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Treatment of ADHD in Children

Dr. Yuval Raveh, Specialist in Child and Adolescent Psychiatry, Director of the Department of Child and Adolescent Psychiatry in the Ministry of Health
15 October 2025

Attention Deficit Hyperactivity Disorder (ADHD) is a complicated condition that affects many children, but its symptoms can be managed with various strategies. The main goal of treatment is to help children manage their symptoms, face challenges, and improve their quality of life, self-confidence, and social skills.

Medication is the primary treatment and has been proven effective and safe in many studies. Different types of medications are available, and a healthcare professional will determine which is best for your child. Other therapies, such as psychotherapy, parent training, and occupational therapy, may also be included in the treatment plan.

Not treating ADHD can lead to serious issues, including problems in school, feelings of loneliness, and difficult behaviors. Early intervention can prevent future challenges, boost self-esteem, reduce behavioral problems, and help children reach their academic potential.

Many parents find it hard to decide whether to use medication. It’s essential to consult a professional for answers and to explore the best options for your child.

ADHD is a complex condition, but there are many ways to manage it and improve the quality of life for affected children. Treatment does not “cure” ADHD; it helps manage symptoms and challenges, allowing children to function better in school, socially, and in their everyday lives.

The primary goal of therapy is not to turn the child into a “super student,” but to help them cope with their challenges in a supportive and empowering way. Therapy can boost self-confidence, self-esteem, and social well-being. It can also help children manage tasks that require focus and patience, instead of avoiding them. This approach helps children meet age-appropriate expectations, like staying in one place for a longer time in class and participating in lessons as needed.

The Importance of Treating ADHD

  • Improving self-esteem
  • Preventing future difficulties
  • Reducing behavioral challenges
  • Helping maximize potential

Clinical experience shows that not treating children with ADHD can lead to serious problems. Research indicates that children who don’t get the right treatment have a hard time fitting into regular classrooms, especially in today's crowded classrooms.

Without treatment, a child may feel different and alone, which can lead to issues like behavioral disorders or avoiding schoolwork. The effects go beyond just poor grades; children may act out or try to be the class clown and feel like they are failing. They often face rejection from teachers and peers, causing significant emotional pain, low self-esteem, and trouble making friends. In severe cases, this can lead to frequent school changes or even dropping out.

Benefits of treating ADHD

  • Better self-esteem: Success in school and social situations can boost confidence.

  • Preventing future issues: Early treatment can stop emotional and behavioral problems from developing later.

  • Less behavioral trouble: Treatment helps with emotional control and reduces the chance of behavioral issues.

  • Helping achieve academic potential: Proper treatment can greatly improve focus and learning skills.

Important to know

Important to know

Children with ADHD who are smart may do well in early school years. However, as academic and social pressures increase in later grades, the challenges of ADHD become more noticeable. Early diagnosis and treatment can help avoid future problems.

Types of treatment for ADHD

The treatments listed here are appropriate for children aged 6-18 years (and sometimes for younger kids).

  • Medication
  • Psychotherapy
  • Parental training
  • Occupational therapy

Types of medication

Medication is important, and many studies support its effectiveness. If your child is diagnosed with ADHD, professionals will probably recommend it. Never give your child (or yourself) any medication without a prescription or medical advice.

The largest and most effective group of medications for treating ADHD targets hyperactivity and impulsiveness. These medications can help both a child who throws chairs and a girl who sits quietly but has a wandering mind, as the root of their issues is similar. It's important to remember that these are the oldest medications that have been thoroughly studied, including specific research on children, and they are proven to be effective and safe. Research shows that these medications help reduce symptoms in about 80% of children, with that number rising to over 90% when the medication is adjusted as needed.

How Stimulants Work

These medications boost the activity of brain systems that are responsible for executive functions and controlling behavior, which are often underactive in children with ADHD. There are different types of medications in this group, varying in both the active ingredient and how they release in the body. These variations affect how long the medication lasts. The most common medications contain a substance called “methylphenidate,” and they are categorized based on their release mechanism: immediate-release medications last for 4 hours, while sustained-release options can last 6, 8, 10, or 12 hours.

Common Side Effects

  • Loss of appetite: This is the most frequent side effect, affecting over 90% of children. If your child is taking the medication and eating normally, the effectiveness of the medication should be reviewed. Loss of appetite is often disliked by children. To manage this, it’s best to have them eat before taking the medication and plan a large meal after its effects wear off. To prevent extended periods without food, it’s a good idea to send them to school with food they enjoy. Additionally, loss of appetite can be confused with thirst, so it's very important to ensure they drink enough fluids. While the body can go without food for several hours, not having water can cause issues.

  • Palpitations: This refers to a rapid heartbeat or the feeling of the heart pounding. This usually happens shortly after taking the medication and tends to decrease as the body adjusts to it.

  • Hypersensitivity: This shows up as frequent crying and being easily upset. It's important to keep track of how severe this symptom is and how it affects the child's life.

  • Nausea: This usually goes away after a short time.

  • Insomnia: Since the medication is a stimulant, taking it at bedtime might make it hard to fall asleep. This effect is stronger with long-acting medications.

  • Tics: The medication may make existing tics worse. It's important to understand that tics and ADHD often appear around the same age. So, if tics happen after starting the medication, the medication doesn't cause them; it may just make them more noticeable. Tics would likely have developed even without the medication.

  • Anxiety: Stimulant medications may increase feelings of anxiety. If anxiety becomes very severe, consider changing the medication. For children with ADHD who have trouble in social situations because of anxiety, medication can actually help reduce these feelings.

  • “Rebound”: When the medication wears off, behavior may temporarily become more intense. For example, if a medication works for four hours, the child might become restless for about half an hour after that. The longer the medication lasts, the lower the chance of a rebound effect. Ideally, rebound effects should happen at home rather than during school.

Side Effects That Must Be Immediately Addressed

Serious sadness or social withdrawal caused by the medication is a serious side effect that shouldn't be ignored. In these cases, the dosage should be changed or the medication switched. Sometimes, children may not express their feelings openly, so it's important to ask teachers and friends about their behavior during class, breaks, and social situations.

These medications are usually not the first choice for treatment because they are generally less effective in managing all three groups of ADHD symptoms: hyperactivity, impulsivity, and inattention. However, they can be effective and are recommended when stimulants don't work. They also have other benefits, like lasting longer and allowing for dosage adjustments as needed.

Atomoxetine

Atomoxetine is a medication used to treat depression and anxiety, and it has been found to be effective for ADHD. It needs to be taken every day, not just on school days, but also on weekends, holidays, and vacations. You will start to see its effects about 3-4 weeks after beginning treatment, and that is when long-term improvements may start to happen. The dosage should be increased slowly and stopped gradually.

This medication works for both ADHD and anxiety, which is helpful for children who have both issues. However, it is not used as often because it is generally less effective than other common ADHD medications. On the plus side, it has fewer side effects, making it easier to use. It is usually suggested for children who have anxiety alongside ADHD or when standard treatments don't work. Unlike stimulant medications (like methylphenidate), this medication typically does not cause loss of appetite.

Common Side Effects

  • Digestive Issues: Such as nausea, constipation, and stomach pain. These side effects usually happen in the first few days of treatment and often go away afterward.

  • Headaches: Common during the early days of treatment.

  • Sleep Problems: Can occur if the medication is taken in the afternoon or evening.

  • Fatigue

Side Effects That Need Attention

In rare cases, there may be a sudden change in behavior, like an overly high mood or long-lasting insomnia. If this happens or if you have any concerns, it's important to get medical help right away.

Medications for High Blood Pressure That Are Also Used for ADHD

Medications like clonidine and guanfacine can help with ADHD symptoms, but they are not usually the first choice for treating this condition. However, they can effectively manage ADHD symptoms, as well as behavioral issues and tics, making them suitable in some cases.

Side Effects

  • Fatigue

  • Dizziness (especially when changing positions quickly)

  • Dry mouth

Side Effects That Need Attention

If you experience dizziness and feel unsteady, it’s important to stay hydrated and change positions slowly, such as moving from sitting to standing or from lying down to sitting. If these side effects continue, seek medical help.

A preparation with the active ingredient methylphenidate is available as a patch. The patch releases the active ingredient over several hours, providing a longer-lasting effect. This option can be convenient for children who have trouble swallowing pills. Additionally, the patch does not affect the digestive system. However, its main downsides include its size and cost, and factors like sweating and dirt can cause it to loosen and fall off, making it less effective.

Antidepressants and Anti-Anxiety Medications

These medications contain active ingredients related to the brain chemicals serotonin and norepinephrine, and sometimes dopamine. They are used when other treatments have not worked. Taken daily, their side effects are similar to those of atomoxetine.

Considerations When Taking Medication

  • Proper Use: It is important to give the recommended dose at the right times and to supervise the child during this process.
  • Patience: Parents, the child, and the school need to understand that it takes time to adjust to the medication and its effects. It is essential to be patient and allow time for it to work.
  • Trial and Error: There are many types of medications, and it’s not possible to know which one will work best for your child without trying. Therefore, it is important to give each medication a fair chance and, if it doesn’t work, to try another until finding the most effective option.
  • Side Effects: Some side effects may worry parents. It is important to inform the doctor about any side effects experienced. The medication may be adjusted or changed to reduce these effects.
  • Duration of Effect: ADHD medications work quickly, meaning they begin to take effect within minutes of being taken.
  • Discretion: The way medication is taken can be flexible. For example, one might choose to take it on school days but not on weekends, or take it on exam days while skipping it on other days. It’s also possible to combine different types, such as taking long-acting Ritalin in the morning and short-acting Ritalin later in the day. This should only be done with medical advice and professional supervision.

Important to know

Important to know

Most ADHD medications can be taken with other medications. It is essential to inform the treating physician to check for any harmful interactions or contraindications.

Common Reasons for Avoiding Medication

Many parents are unsure about giving medication to their children with ADHD for several common reasons:

  • Fear of side effects: Medications can have various side effects. It's important to follow medical instructions closely and talk to the doctor about any concerns.

  • Fear of medication dependence: Some people mistakenly believe that ADHD medications can lead to addiction. It's essential to know that when used correctly under a doctor's supervision, these medications do not cause addiction.

  • Preference for “natural” treatment: Some parents want to try “natural” approaches to treating ADHD, like diet changes, supplements, or exercise. While these methods can support medication, they often aren't effective on their own, and there's not enough scientific evidence to prove they work well.

  • Fear of social stigma: There are many negative views about using ADHD medications, which can make parents worried about how others might react.

  • The misconception that “ADHD medication is like illegal drugs”: This is a myth. Unlike illegal drugs, ADHD medications are taken under medical supervision and can help children focus. When used legally and properly, these medications are not addictive and are safe.

If your child has ADHD, it's normal to have worries and questions about using medication. It's important to discuss these with a doctor who specializes in ADHD to make the best choice for your child.

Non-Medication Therapeutic Options

In addition to medication, psychological therapy is recommended, especially for children facing other challenges like behavioral issues, social difficulties, low self-esteem, anxiety, or avoidance. Psychological therapy is usually more effective when combined with medication rather than used alone. This can include art therapy.

Parents should participate in sessions with a child psychologist, clinical social worker, or art therapist. Involving parents can help them prepare for what's ahead and manage their child's unique challenges. It's best to choose a qualified therapist who works with children in general and specifically with those who have ADHD.

Occupational therapy helps children with ADHD improve their daily functioning. One effective method is Cog-Fun (Cognitive Functional) therapy. When used with medication, this therapy can enhance the child's quality of life.

It's important for those choosing this therapy to find occupational therapists who specialize in it, as it requires specific tools and equipment.

Food Supplements

There isn't enough scientific evidence to support the effectiveness of alternative therapies for children with ADHD. However, some dietary supplements, like phosphatidylserine and omega-3, may help reduce ADHD symptoms when used alongside medication. If you choose to add food supplements to treatment, make sure they support, rather than replace, medication.

Computer Training-Based Therapies

Biofeedback and neurofeedback are therapies that aim to control automatic responses, like heart rate (biofeedback) and brain activity (neurofeedback). Research on these therapies has shown mixed results regarding their effectiveness. Long-term studies have not proven these therapies to be very effective. Additionally, they tend to be expensive and are not typically covered by health insurance plans.