ADHD Meds Might Not Work the Way We Thought, New Study Finds
Why sleep and motivation may be just as important as medicine in treating ADHD
Updated April 27, 2026 | Reviewed by Davia Sills
What we thought we knew about ADHD medicine
A recent study from Washington University in St. Louis that was published in the science journal Cell is changing what we thought we knew about how stimulant medications affect the brains and alter the behaviors of children with attention -deficit/hyperactivity disorder (ADHD).
Stimulants like Ritalin and Vyvanse block the reuptake of the neurotransmitters dopamine and norepinephrine, thus increasing their concentrations at the level of the synapse. That part isn’t in question. The question is what brain regions are affected by this activity. Since the prefrontal cortex contains our attention circuits, it makes intuitive sense that this would be the brain region where stimulants exert their effects.
But this turns out not to be true.
What new MRI imaging data tells us
This new study looked at nearly 12,000 resting-state functional magnetic resonance imaging studies (fMRIs) in children aged 8 to 11 years. Out of those, 337 images were of children who had taken a stimulant the morning of the study. In these children, researchers found no activity in any of the frontal cortex brain regions that control attention.
Huh… So if stimulants aren’t increasing attention by activating the attention areas in our brains, how are they working (because they do work for most kids)? The fMRIs showed that the largest changes in functional connectivity (FC) occurred in areas of the brain associated with arousal (the dorsal and ventral attention networks, DAN and VAN, and the frontoparietal network), as well as those areas associated with anticipation of rewards (the salience or parietal memory network or SAL/PMN).
ADHD is more about reward and motivation than a deficit of attention
And this makes sense. We have used stimulants to treat narcolepsy and also the drowsiness associated with traumatic brain injury . It also explains why so many parents of children with ADHD have told me, “But Doc, how can he have attention deficit when he can play video games for hours?”
It turns out that if our brains can convince us that a task is fun and interesting or reward us for our attention with a hit of dopamine, a mundane task can become salient and worth our time and therefore easier to concentrate on. In other words, stimulants reward our brains before we even begin the task, so we are able to persist at something that may not otherwise interest us.
Key findings about sleep
Another fascinating finding in this study has to do with brain changes that occur when we are sleep-deprived. Nearly half of the children in this study reported getting less than the recommended nine hours of sleep per night. Interestingly, the functional connectivity pattern produced by stimulant medication in the brain mirrored that of a well-rested brain. This finding was borne out in the classroom as well. Sleep-deprived children on stimulants had grades equal to well-rested kids who were not on meds.
The importance of the study is not that stimulant medications work. That was not in question. The study is simply asking us to think differently about how they work. Now, doctors who prescribe these medications must reframe our conversations with parents, talking about motivation and rewards, and not simply talking about an inattentive brain.
Also implicit in the study’s findings is the importance of screening for sufficient sleep and optimizing sleep schedules in kids as a primary or concomitant intervention. Medication cannot be a substitute for a good night’s sleep. Even though ADHD medication appears to be able to compensate for sleep deprivation in the short term, both in terms of brain changes on fMRI and classroom performance, the long-term effects of chronic lack of sleep are still serious and include an increased risk of depression and cellular damage from stress , as well as neuronal loss.
Kay BP et al. Stimulant medications affect arousal and reward, not attention networks. Cell. 2025 Dec 24;188(26):7529-7546.e20. doi: 10.1016/j.cell.2025.11.039. PMID: 41448140; PMCID: PMC12834599.
Share this post Facebook Bluesky Linkedin Email
There was a problem adding your email address. Please try again.
By submitting your information you agree to the Psychology Today Terms & Conditions and Privacy Policy
Carolyn Roy-Bornstein, MD, is a retired pediatrician and the Writer-in-Residence at a large family medicine residency program where she leads physicians in narrative medicine workshops.
Get the help you need from a therapist near you–a FREE service from Psychology Today.
This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.