Prescriptions for attention deficit/hyperactivity disorder medications spiked in the first year of the pandemic, according to a report published Thursday by the Centers for Disease Control and Prevention.
The jump in prescriptions came after several years of increases, going back to 2016, the report found. The trend coincides with rising rates of ADHD diagnoses in adolescents, adults and women.
“This report shows there is this growing population of adults who have been diagnosed with ADHD, and there is need for support for this population,” said lead study author Melissa Danielson, a CDC statistician.
Pandemic pressure
In the report, researchers used insurance claim data to determine the number of stimulant prescriptions filled from 2016 to 2021 for people ages 5 to 64 years.
Three types of stimulants are approved for ADHD: amphetamine (Dexedrine, Adderall), methamphetamine (Desoxyn), and methylphenidate (Ritalin).
Overall, the percentage of people enrolled in employer-sponsored insurance plans who had a stimulant prescription filled rose from 3.6% in 2016 to 4.1% in 2021, but zooming in on certain years and age groups revealed much larger upticks, especially in prescriptions filled by adults during the first year of the pandemic. Patients who paid for their medication out-of-pocket were not included in the data.
From 2020 to 2021, the number of stimulant prescriptions filled rose by more than 10% among females ages 15 to 44 years and males ages 25 to 44 years. Among women ages 20 to 24, there was a nearly 20% increase.
Diagnoses for all mental health disorders increased during the pandemic.
Joshua Langberg, an ADHD specialist and director of the Center for Youth Social Emotional Wellness at Rutgers University, said that this could explain the additional bump in teens and adults filling prescriptions for ADHD medications during this time.
“People tend to seek out diagnoses during times of stress and crisis, and we have anecdotal evidence that there was a significant increase in people seeking diagnoses during the pandemic,” Langberg said.
Increased access
Overall, stimulant prescriptions dipped slightly in kids, but rose in most adults, especially in women, the report found.
The exact reasons for the decrease among children are unknown, Danielson, of the CDC, said.
One reason for the uptick in teen and adult stimulant prescriptions could be changes in how ADHD is diagnosed. The Diagnostic and Statistical Manual of Mental Disorders, the set of guidelines professionals use to diagnose mental health disorders, was updated in 2013 in response to a growing understanding of how ADHD may manifest differently in different people.
One of the changes raised the qualifying age for when a person’s symptoms had to have started, from 7 to 12 years old. In other words, people whose symptoms began at a later age would now be considered eligible for an ADHD diagnosis, said Langberg.
Symptoms fall into two categories, inattention and hyperactivity–impulsivity, and include not following through on instructions, not paying close attention to details, losing things often, and talking excessively.
While the symptoms used to diagnose ADHD in children and adults are the same, adults need fewer symptoms to qualify, said J. Russell Ramsay, director of the Adult ADHD Treatment and Research Program at the University of Pennsylvania’s Perelman School of Medicine.
Pandemic-era changes that allowed mental health providers to see patients via telehealth opened up opportunities for more people to access care. This included a change that allowed qualified practitioners to prescribe Schedule II stimulants — which includes the stimulants approved for ADHD — over telehealth without first seeing a patient in person, which was previously forbidden.
“That increased access allowed some people who had flown under the radar, or who said they were doing well enough, to get help,” said Ramsay.
Raised awareness
In recent years, social media has fueled an increase in awareness of how the signs of ADHD may occur differently in women and adults, which has likely driven more people whose symptoms had been overlooked to seek a diagnosis later in life, Ramsay said.
But increased awareness can be a double-edged sword. Viral memes or online videos could also lead to misdiagnoses.
“The upside of awareness is more women are being diagnosed. The downside is people may see ADHD in themselves when it isn’t there,” Ramsay said.
A lot of ADHD symptoms, such as trouble focusing, are not unique to the disorder, which can further complicate an accurate diagnosis.
“Things like distractibility can be a symptom of anxiety, depression, schizophrenia, or even Lyme disease. You need more information,” said Ramsay.
The complexity of the disorder has led to both over- and under-diagnoses, Langberg said.
“A comprehensive evaluation for ADHD is time consuming, can be costly, and it involves not just assessing for ADHD, but other things that can lead to concentration issues such as anxiety, depression and lack of sleep,” he said, noting that providers often don’t have the time, expertise or resources needed to carry out comprehensive ADHD evaluations for all people who need them.
Questionnaires may replace a comprehensive assessment in some cases, and some telehealth companies and pharmacies are under investigation for potentially over-prescribing stimulant ADHD medication.
“Because ADHD occurs with other mental health disorders half the time, you have to make sure one of those is not causing symptoms of ADHD,” said Dr. Lenard Adler, director of the Adult ADHD Program at NYU Langone. “You have to take a careful history.”
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