (INCB). Green List: List of Psychotropic Substances under International Control, 2026 edition, Part three, prohibition of export and import pursuant to article 13, by prohibited substance. incb.org.