There is no cure for ADHD, but treatment can make a real difference to daily life. In the UK, treatment for adults is guided by NICE guideline NG87. It sets out a step-by-step approach that looks at your whole situation, not just your symptoms.
The NICE approach in brief
NICE recommends that treatment for adults:
- starts with information about ADHD and how it affects you
- includes changes to your environment at work, study and home
- offers medication if symptoms still cause significant problems in at least one area of life
- considers psychological support for people who choose not to take medication, can’t take it, or still struggle while taking it
- is reviewed regularly, with medication reviewed at least once a year
Understanding ADHD (psychoeducation)
Learning about ADHD is a treatment in itself. Understanding why certain things are hard can reduce shame and help you plan around your difficulties. A specialist should explain the diagnosis, what it means for you, and where to find reliable information and peer support.
NICE also says people should be told about the possible effect of ADHD on driving. There’s more on that on the page about living with ADHD.
Changes to your environment
NICE describes environmental modifications as changes to your surroundings that reduce the impact of ADHD on daily life. Examples it gives include:
- changing where you sit, or the lighting and noise around you
- reducing distractions, for example by using headphones
- working in shorter periods of focus with movement breaks
- getting written instructions as well as spoken ones
At work, changes like these can be requested as reasonable adjustments.
Medication for adults
The NHS says ADHD medicines must be started and monitored by an ADHD specialist. For adults, NICE recommends the following order.
| Medicine | Type | Where it fits for adults (NICE) |
|---|---|---|
| Lisdexamfetamine | Stimulant | First-line option |
| Methylphenidate | Stimulant | First-line option |
| Dexamfetamine | Stimulant | Considered if lisdexamfetamine helps but its longer effect isn’t tolerated |
| Atomoxetine | Non-stimulant | Offered if stimulants aren’t tolerated or haven’t worked after adequate trials |
| Guanfacine | Non-stimulant | Only with advice from a specialist tertiary ADHD service |
First-line options
NICE recommends offering lisdexamfetamine or methylphenidate as first-line medicines for adults. If one hasn’t helped enough after a six-week trial at an adequate dose, NICE suggests considering a switch to the other.
Methylphenidate comes in different forms. Some work for a few hours, and modified-release versions last longer. The NHS says that once the right dose is found, methylphenidate should start to work within 30 to 60 minutes.
Other options
If a person can’t tolerate lisdexamfetamine or methylphenidate, or their symptoms haven’t responded to separate six-week trials of both, NICE recommends offering atomoxetine. NICE says guanfacine should not be offered to adults without advice from a tertiary ADHD service.
If symptoms don’t respond to at least one stimulant and one non-stimulant, NICE recommends a second opinion or referral to a tertiary service.
Finding the right dose
Medication is started at a low dose and adjusted gradually. This is called titration and usually involves regular reviews. See ADHD titration for what to expect.
Side effects
All medicines can cause side effects. Many settle with time or a change in dose, but some need urgent attention.
The NHS lists these as common side effects of methylphenidate in adults:
- headaches
- trouble sleeping
- loss of appetite
- stomach ache
- dry mouth
- feeling or being sick
Other ADHD medicines have their own side effect profiles, which your prescriber should explain.
A few other points from the NHS about methylphenidate:
- Stopping: only stop if your doctor tells you to. Stopping suddenly can cause withdrawal symptoms such as depression.
- Alcohol: try not to drink alcohol, as it can increase the effects and side effects.
- Driving: it’s best not to drive until you know how the medicine affects you.
- Misuse: there is a risk of addiction if it isn’t taken as prescribed.
NICE also advises prescribers to be cautious with stimulants where there is a risk of misuse or of medicine being passed on to others.
Health checks before and during treatment
Before starting
NICE says that before starting ADHD medication, you should have a full assessment that includes:
- a review of your mental health and social circumstances
- a review of your physical health, including any heart symptoms such as fainting or breathlessness on exercise
- your family history of heart problems
- baseline pulse and blood pressure
- height and weight
NICE says an ECG (heart tracing) isn’t needed before starting stimulants, atomoxetine or guanfacine unless there are specific heart risk factors. In some cases, a heart specialist’s opinion may be needed first.
While you take medication
NICE recommends that adults taking ADHD medicine have:
- pulse and blood pressure checked before and after each dose change, and every six months
- weight checked every six months
- a review at least once a year by a professional with ADHD expertise, to decide whether to continue
Your prescriber will tell you how these checks will be done. Some services ask you to take your own blood pressure readings at home or at a pharmacy.
Non-drug support
NICE recommends considering non-drug treatment for adults who:
- have made an informed choice not to take medication
- find it hard to take medication regularly
- find medication doesn’t work or can’t tolerate it
- benefit from medication but still have significant difficulties
NICE describes this as a structured, supportive psychological intervention focused on ADHD, with regular follow-up. It may include elements of, or a full course of, cognitive behavioural therapy (CBT). The NHS also mentions CBT and mindfulness as talking therapies that may be recommended.
Other types of support people find useful include:
- ADHD coaching, which focuses on practical skills like planning and routines. Coaching is not regulated in the same way as therapy, so check a coach’s training and experience.
- Peer support groups, online or in person
- Workplace or study support, including reasonable adjustments, Access to Work and Disabled Students’ Allowance
- Healthy routines, as the NHS recommends exercise, enough sleep and regular meals
See living with ADHD for more practical strategies.
When other conditions are involved
Many adults with ADHD also have anxiety, depression, sleep problems or another condition. These can affect which treatment is safest and most effective, and sometimes need treating first. See ADHD and other conditions.
Treatment with Happy Clinic
Happy Clinic’s consultant psychiatrists can prescribe ADHD medication, including stimulants, only where clinically appropriate. Treatment may need physical health checks and monitoring, followed by titration reviews. Once your treatment is stable, Happy Clinic can propose a shared care agreement to your NHS GP, although whether the GP accepts is up to them. See shared care.
Happy Clinic does not provide psychological therapy itself, but its psychiatrists may advise on therapy options.