What really works for ADHD: Pills, therapy and what global evidence shows

The largest-ever review of ADHD treatments finds medicines work best in the short term, CBT helps adults, and long-term answers remain missing, forcing families and doctors to weigh benefits against h

Living with ADHD (Attention-Deficit/Hyperactivity Disorder), a neurodevelopmental condition marked by persistent inattention, hyperactivity and impulsivity, often means navigating a maze of advice on pills, therapy, diets, apps and exercise plans, all claiming to be the solution. But what actually works?

 

A major new study titled Benefits and harms of ADHD interventions: umbrella review and platform for shared decision making, published in The BMJ, attempts to settle this confusion.

 

By analysing more than 200 meta-analyses of clinical trials, covering 31 different interventions and 24 outcomes, researchers found that medications remain the most effective short-term treatments, with cognitive behavioural therapy (CBT) showing clear benefits for adults.

 

 

However, almost all reliable evidence is short term, even though ADHD treatment often continues for years. To help families and clinicians weigh trade-offs, the researchers also launched an open-access decision-making website — the Evidence-Based Interventions for ADHD (EBI-ADHD) platform — allowing users to compare treatments by age group, see benefits and harms side by side, and understand how strong or uncertain the evidence is.

Which ADHD treatments work best for children and adolescents?

For children and adolescents, the strongest evidence supports medication, particularly in the short term of around 12 weeks.

 

Five medicines showed moderate to high-certainty evidence for reducing ADHD symptoms:

• Methylphenidate
• Amphetamines
• Atomoxetine
• Alpha-2 agonists such as guanfacine and clonidine
• Viloxazine

Among these, methylphenidate showed the most consistent benefits across clinicians, parents and teachers. However, some medicines were linked to poorer tolerability, meaning children were more likely to stop them due to side effects.  ALSO READ | How undiagnosed ADHD raises addiction risk, especially in women

What works best for adults with ADHD?

In adults, the evidence base is narrower but clearer. The review found moderate to high-certainty evidence for:

• Methylphenidate
• Atomoxetine
• Cognitive behavioural therapy (CBT)

CBT was the only non-drug intervention with reasonably strong evidence for improving core ADHD symptoms in adults, particularly when assessed by clinicians. This makes it an important option for adults who cannot tolerate medication or prefer a non-pharmacological approach.

Are ADHD medicines safe and well tolerated?

The study highlights a persistent tension in ADHD care: effectiveness versus tolerability.

 

In children and adolescents, methylphenidate was not significantly worse than placebo for tolerability and even showed better overall acceptability. Amphetamines, however, were more likely to lead to treatment discontinuation due to side effects.

 

In adults, the picture was more complex. Both methylphenidate and atomoxetine were associated with worse tolerability than placebo, indicating that side effects remain a challenge even when symptoms improve.

 

Importantly, the review did not find strong evidence linking these medicines to increased suicidal behaviour in children and adolescents.  ALSO READ | 6 expert-backed ways parents can build better routines for kids with ADHD

Do non-drug approaches like mindfulness or exercise really help?

Many families explore non-drug options hoping for safer or longer-lasting benefits.

 

According to the review, interventions such as mindfulness, exercise, acupuncture and cognitive training sometimes showed large improvements, but the quality of evidence was low or very low. This was usually because studies involved small samples or carried a high risk of bias.

 

Mindfulness showed possible longer-term benefits in adults, but the evidence remained weak and inconclusive. In short, these approaches may help some individuals, but science cannot yet reliably predict who will benefit, by how much, or for how long.

Why is long-term ADHD evidence still missing?

One of the study’s most striking findings is the absence of high-certainty evidence for long-term benefits of any ADHD treatment, drug or non-drug.

 

This gap matters because ADHD is often lifelong. Most trials last only weeks or months, while real-world treatment can extend across years or decades. The authors stress the urgent need for long-term, real-world studies that reflect how ADHD is actually managed outside controlled trial settings.  ALSO READ | What is rejection sensitive dysphoria in ADHD and how can you manage it?

What should patients and families take away from this?

The review does not argue for a one-size-fits-all approach. Instead, it emphasises informed decision-making.

 

Medications remain the most effective short-term tools, CBT stands out for adults, and many popular alternatives still lack solid evidence. By clearly separating what is well supported from what remains uncertain, the study aims to reduce confusion, avoid wasted effort and empower people with ADHD to take part in decisions about their own care. 

Since you're already here

…and clearly interested in your health, take a moment to explore our varied range of stories on wellness, medical research, and public health insights.

• Caught flu despite the jab?  Why did I catch the flu even after taking the vaccine? Doctor explains
• Mental health help decoded  Psychiatrist vs psychologist: Who does what and whom to approach for help
• First therapy session fears?  Don’t fear therapy: Experts reveal what really happens in the first session
• Safe cough relief for kids  Do kids even need cough syrups? Doctors say they may do more harm than good
• Secrets of a long life  Want to live longer? Science says being active and organised is the key
• Heart under pressure  Financial stress and heart attacks: Why money matters as much as cholesterol
• Myths vs immunity  Vaccines, weather, kadha: What really helps immunity and what doesn’t
• Frown lines and fine lines  From frowns to smiles: These 7 tiny expressions speed up visible ageing
• Caring without crashing  Ageing parents, adult kids: How to grow together without burning out

For more health updates, follow #HealthWithBS 

This content is for informational purposes only and is not a substitute for professional medical advice.