The Clinicians’ Guide to Treating Complex ADHD is a clinical compendium from Medscape, MDEdge, and ADDitude designed to guide health care providers through the difficult, important decisions they face when treating pediatric and adult patients for ADHD and its comorbid conditions. This guided email course will cover the following topics:

• DECISION 1: What should I consider when developing a comprehensive treatment plan for ADHD?
• DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
• DECISION 3: How can I decide which ADHD medication to prescribe first?
• DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
• DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
• DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
• DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

NOTE: This resource is for personal use only.

STIMULANT + NON-STIMULANT: How can combination therapy improve symptoms with fewer side effects?

A: The term refers to using a stimulant and a non-stimulant to reduce ADHD symptoms. There were no lectures in medical school on this therapy and no studies of it when… | Keep reading on ADDitude »

SLEEP: Stimulant use is associated with an elevated risk for sleep problems. How can clinicians address this side effect?

A: Clinicians should titrate while evaluating a patient’s environmental and familial conditions, screen for primary sleep disorders, and… | Keep reading on ADDitude »

MED CHANGES: When should a patient switch to a different medication and/or dosage?

A: If a stimulant is causing excessive irritability, restlessness, or seriousness throughout the day, a dose reduction… | Keep reading on MDedge »

ADHERENCE IN CHILDREN: How can clinicians improve medication adherence in children with ADHD?

A: ADHD medication initiation and adherence are increased when patients have a strong working alliance with their clinician and trust the health care system… | Keep reading on ADDitude »

ADHERENCE IN ADULTS: How can clinicians improve medication adherence in adults and adolescents with ADHD?

A: As clinicians, we must acknowledge how difficult it is take medications every day. And we must be proactive in asking our patients, “How many times did you skip a dose, and what impact did that have… | Keep reading on ADDitude »

RELATED RESOURCES

How to Optimize ADHD Medication: Strategies for Achieving Better Symptom Management

Expert Webinar with William Dodson, M.D., LF-APA | Listen now on ADDitude »

Why Adults with ADHD Abandon Medication — and How to Improve Treatment Outcomes

Expert Webinar with William Dodson, M.D., LF-APA | Listen now on ADDitude »

How to Optimize Stimulant Treatment for Children and Adults: Better Symptom Management Without Side Effects

Expert Webinar with Thomas E. Brown, Ph.D. | Listen now on ADDitude »

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
DECISION 3: How can I decide which ADHD medication to prescribe first?
> DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

MEDICATION CHART: What are the similarities and differences between the most commonly prescribed ADHD medications?

A: This chart presents the most popular and most commonly prescribed medications used to treat ADHD in children and adults… | Keep reading on ADDitude »

METHYLPHENIDATE: How effective is methylphenidate in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

AMPHETAMINE: How effective is amphetamine/dextroamphetamine in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

DEXMETHYLPHENIDATE: How effective is dexmethylphenidate in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

LISDEXAMFETAMINE: How effective is lisdexamfetamine in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

ATOMOXETINE: How effective is atomoxetine in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

RELATED RESOURCES

Pills and Beyond: A Guide to the Formulations and Delivery Options of ADHD Medication

Expert Webinar with Laurie Dupar, PMHNP, RN, PCC | Listen now on ADDitude »

Medication Management: How to Use and Adjust Stimulants Safely

Expert Webinar with William Dodson, M.D., LF-APA | Listen now on ADDitude »

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
> DECISION 3: How can I decide which ADHD medication to prescribe first?
DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

MEDICATION: What classes of medication have been shown to treat ADHD effectively?

A: Methylphenidate is the drug of choice approved by FDA for ADHD in children aged 6 years or older. It is the most commonly used drug… | Keep reading on Medscape »

BEST PRACTICES: How can a clinician determine a patient’s optimal dosage of the stimulant medications used to treat ADHD?

A: Many pediatricians are trained to give a certain number of milligrams per kilogram of a patient’s body mass, but there is no evidence that dose is affected by size, age, gender… | Keep reading on ADDitude »

THE MED DECISION: How should clinicians navigate parental concerns around treating children with ADHD medication?

A: While it’s important to educate parents on how medications work and why they might be used, it’s equally critical for clinicians to support… | Keep reading on ADDitude »

HEART HEALTH: Do cardiovascular risks exist for older adults taking ADHD medication?

A: A new meta-analysis concluded that “ADHD medication use was not statistically significantly associated with the risk of any CVD… | Keep reading on ADDitude »

ADHD & SUD: Does ADHD medication increase risk for future substance use problems?

A: No. What’s more, treatment with ADHD stimulant medication prior to age 9 may actually decrease a child’s likelihood of abusing drugs and alcohol later in life, according to research… | Keep reading on ADDitude »

RELATED RESOURCES

ADHD Medication Options and Benefits for Children

Expert Webinar with Walt Karniski, M.D. | Listen now on ADDitude »

Medicating Your Child with ADHD: How to Manage the Feelings of Guilt and Judgment, and Make Peace with Your Decision

Expert Webinar with Roberto Olivardia, Ph.D. | Listen now on ADDitude»

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
> DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
DECISION 3: How can I decide which ADHD medication to prescribe first?
DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

May 1, 2023

A new stimulant medication, Xelstrym (dextroamphetamine), will soon be available for the treatment of attention deficit hyperactivity disorder (ADHD) in children ages 6-17 and adults 18 and older. Xelstrym is the only transdermal amphetamine patch to be approved by the Food and Drug Administration (FDA). It was presented at the annual conference of the American Professional Society of ADHD and Related Disorders (APSARD) by drug manufacturer Noven Pharmaceuticals, Inc., in January.

Xelstrym is a once-daily patch that should be administered two hours before an effect is needed and removed after nine hours. It has a printed backing on one side and a release liner on the other. Medication is absorbed through the skin via application to the hip, upper arm, chest, upper back, or flank areas.

According to a Noven press release distributed on January 10, Xelstrym would be available by the end of March. It is now expected to launch later this year.

Xelstrym is available in the following strengths: 4.5mg, 9mg, 13.5mg, and 18mg. Patients with a known sensitivity to amphetamine products should avoid taking Xelstrym. ^{1, 2}

The FDA approved Xelstrym in March 2022, one year after approving the stimulant Azstarys for the treatment of ADHD in people ages 6 and older.

Dextroamphetamine is approved for the treatment of narcolepsy and ADHD. U.S. brand names for dextroamphetamine, besides Xelstrym, include:

• Dexedrine
• Dexedrine Spansules
• Procentra
• Zenzedi
• Dextrostat
• Liquadd

Adderall Shortage: Could Xelstrym Help Patients?

Xelstrym may help lessen the impact of the lingering Adderall shortage — which began last November and has affected the supplies of other well-known stimulants — however it is also a Schedule II medication subject to regulations by the U.S. Drug Enforcement Administration (DEA). After a $21 billion nationwide opioid settlement, new limits were imposed on controlled drug supplies by the DEA. ADHD stimulant medications are classified as federally controlled substances (CII).

In a recent ADDitude reader panel, patients described the hardships they’ve faced since the shortage began. Ann from Illinois, like many women with ADHD, went undiagnosed for much of her life. She was diagnosed in October 2021 but has struggled to fill her prescription since then.

“All my life, I beat myself up mentally because I thought I was lazy and worthless, but knowing I had ADHD and needed support from medication made me see myself in a new light,” she said.

“It was heartbreaking for me when the Adderall shortage hit my local area. It felt like this new healing journey was cut abruptly when I could no longer find my medication in stock anywhere. I became depressed as I fell back into old habits where I laid around screaming at myself in my mind to get up and do something, anything! Thankfully, my pharmacist worked with me to get on Vyvanse.”

One ADDitude reader said they called seven pharmacies in one day to get their Adderall prescription filled, but instead “went two weeks without medication because there was nothing I could do.”

Tiff, who lives in Kentucky, hasn’t gotten “any dose or type of ADHD medication since late August 2022.”

“Currently, I take Bupropion twice a day. It is not helping with my ADHD at all. We couldn’t get Vyvanse paid for, so that was a no-go. This is affecting every aspect of my life, including work.”

One mom from California relayed the hardship her family experiences due to 30-day refill maximums for her child’s Class II stimulant medication.

“It is a real hardship for my child in college,” she said. “We have to work together as a family to get him his medication during this critical time of his education. And there is little empathy from our health providers. They just expect us to ‘buck up and deal with it.’”

More on Xelstrym

To learn more about Xelstrym, including usage and side effects, visit www.noven.com/xelstrym/. To receive future updates on its release, visit www.xelstrym.com.

Sources

¹Noven Pharmaceuticals, Inc. (n.d.) Xelstrym. https://www.noven.com/xelstrym/

²Daily Med. (2023, March 28). Label: Xelstrym. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0862f02a-72a8-41cc-8845-57cf4974bb6f&audience=consumer

April 24, 2023

One in four middle and high school students has reported abusing prescription stimulant medications used to treat ADHD, according to a cross-sectional study recently published in the journal JAMA Network Open. ¹ Non-medical use of prescription stimulants among teens remains more prevalent than misuse of other prescription drugs, including opioids and benzodiazepines, the research found.

According to researchers at the University of Michigan, students who used marijuana in the past 30 days were four times more likely to abuse ADHD medications than teens who did not use cannabis. In addition, stimulant drug abuse was 36% more likely to occur in schools with a large population of students with stimulant medication prescriptions to treat ADHD than it was in schools with fewer students using prescription stimulants like Adderall or Ritalin. (Studies have shown that one in every nine high school seniors reported taking prescribed stimulants for ADHD.) (², ³)

According to the research, other factors associated with increased rates of stimulant drug abuse included:

• Schools located in suburban, non-Northeastern regions of the U.S.
• Schools with a high proportion of parents with a college degree
• Schools with a higher proportion of white students
• Schools with a medium amount of binge drinking among students (10%-19% of the total student body)

Prolonged stimulant abuse, researchers said, can lead to several detrimental health effects, including cardiovascular conditions, depression, anxiety, seizures, overdoses, psychosis, and stimulant use disorder.

“The key takeaway here is not that we need to lessen prescribing stimulants for students who need them, but that we need better ways to store, monitor, and screen for stimulant access and use among youth to prevent misuse,” said study author Sean Esteban McCabe, Ph.D.

For the study, the University of Michigan research team analyzed data collected between 2005 and 2020 by Monitoring the Future, a National Institute of Drug Abuse (NIDA) multi-cohort survey that measures drug and alcohol use among adolescents nationwide. More than 230,000 teens in grades 8, 10, and 12 from 3,284 secondary schools participated in the survey.

Dangers of Stimulant Misuse

Counterfeit Medication

Demand for prescribed stimulants to treat ADHD symptoms increased substantially from 2020 to 2021, a recent U.S. Centers for Disease Control and Prevention (CDC) report found. According to the CDC report, prescription stimulant fills were highest among males and females aged 5–19 and 15–24 years, respectively. ⁴

Previous studies have reported that more than half of adolescents who misuse prescription stimulants get the medication for free from friends or relatives. ⁵ However, illicit medications are increasingly obtained via online drug markets and social media referrals, making it harder to differentiate real and counterfeit medications. ⁶

“The drug supply has rapidly changed,” said National Institute on Drug Abuse Director Nora Volkow in a press release about the study. “What looks like medications — bought online or shared among friends or family members — can contain fentanyl or other potent illicit substances that can result in overdoses. It’s important to raise awareness of these new risks for teens.”

Students who use counterfeit medications often believe they are obtaining the actual medication as dispensed by a pharmacist, explained Kevin Antshel, Ph.D., professor of psychology at Syracuse University. “However, students obtaining counterfeit medications may purchase a product that is laced with potentially lethal amounts of drugs, usually fentanyl or methamphetamine,” Antshel said. “Fentanyl is especially concerning. A lethal dose of fentanyl is roughly the size of a few grains of salt.”

In May 2022, two Ohio State students died from suspected use of counterfeit stimulant medication laced with a synthetic opioid.

Drug Diversion

The University of Michigan researchers recommended that caregivers educate teens about the consequences of drug diversion (selling or sharing prescribed medications). “Nearly a quarter of adolescents who are prescribed stimulant therapy will be approached to divert their stimulant medications by their peers before the completion of high school (and more than half [54%] during college),” they wrote. ⁷, ⁸

Theresa E. Laurie Maitland, Ph.D., coordinator of the Academic Success Program for Students with learning differences and ADHD at the University of North Carolina, Chapel Hill, learned first-hand how widespread medication diversion is on college campuses.

“I asked a graduating senior if he had any advice for me. He said, ‘There’s one topic I wish you’d talk about with all students taking ADHD medication: How to handle the demand they will face to give away or sell their pills!’

“I was shocked but hid my reaction and listened attentively,” she said. “The student had been open about stimulant use, and the news spread quickly among his peers and classmates. He was often approached to sell or hand over ‘just one pill.’”

The FDA classifies stimulants as Schedule II controlled substances. Most state laws follow federal laws, with criminal penalties for possession without a prescription.

“Even if no money is exchanged, sharing your medication is, technically, ‘dealing drugs,’ and anyone who expects you to do it isn’t a true friend,” said Susan Yellin, Esq., Director of Advocacy and Transition Services at The Yellin Center for Mind, Brain, and Education in New York.

How Parents Can Help Teens

“The diversion of stimulant medication has serious legal and health risks for undiagnosed students and major personal, legal, and financial consequences for teens diagnosed with ADHD,” Maitland said. “We must inform those with ADHD about this important issue.”

Maitland offered the following suggestions to caregivers and teens:

1. Talk to Family Physicians
“For middle and high school students, doctors can provide printed or video material explaining the legal and health risks associated with sharing or selling stimulants,” she said.

2. Value Your ADHD Diagnosis
It’s important that adolescents understand and accept their ADHD diagnosis, and that parents include them in healthcare decisions. “When students accept their diagnoses and value their medication, they have no desire to give or sell their pills to others,” Maitland said.

3. Use Discretion
Teens must store their ADHD medications in a lockbox or other secure device. They should also use discretion when sharing information about their stimulant use. “Many students have told me it is best not to discuss one’s stimulant use until they make friends (or maybe not at all),” Maitland said.

4. Foster Open Dialogue
Parents should talk with their children about the health and legal risks of misusing, sharing, or selling medication and potential scenarios they may encounter.

Teens can even role-play what to say if a family member, friend, or stranger asks them for pills. “Have teenagers rehearse several scripts to prepare them to say ‘no’ and to deal with pressure,” Maitland said.

Most importantly, Maitland continued, “Young people need to know they can turn to us in awkward situations and talk with us about something they regret having done.”

Sources

¹McCabe, S.E., Schulenberg, J.E., Wilens, T.E., Schepis, T.S., McCabe, V.V., and Veliz, P.T. (2023). Prescription Stimulant Medical and Nonmedical Use Among US Secondary School Students, 2005 to 2020. JAMA Netw Open. (4):e238707. doi:10.1001/jamanetworkopen.2023.8707

²Garfield, C.F., Dorsey, E.R., Zhu, S., et al. (2012) Trends in Attention Deficit Hyperactivity Disorder Ambulatory Diagnosis and Medical Treatment in the United States, 2000-2010. Acad Pediatr. 12(2):110-116. https://pubmed.ncbi.nlm.nih.gov/22326727/

³Xu, G., Strathearn, L., Liu, B., Yang, B., and Bao, W. (2018) Twenty-Year Trends in Diagnosed Attention-Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997-2016. JAMA Netw Open. 1(4):e181471. https://10.1001/jamanetworkopen.2018.1471

⁴Danielson, M.L., Bohm, M.K., Newsome, K., et al. (2023). Trends in Stimulant Prescription Fills Among Commercially Insured Children and Adults — United States, 2016–2021. MMWR Morb Mortal Wkly Rep 2023;72:327–332. https://doi.org/10.15585/mmwr.mm7213a1

⁵Compton, W.M., Han, B., Blanco, C., Johnson, K., Jones, C.M. (2018) Prevalence and Correlates of Prescription Stimulant Use, Misuse, Use Disorders, and Motivations for Misuse Among Adults in the United States. Am J Psychiatry. 175(8):741-755. https://doi.org/10.1176/appi.ajp.2018.17091048

⁶Moyle, L., Childs, A., Coomber, R., and Barratt, M.J. (2019). #Drugsforsale: An Exploration of the Use of Social Media and Encrypted Messaging Apps to Supply and Access Drugs. Int J Drug Policy. 63:101-110. https://doi.org/10.1016/j.drugpo.2018.08.005

⁷McCabe, S.E., Teter, C.J., and Boyd C.J. (2006). Medical Use, Illicit Use, and Diversion of Abusable Prescription Drugs. J Am Coll Health. 54(5):269-278. https://doi.org/10.3200/JACH.54.5.269-278

⁸McCabe, S.E., West, B.T., Teter, C.J., Ross-Durow, P., Young, A., and Boyd, C.J. (2011). Characteristics Associated with the Diversion of Controlled Medications Among Adolescents. Drug Alcohol Depend. 118(2-3):452-458. https://doi.org/10.1016/j.drugalcdep.2011.05.004

As The Washington Post recently reported, the Adderall shortage is causing disruptive and frustrating ripples in the academic and social lives of students with ADHD.

New limits on controlled drug supplies, paired with increased demand for that supply and lingering supply chain disruptions, have touched millions of patients prescribed ADHD stimulant medication. The medication shortage, now entering its eighth month, has had a jarring effect on families, especially the parents who are expected to manage their kids’ modified treatment plans and adapt to the pain points of tracking down and trying out new medication options.

Recently, ADDitude asked parents and teachers: Have you noticed the impact of the ongoing Adderall shortage on any of your students’ school and homework performance? Their classroom behavior?

Their answers point to a domino effect wherein the Adderall shortage has caused constrictions in other medications’ supplies. The cost of alternative, name-brand drugs can run significantly higher than Adderall, causing a financial burden that not every family can sustain.

Inadequate medication coverage is causing some children to experience behavioral problems in the classroom. Some students are not consequently showing up for school, or they’re being kept home, according to caregivers, roughly half of whom also have ADHD. Adults who relied on Adderall, including teachers, say they are struggling to attend to their own responsibilities — many of which directly impact their kids. That includes getting to school on time, reviewing homework, and sticking to a consistent routine.

[Download: Free Parenting Guide for Caregivers with ADHD]

The Adderall shortage may be temporary, but the repercussions could have a lasting emotional, social, and academic impact on developing kids. Hear what caregivers had to say about the Adderall shortage, below, and contribute your experience in the Comments section, above.

Adderall Shortage: Impact on Students with ADHD

“Some children who had used Adderall in the past have been changed to a different medication. The interruptions, resets, and resumption of new medications is noticeable in the classroom. Management tools and strategies are very helpful at these times.” — Jo Ann, Missouri

“The Adderall shortage is creating huge anxiety in my daughter, which leads to migraines. She does not function as well on other medications.” — Lisa, New York

“We couldn’t get the medications we needed, and had to get Vyvanse. It’s working, but the first fill was $400 with insurance. Not everyone can bear that, which may stop people from taking their medications at all. Neither of our two kids can do homework well without ADHD medications.” — An ADDitude reader

[Read: Could You Be Saving Money On Your ADHD Medication? Find Out Here]

“I am a teacher who has ADHD. For myself, luckily, I haven’t experienced a shortage for the slow-release Adderall, yet. For my students, absolutely. I noticed a huge increase in the number of students who fail to turn in assignments on time or fail to come to school.” — Noelle, New York

“We were briefly affected by the Concerta shortage prior to Adderall and, yes, it was difficult. My son relies on his daily medication to function. If I cannot give it to him, I will keep him home from school because I cannot send him into battle without the proper weapons to be successful. During those few months, I had to be proactive in contacting different pharmacies within short periods of time. I was also prepared to pay for the name brand out of pocket if we could not access the generic, as insurance would not cover the name brand.” — Amanda, North Carolina

“I have not noticed this, but the high cost of Vyvanse has definitely affected some of the lower-income high school students that I teach. Many lower-income families simply cannot afford it and are forced to use a drug that is less effective.” — Donna, Texas

“As a person, I need my Adderall to function. As a mom, I need my Adderall to support my kids. The shortage has left me unable to drive for field trips, get my kids to school on time, or even get out of bed at times.” — Lacey, California

“I am not always made aware if/when my students are on medications and/or when they stop, start, or change. However, I have observed changes in certain students’ behaviors (e.g. increased inattention, increased physical impulsivity).” — Theresa, Georgia

“As a teacher, it is a difficult (and blurry) line when it comes to medications and students. I have to assume a lot of students are medicated, but because their parents have not shared this with the school, I may not know for certain. And even if the information has been shared with the school, that doesn’t mean I am privy to that information as a classroom teacher. So, at this moment, I really don’t know if there are students who are being impacted by the Adderall shortage. What I know is that personally I am, and it makes my days very difficult.” — Brianna, Iowa

“My 14-year-old son started a generic Concerta this year for the first time. A few weeks ago, I couldn’t find a pharmacy to fill the generic. Eventually, I figured out that my insurer’s online pharmacy could fill a brand name Concerta prescription. In the meantime, about three weeks went by when my son struggled more with homework and tests. I am told the Concerta shortage is a result of Adderall patients seeking alternatives.” — An ADDitude reader

“Our oldest son with ADHD is already out of college and working. I know the shortage has affected his ability to feel like he’s performing well at his new job. He’s developed other strategies that he’s implementing (through years of CBT), but I have noticed that things seem to be more of a struggle than they were a year ago for him.” — Jenny, South Carolina

“I am a preschool teacher; my students are largely unmedicated. However, the shortage has affected my co-workers and some of the parents of my students in a noticeable manner. One parent-teacher conference devolved into hysterical laughter because everyone forgot all the important paperwork. I’m lucky I found a non-stimulant option for myself.” — Holly, Washington

“I am no longer a teacher, but I can say that for me, personally, I am having a hard time completing any tasks, and I am surprised I am even completing this task right now. I suppose it’s because I have other, what I might consider more important things to do, and answering this question is a distraction.” — Marisa, Georgia

“I was worried for my son, but his psychiatrist worked out other medication options with him.” — Cathy, California

Adderall Shortage: Next Steps

• Download: ADHD Medication Tracking Log
• Read: What Do You Mean You’re All Out?
• Read: A Patient’s Guide to Overcoming ADHD Medication Disruptions

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

April 2, 2023

Demand for prescribed stimulants to treat ADHD symptoms increased substantially from 2020 to 2021, especially among women, a new U.S. Centers for Disease Control and Prevention (CDC) report found. Stimulant medication use among women in their 20s and 30s rose 17.5% with the biggest jump among women aged 20-24, 6.2% of whom now take a stimulant medication for ADHD, the CDC said. Notably, stimulant use also rose 16% among women aged 50-54, 2.9% of whom now take medication for ADHD — up from 2.1% in 2016.¹

According to the CDC report, more than 10% of all females aged 15–44 and males aged 25–44 filled prescriptions for stimulants commonly used in ADHD treatment in 2020-2021. The CDC arrived at these numbers by analyzing data from the Merative MarketScan Commercial Database, a national convenience sample of deidentified healthcare claims from enrollees in employer-sponsored insurance plans from 2016–2021. The percentage of enrollees with prescription stimulant fills rose from 3.6% in 2016 to 4.1% in 2021.

Rise in Women Diagnosed with ADHD

A spike in ADHD diagnoses among women likely contributes to the jump in stimulant medication prescriptions. The number of women aged 23 to 49 who were diagnosed with ADHD nearly doubled from 2020 to 2022, according to a new study from Epic Research. The health analytics firm reported that, though males are more likely to be diagnosed with ADHD than are females, the gender gap has decreased during the past 12 years. In 2010, males were 133% more likely to be diagnosed with ADHD than were females; in 2022, men were 28% more likely to receive an ADHD diagnosis. The study analyzed data from 3,389,383 patients diagnosed with ADHD between 2010 and 2022.²

The increase in adult diagnoses and stimulant medication prescriptions aligns with findings from a 2021 ADDitude survey of 2,365 adults, 26.5% of whom said they had received a formal ADHD diagnosis within the last year. What’s more, nearly 22% of adult survey respondents said they began taking ADHD medication for the first time during the pandemic — among newly diagnosed adults, this number was 64%. Only 5.5% of adults said they stopped taking medication and only 4.5% decreased dosage during the pandemic.

Pandemic Influences Demand for Stimulants

Policies enacted during the pandemic, which expanded access to prescription stimulants via telehealth providers, contributed to the increase in stimulant prescriptions. Overall, 56% of adults surveyed by ADDitude reported changes in their treatment team during the pandemic with nearly a quarter using telehealth appointments for the first time. Among newly diagnosed adults, 57% began seeing an ADHD professional for the first time during the pandemic.

According to U.S. Census data from 2022, 22% of Americans have used telehealth services. In a survey of 484 adult ADDitude readers conducted in April 2022, 57% reported using telehealth services and/or mental health apps during the preceding two years. A staggering 97% of the Cerebral users diagnosed with ADHD reported receiving a new prescription, according to the survey. Roughly 59% of those respondents said they were prescribed Adderall; 34% were prescribed Wellbutrin; and less than 10% were prescribed Vyvanse, Strattera, or Ritalin.

This upswing in demand undoubtedly contributed to the ongoing, nationwide Adderall shortage, which began in August 2022 and continues to impact as many as 75% of ADHD patients, according to ADDitude surveys of clinicians and patients conducted late last year and early this year.

Source

¹Danielson, M.L., Bohm, M.K., Newsome, K., et al. Trends in Stimulant Prescription Fills Among Commercially Insured Children and Adults — United States, 2016–2021. MMWR Morb Mortal Wkly Rep 2023;72:327–332. https://doi.org/10.15585/mmwr.mm7213a1

²Russell, J., Franklin, B., Piff, A., Allen, S., and Barkley, E. (2023, March 30). Number of ADHD Patients Rising, Especially Among Women Epic Research. Epic Research. https://epicresearch.org/articles/stimulant-prescribing-rates-remain-steady-for-patients-with-adhd

This is a very common problem. ADHD medication only treats symptoms while the medication is at an effective level in the brain. Once the medication wears off, the benefits stop. That means that paying attention to how long a medication lasts, even if it is branded as long-lasting, is important.

If your child is on short-acting four-hour Ritalin, for example, a dose around lunchtime will wear off around 3:30 p.m. Not only that, but side effects like irritability might occur when the medication wears off too quickly. On the other hand, even if your child takes a 10-hour medication at 7 a.m., it will wear off at 5 p.m. — not good if your child does homework after dinner.

[Read: How to Survive the After-School Witching Hour]

Older children and teens may need medication that lasts even longer, often well into the evening hours. Otherwise, they’ll be attempting homework, tutoring, dance practice, soccer, and other activities without the benefit of ADHD medication.

As common as this issue is, there is almost always a solution that maximizes the benefits of the medication without introducing or worsening side effects. Clinicians typically solve the problem of medication wearing away too early by prescribing a short-acting medication to be taken in the evening, or whenever initial medication is wearing off. You might consider giving the short-acting medication to your child right after dinner so that it lasts for about four hours and wears off before bedtime. A low dose will also ensure that no sleep difficulties come from the added medication.

If you take this approach, you must use the same type of stimulant medication at all times. That is, if your child takes a methylphenidate in the morning, use a methylphenidate (not an amphetamine) in the evening. Download a complete chart of ADHD medications here.

How to Treat ADHD in Children: Next Questions

1. What ADHD medications are used to treat children?
2. Is ADHD medication right for my child?
3. What are common side effects associated with ADHD medication?
4. What natural treatments help kids with ADHD?
5. What if the medication stops working?
   • How long will it take to get the medication and dosage right?
   • How do we know the medication is working?
   • When is it time to switch medications?
   • What should I do if my child stops taking their medication?
   • How can we solve medication rebound problems?
6. How can I find an ADHD specialist near me?

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “ADHD Medication Options and Benefits for Children” [Video Replay & Podcast #438] with Walt Karniski, M.D., which was broadcast on January 19, 2023. Dr. Karniski is the author of ADHD Medication: Does It Work and Is It Safe?

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

The use of ADHD medication during pregnancy causes no impairment of a child’s neurodevelopment or physical growth, according to research published in Molecular Psychiatry.¹ A large population-based register study found in-utero exposure to medication for ADHD, including stimulants, did not impair a child’s neurodevelopment or growth compared to children whose mothers stopped taking ADHD medication prior to conception.

Research was conducted using data from Danish nationwide registers, including more than one million children born between 1998 and 2015. Of those, 898 children were delivered by mothers who started or continued taking ADHD medication during pregnancy; this became the study’s “exposed” group. The “unexposed” group included 1,270 children whose mothers discontinued — but had previously taken — ADHD medication before conception.

Prenatal & Postnatal Exposure to ADHD Medication

After adjusting for maternal demographic characteristics and psychiatric data, researchers found no difference in long-term neurodevelopmental or growth outcomes between the two groups. In other words, women could stop taking medication before conception or continue during pregnancy without putting their child at greater risk of neurodevelopmental psychiatric disorders (ADHD, ASD); neurodevelopmental impairments (vision, hearing, seizures, epilepsy); or growth impairments.

Though the percentage is small, the number of pregnant women taking ADHD medication has steadily increased over time.^{2, 3} In fact, ADHD medication is one of the most common medications prescribed during pregnancy.^{3, 4}

In a recent survey of ADDitude readers, 2.39% of 1,170 women who had been pregnant reported taking medication for their ADHD following conception. Many of those who did not take medication said they remained undiagnosed and untreated at the time of their pregnancies, and therefore had no prescribed medications. Just 2.58% took ADHD medication while breastfeeding.

If a woman decides to discontinue use while both pregnant and breastfeeding, she may go a year or longer without pharmacological treatment — a first-line treatment for ADHD.

“I stopped [taking] Adderall leading up until delivery, and had been told I couldn’t take it at all during breastfeeding,” wrote one 33-year-old woman in Texas. “I went back to work three months postpartum. I really struggled with symptoms and felt unable to do my job.

“I did some additional research… that suggested a low breastmilk transfer rate for Adderall, and an even lower rate with Ritalin. Five months postpartum, I brought that data to my GP, who agreed to prescribe 5mg of Ritalin twice daily. I continued exclusively breastfeeding for two more months, then did a combination of breastfeeding and formula until weaning completely when my daughter was nine months. At that time, my GP switched me back to Adderall. During this time, my daughter showed no adverse effects, remaining on her growth trajectory in the 90th percentile and sleeping like a champ!”

Impact on Children

The decision to cease or continue treatment for ADHD while pregnant is difficult, in large part because the effects of ADHD medication in utero are not well-documented. Due to the nature of the problem, research is limited to register studies like this most recent one — the second and largest long-term register study to examine the effects of ADHD medication during pregnancy.

In addition, the research is conflicting. A 2015 U.S. population-based study found that ADHD medication use in early pregnancy was associated with three specific, selected birth defects.⁵ Another U.S.-based study, published in 2017, suggested an increased risk of cardiovascular defects from prenatal exposure to methylphenidate — but not amphetamines.⁶

While exposed children faced no increased risks for common neurodevelopmental outcomes in the present study, researchers found that exposed children born to mothers who used other psychotropic medication during pregnancy were more likely to develop ADHD. This was also found when the mother had filled two or more prescriptions for ADHD medication during pregnancy.

Because the increased risk was limited to ADHD only, researchers speculate these results may be “driven by severity of maternal ADHD” through “higher disease liability for ADHD and through referral bias, that is, offspring of mothers with severe ADHD are assessed more carefully for ADHD.”

Impact on Women with ADHD

On average, women in the U.S. have their first child by age 27.⁷ According to the ADDitude survey, it’s around this time that women report a major impact caused by their ADHD symptoms. The majority — 64% to 70% of 2,010 respondents — said the overall impact of ADHD was major or life-altering in their 20s and 30s.

Half of survey respondents who had been pregnant said their ADHD symptoms remained stable during pregnancy. But following delivery, 56.7% of them said they experienced symptoms of postpartum depression. Around more than one-third told ADDitude these symptoms lasted for more than 6 months; for nearly 10%, postpartum depression lasted more than two years.

Similar findings were discovered in a 2020 survey conducted by the MGH Center for Women’s Mental Health. No significant changes in ADHD symptoms were reported by women during pregnancy, but those who chose to discontinue psychostimulant medication experienced a significant increase in postpartum depressive symptoms. Women who elected to adjust their ADHD medication use, or maintained the same prescription schedule, did not experience a significant change in depressive symptoms.

Limitations and Future Research

“Pregnant women who depend on stimulants for daily functioning must weigh the potential of exposing their fetus to unknown developmental risks against potential medical, financial, and other consequences to both mother and child that are associated with exacerbation of ADHD symptoms when stopping the medication, such as inability to maintain employment and unsafe driving,” the researchers stated.

ADHD medication in the present study included stimulants (methylphenidate, amphetamine, dexamphetamine, lisdexamphetamine) and other treatments (modafinil, atomoxetine, clonidine).

“The present study provides reassurance that several essential categories of child outcomes that could reasonably be suspected to be affected by stimulants, including body growth, neurodevelopment, and seizure risk, do not differ based on antenatal stimulant exposure.”

Compared to women without ADHD, the study’s sample population of women with ADHD tended to be younger at the time of childbirth, more likely to smoke during pregnancy, and more likely to have children born preterm or with low birth weight. This finding was consistent regardless of whether the mother took ADHD medication during pregnancy.

Finally, more research is needed to differentiate between the effects of ADHD medication types, dosage, and trimester. This study was limited to diagnoses formally entered into the Danish register. Future research should be expanded to include a larger sample population.

Sources

¹Madsen, K. B., Robakis, T. K., Liu, X., Momen, N., Larsson, H., Dreier, J. W., … Bergink, V. (2023). In utero exposure to ADHD medication and long-term offspring outcomes. Molecular Psychiatry, 1–8. doi: 10.1038/s41380-023-01992-6

²Lemelin, M., Boukhris, T., Zhao, J. P., Sheehy, O., & Bérard, A. (2021). Prevalence and determinants of attention deficit/hyperactivity disorder (ADHD) medication use during pregnancy: Results from the Quebec pregnancy/children cohort. Pharmacology research & perspectives, 9(3), e00781. https://doi.org/10.1002/prp2.781

³Haervig, K. B., Mortensen, L. H., Hansen, A. V., & Strandberg-Larsen, K. (2014). Use of ADHD medication during pregnancy from 1999 to 2010: A Danish register-based study. Pharmacoepidemiology and drug safety, 23(5), 526–533. https://doi.org/10.1002/pds.3600

⁴Louik, C., Kerr, S., Kelley, K. E., & Mitchell, A. A. (2015). Increasing use of ADHD medications in pregnancy. Pharmacoepidemiol Drug Saf, 24, 218– 220, doi: 10.1002/pds.3742.

⁵Anderson, K. N., Dutton, A. C., Broussard, C. S., Farr, S. L., Lind, J. N., Visser, S. N., Ailes, E. C., Shapira, S. K., Reefhuis, J., & Tinker, S. C. (2020). ADHD medication use during pregnancy and risk for selected birth defects: National birth defects prevention study, 1998-2011. Journal of Attention Disorders, 24(3), 479–489. https://doi.org/10.1177/1087054718759753

⁶Huybrechts, K. F., Bröms, G., Christensen, L. B., Einarsdóttir, K., Engeland, A., Furu, K., Gissler, M., Hernandez-Diaz, S., Karlsson, P., Karlstad, Ø., Kieler, H., Lahesmaa-Korpinen, A. M., Mogun, H., Nørgaard, M., Reutfors, J., Sørensen, H. T., Zoega, H., & Bateman, B. T. (2018). Association between methylphenidate and amphetamine use in pregnancy and risk of congenital malformations: A cohort study from the international pregnancy safety study consortium. JAMA psychiatry, 75(2), 167–175. https://doi.org/10.1001/jamapsychiatry.2017.3644

⁷Osterman, M.J.K., Hamilton, B.E., Martin, J.A., Driscoll, A.K., & Valenzuela, C.P. (2023). Births: Final data for 2021. National Vital Statistics Reports; 72(1). DOI: https://dx.doi. org/10.15620/cdc:122047.

Low-income Black families are more likely to seek medication treatment for their children with ADHD following positive experiences and collaborative involvement with healthcare providers and schools, according to a new study published in the Journal of Attention Disorders. ¹

Researchers analyzed datasets from the National Survey of Children’s Health (NSCH) that comprised 450 uninsured or publicly insured Black children with ADHD, ages 6 to 17, who were taking ADHD medication. Researchers analyzed the data to test the validity of seven themes that emerged in their initial-stage interviews with low-income Black caregivers of children with ADHD recruited from an outpatient pediatric behavioral health clinic in New Jersey. The caregivers were interviewed about their views, concerns, and accounts of treatment decisions and treatment experiences for their children; their input helped form the study’s hypotheses.

7 Hypotheses Related to ADHD Medication Decision-Making for Black Children

Researchers identified seven themes from the interviewed caregivers regarding their treatment decisions.

• Child safety and volatility related to the child’s behavior influenced treatment decisions, as did caregiver aggravation tied to the frustrations and burdens of caring for a child with ADHD. Caregivers believed that medication would decrease their children’s ADHD symptoms, such as impulsivity and inattention, and would keep their children and others safe.
• Family-centered care (FCC) and shared decision-making (SDM) were commonly reported among caregivers who felt included in their children’s treatment decisions. Some caregivers felt clinicians involved them in decision-making about their child’s treatment; others felt dismissed and believed clinicians perceived them as uneducated. Caregivers also described positive (appreciation to schools for identifying the need for treatment, administering medications, etc.) and negative (frequently disrupted by school calls, the perception that children had lower intelligence, etc.) experiences with schools.
• Caregiver mental health — caregivers and other family members commonly took medication for a psychiatric diagnosis.
• Sole parent status were associated with self-reported “feelings of being alone in dealing with the challenges of parenting a child with ADHD with a right to independence in making decisions regarding treatment,” researchers wrote.

Analysis of the NSCH data confirmed that SDM and FCC did impact caregivers’ decisions to medicate their children. Researchers reported that children whose caregivers engaged actively in the treatment decision-making process were twice as likely to take ADHD medication as were those who did not. Conversely, feeling dismissed or excluded from decision-making made caregivers apprehensive and unsure regarding medication choices for their children.

Black children who do not receive appropriate treatment can suffer severe consequences for behaviors associated with their ADHD symptoms. “Ample data shows Black students are more likely to be placed in the school-to-prison pipeline than white students,” said Tumaini Rucker Coker, M.D., MBA, Associate Professor of Pediatrics and Chief of General Pediatrics at the University of Washington School of Medicine. “Black students are suspended and expelled three times more often than white students.² And when students are suspended or expelled for behavior, they’re almost three times more likely to be in contact with the juvenile justice system in the following year.” ³

The study also found that Black children who previously received special education services were more than twice as likely to be treated with medication than were those who never received services. However, researchers could not determine “the exact nature of the relationship between receiving special education services and taking medication for ADHD.”

Findings did not confirm a direct causal relationship between taking ADHD medication and caregiver mental health, child safety and volatility, or sole caregiver status. However, the authors wrote that “these topics warrant further discussion.”

Why Shared Decision-Making Matters

Current guidelines for treating ADHD in children focus on behavioral therapy and medication management; however, “Black children are significantly less likely to receive medication than white children due to racially based structural and attitudinal barriers,” researchers wrote. ⁴, ⁵, ⁶

“Sufficiently addressing disparities in care starts with understanding why racial and ethnic imbalances matter, the roots of these inequities, and their consequences for overall health and well-being,” said Coker, who discussed how barriers to ADHD diagnosis and treatment – from the clinical level to systemic factors – disproportionately impact children and adolescents of color in the presentation titled “Equity, Diversity, and ADHD: Achieving Equitable ADHD Care for African American and Latinx Children” at the 2021 APSARD Annual Virtual Meeting.

Next Steps for Clinicians

Sarah Vinson, M.D., Associate Clinical Professor of Psychiatry and Pediatrics at Morehouse School of Medicine, offered several tips for clinicians in the ADDitude article “Evaluating and Treating ADHD in African American Children: Guidance for Clinicians.”

• Clinicians should strive for cultural humility — and embrace the idea that the patient’s family is the expert on the child and their situation. “The patient’s expertise is needed, and cultivating this relationship is a two-way process,” Vinson said. “The clinician educates the patient and family about ADHD, and the caregiver informs the clinician about the child’s realities, challenges, and ideas about ADHD and other neurological and mental health issues.”
• Clinicians should learn how patients and families feel about the child’s ADHD diagnosis, the possibility of medication, and what resources the family can access. “Some families, for example, may bring up the difficulties surrounding being a Black person in a racist society, and having that compounded by mental illness and medication — both of which are still commonly stigmatized,” she said.
• Clinicians must explain what medications do and don’t do to allow patients and families to make informed choices and set realistic expectations.
• Clinicians should understand issues surrounding insurance and family dynamics. “Black children are more likely to be publicly insured, meaning that the medication formulations available are limited,” Vinson said.
• Clinicians should avoid aiming for competency alone. Vinson explained, “Being aware of and continuously learning about historical and current factors (at the local level and beyond) can help clinicians contextualize experiences and issues related to Black communities.
• White clinicians must contend with their ingrained biases and examine any defensiveness and fragility that comes with it to address larger, structural issues.
• Clinicians should know what resources local schools have available and what inequities exist regarding access to school counselors, therapists, and psychoeducational testing to inform treatment planning.
• Clinicians should be guided by an understanding that any intervention which helps the primary caregiver and family unit feel heard and informed is important.

Researchers from the Journal of Attention Disorders study reiterated Vinson’s recommendation in their report. “Clinicians must recognize that applying their expertise in concert with FCC and SDM can ensure that the most vulnerable children receive evidence-based treatment for ADHD,” they wrote. “Interventions should focus on supporting teachers to partner with low-income Black caregivers of children with ADHD and developing partnerships between school districts and medical providers to ensure appropriate referrals for ADHD care and improve access to care for vulnerable populations.”

The study had several limitations, including the lack of specificity regarding medication decision-making over time for low-income Black children with ADHD. Researchers recommended that future research focus on communication between teachers and caregivers from this demographic and the relationship between medication treatment and exit from special education services.

Sources

¹Glasofer, A., Dingley, C., Kim, J., Colosimo, R., & Gordon, H. R. D. (2023). Medication Decision Making in Low-Income Families of Black Children With ADHD: A Mixed Methods Study. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547231158382

²U.S. Department of Education Office for Civil Rights (USDEOCR). (2014). Civil rights data collection, data snapshot: School discipline. Retrieved from https://www2.ed.gov/about/of-fices/list/ocr/docs/crdc-discipline-snapshot.pdf

³Fabelo, T., Thompson, M. D., Plotkin, M., Carmichael, D., Marchbanks, M. P. III, and Booth E. A. (2011). Breaking Schools’ Rules: A Statewide Study of How School Discipline Relates to Students’ Success and Juvenile Justice Involvement. New York , NY; College Station, TX: Council of State Governments Justice Center; Public Policy Research Institute of Texas A&M University. Retrieved from https://www2.ed.gov/about/of-fices/list/ocr/docs/crdc-discipline-snapshot.pdf

⁴Bax, A. C., Bard, D. E., Cuffe, S. P., McKeown, R. E., Wolraich, M. L. (2019). The Association Between Race/Ethnicity and Socioeconomic Factors and the Diagnosis and Treatment of Children with Attention-Deficit Hyperactivity Disorder. Journal of Developmental & Behavioral Pediatrics, 40(2), 81–91. DOI: 10.1097/DBP.0000000000000626

⁵Danielson, M. L., Bitsko R. H., Ghandour R. M., Holbrook J. R., Kogan M. D., Blumberg S. J. (2018a). Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents. Journal of Clinical Child & Adolescent Psychology, 47, 199–212. https://doi.org/10.1080/15374416.2017.1417860

⁶Rostain, A. L., Ramsay J. R., Waite R. (2015). Cultural background and barriers to mental health care for African American adults. Journal of Clinical Psychiatry, 76, 279–283. https:0.4088/JCP.13008co5c

Each clinician has their own way of determining the right ADHD medication and dosage for a patient. A common approach (and the one I use) is the following:

• Start patients on a low dose of a long-acting methylphenidate.
• If the patient is a young child or has difficulty swallowing a capsule, consider a liquid formulation, a chewable tablet, or a skin patch.
• If symptoms persist on the lower dose, consider increasing the dose.
• If methylphenidate is ineffective even at the higher dose and/or produces significant side effects, switch to a long-acting amphetamine.
• If either methylphenidate or amphetamine are effective but produce significant and intractable side effects, consider adding a non-stimulant.
• If either stimulant is ineffective, switch to a non-stimulant entirely.

[Get This Free Download: Comparison Chart of Stimulants & Non-Stimulants]

Why This Approach Works

Decades of research indicate that methylphenidate is as effective as amphetamine, but more easily tolerated as it comes with fewer side effects, which is why methylphenidate is commonly prescribed first.¹ Long-acting methylphenidate provides most patients with the all-day coverage they need, though I may prescribe a short-acting preparation during key points of the patient’s day, like in the morning to jump-start the beneficial effects of medication as the child gets ready for school, or as the medication is wearing off to extend the duration of the initial long-acting medication.

We start a patient with a low dose and adjust dose upward from there to ensure that there is optimum benefit with minimal or no side effects. We gradually increase the dose until the patient sees positive results (or even greater benefit).

Even if a patient, whether a child or an adult, sees benefits with the low dose of medication I started them on, I still encourage them to experiment with a higher dose of the medication. Parents of children who are newly diagnosed with ADHD are often resistant to the idea, but I explain to them that the benefits, even with a minimal dose increase, may be even greater than what they are currently seeing. If side effects do occur at a higher dose, then the dose can be lowered to the previous one. To further fine-tune a patient’s dose, I would consider a liquid preparation or a skin patch.

It is important to understand that while decades of scientific research establish the effectiveness of ADHD medications, a trial-and-error approach is often necessary when starting an ADHD medication, as each patient may respond differently to a given medication. Thankfully, the many different ADHD medication options available allow us to tailor treatment to the needs of each child or adult for maximum benefit with the least amount of side effects.

How to Treat ADHD in Children: Next Questions

1. What ADHD medications are used to treat children?
   • What are all of my ADHD medication options?
   • What are the most popular ADHD medications?
   • How does ADHD medication work?
   • How do stimulants and non stimulants differ?
   • How do short-acting and long-acting stimulants differ?
   • What are the benefits and risks of ADHD medication?
2. Are ADHD meds safe for my child?
3. What are common side effects associated with ADHD medication?
4. What natural treatments help kids with ADHD?
5. How can I find an ADHD specialist near me?

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “ADHD Medication Options and Benefits for Children” [Video Replay & Podcast #438] with Walt Karniski, M.D., which was broadcast on January 19, 2023.
Dr. Karniski is the author of ADHD Medication: Does It Work and Is It Safe?

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., Carucci, S., Atkinson, L. Z., Tessari, L., Banaschewski, T., Coghill, D., Hollis, C., Simonoff, E., Zuddas, A., Barbui, C., Purgato, M., Steinhausen, H. C., Shokraneh, F., Xia, J., & Cipriani, A. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. The lancet. Psychiatry, 5(9), 727–738. https://doi.org/10.1016/S2215-0366(18)30269-4

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Pregnancy is magical and excruciating. Exciting and overwhelming. Demanding and the calm before the storm.

This is true for most people who experience pregnancy, but it’s doubly true for those with ADHD, roughly 96% of whom cease taking stimulant medication while pregnant and nursing. On top of that, the new and unrelenting demands of caring for an infant, while experiencing changing hormone levels and disrupted sleep, can amplify ADHD symptoms and bring a new level of difficulty to daily functioning.

For women who discontinued ADHD medication use during pregnancy, in particular, coping with raw emotions, a new routine, and a new baby may feel next to impossible and lead to comorbid anxiety and depression. It is important for clinicians treating perinatal women with ADHD to consider the benefits and risk of stimulant use in this critical time of transition.

In this webinar, women, partners, and professionals will learn:

• About the intersection of ADHD symptoms and neurobiology in perinatal women during and after pregnancy
• About the risk analysis of stimulant use versus discontinuation in pregnancy and postpartum
• How to anticipate the demands of early motherhood and risk for depression and anxiety in women with ADHD
• About the impact of hormones on ADHD throughout the lifespan, and the interplay with medication

Have a question for our expert? There will be an opportunity to post questions for the presenter during the live webinar.

Meet the Expert Speaker:

Allison Baker, M.D., is a clinician, researcher, and educator with the Perinatal and Reproductive Psychiatry Clinical Research Program at Massachusetts General Hospital, with an appointment at Harvard Medical School. She has expertise in pediatric obsessive-compulsive disorder, ADHD, adolescent mood disorders, and perinatal psychiatry. Dr. Baker frequently lectures and leads workshops on a variety of topics in child and perinatal psychiatry.

Dr. Baker received her medical degree from the University of Virginia, where she was elected to the Alpha Omega Alpha Honor Society for her excellence in scholarship and professionalism. She completed her residency in general psychiatry at Columbia University, serving as Chief Resident. Dr. Baker trained in child and adolescent psychiatry at the combined program of Columbia and Cornell Universities. Dr. Baker then served on the faculty at Columbia University Medical Center and was a Senior Pediatric Psychopharmacologist at The Child Mind Institute before moving to Boston.

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Closed captions available.

How Many Different ADHD Medications Exist?

ADHD medications come in two major forms: stimulants and non-stimulants. Stimulants are the most effective treatments for attention deficit hyperactivity disorder. Of the 46 medications currently approved by the U.S. Food and Drug Administration (FDA) to treat ADHD, 36 are stimulants.

All these medication choices exist, in part, to allow patients and clinicians to develop a tailored treatment plan — one that reduces the symptoms of ADHD and increases functioning with minimal side effects and hassle for that individual patient. Variety is essential because no two patients with ADHD respond the same way to a given medication.

Short-Acting and Long-Acting ADHD Medications

Without any modifications, the two stimulant medications for ADHD — methylphenidates and amphetamines — are short-acting in nature. They begin to take effect after 30 minutes, peak after about two hours, and wear off about four hours after being taken.

This means that patients with this type of medication will have to remember to take multiple doses a day for full symptom control — not the most effective method for individuals with symptoms of inattention, distractibility, and poor working memory. Unsteady medication levels in the body also affect a patient’s psychological state. This is why children are often irritable when medication starts to wear off.

[Get This Free Download: Comparison Chart of Stimulants & Non-Stimulants]

For a long-time, short-acting medications (like Ritalin and Adderall) were the only medications available for patients with ADHD. Over time, pharmaceutical companies have developed long-acting preparations to extend the therapeutic effectiveness of methylphenidate and amphetamine. Popular long-acting medications today include Ritalin LA (up to 8 hours), Adderall XR (up to 9 hours), Focalin XR (up to 9 hours), Concerta (up to 12 hours), Vyvanse (up to 12 hours), and Jornay PM (up to 24 hours). Each one uses a different method for extending the lifespan of the medication, which helps explain the many different brand names for ADHD medications today.

This is not to say that short-acting medications are not effective or have no place in treating ADHD. Some doctors prescribe a short-acting medication to take as the long-acting medication is wearing off to further extend its effectiveness. For other patients, adding a low dose of a short-acting pill allows the long-acting medication to wear off more gradually, reducing the irritability side effect that often occurs when medication wears off.

Different Delivery Systems

Whether short- or long-acting, ADHD medications today are also available in the following forms:

• tablets
• capsules
• liquid preparations
• chewable tablets
• orally dissolving tablets
• skin patch

Each delivery mechanism has its benefits. Dissolving tablets and liquid preparations, for example, are excellent options for young children who have trouble swallowing pills. Liquid preparations also work well for accurately fine-tuning doses.

[Read: The Top ADHD Medications for Children — Rated by Readers]

As mentioned earlier, there are two stimulant medications, methylphenidate and amphetamine for treating ADHD. But with short-acting and long-acting preparations, four different mechanisms, and six different delivery systems, it is not difficult to produce many different brand name medications for the treatment of ADHD. But remember, in the end, all of these medications are still either methylphenidate or amphetamine.

What About Non-Stimulant Medications?

Non-stimulants are effective in treating ADHD symptoms, but not as effective as stimulants. But compared to stimulants, non-stimulants produce fewer side effects and actually treat many of the side effects that develop from stimulants. That is why non-stimulants can either be used alone to treat ADHD or in combination with stimulants to reduce side effects.

Non-stimulants approved for the treatment of ADHD include clonidine (Catapres, Kapvay), guanfacine (Tenex, Intuniv), atomoxetine (Strattera), bupropion (Wellbutrin), and viloxazine (Qelbree).

Where Can I Learn More About ADHD Medications?

In sum, stimulant medications are the most effective medications for the treatment of ADHD, and they are available in two forms: methylphenidate and amphetamine. They are also available in multiple therapeutic durations and multiple delivery systems, all of which improve compliance and accurate dosing. Awareness of these medication options and benefits result in more effective treatment with fewer side effects.

You can use the Medication Lookup Table on my website (www.adhdmedicationbook.com) to find ADHD medications based on criteria like stimulant type, duration, preparation, and more. For example, if you select “methylphenidate” and “long-acting,” the table will present medication options like Adhansia XR, Concerta, Daytrana, Jornay PM, Quilivant XR and other available medications that fit these exact specifications. But if you extend the criteria to include, say, only liquid preparations, the Lookup Table will show Quilivant XR, the only long acting, liquid methylphenidate medication currently available.

How to Treat ADHD in Children: Next Questions

1. What ADHD medications are used to treat children?
   • What are all of my ADHD medication options?
   • What are the most popular ADHD medications?
   • How does ADHD medication work?
   • How do stimulants and non stimulants differ?
   • How do short-acting and long-acting stimulants differ?
   • What are the benefits and risks of ADHD medication?
2. Are ADHD meds safe for my child?
3. What are common side effects associated with ADHD medication?
4. What natural treatments help kids with ADHD?
5. How can I find an ADHD specialist near me?

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “ADHD Medication Options and Benefits for Children” [Video Replay & Podcast #438] with Walt Karniski, M.D., which was broadcast on January 19, 2023. Dr. Karniski is the author of ADHD Medication: Does It Work and Is It Safe?

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

The nationwide Adderall shortage is now five months old, and it’s reportedly growing more dire by the day. ADHD stimulant medications, in general, are in short supply or impossible to find across the nation, according to the 470 ADDitude readers who answered a recent poll question. What began in October due to “labor constraints” at a manufacturing plant owned by Teva is now a full-blown crisis that’s leaving ADHD patients and clinicians in need of guidance.

“If this was any other organ system, this [shortage] wouldn’t be tolerated,” wrote Jon, a psychiatrist in New York City, in response to the ADDitude poll on Instagram. “They would be talking about it in the highest levels of government and in the media.”

The FDA predicted that supply issues would resolve by early February, though several manufacturers are now estimating recovery in March or April. ADDitude readers tell us they continue to call pharmacy after pharmacy trying to find their medication in stock. Colleen, an adult with ADHD and whose child also has ADHD, says she’s “burnt out from the whole process.”

“It’s a nightmare at my house,” she said. “Except that it’s not Adderall; it’s Concerta (for my daughter) and Vyvanse (for me). Between the two prescriptions, I feel like all I do every week is call for refills, find out our pharmacy doesn’t have any, and call more pharmacies to find out who does have the drug. Then I call the doctor and have her resubmit the script to whatever pharmacy has it.”

Prescriptions for controlled substances cannot be transferred, as Colleen has discovered. Instead, if a patient’s designated pharmacy is unable to fill a prescription, their doctor must write a new script. Those who cannot find their treatment of choice must go without or try an off-brand or alternative medication.

[Download: ADHD Medications – Comparison Chart of Stimulants & Nonstimulants]

Adderall Shortage: Reader Solutions

As the Adderall shortage drags on, we asked ADDitude readers: How has it impacted your life and ADHD treatment (if at all)? Many confirmed the shortage continues to limit the supply and availability of Adderall and stimulant medications in their area. Others shared the following strategies — ones that have helped them obtain their prescription, manage side effects, or remain positive.

1. Check local pharmacies for prescription availability.

• “I’ve been able to find a local pharmacy that is not a chain store and that carries [my medication]. I had to call around in December but was able to find that pharmacy; we’ve had no issues since. I haven’t even bothered trying Walgreens again because I know they’ll still be out.” — David
• “My psychiatrist recommended going to local pharmacies instead of big chains and I’ve found success. But before that advice, it was awful. I spiraled into a depression and felt so out of control.” — Bianca

2. Replace skipped doses with a multivitamin to maintain a routine.

• “There was a point where my medications were showing up late and I would go a few days without my dosage. My psychiatrist told me skipping a day or two during the month is okay to make my medications last until the refills come in. However, the problem with this is the slippery slope of me forgetting to take my meds the next day. Lack of consistency starts to hinder the routine.” — An ADDitude reader
• “Swap it out for a multivitamin or something else benign. This is how it works for oral birth control (sugar pills) and it is quite effective.” — An ADDitude reader

[Directory: Find an ADHD Specialist Near You]

3. Manage side effects to new medications with diet and supplements.

• “Magnesium drinks or gummies like Calm (#CommissionsEarned) can help with the crash.” — Lindsay
• “A little bit of caffeine or a sugar boost around crash time can help smooth out the come-down.” — Ulla
• “I started drinking Matcha. It helps me a lot and I feel less stressed.” — Isa

4. Explore natural treatment options.

• “The silver lining has been seeing people doubling down on non-medication-based tools and finding a positive rhythm they thought was only possible with medication.” — An ADDitude reader

5. Plan for end-of-day burnout.

• “I have started making dinner in the morning and putting it in the fridge to reheat because I have no focus left by around 4 p.m. I’m also now having a cup of coffee at 4:30 p.m.” — Diane

6. Call your insurance company.

• “My husband went to his human resources department, which handles the contract for insurance. They advocated for me, and my request has been approved for Vyvanse.” — Lindsay

7. Move forward with support and optimism.

• “Some sources indicate the shortages should begin dropping at the end of February or sometime in March. Production was increased in the late fall of 2022. Hang in there!” — Chad
• “My love and empathy go out to all those figuring out how to function right now. Lean on all the other supports you have and tell people if you are struggling.” — Theo

 

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Adderall Shortage: Next Steps

• Read: What Do You Mean You Are All Out?!
• Download: Lifestyle Changes for Adults with ADHD
• Learn: Generic ADHD Medications vs. Name-Brand Drugs
• Read: The Pharmacy Delivers, Too?

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

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