Continued Adderall Shortage Means Struggles for People With ADHD

Families of kids—and parents—with ADHD have struggled with a year-long shortage of the ADHD medication Adderall and other stimulants. Here's how they're coping.

Medically reviewed by Emily Edlynn, PhD

In mid-October 2022 the FDA announced a shortage of mixed amphetamine salts, more commonly known as Adderall, a stimulant drug commonly used to treat ADHD. And now, a year out, as the shortage continues, other ADHD medications like focalin are also running low.

There are many medications available for those with ADHD, but stimulants like amphetamines and methylphenidate (commonly known as Ritalin or Concerta) are particularly effective because they introduce more dopamine and norepinephrine into the brain.

ADHD is, in part, caused by slower or dysregulated response to these neurotransmitters, so their increased presence helps neurons connect more efficiently. As a result, instead of noticing everything at once or nothing at all, medication like Adderall can help people with ADHD do what those with typical neurology do with ease—determine what matters in a particular moment and focus on that.

Whereas other shortages we’ve seen in recent years have had somewhat straightforward causes (an outbreak of bird flu leads to egg scarcity; unclean factories cause empty formula shelves), this one is more complex. What’s causing the shortage is a perfect storm of multiple factors.

There are more people being diagnosed with ADHD than ever before. According to the CDC, six million American children had been diagnosed with ADHD in 2019; based on data from the National Survey of Children’s Health (NSCH), this number likely continues to rise.

In addition, a 2019 study in JAMA Network Open shows an increase of 123.3% in ADHD diagnoses among adults, a huge number despite the noted discrepancies among marginalized groups. So, while there’s been a huge swell in folks being diagnosed with ADHD across all age groups, there are likely even more people whose neurodiversity is being missed by medical bias.

This means a lot more people need stimulants, but amphetamines are controlled substances and the EPA is not excited about increasing the quota on a drug that gets neurotypical folks high. A mismatch between patient needs and EPA fears has left millions of kids and adults very much out of luck.

Related: The Best Online ADHD Therapy Services for Kids and the Parents Who Love Them

Why Do People Need Adderall?

A common misconception about ADHD is that it’s a childhood condition that fades in adulthood, but the truth is more complicated. A 2021 analysis of recent literature regarding adult ADHD published in the Journal of Global Health found that, while symptoms of ADHD do decrease over the course of a lifetime (with 18 year olds presenting as more symptomatic than 60 year olds), some 500 million adults worldwide experience symptoms like diminished executive function, sensory processing challenges, increased impulsivity, and more.

All of these are crucial tools for anyone, but especially for parents and caregivers who are trying to keep track of parent-teacher meetings, homework, afterschool activities, and so much more.

Kids with ADHD face the same sensory issues, lack of focus, and increased impulsivity as their adult counterparts, which can create opportunities for both joy and chaos in their and their caregivers’ lives. Many children love getting messy and running amok, but a child with ADHD is more likely to take part in dangerous activities or forget about their responsibilities, adding to a parent’s mental load.

By adding more neurotransmitters to the mix, Adderall and other stimulants can help mitigate these symptoms. Simply put, when their neurons communicate more efficiently, both children and adults are less likely to experience symptoms of ADHD.

What are Executive Function and Sensory Processing?

“Executive function is the sorting, retrieving, and organizing of information that [allows  for] planning, execution, and knowing when a task is done,” says Andrew Kahn, M.D., of Understood.org.

“For adults, and particularly for parents, it's sort of an invisible disability in that we only see the outcomes of it," says Dr. Kahn. "You're tracking doctor's appointments, school, activities, meal and meal planning—functional responsibilities that require a set of skills that includes tracking and executing. For a parent with an executive functioning deficit, which is one of the most important parts of an ADHD diagnosis, this leads to so much chaos and stress.”

For kids, this invisible disability may be interpreted as laziness or disrespect. After all, arriving late or failing to hand in an assignment are not the best way to make a great impression on a teacher or a coach.

Related: The Cost of Diagnosing Learning Disabilities

Too often, though, kids simply don’t have the executive function necessary to know when to leave in order to arrive on time. They may not be able to plan for the scope of a paper they need to turn in. If a kid has ADHD, this isn’t insolence—it’s a neurodifference.

Aliza Pressman, Assistant Clinical Professor in the Department of Pediatrics at the Icahn School of Medicine and host of the podcast Raising Good Humans, calls executive function the “air traffic control tower of the brain.”

And caregivers have a lot of flights to be tracking, Dr. Pressman notes. When one’s executive function is overwhelmed, it goes offline, making way for the “animal brain” to take over with a fight-flight-freeze response. This isn’t helpful in the face of a missed permission slip or a toddler having a tantrum.

“[People with ADHD] pick up on so much in the environment, and we don’t do a great job differentiating what's important from what's unimportant,” says Dr. Kahn. “Sound sensation, the tag on a t-shirt, loud noises—the neurology of ADHD often grabs too much [of that information]. That can lead to irritation and frustration, particularly at the end of the day. We understand kids being naughty because they're too tired, but we don't give that grace to adults with ADHD who are navigating a heavy cognitive load.” 

The sorting and filing of input from the senses is called Sensory Processing, and it’s a crucial part of how we understand the world. People with ADHD constantly receive more input from their senses than neurotypical people and have more trouble processing it all. This leads to more outbursts and missed details, and higher levels of everyday chaos when left unmanaged.

Related: The Best Online Psychiatry Services for You and Your Family

How to Manage ADHD Without Medication

In lieu of or in addition to pharmaceuticals, there are several tools that help mitigate challenges faced by ADHD-ers—all practical, minor adjustments that work with the peculiarity of this neurology instead of fighting it.

Routines and rituals

When crafting routines, it’s important to ensure they work for you. This often means using multi-sensory inputs to get an idea into your brain.

Every time I get out of my car, I say “I turned off the lights” aloud. At first, it felt weird, but now it’s a habit that has eliminated my panic that my car battery may die at any moment. If there’s anything important I need to remember, I use a visual or auditory prompt to help make it really sink in from my highly fallible working memory into my more reliable short term memory. To that end, there’s a sign on my front door that says, “Hang up your keys.” And another on the back door that says, “Lock this twice.”

“[Rituals don’t] make you more rigid, they make you more flexible, because you don't have [pay attention to] all the details of how to get through the day. You're not encumbered with worries about forgetting something,” Dr. Pressman says, “That's why simple things like laying out clothes, packing lunches, putting checklists on your mirror [are so helpful], you don’t need to hold those things in your brain.”

Actual wellness

Another key part of ADHD management is getting enough sleep, exercising, and eating enough. “It takes more energy to fuel an ADHD body,” says Dr. Kahn, “So, in order to do the neurological activities well, I need to have adequate fuel. Sleeping better and having a schedule that makes sense to me are really important first steps in managing my own neurology.”

Exercise, for its part, increases neurotransmitters, like dopamine and serotonin, in your brain and reduces cortisol (a hormone released during a fight-flight-freeze response). Both of these are key to a better functioning brain and can be attained by any motion, even stretching or going for a walk.

For people with ADHD, it can be a challenge to manage our time in a way that ensures we’re getting enough food during the day. Things like hyperfocus or time blindness can mean that we forget to eat, only to remember when we’re running late or too hungry to make something. Having easy to make meals on hand can be the difference between getting enough fuel to run our persnickety brains and an emotional, sensory-driven meltdown.

Related: The Best Online ADHD Therapy Services for Kids and the Parents Who Love Them

Focus strategies and aids

“Some people benefit from the presence of others, a practice called body-doubling. That neurological pressure of another person can actually increase focus,” says Dr. Kahn, “If you increase stimuli in an environment, you don't respond as much to random stimuli. Another [related] strategy is listening to brown noise to help focus.”

Timers and list-making apps with notifications are also very helpful in avoiding distraction or hyperfocus and lessening the mental load of multiple details, respectively.

Related: How To Advocate for School Accommodations for Black Children

Pausing to breathe

For the emotional strain of ADHD, those telltale outbursts, Drs. Pressman and Kahn both recommend breathwork and compassion.

"If you think about the stimulation levels across the day, and you don't do anything to calm them, they're just going to get higher and higher,” says Dr. Kahn, “And at some point, you melt down, or freak out, or yell at someone. Mindfulness and calming strategies, if used regularly, perpetually bring those sensory experiences down and create grace for yourself. As a parent, if you don't give yourself permission to be imperfect, [to be] who you are as a neurodivergent individual, then you're going to perpetually put yourself down and feel badly about yourself.”

An added benefit of this self-acceptance is that it’s setting a great example for our kids. By showing them how to use these various tactics and aids, and by extending ourselves grace when we stumble, we’re showing them the value of self-love. Which may be the most important lesson of all.

Related: How Do I Help My Child Build Confidence and Self-Esteem at an Early Age?

For more Parents news, make sure to sign up for our newsletter!

Read the original article on Parents.