New research proposes that ADHD may increase the risk of gaming disorder (GD) in college students, hindering academic success and sleep. ¹

The study, published in the journal PLOS ONE, reported that 35.7% of college students with GD display ADHD symptoms compared to 23.3% of students without gaming disorder.

Gaming disorder is a mental health condition marked by excessive and compulsive engagement in Internet games, which can significantly disrupt relationships, school, and work. The behavior must be present for at least 12 months (or shorter in severe cases) to receive a GD diagnosis.

After surveying 383 university students in Lebanon, the researchers determined that ADHD symptoms directly affect academic performance and indirectly increase the risk of GD. Among students classified as high academic performers with GPAs of 3.2 and above, only one met the criteria for symptoms of GD or ADHD.

“The absence of GD and ADHD symptoms among high academic performers suggests that academic engagement and success may be protective factors against these conditions,” the study’s authors wrote. “Alternatively, it may be that the symptoms of these disorders disrupt academic performance, which would be consistent with the negative correlation observed between disorder prevalence and academic excellence.”

Gaming behaviors may distract college students from academics as they prioritize playing video games over studying. The study reported that students with a gaming disorder spend more time gaming on weekdays and weekends than do those without the disorder. “The correlation between GD and gaming hours, particularly on non-school days, suggests that free time may exacerbate gaming behaviors, potentially leading to disorder,” the study’s authors wrote. “This finding has practical implications for the management of GD, as it highlights the importance of structured time and alternative leisure activities as part of the therapeutic approach.” ²

Gaming Disorder Affects College Students’ Sleep Habits

According to the researchers, GD also impacts students’ sleep quality and duration. On average, students with GD sleep 6.1 hours; 64.3% wake up in the middle of the night to game. In comparison, those without GD sleep between 6.8 to 7.2 hours, with negligible nocturnal awakenings for males and none for females.

“The high incidence of nocturnal awakenings in the disordered gaming group (DGG) to continue gaming is a concerning trend that warrants attention due to the critical role of sleep in cognitive function, emotional regulation, and overall health,” the study’s authors wrote. ³

Findings also indicate that ADHD is more predictive of GD in females than in males, though other factors beyond ADHD may contribute to the development of GD, especially in females. These results echo a study published in June 2023 in the Journal of Attention Disorders. That study found a staggering 82% of individuals with GD had ADHD; more than half of the participants with ADHD (57%) had GD. ⁴

Why Gaming Appeals to College Students with ADHD

Why are students with ADHD symptoms more susceptible to gaming and, consequently, gaming disorder?

“From escapism and socialization to competition, video games are highly engaging, reinforcing, and stimulating by design,” said Jeremy Edge, LPC, IGDC, during the 2023 ADDitude webinar, “Addictive Technology and Its Impact on Teen Brains.” “Prolonged, excessive exposure to immediate rewards and dopamine hits in gaming may diminish the number of dopamine receptors in the brain over time, which can lead to tolerance and further stimulation seeking. ⁵ Gamers who are motivated by both escapism and achievement and who consider gaming part of their identity, are most at risk for problematic or disordered gaming.”

While the PLOS ONE study suggests a strong link between ADHD symptoms and GD, the study’s design does not establish causality and relies on self-reported data, which may introduce bias. In addition, the prevalence of ADHD in the sample is also higher than typical epidemiological estimates.

“More longitudinal studies are needed to clarify the causal relationships between ADHD and GD and to track how these relationships evolve,” the study’s authors wrote.

Edge emphasized that anyone showing signs of gaming disorder should talk to a doctor or mental health professional. “While still a growing field, help for technology addiction is available and ranges from psychotherapy and inpatient treatment clinics to recovery programs, support groups, and even medication,” he said.

Sources

¹ Hawai, N., Samaha, M. (2024). Relationships of Gaming Disorder, ADHD, and Academic Performance in University Students: A Mediation Analysis. PLOS ONE. https://doi.org/10.1371/journal.pone.0300680

² Buono, F.D., et al. (2020). Gaming and Gaming Disorder: A Mediation Model Gender, Salience, Age of Gaming Onset, and Time Spent Gaming. Cyberpsychology, Behavior, and Social Networking, 23(9): p. 647–651. https://doi.org/10.1089/cyber.2019.0445

³ Bourchtein, E., Langberg, J.M., Cusick, C.N., Breaux, R.P., Smith, Z.R., Becker, S.P. (2019). Technology Use and Sleep in Adolescents With and Without Attention-Deficit/Hyperactivity Disorder. J Pediatr Psychol. https://doi.org/10.1093/jpepsy/jsy101

⁴ Hong, J. S., Bae, S., Starcervic, V., & Han, D. H. (2023). Correlation Between Attention Deficit Hyperactivity Disorder, Internet Gaming Disorder or Gaming Disorder. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547231176861

⁵ Sussman, C. J., Harper, J. M., Stahl, J. L., & Weigle, P. (2018). Internet and Video Game Addictions: Diagnosis, Epidemiology, and Neurobiology. Child and Adolescent Psychiatric Clinics of North America,27(2), 307–326. https://doi.org/10.1016/j.chc.2017.11.015

The U.S. Drug Enforcement Administration (DEA) has issued a proposal to reclassify marijuana from the most tightly regulated Schedule I category to the less stringent Schedule III group of the Controlled Substances Act (CSA). The historic reclassification, if enacted, would recognize the medical uses of cannabis and acknowledge that its potential for abuse is lower than that of other drugs. However, some worry that reclassification could also increase the risk for substance use disorder, particularly in individuals with ADHD.

Marijuana has fallen under the Schedule I classification since 1971. DEA defines Schedule I substances as drugs with no accepted medical use and a high potential for abuse; the category includes heroin, methamphetamines, and LSD, among other drugs. The move to a Schedule III classification puts cannabis in the same category as Tylenol with codeine, steroids, and testosterone.

Cannabis and ADHD

A Schedule III reclassification would not legalize marijuana for recreational use, but it would make it easier to conduct studies and research the medical benefits of the drug.

Looser restrictions could make cannabis seem less harmful than it is, which concerns some ADHD experts.

Olivadia explained in the ADDitude webinar “Marijuana and the ADHD Brain: How to Identify and Treat Cannabis Use Disorder in Teens and Young Adults” that “the adverse effects of cannabis are especially amplified in people with ADHD…Contemporary marijuana has concentrations of THC higher than historically reported, which exacerbates this.”

Studies show that more than half of daily and non-daily cannabis users have ADHD,²and about one-third of adolescents with ADHD report cannabis use.³ People with ADHD are also three times more likely than their neurotypical peers to have ever used marijuana.⁴ The risk of developing cannabis use disorder (CUD), a problematic pattern of cannabis use linked to clinically significant impairment, is twice as high in people with ADHD³.

Further, a new study presented in April at the European Psychiatric Association Congress 2024 found that offspring of mothers with prenatal CUD have up to a 98% increased risk of developing ADHD, a 94% increased risk of autism spectrum disorder (ASD), and a 46% increased risk of intellectual disability (ID) compared to non-exposed offspring. Researchers from Curtin University in Australia analyzed data from more than 222,000 mother-offspring pairs for the study.

“Cannabis can also interact significantly with some ADHD medications,” Olivardia said in the ADDitude webinar.

Research studies have shown that methylphenidate (Ritalin, Concerta) reacts significantly with cannabis and may increase strain on the heart.⁵ Other studies have found that cannabis use can decrease the effect of a stimulant medication.⁶

The increased risk of suicide associated with cannabis use further complicates the use of marijuana by individuals with ADHD, who already face an elevated risk for self-harm and suicide compared to neurotypical individuals.⁷

“I am not so concerned about the reclassification, in part, because it will be much easier for scientists to examine the positive and negative impact of cannabis in randomized controlled trials,” says Timothy Wilens, M.D., chief of child and adolescent psychiatry, and co-director of the Center for Addiction Medicine at the Massachusetts General Hospital. “Currently, it is very difficult to study cannabis, due to very tight restrictions given its Schedule I status. With reclassification, one will be able to study cannabis under the typical regulations for any controlled substance, which will inevitably enhance our understanding of basic mechanisms, medicinal uses, and/or potential harm of cannabis.”

In March, Wilens co-authored a paper published in the Journal of the American Academy of Child and Adolescent Psychiatry that found legalization of recreational marijuana, but not medicinal cannabis, increases the use of cannabis by youth, the effects of which are more dire for young adults and teenagers.⁸

“Youth using cannabis has a number of negative outcomes,” Wilens says. “Our group and others have also shown longer-term negative effects of early cannabis use on cognitive executive functioning — already a problem for many kids with ADHD — and structural brain changes. Other concerns are functional changes in how the brain operates, which highlight difficulties with cognitive performance, such as driving for up to six to eight hours after ingesting cannabis.  Such findings are not surprising given the increased rate of minor and fatal motor vehicle accidents associated with cannabis consumption.”⁹, ¹⁰, ¹¹

Another study of young adults with and without ADHD found that individuals who started using before age 16 fared worse on measures of executive functioning and other cognitive outcomes than did those who began using marijuana later — an especially worrisome finding given that the study participants with ADHD were more likely than their counterparts to report cannabis use before age 16.¹²

Wilens noted that researchers at the National Institutes of Health are studying this issue as part of a project called the Adolescent Brain and Cognitive Development Study (ABCD), the largest long-term study of brain development and child health ever conducted in the United States.

What Draws People with ADHD to Cannabis?

“Cannabis activates the brain’s reward system and releases dopamine at levels higher than typically observed. In low-dopamine ADHD brains, THC thus can be very rewarding,” Olivardia explained. “People with ADHD, whose brain development is delayed by slowly maturing frontal lobes, are thus more vulnerable to cannabis’ effects on neuronal connections.”

ADDitude asked members of its Reader Panel to report their experiences using cannabis. Several readers reported that the benefits of using cannabis outweighed the negatives.

“I self-medicated with weed for many years for mood swings, PMDD, endometriosis, and ADHD before I was diagnosed,” a reader said. “I have a medical card now for my PMDD and other chronic pain issues. It can be a very helpful tool, but I am mindful of my use. If I’m not, it is easy to watch my day — and my energy — slip from my grasp.”

“I have begun trying marijuana edibles about an hour before bedtime after recreational marijuana was legalized in my state this year,” wrote another ADDitude reader. “I have found that a nano-dose of 2 to 3 milligrams of THC clears my head of the usual noise and lets me drop into a deep and restful sleep. I am 45 and (insufficiently) manage my ADHD with non-stimulant medication only.”

Another reader first tried cannabis during the early months of the pandemic and now uses it alongside Strattera. “I do not consume cannabis while working, but I do occasionally use CBG and/or CBD,” the reader said. “THC helps with my symptoms a great deal. Sativa strains are energizing; they help me get up and get things done around the house that I would otherwise procrastinate, such as chores and yard work. Indica strains are relaxing; they help quiet my inner chatter and make it easier for me to meditate and do gentle forms of yoga… Some strains amplify my hyperactive/impulsive tendencies… [but] with the right strains, cannabis can help a great deal with ADHD symptoms.”

Marijuana Rescheduling Next Steps

It’s unlikely that the DEA will reclassify cannabis as a Schedule III drug quickly. First, the White House Office of Management and Budget must review the reclassification proposal and conduct a 60-day public comment period. The proposal then will be reviewed by an administrative law judge, who could decide to hold a hearing before the rule is approved.

The marijuana rescheduling decision was the result of President Joe Biden’s 2022 request for the U.S. Department of Health and Human Services (HHS) and the Attorney General (who oversees the DEA) to review the drug’s classification.

The recreational use of cannabis is legal in 24 states, and 38 states have legal medical marijuana programs.

Sources

¹Jeffers, A.M., Glantz, S., Byers, A.L., Keyhani, S. (2024). Association of Cannabis Use With Cardiovascular Outcomes Among US Adults. J Am Heart Assoc.5;13(5):e030178. https:doi.org/10.1161/JAHA.123.030178
²Loflin, M., et. al. (2014). Subtypes of Attention Deficit-Hyperactivity Disorder (ADHD) and Cannabis Use. Substance Use & Misuse, 49(4), 427-434, https://doi.org/10.3109/10826084.2013.841251
³Francisco, A.P., Lethbridge, G., Patterson, B., Goldman Bergmann, C., & Van Ameringen M. (2023). Cannabis Use in Attention-Deficit/Hyperactivity Disorder (ADHD): A Scoping Review. J Psychiatr Res,157, 239-256. https://doi.org/10.1016/j.jpsychires.2022.11.029
⁴Wilens T. E. (2004). Attention-Deficit/Hyperactivity Disorder and the Substance Use Disorders: The Nature of the Relationship, Subtypes at Risk, and Treatment Issues. The Psychiatric Clinics of North America, 27(2), 283–301. https://doi.org/10.1016/S0193-953X(03)00113-8
⁵Kollins, S. et. al. (2015). An Exploratory Study of the Combined Effects of Orally Administered Methylphenidate and Delta-9-Tetrahydrocannabinol (THC) on Cardiovascular Function, Subjective Effects, and Performance in Healthy Adults. Journal of Substance Abuse Treatment, 48(1), 96-103. https://doi.org/10.1016/j.jsat.2014.07.014
⁶Volkow, N. D., Wang, G. J., Telang, F., Fowler, J. S., Alexoff, D., Logan, J., Jayne, M., Wong, C., & Tomasi, D. (2014). Decreased Dopamine Brain Reactivity in Marijuana Abusers is Associated with Negative Emotionality and Addiction Severity. Proceedings of the National Academy of Sciences of the United States of America, 111(30). https://doi.org/10.1073/pnas.1411228111
⁷Balazs, J., & Kereszteny, A. (2017). Attention-Deficit/Hyperactivity Disorder and Suicide: A Systematic Review. World Journal of Psychiatry, 7(1), 44–59. https://doi.org/10.5498/wjp.v7.i1.44
⁸Pawar, A.K.S., Firmin, E.S., Wilens, T.E., & Hammond, C.J. (2024). Systematic Review and Meta-Analysis: Medical and Recreational Cannabis Legalization and Cannabis Use Among Youth in the United States. Journal of the American Academy of Child and Adolescent Psychiatry. https:/doi.org/10.1016/j.jaac.2024.02.016
⁹ Gruber, S. A., Sagar, K. A., Dahlgren, M. K., Racine, M., & Lukas, S. E. (2012). Age of Onset of Marijuana Use and Executive Function. Psychology of Addictive Behaviors: Journal of the Society of Psychologists in Addictive Behaviors, 26(3), 496–506. https://doi.org/10.1037/a0026269
¹⁰Filbey, F. M., Aslan, S., Calhoun, V. D., Spence, J. S., Damaraju, E., Caprihan, A., & Segall, J. (2014). Long-term Effects of Marijuana Use on the Brain. Proceedings of the National Academy of Sciences of the United States of America,1 11(47), 16913–16918. https://doi.org/10.1073/pnas.1415297111
¹¹lbaugh MD, Ottino-Gonzalez J, Sidwell A, et al. Association of Cannabis Use During Adolescence With Neurodevelopment. JAMA Psychiatry. 2021;78(9):1031–1040. https://doi.org/10.1001/jamapsychiatry.2021.1258
¹²Tamm, L., Epstein, J. N., Lisdahl, K. M., Molina, B., Tapert, S., Hinshaw, S. P., Arnold, L. E., Velanova, K., Abikoff, H., Swanson, J. M., & MTA Neuroimaging Group (2013). Impact of ADHD and Cannabis Use on Executive Functioning in Young Adults. Drug and Alcohol Dependence, 133(2), 607–614. https://doi.org/10.1016/j.drugalcdep.2013.08.001

It began with an Adderall shortage in 2022. Today, prescriptions for many stimulant medications used as the first-line treatment of ADHD are consistently and frustratingly difficult to fill. So it’s unsurprising that ADHD features prominently in the majority of public comments submitted to the Federal Trade Commission (FTC) by stakeholders impacted by long-term medication shortages involved in the treatment of many conditions, including cancer. ADHD patients demand attention on their suffering.

But, by inviting public testimony on the stimulant shortage and pharmaceutical practices, I believe the FTC is only trying to find cover for the Drug Enforcement Administration (DEA). The DEA is the only governmental agency that sets production and distribution quotas for every drug company manufacturing controlled medication. The DEA decides how much of each medication can be released to pharmacies in any given month. Therefore, this problem traces its roots and long tendrils back to the DEA alone. No other agency has the authority to create and prolong it.

The DEA meets with every company that markets a controlled substance each March and April to determine how much of that company’s product can be released each month in the following calendar year. This process tries to predict in March of 2024 how much medication will be needed 21 months later in December of 2025. It is a crude and inadequate system that the DEA is too inflexible to relinquish.

For as long as the United States government has wrestled with combatting the distribution and use of illicit drugs, the DEA has used only one tactic — restricting the amount of drugs available to be sold legally. Now, the DEA is using the same playbook for ADHD stimulants.

Roots of the Adderall Shortage

Two years ago, the DEA decided that ADHD stimulants were being diverted and abused on a large scale, though there was virtually no evidence to support this belief. Studies have shown that a number of people (statistics vary) try stimulants but do not continue to take them without a prescription. About 90% of the diverted immediate-release stimulants are used by a narrow demographic: white male college students who use the drugs so they can stay awake. The medications are not being abused by people with ADHD, many of whom consider the drugs a lifeline for daily functioning.

[Read: Call to Action! Speak Up to End the ADHD Drug Shortage]

The DEA’s skepticism also came on the heels of increased rates of ADHD diagnosis and as a response to online providers who were sloppy about prescribing ADHD stimulants during the pandemic. The online clinics, however, never accounted for more than 1% of all prescriptions issued. And that problem was solved more than two years ago.

The DEA also observed that the number of people taking ADHD medications had been growing by 10% a year for 15 years. The growth rose largely from adults being diagnosed in later life. The relative number of children and adolescents taking stimulants has not changed in 20 years.

The DEA’s apparent logic behind its sweeping decisions was that these adults were abusing prescription stimulants, disregarding the well-documented evidence that ADHD persists after childhood. The rate of diagnosis and medication treatment is rising faster in every European country as well.  In the last year for which I had access to the drug company marketing studies (2014), the average age of diagnosis of ADHD was 31.

The DEA does not bother with facts. Its answer to this increased level of prescriptions: Decrease the amount of drug available regardless of consequences. Even when it became abundantly clear that placing quotas on drug companies had been a disastrous decision, the DEA did not reverse course. Even if the DEA decided in April to raise the allotments of drugs released to pharmacies, its current flawed and inflexible distribution mechanism would not allow for an increase until January 2025.

[Download: The Ultimate Guide to ADHD Medication]

I strongly suspect that the FTC is looking for an agency other than the DEA to blame. First, it said the drug companies were not making enough medication. But the drug companies were making and distributing as much as the DEA allowed them to. The idea that the drug companies were forgoing billions of dollars of profit was always unbelievable. Then the blame was laid on raw material shortages, but after two years, that explanation became hard to believe as well.

Then the FTC, FDA, and DEA blamed the telemedicine-only clinics that sprang up during the pandemic. However, the bad actors in this area have all closed down. Still, there has been no improvement in the shortage.

The time has long since passed for the DEA to admit its fault and fix its broken quota system. There has already been too much needless suffering by innocent people who did nothing to cause the DEA’s restrictions.

Give Your Input on the Drug Shortage

The deadline to submit public RFI comments to the FTC and U.S. Department of Health and Human Services (HHS) is May 30, 2024. Add your testimony at www.regulations.gov. (Direct link to the comment section)

The public can also demand an end to the ADHD medication shortage by writing letters to representatives, the DEA, and the FDA using templates provided by ADDitude.

Adderall Shortage & DEA: Next Steps

• News: ADHD Medication Shortage Comments Top Government Inquiry
• Download: ADHD Treatment Scorecard from ADDitude Readers
• Blog: “This Cannot Be the Price We Pay to Function.”
• Hub: Stimulant Shortage

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For millennia, the diagnosis for almost every female complaint — from chronic pain to digestive woes, palpitations, fainting, headaches, and aching joints — was singular and it was “hysteria” (from the Greek word for uterus).

It was believed for far too long that strenuous activity — physical or mental — would enflame the ovaries and uterus and imperil a female’s delicate constitution. In fact, it wasn’t until 1980 that hysteria neurosis — the catchall for every female ailment — was finally deleted from the American Psychiatric Association’s bible for diagnosis of psychiatric disorders, the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).

The Long History of Gender Bias in Medicine

As President and CEO of the Society for Women’s Health Research (SWHR), I and my staff advocated for more than 30 years for equitable research into women’s health conditions. Along the way, we discovered that not only were women’s health issues exclusive to women not being studied (e.g. fibroids, endometriosis), but women (especially minority women) were not included in clinical trials to determine toxicity, safety and effectiveness of therapies.

The reason, apparently, was the assumption that men and women were the same except for their reproductive organs. Additionally, women were more complicated because of their menstrual cycles and, of course, there was fear of liability if a woman was found to be pregnant during a study and the fetus was harmed. In those days, no early pregnancy tests existed.

It required two Congressionally requested investigations of the NIH and the FDA, several pieces of legislation, and intense lobbying and scientific meetings at various medical schools and research institutions throughout the country to educate and convince researchers and physicians of sex differences continuing to this day.

[Join Our Call for Greater Research on Women with ADHD]

Ending Systemic Bias Against Women

I recently wrote a book titled Sex Cells: The Fight to Overcome Bias and Discrimination in Women’s Healthcare (#CommissionsEarned) (Mayo Clinic Press; April 2, 2024). The title is important because it is necessary to distinguish the difference between biological sex and gender.

Biological sex and gender are not synonymous or mutually exclusive, and both influence health. Sex is considered a biological component; gender is a social construct that involves cultural, environmental, and societal expectations and assumptions. Biological sex is more likely to be related to how disease occurs and develops, while gender may have a significant impact on the manifestations and reporting of symptoms and on healthcare providers’ recognition of symptoms. Gender also influences treatment recommendations and options, and it effects what kind of care is made available.

My book is a natural extension of the work ongoing at SWHR, which has learned that including women and minorities in clinical trials was not enough. It’s clear now that research should begin at the basic biological level with female cells. This, of course, is more complicated and, apparently, it’s more costly include female animals in mammal studies. But it’s also critical work that must be done.

Why Sex Cells Matter

Sex differences as well as expressions of gender result from hormones. Hormones trigger a specific ordering of cells in a fetus and are linked to a wide range of sex-specific conditions and disorders. They are implicated in the prevalence of autoimmune disorders, osteoporosis, some cardiometabolic disorders, and perhaps Alzheimer’s disease in women.

[Read: We Demand Attention on Sex Differences in ADHD]

For example, some vaccines demonstrate higher efficacy in premenopausal women. Sex also influences transplant rejection, and fluctuating hormones may explain why autoimmune conditions are more common in women.

Heart disease, once believed to affect only men, is the Number One killer of white women in the U.S.; among American Indian and Alaska Native women, heart disease and cancer cause roughly the same number of deaths each year. For Hispanic and Pacific Islander women, heart disease is second only to cancer as the cause of death. Still, women with heart disease continue to be dismissed, overlooked, undertreated, and under-studied due to outdated medical preconceptions. The same could be said about women with ADHD.

A small 2021 study titled “Gender Bias in Estimation of Others’ Pain” revealed that, when male and female patients express the same amount of pain, members of the general population of all genders believe that the female pain is less intense than male pain and more likely to benefit from psychotherapy versus medication.

Despite all this evidence of substantial health variations based on biological sex, the scientific community is slow to recognize sex differences in the brain.

Profound differences in men’s and women’s brains influence everything from mental health to autism spectrum disorder. Sex differences exist everywhere in neuroscience, however scientists continue to study the male in animal studies, implying that results apply to biological men and women.

“To make real progress in improving both men’s and women’s health,” wrote Larry Cahill, Ph.D., in his groundbreaking 2014 study “Equal ≠ The Same: Sex Differences in the Human Brain”, “we need neuroscientist and non-neuroscientist alike to determine whether they too operate on the false assumption that ‘equal’ means ‘the same.’ If so, toss that assumption aside. True equality for the sexes demands it.”

On a practical level, no one should be surprised that medications and devices may work differently on biological women and men. We know that many medications cause women problems that were never anticipated or revealed in studies. This is because there are many factors in female biology that impact how a particular medicine works or doesn’t work.

I could go on and on about the discrepancies, but if you are interested in learning more, I urge you to read Sex Cells and to join the movement to eliminate sex biases in medical research. Our lives depend on it.

Gender Bias in Medicine: Next Steps

• Read: The Fate of Females with ADHD Is Improving Too Slowly
• Read: The Grave Consequences of Persistent Gender Role Expectations in ADHD
• Read: ADHD in Women and Girls — Why Female Symptoms Slip Through Diagnostic Cracks
• Hub: ADHD in Women Deserves Equal Attention!

Phyllis E. Greenberger, MSW is winner of the U.S. Department of Health and Human Services Women’s Health Trailblazer Award and Senior Vice President of Science & Health Policy for HealthyWomen. She is author of Sex Cells: The Fight to Overcome Bias and Discrimination in Women’s Healthcare (Mayo Clinic Press).

#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.

#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.

Women with ADHD can continue using the stimulant medication dexamphetamine and the painkiller acetaminophen (brand name: Tylenol) during pregnancy, according to two recent studies that refute a long-standing medical consensus.

An observational study published in the Archives of Women’s Health found that use of dexamphetamine (DEX), the main ingredient in brand-name ADHD medications such as Adderall, Dexedrine, Zenzedi, and ProCentra, does not put women or their babies at increased health risks. However, women who ceased using DEX during pregnancy were more than twice as likely to have a threatened abortion (mild to moderate bleeding during the first trimester) compared to those who continued DEX or who did not use the stimulant during pregnancy.¹

“This could indicate a possible association with DEX withdrawal,” the study’s authors wrote. “However, this is something that requires further investigation due to the small sample size, difficulties examining timing, and the inability to examine spontaneous abortion.”

The researchers analyzed a cohort of 1,688 women diagnosed with ADHD who gave birth in Western Australia between 2003 and 2018. Of the participants, 65% (547) ‘continuers’ took dexamphetamine throughout their pregnancy; 35% (297) ‘ceasers’ stopped using DEX before the end of the second trimester. A matched ‘unexposed’ group of 844 women had prescriptions for dexamphetamine before but not during pregnancy.

The three groups shared similar maternal health and labor and delivery characteristics, such as the onset of labor and delivery method. Complications during pregnancy, such as threatened pre-term labor, premature rupture of membranes, and bleeding in the second trimester, did not differ between the ‘ceasers’ and the ‘unexposed.’

Compared to the ‘continuers’ and ‘ceasers,’ the ‘unexposed’ group had a lower risk of:

• preeclampsia
• hypertension
• postpartum hemorrhage
• neonatal special care unit admittance
• fetal distress

While the findings illustrate the possible benefits of ceasing DEX before conception, the study’s authors noted that discontinuing ADHD medication puts pregnant people with ADHD at a higher risk for depression, anxiety, feelings of isolation, and family conflict. ²

“The results indicated that continuing to take dexamphetamine did not put women or their babies at increased health risks,” said Dani Russell, the study’s lead author, and a Ph.D. student from the University of Western Australia School of Population and Global Health. “Pregnancy can be a really stressful period for women with ADHD, so it is good to know that stopping their medication during pregnancy may not always be necessary.”

This research is part of a larger body of work investigating different ADHD treatments during pregnancy. The study’s authors said that more investigations are needed on the topic.

Acetaminophen Use in Pregnancy Not Linked With ADHD

A new study published in JAMA found that acetaminophen exposure during pregnancy does not increase the risk of autism, ADHD, or intellectual disability in children; however, factors such as genetics and the environment do. ³ This is the largest nationwide cohort study to date on acetaminophen usage during pregnancy. The study challenges prior research claiming that acetaminophen exposure during pregnancy may increase the risk of neurodevelopmental disorders in children. ⁴, ⁵

Scientists from the Karolinska Institute of Sweden and Drexel University’s Dornsife School of Public Health analyzed the prenatal and medical records of nearly 2.5 million children born in Sweden from 1995 to 2019, with follow-up through 2021. Of the 185,909 children exposed to acetaminophen in pregnancy, nearly 9% were diagnosed with autism, ADHD, or an intellectual disability, compared to about 7.5% of children whose mothers did not use the medication while pregnant. Children exposed to acetaminophen had marginally higher rates of diagnoses compared to those not exposed (1.53% vs. 1.33% for autism, 2.87% vs. 2.46% for ADHD, and 0.82% vs. 0.70% for intellectual disability).

The research team used the same database to conduct a second study focused on pairs of siblings whose mothers used acetaminophen during one pregnancy but not the other. This sibling control analysis found no evidence of increased risk of autism, ADHD, or intellectual disability associated with acetaminophen use during pregnancy.

“Associations observed in models without sibling control may have been attributable to confounding,” they wrote. “Results suggested that there was not one single ‘smoking gun’ confounder, but rather that multiple birthing parents’ health and sociodemographic characteristics each explained at least part of the apparent association.”

The study found acetaminophen had similar risks for neurodevelopmental disorders as non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and anti-migraine medicines. (The FDA recommends against using NSAIDs, such as Aspirin and Ibuprofen, in the third trimester of pregnancy because they may cause a blood vessel in the fetus to close prematurely.)

The researchers said that, despite the study’s large sample size and long duration, their reliance on self-reported and prescription dispensing data introduced several limitations. Still, these findings coincide with the American College of Obstetricians and Gynecologists, which maintains that acetaminophen is safe for pregnant women to use.

The Archives of Women’s Health and JAMA studies highlight the importance of pre-conception or early pregnancy counseling, individualized treatment plans, and medication management and recommend that patients discuss all medication decisions with their doctor.

Sources

¹ Russell, D.J., Wyrwoll, C.S., Preen, D.B. et al. (2024). Investigating Maternal and Neonatal Health Outcomes Associated with Continuing or Ceasing Dexamphetamine Treatment for Women with Attention-Deficit Hyperactivity Disorder During Pregnancy: A Retrospective Cohort Study. Arch Womens Ment Health. https://doi.org/10.1007/s00737-024-01450-4

²Damer, E.A., Edens, M.A., van der Loos, M.L.M., van Esenkbrink, J., Bunkers, I., van Roon, E.N., Ter Horst, P.G.J. (2021). Fifteen Years’ Experience with Methylphenidate for Attention-Deficit Disorder During Pregnancy: Effects on Birth Weight, Apgar Score and Congenital Malformation Rates. Gen Hosp Psychiatry. https://doi.org/10.1016/j.genhosppsych.2021.09.003

³Lee, B.K., et al. (2024). Acetaminophen Use During Pregnancy and Children’s Risk of Autism, ADHD, and Intellectual Disability. JAMA. https://doi.org/10.1001/jama.2024.3172

⁴Ji, Y., et al. (2019). Association of Cord Plasma Biomarkers of In Utero Acetaminophen Exposure with Risk of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder in Childhood. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2019.3259

⁵Bauer, A.Z., Swan, S.H., Kriebel, D. et al. (2021) Paracetamol Use During Pregnancy — A Call for Precautionary Action. Nat Rev Endocrinol. https://doi.org/10.1038/s41574-021-00553-7

The diagnostic criteria for ADHD are largely based on studies of young white boys. The symptoms spelled out in the DSM-5 — i.e., Is often “on the go” acting as if “driven by a motor” — do not reflect the lived experiences of many adults with the condition. This gap between clinical guidance and real-life symptoms has contributed to a decades-long problem with misdiagnosis, missed diagnoses, and inadequate treatment for individuals who slipped under the ADHD radar in childhood.

ADHD persists into adulthood for up to 90% of children with the condition. Symptoms evolve and change, but they do not magically disappear. In fact, the Centers for Disease Control and Prevention calls ADHD a “public health concern” with long-term repercussions. The longevity of ADHD is confirmed by scientific research, as is the fact that three boys are diagnosed with ADHD for every one girl with the condition. As a result, we now have a surging population of adults seeking a first-time diagnosis for lifelong symptoms of ADHD that may have become more debilitating, or at least distressing, with age.

“It’s not that ADHD symptoms necessarily get worse with age,” said David Goodman, M.D., assistant professor in psychiatry and behavioral sciences at the Johns Hopkins School of Medicine, during an ADDitude webinar in April 2024. “But when you are younger, ADHD symptoms are disruptive and inconvenient to others; as you age, ADHD symptoms become disruptive and inconvenient to you.”

Pent-up demand for ADHD evaluations among adult patients continues to grow, yet clinicians today have no reliable, standardized metrics for evaluating those symptoms. The DSM-5 contains some guidance for diagnosing adults, but it is controversial and largely considered inadequate. In addition, only 33% of pediatricians, 30% of family practitioners, 25% of nurse practitioners, and 22% of internists said that they received adequate training on ADHD in medical school, according to data presented by the American Professional Society of ADHD and Related Disorders (APSARD) at its 2024 conference.

“ADHD is the second most common psychiatric disorder in adults, but it is rarely focused on” by health care providers, Goodman said during the ADDitude webinar, titled “ADHD in Older Adults: Clinical Guidance and Implications.” “Older patients should not be easily discounted as having age-related cognitive decline and dismissed.”

First-Ever Adult ADHD Guidelines

APSARD is working to remedy this huge obstacle to care. In 2023, it established a 27-member task force that is devising clinical practice guidelines for the diagnosis and treatment of ADHD in adults. According to Goodman, who is leading the medical subcommittee for the task force, the adult ADHD guidelines have the greatest chance at widespread adoption if they are research based, clinically informed, and patient focused.

However, few research studies exist on adults over the age of 50, women, people of color, and minority populations, such as autistic adults with ADHD. If the APSARD guidelines are built on a framework of scientific research, and little, if any, unbiased scientific research exists on huge populations of patients, how thorough or helpful can those guidelines be?

“I wouldn’t say that we are going to write ‘good’ guidelines,” Goodman said during a presentation at the annual APSARD conference in January 2024, “because ‘good’ is defined in the present as what is supported by evidence. We are setting a basic standard of care… these guidelines will evolve as we learn more.”

Even so, APSARD’s clinical practice guidelines for ADHD in adults stand to impact far more than diagnosis and treatment rates. Some experts believe that formal guidelines based on high-quality scientific evidence will compel insurance companies to fully cover the medical treatment of ADHD in adults, which is seldom the case now. Others believe the guidelines could influence nationwide quotas for Schedule II controlled substances set by the Drug Enforcement Administration (DEA), opening the door for greater availability of stimulant medications used to treat ADHD. And many advocates are hopeful that adult ADHD guidelines will contribute to greater public awareness, better medical training, less stigma, and improved mental health outcomes for patients.

The adult guidelines, which are slated for release in late 2024 or early 2025, will take into consideration many of ADHD’s major comorbid conditions, according to committee member Frances Levin, M.D., of the Columbia University Irving Medical Center. Levin confirmed that her subcommittee is meeting with subject-matter experts on substance abuse, depression, and bipolar disorder, among other ADHD-related conditions.

For each psychiatric comorbidity diagnosed alongside ADHD, a patient’s risk of premature death rises exponentially, according to Goodman. The risk of premature death is 1.56 times higher for an adult with ADHD compared to one without ADHD, and it is 29.29 times higher for an adult with ADHD and four comorbid conditions, he said, citing a 2019 study published in JAMA Psychiatry.¹

The Concept of Subthreshold ADHD

The notion of “subthreshold” ADHD was introduced by task force members at the APSARD conference as well. Subthreshold ADHD may not meet the necessary DSM-5 criteria for a diagnosis in childhood, but mild symptoms may become severe due to the stress of parenthood or the hormonal swings that accompany menopause, said Maggie Sibley, Ph.D., head of the diagnosis and assessment subcommittee. People with subthreshold ADHD may not exhibit impairing symptoms before age 12, as required in the current DSM-5 for a diagnosis. However, these undiagnosed, untreated adults may experience significant distress later in life and face an elevated risk for substance abuse, burnout, and professional and personal problems as a result, Sibley argued during a presentation at the 2024 APSARD conference.

“People with subthreshold ADHD may be massively impaired even though they don’t quite meet the criteria for a diagnosis,” said Stephen Faraone, Ph.D., a distinguished professor in the Departments of Psychiatry and Neuroscience & Physiology at SUNY Upstate Medical University, during the APSARD presentation.

Citing 2022 research showing that 63.8% of people with ADHD experienced symptom fluctuations throughout their lives, Sibley said, “We need to recognize that ADHD symptoms are not stable; they wax and wane over the lifespan.”²

Removing or adjusting the DSM requirement that ADHD symptoms must be present before age 12 is one way to improve diagnosis and treatment. Another approach may be to expand the symptom criteria for adult ADHD to include emotional dysregulation, a common and impairing ADHD trait not currently included in the DSM-5. Some experts like Anthony Rostain, M.D., point out that “other DSM disorders allow ‘suffering’ or ‘distress’” due to persistent symptoms as justification for a diagnosis, “but an ADHD diagnosis requires impairment. Can we use impairment or distress instead?”

Implications for Treatment and Care

Though the APSARD task force is squarely focused on developing clinical practice guidelines for the diagnosis and treatment of ADHD in adults, it will also likely “address the issue of prescriptions for older adults with ADHD,” Goodman said. A primary concern is the safety of stimulant medication use among older adults, and the risk for introducing or exacerbating cardiovascular problems. In 2023, JAMA published a meta-analysis of 19 observational studies, involving 3.9 million participants, that found ADHD medications — both stimulants and non-stimulants — do not place patients of any age at greater risk for cardiovascular events, including heart failure and hypertension. The study found that there was no statistically significant association between ADHD medications and cardiovascular disease (CVD), even among middle-aged and older adults.³ Still, some prescribers hesitate or refuse to prescribe ADHD medications to patients older than age 50.

Perhaps surprisingly, the average duration of treatment for adults with ADHD is currently just seven months, said APSARD Past President Ann Childress, M.D., during a presentation on the topic of treatment barriers for adults with ADHD. More than half of adults stop taking their ADHD medication due to “suboptimal management of ADHD symptoms,” she said, citing a 2022 study published in BMC Psychiatry.⁴ 

To reverse this trend, Childress suggested greater clinician education regarding the benefits of long-acting stimulant medication for patients who would benefit from symptom control in professional and personal settings. Currently, 48% of adult ADHD patients are taking a short-acting stimulant, said APSARD President Greg Mattingly, M.D., an associate clinical professor at Washington University School of Medicine. Mattingly reported during an APSARD presentation that long-acting stimulants, sometimes in combination with a non-stimulant medication, are more effective for many of his patients.

APSARD is partnering with Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) to develop clinical tools based on the forthcoming adult ADHD guidelines that clinicians can use to aid the evaluation process, Goodman said.

Mattingly added that ADHD screenings should become a routine part of annual doctors’ visits.

“Five years ago, 20% of pediatricians were screening for depression, and now it is a ubiquitous quality measure,” he said. “ADHD screening has a higher rate of reliability, and it can be a quality measure, too.”

Sources

¹Sun, S., Kuja-Halkola, R., Faraone, S.V., D’Onofrio, B.M., Dalsgaard, S., Chang, Z., Larsson, H. (2019) Association of Psychiatric Comorbidity With the Risk of Premature Death Among Children and Adults With Attention-Deficit/Hyperactivity Disorder. JAMA Psychiatry.76(11):1141-1149. https://doi.org/10.1001/jamapsychiatry.2019.1944

²Sibley, M.H., Arnold, L.E., Swanson, J.M., Hechtman, L.T., Kennedy, T.M., Owens, E., Molina, B.S.G., Jensen, P.S., Hinshaw, S.P., Roy, A., Chronis-Tuscano, A., Newcorn, J.H., Rohde, L.A. (2022). MTA Cooperative Group. Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD. Am J Psychiatry. https://doi.org/10.1176/appi.ajp.2021.21010032

³Zhang, L., Yao, H., Li, L., et al. (2022). Risk of Cardiovascular Diseases Associated with Medications Used in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. JAMA Netw Open. https://doi.org/10.1001/jamanetworkopen.2022.43597

³Schein, J., Childress, A., Cloutier, M., Desai, U., Chin, A., Simes, M., Guerin, A., Adams, J. (2022) Reasons for Treatment Changes in Adults with Attention-Deficit/Hyperactivity Disorder: A Chart Review Study. BMC Psychiatry. https://doi.org/10.1186/s12888-022-04016-9

Even after an ADHD diagnosis, many clinicians are reluctant or refuse to prescribe stimulant medications due to conflicting or outdated information, leaving many older adults with ADHD without proper treatment.

It’s never too late to seek a diagnosis and symptom relief. Use this Patient Resource to begin conversations about and pursue an evaluation for ADHD as an older adult.

In this download, you will learn

• Why it’s never too late for an ADHD diagnosis
• Why older adults with ADHD symptoms go undiagnosed or misdiagnosed
• Why stimulants do not increase cardiovascular risk
• Why ADHD treatment gets tougher with age
• And much more

ADHD symptoms in children are associated with unusual interactions between the frontal cortex and deep centers of the brain where information is processed, according to a recent report in the American Journal of Psychiatry.¹ These findings may help inform additional research into the ADHD brain that leads to more effective treatments and interventions.

A research team from the National Institute of Mental Health (NIMH) and National Human Genome Research found children with ADHD demonstrated heightened connectivity between brain structures involved in learning, movement, and reward, and frontal areas of the brain that regulate emotion, attention, and behavior.

“The present findings suggest that these brain alterations are specifically associated with ADHD and are not indicative of general features of childhood psychopathology or influenced by comorbid symptoms,” the study’s authors wrote.

Researchers have long suspected that ADHD symptoms result from atypical interactions between the frontal cortex and these deep information-processing brain structures. However, the study’s authors noted that prior studies testing this model returned mixed results, possibly due to the small size of the studies they suggested.

The present study examined more than 10,000 functional brain images of 1,696 youth with ADHD and 6,737 without ADHD aged 6 to 18. It was the “largest study to date on changes in subcortical-cortical connectivity in ADHD,” the study’s authors wrote.

The findings underscore the need for more research regarding the association between brain connectivity and ADHD symptoms, the genetic aspects of ADHD, and how brain connectivity patterns relate to treatment outcomes.

Source

¹Luke J. Norman, Gustavo Sudre, Jolie Price, Philip Shaw. (2024). Subcortico-Cortical Dysconnectivity in ADHD: A Voxel-Wise Mega-Analysis Across Multiple Cohorts. American Journal of Psychiatry. DOI: 10.1176/appi.ajp.20230026

High-intensity exercise treats depression as effectively as do cognitive behavior therapy (CBT) and medication, according to a new study that found combining SSRIs, a type of antidepressant, with exercise improved depressive symptoms more than medication alone.¹

The systematic review and meta-analysis led by a research team from the University of Queensland, Australia, found that the more intense the physical activity, the more effective it was at managing depression. More specifically, vigorous exercises (e.g., running, interval training, strength training, mixed aerobic exercise) reduced depression symptoms in participants more than light physical activity (e.g., walking and hatha yoga), although the latter did provide some benefit.

These findings emerged from examinations of 218 randomized controlled trials, including 14,170 participants diagnosed with depression, to determine the effectiveness of exercise, psychotherapy, and antidepressants in treating depression.

When the researchers narrowed their analysis by demographics, they discovered that strength training and cycling positively impacted more women than men, and yoga or qigong provided more benefits to men than women. Yoga appeared more effective among older adults, and younger adults received better results from strength training. The duration and frequency of exercise did not affect the results.

The study also suggested that men appeared to benefit more than women from combining yoga, Tai Chi, or aerobic exercise with psychotherapy. Yoga and aerobic exercise combined with psychotherapy seemed more effective among older adults.

Participants gained the most benefits from group classes or scheduled exercises. The more autonomy participants had over their exercise programs, the weaker the outcome. “When provided with more freedom, the low self-efficacy that is symptomatic of depression may stop patients from setting an appropriate level of challenge (e.g., they may be less likely to choose vigorous exercise),” the study’s authors wrote.

The researchers cautioned that definitive conclusions are impossible to draw, and more studies are needed. “Our review did not uncover clear causal mechanisms, but the trends in the data are useful for generating hypotheses,” they wrote. “It is unlikely that any single causal mechanism explains all the findings in the review.”

“Exercise should be considered alongside traditional interventions as a core treatment for depression,” report author Michael Noetel, Ph.D., said in a press release. “No matter how often people exercised, whether they had other health issues or how severe their depression was, in all scenarios, exercise had a meaningful impact on their depression. Of course, anyone getting treatment for depression should talk to their doctor before changing what they are doing, but most people can start walking without many barriers.”

Exercise and Depression

Members of ADDitude’s reader panel confirm several findings from the study published in The BMJ (British Medical Journal).

“Strenuous full-body aerobic activities like boxing, karate, swimming, or boulder climbing help me get my thoughts in the right place and boost my mood and energy,” one panelist wrote. “Physical activity also helps me fall asleep and feel less stressed overall.”

“Running helps with my anxiety and depression,” another reader said. “It’s like a vacation for my overstimulated brain.”

A recent retiree who goes to the gym six days a week for group fitness classes and strength training sessions with a personal trainer shares that physical activity helps him feel calmer and more focused. “Exercise gives me a sense of accomplishment and community,” he says. “It is truly my second medication.”

Exercise Benefits Children and Teens with ADHD

The benefits of physical activity are not limited to adults; exercise improves the mental health of children and adolescents with neurodevelopmental disorders (NDDs), including ADHD, learning and motor disorders, autism spectrum disorder (ASD), and intellectual disability, according to a recent systematic review and meta-analysis published in JAMA Pediatrics.²

The researchers found that high-frequency (more than 27) 40-minute sessions of physical activity significantly benefited cognitive function, psychological well-being (e.g., self-esteem, quality of life), internalizing (e.g., anxiety and depression), and externalizing (e.g., aggression and disruptive behavior disorders) behaviors in children and adolescents aged 5-17 years with NDDs. They examined 59 studies with more than 3,000 participants.

ADDitude caregivers recognized similar results from their children after participating in physical activities.

One reader takes their son to the YMCA at least three times per week. “Depression can really take hold of my 10-year-old son,” the parent said. “We see great improvements after physical activity. He enjoys the elliptical, rower, spin bikes, automatic stepper, and treadmill.”

“My daughter has been playing hockey since she was young,” a reader said. “She says she can slow her brain down when she’s on the ice and think more clearly, and it’s as if her ‘ADHD evaporates.’”

“Intense cardio activities, like cross-country skiing and soccer, help my son burn off some of his boundless energy, and he gains self-confidence by being good at something nonacademic,” a reader said.

Another reader said, “My oldest is a distance runner. He is committed and gets up early to run his miles or workout. Running gives him that needed dopamine hit to keep his ADHD symptoms under control at the start of the school day.”

Incorporating Exercise in Depression Treatment Plans

A 2023 treatment survey of 11,000 ADDitude readers reaffirms both studies’ findings. Roughly half of the respondents who use this treatment rated exercise as “extremely” or “very” effective. A staggering 94% of caregivers and 95% of adults recommend exercise to treat ADHD symptoms. Yet only 13 % of these respondents said a doctor had recommended exercise to reduce symptoms, and only 37% of all respondents said physical activity was part of their treatment plan.

The BMJ study encourages clinicians to consider exercise a viable alternative to drug treatment or adjuvant for those already taking medication. “The findings support the inclusion of exercise, particularly vigorous exercise, in clinical practice guidelines for depression,” they wrote. “This may help bridge the gap in treatment coverage by increasing the range of first-line options for patients and health systems.”

Sources

¹Noetel, M., Sanders, T., Gallardo-Gómez, D., Taylor, P., del Pozo Cruz, B., van den Hoek, D. et al. (2024). Effect of Exercise for Depression: Systematic Review and Network Meta-Analysis of Randomised Controlled Trials. BMJ. doi:10.1136/bmj-2023-075847.

²Liu C, Liang X, Sit CHP. (2024). Physical Activity and Mental Health in Children and Adolescents with Neurodevelopmental Disorders: A Systematic Review and Meta-Analysis. JAMA Pediatr. doi:10.1001/jamapediatrics.2023.6251.

As coaches and therapists, we are well acquainted with clients like Kevin. At first, we show empathy for his struggle, stay positive, and problem-solve. Each week brings similar tales and we feel stuck. “Am I enabling Kevin?” we wonder. “Is he just saying what he thinks I want to hear? Why is he seeking help if he doesn’t want to take control of his life?”

Why ADHD Brains Struggle to Overcome Procrastination

Kevin’s intentions are likely genuine. He seems enthusiastic about a plan and expresses confidence that he will follow through. It’s his ADHD that has other plans. His brain’s altered rewards-processing system makes the task of turning intention into action a Mount Everest-sized challenge.

[Get This Free Guide: How to Build a Dopamine Menu to Stimulate Your Brain]

When most people feel unmotivated, they call on their executive functions to override the dread of getting started. They use their working memory to hold a goal in mind and recruit willpower to pursue it. They use inhibitory control to resist temptations and stay on task. But Kevin faces a double whammy from his altered rewards processing coupled with weaker executive functions. His attempts to follow through can feel like he is fighting his brain.

To help clients with ADHD get the most out of therapy, our research team at the University of Washington investigates provider strategies to enhance follow-through and created a roadmap for coaches and therapists.

Helping a client cultivate follow-through can be a slow process. Building one small success upon another, over time, can empower clients toward personal growth.

Stop Procrastinating: An Action Roadmap for ADHD Brains

During a Therapy or Coaching Session

• Devote at least 10 minutes to building plans that include details on how, when, and where actions will be taken to implement intentions. Gauge the client’s confidence in following through on intentions and adjust the plan as needed until confidence improves.
• Discuss possible barriers with the client and ask what they will do before they face each obstacle. For example, “What if you go to buy a calendar and the store is out of stock?”
• Put choices into the plan that will build enthusiasm and buy-in. Say, for example, “Will you do this at your desk or at a coffee shop?”
• Explore the outcomes and consequences of following through versus not. “What will it be like to complete your intentions? What will happen if your goals are not realized?”

[Read: How to Set Intentions to Crush Procrastination]

In the Next Session

• Help the client reflect on their attempts at follow-through. Some providers gloss over successes because they do not require problem-solving. Time spent discussing successes is an investment toward future follow-through.
• Reinforce all positive steps, even when follow-through was limited. Did the client complete a task one day out of seven? Celebrate that rather than dwell on what went wrong. Review each aspect of the plan in slow motion to increase the time spent discussing successes.
• Link positive steps to habit formation. Ask the client how they might continue with their new behavior long-term.
• Reframe failures as learning opportunities. Instead of rehashing barriers, ask clients how they wish to move forward. Say, “What will it take for you to be 10 percent more successful next week?” Refrain from giving suggestions except as a last resort. Encourage the client to come up with their own solutions.
• Revisit priorities when follow-through is tough. Are they different than initially thought? Perhaps perfection is not as important as meeting deadlines. Is insisting on one’s way not worth conflicts with others?

Stop Procrastinating: Next Steps

• Free Download: Finish Your To-Do List TODAY
• Take This Quiz: How Seriously Do You Procrastinate?
• Read: Why Do I Procrastinate? ADHD Excuses — and Solutions

Maggie Sibley, Ph.D., is a psychologist and researcher at the University of Washington School of Medicine.

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To what degree are ongoing nationwide ADHD drug shortages worsened by the role of pharmaceutical middlemen? This is the subject of a public inquiry recently launched by the Federal Trade Commission (FTC) and U.S. Department of Health and Human Services (HHS), which issued a joint Request for Information (RFI) on February 14.

The public has until May 30 to publicly submit comments at Regulations.gov.

The RFI asks patients to submit comments, documents, and data regarding how the practices of two types of pharmaceutical drug intermediaries — group purchasing organizations (GPOs) and drug wholesalers — may contribute to generic drug shortages, including how both entities may influence the pricing and availability of pharmaceutical drugs.

“When you’re prescribed an important medication by your doctor, and you learn the drug is out of stock, your heart sinks,” HHS Secretary Xavier Becerra said in a press release. “This devastating reality is the case for too many Americans who need generic drugs for ADHD, cancer, and other conditions. Today’s announcement is part of the Biden-Harris Administration’s work to tackle healthcare monopolies and lessen the impact on vulnerable patients who bear the brunt of this lack of competition.”

More specifically, the federal agencies say they aim to learn:

• Whether and to what extent manufacturers, GPOs, and drug wholesalers are complying with their legal obligations under Section 3 of the Clayton Act and the Robinson-Patman Act.
• Whether and to what extent the available protections for GPOs under the Federal Anti-Kickback Statute affect market concentration and contracting practices by GPOs, as well as drug shortages.
• Whether and to what extent market concentration among GPOs and drug wholesalers has impacted smaller healthcare providers and rural hospitals.
• Whether and to what extent concentration among GPOs and drug wholesalers has disincentivized suppliers from competing in generic drug markets.
• What is the impact of the prevailing GPO compensation model, which may rely on rebates, chargebacks, and administrative fees from manufacturers and suppliers in exchange for favorable treatment, on generic manufacturers and other suppliers?

Since the U.S. Food and Drug Administration (FDA) first reported a shortage of Adderall in October 2022, millions of patients and caregivers have struggled to fill prescriptions with no end in sight.

According to a December 2023 report published in USA TODAY, the average price paid by small to mid-sized independent and chain pharmacies nearly doubled from late 2022 to December 2023 for specific dosages of methylphenidate (i.e., Ritalin and Concerta); the average cost of certain versions of dexmethylphenidate (Focalin) more than doubled during that period.

According to an ADDitude survey of 11,013 adults and caregivers, at least 20% of ADHD patients continued to be impacted by the stimulant shortage in the summer of 2023.

The public can also demand an end to the ADHD medication shortage by writing letters to representatives, the DEA, and the FDA using templates provided by ADDitude.

Stark mental health disparities negatively impact transgender, non-binary, and gender-diverse individuals, according to a recent study of 1.5 million people, including nearly 8,000 transgender people aged 16 or older in England. ¹

According to the study, published in the Lancet Public Health journal, gender-diverse adult populations experience a much higher prevalence of mental health conditions compared to cisgender adults, with inequalities concentrated in patients younger than 35 years. Long-term mental health conditions impact approximately one in two non-binary transgender adults, and one in six transgender men, women, and cisgender non-binary adults; in contrast, just one in ten cisgender men and women is diagnosed with a mental health condition.

The study did not cite the types or severity of conditions. However, previous research has indicated that mental health conditions, such as anxiety, depression, eating disorders, self-harm, and suicidality are more common among transgender, non-binary, and gender-diverse groups.¹, ²,³

Unmet Medical Needs Among Transgender and Non-Binary Patients

The study found that almost one in two transgender, non-binary, and gender-diverse patients (47%) said that their last general practice appointment did not meet their mental health needs. Those patients also reported having their identities invalidated, feeling misunderstood, and experiencing inadequate communication with healthcare providers during their last healthcare provider appointment. Past negative healthcare experiences also led them to fear being stereotyped, pathologized, or discriminated against by medical professionals.

“Cisgender people have a gender identity that matches their sex assigned at birth. In contrast, trans people have a gender identity that is different from the sex assigned at birth,” Sharon Saline, Psy.D., and Julie Julie Mencher, MSW, explained during the ADDitude webinar “Gender Diversity and Neurodiversity: How to Support a Child, Teen, or Young Adult with ADHD Exploring Gender.” “Experiencing this disconnect, many trans people feel significant distress — called gender dysphoria — with their physical sex characteristics or how their gender is misread by others.”

The researchers suggest that mental health outcomes for this patient population could benefit from practitioners who are better training medical staff, adopting inclusive language, and standardizing electronic healthcare record systems to include transgender, non-binary, and gender-diverse identities.

“Such mechanisms would also affirm and validate patients’ gender identities and reduce the psychological burden associated with repeated explaining or being misgendered, again reducing minority stress and potentially improving mental health,” the study’s authors wrote.

Data for the study came from the 2021 and 2022 English General Practitioner Patient Surveys across five gender groups (female, male, non-binary, prefer to self-describe, prefer not to say), within three cisgender and transgender identity groups (cisgender, transgender, prefer not to say).

Health Disparities Among Transgender and Gender-Diverse Medicare Beneficiaries

Findings from the English study are mirrored in research recently published in JAMA Internal Medicine by a research team from the Brown University School of Public Health that found transgender and gender-diverse (TGD) Medicare beneficiaries aged 65 or older were significantly more likely to use the emergency department and be admitted to the hospital from the emergency room than were cisgender beneficiaries the same age. ⁵

“TGD individuals often postpone routine medical care due to various reasons, including anticipated discrimination, lack of knowledgeable clinicians, and costs,” the study’s authors wrote. The study examined data from 3,693 TGD and 6,151,389 cisgender Medicare beneficiaries spanning 2011 to 2020.

Both studies emphasized a call to action for improved mental healthcare and routine medical services for this marginalized community.

“Clinicians and frontline staff should be trained in TGD-inclusive care and cultural humility to reduce enacted discrimination in primary care settings and reduce ED utilization for TGD Medicare beneficiaries,” the Brown University researchers wrote.

“The mental health disparities experienced by transgender, non-binary, and gender-diverse individuals are alarming and call for immediate attention,” the authors of the English study wrote. “The healthcare sector, along with policymakers, must work together to address these unique needs and ensure that these individuals’ mental health of these individuals is not neglected by providing adequate training to healthcare providers, implementing inclusive policies, and promoting understanding and acceptance at all levels of society.”

Sources

¹Watkinson, R. E., Linfield, A., Tielemans, J., Francetic, I., & Munford, L. (2024). Gender-Related Self-Reported Mental Health Inequalities in Primary Care in England: Cross-Sectional Analysis Using the GP Patient Survey. The Lancet Public Health. 9(2), E100-E108. DOI: 10.1016/S2468-2667(23)00301-8

²Coleman, E., Radix, A.E., Bouman, W.P., et al. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8.Int J Transgender Health. DOI: 10.1093/eurpub/cky226

³Zeeman, L., Sherriff, N., Browne, K., et al. (2019). A Review of Lesbian, Gay, Bisexual, Trans, and Intersex (LGBTI) Health and Healthcare Inequalities. Eur J Public Health. DOI: 10.1080/26895269.2022.2100644

⁴Dhejne, C., Van Vlerken, R., Heylens, G., and Arcelus, J. (2016). Mental Health and Gender Dysphoria: A Review of the Literature.Int Rev Psychiatry. doi: 10.3109/09540261.2015.1115753

⁵Gray Babb, et al. (2024). Emergency Department Use Disparities Among Transgender and Cisgender Medicare Beneficiaries, 2011-2020. JAMA Internal Medicine. DOI: 10.1001/jamainternmed.2023.8209

Energy drink consumption is associated with an elevated risk for physical and mental health conditions such as ADHD, depression, anxiety, and suicidal ideation among children and adolescents, according to a new study published in the journal Public Health.¹

The study’s U.K. research team linked energy drink consumption with a higher-than-average risk of poor academic performance, sleep problems, unhealthy dietary habits, and risky behaviors. Children and teens who consumed energy drinks were more likely than non-drinkers to engage in unsafe sex and vehicle use, binge drinking, vaping, violent behaviors, and alcohol and substance use.

Energy drink consumption was also tied to increased ADHD inattention, conduct disorder, and depressive and panic symptoms. The rates of suicidal ideation and attempts increased among those who drank more than one energy drink a day compared to non-drinkers.¹

The systematic review examined 57 studies about the effects of energy drinks on children and young people up to age 21 from January 2016 to July 2022. The data came from more than 20 countries and involved more than 1.2 million children and young adults. (The review did not include the brands of energy drinks consumed.) The report confirmed findings from a similar review in 2016 conducted by the same research team.²

What Are Energy Drinks?

The Centers for Disease Control and Prevention (CDC) defines an energy drink as “a beverage that typically contains large amounts of caffeine, added sugars, other additives, and legal stimulants such as guarana, taurine, and L-carnitine. Energy drinks are marketed as providing mental and physical stimulation; they contain no nutritional value.

The amount of caffeine in energy drinks typically exceeds adults’ daily recommended doses. Data from the Center for Science in the Public Interest shows that energy drinks may contain as little as 75mg of caffeine — slightly less than one average cup of coffee — or up to 316mg per 8 ounces, the equivalent of more than three cups.

Energy drinks have exploded in popularity in recent years, particularly among teens. A 2013 study of 37,500 children and adolescents in 16 European countries found that 18% of children (3–10 years) and 68% of adolescents (10–18 years) consumed energy drinks in the previous year.8 Between 12% and 35% of children and young adults consume them at least once per week.³

The U.K. study found that male teens consume more energy drinks than do females. Taste and energy-seeking were the main drivers of energy drink use. The study also reported that children and teens may turn to energy drinks as a coping mechanism, out of social acceptance, or to enhance performance on tests and in sports.

Energy Drink Consumption Among Kids with ADHD

Nearly 5% of ADDitude Reader Panel members say their children consume energy drinks every day or regularly, according to a recent survey.

“My children like to drink Prime because they think it’s cool, and they like the taste,” one reader said.

“My daughter tries out the latest fads with energy drinks,” said another reader. “I worry about her caffeine consumption. I keep teaching her to watch the caffeine content and to be careful about how much she drinks. I don’t see her drink them — I just see empty containers in her car — so I can’t say what the effect is on her ADHD symptoms.”

Another reader shared that her daughter (now 21) “has used Red Bull daily since high school. She is currently unmedicated (Her choice, not mine.) I believe it helps her focus a little.”

An additional 12% of ADDitude Reader Panelists said their children occasionally consume energy drinks.

“My teen kids will have an energy drink (Yerba Mate or Celsius) now and then for sports or athletic activities like between soccer games on tournament weekends or when skiing,” a reader said. “It adds to their energy, which is fine when engaging in physically demanding activities. I would not allow it before school as it likely would create jitteriness if they had to sit for hours.”

“My child occasionally swipes a sip of his dad’s Red Bull,” said another reader. “Other than that, he doesn’t drink them. We mostly avoid energy drinks because of the additional additives in them.”

Less than half (44%) of reader panelists said their children are prohibited from consuming energy drinks.

“I am fearful of the jittery anxiety it seems to produce,” one reader said. “The [energy drink] crash has caused my son to melt down and become horribly embarrassed when in public.”

“I do not want myself or my children to have energy drinks because they are high in sugar and caffeine,” another reader said. “We have diabetes and heart disease in our family, and we do not need to add on to that.”

Other readers offer energy drink alternatives. “We don’t allow our kids to have energy drinks as they contain harmful ingredients,” the reader said. “We have allowed our kids to try coffee. They don’t care for the taste, but it did help my son to be less crabby in the morning.”

“There’s too much empty sugar and caffeine in them,” another reader said. “As a special treat, my teens with ADHD buy themselves sweet drinks at Starbucks. I encourage caffeine-free drinks. The body is hard enough to understand and regulate without all the added effects of sugar and caffeine.”

Energy Drinks: Next Steps

The observational study could not prove causality between energy drink consumption and poor health outcomes; the drinks could, for example, be more popular among adolescents with naturally low levels of dopamine and/or those facing higher risks of mental and physical health issues. However, the researchers said their findings were strong enough to suggest policymakers consider banning the sales of these products to children.

“We have raised concerns about the health impacts of these drinks for the best part of a decade after finding that they were sold to children as young as 10 years old [for less] than bottled water,” lead author Amelia Lake, Ph.D., a professor of public health nutrition from Fuse, the Centre for Translational Research in Public Health at Teesside University in England, said in a press release. “The evidence is clear that energy drinks are harmful to the mental and physical health of children and young people as well as their behavior and education. We need to act now to protect them from these risks.”

The American Academy of Pediatrics states that caffeine and other stimulant substances contained in energy drinks have no place in the diet of children and adolescents.⁴

Keeping Energy Drinks Out of Children’s Hands — and Mouths

The Centers for Disease Control and Prevention (CDC) offered the following tips for caregivers and educators:

• Teachers and other school staff can educate students about the danger of consuming too much caffeine, including energy drinks.
• Coaches can educate athletes about the difference between energy and sports drinks and the potential dangers of consuming highly caffeinated beverages.
• School nutrition staff can provide only healthy beverages such as fat-free/low-fat milk, water, and 100% juice in the cafeteria.
• Parents, school staff, and community members can join the school or district wellness committee that sets the policies for health and wellness and establish or revise nutrition standards to address the sale and marketing of energy drinks in school settings.
• Adults can model good behavior by not consuming energy drinks in front of kids.

Sources

¹Ajibo, C., Van Griethuysen, A., Visram, S., Lake, A. A. (2024). Consumption of Energy Drinks by Children and Young People: A Systematic Review Examining Evidence of Physical Effects and Consumer Attitudes. Public Health doi: 10.1016/j.puhe.2023.08.024
²Visram, S., Cheetham, M., Riby, D.M., Crossley, S.J., Lake, A.A. (2016). Consumption of Energy Drinks by Children and Young People: A Rapid Review Examining Evidence of Physical Effects and Consumer Attitudes. BMJ Open. doi: 10.1136/bmjopen-2015-010380
³Zucconi, S., Volpato, C., Adinolfi, F., Gandini, E., Gentile, E., Loi, A., and Fioriti, L. (2013) Gathering Consumption Data on Specific Consumer Groups of Energy Drinks. The European Food Safety Authority Supporting Publications. doi: 10.2903/sp.efsa.2013.EN-394
⁴Heckman, M.A., Weil, J., Gonzalez De Mejia, E. (2010). Caffeine (1, 3, 7-Trimethylxanthine) in Foods: A Comprehensive Review on Consumption, Functionality, Safety, and Regulatory Matters. Journal of Food Science. 75(3):R77–87. doi: 10.1111/j.1750-3841.2010.01561

Supporting new parents with ADHD in this sensitive phase is of utmost clinical importance.

The Postpartum Period: What New Mothers with ADHD Face

Clinicians must understand the demands of early motherhood through the lens of ADHD symptoms and management. These include:

• Hormonal swings. When estrogen levels drop in the postpartum period, new mothers are more likely to experience mood swings, irritability, sleep disturbances, and other cognitive problems, presenting an added burden for those with ADHD.
• Negative feelings. Many women with ADHD have had negative views of their self-worth and self-esteem long before giving birth.^{1 2} These feelings can intensify when executive functioning deficits collide with the relentless demands of caring for a newborn. Studies show that challenges stemming from ADHD are linked to less positive parenting, greater over-reactivity with children, lower parental control, and other parenting difficulties.³

In an ADDitude survey of 1,914 women with ADHD, more than half of those who had given birth said they experienced symptoms of postpartum depression (PPD), including feelings of worthlessness (76%), crying spells (76%), mood swings (66%), and irritability (62%), among other symptoms.

[Take This Self-Test: Signs of Postpartum Depression]

The survey, conducted in 2023, also found that nearly half of all women with self-reported PPD said they did not receive any treatment, and nearly 18% said their symptoms lasted longer than two years.

Here are a few comments from ADDitude readers who answered the survey:

“The medical community didn’t take my baby blues seriously after my children were born. They said I just ‘needed to exercise, lose the rest of the baby weight, and focus on my family.’ Then I would be all better.”

“No one talked about it, and my doctor never asked how I was doing. So, I assumed I was weak.”

“My ADHD got significantly worse. I felt overwhelmed and was not supported by my husband.”

“Something in me changed after giving birth. My doctors told me it was anxiety and hormones. I could not shut down my racing mind. I was constantly irritable, impatient, and a complete space cadet.”

[Get This Free Download: The Facts About Major Depressive Disorder in Women]

The Postpartum Period with ADHD: Clinical Implications and Treatment Considerations

The postpartum period is an inflection point that requires an individualized treatment plan based on the specific needs of each patient with ADHD. Considerations include:

ADHD medications and breastfeeding. Though a recent study found that in-utero exposure to medication for ADHD, including stimulants, did not impair a child’s neurodevelopment⁴, it is unclear whether it is safe for a new parent to take ADHD medication while breastfeeding. What we know about medication transfer into breast milk is limited to case reports and case series data, which show that the relative dose of amphetamine or methylphenidate derivatives in breast milk is very low — in many cases less than 1%, when less than 10% is considered low^{5 6}. Overall, this is reassuring data when, historically, the default medical position has been to interrupt a mother’s “non-essential pharmacologic treatment” during breastfeeding. A patient’s improved functioning on ADHD medication should be weighed against potential risks that medication in breast milk might pose.

Strategies to enhance wellbeing. It’s important to encourage postpartum women to get regular exercise, sufficient sleep, and proper nutrition. Emphasize the importance of seeking support at home, spending time in nature, and doing other stress-reducing activities. Cognitive behavioral therapy for ADHD should also be recommended.

Facilitating a team approach. Through the acute postpartum period and well into parenthood, patients with ADHD can benefit from working with an integrated, supportive, and informed healthcare team that understands the impact of hormones on ADHD and the ways in which they interact with medication. Our website, womensmentalhealth.org, is a great resource for patients and clinicians looking to improve their knowledge on women’s mental health across the life cycle. The site provides current information on research findings and explains how these inform day-to-day clinical practice.

Postpartum Care and ADHD: Next Steps

• Read: Treating for Two — ADHD Meds in Pregnancy
• Read: A Self-Care Guide for Moms with ADHD Raising Kids with ADHD
• Read: Bringing Up Baby — Motherhood with ADHD

Allison S. Baker, M.D., is a clinician, researcher, and educator with the Perinatal and Reproductive Psychiatry Clinical Research Program at Massachusetts General Hospital.

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “ADHD, Pregnancy, and Motherhood: A Practical Guide for Hopeful Parents” [Video Replay & Podcast #454] with Allison Baker, M.D., which was broadcast on May 11, 2023.

Sources

¹ Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. The Primary Care Companion for CNS disorders, 16(3), PCC.13r01596. https://doi.org/10.4088/PCC.13r01596

² Arcia, E., & Conners, C. K. (1998). Gender differences in ADHD?. Journal of Developmental and Behavioral Pediatrics : JDBP, 19(2), 77–83. https://doi.org/10.1097/00004703-199804000-00003

³ Park, J. L., Hudec, K. L., & Johnston, C. (2017). Parental ADHD symptoms and parenting behaviors: A meta-analytic review. Clinical psychology review, 56, 25–39. https://doi.org/10.1016/j.cpr.2017.05.003

⁴ Bang Madsen, K., Robakis, T. K., Liu, X., Momen, N., Larsson, H., Dreier, J. W., Kildegaard, H., Groth, J. B., Newcorn, J. H., Hove Thomsen, P., Munk-Olsen, T., & Bergink, V. (2023). In utero exposure to ADHD medication and long-term offspring outcomes. Molecular psychiatry, 28(4), 1739–1746. https://doi.org/10.1038/s41380-023-01992-6

⁵ Marchese, M., Koren, G., & Bozzo, P. (2015). Is it safe to breastfeed while taking methylphenidate?. Canadian Family Physician Medecin de Fmille Canadien, 61(9), 765–766.

⁶ Ilett, K. F., Hackett, L. P., Kristensen, J. H., & Kohan, R. (2007). Transfer of dexamphetamine into breast milk during treatment for attention deficit hyperactivity disorder. British journal of clinical pharmacology, 63(3), 371–375. https://doi.org/10.1111/j.1365-2125.2006.02767.x

As if the ADHD medication shortage wasn’t frustrating enough, patients are now forced to contend with higher prices that could further derail treatment. Certain ADHD medications have doubled or tripled in cost since the shortage began in October 2022, according to a report published in USA TODAY.

The newspaper analyzed the prices that retail community pharmacies pay for common ADHD prescriptions. For specific dosages of methylphenidate (i.e., Ritalin and Concerta), the average price paid by small to mid-sized independent and chain pharmacies nearly doubled from late 2022 to December 2023. The average cost of certain versions of dexmethylphenidate (Focalin) more than doubled during that period, according to the December 2023 report.

“Drug manufacturers may change the list prices of their drugs at any time after launch,” says the Assistant Secretary for Planning and Evaluation (ASPE), principal advisor to the Secretary of the U.S. Department of Health and Human Services. “Over the period from January 2022 to January 2023, more than 4,200 drug products had price increases, of which 46% were larger than the inflation rate. The average drug price increase throughout the period was 15.2%, translating to $590 per drug product.”

The average price change between 2021 and 2022 was 11.5%, an increase of $172, on average.

“Most drug manufacturers make changes to their prescription drug list prices in either January or July of each year, with the greatest number of changes taking place in January,” ASPE reported. “From January 2022 to January 2023, price changes ranged from a decrease of 99% to increases of over 3,000%.”

Drugs.com reported that, without insurance coverage, a supply of 100 capsules of 10mg of Adderall XR costs around $759.54, while 100 tablets of 5mg short-acting Adderall costs around $1,139, depending on the pharmacy. A supply of 100 capsules of Vyvanse costs around $1,306.

Insurance coverage is the most important deciding factor when choosing an ADHD medication for 19% of recent Medscape survey respondents with ADHD, according to Ann Childress, M.D., during a presentation at the 2024 APSARD conference on January 17. ADDitude readers have likewise felt the sting of cost increases for their prescription stimulants.

“My son is on Adderall XR 10mg. The price went from $10 in December to $54 in January to $158 this month,” says one reader. “When I called our prescription care plan, they said the price increase was due to supply and demand. It’s scary how the cost of a medication can fluctuate so much. Fortunately, we have covered the cost, but what about families who can’t?”

Says another reader, “The price differential is extreme: Adderall XR costs about $5 for a 30-day supply; Vyvanse costs $165 for a 30-day supply.”

One reader found a solution with the help of her physician and pharmacist. “My son’s doctor prescribed Cotempla XR-ODT, but my insurance wouldn’t cover it until he tried two other medications first,” the reader says. “It would cost $350 per month if they did approve it. Thankfully, our doctor knew this was a problem for many of his patients. He sent the prescription to a pharmacy that input the manufacturer’s coupons after verifying what our insurance would and would not pay for. Now, our copay is only $35. I’m so grateful for our doctor and the pharmacy who helps their customers get the medicine they need without going bankrupt.”

The U.S. Food and Drug Administration (FDA) first reported a shortage of Adderall in October 2022. More than a year later, millions of patients and caregivers still struggle to fill prescriptions, with no end in sight.