Annie Artiga Garner feels a pit in her stomach every time a teacher approaches at school pickup for her twin 9-year-old boys, both in fourth grade and both diagnosed with attention-deficit/hyperactivity disorder.
Even medicated, the boys have had challenges at school this year, particularly as they and their peers adjust to being back in person after pandemic disruptions over the last few years.
“Our family is really stressed out,” said Garner, who is an associate professor of psychology at St. Louis University.
Because of a national shortage of ADHD meds, which started last fall with Adderall and has now extended to other brands and formulations, Garner’s boys went three days in March without the stimulants that increase important neurotransmitters in their brains. Garner was so concerned about sending them to school unmedicated that she emailed their teachers, the school counselor and school therapist in advance.
“I was worried that if I was already getting such negative feedback over minor ADHD behaviors while they were medicated that there was no telling how bad it could get when they were unmedicated,” Garner said.
The ADHD med shortage is creating huge problems for children — and adults — who rely on the prescriptions. Parents shared stories of frantic calls to pharmacies to find meds in stock and limiting doses on the weekends to save for school days.
“I see children and adolescents struggling,” said Aditya Kumar Singh Pawar, a child and adolescent psychiatrist at the Kennedy Krieger Institute in Baltimore. “Unfortunately, the parents, who already were doing their best to advocate for and support their kids who have ADHD, must go through such uncertainty in treatment.”
Short and long-acting stimulants are most often prescribed to treat ADHD. Because they are controlled substances — meaning they have the potential for abuse — they are regulated by the Drug Enforcement Administration and the Food and Drug Administration. The federal government controls the ingredients, how much is manufactured and how much a pharmacy can keep in stock. The $26 billion opioid settlement in 2022 also has impacted ADHD drug availability when the meds were caught up in broader restrictions on controlled substances.
Manufacturers claim not to have a supply chain issue, and both the FDA and the DEA support that, Pawar said. Even with increased demand, the DEA decided there is no need to increase the quota. “Yet, I think of that parent from only a few days ago who was frantic to secure the last few tablets of a stimulant for their kid that the pharmacy was left with, and several others trying to scramble with alternatives if at all available,” he said.
There are currently more than 40 varieties of methylphenidate drugs in short supply, according to the Bethesda-based American Society of Health-System Pharmacists. Name brands of methylphenidate include Ritalin and Concerta.
That’s in addition to a shortage of Adderall, a mixture of amphetamine salts, which is prescribed for ADHD. In October, the FDA noted the shortage of Adderall, which it attributed to manufacturing delays.
Pawar said stimulants are highly effective medicines, with compelling evidence to support their use.
“While academic performance is often seen as the only target of these medications, the effect is broader,” he said. “Treating a child appropriately for ADHD with proper medicines and therapy not only helps parents’ caregiver stress but also helps them learn other skills, manage their behavior better, improve their interpersonal interactions and decrease chances of injury, to name a few.”
Peter J. Smith, an associate professor of pediatrics at the University of Chicago Medical Center, said it’s important for parents to consider more than one strategy to treat ADHD.
“We know there is a lot of data that supports increasing exercise, apart from medication,” Smith said, adding that parents should increase “very thoughtful and scheduled exercise” in children’s lives. That means 20 to 30 minutes before school and 60 to 90 minutes after school when they’ve been stressed out.
To help with executive function, he recommended a visual schedule, where a child is able to see the time and the task that they need to complete.
He also said parents should talk to their children about what’s happening if they are not able to take their medication. “Ask them what they’re most worried about, what’s going on with them,” he said. “Sometimes we project concerns they don’t have and miss concerns they have. It’s one of those things we have to pay attention to. It’s also important to communicate with the school team.”
Garner said she has been talking to her children about their ADHD diagnoses for a long time and how the medicines work.
“I would encourage parents to have conversations with their kids about how their child’s body feels when they are feeling especially high energy, having a hard time thinking before acting or having a hard time focusing,” Garner said.
She said elementary school-aged kids also can be coached to self-advocate when they need movement or meditation breaks. “This can work well if their teachers at school know about the child’s gaps in medication coverage, so that they provide those breaks when the child requests them, or they can prompt the child to ask for a break.”
Her kids ultimately did okay the days they were not medicated, she said. But she’s still glad she talked to their school team.
“I needed their teachers to be prepared for what could come and I wanted them to have context that would prevent them from making assumptions about the kids’ motivations,” she said. “If I’m being completely honest, I also think I sent the email to save myself from getting even more negative feedback than I was already getting.”
Jackie Spinner is a journalism professor at Columbia College Chicago and a former Washington Post staff writer.