Adderall shortage may be associated with increased use of alternative ADHD medication in children

A national shortage in a common treatment for attention-deficit hyperactivity disorder was associated with changes in stimulant prescriptions filled for children over recent years, a new study suggests.

The dispensing of prescription stimulants – a crucial therapy option for children with ADHD – fell sharply at the onset of the 2020 COVID pandemic but then began to recover, according to the research in Pediatrics.

The Federal Drug Administration’s announcement of a shortage in the stimulant Adderall in October 2022 was followed by a plunge in prescription fills of the medication to kids, adolescents and teens. Simultaneously, however, the dispensing of other types of stimulants grew.

“Our findings suggest that the Adderall shortage did not cause many children to stop stimulant therapy altogether, but it did force some to switch to alternative stimulants,” said lead author Sijia He, M.S., a researcher at the Susan B. Meister Child Health Evaluation and Research Center in the University of Michigan. 

“This would be potentially concerning if the switches may have resulted in worsened ADHD control. We need more research to evaluate whether any switches led to adverse outcomes.”

He and colleagues analyzed changes in stimulant dispensing to children ages 5-17 between 2017 to 2023 using national data that captures 92% of U.S. prescriptions.

The research is believed to be one of the first national studies to evaluate trends in stimulant prescription fills to children during the COVID-19 pandemic and shortage of Adderall.

At the beginning of the pandemic in March 2020, researchers found, the monthly stimulant dispensing rate to children declined by nearly 455 children per 100,000 – or a nearly 19% decrease compared to January 2017.

After March 2020, this rate slowly edged up every month. In October 2022, when the Adderall shortage emerged, dispensing rates for Adderall decreased while the dispensing rate for dexmethylphenidate, commonly known as Focalin, climbed.

The authors found that changes in stimulant dispensing varied by age and sex. For example, among male adolescents aged 12–17 years, stimulant dispensing rebounded to a lesser degree than other groups. This stimulant dispensing rate in December 2023 to male adolescents was 19% lower than would have been expected based on pre-pandemic trends.

For boys aged five to 11 years, the stimulant dispensing rate in December 2023 was similar to what would have been expected.

Meanwhile, the rate of stimulant dispensing was 9% higher than expected among girls aged five to 11 years, consistent with a prior study showing that children with first time ADHD diagnoses were more likely to be girls during the pandemic compared to previous years.

“A potentially optimistic explanation of these findings is that they represent a decrease in underdiagnosis and undertreatment of ADHD in girls,” said Kao-Ping Chua, M.D., Ph.D., senior author of the study and a researcher at University of Michigan Health C.S. Mott Children’s Hospital and the Susan B. Meister Child Health Evaluation and Research Center.

“It’s also possible that symptoms of inattention in girls increased during the pandemic, increasing their need for stimulants,” Chua added.

Addressing the stimulant shortage for children

ADHD is the most diagnosed neurobehavioral condition among U.S. children. Prescription stimulants are often a first-line treatment, making them among the most commonly prescribed controlled substance to children in the country.  

The rate of stimulant dispensing to children may have changed during the COVID-19 pandemic as many children transitioned to virtual learning, Chua says.

Additionally, access to in-person health care was disrupted, potentially decreasing opportunities to diagnose and treat ADHD, although Chua notes such decreases may have been offset by a policy allowing stimulant prescribing via telehealth without an in-person visit.

The FDA pointed to both production issues and unprecedented demand for stimulants in the U.S. – particularly among adults – as factors leading to the 2022 shortage of Adderall.

Chua says policymakers might consider raising limits on stimulant production to ensure that children do not experience barriers to accessing stimulants even if demand for stimulants among adults continues to surge. He also points to the need to ensure appropriate stimulant prescribing to adults, including developing guidelines for the diagnosis and management of adult ADHD. 

“Our findings indirectly demonstrate how increased demand for a medication class in adults may adversely affect access to these treatments for children,” he said.

“It’s crucial to address the shortage of stimulant medications because so many kids rely on them. Untreated ADHD symptoms can harm children’s health and learning.”

 Study Cited: “Prescription Stimulant Dispensing to US Children: 2017–2023.” Pediatrics, DOI: 10.1542/peds.2024-068558