The patient experience is at the heart of medicine. For children and adults with attention-deficit/hyperactivity disorder (ADHD), we know that current treatments have fallen short in providing symptom coverage for the entire active day. This greatly impacts both patients and caregivers.
As practicing child and adolescent psychiatrists and investigators in numerous trials involving ADHD medications, we’ve seen an increase in ADHD therapies mirroring the rise in the diagnoses. According to the Centers for Disease Control and Prevention (CDC), the prevalence of U.S. children with a parent-reported ADHD diagnosis has more than doubled over the last quarter-century, spiking from approximately 5.5% in 1997 to 12% in 2024. Researchers attribute that increase primarily to better recognition of the disorder, decreasing the stigma of this disorder for patients and caregivers, and more definitive guidelines and diagnostic criteria for ADHD.
The CDC also recognizes that ADHD frequently persists beyond childhood and continues to affect millions of adults. Nearly 6% of U.S. adults are estimated to have ADHD, with more than half receiving their diagnosis in adulthood. Approximately one-third report regularly taking stimulant medications — primarily methylphenidate- or amphetamine-based therapies — to manage their symptoms. Stimulants remain the standard of care for most clinicians, accounting for more than 90% of ADHD prescriptions compared with non-stimulant alternatives.
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So, with seven million U.S. children and 15.5 million adults navigating the daily challenges of ADHD, why don’t ADHD drugs carry them through the entire active day?
Redefining the active day
In our conversations around behavioral health, one issue often remains overlooked: most ADHD treatment approaches are still designed around school or work hours.
For children, adolescents and adults with ADHD, symptoms don’t stop at the final school bell or the end of the workday. Students struggle to get ready and out the door in the morning, but the struggle often continues through sports and other after-school activities, homework and social interactions right through bedtime. Adults may finish the workday with focus and energy, then nosedive during evening hours at the expense of family relationships and nighttime activities.
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The most commonly prescribed “all-day coverage” ADHD medications offer an actual duration of efficacy between 10 and 12 hours. The problem is, if a child or adult takes the first dose at 7 a.m., it’s diminished in their bloodstream by 7 p.m. These long-acting or extended-release meds may suggest they cover the active day, but in practice they neglect the realities of the patient’s life. How different is this from a taxi dropping off a passenger a mile before their destination? What we need is a redefinition of the active day and treatments that fully support it.
Aligning treatment with challenges
The next evolution in ADHD therapy needs to focus not only on drug efficacy but also on how treatment aligns with the ever-busy and demanding lives of patients, families, and caregivers.
Medication timing and duration have a significant impact on the patient experience. Parents of children with ADHD know that mornings and evenings are often among the most challenging parts of the day. While rapid onset is critical in the morning, some currently available ADHD medications can take one to two hours to reach their full clinical effect. Likewise, treatments that require an afternoon booster dose can create additional burdens, particularly for school-aged children whose midday medication may be forgotten, missed, diverted, or misused.
Beyond providing symptom control into the afternoon and evening, many children and adults also need a faster onset of action than current therapies can offer. Future ADHD treatments should aim not only to deliver consistent coverage throughout the active day but also to achieve meaningful symptom control within 30 minutes of administration in the morning.
Afternoon booster doses can introduce additional challenges for both children and adults, including difficulty taking medication at the appropriate time, reduced adherence to treatment, increased potential for diversion or misuse of immediate-release formulations, and added out-of-pocket costs for patients and families.
For many families affected by ADHD, the afternoon and evening hours can be among the most challenging. As medication effects begin to wear off, some children and adults may experience rebound or withdrawal symptoms such as dysphoria, difficulty concentrating, dizziness, or headaches. These challenges highlight the need for once-daily treatments capable of providing consistent symptom control throughout the entire active day.
National data show that nearly 78% of children with ADHD have at least one co-occurring condition, including anxiety, depression, low self-esteem, or poor coping skills. Combined with the demands of homework, extended work hours, extracurricular activities, and family responsibilities, these additional burdens further underscore the need for a true all-day treatment solution.
Better options on the horizon
Perhaps the most promising therapies are seen in advances in drug delivery science, which are helping healthcare providers rethink symptom management. Innovative drug delivery technologies are being designed to optimize the timing, onset, and duration of medication release. Many long-acting ADHD medications provide a morning release followed by one or more delayed-release phases; others lean into continuous-release systems or prodrug formulations to sustain their effects into the evening.
To truly improve the patient experience, clinicians should consider each individual’s unique circumstances and select therapies that address any remaining unmet needs. These may include a rapid onset of action, symptom control that extends throughout the entire active day, once-daily dosing that eliminates the need for supplemental booster doses, a range of dosing options that supports treatment optimization, and formulations designed to reduce the potential for misuse and abuse. Ultimately, the most effective treatment strategies are those that align therapeutic benefits with the realities of patients’ daily lives, supporting improved outcomes and a better overall treatment experience.
Photo: Thinglass, Getty Images
Matthew Brams, MD is Chief Medical Officer and a Co-Founder of Cingulate Therapeutics. He was also Medical Director and Principal of Bayou City Research, where he has been instrumental in gaining FDA approval of over 25 central nervous system drugs currently in the marketplace. A Clinical Associate Professor at the Menninger Department of Psychiatry of Baylor College of Medicine, he has published over 30 peer-reviewed journal articles. Dr. Brams has been lead investigator in pivotal trials involving drugs in ADHD, autism and other areas. He has extensive experience in drug development and execution of Phase I-IV trials and has been involved in over 300 clinical trials in both adult and pediatric populations in all areas of psychiatry. Dr. Brams has over 35 years of clinical experience managing patients in the field of adult and child psychiatry with particular expertise in ADHD and autistic spectrum disorders.
Raul R. Silva, MD is a Co-Founder of Cingulate Therapeutics and serves as Chief Science Officer. He is a practicing child and adolescent psychiatrist who has served as Associate Professor and Vice Chairman of Child and Adolescent Psychiatry at New York University School of Medicine. Prior to that, he was the Executive Director of Rockland Children’s Psychiatric Center. He also served as the Deputy Director in the Division of Child and Adolescent Psychiatry at Bellevue Hospital Center in New York City and as Director of Service and Residency Training Director at Columbia University’s St. Luke’s/Roosevelt Hospital Center, where he completed his fellowship in child and adolescent psychiatry. Dr. Silva has authored/coauthored over 125 publications and presented at grand rounds and national meetings on over 120 occasions. He has been Principal Investigator and Co-Investigator for 21 research projects in his field.
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