What ADHD Medications Reveal About Sleep, the Brain, and Digital Health
New Research Shows Common Stimulants May Boost Wakefulness—Not Focus—Prompting Fresh Questions about Medication Safety, Sleep’s Role, and Next-Gen Treatments
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Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental conditions, affecting millions of children and adults worldwide. Symptoms like difficulty focusing, impulsivity, and restlessness can disrupt school, work, and daily life. For decades, stimulant medications such as Adderall and Ritalin have been the cornerstone of treatment, helping many people manage the challenges. But recent research—including a major study published in Cell by researchers at Washington University School of Medicine—has reshaped our understanding of how these drugs work. We asked Dr. Andrew Fuchs, director of practice experience and assistant professor of pharmacy practice at Touro College of Pharmacy, about the meaning of these developments for patients, families, and the future of ADHD care.
What did the research find?
The researchers analyzed data from nearly 5,800 children and found that stimulant medications like Adderall and Ritalin primarily activate the brain’s wakefulness and reward networks, not the classic attention circuits. Moreover, the medications produced brain activity patterns similar to those observed after quality sleep, suggesting they may be masking sleep deprivation. This work has raised important questions about long-term safety, dosing risks, and emerging alternatives like digital therapies.
What does this mean for ADHD meds and how we understand or explain the drugs?
The study confirms that current ADHD treatment outcomes remain valid and effective. However, it reframes the way we explain to patients or their families how stimulants work. Stimulants don't directly improve focus; instead, they increase alertness and make tasks feel more rewarding, which naturally leads to better focus.
Because stimulant medications appear to mimic some of the brain effects of a good night’s sleep, should improving sleep quality be considered a priority before or alongside prescribing ADHD medication?
This data shows us that adequate sleep assessment is critical in correctly diagnosing patients with ADHD. Sleep-deprived children without ADHD showed the same improvements from stimulants as children with ADHD. This means some children labeled with "ADHD" may actually have undiagnosed or undertreated sleep insufficiency instead. If sleep insufficiency is identified, sleep optimization may resolve or significantly reduce focusing difficulties without the need for medication. Children who are already diagnosed with ADHD and taking stimulants should also be assessed for sleep insufficiency as the stimulants may mask the cognitive and behavioral effects of poor sleep, which can lead to other issues. For some children, improved sleep alone or combined with behavioral strategies may reduce or eliminate the need for medication.
Although many people take ADHD medications for years, most clinical studies only examine short-term use—what do we actually know about the long-term safety of these treatments?
Long-term safety data is limited; therefore clinicians should take an individualized approach in monitoring patients with these medications. There should be regular cardiovascular assessments followed by dose optimizations to make sure symptoms are controlled at the lowest effective doses. Also, there should be periodic reassessments if the medications remain necessary with changing life circumstances.
High doses of stimulant medications have been linked to an increased risk of psychosis or mania—how should patients and prescribers balance these risks when determining the right dose?
High doses of certain stimulant medications have been linked with an increased risk; however, the risk has a clear dose response effect -- meaning it is more likely with higher doses. The absolute risk remains low overall, thus a tailored approach to treatment should always be considered. For patients who have a higher risk of psychosis (due to family history or active substance use), stimulants are not the first line treatment. If stimulants are deemed necessary they should always aim for the lowest effective dose and be monitored closely for mood, sleep and any relevant safety concerns.
Beyond traditional pills, what role do newer options such as non-stimulant medications, transdermal patches, inhaled formulations, and FDA-cleared digital therapies play in the future of ADHD treatment?
These new options are promising, in that they can help in really optimizing treatment for each unique individual. The non stimulants are safer alternatives for those with psychiatric risk factors or stimulant intolerance; however, they do not work as quickly. The patches can provide steady drug levels throughout the day and improve medication adherence for some patients. FDA cleared apps such as LumosityRx have been shown to improve attention clinical efficacy comparable with some medications. However, the newer options are best used alongside traditional treatments rather than instead of them. They can be used to further tailor treatments based on individual needs, tolerance and risk profiles.
