Pediatric Stimulant Use Drops Amid COVID-19 and Adderall Shortages

Pediatric stimulant dispensing rates dropped nearly 19% at the onset of the COVID-19 pandemic, with subsequent Adderall shortages in 2022 prompting shifts toward alternative medications, a new study found.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 lead investigator Sijia He, MS, from the Susan B. Meister Child Health Evaluation and Research Center in the University of Michigan.2

The shortage of immediate-release mixed amphetamine salts, such as Adderall, began in October 2022.1 Until now, no national study has assessed changes in stimulant dispensing to children after the COVID-19 pandemic and the Adderall shortage.

Investigators sought to evaluate monthly changes in prescription stimulant dispensing to children aged 5 – 17 years during the start of the COVID-19 pandemic (March 2020) and the Adderall storage (October 2022). They leveraged 2017 to 2023 data from the IQVIA Longitudinal Prescription Database, capturing 92% of US prescriptions.

From January 2017 to March 2020, the monthly stimulant dispensing rate to children was reduced by 18% (-454.9 children per 100,000; 95% confidence interval [CI], -572.6 to -337.2). The rate increased after March 2020 to 12.7 children per 100,000 (95% CI, 6.6 to 18.8).

The nationwide shortage of immediate-release mixed amphetamine salts in October 2022 did not result in a significant level (-39.7 children per 100,000; 95% CI, -189.9 to 110.5) or slope change (-12.1 children per 100,000; 95% CI, -27.5 to 3.3). This indicated that the shortage did not necessarily prevent children from starting or stopping stimulant therapy.

However, in October 2022, there was a reduction in the monthly dispensing rate for immediate-release mixed amphetamine salts and an increase in the monthly dispensing rate for dexmethylphenidate. The study also observed a slope increase in the monthly dispensing rate of atomoxetine in October 2022.

This finding indicates that some children may have switched from immediate-release mixed amphetamine salts to other stimulants or nonstimulants.

“This would be potentially concerning if the switches may have resulted in worsened ADHD control. We need more research to evaluate whether any switches led to adverse outcomes,” He said.2

Stimulant dispensing rates varied by sex.1 In December 2023, the dispensing rate for male adolescents was 19% lower than expected. For boys aged 5 to 11 years, the dispensing rate was similar to what was expected. Moreover, the stimulant dispensing rate was 9% greater than expected among girls aged 5 to 11 years, consistent with an earlier study that had shown that children with a first-time ADHD diagnosis during the pandemic were more likely to be girls.

In the press release, Kao-Ping Chua, MD, PhD, from the University of Michigan Health C.S. Mott Children's Hospital, said the findings could represent a decrease in the underdiagnosis and undertreatment of ADHD in girls.2

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

During the pandemic, access to in-person health care was disrupted, reducing the opportunities to diagnose and treat ADHD. Chua believes the decrease in in-person healthcare could be because of a policy that allowed stimulants to be prescribed via telehealth.

Production issues and stimulants having an unprecedented demand led to the 2022 Adderall Shortage. Chua suggested policymakers consider raising limits on stimulant production and ensuring appropriate stimulant prescribing to adults.

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

References

1. He S, Esteban McCabe S, Conti RM, Volerman A, Chua KP. Prescription Stimulant Dispensing to US Children: 2017-2023. Pediatrics. 2025 Jan 27:e2024068558. doi: 10.1542/peds.2024-068558. Epub ahead of print. PMID: 39864457.
2. Adderall shortage may be associated with increased use of alternative ADHD medication in children. January 27, 2025. https://www.eurekalert.org/news-releases/1071332. Accessed January 28, 2025.