The Rise of Adult ADHD

If you’ve experienced difficulty filling an Adderall prescription this year, you aren’t alone. In August, the Food and Drug Administration addressed the ongoing shortage of common stimulants such as Adderall and Vyvanse, drugs commonly used to treat Attention Deficit Hyperactivity Disorder (ADHD). The letter asked stakeholders to work diligently to ensure patients get access to medications they need. However, with the nationwide rise in ADHD diagnoses, shortages aren’t likely to end soon. There are several reasons why. One drug maker experienced a manufacturing delay. But most of the shortages can be attributed to skyrocketing demand. Between 2012 to 2021, stimulant prescriptions rose by more than 45% in the United States. A recent U.S. Centers for Disease Control and Prevention points to virtual prescribing, permitted widely during the pandemic, as another reason for the demand. These drugs are also hard to come by, because more adults than ever are taking drugs to treat newly diagnosed ADHD.

In New Hampshire, adults between the ages of 30 and 39 accounted for the biggest percentage increase in the number of ADHD prescriptions written between 2000 and 2022, according to New Hampshire Department of Health and Human Services reports. Women were more likely than men to take ADHD medication. In some of these cases, ADHD might’ve been missed during childhood. In others, adults are overreporting their symptoms and getting prescriptions.

“Right now, there’s an epidemic on social media, convincing people they have disorders or diseases they may not have based on vague symptoms,” says Dr. Maria Boylan, a board-certified family practice doctor with Elliot Family Medicine in Bedford, New Hampshire. “The problem is people scroll social media platforms like TikTok for several hours that tell them they’re distracted and having trouble concentrating. Just because you feel that way, it doesn’t mean you have ADHD. Getting the proper diagnosis is important.”

How ADHD Presents in Adults

ADHD is first suspected in children and can look like fidgeting in chairs, interrupting the teacher or daydreaming. There are three types of ADHD: inattentive, hyperactive/impulsive and a combination of both.

• Inattentive ADHD is characterized by difficulties in focusing, forgetfulness, unfinished tasks and carelessness.
• Hyperactive/impulsive ADHD is marked by restlessness, impulsivity and difficulty waiting one’s turn.

These symptoms look similar in both children and adults. The DSM-V, the psychiatric diagnostic manual, describes ADHD as a condition that occurs prior to the age of 12 and persists in at least two settings for at least six months. It’s unlikely an adult would suddenly develop ADHD in their 30s or 40s, Boylan says.

“Either they were unrecognized or not diagnosed as a child, or there’s another explanation for their current symptoms.”

Adults with ADHD may miss deadlines, have trouble completing projects or forget appointments. In severe cases, symptoms can lead to job loss or fractured relationships. ADHD does not just pop up in specific situations or environments; it pervades your entire life. For example, you just wouldn’t experience symptoms of ADHD at work but manage tasks in other parts of your life without difficulty, Boylan says. In some cases, people might think they’re experiencing ADHD symptoms because they’re juggling multiple responsibilities or frequently getting distracted by phones, watches or social media feeds.

“The way we live today, being so reliant on technology, and working more than we ever have, makes life distracting,” Boylan says. “If I see someone who is a successful CEO at a big company with a million things on their plate, tasks to juggle and a family and a home, how can you say their life has been negatively impacted? It’s not the same. A person with untreated ADHD would have a very difficult time even getting to that level of success.”

Mental and Physical Factors to Consider

Before doctors can give adult patients an ADHD diagnosis, they should take a detailed health history and corroborate a patient’s history with input from family members, friends or partners. A comprehensive evaluation can rule out other physical health issues, such as thyroid problems or anemia. Health care providers should look at various demands in a patient’s life, including their job, workload and potential distractions, Boylan says. It’s important for providers to screen for anxiety and depression, because a lot of the symptoms are similar and can present like ADHD but not be. Getting the right diagnosis is critical to ensure proper treatment, Boylan says.

“Getting diagnosed with ADHD is not a quick in-and-out thing — it takes a couple of visits to get diagnosed,” she says. “In some cases, I might consider sending a patient for a neuropsychological evaluation to see if there are other areas of concern.”

Even if you were medicated for ADHD as a child, you may not need to continue taking stimulant drugs if you’ve developed coping strategies. Some adults adapt by choosing professions that align with their ADHD tendencies. Others learn to set reminders. On the other hand, ADHD symptoms can intensify when individuals regularly use alcohol, nicotine or marijuana, Boylan says.

ADHD Medication Misuse

Most medications used to treat ADHD are amphetamine-based stimulants that pose a serious risk for misuse. These pills can improve focus, provide a burst of energy and aid in weight loss, but those aren’t reasons for adults to take them. If you truly have ADHD, it will make you feel more even-keeled and able to do everyday tasks.

In addition to increasing blood pressure and interfering with sleep, ADHD medications like Adderall and Ritalin can cause anger, irritability and even psychosis. They should only be prescribed when medically necessary.

“People become dependent, and we’re seeing that more and more,” Boylan says.

To help prevent misuse, the state of New Hampshire runs a prescription drug-monitoring program that requires health care professionals to monitor Adderall, Vyvanse, Ritalin and Concerta in the same way it monitors opioid prescriptions.

The database tracks patient refills that can be checked by health care providers and pharmacists.

Patients also must sign an agreement that acknowledges that there is a risk of misuse if not taken as prescribed and commit to annual follow-up visits.

Is Adult ADHD Underdiagnosed or Overdiagnosed?

Depending on what study you read, ADHD in adults is either woefully underdiagnosed or overdiagnosed. Some research reports that only 20% of adults with ADHD take medication to treat it. However, it’s not harmful for adults to forgo medication treatment if they have milder symptoms or if they’ve developed coping skills that allow them to manage their lives.

In the past several years, adults have been overdiagnosed with ADHD due to patient demand for treatment, she says.

Physicians might not have enough time or resources to properly diagnose it and cut corners to appease patients looking to feel better.

“I call this ‘fast-food medicine,’ where patients just want to get a diagnosis and a prescription and walk out the door,” Boylan says.

“I always tell patients I don’t prescribe fast-food medicine; I want to make sure I’m doing the right thing for you.”

If you think you might have ADHD, talk to your primary care provider and investing the time to get the right diagnosis.

“If somebody truly has ADHD, it has a big impact on several areas of their life,” she says.