The Changing Landscape of ADHD: Recent Trends in Diagnoses and Treatment
Attention-Deficit/Hyperactivity Disorder (ADHD) has been a topic of increasing interest in recent years, particularly with reports of rising prescriptions for stimulant medications and proposed changes by the Drug Enforcement Agency (DEA) regarding tele-health prescribing [1,2,3]. As a psychiatrist specialising in ADHD treatment, I find it crucial to stay informed about the latest trends and research in this field. A recent study by Epic Research provides valuable insights into the changing landscape of ADHD diagnoses and treatment [4].
Consistency in Medication Prescriptions
One of the most striking findings from the study is the consistency in stimulant medication prescriptions for ADHD patients. Since 2013, between 61% and 64% of patients with ADHD diagnoses have been prescribed stimulant medications. This percentage has actually decreased from a high of 68% in 2011 [4].
Interestingly, while stimulant prescriptions have remained relatively stable, there has been a slight increase in non-stimulant ADHD medication prescriptions. The percentage of patients prescribed only non-stimulant medications increased from 5% in 2011-2017 to 7% in 2021 and 2022 [4].
Rising ADHD Diagnoses
Perhaps the most significant trend revealed by the study is the substantial increase in ADHD diagnoses. The incidence of ADHD in the study population has tripled since 2010, rising from 0.19% of patients to 0.57% in 2022. The most marked increase occurred from 2020 to 2022 [4].
This trend raises important questions about the factors contributing to this rise. While increased awareness and improved diagnostic tools may play a role, it's crucial to consider other potential influences, such as changes in our educational and social environments.
Rising ADHD Diagnoses
Perhaps the most significant trend revealed by the study is the substantial increase in ADHD diagnoses. The incidence of ADHD in the study population has tripled since 2010, rising from 0.19% of patients to 0.57% in 2022. The most marked increase occurred from 2020 to 2022 [4].
This trend raises important questions about the factors contributing to this rise. While increased awareness and improved diagnostic tools may play a role, it's crucial to consider other potential influences, such as changes in our educational and social environments.
Age-Related Trends
The study also revealed interesting age-related trends in ADHD diagnoses:
1. Children aged 6-11 remain the most likely to be diagnosed with ADHD [4].
2. There's been a significant increase in diagnoses among adults. For instance, the incidence in the 30-49 age group nearly doubled from 0.34% in 2020 to 0.64% in 2022 [4].
These findings highlight the importance of recognising that ADHD is not just a childhood disorder and that symptoms can persist into or first appear in adulthood.
Narrowing Gender Gap
Historically, ADHD has been diagnosed more frequently in males than females. However, this study shows that the gender gap is narrowing:
1. The ratio of males to females diagnosed with ADHD decreased dramatically over the past 12 years.
2. In 2010, males were 133% more likely to be diagnosed with ADHD than females. By 2022, this difference had shrunk to just 28% [4].
Most strikingly, the incidence of ADHD diagnosis in women aged 23-29 and 30-49 nearly doubled from 2020 to 2022 [4]. This supports previous research indicating that females tend to be diagnosed with ADHD later in life than males [5].
Implications for ADHD Treatment
These trends have significant implications for ADHD treatment:
1. Adult ADHD: The rise in adult diagnoses emphasises the need for age-appropriate treatment strategies. Adult ADHD often presents differently from childhood ADHD and may require different approaches.
2. Female ADHD: The increase in diagnoses among women highlights the importance of recognising how ADHD symptoms may manifest differently in females. Clinicians need to be aware of these differences to avoid under-diagnosis or misdiagnosis.
3. Medication Management: While stimulant medications remain the most common treatment, the slight increase in non-stimulant prescriptions suggests a growing role for these alternatives. Each patient's treatment plan should be individualised based on their specific symptoms, co-morbidities, and response to medication.
The landscape of ADHD is changing, with more diagnoses being made, particularly among adults and females. As mental health professionals, it's crucial that we stay informed about these trends and adapt our diagnostic and treatment approaches accordingly.
If you suspect that you or a loved one might have ADHD, don't hesitate to seek professional help. Early diagnosis and appropriate treatment can significantly improve quality of life and overall functioning.
References
Cohen AMB. Adderall users struggle with ongoing shortage while reason -- and resolution -- remain uncertain. CNN. 2023.
Sharp Uptick in Adderall Prescribing for Adults Ages 22-44 Amid COVID-19 Pandemic. Trilliant Health. 2023.
DEA Announces Proposed Rules for Permanent Telemedicine Flexibilities. DEA. 2023.
Russell J, Franklin B, Piff A, Allen S, Barkley E. Number of ADHD Patients Rising, Especially Among Women. Epic Research. 2023.
Crawford N. ADHD: A women's issue. American Psychological Association. 2003.
