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Stimulant medications are often the go-to treatments for attention-deficit/hyperactivity disorder (ADHD), but they aren’t ideal for everyone. Adults, adolescents, and children who can’t take stimulants—due to side effects, contraindications, shortages, or personal preference—still have effective, science-backed options. This is happening as requests for evaluations for ADHD are hitting new highs among everyone from children to adults. That’s atop the estimated 15 million adults in the US who have already been diagnosed with ADHD.
Several non-stimulant ADHD medications offer hope for better focus, fewer side effects, greater availability, and reduced misuse potential. In this article, we’ll explore what ADHD is, who it affects, the medications available beyond stimulants, and new insights you’ll want to know about food dyes and ADHD.
What Is ADHD and How Do Medications Help?
Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurodevelopmental condition characterized by developmentally inappropriate levels of inattention and impulsivity, with or without hyperactivity. It begins in childhood and can continue into adolescence and adulthood. Attention-deficit/hyperactivity disorder is one of the most common psychiatric disorders diagnosed in children. To be diagnosed with ADHD, symptoms must appear before age 12 and last at least six months in more than one setting (e.g., home, school, work, etc.).
This disorder is classified into three types based on the predominant symptoms: inattentive type, hyperactive-impulsive type, or combined type. While some people think ADHD is just fidgeting in school, that’s not true. Inattentive symptoms include distractibility, forgetfulness, and difficulty sustaining focus, while hyperactive-impulsive symptoms involve excessive talking, fidgeting, and acting without thinking. Many people experience a combination of both types. If you have these symptoms, you know how much they can affect your everyday life—whether as a child or adult.
The exact cause of ADHD is unknown, but it is strongly influenced by genetic factors, with heritability estimates around 74%. Neurobiological findings show that individuals with ADHD often exhibit differences in brain structure and function. The brain regions where differences have been seen are involved in attention regulation, impulse control, and executive function.
Parents are often blamed for the way ADHD shows up in children, but ADHD is not a result of poor parenting or lack of discipline. Instead, it reflects a complex interplay of genetic, neurochemical, and environmental influences. While once believed to be primarily a childhood condition, one study found that ADHD persists into adulthood in around 90% of people, although intermittent periods of remission can occur. Adult ADHD often manifests as disorganization, restlessness, poor time management, and emotional dysregulation rather than overt hyperactivity.
That does not mean it’s any less of an issue, however. Picture an office worker who bounces their leg and fidgets through meetings, distracting others, spends too much time talking with coworkers in the break room, leading to missed deadlines, and experiences bursts of anger, even with their boss. All of this can put a person’s job in jeopardy. That’s what ADHD treatment is essential, even in adults.
There is no single diagnostic test for ADHD, but rather, diagnosis involves comprehensive interviews, behavioral assessments, and symptom rating scales. Treatment typically includes behavioral strategies, educational support, and medications—stimulant or non-stimulant—tailored to the individual’s needs and symptom profile.
And it’s clear that ADHD is not just psychological, but rather also biological in nature. Research shows that ADHD can be seen in the brain. It is associated with alterations in neurotransmitters dopamine and norepinephrine signaling in brain regions such as the prefrontal cortex, which governs executive function, emotional regulation, and working memory.
Medications for ADHD typically aim to alter neurotransmitter activity to improve attention, reduce impulsivity, and decrease hyperactivity:
• Stimulants like lisdexamfetamine (Vyvanse) and mixed amphetamine salts (Adderall) exert their therapeutic effects on ADHD by increasing dopamine and norepinephrine in the brain, which improves attention, executive function, and impulse control. However, they can often suppress appetite, increase heart rate, elevate blood pressure, and are possibly associated with cardiovascular disease. They also carry a risk of misuse and are controlled substances, not to mention the fact that shortages can make them difficult to obtain.
• Non-stimulants offer alternatives by targeting norepinephrine or alpha-adrenergic receptors. They generally have a slower onset but are preferred for individuals who experience side effects from stimulants or have comorbid anxiety, cardiovascular concerns, or a history of substance use.
The Rise of ADHD Diagnoses in Adults and Teens
Attention-deficit/hyperactivity disorder diagnoses in both males and females have climbed sharply in recent decades. While some claim this is due to overdiagnosis, this increase is more likely driven by broader recognition of inattentive symptoms, improved awareness in the general public and healthcare providers, and better diagnostic tools.
This has been particularly true in females, as is noted here:
“Similar trends have been seen among girls, who demonstrated a 3 times higher increase in diagnosis rates than boys over the past two decades . . . experts have attributed changes in DSM-IV diagnostic criteria to recent diagnostic trends. Following changes that placed increased focus on inattention, rather than hyperactivity, there was a correspondingly significant increase in ADHD diagnosis among females. Specifically, between 1991 and 2008, diagnosis rates increased by a factor of 5.6 in girls compared to only 3.7 in boys.”
The gender-specific data show girls have caught up with boys in diagnostic rates thanks to this improved understanding.
The Centers for Disease Control and Prevention (CDC) notes that in 2022, an additional 1 million US children aged 3-17 years had ever received an ADHD diagnosis compared to 2016.
Also, an article from the Associated Press says:
“ADHD diagnoses amongst adults in the U.S. are on the rise . . . Diagnoses have been rising for decades but seem to have accelerated in the last few years . . . Some doctors say the number of people coming in for evaluation is skyrocketing.”
Why Some Adults Can’t Take Stimulants
Stimulant medication can effectively treat ADHD, but it’s not for everyone. Here are some common reasons non-stimulant ADHD medications are sought:
• Side effects: Insomnia, appetite loss, nervousness, or elevated heart rate can occur with stimulants.
• Anxiety or mood disorders: Stimulants can exacerbate some symptoms, particularly anxiety.
• A history of substance use: Stimulants carry a risk of abuse and are controlled substances.
• Cardiovascular risks: High blood pressure, arrhythmias, or heart disease can occur with stimulants.
• Shortages: Stimulants sometimes experience shortages that non-stimulant options do not face.
• Personal preference: Some desire a non-controlled, long-term treatment option that isn’t a stimulant.
Fortunately, newer-generation non-stimulants address many of these concerns.
4 Non-Stimulant ADHD Medications for Adults, Adolescents, and Children
There are four non-stimulant medications for ADHD that warrant attention.
Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI) that increases norepinephrine availability in the brain. The Food and Drug Administration (FDA) has approved its use in children, adolescents, and adults. Atomoxetine can start to work within one to two weeks, but there is an incrementally increasing response for up to 24 weeks or longer.
As with all medications, there are pros and cons to taking atomoxetine. If your doctor has prescribed this medication, they have assessed that the pros outweigh the cons. That being said, any concerns you have should always be addressed by a medical professional.
Pros:
• There is no known abuse potential; it is not a controlled substance.
• You only have to take it once a day.
• It can improve inattention and executive function.
Cons:
• It can cause dry mouth, nausea, dizziness, and insomnia.
• There is a black box warning for suicidal ideation in young people from the FDA.
Guanfacine extended release (ER) helps the brain’s attention and self-control systems work better by calming overactive signals and reducing distractions. It is approved for people under the age of 18 with ADHD and used off-label in adults. It may take two weeks to show results.
Pros:
• It calms hyperactivity and impulsivity.
• It tends to improve sleep when insomnia is present.
• There is no abuse potential; it is not a controlled substance.
Cons:
• It can cause sedation, dizziness, and hypotension (low blood pressure).
• It may not improve inattention as effectively as SNRIs.
You can think of clonidine extended release (ER) as working by calming the body’s “fight-or-flight” response, which can help reduce hyperactivity, inattention, and impulsivity in people with ADHD. Clonidine ER is approved for pediatric ADHD. This medication may begin working in a few days, although sedating effects often occur sooner.
Pros:
• It helps with hyperactivity, inattention, and impulsivity.
• Clonidine ER can be combined with stimulant medications.
Cons:
• It can cause sedation, fatigue, and dry mouth.
• It can cause low blood pressure.
4. Viloxazine ER (Qelbree)
Viloxazine Extended Release (ER) is an SNRI with additional effects on serotonin. It alters multiple neurotransmitters in the brain to improve attention and reduce hyperactivity. It was approved in 2021 for treating ADHD in children and adults. Clinical benefits can be felt within one to two weeks; however, they continue to improve over time.
Pros:
• It has a comparatively mild side effect profile.
• There is no abuse potential; it is not a controlled substance.
• Capsules can be opened and sprinkled on food.
Cons:
• It may cause sleepiness, irritability, or decreased appetite.
• Insurance may require a prior trial of atomoxetine (Strattera) due to the cost of viloxazine ER.
• There is a black box warning for suicidal ideation in young people from the FDA.
In comparison to these non-stimulant options, medications like lisdexamfetamine and mixed amphetamine salts can disrupt sleep, worsen irritability, and trigger anxiety, are not recommended for individuals with severe cardiovascular conditions, as they can increase heart rate, blood pressure, and even the risk of heart attacks or strokes, and are classified as Schedule II drugs, because these stimulant drugs carry a significant risk of misuse and addiction.
ADHD and Food Dyes: What the Research Shows
While medication for ADHD can be helpful and necessary in some cases, it’s important to remember that other things can affect ADHD, too. Artificial food dyes like red 40, yellow 5, and blue one have long been suspected of affecting behavior. One study showed that synthetic color additives can modestly increase hyperactivity and inattention in about 8% of children. Other studies have borne this out as well.
It’s also of note that:
• The United Kingdom and European Union require warning labels on foods containing certain dyes.
• California passed a bill banning red three from foods starting in 2027.
• The FDA is revoking authorization for certain dyes, working with industry to remove certain dyes from products, authorizing new color additions, and partnering with the National Institutes of Health to conduct comprehensive research on how food additives impact children’s health and development.
Natural alternatives like beet extract, turmeric, and spirulina are becoming more common in foods and may be good alternatives for children and adults with ADHD.
FAQs About Non-Stimulant ADHD Medications
Many people have specific queries about non-stimulant medications for ADHD. Here are some common frequently asked questions.
Q: Can adults take non-stimulant ADHD medications?
A: Yes. Atomoxetine and viloxazine ER are FDA-approved for adults, and others are commonly prescribed off-label based on the clinical expertise and judgment of the prescribing doctor.
Q: Do non-stimulants work as well as stimulants?
A: Some feel non-stimulant medications may be slightly less potent, but they are still highly effective for many. Non-stimulant medications also have lower risks of abuse and fewer stimulant-related side effects.
Q: How long do they take to work?
A: Some non-stimulant medications for ADHD can show benefits within a few days, while others, such as the SNRIs, may take several weeks.
Q: Can I take a non-stimulant and a stimulant together?
A: Yes. Combination therapy is sometimes used to balance symptom control and side effects.
Choosing the Best ADHD Treatment Without Stimulants
Finding the proper treatment for ADHD doesn’t always mean starting with a stimulant—and for many adults, adolescents, and children, non-stimulant medications offer effective, tolerable, and sustainable relief. Whether you’re dealing with side effects, managing co-occurring conditions like anxiety or heart concerns, or simply prefer a non-controlled medication, options like atomoxetine (Strattera), viloxazine ER (Qelbree), guanfacine ER (Intuniv), and clonidine ER (Kapvay) can provide meaningful improvements in focus, impulsivity, and emotional regulation.
Each of these medications has a unique way of working, side effect profile, and time to benefit, so it's important to work closely with a healthcare provider to find the best fit for your needs. You may also benefit from combining a non-stimulant with a stimulant, or from dietary changes—such as reducing artificial food dyes—when sensitivity is suspected.
Ultimately, managing ADHD is not one-size-fits-all. With new non-stimulant options and growing research into lifestyle factors like diet, more people than ever can find a safe, effective path forward—without relying on traditional stimulant medication.
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