When it comes to ADHD treatment, stimulant medications like methylphenidate and amphetamine-based drugs often take center stage. But for some individuals—due to side effects, comorbid conditions, or personal preference—stimulants may not be the right fit. That’s where atomoxetine (Strattera) offers a compelling, evidence-based alternative grounded in modern neuroscience.

What Is Atomoxetine?

Atomoxetine is a selective norepinephrine reuptake inhibitor (NRI) approved by the FDA for the treatment of ADHD in both children and adults. Unlike stimulants, it is not a controlled substance and has no known abuse potential, making it a unique option in ADHD pharmacotherapy.

How It Works: The Neuroscience Behind Atomoxetine

To understand atomoxetine’s effect, it’s helpful to briefly revisit the neurobiology of ADHD. ADHD is associated with dysregulation in dopaminergic and noradrenergic circuits, particularly in the prefrontal cortex (PFC)—the brain region responsible for executive functioning, attention regulation, and working memory.

While stimulants increase both dopamine and norepinephrine through transporter inhibition and increased release, atomoxetine works selectively on norepinephrine. Specifically, it blocks the norepinephrine transporter (NET), increasing extracellular levels of norepinephrine (and indirectly dopamine) in the PFC. Interestingly, the PFC has few dopamine transporters, so dopamine is largely cleared by NET in this area. As a result, blocking NET enhances both norepinephrine and dopamine activity where it matters most for ADHD symptoms.

This mechanism has been confirmed in animal studies and neuroimaging research in humans, which show increased catecholamine availability in the PFC after atomoxetine administration (Bymaster et al., 2002; Chamberlain et al., 2009).

Evidence-Based Efficacy

Atomoxetine’s efficacy has been established through multiple randomized controlled trials and meta-analyses:

• Effect size: While smaller than stimulants (Cohen’s d ≈ 0.6 vs. 0.9 for stimulants), atomoxetine still shows statistically and clinically meaningful reductions in core ADHD symptoms (Michelson et al., 2001; Kratochvil et al., 2006).

• Onset: Effects are gradual, typically emerging over 2 to 6 weeks, with full benefit sometimes seen at 8 to 12 weeks.

• Maintenance: Atomoxetine shows benefit in long-term symptom control, including reducing the risk of ADHD relapse in maintenance studies (Upadhyaya et al., 2008).

• Executive functioning: Some studies show improvements in working memory, response inhibition, and emotional regulation—functions mediated by the PFC.

When Atomoxetine Makes Sense

Atomoxetine may be a preferred choice in several clinical scenarios:

• History of substance use disorder: No abuse potential makes it safer.

• Co-occurring anxiety: Atomoxetine has been shown to have anxiolytic properties, possibly due to norepinephrine modulation.

• Tic disorders: Unlike stimulants, atomoxetine does not typically exacerbate tics.

• Sleep issues: It may be better tolerated in individuals with insomnia or circadian rhythm delays, especially when taken in the morning.

Side Effects and Considerations

Like all medications, atomoxetine is not without risks:

• Common side effects include decreased appetite, GI upset, fatigue, and irritability.

• Rare but serious risks include suicidal ideation (especially in youth), liver injury, and cardiovascular concerns. A black box warning advises monitoring for suicidal thinking in children and adolescents.

• Atomoxetine is metabolized by CYP2D6, so genetic variation or drug interactions can affect blood levels and efficacy.

Clinical Pearls

• Atomoxetine should be titrated slowly, often starting at half the target dose and increasing after a week or more.

• Patients should be advised that benefits are not immediate—setting realistic expectations is key to adherence.

• Combining atomoxetine with behavioral therapy yields better outcomes than medication alone.

Final Thoughts

Atomoxetine represents a meaningful advancement in ADHD treatment. Grounded in neuroscience and validated by robust clinical research, it provides a non-stimulant option that addresses core symptoms while aligning with specific patient needs. For clinicians, understanding its unique mechanism and application can help expand the ADHD treatment toolkit in evidence-based, individualized ways.

July 28, 2025 by Twin Cities ADHD

References:

• Bymaster, F. P., Katner, J. S., Nelson, D. L., et al. (2002). Atomoxetine increases extracellular levels of norepinephrine and dopamine in prefrontal cortex of rat: a potential mechanism for efficacy in ADHD. Neuropsychopharmacology, 27(5), 699–711.

• Michelson, D., Faries, D., Wernicke, J., et al. (2001). Atomoxetine in the treatment of children and adolescents with ADHD: a randomized, placebo-controlled, dose-response study. Pediatrics, 108(5), e83.

• Chamberlain, S. R., Del Campo, N., Dowson, J., et al. (2009). Atomoxetine improved response inhibition in adults with attention deficit/hyperactivity disorder. Biological Psychiatry, 66(2), 117–123.

• Kratochvil, C. J., Vaughan, B. S., Harrington, M. J., et al. (2006). Atomoxetine for the treatment of attention-deficit/hyperactivity disorder: a review. Neuropsychiatric Disease and Treatment, 2(4), 349–366.

• Upadhyaya, H. P., Desaiah, D., Schuh, K., et al. (2008). Maintenance of response following open-label atomoxetine treatment for ADHD: a randomized, placebo-controlled withdrawal study. Journal of the American Academy of Child & Adolescent Psychiatry, 47(8), 936–944.

ICD-10 Code: F90.0 – Attention-Deficit Hyperactivity Disorder, Predominantly Inattentive Type

When you picture ADHD, do you think of hyperactivity, blurting, and bouncing off the walls? That’s only part of the story. For many—especially girls and adults—the experience is quieter, less visible, and often misdiagnosed. ADHD, Predominantly Inattentive Type is a legitimate and challenging form of ADHD, and it’s time we shine a light on it.

What Is ADHD, Inattentive Type?

According to the ICD-10, ADHD is classified under F90.0, which includes Predominantly Inattentive Type—characterized by persistent patterns of inattention without hyperactivity or impulsivity.

Symptoms Include:

• Difficulty sustaining attention on tasks or conversations

• Often seeming not to listen, even when spoken to directly

• Struggling to follow through on instructions

• Frequent loss of necessary items (keys, notebooks, phones)

• Trouble organizing tasks and time

• Easily distracted by unrelated stimuli or daydreaming

• Forgetting daily obligations, appointments, or deadlines

These symptoms must be present for at least six months, occur in more than one setting (e.g., home, work, school), and interfere with social, academic, or occupational functioning.

“ADHD is not a matter of not trying hard enough. It’s a matter of not having the brain wiring to do what others do naturally.”
— Dr. Stephanie Sarkis, PhD, NCC, LMHC

Why Inattentive ADHD Often Goes Undetected

Because individuals with inattentive ADHD are less disruptive, they’re more likely to be overlooked—especially girls and women. Instead of acting out, they may withdraw, internalize their struggles, or develop anxiety and depression as secondary symptoms.

Adults with undiagnosed inattentive ADHD are often mislabeled as “lazy,” “flaky,” or “disorganized,” when in fact their brains are working overtime to keep up with basic demands.

The Diagnostic Process: ICD-10 and DSM-5

The ICD-10 uses F90.0 as the diagnostic code for ADHD, regardless of subtype. In contrast, the DSM-5 provides separate specifiers for:

• Predominantly Inattentive Presentation

• Predominantly Hyperactive/Impulsive Presentation

• Combined Presentation

Assessment typically involves:

• Clinical interviews and symptom checklists (e.g., ASRS)

• Collateral input from teachers, parents, or partners

• Screening for co-occurring conditions

• Rule-outs for other causes (e.g., trauma, anxiety, sleep issues)

Evidence-Based Treatments That Help

Effective treatment for ADHD, Inattentive Type is multimodal, combining medical, behavioral, and environmental supports.

1. Medication

Stimulants like methylphenidate or amphetamines are first-line treatments. Non-stimulants like atomoxetine or guanfacine can also be effective, particularly for those with co-occurring anxiety.

2. Cognitive Behavioral Therapy (CBT)

CBT helps individuals:

• Reframe negative self-talk (“I’m just lazy”)

• Build routines and planning strategies

• Develop emotional regulation skills

“People with ADHD are not broken—they have different operating systems. Once you understand the system, you can work with it instead of against it.”
— Dr. Stephanie Sarkis

3. ADHD Coaching and Skill Building

Therapeutic coaching or EF-based interventions can teach:

• Task breakdown and planning

• Use of external structures (timers, lists, calendars)

• Accountability and problem-solving

4. School or Workplace Accommodations

Students and professionals benefit from:

• Extended time

• Reduced distractions

• Clear deadlines and reminders

• Flexibility with routines and expectations

You Are Not Alone

If you’ve been quietly struggling with attention, focus, or follow-through—and blaming yourself—it’s time to shift the narrative. Inattentive ADHD is real, valid, and treatable. With the right support, people with this diagnosis can build meaningful, organized, and successful lives.

July 28, 2025 by Twin Cities ADHD

References:

• World Health Organization. ICD-10: F90.0 ADHD

• American Psychiatric Association. DSM-5 Diagnostic Criteria for ADHD

• Sarkis, S. (2018). Adult ADD: A Guide for the Newly Diagnosed

• Barkley, R. A. (2015). Taking Charge of Adult ADHD

• Tuckman, A. (2017). Understand Your Brain, Get More Done

• Ramsay, J. & Rostain, A. (2015). The Adult ADHD Tool Kit

Summer break can be a double-edged sword for individuals with ADHD—especially kids and teens. On one hand, it’s a break from academic pressures and social demands; on the other hand, the loss of structure can intensify ADHD symptoms and lead to more stress at home. The key to thriving through the summer lies in balancing freedom and flexibility with predictable routines and scaffolding.

The ADHD Brain and the Need for Structure

Dr. Russell Barkley, one of the most prominent researchers in ADHD, explains that ADHD is fundamentally a disorder of self-regulation and executive functioning. Executive functions include the brain's ability to plan, organize, manage time, and regulate emotions and behavior—all of which are challenged in unstructured environments like summer break.

“Children with ADHD don’t have a knowledge problem—they have a performance problem.” — Dr. Russell Barkley

This means they may know what to do, but they struggle to do it consistently, especially without external supports.

Why Unstructured Time Is a Risk Factor

Without school to provide an external framework, kids with ADHD may experience:

• Increased screen time and decreased physical activity

• Poor sleep routines

• More impulsivity, boredom, and emotional dysregulation

• Conflicts at home due to unmet expectations or unclear routines

Dr. Ari Tuckman, psychologist and ADHD expert, emphasizes that consistency and predictability help people with ADHD feel more secure and reduce anxiety.

“Structure helps reduce decision fatigue and increases the chances that things will get done.” — Dr. Ari Tuckman, PsyD, MBA

Evidence-Based Strategies for a Smoother Summer

Here are strategies rooted in CBT, Parent Management Training, and Executive Function coaching to help manage ADHD symptoms during summer.

1. Create a Flexible but Predictable Routine

Keep a loose but clear daily rhythm. Use visual schedules, alarms, or timers. Include:

• Wake-up and bedtime anchors

• Regular meals and snacks

• Screen time windows

• Movement or outdoor time

• Downtime and creative play

Research in behavioral parent training supports using positive reinforcement and predictable transitions to reduce oppositional behavior in children with ADHD.

2. Use Visual and External Cues

Dr. Barkley suggests using externalized forms of executive functioning—like lists, timers, and calendars—to support memory, time awareness, and task initiation.

Consider:

• A dry-erase board with daily tasks

• Morning and evening checklists

• Visual timers for transitions

3. Make Screen Time Structured and Earned

Rather than banning screens (which may backfire), set clear expectations and limits. For example:

• “First we do chores and movement, then screen time.”

• Use a points system or behavior chart (from PMT models) for motivation.

4. Focus on Strengths and Interests

Summer is an ideal time to support strength-based learning. This aligns with the ADHD coaching model which encourages building motivation and engagement through interest-based tasks.

Encourage:

• Hobbies (music, building, cooking, art)

• Outdoor adventures or sensory play

• Volunteering or social opportunities

5. Support Emotional Regulation

ADHD often coexists with emotional dysregulation. Build in calming activities and help kids name and manage their feelings. Mindfulness practices, CBT techniques (like thought reframing), or even just quiet reading time can help.

Bonus: Support for Parents Too

Parenting a child with ADHD through the summer requires flexibility and compassion—for your child and yourself. Use self-compassion techniques and connect with other parents when possible. Books like “The Explosive Child” by Ross Greene or “Smart but Scattered” by Dawson & Guare can offer tools and hope.

Final Thoughts

Summer doesn’t have to be a free-for-all—or a constant battle. With intentional structure, realistic expectations, and evidence-based strategies, families with ADHD can have a summer filled with connection, growth, and fun.

July 21, 2025 by Twin Cities ADHD

References:

• Barkley, R. A. (2015). Taking Charge of ADHD.

• Tuckman, A. (2009). More Attention, Less Deficit.

• Greene, R. (2014). The Explosive Child.

• Dawson, P., & Guare, R. (2009). Smart but Scattered.

• Chronis-Tuscano, A., et al. (2006). Parent Training for Children with ADHD: Evidence-Based Interventions.

• Abikoff, H., & Gallagher, R. (2009). Cognitive Behavioral Therapy for ADHD in Children and Adolescents.

Parenting a child with ADHD can be overwhelming at times, but the right strategies and support can make a big difference. Here are five essential things to keep in mind:

1. ADHD is real—and it’s not your fault.
ADHD is a neurodevelopmental condition, not a result of poor parenting or laziness. It affects how the brain regulates attention, emotion, and impulse control. Your child’s behavior isn’t a reflection of your efforts—it’s a reflection of their needs.

2. Structure and routine are your best friends.
Kids with ADHD thrive when they know what to expect. Clear routines, visual schedules, and consistent boundaries create a sense of safety and help reduce overwhelm.

3. Praise progress, not perfection.
Many children with ADHD receive more correction than encouragement. Make an effort to notice small wins, like remembering a backpack or taking a break instead of melting down. This builds confidence and reinforces positive behavior.

4. Emotional regulation is part of the picture.
ADHD isn’t just about attention. Many kids struggle with big emotions and impulse control. Model calm, validate their feelings, and teach them tools to self-regulate—like taking deep breaths or using movement breaks.

5. You deserve support too.
You don’t have to do this alone. Whether it’s therapy, parent coaching, or simply connecting with others who get it, finding support for yourself will help you stay grounded and responsive—not just reactive.

Supporting a child with ADHD is a journey—and with the right tools and mindset, it can be one full of growth, connection, and resilience.

If you’re feeling stuck or unsure how to best support your child with ADHD, you don’t have to figure it out alone. Reach out to us at Twin Cities ADHD—we’re here to help you understand what’s going on beneath the behavior and build a plan that works for your unique family.

Contact us today to get started.

June 10, 2025  by Twin Cities ADHD

🧠 What Does ADHD Really Look Like?

Recognizing the Signs—and Why It’s Often Missed

At Twin Cities ADHD, we hear it all the time:

“I thought ADHD was just for hyper little boys.”
“But I do well at work—how could I have ADHD?”
“I’m just tired. Or anxious. Or maybe lazy?”

ADHD is often misunderstood—especially in women and adults. It doesn’t always look like bouncing off the walls or failing at school. Sometimes it looks like perfectionism, overwhelm, or the invisible exhaustion of trying to keep it all together.

Let’s clear things up.

Common Signs of ADHD

ADHD usually shows up in three patterns: inattentive, hyperactive/impulsive, or combined. But most people don’t fit perfectly into one box.

Inattentive Signs:

• Constantly losing track of your keys, coffee, or that thing you just had

• Struggling to follow conversations, even when you want to

• Feeling mentally drained after “simple” tasks

• Procrastinating until the last possible second

• Forgetting appointments, birthdays, or deadlines—no matter how important

Hyperactive/Impulsive Signs:

• Feeling restless or “on edge,” even while sitting still

• Interrupting or talking over people (then cringing afterward)

• Trouble waiting your turn—in traffic, in line, or in conversation

• Speaking before thinking, and later regretting it

• Needing movement, background noise, or stimulation to focus

Combined ADHD:

Many people experience a blend of both. In adults—especially women and AFAB folks—it might show up as emotional intensity, chronic people-pleasing, or feeling constantly “behind,” no matter how hard they try.

What ADHD Can Be Mistaken For

ADHD symptoms often overlap with other conditions. That’s why a thoughtful, personalized assessment is so important. ADHD is frequently confused with:

• Anxiety – racing thoughts, restlessness, difficulty focusing

• Depression – low motivation, mental fatigue, disorganization

• Sensory issues – easily overwhelmed or distracted by the environment

• Bipolar disorder – impulsivity, mood fluctuations

• Trauma – hypervigilance, memory gaps, difficulty regulating emotions

It’s not about slapping on a label. It’s about finally having a framework for what you’ve been living with—and a plan that actually works.

You’re Not Broken. You’re Wired Differently.

If any of this resonates with you, it’s worth exploring.
No shame. No judgment. Just real conversations, real strategies, and support that sees your strengths—not just your struggles.

🌀 Ready to take the next step? Book a free consult. We’re here when you’re ready!

Twin Cities ADHD June 1, 2025