Rebecca Chasnovitz, MD, highlights updates in pediatric ADHD medication

In a recent discussion with Contemporary Pediatrics, Rebecca R. Chasnovitz, MD, associate professor of general pediatrics and adolescent medicine at the University of North Carolina at Chapel Hill, highlighted evolving research and clinical perspectives on pediatric attention-deficit/hyperactivity disorder (ADHD), emphasizing the dynamic nature of the condition and the importance of individualized care.

One of the most notable trends in ADHD research is the growing recognition that symptoms often fluctuate across the life span. Long-term studies suggest that up to two-thirds of children diagnosed with ADHD experience periods of partial remission followed by recurrence of symptoms in adolescence or adulthood.

Interestingly, many children show some reduction in symptoms during early adolescence, even as academic and social demands increase. A smaller group maintains consistently high symptom levels throughout life, while an even smaller subset may experience full remission after meeting diagnostic criteria in childhood. These findings underscore ADHD as a condition that evolves over time rather than following a fixed trajectory.

In terms of treatment, stimulant medications remain the gold standard. The 2 primary classes—central nervous system stimulants such as methylphenidates and amphetamines—demonstrate the largest effect sizes for reducing core ADHD symptoms and improving overall functioning. However, adverse effects are common and can include appetite suppression, weight loss, reduced height velocity, headaches, stomach aches, nausea, and mood changes or irritability.

Nonstimulant medications provide important alternatives. Norepinephrine reuptake inhibitors, such as atomoxetine and newer agents like viloxazine, are effective but generally less potent than stimulants. They may benefit children who do not tolerate or respond well to stimulants, although appetite suppression can still occur.

Alpha agonists, including guanfacine and clonidine, offer another option. Although somewhat less effective for core symptoms, they have minimal impact on appetite and may be preferable for certain patients. Emerging evidence also suggests that combining stimulants with nonstimulants may offer modest additive benefits.

Several newer medications are in development or have recently been approved. Serdexmethylphenidate, a prodrug formulation of dexmethylphenidate, offers extended symptom control—lasting up to 13 hours—which may help older children with longer school days and extracurricular demands. Another investigational agent targets norepinephrine, dopamine, and serotonin pathways. Although not as effective as stimulants, it may offer theoretical mood benefits for children with co-occurring mood disorders, an area still under investigation.

Chasnovitz emphasized that optimal ADHD management requires a personalized approach. Children vary significantly in symptom patterns, treatment response, and family circumstances. Regular follow-up—often every 3 months or more frequently during treatment adjustments—is critical to monitor symptom changes and medication effects.

In addition to pharmacotherapy, behavioral therapy, parent training, and school supports can provide additional benefit. Ultimately, clinicians must partner with families to tailor treatment plans that balance effectiveness, tolerability, cost, and individual needs over time.

No relevant disclosures.

Reference

Serdexmethylphenidate and dexmethylphenidate (oral route). Mayo Clinic. Updated February 1, 2026. Accessed February 23, 2026. https://www.mayoclinic.org/drugs-supplements/serdexmethylphenidate-and-dexmethylphenidate-oral-route/description/drg-20510796