Advances in the management of ADHD in children and adolescents

AbstractThis review synthesizes evidence on managing attention deficit/hyperactivity disorder (ADHD) in children and adolescents, focusing on studies published between 2019 and 2025. Recent research supports a dimensional, pleiotropic model of ADHD characterized by heterogeneity, developmental fluctuation, and frequent comorbidity. ADHD is a chronic, fluctuating condition, underscoring the need for sustained and individualized care. Diagnostic strategies favor semi-structured interviews over rating scales, with neuroimaging or biological tests offering limited diagnostic utility. Neuropsychological testing situates symptoms within broader cognitive developmental profiles. Psychosocial interventions—particularly behavioral parent training, school focused interventions, and cognitive behavioral therapy—produce small but meaningful improvements in functioning, with outcomes strongly shaped by rater, expectancy, and context. Lifestyle interventions targeting physical activity and sleep show modest adjunctive benefits. Cognitive training does not generalize beyond trained tasks, and effects on neurofeedback are predominantly non-specific and contextual. Digital tools are expanding, but few are rigorously validated. Pharmacological treatment remains central, with stimulants showing robust short term efficacy and non-stimulants providing effective second line options. Advances in titration strategies, formulation design, and pharmacogenetics support movement towards precision oriented and personalized prescribing. Overall, the evidence supports a multimodal, pragmatic approach to care aligned with current international guidelines.