Changes to ADHD Guidelines and Tips for Treating ADHD

James Sherer, MD, an addiction psychiatrist, discussed evolving diagnostic and therapeutic considerations in attention-deficit hyperactive disorder (ADHD). Recent revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) broadened ADHD criteria, increasing inclusivity by raising the age of symptom onset from 7 to 12 years and reducing required associated symptoms from 6 to 5. The DSM-5 also emphasizes the importance of collateral information, such as school records or family reports, when confirming a diagnosis.

Sherer reaffirmed that psychostimulants remain the first-line and most effective therapy for ADHD, with nonstimulant options available for cases involving contraindications (eg, cardiac arrhythmia, seizure history). He noted the recent US Food and Drug Administration approval of viloxazine, a nonstimulant with antidepressant-like properties, as an additional treatment option for pediatric patients. He encouraged clinicians not to avoid stimulant prescribing due to addiction concerns, citing evidence that appropriate stimulant use rarely leads to misuse.¹

Adjunctive lifestyle interventions—structured time management, organizational strategies, and technological tools such as calendars and reminders—were highlighted as essential components of comprehensive care. Sherer also mentioned the Pomodoro technique as an effective method for improving sustained attention.

He emphasized sex-based clinical differences: women more often present with inattentive symptoms and comorbid mood disorders, whereas men more frequently exhibit hyperactive and impulsive behaviors.² Sherer also underscored the strong epidemiologic association between ADHD and substance use disorders, possibly due to overlapping neurobiologic and genetic factors. Despite this comorbidity, he concluded that ADHD remains a gratifying and rapidly evolving area of psychiatric practice, offering significant therapeutic impact.

References

1. Chang Z, Lichtenstein P, Halldner L, et al. Stimulant ADHD medication and risk for substance abuse. J Child Psychol Psychiatry. 2014;55(8):878-885.

2. Stibbe T, Huang J, Paucke M, et al. Gender differences in adult ADHD: cognitive function assessed by the test of attentional performance. PLoS One. 2020;15(10):e0240810.