Adderall Shortage Drives Shift to Alternative ADHD Medications in Children

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Amid the COVID-19 pandemic, the number of children taking Adderall to treat attention-deficit/hyperactivity disorder (ADHD) decreased due to a national shortage. However, data from a study published in Pediatrics shows that although numbers slowly recovered, many children transitioned to alternative stimulants, such as Focalin (dexmethylphenidate).¹

“Our findings suggest that the Adderall shortage did not cause many children to stop stimulant therapy altogether, but it did force some to switch to alternative stimulants,” said study lead author Sijia He, MS, researcher, Susan B. Meister Child Health Evaluation and Research Center in the University of Michigan. “This would be potentially concerning if the switches may have resulted in worsened ADHD control. We need more research to evaluate whether any switches led to adverse outcomes.”

For accurate results, investigators analyzed the 2017 to 2023 IQVIA Longitudinal Prescription Database to evaluate level and slope changes in the monthly stimulant-dispensing rate in both March 2020 and October 2022, capturing 92% of prescriptions in the United States. The analysis also incorporated 70% of data from mail-order and long-term care pharmacies. Important data included an encrypted patient identifier, national drug codes, patient sex, year of birth, and state of residence.

The primary objective of the study was to determine monthly stimulant-dispensing rate, defined as the number of children between five and 17 years of age with one or more dispensed stimulant prescription per 100,000 in the United States.

Results found that in March 2020, the monthly stimulant-dispensing rate to children declined 18.8% from January 2017. After March, this increased to 12.7 children per 100,000 a month. In October 2022, there was no level change, but estimates were negative. The authors discovered that overall changes varied by sex and age, with adolescent males between 12 and 17 years of age demonstrating a 19% lower stimulant dispensing rate in December 2023 than expectations based on pre-pandemic trends. In girls between 12 and 17 years of age, the level change was −82.9 (−201.7 to 35.8) in October 2022 and the slope change was −19.9 (−32.1 to −7.8).²

“A potentially optimistic explanation of these findings is that they represent a decrease in underdiagnosis and undertreatment of ADHD in girls,” said Kao-Ping Chua, MD, PhD, senior author of the study, researcher at University of Michigan Health C.S. Mott Children's Hospital and the Susan B. Meister Child Health Evaluation and Research Center. “It’s also possible that symptoms of inattention in girls increased during the pandemic, increasing their need for stimulants.”

The authors summarized that there were three main findings from the study. First, the stimulant-dispensing rate to children in December 2023 was 6.6% lower than the rate predicted by pre-pandemic trends. This was a result of no full recovery amid the first decline in March 2020. Further, the monthly stimulant-dispensing rate changed by age and sex, notably with the significant decrease in adolescent boys. Lastly, the shortage of Adderall was associated with a decline in dispensing but not with a decline in the overall stimulant-dispensing rate.

Moving forward, the authors suggest that future studies could help prevent any future shortages of ADHD stimulants.²

“Our findings indirectly demonstrate how increased demand for a medication class in adults may adversely affect access to these treatments for children,” said Chua. “It’s crucial to address the shortage of stimulant medications because so many kids rely on them. Untreated ADHD symptoms can harm children’s health and learning.”

References

1. Adderall shortage may be associated with increased use of alternative ADHD medication in children. EurekAlert! January 27, 2025. Accessed January 28, 2025. https://www.eurekalert.org/news-releases/1071332

2. Prescription Stimulant Dispensing to US Children: 2017–2023. Pediatrics. January 27, 2025. Accessed January 28, 2025. https://publications.aap.org/pediatrics/article/doi/10.1542/peds.2024-068558/200682/Prescription-Stimulant-Dispensing-to-US-Children?autologincheck=redirected