You are capable, and still lose hours to tasks that should be simple. That is often ADHD, not a lack of effort, and it responds well to treatment.
You are capable, and still lose hours to tasks that should be simple. That is often ADHD, not a lack of effort, and it responds well to treatment.
You are capable, and still lose hours to tasks that should be simple. That is often ADHD, not a lack of effort, and it responds well to treatment.
You are capable, and still lose hours to tasks that should be simple. That is often ADHD, not a lack of effort, and it responds well to treatment.
About the speciality
About the speciality
Struggles with focus, organization, and follow-through don't always mean a lack of effort. They are often linked to ADHD or executive function challenges. I work with both adults and teens to reduce overwhelm, strengthen routines, and build confidence using evidence-based strategies, including CBT, ACT, and performance psychology. Together we will develop practical tools tailored to your goals, whether that means deciding whether you need ADHD coaching, ADHD therapy, or both, or, for parents, knowing what to focus on after a child's diagnosis.
If you are a parent or caregiver of someone with ADHD, the hardest question is often what actually helps. This short Caregiver Accommodation Scale walks you through the everyday responses we all reach for, shows which ones may be quietly keeping the struggle going, and gives you a personalised plan for what to focus on first.
Struggles with focus, organization, and follow-through don't always mean a lack of effort. They are often linked to ADHD or executive function challenges. I work with both adults and teens to reduce overwhelm, strengthen routines, and build confidence using evidence-based strategies, including CBT, ACT, and performance psychology. Together we will develop practical tools tailored to your goals, whether that means deciding whether you need ADHD coaching, ADHD therapy, or both, or, for parents, knowing what to focus on after a child's diagnosis.
If you are a parent or caregiver of someone with ADHD, the hardest question is often what actually helps. I do not ask you to take my word for any of this. Further down this page you can read the research I base my ADHD practice on, including what genuinely helps, what does not, and what is marketed to families but wastes time and money.
Also, this short Caregiver Accommodation Scale walks you through the everyday responses we all reach for, shows which ones may be quietly keeping the struggle going, and gives you a personalised plan for what to focus on first.
Struggles with focus, organization, and follow-through don't always mean a lack of effort. They are often linked to ADHD or executive function challenges. I work with both adults and teens to reduce overwhelm, strengthen routines, and build confidence using evidence-based strategies, including CBT, ACT, and performance psychology. Together we will develop practical tools tailored to your goals, whether that means deciding whether you need ADHD coaching, ADHD therapy, or both, or, for parents, knowing what to focus on after a child's diagnosis.
If you are a parent or caregiver of someone with ADHD, the hardest question is often what actually helps. This short Caregiver Accommodation Scale walks you through the everyday responses we all reach for, shows which ones may be quietly keeping the struggle going, and gives you a personalised plan for what to focus on first.
Struggles with focus, organization, and follow-through don't always mean a lack of effort. They are often linked to ADHD or executive function challenges. I work with both adults and teens to reduce overwhelm, strengthen routines, and build confidence using evidence-based strategies, including CBT, ACT, and performance psychology. Together we will develop practical tools tailored to your goals, whether that means deciding whether you need ADHD coaching, ADHD therapy, or both, or, for parents, knowing what to focus on after a child's diagnosis.
If you are a parent or caregiver of someone with ADHD, the hardest question is often what actually helps. This short Caregiver Accommodation Scale walks you through the everyday responses we all reach for, shows which ones may be quietly keeping the struggle going, and gives you a personalised plan for what to focus on first.
For parents: what’s a parent’s role in this process?
What is ADHD and executive function coaching with Dr Rick Smith?
Will this help with school or work performance?
Do I need a diagnosis to start?
What kind of challenges do you help with?
What’s the difference between therapy and coaching for ADHD?
Do I need ADHD coaching or therapy?
General FAQs
ADHD
Anxiety
OCD
Screen Time
School Refusal
Defiant Behaviour, PDA, ODD
Parenting Support (SPACE Model)
Procrastination
Performance Psychology
Executive Coaching for Burnout
Substance Use
For parents: what’s a parent’s role in this process?
What is ADHD and executive function coaching with Dr Rick Smith?
Will this help with school or work performance?
Do I need a diagnosis to start?
What kind of challenges do you help with?
What’s the difference between therapy and coaching for ADHD?
How much does ADHD coaching cost in Hong Kong?
Evidence Library
Treating ADHD
What the research shows about treating ADHD: what helps, what does not, and what wastes time and money.
The overall picture
ADHD research splits cleanly into two questions: what reduces the core symptoms of inattention, hyperactivity and impulsivity, and what improves the life around those symptoms. For core symptoms, medication does the heavy lifting. The stimulants, methylphenidate in children and adolescents and amphetamines in adults, produce the largest and most consistent effects of anything studied, and the non-stimulant options work but less powerfully. The picture for non-drug treatments is more nuanced and easy to misread. When the people rating improvement know who got the treatment, behavioural and dietary approaches look effective; when raters are properly blinded, most of that effect shrinks or disappears for core symptoms. The important exception is that behavioural and family work still produces real, blinded improvements in the things parents often care about most: parenting quality, conduct problems, and the emotional climate at home. In adults, CBT earns its place not by fixing attention directly but by reducing the anxiety, low mood and disorganisation that ride alongside it. Several widely marketed options have been tested and found ineffective for the core symptoms, and parents deserve to know: neurofeedback (brain training) fails once a sham control is used, computerised cognitive and working-memory training improves the practised task but does not carry over to real-world symptoms, and the belief that sugar causes hyperactivity has been disproved in blinded studies. These are flagged here so time and money go toward what actually works.
A note on scope: this library is here to help you evaluate the psychological therapies. The medication studies are included for honest context, because weighing therapy properly means seeing the whole evidence map. I support medication where it helps, but prescribing decisions sit with a doctor or psychiatrist, not with a psychologist.
How to weigh these studies. Not all evidence is equal. From strongest to weakest: network meta-analysis (pools dozens of trials) > meta-analysis > large randomised trial (RCT) > small pilot trial > observational study. Each card shows its study type, and you can sort by strongest evidence first.
Comparative efficacy and tolerability of ADHD medications across the lifespan
Cortese et al. · The Lancet Psychiatry
At a glance
Stimulant medication reduces the core symptoms more than anything else studied.
For parents
The definitive comparison of ADHD medications. It found that the stimulants work best, with a clear age split: methylphenidate is the first-choice medication for children and teenagers, and amphetamines for adults. The benefit is larger than for any other treatment studied.
For adults, therapy helps most with the anxiety, low mood and self-esteem that ride alongside ADHD.
For parents
For adults, this review shows where talking therapy earns its keep. CBT helps with the core symptoms somewhat, but its bigger contribution is reducing the depression and anxiety that so often travel with adult ADHD, and lifting self-esteem and quality of life.
Regular exercise helps attention and self-control, though not hyperactivity itself.
For parents
Regular physical exercise helps children with ADHD in specific ways. It improves attention, planning and self-control, and motor skills, though it does not reliably reduce hyperactivity itself. It is a healthy, low-risk addition to treatment rather than a stand-alone answer, and worth building into a child's routine.
Chang, Su, Mondelli & Pariante · Neuropsychopharmacology
At a glance
Fish oil gives a small but genuine benefit. A helpful add-on, not a main treatment.
For parents
Fish-oil (omega-3) supplements are the one dietary approach with reasonable evidence behind them. The effect on ADHD symptoms is small, much smaller than medication, but it is real, and children with ADHD tend to have lower omega-3 levels to begin with. A modest add-on, not a replacement for first-line treatment.
Neurofeedback (brain training): tested, ineffective for core symptoms
Cortese et al. · J. Am. Acad. Child & Adolescent Psychiatry
At a glance
It only seems to work when the person judging knows the child had it. In a proper test, it does nothing.
For parents
Neurofeedback is marketed heavily to families as a drug-free way to retrain the ADHD brain. It has now been tested properly, and it does not work for the core symptoms. It looks helpful only when the people rating the child know they had the treatment; in the trials that used a convincing fake (sham) version or blinded raters, the benefit disappears. It is expensive and time-consuming, and the evidence does not support it as an ADHD treatment.
Cognitive and working-memory training: no real-world benefit
Cortese et al. · J. Am. Acad. Child & Adolescent Psychiatry
At a glance
You get better at the computer game you practise, but ADHD symptoms and schoolwork do not improve.
For parents
Computerised brain-training programmes (such as working-memory training) are sold as a way to fix the attention problems in ADHD. Tested properly, they improve the narrow skill you practise on a computer but do not carry over into fewer ADHD symptoms or better schoolwork. Working-memory training specifically showed no effect on ADHD symptoms at all. It is not a substitute for treatments that work.
Behavioural interventions across multiple outcome domains
Daley et al. (European ADHD Guidelines Group) · J. Am. Acad. Child & Adolescent Psychiatry
At a glance
Parenting support genuinely improves behaviour and family life, even though it does not reduce attention symptoms.
For parents
The essential companion to the review above. It shows what behavioural and parenting work genuinely delivers. Even under blinded assessment, it improves parenting quality and reduces conduct problems, the defiance and rule-breaking that often cause the most family stress, even though it does not directly reduce core attention symptoms.
Non-pharmacological interventions: dietary and psychological treatments
Sonuga-Barke et al. (European ADHD Guidelines Group) · The American Journal of Psychiatry
At a glance
Most non-drug treatments stop working once the study is done properly; only fish oil keeps a small benefit.
For parents
This landmark review tested the honest question about non-drug treatments: do they still work when the people judging improvement do not know who received them? For most, the apparent benefit to core symptoms faded under that stricter test. Two dietary approaches held up modestly.
The sugar myth: sugar does not cause hyperactivity
Wolraich, Wilson & White · JAMA
At a glance
In blind tests, sugar does not change children's behaviour. The link is in the eye of the beholder.
For parents
One of the most stubborn beliefs in parenting is that sugar makes children hyperactive, so cutting sugar should calm an ADHD child. It has been tested thoroughly, and it is not true. Across the blinded studies, sugar had no effect on children's behaviour or thinking. The strong parental impression appears to come from expectation, not from the sugar itself. Restricting sugar is not an ADHD treatment.
The MTA study: medication, behavioural treatment, and their combination
MTA Cooperative Group · Archives of General Psychiatry
At a glance
Medication works best on the core symptoms; behaviour therapy helps the problems around them.
For parents
The most influential trial in childhood ADHD. Carefully managed medication beat behavioural therapy alone and beat ordinary community care for reducing core symptoms. Combining medication with behavioural work did not add much for core symptoms, but helped with things like defiance, anxiety, social skills and the parent-child relationship.
Dr Rick Smith, is a dual-doctorate clinical psychologist in Hong Kong specialising in ADHD, OCD, anxiety, executive functioning, and performance psychology. He works with adults and adolescents in his Central Hong Kong practice and online.
Dr Rick Smith, is a dual-doctorate clinical psychologist in Hong Kong specialising in ADHD, OCD, anxiety, executive functioning, and performance psychology. He works with adults and adolescents in his Central Hong Kong practice and online.
Dr Rick Smith, is a dual-doctorate clinical psychologist in Hong Kong specialising in ADHD, OCD, anxiety, executive functioning, and performance psychology. He works with adults and adolescents in his Central Hong Kong practice and online.
