Anne Buchanan, DO. Child and adolescent psychiatrist; Medical Director, Caring Transitions Program, NYC Health + Hospitals, New York, NY.
Dr. Buchanan has no financial relationships with companies related to this material.
Michael, 10, struggles with inattention and impulsivity. Teachers describe him as bright but distractible. He loses assignments and interrupts class discussions. In the face of declining grades and increasing frustration, Michael’s parents ask about medication options, even though they are worried about side effects.
Where is ADHD care today? In this era of increased concerns about psychotropic medications for children and teens, we need to be clear on the basics of ADHD care, know where new treatments fit in, and address common co-occurring conditions.
ADHD affects about 8% of children globally, with psychostimulants remaining the gold standard treatment (Ayano G et al, J Affect Disord 2023;339:860–866). However, the landscape has expanded significantly with novel formulations, nonstimulant medications, and digital therapeutics offering more options for personalizing care.
Newer ADHD treatments
Novel stimulant formulations
Several innovative medications address the clinical challenges we see in patients daily, albeit with the usual side effects.
Serdexmethylphenidate/dexmethylphenidate (Azstarys)
Dextroamphetamine patch (Xelstrym)
Delayed-release methylphenidate (Jornay PM)
Extended-release methylphenidate (Relexxii)
Nonstimulant innovations
Viloxazine ER (Qelbree)
Clonidine (Onyda XR)
Digital therapeutics
EndeavorRx
ADHD + co-occurring conditions
ADHD frequently travels with other psychiatric conditions, complicating our treatment decisions. The key is understanding symptom chronology—distinguishing primary disorders from secondary ones and identifying which symptoms cause the greatest functional impairment. Don’t hesitate to consult colleagues when presentations become complex.
Remember that stimulant medications remain our cornerstone treatment even with comorbidities, but optimal care combines pharmacologic treatment with psychosocial interventions.
ADHD + anxiety
This combination requires careful assessment of symptom relationships, as apparent anxiety may represent untreated ADHD symptoms.
Treatment approach:
Important considerations:
ADHD + depression
Treatment approach:
Important considerations:
ADHD + autism
Important considerations:
ADHD + bipolar disorder (BD)
Treatment approach:
Important considerations:
ADHD + psychosis
Treatment approach:
Important considerations:
Michael’s anxiety appears mild and mostly school-related compared to his prominent ADHD symptoms. You discuss the range of options and recommend stimulant medication while monitoring his anxiety. Michael and his parents decide to start with an alpha agonist, which provides a reasonable alternative approach.
Carlat Verdict
We can usually achieve good outcomes with first-line stimulant approaches, but expanding medication options provide valuable alternatives when standard treatments aren’t suitable. The key is matching the treatment to the child while keeping functional improvement as the primary goal. Keep up to date on what’s out there by checking: www.adhdmedicationguide.com.
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