The first morning my husband took his ADHD medication, he texted me from the office at 10.40am. It said: "Is this what it is like for everyone? I have done my emails. All of them. It is quiet in here." He was thirty nine. He had been told for three decades that he was clever but lazy, and he had believed it.
Our son Theo had been diagnosed eight months earlier, and watching the two of them go through treatment at the same time, one at ten and one at nearly forty, taught me more about what works than any leaflet. This article lays out the treatments for ADHD in children and adults, what the trials say about each, what the side effects actually feel like, and the honest answer to the question everyone asks quietly: can ADHD be cured?
Can ADHD be cured?
No, and it is worth sitting with that for a second rather than skipping past it. ADHD is a difference in how the brain's attention and reward systems develop and run, not an infection or a habit. There is no treatment that changes that wiring permanently. What there is, and it matters enormously, is treatment that lets the brain work well most of the day, plus skills and structures that hold when the treatment wears off.
Some children do see symptoms fade with age. Long term follow up suggests around a third reach adulthood without impairing symptoms, a third improve but still meet criteria, and a third continue much as before (Faraone et al., Psychological Medicine 2006). Nothing yet predicts reliably which group a given child is in, and treatment does not seem to change the group. It changes what happens to that child while they are in it.
ADHD treatments compared
The best single piece of evidence is a network meta analysis of 133 randomised trials in the Lancet Psychiatry that compared every licensed ADHD medicine head to head (Cortese et al., Lancet Psychiatry 2018). I have put its findings on one chart alongside the non drug treatments.
| Treatment | Best for | Onset | Main downsides |
|---|---|---|---|
| Methylphenidate (Ritalin, Concerta, Medikinet, Equasym) | First choice for children in the UK; also adults | 30 to 60 minutes | Appetite loss, sleep delay, headaches, slight rise in heart rate |
| Lisdexamfetamine (Elvanse, Vyvanse) and other amphetamines | First choice for adults in the UK; second line for children | 1 to 2 hours, lasts 12 to 13 | Same as above, sometimes more irritability as it wears off |
| Atomoxetine (Strattera) | When stimulants are unsuitable, tics, anxiety, misuse risk | 4 to 6 weeks | Nausea, tiredness, rare liver effects; less effective |
| Guanfacine (Intuniv) | Children, especially with tics or sleep problems | 2 to 4 weeks | Drowsiness, low blood pressure |
| Parent training | All children under 5; alongside medication for older children | 8 to 12 weekly sessions | Time, and needing both parents to buy in |
| CBT for ADHD | Adults, ideally once medication is stable | 12 to 16 sessions | Cost and availability |
| ADHD coaching | Adults and teens, practical systems | Ongoing | Unregulated; weak trial evidence |
ADHD medication: what it does and what it feels like
Stimulants raise dopamine and noradrenaline in the parts of the brain that manage attention and impulse control. The name puts people off. At the doses used for ADHD, in people who have ADHD, the effect is calming and focusing, not speeding up. Theo described it as "the noise in the classroom is still there but it is not inside my head any more."
The dose finding phase
Nobody gets it right first time. Clinicians start low and step up every one to two weeks while tracking symptoms, appetite, sleep and mood. Theo went through three doses and two formulations over four months before we found one that got him through the school day without wrecking his tea. My husband needed a small immediate release top up at 4pm because his long acting dose wore off exactly when he was driving home, and a tired, unmedicated ADHD brain on a motorway is not something to shrug at.
Side effects, honestly
- Appetite. The most common and the most manageable. A big breakfast before the dose, a proper meal when it wears off. Our ADHD diet article has the breakfasts that work.
- Sleep. Usually a timing issue. Earlier dose, shorter formulation, or in some children a small dose of melatonin (prescribed in the UK, over the counter in the US).
- Growth. Children on stimulants for years end up on average around 1 to 2 cm shorter than predicted (Swanson et al., JCPP 2017). Height and weight are plotted at every review for this reason.
- Heart. Small rises in heart rate and blood pressure are normal. Serious cardiac events are not increased in large cohorts (Cooper et al., NEJM 2011), but a family history of early sudden cardiac death should be discussed before starting.
- Mood. Some people get flat or irritable, especially as the dose wears off. That usually means the dose or the drug is wrong, not that medication is wrong for them.
Does medication change lives or just test scores?
This is the part that convinced me. Swedish researchers followed tens of thousands of people with ADHD and compared each person's own risk during periods on and off medication, which cancels out most of the confounding.
Road traffic accidents fell by 38 percent in men and 42 percent in women (Chang et al., JAMA Psychiatry 2014). Criminal convictions fell by 32 percent (Lichtenstein et al., NEJM 2012). Substance use disorders, depression and suicidal behaviour all fell too. The old fear that stimulants lead to addiction runs the wrong way in the data.
Therapy and skills: what actually helps
For children
Parent training programmes are the first line treatment under five and a strong addition at any age. They do not change core ADHD symptoms much when rated by blinded observers, but they cut family conflict, improve behaviour and help parents feel less like they are failing (Daley et al., JAACAP 2014). School based support, a daily report card between teacher and home, and organisational skills training for older children all have trial support.
For adults
CBT designed for ADHD, which focuses on planning systems, breaking tasks down, and challenging the "I am useless" thoughts, has a medium effect size on top of medication (Knouse et al., Journal of Consulting and Clinical Psychology 2017). My husband's therapist spent two sessions just on how he handles post. He now opens it standing at the recycling bin. It sounds trivial. Unpaid bills were the reason we nearly lost the house in 2019.
Lifestyle treatments: real but modest
Exercise, sleep and diet all have measurable effects on ADHD symptoms, roughly in that order of strength. None replaces medication for moderate to severe ADHD. All of them make medication work better and cover the hours when it has worn off. Sleep in particular: around 70 percent of children with ADHD have a sleep problem, and a brief sleep programme in a randomised trial improved ADHD symptoms, memory and quality of life for months (Hiscock et al., BMJ 2015).
Weight is the one that catches people out. Adults with untreated ADHD are 55 percent more likely to have obesity, and the excess disappears in adults on treatment (Cortese et al., American Journal of Psychiatry 2016). If ADHD has been shaping your eating for years, the BMI calculator is a quick, private place to see where you stand, and the diet and exercise plan is built for ADHD brains rather than against them.
Choosing treatment: children, teenagers and adults
The guidelines differ by age, and so do the practical problems.
Under five
Medication is rarely used and NICE recommends against it as a first step. A structured parent training programme comes first, along with nursery support and a hard look at sleep. Many children this age who look like they have ADHD turn out to have a sleep disorder, a language delay or simply to be the youngest in the class. Relative age matters: children born in the last month of the school year are diagnosed with ADHD around 30 percent more often than those born in the first month, which says something about how we assess as well as about the children (Layton et al., NEJM 2018).
Five to seventeen
Medication is offered if symptoms are still causing significant impairment after environmental changes have been tried. Methylphenidate is first line in the UK; in the US either methylphenidate or an amphetamine is used first. A long acting formulation once a day is usually preferred over immediate release several times a day, for the child's dignity as much as convenience. Nobody wants to queue at the school office at lunchtime. Teenagers need a specific conversation about driving, alcohol, and the temptation to sell or share tablets. They also need to be in charge of their own treatment by sixteen or they will quietly stop it at university.
Adults
Lisdexamfetamine or methylphenidate first, with atomoxetine as an alternative. Adults are often diagnosed after their own child is, which was exactly our story. They usually arrive with years of accumulated anxiety, low mood and coping habits, some of which are excellent and some of which are alcohol. Treatment that ignores those tends to fail. The best adult clinics treat the ADHD first, then reassess the anxiety and depression, because a good proportion of it lifts once the ADHD is under control.
What to expect and what to ask
A good first prescribing appointment covers blood pressure, heart rate, height and weight, a cardiac history, any tics, sleep, appetite, mood and substance use. Then a starting dose with a plan to review in two to four weeks. Questions worth asking:
- What time of day do we most need this to work, and does the formulation match that?
- What should we do if appetite or sleep suffers, and who do we call?
- When will we review the dose, and how will we measure whether it is working? A rating scale filled in by school or a partner is more honest than memory.
- What is the plan for holidays and weekends?
- What support is available besides tablets: parent training, CBT, school plan, workplace adjustments?
Keep a simple diary for the first two months: dose time, breakfast, sleep time, and a one line note from school or work. Ours showed within three weeks that Theo's first formulation was wearing off at 2pm, which was exactly when the phone calls from school were coming. That single observation changed the prescription and the phone calls stopped.
Treatments without good evidence
- Neurofeedback. Looks promising in unblinded trials, close to zero when raters are blinded (Cortese et al., JAACAP 2016).
- Cognitive training apps. Improve the trained task, do not transfer to real life.
- Omega 3 alone. Effect size around 0.16. Cheap and safe, but not a treatment (Bloch and Qawasmi, JAACAP 2011).
- Restriction diets for everyone. Small effects under blinded conditions. Covered in the diet article.
- CBD, nootropics, microdosing. No controlled trials of meaningful size.
Do you take ADHD medication for life?
Not necessarily. NICE recommends a review at least once a year, including a discussion of whether to try a break. Many families use school holidays to check whether the medicine is still needed. Some adults stop when their life has enough structure to hold without it. Others, like my husband, decide that the version of themselves on medication is the one they want to keep being, and there is no shame in that either.
Theo asked me last year whether he would have to take tablets forever. I told him the truth: I do not know, and it is his decision when he is older. What I do know is that in the meantime he has stopped describing himself as the naughty one. That is the outcome I was treating.
Read next
- ADHD Causes, Symptoms and Whether It Can Be Prevented
- ADHD Diet and Exercise Plan: Foods That Help Focus
- BMI Calculator
- Obesity Treatment: Can It Be Cured? Drugs, Diet, Surgery
Frequently asked questions
What is the most effective treatment for ADHD?
Stimulant medication, methylphenidate or amphetamines, has the largest effect on core symptoms in head to head trials. Combining it with parent training or CBT and good sleep gives the best overall outcomes.
Can ADHD be treated without medication?
Yes, particularly mild ADHD and children under five, using parent training, school support, sleep, exercise and structure. For moderate to severe ADHD, non drug treatments alone usually leave significant impairment.
Are ADHD medications addictive?
At prescribed doses in people with ADHD, no. Large studies show lower rates of substance use disorder during treated periods. Misuse risk is mainly from diversion of immediate release tablets to people without ADHD.
How long does it take for ADHD medication to work?
Stimulants work within an hour of the first effective dose. Finding that dose takes weeks. Atomoxetine and guanfacine take four to six weeks to show their full effect.
Does ADHD go away with age?
Around a third of children reach adulthood without impairing symptoms. The rest improve but still meet criteria, or continue much as before. Hyperactivity fades most; inattention persists most.
This article is for information only. Medication decisions should always be made with a qualified prescriber who knows your history.
