Are We Relying Too Much on Medication to Manage ADHD in Children, and What Alternatives Should We Consider?

Disclaimer: Dr. Ryan Yam is a Doctor of Psychology (Psy.D.), not a medical doctor. This article is for informational purposes only and does not constitute medical advice or consultation. Please seek the guidance of a licensed medical professional for additional medical consultations or advice.

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most commonly diagnosed neurodevelopmental conditions in children. A recent meta-analysis suggests that there is approximately 1 in 9 U.S. children have ever received an ADHD diagnosis (11.4%, 7.1 million children), and 10.5% (6.5 million) have current ADHD (Danielson et al., 2024). The ADHD hallmark symptoms—persistent inattention, hyperactivity, and impulsivity—can significantly disrupt home and school functioning. From my experience, parents often seek healthcare providers for solutions, which usually become a diagnosis and subsequent prescription of ADHD medications. However, are we relying too heavily on medication as a quick fix, and are there alternatives that could better address the complex challenges ADHD presents?

The Role of Medication: Helpful but Limited

Medication, such as stimulants, is the most common form of treatment to manage ADHD symptoms among U.S. children and adolescents with ADHD (Danielson et al., 2024). They provide a fast boost in focus and self-regulation for children and adolescents. However, the problem is that the medication alone does not address the full scope of challenges that children with ADHD face. From my clinical and school experiences in the past few years, children and adolescents who take medications may have improved focus and hyperactive behaviors. Still, they cannot always complete tasks or carry out the activities they want to do. For example, they may sit still and look at the materials they were asked to complete but often spend too much time on them or have no clear idea of how to finish them. These challenges come from the foundational ADHD symptoms, which result from deficits in executive functions, such as difficulty organizing or initiating tasks, regulating emotions, being flexible, self-awareness, and managing time. These deficits remain significant hurdles even when symptoms are partially managed through medication.

Additionally, medication efficacy varies depending on the ADHD subtype. Research by Preston et al. (2021) notes that stimulants are less effective for inattentive-type ADHD, raising questions about whether they are the best solution for every child.

The Overdiagnosis Dilemma

It is commonly said that ADHD is overdiagnosed and that children are overly prescribed ADHD medications. There is concern about how ADHD is diagnosed. Often, diagnoses are based on limited tools, such as rating scales/questionnaires completed in a clinic or school in a limited time, without a comprehensive evaluation of the child's medical history, family dynamics, and environmental factors.

Conditions such as brain damage, anxiety disorders, agitated depression, situational stress, bipolar mania, prepsychotic conditions, impaired affect regulation associated with severe early abuse or neglect, and boredom may present with hyperactivity and inattention, which mimic ADHD symptoms (Preston et al., 2021). Without an in-depth understanding of the root cause of the symptoms, children may be inaccurately diagnosed with ADHD and unnecessarily placed on ADHD medication. Still, their core conditions remain unaddressed.

Disparities in Diagnosis and Treatment

One of the most concerning aspects of ADHD diagnosis and treatment is the racial and ethnic disparities that persist. Research by Coker et al. (2016) highlights that African American and Latino children are less likely to be diagnosed with ADHD and prescribed medication than their white peers. Systemic barriers, such as limited access to healthcare and cultural stigma surrounding mental health, play a significant role.

Many people may ask: How come there is limited access to healthcare? Doesn't the Healthcare Act protect everyone in the United States? Sadly, African American parents often express mistrust in medical professionals due to their history of racial discrimination. They usually voice concerns about whether the recommendations truly serve their child's best interests. In contrast, Latino families may face additional barriers, such as language differences and fears related to immigration status, further limiting access to appropriate diagnosis and treatment.

Parents' Perspectives on Medication

Parental attitudes toward ADHD medication vary widely, often influenced by cultural and socioeconomic factors. Some parents view medication as necessary for their child's academic success, while others are wary of potential side effects or the stigma associated with medication. For example, Asian parents may believe the medication would fix their children's attention and/or hyperactive issues in class, leading to academic success. In contrast, African American parents often resist using medicines due to their concerns about their long-term side effects. ADHD neurology could have been a distinct survival advantage in a hunter-gatherer culture (Lloyd, 2015). Therefore, it is understandable that some cultures may not view ADHD as a "disorder" if they hold the perspective of ADHD symptoms being important survival skills.

Does it mean wealthy parents' children often get treated well? Parents with greater resources may rely heavily on medication to manage their children's symptoms due to their preference for quick solutions. Unfortunately, this overreliance on medication may overlook the importance of evidence-based psychosocial interventions, such as parent management training and family therapy.

Alternative Evidence-Based Interventions

Medication should never be the sole focus of ADHD treatment. A more comprehensive approach includes:

Parent Training and Behavioral Therapy: Teaching parents strategies to shape their child's behavior and improve emotional regulation is crucial. Parent training is based on a positive reinforcement approach to empower families to create a supportive home environment that fosters their child's development.

Executive Function Skill Development: Children with ADHD struggle with executive functioning, such as planning, organizing, and self-monitoring. Cognitive training programs, like Cogmed and cognitive behavioral therapy, can help strengthen these skills and improve overall functioning.

The Way Forward

While medication can help manage symptoms, it is not a cure-all. Culturally sensitive care and increased access to mental health services can help bridge the gap in diagnosis and treatment among underserved populations. Besides, clinicians must use a comprehensive evaluation to ensure that ADHD is not misdiagnosed. Children benefit most from treatment plans that include behavioral therapy, executive function skill-building, and culturally informed care.

We must recognize that ADHD is not just about inattention or hyperactivity. It is about understanding each child's unique needs and providing them with the tools to thrive—not just survive. Medication can be helpful in the toolkit, but it should never be the only one. Childhood mental health problems are more likely to lead to full recovery and psychological well-being if addressed before the age of 14. (Lloyd, 2015) The myth that children will "grow out" of ADHD needs to be replaced by the understanding that the sooner treatment is started, the better the outcomes for the child.

About the Author

Ryan Yam, Psy.D.

Licensed Educational Psychologist and founder of Dual Minds Psychology. Dr. Yam specializes in ADHD treatment, executive functioning skill development, and culturally sensitive care for children and adolescents.

References:

Danielson, M. L., Claussen, A. H., Bitsko, R. H., Katz, S. M., Newsome, K., Blumberg, S. J., Kogan, M. D., & Ghandour, R. (2024). ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment. Journal of Clinical Child & Adolescent Psychology, 53(3), 343–360. https://doi-org.alliant.idm.oclc.org/10.1080/15374416.2024.2335625

Coker, T. R., et al. (2016). Racial and ethnic disparities in ADHD diagnosis and treatment. Journal of Developmental and Behavioral Pediatrics, 37(6), 459-466.

Preston, S. L., et al. (2021). Medication response in children with ADHD subtypes: A review of the literature. Journal of Attention Disorders, 25(8), 1055-1064.