AHRQ

ADHD treatment: Evidence limited on head-to-head comparisons between stimulants and nonstimulants

July 23, 2025

Key points on treatment and monitoring from AHRQ's systematic review of evidence on attention deficit hyperactivity disorder (ADHD) in children and adolescents:

Treatment

• Several modalities improve core ADHD symptoms compared with controls such as placebo, including FDA-approved medications and psychosocial interventions, with high or moderate strength of evidence.
• FDA-approved stimulants (methylphenidate, amphetamine, etc.) and non-stimulant (atomoxetine, alpha agonist, etc.) medications had the strongest evidence across interventions for significantly improving ADHD symptoms and additional outcomes, including broadband measures and functional impairment.
• Head-to-head comparisons didn’t detect statistically significant differences between stimulant and non-stimulant medications for most effectiveness outcomes and adverse events.
• There was little evidence that combination therapies of medication plus psychosocial therapies produce better results than medication alone, but existing research evaluated unique combinations of intervention components.
• Despite the large body of research, comparative effectiveness and safety information is limited, and more research is needed to support choosing between treatments.
• Data were insufficient to assess the effect of co-occurring disorders on treatment effects.
• There were too few studies reporting on diversion to quantify the risk of diversion of pharmacological treatment.

Monitoring

• Very few monitoring studies have been reported, and more research is needed on how youth with ADHD should be monitored over time.
• Different assessment modalities may provide valid but different perspectives, and more than a single assessment modality may be required for comprehensive and effective monitoring of ADHD outcomes over time.

Source:

Systematic Review: ADHD Diagnosis and Treatment in Children and Adolescents. Content last reviewed November 2024. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. https://effectivehealthcare.ahrq.gov/products/attention-deficit-hyperactivity-disorder/research