Attention-deficit-hyperactivity disorder (ADHD) includes a mix of ongoing challenges, such as having difficulty paying attention, hyperactivity, and impulsivity. In the U.S., ADHD afflicts an estimated 7 million children, ages 3 to 17. According to one study, among American children, the prevalence of this diagnosis rose from 6.1 percent in 1997-1998 to 10.2 percent in 2015-2016.[1]

Children with ADHD often struggle with low self-esteem, have troubled relationships, and demonstrate poor school performance. Symptom severity and frequency may lessen with age, and while some people never completely “outgrow” their ADHD symptoms, they can develop ways to live with them successfully.

The DSM-5 identifies three types of ADHD:

Predominantly inattentive. Most symptoms fall under inattention; having trouble focusing and staying on a task, along with difficulty getting and staying organized.

Predominantly hyperactive-impulsive. Most symptoms involve hyperactivity and impulsivity. Hyperactive means being overly or problematically active and having too much energy—typically flitting from stimulus to stimulus, depending on whatever catches the person’s interest (think “squirrel!”) in ways that can be disruptive to the task at hand or to the immediate (classroom) environment. Being impulsive means acting without thinking ahead or considering the effects of behavior.

Combined. A mix of inattentive, hyperactive, and impulsive symptoms. The person meets the criteria for both predominantly inattentive and predominantly hyperactive and impulsive types of ADHD.

ADHD occurs more often in boys than in girls, and related behaviors can manifest differently across genders. As a generalization, boys are often more hyperactive, and girls may tend to quietly not pay attention. For decades, Ritalin and Adderall (known as psychostimulants) have been the go-to medications in the treatment of ADHD, and it has long been assumed that they work by acting on the brain’s attention circuitry. However, new research finds that this is not the case.

According to a just-published study in the journal Cell, these medications primarily target the brain’s reward and wakefulness centers. The research, which used brain imaging data from nearly 5,800 children ages 8 to 11 diagnosed with ADHD, also indicated that lack of sleep appears to play a critical role in this disorder.[2]

People with ADHD are not only at risk for school problems in childhood and adolescence, but also for social, occupational, physical, and mental health challenges across their entire lifespan. For many, taking psychostimulant medications makes a massive positive difference in their quality of life and ability to be successful. Importantly, although ADHD is generally thought of as a childhood condition, an estimated 15.5 million American adults have the diagnosis, and roughly half of them received the diagnosis in adulthood.[3]

The recent study utilized brain images from children enrolled in the Adolescent Brain Cognitive Development (ABCD) study, which began in 2015. Researchers compared images of children who took prescription stimulants on the day of their scan with those of children who did not take stimulants. By examining the connections that enable different regions of the brain to communicate with one another, researchers discovered these medications promoted increased activity in the wakefulness and reward regions—but not in the regions associated with attention.

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Both Adderall and Ritalin increase the levels of dopamine and norepinephrine in the brain. Ordinarily, the acute effects of nervous system stimulants include a heightened sense of well-being, feelings of euphoria, excitement, increased alertness, and mental and motor activity—effectively speeding them up—similar to what might be observed in a manic state. That’s why methamphetamine and similar substances are sometimes known generically as “speed,” and those under the influence of stimulants describe sensations of being “wired.” Stimulants also reduce appetite and, not uncommonly, result in insomnia. Conversely, for individuals with ADHD, stimulants—including nonprescription forms—have the paradoxical (essentially opposite) effects of helping them slow down and experience greater calm.

Adderall and Ritalin don’t appear to lead directly to greater attention but rather allow people with ADHD to keep working on activities that otherwise wouldn’t hold their interest, such as certain school assignments or household chores. They help kids with ADHD do better in school—both academically and behaviorally—by enhancing their capacity to focus. They also appear to be beneficial to kids who don’t sleep enough, and many American children and adolescents (as well as adults) don’t get enough sleep. Notably, the study found that psychostimulants did not lead to better school performance in children who did not have ADHD and were not sleep deprived.

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Sleep challenges leading to degrees of sleep deprivation are common in ADHD, although unfortunately, sleep problems are rarely recognized or adequately treated in children and adolescents afflicted with the disorder. The new study supports an increasing body of research that identifies a lack of proper sleep as a contributor to ADHD.[4]

The new research suggests that related to the treatment of ADHD, in addition to medication options and behavioral strategies, professionals and families need to address the issue of sleep. While sleep medications are one option for kids with ADHD, it is extremely important to pay attention to behavioral and environmental modifications that can significantly improve sleep hygiene—setting and following a consistent bedtime combined with some form of winding-down routine that decreases the level of stimulation before attempting sleep such as limiting light exposure, decreasing room temperature, and turning off TV, computer, and phone screens.

Copyright 2026 Dan Mager, MSW, LCSW

References

[1] Li Y, Yan X, Li Q, et al. Prevalence and Trends in Diagnosed ADHD Among US Children and Adolescents, 2017-2022. JAMA Netw Open. 2023;6(10):e2336872. doi:10.1001/jamanetworkopen.2023.36872

[2] Kay, Benjamin P. et al., Stimulant medications affect arousal and reward, not attention networks, Cell, Volume 188, Issue 26, 7529 - 7546.e20, December 24, 2025.

[4] Cassoff J, Wiebe ST, Gruber R. Sleep patterns and the risk for ADHD: a review. Nat Sci Sleep. 2012 May 29;4:73-80. doi: 10.2147/NSS.S31269. PMID: 23620680; PMCID: PMC3630973.