Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood, affecting approximately 6.5 million US children.1 ADHD is a serious, chronic health condition that can have profound effects on children’s academic performance, social relationships, and mental health.2,3 As these children grow up, ADHD is associated with adverse outcomes in adulthood, including lower occupational attainment and increased risk for substance use disorders, automotive accidents, incarceration, and even risk of premature death.4–6
ADHD requires a multimodal treatment approach that combines behavioral, educational, and pharmacological treatments.7 Although evidence-based psychosocial interventions have the potential to improve long term outcomes in children with ADHD, they are often not covered by insurance.7–9 Coupled with a limited number of available clinicians and long waitlists, inequity in access to psychosocial treatment compounds the adverse impact of ADHD on many children. In general, pharmacological treatments, such as stimulant medications, have been easier to access. However, in the aftermath of the COVID-19 pandemic, a nationwide shortage of stimulants wreaked havoc on what had previously been a predictably accessible treatment for millions of US children, leading to potentially devastating consequences.10
In this issue of Pediatrics, He et al. explore the impact of the recent national stimulant shortage on prescription patterns for children with ADHD.11 Their findings suggest that the shortage did not primarily force children to stop stimulant therapy, but rather led them to other stimulant or nonstimulant medications. These findings alone do not adequately capture the burden on families and clinicians scrambling to find necessary medical treatment for children with ADHD every month. He et al. imply that this shortage is behind us, when in fact forcing children to switch to other stimulant medications has led to cascading shortages that are constantly changing.11 This leads to countless hours spent each month by families calling pharmacies and their child’s clinician and driving miles to pick up prescriptions to ensure that there are no interruptions in their children’s medical care. Those experiencing poverty or who do not speak English, for whom calling and traveling to multiple pharmacies is often impossible, have no way to ensure access to their child’s much needed medication.
He et al. highlight the fact that the number of stimulant prescriptions for children were below levels predicted by pre-pandemic trends at the end of 2023.11 However, more children are being diagnosed with ADHD than ever before.1 This suggests that there is a large proportion of children with ADHD who are undertreated. Furthermore, there continue to be significant disparities in rates of ADHD diagnosis by race and ethnicity, with lower rates among Black, Asian, and Hispanic children.12–14 Black children are more likely to be misdiagnosed with oppositional defiant disorder and conduct disorder and are less likely to be diagnosed with ADHD.13,14 As a result, there are still many groups who are mis- or underdiagnosed.
Ultimately, the stimulant medication shortage is only one factor affecting our ability to support children with ADHD to reach optimal long-term outcomes. ADHD affects millions of US children, but many children are not receiving much needed evidence-based treatment. It is only by addressing disparities in access to high quality diagnostic and treatment services, including psychosocial and pharmacological treatment, that we can help to ensure a better future for the millions of US children with ADHD.
Sarah Weas drafted the initial manuscript and critically reviewed and revised the final manuscript. Dr William Barbaresi co-wrote and critically reviewed and revised the manuscript for content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
CONFLICT OF INTEREST DISCLOSURES: The authors have no have no conflicts to disclose.
FUNDING: No funding was secured for this commentary.
COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2024-068558.
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