It’s less because the medications are so effective relative to therapy. Ideal solution is a combination treatment. However, it’s hard to convince people to make scheduled appointments to interact with another person and discuss part of themself they’re not proud of, so many people reach for medications instead of therapy in all psychiatric conditions (not just ADHD).

Therapy is actually a wonderful adjunct to medication because it helps instill lasting behavioral changes. A lot of people mistake the early motivational boost of stimulants for ADHD remission, but once the energizing effect of stimulants disappears due to tolerance, they’re left with the same bad habits they started with. Therapy can help build a better foundation for when the energizing side effect of stimulants disappears and only the attention-enhancing effects remain.

The meds available for ADHD are remarkably effective relative to other psychiatric disorders though. For depression there are a number of (placebo-controlled) studies showing CBT + meds reduces symptoms more than either alone do, to the point there is a hypothesized complementary effect. It's also pretty common for moderate depression cases to continue with maintenance therapy but go off meds (with proper supervision ofc) once things are under control.

Therapy is a lot more work for the patient - more time consuming, more costly, can be emotionally taxing in the early stages, etc. So I understand the desire for a meds only solution, and in some cases that is possible. But talking about therapy more generally I would encourage anyone who can to give it a try, just as I would encourage people to put effort into their diet, exercise, etc.

Obviously make sure it is evidence-based therapy though, something like CBT that has been well-studied. There are flavors of talk therapy that are total pseudoscience.

Most people seem to think that medication for ADHD is great, but for my son, the side effects were unacceptable: nausea, vomiting, extreme irritability. If therapy is even an option, none of the medical professionals we’ve spoken to has offered it. Maybe it’s because he’s on the young side (7). Anyway, it’s frustrating that everyone sees medication as the answer when the side effects are so awful—but maybe our experience is outside the norm.

That sounds somewhat unusual, but side effects are a very individual thing. It might be you can't get a low enougb dose for your child. I'm a full, rather large adult, and I only need abouy 5-10mg of ritalin, and going above that is unpleasant. I'm sure I'd have been quite sick if I was taking that dose (5mg seems to be close to the minimum they'll do) at 7.

A lot of doctors start patients at crazy high doses (over 10mg) and a lot of patients do indeed benefit from 50+mg.

If medication isn't tolerated, starting therapy early seems like a great idea.

Side effects also vary with the active substance used, release mode, and other factors. Like with depression, ADHD treatment also starts with a process of matching the right meds to the person. So if the first prescription has bad side effects, tell your doctor and get them to prescribe an alternative. There's easily a dozen options to go through before giving up on meds entirely.