Adult ADHD prescriptions still on the rise, especially among older women
Prescriptions for ADHD medications have been spiking in recent years, with the sharpest increase among middle-aged and older women. They're also the least likely to misuse the prescription stimulants, a new study finds.
The rise among women ages 35 to 64 has been substantial. At the end of 2022, 1.7 million women in this age group were prescribed stimulants such as Adderall and Ritalin for ADHD, compared to 1.2 million prescriptions in 2019.
There's been an overall jump in ADHD prescriptions since the pandemic and the rise of telehealth. The new analysis, published in JAMA Psychiatry by researchers at the National Institute on Drug Abuse, also looked into how the medications are being misused — that is, taking more of the drugs than prescribed, taking them at times that differed from what the doctor ordered or using medication from someone else's prescription
The researchers used data from more than 83,000 adults, ages 18 to 64 who participated in the 2021-2022 National Surveys on Drug Use and Health. Information on prescriptions came from the 2019-2022 IQVIA Total Patient Tracker and National Prescription Audit New to Brand databases.
They found that the prevalence of misuse of prescription stimulants among women aged 35 to 64 was significantly lower than it was among men of the same age (13.7% versus 22.0%). Middle-aged women also misused their medications less than younger women (13.7% versus 36.8%).
Three types of stimulants are approved for ADHD: amphetamine (Dexedrine, Adderall); methamphetamine (Desoxyn); and methylphenidate (Ritalin).
Overall, just over a quarter of people with prescriptions for ADHD medications reported misusing them. About 9% had what is called prescription stimulant use disorder, or addiction.
People taking an amphetamine or methamphetamine were more likely to misuse than those taking a methylphenidate.
The researchers aren't sure why there was such a big increase in older adult women being prescribed stimulants for ADHD.
'It is a very large increase that I can't fully explain,' said a study co-author, Dr. Wilson Compton, deputy director at the National Institute on Drug Abuse
The size of the increase in middle-aged women is surprising, said Aaron Brinen, an assistant professor of psychiatry and behavioral sciences at the Vanderbilt University Medical Center in Nashville, who was not involved in the study.
Girls with the neurodevelopmental disorder may not be diagnosed because their symptoms are often more subtle than those exhibited by boys, who are more likely to show symptoms of hyperactivity or impulsiveness, research indicates.
'I wonder if it speaks to women feeling more empowered to talk about what they are needing and about their struggles in life,' Brinen said.
They may realize that they had ADHD as children but were never diagnosed.
'Girls are more likely to be overlooked because the way they express ADHD isn't likely to be captured by teachers,' he added.
Brinen has female friends who weren't diagnosed and treated until they were in their 50s.
'It was the first time in their lives that they felt functional,' he said. 'It's a tragedy that it took so long.'
Untreated ADHD can lead to feelings of failure and depression, Brinen said. 'People think of them as not trying, but they are constantly trying and meeting disappointment,' he added.
Brinen suspects women with ADHD are less likely to misuse the stimulants because their prescriptions make life easier. They don't get high from the stimulants, they just feel more normal.
Women with ADHD sometimes manage to get by until they hit a stage where life becomes more difficult and challenging, said Mariely Hernandez, a clinical psychologist who specializes in addiction and ADHD and is a postdoctoral research fellow in the department of psychiatry at the Columbia University Vagelos College of Physicians and Surgeons in New York.
The symptoms of ADHD might become a much bigger problem when women have children, Hernandez said. 'The executive function needed to manage a family may exceed their cognitive resources, especially when the children are young,' she added. 'Then their symptoms become too impairing.'
Hormonal status can also affect the severity of symptoms, Hernandez said. 'We see a lot of women diagnosed at menopause,' she said, adding that low estrogen levels in a woman with ADHD can lead to a dopamine deficit.
'Dopamine underlies our reward system,' she explained. 'If you don't make enough or aren't able to properly utilize it, you won't be able to focus as well. Women will say, 'I can't live like this. I want to be evaluated.''
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a day ago
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The misuse of ADHD drugs – and what they really do to your body and brain
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Such exemptions have tripled in the last five years, so suspicion has turned to the 'subjective assessments' by doctors to diagnose athletes with ADHD in adulthood, John Brewer, a former UK Anti Doping board member told The Telegraph last month. There has been a known black market for ADHD drugs ever since they became available to buy online, with packets of Ritalin, the drug most commonly prescribed to people with ADHD in Britain, selling for less than £20 on the websites of unscrupulous online pharmacies. It's more common, however, for stressed students and professionals alike to acquire spare pills from friends and family. In fact parents, who believe they have ADHD but have never been diagnosed, have been known 'to take stimulants that have been prescribed for their children because they think it helps them to perform better', says Katya Rubia, professor of cognitive neuroscience at King's College London. What are the main ADHD drugs and how do they affect your brain? In Britain, the drug most commonly prescribed for ADHD is Ritalin, the brand name for the drug methylphenidate – a type of stimulant drug. Adderall, another stimulant drug, is typically prescribed in America, and sometimes finds its way into the hands of British students (or professionals) illegally. There is an important distinction between 'misuse' of ADHD drugs – taking them in their prescribed doses when you don't have ADHD – and 'abuse', which means taking large amounts of Adderall or Ritalin for a high, says Prof Rubia. ADHD drugs are considered to be 'very safe' in the small doses prescribed to treat the condition, adds Prof Rubia, but abusing the drugs can cause heart palpitations, stomach aches and can be 'neurotoxic'. 'They actually change your brain's dopamine system, producing effects like anxiety and depression, as well as inattention and difficulties with memory,' she adds. In other words, abusing ADHD drugs can leave you with a set of symptoms that look a lot like ADHD. 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Here, worsened memory seemed to be behind the decline in ability. 'Dopamine doesn't only affect motivation, but also your memory, and drugs like Ritalin work on the dopamine receptors in your prefrontal cortex' – the part of your brain that manages your working memory and lets you retrieve memories from the past, Prof Bossaerts points out. The effects of taking so-called 'smart drugs' (also known as 'study drugs') are also short-lived. 'Students who take them might feel a bit down and sluggish for a few days after their exams, but they'll quickly pick up again in most cases,' says Prof Bossaerts. Abuse, or taking large amounts of Adderall or Ritalin for a high, is another matter. This means that the drugs have a 'high potential for abuse', even if you start out taking them occasionally to pull an all-nighter or meet an important deadline, Prof Rubia believes. 'As your body gets used to them, you need more and more to feel the same effects.' 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A Taekwondo black belt or football star probably has a higher likelihood of having the condition than the average person, Prof Rubia believes. 'People with ADHD are very often good at sports,' she explains. 'They have more energy than the average person, and where academics might have been a struggle at school, they might have realised their talent for sports and pursued that instead.' Intense sports practice can also be an effective tool for managing ADHD symptoms. Prof Rubia recalls meeting an Olympic karate fighter who had 'managed to overcome his ADHD without medication by training in a very focused way'. A sportsperson who takes ADHD drugs without having ADHD, however, might be in for a shock. Though the drugs might improve performance in the short term by making athletes 'feel less tired and more alert, as if they've had a lot of coffee,' Prof Rubia says people misusing the drugs over weeks or months might find themselves feeling less motivated and alert than they were before. 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Scottish Sun
a day ago
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The Sun
a day ago
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I'm a psychologist and there are 5 things your kids must NEVER do if they have ADHD – or they risk making symptoms worse
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As of 2024, 2.6 million people in the UK were estimated to have ADHD, approximately 708,000 children and 1.9 million adults. Prescriptions for ADHD increased significantly from around 25 items per 1,000 people in 2019-20 to 41.55 items in 2023-24. But this increase isn't necessarily due to a true surge in cases. It reflects a number of factors, such as increased awareness and recognition of the condition, updates in diagnostic guidelines, and sociocultural pressures such as overstimulating digital environments. While the rise partly reflects these factors, it also raises important questions about overdiagnosis, the medicalisation of typical behaviour, and the need for individualised care. Do you or your child have ADHD- Here's the NHS test as Brits waiting two years for diagnosis To better understand the condition, chartered counselling psychologist Dr Sheena Kumar shared everything you need to know - from telltale signs to what to avoid. 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According to Dr Kumar, the following symptoms always start in childhood, even if they weren't recognised: Losing focus, even in conversations or reading Misplacing things, forgetting tasks, or missing deadlines Struggling to start or finish tasks that need mental effort Feeling restless, talking a lot, or interrupting without meaning, which impacts your relationships Having trouble managing time, emotions, or priorities For adults, it might look less like physical hyperactivity and more like feeling mentally scattered or overwhelmed all the time, says Dr Kumar. What NOT to do if you have ADHD For people with ADHD, their brain works differently to neurotypical people, especially in areas like attention, impulse control, and executive functioning. Because of this, some habits and choices can make symptoms worse or lead to burnout - especially for kids. Dr Kumar says: "You want to find ways to support your brain rather than to add extra demand to it." ADHD in children and young people Symptoms of ADHD usually start before the age of 12. A child or young person may show signs of being inattentive, such as: being easily distracted finding it hard to listen to what people are saying or to follow instructions forgetting everyday tasks, like brushing their teeth or putting on socks They may show signs of being hyperactive and impulsive, including: having high energy levels fidgeting or tapping their hands and feet talking noisily feeling restless, or getting up and moving around when they're supposed to sit still finding it hard to wait their turn, or interrupting conversations Most children and young people with ADHD have symptoms of both the inattentive and hyperactive-impulsive type. Some only show signs of one type. ADHD is thought to be recognised less often in girls than boys. This may be because girls with ADHD more commonly have inattentive symptoms and these can be harder to recognise. If you're worried that ADHD may be affecting your child, talk to one of their teachers. The teacher will usually make a referral to the school's special educational needs co-ordinator (SENCO), who can discuss support in the classroom or with homework, or help with building confidence and friendships. If you're still worried or you think your child needs additional support, you may want to make an appointment with a GP. Source: NHS Here are five things she recommends to avoid: 1. Prioritise sleep People with ADHD tend to have a higher rate of sleep disorders. Studies indicate that 50 to 80 per cent of people with ADHD experience sleep difficulties, including a higher likelihood of insomnia, sleep apnoea, periodic limb movement disorder, and restless leg syndrome. For children, ADHD can lead to trouble falling asleep, staying asleep, and getting up in the morning. And sleep deprivation amplifies ADHD symptoms. It hinders the brain's ability to concentrate, making it more challenging for individuals with ADHD to stay focused and attentive. Dr Kumar advises: "Prioritise sleep, and if you struggle, research and try different ways to help sleep." 2. Don't overcommit The impulsivity and difficulty with time management associated with ADHD can contribute to taking on more tasks than one can realistically manage. Kids in particular may also struggle to say 'no'. This could be related to schoolwork, exams, or social situations such as hanging out with their friends. But overcommitment can be particularly problematic for individuals with ADHD, often leading to stress, burnout, and difficulty following through on commitments. Dr Kumar says: "Learning to say 'no' doesn't make you rude, it makes you honest." 3. 'Just try harder' The belief that someone with ADHD must exert extra effort to perform tasks can negatively impact self-esteem, warns Dr Kumar. This can be due to a combination of factors, including the feeling of being constantly behind, the internalisation of external criticism, and the challenges associated with emotional regulation. Telling a child with ADHD to 'just try harder' is ineffective and can be harmful because ADHD is a neurological condition, not a lack of effort or motivation. Instead of focusing on the perceived need to exert more effort, people with ADHD should adopt strategies to improve focus, organisation, and overall functioning. These strategies should be tailored to individual needs and preferences, and may include using tools to manage time and tasks, incorporating physical activity, and seeking professional guidance. 4. Ignore your emotions People with ADHD shouldn't ignore their emotions because neglecting them can lead to a number of difficulties. Children with ADHD may especially have difficulty regulating and managing their emotions. This can potentially result in intense outbursts and difficulty managing everyday situations. "Working on regulation skills helps," says Dr Kumar. 5. Never self-diagnose or self-medicate While parents are key to recognising potential ADHD symptoms and initiating the process of seeking a diagnosis from a doctor, they should never diagnose their child with the condition themselves. Self-diagnosing and self-medicating ADHD is strongly discouraged because it can lead to inaccurate diagnoses, ineffective treatment, and potential harm. A formal diagnosis requires a thorough evaluation by a qualified healthcare professional, and treatment plans should be tailored to individual needs under the supervision of a medical professional. You risk the danger of making symptoms worse, says Dr Kumar. The best way to get diagnosed To go down the NHS route, visit your GP and ask for a referral to an ADHD specialist (only certain professionals are qualified to diagnose, such as psychiatrists and psychologists). Dr Kumar advises: "You'll usually be asked to bring examples of how your symptoms affect your daily life. "But note - while the NHS pathway is free, unfortunately waiting times can be up to three years. "If a private assessment is an option for you, diagnosis tends to be a lot quicker. "In my clinic I also do online ADHD assessment and diagnosis with adults." What happens if ADHD is never diagnosed? ADHD that is never diagnosed can hide under layers of frustration, burnout, or health issues. A diagnosis can be the first step toward understanding yourself, finding effective strategies, and feeling less alone. Dr Kumar adds: "Many people experience underachievement, feeling capable but consistently falling short due to disorganisation, missed deadlines, or procrastination. "This often leads to low self-esteem, with individuals internalising harmful beliefs like 'I'm lazy' which can increase the risk of anxiety and depression. "Without understanding the root cause, people may turn to coping mechanisms like excessive caffeine, or other substances to self-regulate. "Relationships may also suffer due to impulsivity, forgetfulness, or emotional reactivity, all of which can create unnecessary conflict. "Getting a diagnosis can bring clarity, relief, and a starting point for meaningful support." How ADHD is treated For some people, just knowing their diagnosis brings relief as it helps them to make sense of themselves and they do not want formalised treatment. For those that want treatment, that can look like a combination of medication, psychological support, and lifestyle adjustments, says Dr Kumar. She explains: "Psychological therapies, such as cognitive-behavioural therapy (CBT), support managing time, emotions, and daily challenges, often alongside coaching and family education. "Lifestyle changes like establishing routines, using organisational tools, exercising, and prioritising good sleep also play an important role. " Schools may provide additional support through formal plans, and regular follow-ups with healthcare professionals ensure the treatment is effective and adjusted as needed. "Overall, treatment is personalised to help improve daily functioning and quality of life."
