Conversations in ADHD: Highlights From APSARD 2026

Experts from a range of specialties in attention-deficit/hyperactivity disorder (ADHD) convened to share emerging clinical issues and research at the 2026 conference of the American Professional Society of ADHD and Related Disorders (APSARD). From new pharmacological data to ADHD and pregnancy, here are some key moments to catch up on from APSARD.

See our full APSARD coverage here.

Stimulant Medications in Childhood and Future Substance Use Risk

Many parents have concerns about the impact of ADHD medications on their child’s risk of substance use disorder, but as presenters Brooke Molina, PhD; Brian D’Onofrio, PhD; and Ryan Sultan, MD, outlined, medication use in childhood does not appear to predict substance use.¹

From the research we do have, Molina pointed out that factors driving ADHD treatment and substance use disorder may account for associations between the conditions. Severity of symptoms, educational and social functioning, parental psychopathology, family involvement, and access to resources (education, income, social network) can affect both seeking ADHD treatment and the risk of substance use disorder.

The clinical samples available with longitudinal data on stimulant medication and substance use mostly include a research-based diagnosis in childhood, are well characterized clinically, and are prospectively studied. Measuring substance use in these types of studies is important, Molina asserted, because elevated risk begins with use at a young age before substance use disorder develops and because it measures later-in-life consequences such as substance use disorder treatment.

D’Onofrio pointed out that from some observational studies, the association between stimulant medication use and substance misuse was moderated by age of medication initiation and length of treatment. In fact, findings from some studies indicated that stimulant medication was associated with reductions in more serious substance use issues (ie, needing to seek emergency care, death related to substances).²

Of some of the more well-known samples, most found a neutral association of ADHD treatment in childhood and later substance use or a protective effect of ADHD treatment in childhood against later substance use.^3-5

References

1. Molina B, D’Onofrio B, Sultan R. Do stimulant medications prevent substance use by people with ADHD: untangling the evidence for clinical application. Presented at: American Professional Society of ADHD and Related Disorders; January 15-18, 2026; San Diego, CA.

2. McCabe SE, Figueroa O, McCabe VV, et al. Is age of onset and duration of stimulant therapy for ADHD associated with cocaine, methamphetamine, and prescription stimulant misuse? J Child Psychol Psychiatry. 2024;65(1):100-111.

3. Groenman AP, Schweren LJS, Weeda W, et al. Stimulant treatment profiles predicting co-occurring substance use disorders in individuals with attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry. 2019;28(9):1213-1222.

4. Harty SC, Pedersen SL, Gnagy EM, et al. ADHD and marijuana-use expectancies in young adulthood. Subst Use Misuse. 2015;50(11):1470-1478.

5. Molina BSG, Howard AL, Swanson JM, et al. Substance use through adolescence into early adulthood after childhood-diagnosed ADHD: findings from the MTA longitudinal study. J Child Psychol Psychiatry. 2018;59(6):692-702.

Risk-Risk Analysis for Continuing ADHD Pharmacotherapy During Pregnancy

“This is the hottest topic in ADHD,” said Greg Mattingly, MD, continuing the conversation on the effects of altering ADHD pharmacotherapy on both mothers and their developing children. Presenters Allison Baker, MD; and Kathrine Bang Madsen, PhD, showcased the risk-risk analysis strategy that may be most beneficial for clinicians helping patients decide whether to continue medication into pregnancy.¹

Baker outlined how ADHD symptoms can become more challenging to manage during pregnancy. As a result, many women have a desire to continue their medication after becoming pregnant. For the perinatal period, there is a range of nonpharmacological treatments; however, some patients may still need their medication for daily functioning. These patients should consider continuing their medication through pregnancy, Baker recommended. In milder cases not requiring medication for everyday functioning, clinicians can provide psychoeducation, cognitive behavioral therapy, dialectical behavioral therapy, and mindfulness exercises.

Clinicians should not jump to discontinue pharmacotherapy for ADHD immediately when a patient becomes pregnant, Baker posited. Findings from a study “highlighted that the decision, very strictly, of discontinuing medication may roughen ADHD symptoms, specifically functional impairment, as well as be a vulnerability factor for mood symptom roughening,” Baker said.^1,2 Clinicians must consider the balance of risks and benefits for continuation vs discontinuation, Baker advocated.

Bang Madsen highlighted recent research on ADHD and pregnancy, framing the essential questions that patients are asking:

• If I continue my medication, what could happen to the baby?
• If I stop my medication, what could happen to me?

Common concerns about the potential impact of stimulants on pregnancy often include congenital malformations, increased blood pressure or vascular tone, increased risk of miscarriage in already vulnerable pregnancies, and complications such as preterm birth.¹

A risk-risk analysis, rather than a risk/no-risk analysis, is essential when deciding with patients whether to continue ADHD medication into pregnancy, the presentation concluded.

References

1. Baker AS, Madsen KB. ADHD and pregnancy. Presented at: American Professional Society of ADHD and Related Disorders; January 15-18, 2026; San Diego, CA.

2. Baker AS, Wales R, Noe O, et al. The course of ADHD during pregnancy. J Atten Disord. 2022;26(2):143-148.

Innovation in ADHD Medication With Ongoing Trials

It is an exciting time for new treatment approaches for ADHD, particularly those addressing comorbid symptoms and executive dysfunction, Timothy Wilens, MD, told Psychiatric Times.

Among the developments drawing attention were data from an ongoing naturalistic trial of viloxazine (Qelbree), an extended-release agent being studied in real-world clinical settings, which he believes will be useful for the everyday clinician. Multiple posters presented demonstrated improvement in depression and anxiety.¹

Wilens also noted growing clinician interest in agents with broader neurotransmitter activity. “Most people are interested in medicines like viloxazine XR [extended release] because it has this combined neurotransmitter type of medicine,” he said. Because of this profile, he noted the medication has potential for affecting depression and anxiety, emphasizing that “treating comorbidities in ADHD is an interesting and very concerning issue for clinicians.”

Another agent discussed at the APSARD conference was centanafadine, an investigational nonstimulant agent not yet approved by the US Food and Drug Administration, Wilens reported. Phase 3 data show that centanafadine, particularly the higher dose, improved ADHD in children and adolescents, he added.²

He noted centanafadine is considered a triamine reuptake inhibitor, which appears to distinguish it clinically. Early analyses suggest benefits beyond core ADHD symptoms: “They’re finding statistically and clinically significant improvements in cognitive executive functioning as well as the dysregulation component of executive functioning.”

Longer-term data are also emerging. “They’re doing a 3-year study in 600 individuals,” Wilens said, noting that early follow-up shows continued efficacy, with effectiveness through 1 year. He added that adverse events were tolerable, with a relatively low dropout rate of approximately 6% and no new adverse events.

References

1. Lin M. Viloxazine ER in adults with ADHD and depression and/or anxiety symptoms: impact on sleep. Poster presented at: American Professional Society of ADHD and Related Disorders 2026 Annual Conference; January 15-18, 2026; San Diego, CA.

2. Wilens T. Long-term safety and efficacy of centanafadine in children and adolescents with ADHD: results from a phase 3 open-label extension study. Poster presented at: American Professional Society of ADHD and Related Disorders 2026 Annual Conference; January 15-18, 2026; San Diego, CA.

Centanafadine Profile Shows Promise for ADHD Treatment

A poster for centanafadine shared data confirming the drug as a norepinephrine, dopamine, and serotonin reuptake inhibitor that showed unique activity across all monoamine transporters.¹

The study utilized intracerebral microdialysis on rats to measure the effects of centanafadine on extracellular monoamines in the prefrontal cortex and ventral striatum—regions considered critical in ADHD treatment.

Data showed potential for benefit in symptoms associated with ADHD, such as emotional dysregulation, executive function deficits, and comorbid anxiety symptoms. Centanafadine was confirmed to increase extracellular concentrations of norepinephrine, dopamine, and serotonin in cortical and subcortical regions, dependent on dose.

In findings from previous phase 3 trials, the drug showed positive efficacy and safety results in children, adolescents, and adults. Results from a randomized controlled trial of centanafadine in adolescents showed that a 328.8-mg dose was efficacious for the treatment of ADHD in those aged 13 to 17 years.² Findings from a later 52-week open-label study for safety and tolerability showed centanafadine sustained release 400 mg was safe and efficacious for long-term treatment of adults with ADHD.³ Otsuka Pharmaceutical, the developer of centanafadine, submitted a new drug application to the US Food and Drug Administration in November 2025.⁴

References

1. Heal DJ, Smith SL, Gosden J, et al. Pharmacological characterization of centanafadine—potential implications for efficacy and safety in ADHD and comorbid psychiatric disorders. Poster presented at: American Professional Society of ADHD and Related Diseases; January 15-18, 2025; San Diego, CA.

2. Ward CL, Childress AC, Jin N, Turkoglu O, Skubiak T, Wilens TE. Centanafadine for attention-deficit/hyperactivity disorder in adolescents: a randomized clinical trial. J Am Acad Child Adolesc Psychiatry. Published online July 4, 2025.

3. Mattingly GW, Turkoglu O, Chang D, et al. Fifty-two-week open-label safety and tolerability study of centanafadine sustained release in adults with attention-deficit/hyperactivity disorder. J Clin Psychopharmacol. 2025;45(5):454-462.

4. Otsuka Pharmaceutical submits new drug application to U.S. FDA for centanafadine for the treatment of ADHD in children, adolescents, and adults. Press release. Otsuka Pharmaceutical. November 24, 2025. Accessed January 15, 2026. https://www.otsuka-us.com/news/otsuka-pharmaceutical-submits-new-drug-application-us-fda-centanafadine-treatment-adhd