Neurofeedback and ADHD

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We Understand the Reluctance to Treat a Child’s ADHD with Medication

Well, we sort of understand. That is, we’ve talked to many, many parents of children with ADHD through the years and have heard their concerns, their anguish, even, at the idea of giving their child a medication. (See our free page on ADHD Treatment.) In their search for anything else to treat their child’s ADHD they find discussions of dietary changes, behavior therapies, training for parents, herbal “medicines”, dietary supplements, minerals, meditation, massage therapy, computer training, app-based programs, and neurofeedback, that is, biofeedback. Neurofeedback is usually in the list and it has the appeal of sounding “scientific” but the child doesn’t have to swallow a pill. But the reality is that, with rare exception, a person with moderate-to-severe ADHD needs a medication. Skipping a needed medication means that the ADHD is not treated. Untreated ADHD is a setback for the child, both in the short run and life-long.

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Neurofeedback (Biofeedback) Doesn’t Work

Because it seems scientific and because it’s not medication, thousands of researchers have tried for almost half a century to find a neurofeedback of some sort that works. There are sensorimotor rhythm neurofeedback, theta/beta ratio protocol neurofeedback, and brain imaging neurofeedback approaches. But despite all this research, modifying the patterns of underlying brain activity has never been shown improvements in ADHD behaviors or cognition. Through the past forty years neurofeedback has never received FDA approval as a treatment that works for ADHD. The claims of ADHD treatment success have been based on case reports and small non-blinded, uncontrolled studies. Recently Dr. Lam at King’s College London and her colleagues completed a remarkably well-designed and carefully run study of functional magnetic resonance imaging neurofeedback as a treatment for children with ADHD (reference below). The study showed that sham, that is, fake neurofeedback, worked just as well as the real, active neurofeedback.

Even the Most Sophisticated and Elegant Neurofeedback for ADHD Finds No Benefit

This study is of the highest quality, with a carefully determined brain area target and the best research design. It showed that the active neurofeedback did not treat the ADHD. This study is one of many studies of equal quality showing neurofeedback to be of no use in treating ADHD. The wide variety of studies showing no benefit from neurofeedback means that the supposed treatment effect of neurofeedback does not arise from any specific type of neurofeedback choice or a change in brain activity target. The false flag of possible benefit comes from the nonspecific efforts like the supportive coaching, the effect of positive reinforcement for sitting still, and other efforts that are also in the placebo arm of each study. At some point we have to stop doing more dead end research. And clinical practitioners, in good conscience, need to stop offering it as a valid treatment.

One of our Readers in New Orleans (Louisiana, USA) commented:

Everywhere I look and read it all says that biofeedback works really well, that you just have to have the right kind.

This is true and sadly happens a lot. There’s a saying at the fringes of science: “If you can’t dazzle with data then bury with tons of baloney.” With forty years of information and misinformation mixed together, often copied, republished, repeated, and piled high, if one reads through the whole mess without a high level of knowledge and skepticism we see how it could make one a believer, even if a bewildered believer.

Lumped into the jumble are studies of little value, retrospective reports, case series, and studies with small samples. Often the diagnoses are uncertain and the children’s other medical conditions are multiple and varied. Study protocols, if they exist, or not standardized and the studies don’t have blinded comparison groups. Some of the studies that supposedly show the benefit of biofeedback chose people to rate the treatment’s success who have a high “positive expectation bias” and are really invested (sometimes financially invested) in the treatment working. If the raters are properly blinded and not biased the study’s success goes away.

Meta-analysis after meta-analysis that include only quality studies continue to show that neurofeedback does not treat ADHD, does not help children with ADHD to focus better or perform better. On the other hand, meta-analyses that grab any studies they can find, regardless of quality, sometimes come out with a different answer. But, there’s no way around the fact that the total, unfiltered information pool on treating ADHD with neurofeedback or biofeedback is a mess.

A Summary Statement by an Experienced ADHD Clinician

James J. McGough, MD, MS, is a Professor of Clinical Psychiatry in the University of California, Los Angeles, School of Medicine. He’s the Director of the Clinical Programs for ADHD and is Board Certified in Child and Adolescent Psychiatry. He wrote the first of the two published papers listed below. He makes several good points. A central point is, is it appropriate for clinicians to keep recommending and for parents to keep trying to use neurofeedback as though it actually treats ADHD when there is so much evidence that it does not treat ADHD? The fact that it’s a low-risk treatment is meaningless if it’s not a treatment at all. Parents might not like the idea of medications but there’s over half a century of experience showing that they work short-term and long-term and have a good safety profile.

A cute little girl with long brown hair in a pink dress sits with a book in her hands looking vague as a daydreaming bubble and arrows in many directions float around her.
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While Ineffective Treatments Are Pursued the Clock Keeps Ticking

ADHD is a developmental disorder, meaning that as the child grows and develops the existence of ADHD shapes that development. And if the ADHD bends the development the wrong direction, that bend exists and doesn’t go away. Not treating ADHD in the right way at the right time has life-long consequences. So to spend six months, or a year, or two years trying a treatment that doesn’t work instead of trying a treatment that does work damages the child during critically-important stages of growth and maturation. We do need to have, and it’s great to have, research into new and better ways to treat ADHD. But neurofeedback is not one of them. Don’t waste a child’s time. They don’t have time to waste. We understand that there are rare instances when a parent just can’t get a medication to work. But is a treatment that doesn’t work the right answer?


James J. McGough MD MS. Neurofeedback for ADHD: Time to Call It Quits? American Journal of Psychiatry, Vol. 179 No. 12, December 2022, pp. 888-889.

Sheut-Ling Lam, Marion Criaud, Steve Lukito, Samuel J Westwood, Deborah Agbedjro, Olivia S Kowalczyk, Sarah Curran, Nadia Barret, Chris Abbott, Holan Liang, Emily Simonoff, Gareth J Barker, Vincent Giampietro, Katya Rubia. Double-blind, sham-controlled randomized trial testing the efficacy of fMRI neurofeedback on clinical and cognitive measures in children with ADHD. American Journal of Psychiatry, Vol. 179 No. 12, December 2022, pp. 947–958.

Helpful links:

Pediatrics and Child Health on the efficacy of neurofeedback in the management of children with ADHD

Journal of Attention Disorders: What Do Meta-Analyses Have to Say About the Efficacy of Neurofeedback Applied to Children With ADHD?

ADHD Treatment – Free Page

ADHD Treatment

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ADHD Treatment – There Are Several Good Options

We’ve spent many years treating children and adults with ADHD. It’s heartwarming to see the improvement in a person when everything falls into place. It’s not instant. There are steps along the way. The right diagnosis. Working with parents, family, teachers, and spouses. Finding the best medication. Balancing therapy and medication. Check for other diagnoses and medical conditions hiding behind the ADHD. Usually someone with ADHD want to do well, wants to get things done. but just can’t do it. Get all the parts in place and a while later life is in a better place. They realize that they have more control over themselves and pursuing their daily activities. And, it often comes as a surprise. The treatment doesn’t change a devil into an angel, it evolves a mischievous rascal into putting energy toward becoming a true competitor in life.

A Reader Asks:

With non-controlled drugs available for ADHD why does anyone use any of the stimulants?

Most parents who come with children with ADHD and many adults who present with ADHD ask this same question initially, and it’s a good question. Our Neuroscience Research & Development Consultancy website gets a lot of queries on this topic. As part of our answer we include the next few paragraphs below. The answer is that usually it’s one of the stimulants that works much better and much more quickly than the available non-stimulant medications. When there’s a family of medications that’s known to usually work better, it makes sense to try a few medications in this family of compounds first. If for some reason none of them work well or if they cause problematic side effects, then the next medications to try would be the non-stimulants, medications such as viloxazine (Sebree®) or atomoxetine (Strattera® or generic atomoxetine).

ADHD Treatment – Balancing Practicality Against Biased Opinion

Further down the page we make the case as well as we can that the most well studied medications, with the most well-known safety profiles, are the stimulants. They’ve been in use since the 1950s, and they’re the best tried-and-true medications for ADHD. It is true that these medications are DEA Schedule II. And it’s also true that in some instances they can be abused. But for treating children with ADHD, the stimulants are rarely abused. And the DEA scheduling shouldn’t matter for appropriately handled medications. The focus should be on what works best with the fewest side effects. The medications that are FDA-approved for ADHD that are not Schedule II are considered by many ADHD physicians as second-line treatments to be used if, for some reason, the stimulants cannot be used.

ADHD Treatment – When Not To Use Stimulants

There are times when the stimulants shouldn’t be used. We discuss this topic more fully below, but in short for now… If none of the stimulant medications can be used because they don’t help enough or because they cause too many side effects, then of course it makes sense to avoid them. There are several FDA-approved medications for ADHD that aren’t stimulants to try next. They’re medicines that are taken daily (just as the stimulants are) but the non-stimulant medications take several weeks, up to four to six weeks, to begin to help.

The Medical Letter on Drugs and Therapeutics on One of the Newest of These Non-Stimulant Medications

The Medical Letter on Drugs and Therapeutics is a highly respected medical information source that has been published twice-monthly since 1958. One huge benefit of The Medical Letter is that It’s independent of any pharmaceutical industry influence. It accepts no advertising and has a strict policy that no reprints will be sold to the pharmaceutical industry. It’s supported by subscriptions. In the June 28, 2021, issue The Medical Letter reviewed the latest FDA-approved non-stimulant. (The full Medical Letter reference is at the bottom of this page.) The Medical Letter’s conclusion is below. The conclusion ends with the statement, “Stimulants are preferred for most patients.

The Medical Letter on Drugs and Therapeutics Discussing Viloxazine 

“Standard Treatment — Stimulants such as amphetamines and methylphenidate are the drugs of choice for treatment of ADHD.” “Nonstimulants such as atomoxetine and the alpha2-agonists clonidine and guanfacine are not controlled substances. They are less effective than stimulants but may be preferred for school-age children because they cause fewer adverse effects.”

“Conclusion — In short-term clinical trials, the selective norepinephrine reuptake inhibitor viloxazine (Qelbree) was more effective than placebo for treatment of ADHD in children 6-17 years old. As with atomoxetine (Strattera, and generics), the other selective norepinephrine reuptake inhibitor approved for treatment of ADHD, somnolence, increases in heart rate and blood pressure, weight loss or failure to gain weight, and suicidal ideation may occur with its use. How viloxazine compares in efficacy with atomoxetine or other nonstimulants for treatment of ADHD is unknown. Stimulants are preferred for most patients.

ADHD Treatment Usually Requires a Medication

It’s also true that many parents don’t want to use a medication to treat their child’s ADHD. Similarly, many adults with ADHD don’t want to take a pill every day. But trying to treat ADHD yet avoid taking a medication is usually a mistake. The medications that work to treat ADHD, when you find the right one, will typically help remarkably well with just a few side effects. 

How the Right Medication Can Help with ADHD Treatment

Major ADHD help number one, the right medication will lessen the driven over-activity. In addition, it will help lessen the dilemma of acting before thinking (rather than thinking before acting, the usual best way). And finally, the right medication can help improve clear thinking and focus. That is, for her to do the things now that she wants to do and not daydream or waste time inadvertently doing things that don’t matter to her. When you find the correct medication that works it’s likely that she’ll be more able to make choices to help herself and to succeed more often. Her life will be better in school, at work, and at home with family.

A cute little girl with long brown hair in a pink dress sits with a book in her hands looking vague as a daydreaming bubble and arrows in many directions float around her.
Photo by khamkhor

Finding the Best Right Medication for ADHD Treatment

A child or person is struggling with tasks that those around him seem to find easy to do. The question of ADHD arises, the evaluation is done, and the diagnosis is made. Then the challenge is to find the best medication for him, for her, for yourself. The good news is that there are several medications in different medicine families that are effective for treating ADHD. What matters, and matters quite a lot, is that you work with your physician to find the best right medication. Medication for ADHD is not “one size fits all”. And we emphasize not just a right medication but the best right medication. Some medications will help a lot while others will help just a little or not help at all. Some will have only a few side effects while others might have side effects that make you feel awful.

Your Physician Will Help Find the Best Medication More Quickly

You and your physician need to find the medication for you that has the best balance of helping and with the fewest side effects. But here’s the dilemma: There’s no way to tell for sure what will happen before trying a medication. If your physician does not usually treat people with ADHD, hopefully he can refer you to a physician with lots of experience. A skilled clinician who knows what she’s doing, and who’s working hard to help you, can find this best right medication for you much more quickly.

How Much Does a Medication Help and What Are Its Side Effects?

Once you’re trying a new medication, the easy way to learn if and how much it helps is to ask trusted people around you. Here’s the dilemma. Your brain is your bodily organ that needs the medication. But your brain is also your bodily organ that needs to decide if the medication works. When your brain is trying hard to work how can it, at the same time, know how well a new medication is working. It’s like looking at yourself in a mirror and judging yourself fairly. It’s hard to do.

Trusted Advice from Trusted People

First you need to identify for yourself a trusted relative and/or a trusted close friend. Explain the situation and have them work with you to check out your medication’s benefits and side effects. “Trusted” is an important word here. Someone who is on your side. As the days click by and you’re taking the new medication, ask each of them what they think. For a child, it’s valuable for parents also to go to the child’s school and find out what the teachers are seeing.

Which Medication Works Best and Most Often for ADHD Treatment?

There are several medications that, since the 1950s, have been found to be the medications that most often work best for ADHD. The common name for all these medications is “stimulants” because they are stimulants for people who don’t have ADHD. They don’t work as stimulants for people with ADHD. For people with ADHD they usually make thinking more clear and slow and calm behavior. When started, these medications start working to treat ADHD in a day or two, or within a few days.

How Do These Medications Work?

These medications allow those brain nerve circuits to work better that do the clear thinking and that keep everything, including behavior, under control. And they calm the circuits that push hard to drive activity and action before thinking. They’re safe when given and watched by a physician who knows them and who follows what’s happening with your child. But these medications are not always safe. One has to take them seriously and use them with care.

Which ADHD Treatment Medications Are These?

The typical medications in this group are methylphenidate (e.g., Ritalin®, Concerta®), dextroamphetamine (e.g., Dexedrine®), and the dextroamphetamine/amphetamine combination (Adderall®). All are available as (hopefully less expensive) generics.

Only Certain Physicians Can Write for these Medications

All of the medications in this group are prescription medications that are DEA Schedule II controlled substances. A licensed medical physician has to write the prescription for them. And, not all licensed physicians are willing to work with these medications. Physicians who know these medications well and who regularly treat people with ADHD will write for the prescriptions if they are appropriate.

Mostly, These Medications Are Safe

These medications are mostly safe when used with care and when you’re working with a physician who knows these medications and is experienced in treating ADHD. If the medication you finally choose works well and the side effects are minimal, it can be used for a long time, for years. You might be able to use the same medication for a lifetime if it’s needed for a lifetime. If a medication you try doesn’t work or has problem side effects, stop it and find a different medication or a medication of a different type. Continue your search until you find the one that will work.

CHADD Links (CHADD is Children and Adults with Attention-Deficit/Hyperactivity Disorder.)

Here is a link to a CHADD site discussing medication management for children with ADHD with a long section on use of, benefits of, side effects of, and risks of the stimulant family of medications:

Here is a link to another CHADD site for these same topics for adults with ADHD:

Oppositional and Defiant

Other Types of ADHD Treatment Medication

There are ADHD medications of other types to try if none of the medications discussed above help enough or have too many side effects. These other medications are not stimulants, are taken daily, and take several weeks to work. They might take as long as four to six weeks to start working.

atomoxetine and viloxazine

Two of these non-stimulant, take-longer-to-start-working medications are atomoxetine (Strattera®) and viloxazine (Qelbree®). They’re meant to work in the same way as the stimulants, that is, to boost activity in the brain’s circuits that support clear thinking and that keep everything under control. And, to calm the circuitry driving the activity and action taking place before thinking. While these two medications might be thought of as second-choice medications after the stimulants, some people do find that they are effective and have tolerable side effects. The atomoxetine is FDA-approved for ADHD in children, teenagers, and adults and viloxazine is FDA-approved for children and adolescents ages 6 to 17 (but might also work well in adults).

venlafaxine and desvenlafaxine

This next different family of medications includes venlafaxine (Effexor®) and desvenlafaxine (Pristiq®). Physicians and medical scientists have less information about using venlafaxine for ADHD. And even less information on desvenlafaxine. So, more physicians have experience with the stimulants, atomoxetine, and viloxazine, and fewer physicians have much experience with venlafaxine and desvenlafaxine. These two medications are effective for some people with ADHD, however, so ask your physicians about them. If the other medications listed above aren’t effective for you or cause problem side effects, maybe it’s time to try venlafaxine or desvenlafaxine.

clonidine and guanfacine

This is another completely different type of medication that sometimes helps when treating ADHD. These two medications were originally developed for treating high blood pressure. If a person with ADHD has intolerable side effects with the other ADHD medications discussed above, your physician might suggest you try one of these. Examples are clonidine (Catapres®, Kapvay®) and guanfacine (Tenex®, Intuniv®). They do lower blood pressure and affect heart rate so these vital signs need to be checked regularly while taking these medications. They can also make an otherwise energy-filled child or teenager feel slow and tired.

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Photo by Dwi Rizki Tirtasujana

Be Super Cautious Regarding “Herbs” and “Natural” Products

There are many websites and stores with a marketing “hard-sell” that one does not need real medications to treat ADHD. This is false information and bad information. The natural supplement and herbal market is the wild west, completely not inspected and not regulated. It’s a jungle of a few quality vitamins and many, many bogus substances. Some of the popular commercial hard-sell pitches are for ginko biloba, bacopa monnieri, caffeine (good grief, just have a cup of coffee or tea), L-theanine, rhodiola rosea, phosphatidylserine, omega-3 fish oil (here again, just eat some fish), alpha GPC, huperzine A, L-tyrosine, 5-HTP, and GABA.  Be super cautious, and buyer beware!

ADHD Treatment Is Often Really Successful

Children with ADHD often do much, much better in school and with family and friends when taking one of these good medications for ADHD. Adults with ADHD are more successful at work and have a better family life with their spouse and children when taking the right medication that works well.

autism boy

Therapy – The Essential Non-Medication Part of ADHD Treatment

Along with finding and taking the best right medication, it’s important to become educated about ADHD and about yourself. In psychotherapy or other types of supportive help you can learn about ADHD and how it affects you. Those who have ADHD, whether children, teenagers, or adults, need to be able to work with a good person they trust. Really. It’s true. Having ADHD is not easy. Living with it and getting it treated can be really frustrating and confusing. Look at it this way. This ADHD person is trying to think clearly and get it right. But thinking clearly is the problem. If, at the start, the person could just think clearly they would not need the medication or the therapy. The journey through the jungle goes better with a guide.

Many Non-Medication Choices for ADHD Treatment  

There are many choices for this essential therapeutic help.  Some examples are:

  • Behavior therapy
  • Interpersonal therapy
  • Family therapy
  • Marital therapy (for parents or for adults)
  • Educational approaches, training on specific skills or situations, like:
  • Stress management
  • Test taking in school
  • Dating relationships
  • Group therapy
  • Parenting skills training (raising a child with ADHD, while eventually rewarding, is a fast-moving challenge day-to-day)

Therapy is essential. A physician cannot just give a child or adult a pill and expect everything will go well. It doesn’t. Get into therapy, the therapy of your choice with the therapist of your choice.

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Photo by Victoria_Art (

One Final Word of ADHD Treatment Caution

People who try to treat ADHD without using any medications are making a huge mistake. Whether it’s your ADHD or your child’s, avoiding a medication altogether usually increases the frustration level for everyone. Yes, therapy has an essential role. One cannot throw pill at a person and expect all to go well. But at the same time, therapy without a medication is robbing the person of the best chance she has of having life go well. We know you’ll read many opinions to the contrary, but we assure you that they are complete boloney.

Below are two more links to expand on this topic of therapies for ADHD:

CHADD on Treatment of ADHD

CHADD Treatment Overview for Parents

(CHADD is Children and Adults with Attention-Deficit/Hyperactivity Disorder.)

Literature Reference for The Medical Letter on Drugs and Therapeutics

Viloxazine ER (Qelbree) for ADHD, The Medical Letter on Drugs and Therapeutics, Vol. 63, Issue #1627, June 28, 2021, p. 98 – 100.


ADHD boy in classThe Great Value of Children, Adolescents, and Adults with ADHD

People with ADHD deserve a better reputation, whether they are children, adolescents, or adults. With a correct diagnosis and appropriate treatment they become creative, energetic contributors for themselves and to the world around them. Too often, they’re not shown in a good light, probably due to a missed diagnosis or no treatment. A missed diagnosis or no treatment is caused by the adults around them. Children, after all, cannot on their own seek a diagnosis and pursue treatment. People with ADHD can be a great asset to most situations. Typically they’re bright, easy to work with, and prefer to be problem solvers, not problem creators. That said, some individuals with ADHD can be more complicated. More on that below.

Surprise – Many People with ADHD Are Not Overly Active

A cute little girl with long brown hair in a pink dress sits with a book in her hands looking vague as a daydreaming bubble and arrows in many directions float around her.
Photo by khamkhor

What! Now, wait a minute here. Doesn’t ADHD stand for Attention Deficit Hyperactivity Disorder? Well, yes, it does, and that can cause a lot of confusion. Because, it does seem to make sense that a person with ADHD should be overly active. But it’s not always true. It is true that many children and adults with ADHD really are over active. But it’s also true that many are not very active at all. In fact, some don’t move around much. Individuals with ADHD who appear calmer and less active still find it hard to focus their thinking on one thought for very long. In that way, all people with ADHD struggle with focus whether they’re hyperactive or not.

One of our readers in Boulder. Colorado commented:

It’s upsetting to me that the ADD diagnosis was not recognized in girls 37 years ago. It turns out I had it, that is, I have it, the inattentive type. School was hard. I didn’t do well. Dropped out halfway through college and got married. My daughter was recently diagnosed. Daydreaming, scattered, poor in school. Then it was realized that I’ve had it since I was a kid. Now we’re both taking medicine and life is different. I mean, for me, now I have a life for the first time.

Your situation is certainly a good news / bad news story. It’s true that, while we don’t know all the causes of ADHD, it does run in families. There appears to be some genetic basis for ADHD. And, just as you describe, while the ADHD is there in childhood, often people with inattentive ADHD don’t get a good diagnosis until they are adults. As a result, school years are tough. These kids get reprimanded a lot at home and in school for poor attention. As you describe with your daughter, they’re daydreamers. Assignments don’t get finished. Without the hyperactivity no one thinks of ADHD. Your history is also typical in that this is an especial problem for girls who might be more quiet and passive than hyperactive boys. In the classroom the ADHD diagnosis does not jump out at people. Another usual part of your description is that adult women too often are not recognized as having ADHD until one of their children is diagnosed and Mom sees the similarities in her history situation and their child’s situation.

The “Attention Deficit” Part of ADHD

It gets less public discussion than the hyperactive part, but there is this “attention deficit” part. Attention deficit means that the person has trouble focusing their attention for very long. Since they’re not all-over-the-map with activity, these individuals sit quietly, daydreaming, their mind wandering from one thing to another. And that daydreaming is the dilemma. Girls and women are more likely than boys and men to have this calmer type. Remember, we’re trying to get more girls into STEM studies. Clearly this daydreaming rather than focusing creates problems in school in younger years and at work as careers move forward. Because they’re sitting quietly and not disruptive, they don’t come to anyone’s notice. But because they’re daydreaming and not focused, it’s much harder to learn. They can be really smart but not get anything done. That can put STEM (Science, Technology, Engineering, and Math) down the drain.

The Diagnosis of ADHD – It’s How the Brain Is Wired

ADHD is a brain-based condition. It’s not imaginary and not changeable with stern parenting or strict education. It’s how a person’s brain is wired, hard-wired, often for life. Some people with ADHD have the “inattentive” type while others have the “hyperactive/impulsive” type. Inattention means that your mind drifts and allows you to wander off the task in front of you. It’s difficult to pay attention over time to the narrow, limited focus of a job or task.

The Hyperactive Part of ADHD

The “hyperactive/impulsive” type is the ADHD type that most people think of when they think of ADHD. The overly active, or “hyperactive”, means full of energy and continuously on the move, not staying still. Or at least this is the way that the person with ADHD might appear to parents, friends, spouses, and relatives who do not have ADHD. The social situations in which this individual finds himself are mainly a problem if he is restricted and cannot freely move around. If stopped, he/she becomes really uncomfortable. Maybe uncomfortable to the point of being upset and disruptive. In the classroom or in a business meeting these individuals talk out of turn. Children “fidget” even when they’re asked to sit still. If he cannot move much he might start tapping his fingers or the toes of his shoes. Anything that helps “get the wiggles out.” They’re restless. Continuously.

Young boy about six years old perched on a Speedee brand bright green all-terrain quad bike with a blank background, perhaps in a studio. He's looking excited and confident, hands on the handlebars and making motor revving sounds while a friend that's his age looks on. On his knitted cap it says, "Be Cool".
Photo by White77

The Impulsive Part of ADHD

The impulsive part of ADHD might be funny if it didn’t so often lead to dilemmas. The quick action of people with ADHD means that at times these individuals’ bodies move and act before the executive circuits of their brain have even thought about it. The problem with this situation can be shown using the old military target practice firing sequence of shooting a weapon at a target: ready, aim, fire. The impulsive person with ADHD might shoot the weapon before any thought takes place, then he thinks about it and gets ready and aims. One can see the risk. The front yard summersault can start and complete before the child thinks about the mud puddle just ahead. Another aspect of this is interrupting others when they are talking. Or bursting into a social group uninvited. And making snap decisions, even important ones with long-term consequences, without much thought.

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As These 3 Parts of ADHD Sort Out Among Individuals…

As we sort these 3 parts of ADHD among the people who have ADHD, it gives us 3 types:

  • A combined inattentive and hyperactivity-impulsivity type
  • A mostly inattentive type
  • A mostly hyperactive-impulsive type

ADHD Remains a Medical Puzzle

Though all the doctors doing research on ADHD think they’re moving closer to what it really is and what causes it, for now it remains a puzzle. And because no one has nailed down the true cause, everyone thinking about it comes up with a “laundry list” of causes. Some are experts and some are not. Those who believe in one or another cause come up with the reasons why they think their view is the correct one.

Here are a few examples

  • maybe a family history and inherited genes cause ADHD
  • or, a mother’s cigarette smoking, alcohol use, or drug use during pregnancy
  • maybe a mother’s exposure to harmful environmental toxins during pregnancy
  • perhaps direct toxic exposure of the person with ADHD, like high lead levels at a young age
  • or low birth weight
  • maybe brain injury during birth or while growing up

Then Reality Steps In… Complex ADHD Situations

The ADHD described at the start of this page is just typical, garden-variety, uncomplicated ADHD. And those who have usual ADHD are lucky. In the larger real world the medical condition of ADHD can get complicated. Along with ADHD children can have learning disabilities, anxiety disorders, conduct problems, depressed mood states, and the poor judgement to use harmful drugs and/or alcohol. Mix any one, or two, or three of these situations with ADHD and the result is a person who really struggles in life. A good doctor who believes in the person with a complicated ADHD situation can be a powerful support to assist the child, adolescent, or adult to work through everything and come out more of a winner.

ADHD Treatment

There’s more complete information on treating ADHD on our main page on ADHD Treatment.

Here’s A Brief Overview of Treating ADHD

To put it right out in front, a person with moderate-to-severe ADHD needs a medication. There’s no way around it. Many people hope to avoid using medications, which is sort of understandable. Then there is a set of people against medication for ADHD who do their best to make it sound bad. In a negative tone of voice they refer to ADHD medications as drugs or pills. If these people felt the same about insulin for type-1 diabetes many people with type-1 diabetes would be dead. Parents often try to avoid using a medication for their children, which is, again, understandable. But skipping a needed medication makes things worse, both in the short term and life-long. It might be that a person with mild ADHD could work it out, make it through life and not use a medication, and still win. But even so, why? Why, on purpose, spend a life working hard to get to 80% when one can work much less hard and make it to 95%?

Here’s Why People Need Medication for ADHD

In the old days of black-and-white television shows of the 1950s there was a popular series, The Adventures of Robin Hood. A guy in Robin Hood’s gang was Little John, a large, strong, muscle-man. In one episode, Little John (played by Archie Duncan) is carrying a big wooden box. As they walk through Nottingham Forest, he struggles more and more to carry it. Finally, he can’t keep going. He can’t understand why he has this “weakness” because the box is not that big and he can carry just about anything of any weight. He’s the “Lou Ferrigno”, the “Arnold Schwarzenegger”, of Robin Hood’s band of thieves.

Why Little John Feels Weak; Mystery Solved

Little John decides that there must be some wicked black magic, a curse on the box, that’s making him weak. But when they open the box, he finds that it holds a stone block used for minting the King’s gold coins. That’s why he couldn’t keep carrying it. It was one huge piece of solid rock. The point of the story is this. Anyone can put a 10-pound backpack on their back and hike all day. But put on a 150-pound backpack and most of us would collapse in a few steps. Without medication, you’re asking a person with ADHD to carry around a 75-pound backpack all the time, for life. They are going to struggle and at times fall. With medication, that backpack shrinks to 10-pounds like the rest of us can carry.

Here’s What Medication Does for ADHD

The medications are supposed to lessen the over activity, lessen the impulsive actions, increase the individual’s ability to focus, and improve how long the person can stay focused. If all this works they do better in school, earn more money and get more promotions at work, and are more fun and happier at home with family.

Choosing Which Medication for ADHD

The Stimulants

Methylphenidate, the amphetamines, and other “stimulant” medications work best for most people with ADHD. While they are stimulants for people who don’t have ADHD they’re calming if you do have ADHD. It’s the way the ADHD brain works. At the right dose, these medications help the brain’s executive circuits. The person can think more clearly and keep everything under better control. These medications also turn down the volume knob on the brain circuits that push for endless on-the-go activity and change the brain’s circuit activity so the person is less impulsive. With a good physician following along, for most people these medications are safe to use.

A Reader In New Zealand Wrote…  No Amphetamines There!

A reader in New Zealand wrote to say that they are not allowed to use any amphetamine medications, not even to treat ADHD. They can get methylphenidate medications, like Ritalin, Ritalin LA, and Concerta for ADHD. But they can’t get amphetamines like Dexedrine, Adderall, Adderall XR, or Vyvanse. This isn’t good for some people with ADHD. While most people with ADHD do well with methylphenidate, some children, adolescents, and adults instead need one of the amphetamines.

Non-Stimulant Medications

There are other medications that sometimes work when the stimulants don’t work or when they cause problem side effects. These medications are not stimulants. These non-stimulants take a few weeks to start working. The stimulants start working right away, within a day or two.  See the page on ADHD Treatment for more information about the non-stimulants.

A Person with ADHD Needs More Than Just a Tablet or Capsule

Let Us Show What We Mean by Talking About Diabetes

Take Type I diabetes, for example, the type that requires insulin injections. If a teenager gets Type I diabetes, how well would he do if you gave him one of the little bottles of insulin and a syringe with a needle and said, “There you are,” and sent him home. No instructions. No explanations. We can say for sure, he would not do well. He wouldn’t know how to do it. That’s why there are so many huge medical clinics set up everywhere for diabetes education.

Young blond girl about 10 years old looking studious and sitting at a kitchen table with bananas and peaches in a tray in the foreground. She's looking at a laptop computer and has books beside her on the table.
Photo by Markus Trier (Follow Muscat_Coach on Facebook)

Educating Someone About Their ADHD

Like the diabetes example above, just tossing a medication at a person who needs it for ADHD doesn’t help. Someone with ADHD needs to learn all about this brain-based medical condition. The education and support might come in the form of “therapy”. The combination of the right medication and best-fit therapy is the most powerful way to lessen ADHD. There are many types of therapy. There’s behavior therapy and interpersonal therapy. Family therapy or marital therapy (for parents or for adults) might be helpful. Training on specific skills or situations (stress management, test taking in school, dating relationships) might make success in life more likely. Another helpful set of skills one can learn is parenting skills training. Raising a child with ADHD, while rewarding in the long run, is a fast-moving challenge day-to-day. There’s more information about therapies for ADHD on the ADHD Treatment page.

Did You Know That…  Astronaut Scott Kelly has ADHD?

Astronaut Kelly has been on the lecture circuit. As part of his talk he says that he has ADHD. He described it at the Marin Speaker Series in February 2018 (San Rafael, Marin County, California). He said that he was a child before ADHD was considered as a diagnosis for problems in school, but he feels certain that if he were a child today he would be diagnosed as having ADHD.

Scott Kelly’s Santa Barbara Independent Interview

Astronaut Kelly also discussed his ADHD in an interview with the Santa Barbara Independent, a news, arts, and alternative newspaper published every Thursday in Santa Barbara (California). He said that, as a child, every year he promised himself that he would pay attention in class and finish his homework. It never happened. He could not get it done. Then he was inspired by the book about astronauts, The Right Stuff, and used this as his motivation to learn new habits of study, school, and work to become an astronaut. He succeeded, of course, and, among other achievements, spent a year on the International Space Station.

Helpful links:

Attention Deficit/Hyperactivity Disorder – National Institute of Mental Health

Attention Deficit/Hyperactivity Disorder – Center for Disease Control and Prevention (CDC)

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)

Attention Deficit/Hyperactivity Disorder in Children – The Mayo Clinic

What is ADHD? – American Psychiatric Association