Pediatric Attention Deficit Hyperactivity Disorder (ADHD) Treatment & Management

Updated: Mar 31, 2022
  • Author: Maggie A Wilkes, MD; Chief Editor: Caroly Pataki, MD  more...
  • Print

Medical Care

The first line of treatment for ADHD in children and adolescents is the use of stimulant medications, such as methylphenidate agents and amphetamine/mixed amphetamine salts agents. Educational interventions may be used adjunctively and are helpful in improving academica work habits, organizational skills, and approaches to academic assignments.  The range of psychotropic medications used in the treatment of ADHD is detailed in the Medication section. While behavioral and psychotherapeutic interventions have not been effective in controlling the core features of ADHD in most children, oppositional behaviors, parent-child problems, and social/peer problems that often accompany ADHD can be ameliorated by these approaches.

Most components of behavioral care take place outside of the primary care provider's office. Common components are briefly described below to assist in referral and consultation. Not all components are necessary for every child.

School or education interventions

The age of the child at initial diagnosis and the severity of the symptoms of ADHD (ADD) likely affect the extent to which the child benefits from working with education specialists.

Consultants initially involved with diagnosis and evaluation can also be important in promoting the development of study skills.

Teachers have an important function. Their periodic feedback about the child's school performance through the use of standardized scales, narrative descriptions, and telephone follow-up is generally an indispensable component of ongoing care.

Implementation of academic accommodations and adaptations is often necessary


Behavioral modification and family therapy are often helpful for concurrent problems with peers and family conflicts in children with ADHD.

For some adolescents, ADHD coaching, participating in a support group, or both can help normalize the disorder and assist them in obtaining well-focused peer feedback and general information.

Psychologists, behavioral developmental pediatricians, clinical social workers, and nurse practitioners who are well familiarized with ADHD can be invaluable in improving social skills, decreasing family and peer conflicts, and increasing prosocial behaviors in children with ADHD.

Given that the majority of children with ADHD often have concurrent conditions such as learning disorders, oppositional and defiant behaviors,and anxiety and mood disorders, these symptoms and disorders should be addressed concurrent to the treatment of ADHD.



The timing of consultations depends on the practitioner's degree of knowledge and experience with the evaluation and treatment of ADHD (ADD). Several possible scenarios are described below.

Referral to an ADHD (ADD) specialist, clinic, and/or a psychiatrist or a behavioral developmental pediatrician

In this scenario, the patient may or may not be well known and may have a family member with ADHD (ADD) but no coexistent conditions. However, the clinician feels the patient must be questioned further about ADHD or coexistent conditions.

The patient may or may not be well known and may have no family history of ADHD (ADD) but has a concerning family history of a mood or anxiety disorder.

The patient may or may not be well known and perhaps has other family members with ADHD (ADD) whose condition is stabilized by medications without problems with coexistent conditions; however, ADHD (ADD) cannot be diagnosed and/or coexistent conditions cannot be ruled out with confidence.

A brief consultation with or referral to an ADHD (ADD) specialist or a psychiatrist or behavioral developmental pediatrician

In this scenario, the patient may or may not be well known to the practitioner, and the condition has been stabilized by medications without problems with identified coexistent conditions. However, the medication either no longer works or has started to cause adverse effects, and the medication cannot be adjusted with confidence.

Referral as soon as possible to a specialist or specialty clinic for drug rehabilitation

In this scenario, a patient is being evaluated and is not taking psychostimulants or is being re-evaluated for current psychostimulants and chemical abuse is noted. If the patient is taking psychostimulants and if the medications are being taken properly, a consultation call to decide whether the stimulants should be continued may be more appropriate than simply stopping them.



No special diet clearly affects ADHD (ADD). Until this situation changes, a healthy diet with minimal, if any, caffeine should be emphasized. Note that, in children, caffeine is often consumed in the form of chocolate candy, chocolate milk, or "energy" drinks.

While additional studies are warranted to verify the data, the results from one study suggest that a restriction diet may reduce ADHD symptoms in some children; food color additives were identified as a possible association with ADHD symptoms. [9]



No evidence-based studies have been conducted to elucidate the potential role of physical activity in children with ADHD (ADD). However, anecdotal clinical reports commonly attest to improvements in focus and sleep quality associated with regular physical activity and exercise. In addition, regular physical activity is important in patients with some of the common coexistent conditions (eg, depression, anxiety) and helps improve concentration. Therefore, physical activity is often an important component of therapy.