Evidence at a Glance
Quick-answer evidence summaries organized by the clinical questions they answer. Type a question below to find synthesized, cited answers drawn directly from lesson content.
Assessment & Diagnosis
10How Do I Evaluate and Diagnose ADHD?
How do I evaluate and diagnose ADHD?
ADHD diagnosis is clinical — no single test confirms it. A comprehensive evaluation requires multi-informant data (parent, teacher,…
DSM-5 Diagnostic Criteria for ADHD by Age
What are the diagnostic criteria for ADHD, and how do they change by age?
The DSM-5-TR criteria for ADHD include age-specific symptom thresholds (6/9 for children, 5/9 for ages 17+), onset before age 12,…
Which ADHD Rating Scale Should I Use?
Which ADHD rating scale should I use for my patient?
The answer depends on the clinical question, the patient's age, and whether you are screening, diagnosing, or monitoring treatment response…
What Conditions Mimic ADHD, and How Do I Tell Them Apart?
What conditions mimic ADHD, and how do I tell them apart?
Nearly 78% of children with ADHD carry at least one co-occurring condition, which means the clinical question is rarely "is it ADHD or…
When Should I Order Neuropsychological Testing for Suspected ADHD?
When should I order neuropsychological testing for suspected ADHD?
Neuropsychological testing is not required for routine ADHD diagnosis, and using it as a standalone diagnostic tool is an evidence-practice…
ADHD Missed in Girls and Women
Why is ADHD systematically missed in girls and women, and what should I do about it?
The gap between clinical ADHD gender ratios (boys outnumber girls 9:1 to 10:1) and community population ratios (approximately 2:1)…
Can You Diagnose ADHD Reliably in a 4-Year-Old?
Can you diagnose ADHD reliably in a 4-year-old?
Yes, but with developmental caveats that require more clinical discipline than school-age evaluation.
How Do I Diagnose ADHD in an Adult Who Was Never Identified as a Child?
How do I diagnose ADHD in an adult who was never identified as a child?
Most adult ADHD diagnoses are "late-identified" rather than "late-onset" - the pathology is developmentally continuous even when the…
If I Have ADHD, What Are the Chances My Child Has It Too?
If I have ADHD, what are the chances my child has it too?
The short answer is substantially higher than the general population, but not deterministic.
Is There a Brain Scan or Biological Test That Can Diagnose ADHD?
Is there a brain scan or biological test that can diagnose ADHD?
No, and understanding why requires knowing what neuroimaging actually shows, because the group-level findings are real and robust while the…
Comorbidity
13How Common Are Comorbidities in ADHD and What Should I Screen For?
How common are comorbidities in ADHD and what should I screen for?
At least 60-80% of individuals with ADHD have one or more comorbid conditions. The most common are ODD/CD (~40-60%), anxiety disorders…
Comorbid Anxiety in ADHD - Presentation, Treatment Response, and Sequencing
How does comorbid anxiety change my ADHD treatment approach?
Anxiety co-occurs in 25 - 40% of ADHD patients and changes the treatment calculus in ways that are largely favorable, but only if the…
ADHD with Comorbid ODD/Conduct Disorder - The Externalizing Cascade
How does comorbid ODD or Conduct Disorder affect ADHD treatment and prognosis?
ODD co-occurs in 40 - 60% of children with ADHD, making it the single most common behavioral comorbidity, and its presence changes both the…
ADHD with Comorbid Depression, Suicide Risk, and Bipolar Overlap
How do I manage depression and assess suicide risk in my ADHD patient?
The comorbidity of ADHD and depression is common, bidirectional, and high-stakes.
ADHD, Learning Disabilities, and ASD - Disentangling Overlapping Neurodevelopmental Conditions
How do I untangle ADHD from learning disabilities and ASD?
These comorbidities are the most common source of apparent ADHD "treatment failure." Learning disabilities affect 30 - 50% of children with…
ADHD, Stimulant Treatment, and Substance Use Disorder Risk
Do stimulants increase or decrease my patient's risk of substance abuse?
The parental fear that stimulants will "start" substance problems is one of the most common concerns in ADHD practice, and the evidence…
Stimulants and Tic Disorders in ADHD
Should I stop stimulants if my patient develops tics?
The evidence no longer supports the historic contraindication of stimulants in patients with tics.
ADHD Emotional Dysregulation vs. DMDD - Differential Diagnosis and Treatment Sequencing
Is my patient's explosive irritability ADHD emotional dysregulation or DMDD?
Emotional dysregulation affects an estimated 25 - 45% of children with ADHD, and approximately one in five school-aged children with ADHD…
ADHD and OCD - The Impulsive-Compulsive Paradox
How do I manage the overlap between ADHD impulsivity and OCD compulsivity?
ADHD and OCD sit at opposite ends of a behavioral control spectrum - ADHD is a disorder of under-control (impulsivity, novelty-seeking)…
ADHD vs. PTSD Hyperarousal - Differential Diagnosis and Treatment Sequencing
How do I distinguish ADHD hyperactivity from PTSD hyperarousal?
ADHD and PTSD share enough surface-level symptoms - concentration deficits, psychomotor restlessness, irritability, chronic sleep…
The Sleep-ADHD Bidirectional Cycle
Is my patient's sleep problem causing ADHD symptoms, or is ADHD causing the sleep problem?
The answer to "is sleep causing ADHD symptoms or is ADHD causing the sleep problem?" is usually both, simultaneously, and the bidirectional…
The Master Comorbidity Treatment Sequencing Algorithm
My patient has ADHD plus multiple comorbidities - which do I treat first?
Treatment sequencing for comorbid ADHD does not mean treating one condition to completion before addressing the next - in most…
Treating ADHD in the AuDHD Patient - Medication Selection and Sequencing
How do I treat ADHD when my patient also has autism?
The comorbid AuDHD population responds to stimulants but tolerates them poorly - 18-19% cannot complete titration due to irritability,…
Monitoring & Long-Term Management
7What Are the Common Side Effects of ADHD Medications and How Do I Manage Them?
What are the common side effects of ADHD medications and how do I manage them?
The most common stimulant side effects are appetite suppression (~50-60%), insomnia (~25-50%), and headache (~15-25%). Most are…
Cardiovascular Monitoring Thresholds on Stimulant Medications
What blood pressure and heart rate values are too high for a patient on stimulants?
Stimulant medications produce small, measurable hemodynamic changes - average heart rate increases of 1 - 2 bpm and blood pressure…
Growth Suppression During Stimulant Treatment
How much growth suppression should I expect from stimulants, and when should it change my treatment?
Stimulants produce measurable growth suppression - weight first, height later, but the clinical significance depends heavily on duration of…
ADHD Visit Frequency and Monitoring Structure
How often should I see my ADHD patient, and what should I check at each visit?
The monitoring framework for ADHD has two distinct phases - titration and maintenance - with different cadences, different goals, and…
Defining and Measuring ADHD Treatment Success
How do I know if ADHD treatment is actually working?
"Is the medication working?" is not a yes/no question - the answer depends entirely on how "working" is defined and who is reporting.
ADHD Long-Term Course and Prognosis
Will my patient outgrow ADHD, and what predicts the long-term course?
The old "Rule of Thirds" - one-third remit, one-third persist with impairment, one-third have severe outcomes - is obsolete.
Structuring Long-Term ADHD Management
How should I structure long-term ADHD management in my practice?
ADHD management that stops at "stabilize and discharge" fails.
Pharmacology
15What Medications Are Available for ADHD and When Do I Use Each?
What medications are available for ADHD and when do I use each class?
ADHD medications fall into three tiers: first-line stimulants (methylphenidate and amphetamine, NNT 2-3, ~70-80% response rate),…
How Stimulant Medications Work in the Brain
How do stimulant medications actually work in the brain?
Methylphenidate and amphetamine both increase dopamine and norepinephrine in the prefrontal cortex, but through fundamentally different…
Should I Start with Methylphenidate or Amphetamine?
Should I start with methylphenidate or amphetamine?
The optimal first-line stimulant depends on the patient's age - a finding that emerges not from efficacy data alone (amphetamine wins on…
Which Stimulant Formulation Gives the Right Duration of Coverage?
Which stimulant formulation gives the right duration of coverage for my patient's day?
Selecting a stimulant formulation is a clinical engineering problem - matching a drug delivery profile to the patient's actual day, not…
Stimulant Titration by Age Group
How do I titrate stimulant medication, and how does it differ by age?
Stimulant titration follows a consistent principle across age groups - start low, increase incrementally, titrate to effect rather than to…
When Should I Choose Atomoxetine, and Does CYP2D6 Metabolizer Status Matter?
When should I choose atomoxetine, and does CYP2D6 metabolizer status matter?
Atomoxetine occupies a specific niche: it is the strongest non-stimulant option for patients where stimulants are contraindicated, poorly…
How Do Guanfacine and Clonidine Compare for Treating ADHD?
How do guanfacine and clonidine compare for treating ADHD?
Both alpha-2 agonists reduce prefrontal cortex "noise" through the same receptor mechanism, but a 10-fold difference in receptor…
How Does Viloxazine Compare to Other Non-Stimulant Options?
How does viloxazine compare to other non-stimulant options?
Viloxazine ER (Qelbree) is a mechanistically distinct non-stimulant that combines norepinephrine reuptake inhibition with direct serotonin…
When Should I Add a Second ADHD Medication, and Which Combination?
When should I add a second ADHD medication, and which combination?
The decision to combine ADHD medications should follow a clear hierarchy: (1) confirm the monotherapy agent has been optimized to an…
Treatment Resistance and the Systematic Troubleshooting Algorithm
What's the systematic approach when ADHD medication isn't working?
What clinicians label "treatment-resistant ADHD" is more often optimization-resistant prescribing.
What Do I Tell My Pregnant Patient About ADHD Medication?
What do I tell my pregnant patient about ADHD medication?
No definitive clinical guidelines exist specifically for ADHD medication use in pregnancy.
Should My Patient Take a Medication Break, and How Do I Structure One?
Should my patient take a medication break, and how do I structure one?
Drug holidays are among the most commonly practiced but least rigorously studied interventions in ADHD management - between 25% and 70% of…
How Do I Reduce Stimulant Diversion Risk in My Adolescent Patient?
How do I reduce stimulant diversion risk in my adolescent patient?
Approximately 18% of middle and high school students with a stimulant prescription divert their medication, and 22.6% of students report…
What New ADHD Medications and Treatments Are on the Horizon?
What new ADHD medications and treatments are on the horizon?
The ADHD treatment pipeline is expanding beyond the two-stimulant-class, three-non-stimulant paradigm that has defined prescribing for two…
What Does the MTA Study Tell Us About Medication vs. Behavioral Therapy for ADHD?
What does the MTA study tell us about medication vs. behavioral therapy for ADHD?
The MTA is the largest and most influential longitudinal treatment study in ADHD (N = 579, 16-year follow-up).
Psychosocial Interventions
11What Non-Medication Treatments Work for ADHD, and Which Ones Don't?
What non-medication treatments work for ADHD, and which ones don't?
Evidence-based non-medication treatments for ADHD include behavioral parent training (SCCAP Level 1 for children), organizational skills…
Behavioral Parent Training - Program Selection and the Medication Question
Which behavioral parent training program should I recommend, and can it replace medication?
Behavioral parent training is the recommended first-line treatment for preschool ADHD and a core component of multimodal treatment at all…
School Interventions for ADHD - What Works, What Doesn't, and What's Just Window Dressing
What school interventions actually help students with ADHD, and which don't?
The most commonly implemented school responses to ADHD - preferential seating, extended time on tests - are among the least supported by…
Organizational Skills Training for ADHD
How do I help my patient with ADHD get organized?
Organization, time management, and planning (OTMP) deficits are among the most functionally impairing aspects of ADHD, and among the most…
CBT for ADHD - How It Differs from Standard CBT and When It Works
Does CBT work for ADHD, and how is it different from standard CBT?
Cognitive-behavioral therapy for ADHD is not the same intervention as CBT for depression or anxiety - it targets a different mechanism…
Popular ADHD Interventions That Lack Evidence
Which popular ADHD interventions lack evidence?
Families regularly ask about neurofeedback, brain-training programs, and social skills groups - interventions that are heavily marketed,…
Lifestyle Interventions for ADHD
Which lifestyle interventions have evidence for ADHD?
Lifestyle interventions for ADHD occupy a spectrum from "universally recommended with no downside" (exercise, sleep hygiene) to…
Treatment Engagement and Adherence in ADHD - Especially Teenagers
How do I keep my ADHD patients engaged in treatment - especially teenagers?
ADHD treatment has an adherence problem that compounds with age.
Telehealth for ADHD Management - Assessment, Treatment, and Stimulant Prescribing
Can I effectively manage ADHD via telehealth, including prescribing stimulants?
Telehealth for ADHD is no longer a pandemic workaround - nearly half of adults with ADHD have used telehealth services, and validation data…
ADHD Coaching vs. Therapy - When to Refer and What to Expect
What's the difference between ADHD coaching and therapy, and when should I refer?
ADHD coaching and ADHD-adapted therapy (CBT, MCT) address overlapping functional domains but operate on fundamentally different models.
Communicating ADHD Prognosis Without Creating Hopelessness
How do I talk to families about ADHD prognosis without creating hopelessness?
The old "Rule of Thirds" - one-third remit, one-third persist mildly, one-third have severe outcomes - has been replaced by a more accurate…
Special Populations
8Preschool ADHD Treatment Hierarchy
What's the treatment approach for ADHD in a preschooler?
For preschool ADHD, behavioral parent training is the recommended first step, but the evidence comes with important caveats about severity,…
Adolescent ADHD Management
How does ADHD management need to change when my patient hits adolescence?
Adolescence restructures ADHD management around three high-stakes problems that don't exist in childhood: driving, substance use risk, and…
Hormonal Effects on ADHD Across the Female Lifespan
How do hormones affect ADHD symptoms and medication efficacy across the female lifespan?
The estrogen-dopamine interaction is the central mechanism linking hormonal status to ADHD symptom expression and medication efficacy in…
Adult ADHD Treatment - What Changes from Pediatric Practice
How does adult ADHD treatment differ from pediatric?
Adult ADHD treatment shares the same pharmacological foundations as pediatric treatment but differs in phenotype recognition, dosing logic,…
Preventing Treatment Loss at the Pediatric-to-Adult Transition
How do I prevent my patient from falling off treatment at the pediatric-to-adult care transition?
The transition from pediatric to adult ADHD care is a systemic failure point, not an individual one: only 6% of young adults with ADHD…
Cognitive Disengagement Syndrome (CDS) - Recognition and Treatment Implications
What is Cognitive Disengagement Syndrome and does it respond differently to treatment?
CDS is a clinically significant attention construct that the lesson content introduces but does not yet cover in the depth its prevalence…
ADHD Presentation Changes Across the Lifespan
What does ADHD look like at different ages, and why does the presentation change?
ADHD does not change biologically at different ages, but its clinical face changes substantially because the same neurodevelopmental…
ADHD in Older Adults — What Changes After 65
How do I manage ADHD in a patient over 65?
No clinical practice guideline addresses ADHD treatment specifically in adults over 65. No randomized controlled trial has been conducted…
Systems & Management
5IEP vs. 504 Plan - Which Framework Fits Your ADHD Patient?
Does my ADHD patient qualify for an IEP or a 504 plan, and what's the difference?
Two federal statutes govern school supports for students with ADHD in the United States, and they are not interchangeable "levels" of…
Writing Effective School Recommendations for ADHD Patients
How do I write an effective school recommendation for my ADHD patient?
The most common point of failure in educational advocacy for ADHD is the clinician's letter.
Is ADHD Overdiagnosed?
Is ADHD overdiagnosed?
The clinical answer is both overdiagnosed and underdiagnosed - simultaneously, in different populations, for different reasons.
Racial and Socioeconomic Disparities in ADHD Diagnosis and Treatment
Are there racial and socioeconomic disparities in ADHD diagnosis and treatment?
The neurobiology of ADHD does not vary by race.
Managing ADHD Patients During a Stimulant Shortage
How do I manage my ADHD patients during a stimulant shortage?
The stimulant shortage that began in October 2022 is not a historical curiosity - it is an ongoing clinical reality that has forced…