Treatment Options for ADHD 

If your assessment indicates an ADHD or ADD diagnosis, we will work with you to explore all available treatment options, including both non-pharmacological and pharmacological approaches.

For those for whom medication is clinically indicated, Aspire ADHD provides comprehensive medication management for individuals diagnosed with ADHD. Our goal is to ensure that any prescribed medications are effective, safe, and aligned with your personal treatment goals. 

While medication can be a powerful tool in managing ADHD, it is not mandatory to undergo treatment with us. If you prefer, you have the option to seek treatment elsewhere. At Aspire ADHD, our focus is on providing compassionate, evidence-based care that empowers you to live your best life. 

Please note, we do not currently offer ADHD coaching or therapy, but our providers are committed to helping you find the right resources to complement your treatment.

Non-Pharmacological ADHD Management 

In addition to ADHD medications, non-pharmacological strategies can play a significant role in managing ADHD and ADHD symptoms. These approaches include behavioral therapy, which helps individuals develop coping mechanisms and improve organizational skills, and cognitive behavioral therapy (CBT), which focuses on modifying negative thought patterns. 

Parent training programs can provide families with techniques to manage challenging behaviors, while academic accommodations such as individualized education plans (IEPs) can help students succeed academically. Additionally, lifestyle changes like regular physical activity, structured routines, and mindfulness techniques can improve focus and reduce impulsivity. These interventions, used alone or alongside medication, contribute to a comprehensive treatment plan.

Medication Management for ADHD

ADHD affects millions of children, adolescents, and adults in the United States. The condition can impact attention, impulse control, organization, time management, emotional regulation, executive functioning, academic performance, work productivity, and many other aspects of daily life. For many individuals with ADHD, medication can be an important component of a comprehensive, individualized treatment plan. 

ADHD medications can improve core symptoms such as inattention, impulsivity, and hyperactivity. However, medication alone may not address all of the functional challenges associated with ADHD. As the saying goes, “pills do not substitute for skills.”

Many individuals with ADHD benefit from combining medication management with behavioral strategies, psychotherapy, ADHD coaching, organizational systems, lifestyle modifications, and other supportive interventions designed to improve executive functioning and daily performance.

ADHD also frequently occurs alongside other psychiatric conditions, including anxiety disorders, depression, substance use disorders, and sleep disorders. Identifying and appropriately treating coexisting conditions is an important part of developing a safe, effective, and individualized treatment plan.

At Aspire ADHD, medication management is individualized based on each patient’s symptoms, medical and psychiatric history, coexisting conditions, previous treatment response, potential risks, and personal treatment goals. Treatment plans are monitored and adjusted over time to optimize symptom improvement, daily functioning, and overall quality of life.

How ADHD Medications Work

Medication does not cure ADHD; when effective, ADHD medications eases ADHD symptoms during the time it is active. Thus, it is not like an antibiotic that may cure a bacterial infection, but more like eyeglasses that help to improve vision only during the time the eyeglasses are actually worn.

Medications that most effectively improve the core symptoms of ADHD seem primarily and directly to affect certain neurotransmitters. The neurotransmitters involved are dopamine (DA) and norepinephrine (NE). Both neurotransmitters appear to play a role in the attentional and behavioral symptoms of ADHD. 

Practitioners cannot know in advance which drug will work best for a particular patient without trying them. To determine the optimal medication and dosage for each individual, healthcare providers typically use an ADHD medication trial. This process begins with a low dose that is gradually increased at 3–7 day intervals until the desired clinical benefits are achieved. 

Additionally, pharmacogenetic testing (PGx) can be performed if desired to help identify which ADHD medications may work best based on the individual's genetic profile. Pharmacogenomic (PGx) testing is typically not covered by insurance. For this reason, we generally recommend PGx testing for patients who have experienced significant side effects or a poor response to previous ADHD medications, rather than as a routine part of every ADHD evaluation.

ADHD Medications: Stimulants and Non-Stimulants

Medications used to treat ADHD are broadly categorized into two main groups: stimulant and non-stimulant medications. Both can be effective treatment options, but they differ in how they work, how quickly they begin to take effect, their potential side effects, and the patients for whom they may be most appropriate.

Stimulant medications, including methylphenidate-based and amphetamine-based medications, increase the availability of dopamine and norepinephrine within the central nervous system. These neurotransmitters play important roles in attention, motivation, impulse control, and executive functioning. Stimulants generally have a rapid onset of action and are considered first-line pharmacologic treatments for ADHD.

Non-stimulant medications work through several different mechanisms depending on the medication prescribed. These medications may affect norepinephrine, dopamine, serotonin, or specific adrenergic receptors involved in attention, impulse control, emotional regulation, and executive functioning. Non-stimulants may be considered when stimulant medications are ineffective, poorly tolerated, contraindicated, or when the potential risks of stimulant treatment outweigh the expected benefits.

Choosing between stimulant and non-stimulant medication requires an individualized approach. Treatment decisions should be based on a comprehensive clinical evaluation and consideration of the patient’s age, ADHD symptoms, level of impairment, medical and psychiatric history, coexisting conditions, current medications, previous treatment response, potential side effects, risk factors, daily schedule, and treatment preferences.

At Aspire ADHD, medication selection and ongoing treatment decisions are individualized and monitored over time to help patients achieve meaningful improvements in ADHD symptoms and daily functioning while minimizing potential side effects and medication-related risks.

Stimulant Medications for ADHD

Psychostimulant medications, commonly referred to as stimulants, are the most widely used medications for ADHD. They are considered a first-line treatment and are among the most effective pharmacologic treatments available for reducing core ADHD symptoms in children, adolescents, and adults.

Stimulants primarily affect dopamine (DA) and norepinephrine (NE), two neurotransmitters involved in attention, motivation, alertness, impulse control, and executive functioning.

How Do Stimulant Medications Work?

The two primary classes of stimulant medications used to treat ADHD are methylphenidate-based medications and amphetamine-based medications. Although both increase the availability of dopamine and norepinephrine in the central nervous system, they do so through somewhat different mechanisms.

Methylphenidate medications primarily inhibit the reuptake of dopamine and norepinephrine, increasing the availability of these neurotransmitters between nerve cells.

Amphetamine medications increase the release of dopamine and norepinephrine and also reduce their reuptake, resulting in greater availability of these neurotransmitters within the central nervous system.

These effects can improve attention, concentration, impulse control, task initiation, working memory, and other aspects of executive functioning.

Stimulants like methylphenidate (Ritalin) and amphetamines (Adderall) are highly effective, with 70-80% of individuals experiencing symptom improvement. 

How Do Stimulants Affect the Brain?

Stimulant medications influence several brain regions and neural networks involved in ADHD symptoms. Their effects are especially important within the prefrontal cortex and related brain circuits responsible for attention, executive functioning, motivation, emotional regulation, and behavioral control.

• Prefrontal Cortex: Supports attention, working memory, organization, planning, task initiation, impulse control, and other executive functions.
• Anterior Cingulate Cortex: Plays an important role in attention, error monitoring, motivation, decision-making, and behavioral regulation.
• Basal Ganglia and Related Circuits: Involved in motivation, reward processing, motor activity, and behavioral control.
• Cerebellum: Contributes to motor coordination, timing, attention, and aspects of cognitive control.
• Default Mode Network: Stimulant treatment may improve regulation of brain networks associated with mind wandering and internally directed thought, helping individuals maintain attention during tasks.
• Limbic and Reward Circuits: Dopamine and norepinephrine signaling within these circuits can influence motivation, emotional regulation, reward processing, and goal-directed behavior.
• The effects of stimulant medications are complex and extend beyond individual brain regions. Current research suggests that effective ADHD treatment may improve communication and regulation across multiple interconnected brain networks.

Types of Stimulant Medications

The two primary classes of stimulant medications used to treat ADHD are:

• Methylphenidate-based stimulants, which include medications such as methylphenidate and dexmethylphenidate.
• Amphetamine-based stimulants, which include medications such as mixed amphetamine salts, dextroamphetamine, and lisdexamfetamine.

Stimulant medications are available in short-acting, intermediate-acting, and long-acting formulations. The duration of effect varies considerably depending on the medication, formulation, dose, metabolism, and individual response.

Short-acting formulations typically provide symptom coverage for approximately 3 to 6 hours, while many long-acting formulations may provide approximately 8 to 16 hours of symptom control.

Individual responses vary. A medication that provides adequate symptom coverage for one patient may have a shorter or longer duration of effect in another.

Onset, Duration, and Individualized Medication Selection

Stimulant medications generally have a relatively rapid onset of action, with many formulations beginning to take effect within approximately 30 to 60 minutes. Depending on the specific medication and formulation, therapeutic effects may last from several hours to most of the day.

Selecting the most appropriate ADHD medication requires an individualized approach. Treatment decisions should consider the patient’s age, ADHD symptoms, medical and psychiatric history, current health status, other medications being taken, previous treatment response, potential side effects, and daily schedule. Ongoing medication management allows the treatment plan to be adjusted over time based on effectiveness, tolerability, and the patient’s individual needs.

Short-Acting “Booster” Doses

Some patients taking a long-acting stimulant medication may experience a return of ADHD symptoms later in the afternoon or evening as the medication wears off.

In selected patients, a clinician may prescribe a small dose of a short-acting stimulant later in the day to extend symptom coverage. This is sometimes referred to as a “booster” dose.

Booster doses may be considered for patients who need additional symptom control during homework, work responsibilities, driving, or other late-afternoon and evening activities.

The decision to combine long-acting and short-acting stimulant formulations should be individualized and based on clinical response, duration of symptom coverage, side effects, sleep patterns, and the patient's daily schedule.

Stimulant Medication Regulation and Safety

Most stimulant medications prescribed for ADHD are classified as Schedule II controlled substances by the U.S. Drug Enforcement Administration (DEA). This classification reflects their potential for misuse, abuse, and physical dependence.

When prescribed appropriately and monitored by a qualified healthcare professional, stimulant medications can be safe and effective treatments for ADHD.

Patients receiving stimulant medications should be monitored for treatment response, medication adherence, blood pressure, heart rate, appetite, sleep disturbances, mood changes, and potential adverse effects.

Non-Stimulant Medications for ADHD

Non-stimulant medications are an important treatment option for children, adolescents, and adults with ADHD. They may be considered when stimulant medications are ineffective, cause significant side effects, are contraindicated due to certain medical or psychiatric conditions, or when there are concerns about stimulant misuse or diversion.

How Do Non-Stimulant Medications Work?

Unlike stimulant medications, non-stimulant ADHD medications do not all work through the same mechanism of action. Depending on the medication, they may affect norepinephrine, dopamine, or specific receptors involved in attention, impulse control, emotional regulation, and executive functioning.

Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor that increases norepinephrine availability and indirectly influences dopamine signaling within the prefrontal cortex.

Viloxazine ER (Qelbree) primarily modulates norepinephrine signaling and also affects serotonin pathways involved in attention, mood, and emotional regulation.

Guanfacine ER (Intuniv) and clonidine ER (Kapvay) are alpha-2 adrenergic receptor agonists that affect signaling within the prefrontal cortex and related neural networks involved in attention, impulse control, hyperactivity, and emotional regulation.

When Are Non-Stimulant Medications Considered?

Non-stimulant medications may be appropriate for patients who do not respond adequately to stimulant medications, experience significant stimulant-related side effects, have certain coexisting medical or psychiatric conditions, or have concerns related to stimulant misuse or diversion.

They may also be considered for patients with coexisting anxiety, sleep disturbances, tic disorders, emotional dysregulation, or cardiovascular concerns, depending on the individual medication and the patient's medical history.

Effectiveness of Non-Stimulant Medications

On average, stimulant medications have larger and more immediate effects on core ADHD symptoms. However, non-stimulant medications can provide meaningful symptom improvement and may be the preferred treatment option for some patients.

Unlike stimulants, which typically begin working the same day they are taken, many non-stimulant medications require consistent daily use and may take several weeks to reach their full therapeutic effect.

Potential Side Effects

Side effects vary depending on the medication prescribed and may include gastrointestinal symptoms, decreased appetite, fatigue, sleep disturbances, headaches, dizziness, changes in mood, and changes in blood pressure or heart rate.

Patients receiving non-stimulant medications should be monitored regularly to evaluate treatment effectiveness, medication adherence, potential side effects, and overall functioning.

Selecting an ADHD medication should be based on a comprehensive evaluation and individualized consideration of the patient's symptoms, medical and psychiatric history, previous treatment response, coexisting conditions, potential side effects, and personal treatment goals.

Schedule Your ADHD Evaluation

Comprehensive ADHD evaluations for children, adolescents, and adults are available in Massachusetts, New Hampshire, and Connecticut. In-office evaluations and ADHD testing are available at our Walpole, MA location, with convenient online evaluations available to eligible patients throughout all three states.

Already diagnosed with ADHD and looking for a new provider? Aspire ADHD also provides ongoing ADHD medication management for eligible patients with a previously established diagnosis. Prior diagnostic and treatment records may be required before assuming medication management.

If you are concerned that you or your child may have ADHD, a comprehensive evaluation can provide clarity, identify factors that may be contributing to symptoms, and help determine the most appropriate next steps for treatment.

At Aspire ADHD, objective computerized testing is incorporated into the evaluation process to provide additional information about attention, response control, and patterns of performance that can support diagnostic decision-making and individualized treatment planning.

Computerized ADHD testing is not reliably covered by commercial insurance plans and may require an additional out-of-pocket fee. However, it offers patients access to objective testing at a substantially lower cost than a comprehensive neuropsychological evaluation.

Take the first step toward greater clarity and an individualized treatment plan for you or your child.