Children with ADHD facing a Stimulant Medication Shortage - A crisis situation

A number of children who I prescribed a stimulant medication for treatment of their ADHD symptoms, have recently faced major problems in having the prescriptions filled at a local pharmacy. Some parents have driven hours to find a pharmacy that may have an available stock of the medication, only to be disappointed when getting there.

This shortage has created much anxiety and has been a nightmare for children preparing to return to school.

A national shortage of stimulant medications has been present for quite some time. It is estimated that hundreds of thousands (if not more) of children may be returning to school without their much needed medication this Fall.

This supply problem has existed for some time. As far back as October 2022, the FDA reported a shortage of the short-acting stimulant, d-amphetamine (or Adderall). Other stimulant medications continue to be in short supply. Some extended release forms of methylphenidate (or Ritalin) were also discontinued this year, adding to the shortage problem.

Without medications, parents report that their child has become very difficult to manage due to severe over activity, impulsiveness, risk taking, moodiness, and irritability.  Parents fear that when their child returns to school, they will experience problems in focusing and completing tasks, and in completing classroom assignments. This fear is real, as without stimulant medications, some children had been aggressive, disruptive in the classroom, and suspended from school. These children often engaged in arguments with peers, leading to their being socially isolated. These children may become depressed at not being able to complete school work, or have failing grades, and give up trying due to feeling overwhelmed.

What has led to this problem?

It is reported that the number of individuals, children and adult, prescribed stimulants has increased enormously over  a short period of time, possibly related to the recent Covid-19 pandemic.  It is estimated that 5.3 million children now take a stimulant in the US, and the prescription of stimulants has increased over 8% nationwide over a two year period. It is unlikely that the number of children diagnosed with ADHD has increased by itself. This may represent a trend in the over diagnosing of ADHD by various professionals.

In addition, pharmaceutical companies have faced shortages of the ingredients needed to produce stimulants, leading to they not being able to manufacture enough in a timely manner.
It is not clear how these shortages  of ingredients occurred.

What to do?

In a number of cases, I have been able to prescribe another medication to replace the stimulant that has not been available. Sometimes, another stimulant has been available, and could be substituted, after managed care insurance company approval.

I have also prescribed a non-stimulant medication such as atomoxetine (or Strattera), guanfacine (or Intuniv), and clonidine (or Catapres) which has been effective in lessening many of the ADHD symptoms.

I advise parents to discuss the possibility of providing the child with 504 accommodations which could involve assigning the child to a special needs class. Parents can also ask the school to complete an individualized education plan (IEP) that addresses the child’s special needs when return to school to assess the child’s academic strengths and needs. Parents can ask whether a classroom aide could be assigned to work with their child as well.

It is wise for parents to visit the school and meet with the child’s teacher in order to review if some classroom strategies may be helpful in addressing their child’s ADHD symptoms. Strategies like assigning a child a front row seat in the classroom to reduce distractions may be useful. Allowing the child to leave the classroom briefly for a time out, or allow the child more times to complete classroom work, may also be useful.

The child with ADHD can benefit from enrollment in a counseling program that utilizes therapeutic approaches including cognitive behavior therapy (CBT) to improve a child’s poor emotional regulation.  A therapist might also help the child develop coping strategies in dealing with their issues with poor focus and attention to task.

In more difficult situations, I have prescribed IBHS (Individual Behavioral Health Services) to provide one on one assistance in the classroom, or in the home, A Behavioral Consultant, Mobile Therapist, and or a Behavioral Health Technician compromise members of a team who can provide this intensive service.

A parent or caregiver should let a child know that the moodiness, feelings of anger,  poor focus, forgetfulness, and conflict with siblings and peers are related to not receiving the medication.

Because a child’d behavior without medication can be very difficult, parents at times feel frustrated and angry by their child’s behavior. I advise parents to remember that this behavior will improve once medication is again available, and advise them to support their child through this difficult time. Professional guidance may be helpful in this regard.

Hopefully, this crisis of the stimulant medication supply will soon end.

Let me know your experience or thoughts on this problem.

Robert A. Lowenstein MD
email to: [email protected]