ADHD medication: what it is, how it works and the risks

Which medicines are used for ADHD in Australia

ADHD medicines fall into two groups. Stimulants are usually tried first. Non-stimulants are used when stimulants aren't suitable, don't help enough or cause side effects.

Off-label means prescribed outside the use the TGA approved. The Australian guideline includes some off-label options, such as guanfacine for adults.

For more on individual medicines, see our guides to lisdexamfetamine (Vyvanse), dexamfetamine and methylphenidate (Ritalin and Concerta).

What the research shows

A 2018 network meta-analysis in The Lancet Psychiatry (Cortese and colleagues) pooled 133 double-blind randomised trials comparing ADHD medicines with each other or with placebo. The main efficacy analysis covered about 10,000 children and teenagers and 8,000 adults, at around 12 weeks.

• In children and teenagers, every medicine studied reduced symptoms more than placebo on clinician ratings. Amphetamines (including lisdexamfetamine) had the largest average effect, then methylphenidate, then atomoxetine.
• In adults, amphetamines, methylphenidate, bupropion and atomoxetine did better than placebo; modafinil did not.
• More people stopped amphetamines than placebo because of side effects, in both age groups. In adults this was also true of methylphenidate and atomoxetine, and in children, of guanfacine.

Weighing benefits against side effects, the authors favoured methylphenidate for children and teenagers, and amphetamines for adults, as first choices for short-term treatment.

A 2025 review of adult treatments (Ostinelli and colleagues, 113 trials, 14,887 adults) found stimulants and atomoxetine were the only treatments with evidence of reducing core symptoms in the short term, on both self-ratings and clinician ratings. More people stopped atomoxetine than placebo. Medication did not clearly improve quality of life, and most trials lasted three months or less, so long-term benefit is less certain.

The Australian guideline, developed by the Australasian ADHD Professionals Association (AADPA), recommends methylphenidate, dexamfetamine or lisdexamfetamine as the first medicine to try where ADHD symptoms cause significant impairment. Its authors judged the evidence not certain enough to set different first choices by age. If stimulants don't suit or haven't worked at adequate doses, it recommends atomoxetine or guanfacine (and for children, clonidine). For young children, a paediatrician or child psychiatrist should assess first, and medication should be used cautiously.

Schedule 8 rules and who can prescribe

Methylphenidate, dexamfetamine and lisdexamfetamine are Schedule 8 medicines, also called controlled drugs. Schedule 8 medicines have special rules to reduce the risk of misuse or dependence, covering how they are supplied, sold, owned and used. Each state and territory sets its own rules, and prescribers may need a permit or authority from the health department.

In general terms:

• For under-18s, starting a stimulant is restricted in most states and territories to paediatricians and child and adolescent psychiatrists. Queensland is the exception.
• For adults, treatment is usually started by a psychiatrist. Some jurisdictions now allow trained GPs to diagnose and prescribe.
• In some states, GPs can continue a prescription under set conditions, such as a specialist diagnosis and regular specialist review.

These rules have changed several times recently, so check the current position with your state or territory health department.

Misuse and diversion (medicine ending up with someone it wasn't prescribed for) of ADHD stimulants are common, and prescribers are expected to check real-time prescription monitoring before each script or review. Prescription medicines must only be taken by the person they are prescribed for; giving or selling them to someone else is illegal.

Questions to ask the prescriber

• Why this medicine and form, rather than the alternatives?
• How long does one dose last, and when should it be taken?
• Which side effects are expected, and which mean we should contact you?
• How and how often will heart rate, blood pressure, height and weight be checked?
• How will we judge whether it is working, and when is the next review?
• Does it interact with other medicines, alcohol or health conditions?
• What non-medication support should go alongside it?
• How would we stop it safely, if we decided to?

This guide is general information, not medical advice. Decisions about starting, changing or stopping ADHD medication are made with the prescribing doctor.