Stimulants in ADHD and AuDHD

This chapter provides an in-depth and clinically practical overview of stimulant medications used in the management of attention-deficit hyperactivity disorder (ADHD) in children and adolescents. Beginning with their historical origins and evolving therapeutic roles, the chapter explains the distinct pharmacological differences of methylphenidate and dexamfetamine and how these differences translate into real-life clinical effects. It highlights the functional impact of ADHD across development, the benefits of appropriately targeted medication trials, and the importance of integrating psychoeducation, environmental adjustments, lifestyle measures, and therapy into comprehensive care. Detailed guidance is offered on physical and physiological side effects; safe prescribing practices; medicolegal obligations; and the nuanced considerations required when treating children with co-occurring autism, anxiety, or complex regulation challenges. The chapter also distinguishes use of short-acting and long-acting stimulant formulations, discusses their advantages and limitations, and outlines practical strategies for dose titration, minimising rebound effects, and supporting adolescents with increasing academic demands. Additional clinical pearls address stimulant use in preschoolers, the concept of ‘unmasking’ autism traits, and combined SSRI–stimulant treatment in highly anxious ADHD or combined AuDHD presentations.