Stimulant prescriptions rebound to pre-pandemic levels for girls, not boys
Key takeaways:
- Stimulant dispensing rates in December 2023 were 18.8% lower than pre-pandemic levels among adolescent boys.
- The Adderall shortage in late 2022 did significantly affect overall stimulant dispensing rates.
Although stimulant dispensing rates have rebounded to — or exceeded — pre-pandemic levels among girls, the dispensing rate among adolescent boys was almost 19% lower than it was before March 2020, according to study findings.
Previous research showed that stimulant prescriptions increased among most age groups, including adolescent girls and adult men and women, in the first year of the COVID-19 pandemic. However, rates fell drastically among children and adolescent boys during that period, according to Kao-Ping Chua, MD, PhD, assistant professor of pediatrics and health management and policy at University of Michigan, and colleagues.
“I speculate that the decline in stimulant dispensing to children during the pandemic [was] related to decreased need for stimulants due to the shift to virtual schooling,” Chua told Healio. “Additionally, decreases in health care visits during the pandemic reduced the number of opportunities to diagnose and treat ADHD in children.”
Chua and colleagues analyzed trends in stimulant prescriptions for children aged 5 to 17 years between Jan. 1, 2017, and Dec. 31, 2023, in the United States. They were specifically looking for changes after two time points: March 2020, which marked the beginning of the COVID-19 pandemic and a switch to at-home learning; and October 2022, when the FDA announced a shortage of immediate-release mixed amphetamine salts (Adderall). The researchers compared actual data to predicted trends based on rates from January 2017 to February 2020.
Overall, stimulant dispensing decreased 8% from 2,989.2 per 100,000 children in January 2017 to 2,749.4 per 100,000 children in December 2023. Levels appeared steady from 2017 to the beginning of 2020 and dropped 18.8% in March 2020. Dispensing rates gradually increased by 12.7 children per 100,000 each month until October 2022 when they leveled out again.
Although immediate-release mixed amphetamine prescriptions decreased in October 2022, the researchers did not see a significant change in overall stimulant use compared with post-pandemic trends.
“Our study suggests that the Adderall shortage prompted some children to switch from this medication to other stimulants,” Chua said.
Although boys received more stimulant prescriptions than girls at all time points, the rate of dispensing rebounded among girls faster than boys. Rates among girls aged 5 to 11 years were 9% higher than predicted with pre-pandemic trends, whereas boys in this age group were receiving 0.6% fewer stimulant prescriptions than predicted. Stimulant dispensing rates were 2.8% lower than predicted among adolescent girls and 18.8% lower among adolescent boys.
“The stimulant dispensing rate to male adolescents decreased abruptly after March 2020 and did not recover to the pre-pandemic baseline, unlike in other children,” Chua told Healio. “This parallels another analysis we published last year, which showed that antidepressant dispensing to male adolescents followed the same pattern.
“As there is little reason to believe that the mental health of male adolescents improved during the pandemic, our findings raise the concern that the pandemic increased the undertreatment of mental health conditions in this group.”
This concern was echoed by Sarah Weas, MSN, MPH, from Boston Children’s Hospital and William J. Barbaresi, MD, from Harvard Medical School in a related editorial.
“More children are being diagnosed with ADHD than ever before,” they wrote. “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 U.S. children with ADHD.”
References:
- He S, et al. Pediatrics. 2025;doi:10.1542/peds.2024-068558.
- Weas S, et al. Pediatrics. 2025;doi:10.1542/peds.2024-069093.
Perspective
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With home-based schooling, many parents opted out of medications for their child, assuming the distractions were fewer, and they could monitor the learning and behavior at home. However, some children — even those without ADHD — were distracted by home stimuli: video games and computer games commonly.
There was a nationwide shortage of stimulant medications during this time period, especially the mixed amphetamine salt Adderall XR. However, Adderall was then followed by other forms of amphetamine and by methylphenidate. So, with limited access to medications and more remote learning, some parents may have chosen to forego treating their children during the pandemic period. This approach probably has spilled over a little to this day. It may be interesting and useful to examine the trajectory of medication prescriptions during the post-COVID 5-year period or decade.
The whole pandemic was a forced experiment in remote learning and work, so I would be careful about conclusions about long-term trends if they include this period.
Dispensing during the COVID years must be separated from non-COVID years going forward. In our research, we use the dates of the federal government’s emergency declaration and its lifting for these periods of time.
Pediatricians should carefully consider the learning environment and child’s behavior, focus and performance before prescribing medications because ADHD might not be the cause of the problems. However, ADHD is real, and one should not take these population trends into account when making decisions around the diagnosis and treatments; these decisions need to be individualized and based on both home and teacher reports.
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