ADHD Weekly, October 17, 2024

About half of adults who have a current diagnosis of ADHD receive care through telehealth services, either through an individual provider or practice, or from a provider employed by an online mental health care company.

The Centers for Disease Control and Prevention released the findings of the first study of the prevalence of adult ADHD in more than a decade in the early part of October. The researchers focused on adults’ use of telehealth services for ADHD, the effects of that care for both individuals and on public health, and how the information provided in the study is important for regulatory decisions under consideration by Congress and federal agencies regarding both telehealth care and the ongoing ADHD medication shortage.

The new prevalence rate—the percentage of individuals in a population who have ADHD—has increased to six percent, an estimated 15.5 million adults in the United States. About half of these adults have used telehealth services, either at some point or as ongoing care. As part of their treatment plans, about half of the adults with ADHD include medication—with 71.5 percent of them facing difficulties in getting their prescription filled because of the medication shortages.

Pandemic emergency provisions, telehealth care, and medication shortages

As the response to the COVID-19 pandemic began, restrictions were relaxed on both how telemedicine was practiced and the ability of prescribers to write prescriptions for stimulant medications. Previously, in an effort to prevent misuse of stimulant medications, patients were required to have at least one in-person evaluation before stimulant medication for ADHD could be prescribed. Separately, restrictions on how telehealth could be provided, such as requiring specialized communication equipment or computer programs that were HIPAA-compliant, were relaxed. This meant healthcare providers could use popular video chat programs, such as Zoom, to meet with patients. The pandemic provisions meant to keep people at home to limit the spread of COVID enabled many adults to receive ADHD and mental health care for the first time.

For established patients, the emergency provisions meant they could continue their ADHD care without disruption. For new patients, it meant evaluation and treatment were now possible with the removal of barriers, such as distance or needing to take leave from work to meet with an ADHD professional.

“Telehealth hasn’t just made life easier; it’s made treatment more accessible,” says CHADD President Jeremy Didier, LSCSW, LMAC. “The new CDC data shows that 46% of adults with ADHD have used this telehealth lifeline to manage their condition.”

Didier received an ADHD diagnosis at age 36; women are more likely to receive an ADHD diagnosis in adulthood than men are. Boys are more likely to be evaluated and diagnosed with ADHD than girls during the elementary and high school years. This leaves many girls undiagnosed and struggling until they, as women, can seek an evaluation and treatment.

“The diagnosis came as a relief and validation—a way to understand years of impulsivity, inattention, and struggles with daily life,” Didier says. Four of her five children also have ADHD. Telehealth care and medication management enabled her to take control of her life and help her children manage theirs. “Now, the control I have gained is under threat—first from drug shortages, and now from Congress.”

Rule extensions for telehealth care may end

The extension to the original emergency provision was set to expire in September. It continues at this time while lawmakers and the Drug Enforcement Agency work out new rules to manage telehealth care and providers’ ability to prescribe stimulant medications. Without updates or new rules from the DEA, patients will again be required to have in-office appointments and providers will not be able to continue their stimulant medication prescriptions without having seen that patient in their office at least half of the time.

Eleven senators are pushing back on these restrictions. They have written an open letter, in which they say, “It is vital that any new regulations do not erect barriers to necessary, life-saving care. The pandemic telemedicine flexibilities increased access to medications… improved addiction treatment retention, and reduced overdoses.”

Helen Hughes, MD, MPH, is the medical director of the office of telemedicine at Johns Hopkins Medicine in Maryland. She says that had the proposed rule to replace the emergency extension been put in place it would have disrupted care for patients who depend on telehealth appointments and prescriptions.

“These medications span a number of clinically important use cases, including ADHD, seizures, palliative care, and pain management,” Hughes says. “With the enhanced national focus on new DEA rules, we have already had pharmacies refuse to provide prescriptions if we cannot provide evidence of an in-person visit with the prescriber.”

The researchers at the CDC noted that one third of adults with ADHD receive telehealth treatment for ADHD, for medication management or therapy. They also use telehealth care services twice as much as adults who do not have ADHD. The researchers note that ADHD experts suggest the benefit of increased evaluations and treatment for ADHD outweigh the possible risks. The results of their research are valuable in the discussions of public health and telehealth.

“Information on diagnosis and treatment helps the development of clinical care guidelines and regulatory decision-making around medication shortages and telehealth for ADHD,” they write.

“Current telehealth regulations are set to expire on December 31, unless the DEA extends them or Congress intercedes to pressure the DEA to extend,” says Didier. “The risks of losing access to these services are significant. If the current telehealth regulations are allowed to expire without a long-term federal government solution, millions of people could face severe disruptions in their care.”

Easing medication shortages

In response to the medication shortages, the DEA has increased the amount of stimulant medications that can be manufactured for 2024. This does not include changes to the amounts allowed for 2025.

A combination of manufacturing limits, an increase in diagnoses, and production shortages related to the pandemic caused a shortage of available ADHD medications, first seen in 2021, and becoming more severe throughout 2022 and 2023.

“My life was stable and well-managed,” Dider says. “That is, until 2023 when roadblocks suddenly appeared in the form of DEA production limits and pharmacy stock issues. My ability to access what I consider to be life-saving medication—for myself and my children—came to a screeching halt, and my entire family felt the impact.”

During the last year and half, finding pharmacies that could fill her prescriptions and those of her children became an almost full-time job. Her experience reflected that of 71% of adults with similar ADHD medication prescriptions.

What you can do to help

CHADD’s public policy committee last year encouraged members of the ADHD community to contact their federal representatives to express their concerns on the medication shortages and barriers to healthcare. The committee continues to encourage people to make their concerns heard regarding medications and telehealth. You can learn more about what you can do at A Way You Can Address the Medication Shortage.

“Ensuring that telehealth services remain a permanent part of the ADHD treatment landscape is essential,” Dider says. “For families like mine, it’s the difference between chaos and calm, between managing symptoms and letting them spiral. As we continue to gather data on adult ADHD, one thing is clear: We need to keep advocating for better access to care—whether through telehealth, addressing medication shortages, or developing long-term solutions for treatment. ADHD isn’t just a neurodevelopmental disorder—it’s a public health issue.”

Read more on ADHD and telehealth care:

• Transcript: Telehealth in ADHD Diagnosis and Treatment
• Telemental Health: Benefits and Potential Pitfalls
• The Therapist Is Online: Telehealth for ADHD Has Benefits and Drawbacks
• What Parents Should Know Before Contacting an Online ADHD Provider
• Telehealth for Teens and Young Adults with ADHD