What Stimulant Medication Can Do for the ADHD Brain

“You forgot to include my address on the script, so the pharmacy won’t fill my prescription.” The words fell out of my mouth while I pressed my palm against the edge of my kitchen island.

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“Yes, well. Sorry. It happens. You’ll just have to drive back to the office to have him write it in,” said the receptionist. As if this were a routine conversation she has with every patient.

“But you’re 45 minutes away from me. It’s rush hour.”

The receptionist paused.

The granite was digging into my hand now. Dr. Hirsch’s rushed handwriting spelling out “Ritalin 5mg” glared back at me between the creases of the paper script. I raised my shoulder and squeezed my phone closer to my ear. Then sucked in my breath and let out a weak, “OK.”

Click.

I was 33, and after 15 years of suspecting I had attention-deficit/hyperactivity disorder (ADHD), I had finally started the process of confirming my diagnosis and seeking help. Admittedly, I waited too long, because right after I hung up, I even surprised myself with that agonizing scream that reverberated throughout my kitchen. It was such a painful, resounding sound that was then outdone by pure, uncontrollable sobbing.

While driving back to my psychiatrist’s office, I realized how tiring all of “this” was. This—the keeping it all together and under wraps, the making sure no one viewed me as drug-seeking (because I wasn’t), the persistent mess-ups, and the running out of excuses to explain them away. You know—this. This was depleting, and for a moment I thought I was finally about to fix everything—but that stupid missing address on that tiny square of paper in the middle of my addressed house is what got me.

Why Did I Wait So Long to Get Diagnosed with ADHD?

Honestly, the main reason was the stigma and the fear that I would be mislabeled as incapable in my role as a clinical psychologist. Secondary to that was the deep misunderstanding of ADHD in females and the thought that I would need to “convince” someone that I did, in fact, suffer from ADHD, and that I did, in fact, need stimulant medication to treat it.

Beyond these issues is the problem with misinformation surrounding the use of stimulant medications for ADHD treatment. But what if I told you that since about 2010, there has been a growing body of brain imaging research that completely flops the stimulant stigma on its head?

To date, there have been about 34 peer-reviewed published research studies whose results altogether suggest that taking stimulant medication to treat ADHD is associated with structural and functional brain improvements. Sometimes, this is so much so that the brains of individuals with ADHD treated with stimulants for two or more years become nearly indistinguishable from neurotypical brains.

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“But"—you might be thinking (rightfully so)—"individuals with ADHD can also be treated with nonstimulant medications, so why the big hullaballoo over stimulants?”

In 2009, Faraone conducted a meta-analysis that compared the efficacy of different ADHD medications. The meta-analysis included 32 drug-placebo comparisons assessing the helpfulness of different ADHD medications (including immediate-release stimulants, extended-release stimulants, and nonstimulant medications) for the reduction of ADHD symptoms. He found that the effect sizes for immediate-release and extended-release stimulant medications were similar and that the stimulant medications were significantly more effective than the nonstimulants.

What does this mean? Imagine 100,000 patients with ADHD were administered medication. According to Faraone's results, if that medication were a nonstimulant, then about 40,000 of those 100,000 patients would not respond to the medication. Conversely, if the medication administered was a stimulant, only about 25,000 patients would be non-responders.

This information matters to both patients and doctors, who share the goal of limiting time and resources (e.g., cost) in finding the patient the most effective treatment. Now, keep in mind that these are large-scale studies examining large groups of people. On an individual level, there may be specific needs and differences that may make any individual not fit neatly into these descriptions.

If you're thinking, "Well, this doesn't apply to me," it's possible that these findings don't. People are complicated, and each individual is unique. At the same time, though, it is crucial to also consider research evidence when instructing professionals and patients about each treatment option, and stimulant medications, according to Faraone and other ADHD experts, should be the first-line treatment for ADHD.

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But Aren't Stimulants Risky?

As with any medication, the goal is to assess the risk-to-benefit ratio for each individual and to base that assessment on scientific findings. And the research on stimulant medications in the treatment of ADHD is clear. In most cases, the benefits significantly outweigh the risks.

In a meta-analysis including 17 randomized controlled trials (RCTs) with 5,388 participants, Bellato et al. (2025) showed that "amphetamines, methylphenidate, and atomoxetine were significantly more efficacious than placebo in improving quality of life in [children and adults] with ADHD."

Other research focusing on the protective effects of stimulant medications has shown that, in comparison to non-ADHDers, people with ADHD are significantly more likely to die prematurely due to accidents. Brunkhorst-Kanaan et al. (2021) identified major accidental injuries among individuals with ADHD and highlighted that treating ADHD with medication across age groups alleviates the risks associated with accidental injury.

ADHD adolescents seem to be at greatest risk for traumatic brain injuries, probably due to risky driving. Past research has shown a clear association between ADHD symptoms and risky driving, but this association is alleviated by treatment with ADHD stimulant medication (Barkley & Cox, 2007).

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There have been a few studies finding that adults with ADHD tend to live shorter lives than adults without ADHD. For example, a 2025 study coming out of the UK (O'Nions et al., 2025) that included over 330,000 participants found that, on average, ADHD males lose about 6 years of life and ADHD females lose about 8 years.

The authors explain that a combination of an unhealthy lifestyle, common medical comorbidities, and accidental injury likely contributes to ADHDers' higher mortality rate compared to those without ADHD. It is also notable that individuals with ADHD are at higher risk for purposeful, self-inflicted injury due to their challenges with emotional dysregulation, so suicides are probably also contributing to ADHDers' higher mortality rates.

Indeed, Barkley and Fischer (2018) note that "ADHD is also associated with an increased risk for suicidal ideation, attempts, and completions." These authors similarly found that the estimated life expectancy of individuals with ADHD was about 8 years lower than that of those without ADHD. Those whose symptoms remained persistently interfering from childhood into adulthood lost up to 12.7 years of life.

So, given the robust efficacy of stimulant medications in the treatment of ADHD, it’s quite surprising that fearmongering myths about stimulant medications continue to linger, sustaining unnecessary and detrimental stigma and hesitation among prescribers.

But circling back to the topic that drove this post—maybe if more people knew about the research connecting stimulant medication use over several years to brain growth (which Dr. Russell Barkley refers to as neuropromotion) in ADHDers, they would be less hesitant and more willing to explore stimulant treatment for ADHD in children and adults.

What ADHD Meds Can Do for the Brain

Let’s dive into this research by starting with the largest qualitative literature review on the subject because it included a whopping 29 brain imaging studies comparing the brains of ADHDers who had been taking stimulant medications for several years to the brains of ADHDers who had not been taking stimulant medications and to neurotypical brains (Spencer et al., 2013). After reviewing the literature, the authors concluded that most of the results showed brain improvements in areas commonly affected by ADHD when individuals treated their ADHD with stimulant medication.

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If we dig back to earlier publications included in that review, we find research such as Sobel et al.'s (2010), which showed that ADHD youth who took stimulant medication had improved basal ganglia morphology compared to ADHD children who did not use stimulant medication.

Similarly, in 2011, Frodl and Skokauskas conducted a meta-analysis focusing on caudate and grey matter volumes. Their meta-analysis covered studies including children and adults, as well as longitudinal and cross-sectional studies. Like Sobel et al. (2010), they found that basal ganglia volumes improved in individuals treated with stimulant medications when compared to those who were untreated.

In later years, similar findings were shown for the cerebellum (Ivanov et al., 2013), frontal lobe grey matter (Moreno-Alcazar et al., 2016), brain regions associated with saliency and reward processing (right insula and left nucleus accumbens; Wu et al., 2024), and surface-based metrics of the brain (Ghozy et al., 2025). Again, some of these studies found that these brain improvements were so profound that ADHDers who took stimulant medications for at least two years had brains that were nearly indistinguishable from neurotypical brains.

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I hope that you can walk away from this with a new understanding of stimulant medications in the treatment of ADHD. As a woman with ADHD, I experienced the shame that is so deeply tied to stimulant stigma—but I now know how unfortunately misguided that stigma is.

I wouldn’t want anyone to feel the intense level of desperation that I felt after putting off seeking medication for so long. We deserve optimal treatment for our challenges, just like anyone else.

*Dr. Hirsch is a false name used to protect his (and my) confidentiality.