As conversations around ADHD gain traction in policy circles and the media, public attention is increasingly focused on ADHD treatment and the use of stimulant medications. A recent Axios article highlights rising stimulant use, particularly among women. That story is important. But what’s more important is understanding what is driving increased stimulant use.
A circular reality gives us part of the answer: ADHD is increasingly part of the public vocabulary, more people are getting information from social media (some right, much wrong) about ADHD, and this causes many to be either mis-diagnosed or under-diagnosed. It’s not just that more people are using stimulants – it’s whether those medications are reaching the right patients. The answer, too often, is that they aren’t. And we have more to do to ensure the system can support more consistent, accurate ADHD diagnosis.
The Axios article notes that a growing share of stimulant prescriptions is now coming from primary care providers and other non-specialists, signaling a broader shift in where and how ADHD care is delivered. That is neither surprising nor problematic. But these prescribers are hindered by a lack of resources that make accurate diagnoses of nuanced medical conditions that manifest differently from one patient to another. In the realm of ADHD, they also lack critical tools that are needed to help them diagnose patients effectively. Today there are literally no standardized clinical guidelines for ADHD in adults, leaving medical professionals only with pediatric guidelines that don’t have much to do with adult ADHD. Likewise, there are not enough objective screening and diagnostic tools to help clinicians differentiate ADHD from other conditions that may have similarities, but that are not actually ADHD, like depression or anxiety, among others. We cannot expect diagnostic accuracy for a condition with no biomarkers in the absence of these critical resources, and more needs to happen to ensure their availability.
Finally, as stimulant prescriptions rise, it is important to examine not just how many patients are treated, but whether they are receiving the therapy that is most appropriate for them. In many cases, older stimulants are cheaper and insurers preference them, even though newer medications may be better for many patients. At the same time, newer formulations may offer advantages for patients, including typically lower misuse potential. This raises important questions about how to ensure patients can access the full range of evidence-based treatment options, and how we can push back against insurers making decisions to push low-cost treatment options that not only may not serve patients, but also may lend themselves to medical misappropriation in some instances.
The good news is that rising diagnoses, particularly among women, demonstrates that our care system is beginning to better recognize ADHD across the lifespan. For years, many individuals, especially women, were overlooked because their symptoms did not align with traditional diagnostic frameworks. Greater awareness and evolving understanding of how ADHD presents across different populations are helping to close that gap. But recognition alone is not enough. To ensure diagnostic accuracy, it must be paired with stronger clinical tools, particularly for primary care clinicians on whom the burden of diagnosis disproportionately falls.
For us at Mindful Choices, this is not about whether there should be more or less medication, but rather ensuring that the right diagnosis and treatment gets to the right patient. It is about ensuring care is appropriate, individualized, and grounded in clinical expertise. As the conversation continues to evolve, the focus must remain on helping people get the right care, at the right time, in the right way.