infographic: women account for majority of adhd drug claims throughout covid-19 pandemic
the report from the reformulary group shows that not only are adhd medications on the rise in all age groups, but prescriptions in female claimants have seen a three-fold increase since the few years before the covid-19 pandemic.
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when broken down into age groups, the data from reformulary shows that female adhd claimants between 25 and 44 rose by 205.2 per cent in 2023, compared to males in the same age group, which still saw a significant increase of 98.2 per cent.
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reformulary group is the provider of the drug claim data and contributed to the analysis of the data for the purposes of this article. adhd, or attention-deficit/hyperactivity disorder, is a common mental health disorder marked by symptoms such as inattention, hyperactivity, and impulsivity. for decades, children and adolescent males were the most affected by the disorder. according to research conducted between 1999 and 2012, youth aged 10-14 had the highest prevalence rates of adhd, with males being three times more likely to develop the disorder than females. because of that, these demographics have long led the way in adhd medication prescriptions.
however, in recent years, that script has flipped dramatically. now, according to research from reformulary group, women between the ages of 25-44 have taken over the top spot when it comes to adhd prescription drug claims – further emphasizing a trend that has seen an increase in the diagnosis of women with adhd since the covid-19 pandemic began.
reformulary group is an expert-led healthcare company that has built and manages its own prescription drug formulary (drug list) based on extensive research of the clinical and cost-effectiveness evidence for drugs. their formulary – the reformulary and drugfinder search tool – is used by over 1,000 organizations (companies, unions, etc.) comprising 450,000 employees and their dependents.
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reformulary’s claims database shows a 67 per cent increase in claims for adhd drugs. the database comprises de-identified prescription drug claims for about five million canadians, with 37 million claims annually, covered by private drug plans nationally.
the report from the reformulary group shows that not only are adhd medications on the rise in all age groups, but prescriptions in female claimants have seen a three-fold increase since the few years before the covid-19 pandemic.
the shift in adhd prescription drug claims and the impact of covid-19
by the end of 2023, more women in canada were being prescribed adhd medications than any other demographic. historically, males under the age of 18 were the most likely to get prescriptions for adhd medication. still, the data from reformulary shows the change happening right around the time the covid-19 pandemic began.
in 2020, males accounted for 57.8 per cent of adhd drug claims, while females made up 39 per cent, respectively. then, in 2023, the shift occurred, with females making more claims for adhd medication at a rate of 49.4 per cent compared to males at a rate of 47.3 per cent. an additional 3.3 per cent of claimants did not identify their sex as male or female.
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when broken down into age groups, the data from reformulary shows that female adhd claimants between 25 and 44 rose by 205.2 per cent in 2023, compared to males in the same age group, which still saw a significant increase of 98.2 per cent.
the reason for the rise during the pandemic isn’t clear, but tatiana rivera cruz, clinical social work and therapist licsw with adhd advisor, believes that new ways of working and living at home may have contributed to an understanding of previously misunderstood traits and symptoms.
“i think it’s a fact of going into this switch of my daily routine of going to work, and then all of a sudden, we’re at home with others working, maybe remote, or others not working because maybe your work can’t be done remotely,” she said. “it gives you more time to sit down and think—that space to analyze things that may have been there in the air forever but just being occupied the rest of the day and not thinking about it.”
other medical professionals have come to similar conclusions. in an article published by self, dr. ellen littman, a clinical psychologist, and co-author of the book understanding girls with adhd, commented that women who have yet to receive a clinical diagnosis for adhd have a higher likelihood of experiencing comorbid mood changes, including increased anxiety and depression, in response to emergency events such as the pandemic.
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“the pandemic amplified all adhd challenges to unprecedented levels,” littman told self. “when women are robbed of routines that provide a structure for them, which is really essential to their functioning, they’re reporting much more anxiety, depression, and self-doubt.”
without the typical pre-pandemic routines, women who relied on heavily structured lives to function were left in the lurch, having to self-regulate without the organization that many people with adhd rely on to perform daily activities adequately. ultimately, this lack of structure could have shed light on an already-existing adhd disorder that had yet to be diagnosed.
other research examining the effects the covid-19 pandemic had on people already diagnosed with adhd shows that symptoms did worsen during the years-long pandemic. the study cited a six to 21 per cent increase in symptoms of adhd among university students of both sexes in japan. while this doesn’t show a direct connection to rising rates of adhd in canadian women, it does act as confirmation that adhd symptoms were exacerbated during the pandemic.
females with adhd misunderstood as children, diagnosed as adults
rivera cruz works with patients directly and conducts evaluations using the diagnostic and statistical manual of mental disorders, fifth edition (dsm-5). the dsm-5 is a standardized diagnostic tool used by medical professionals to diagnose mental health disorders in people of all ages. it acts as a guide to help identify symptoms, signs, and characteristics that fit into the diagnostic criteria for disorders such as adhd.
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rivera cruz sees firsthand how many people have adhd and suspects that the cause may not be all that mysterious. it could be as simple as people failing to receive the help they needed in childhood.
“i believe that there’s a lot of people out there that have been struggling since they were children and have never been officially diagnosed, evaluated, or tested.”
her theory is reiterated in scientific research that proves young girls are less likely to be diagnosed because their symptoms are not as obvious. according to research, young girls with adhd are more likely to internalize their symptoms, whereas young boys externalize. this means that when girls experience symptoms, their way of coping is not as visible to others. for example, a young boy who has adhd may be hyperactive and a young girl will be more inattentive. the diagnosis is the same, but the way it presents differs drastically.
the type of adhd between boys and girls often differs as well, with young males being more likely to experience adhd impulsive/hyperactive and young females experiencing adhd inattentive/distractible. these less obvious symptoms in young women are likely to be mistaken for character traits as opposed to signs of a mental health disorder. when looking at the dsm-5 for diagnosis, young women with more subtle signs of adhd often fail to meet the diagnostic criteria as well.
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according to another study published in the journal of attention disorders, the ratio of males to females in childhood and adolescence with adhd is 3:1. when looking at adults with adhd, that ratio is closer to 1:1. the study suggests that, because of those changing ratios, women are more likely to be underdiagnosed in childhood and adolescence than males. seeking help through adulthood could then be seen as a correction of a past oversight regarding an adhd diagnosis.
“most of the clients, when they come, in the middle of the interview i always ask, ‘how was it in your childhood? how was it in your teen years?’ and i dare to say that all of them had noticed a difference because their parents have been telling them, ‘when you were a kid, this happened.’ rivera cruz said. “as an adult, you feel that it’s more noticeable and has a different impact on your life.”
treating adhd symptoms without proper diagnosis
it’s also possible that rising cases could be correlated with the fact that drugs are being used in a way that may or may not be conducive to the symptoms people are experiencing. the changes in medications used for adhd may also play a role. for example, the first-line therapy for adhd is typically stimulants. however, not everyone who presents with adhd symptoms benefits from that type of drug.
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“the experience i have in this process is that there are a lot of clients who come with an unofficial diagnosis of adhd, and they see a mental health provider who says, ‘i guess you may have traits for this; you need to get tested and evaluated. i can’t do the assessment, but i’m going to give you this prescription,’” rivera cruz said.“i think that’s a very delicate topic that every single provider who works with medication needs to address in a different way.”
medications given for adhd could be done so for the wrong reasons, with providers failing to go through the proper evaluations and assessments before offering up medication. other medical professionals echo these sentiments when it comes to the rising rates of adhd medication needs across the country.
according to an article published in the new york times, “experts have questioned the increase in adhd diagnoses among children and adolescents. the rates far outstrip the estimated prevalence of the disorder.” this may be an indication that not only are people being given adhd medications for the wrong reasons, but they may also be being misdiagnosed right out of the gate.
keith conners, the psychologist who “set the standard for diagnosing adhd,” spoke to psychology today in 2016 about the topic, stating that even over a decade ago, adult adhd may not be as prevalent as some believe.
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“adult adhd is real and of great life importance, but quite rare and easily overdiagnosed,” he said, as quoted by psychology today “beware the charlatans and fringe practitioners making a new assault to capture the drug market. also, remember that modern life is complicated. perhaps you need to simplify your life before you decide you have adhd.”
research surrounding the overdiagnosis of adhd is rare, but one study published in the canadian journal of psychiatry found that adults may be prescribed adhd medications without warrant for a few reasons, including:
- flawed diagnostic criteria in the dsm-5: the diagnostic criteria for adhd in adults is broad, which causes challenges when accurately diagnosing an adult with adhd.
- failure to consider differential diagnoses: more than one mental health disorder can cause inattention, one of the common symptoms of inattentive type adhd.
- failing to consider childhood onset: according to the study, “one cannot have adult adhd without first having childhood adhd.” this vital piece of the puzzle is often missed when diagnosing adult adhd and could help determine if a person is experiencing a true adhd disorder or simply symptoms of it that could be present in many other conditions or situations.
- too much reliance on screening tools: screening is a great way to tell if someone needs a proper assessment, but these tools often have a high false-positive rate. failure to acknowledge the shortcomings of these tools could lead to overdiagnosis.
- seeking out stimulants under false pretences: the societal demands placed on young adults today, especially women, are heavy. since stimulant drugs can help focus and attention in those without adhd, some people may be seeking out these drugs purposefully to help increase performance at work or in life.
- medicalization of modern culture: the accessibility of information is high in modern society, and because of that, normal life problems that people experience are often over-medicalized. if a person experiences a lack of concentration, they may see something online that indicates they may have adhd, and then they can mould themselves to fit that narrative.
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societal influence on adhd and the rise of cases
mental health professionals primarily rely on people to explain what they’re going through in the best way possible to infer a diagnosis. in some cases, people find it hard to articulate their symptoms or may misdescribe what they’re experiencing, which can lead to improper diagnoses and, thus, the wrong medication.
rivera cruz believes that where people are getting their information could be a significant factor that plays into people self-diagnosing themselves with adhd before seeing a doctor to get confirmation and then medication.
“it depends on what resources you have been seeing. for example, clients have said, ‘well, i saw this podcast about a doctor talking about clinical symptoms related to this.’ that source is trustworthy. but when i hear about persons who saw this on tiktok, then i ask, ‘okay, well, what specifically did you see?’”
anyone who has social media has likely seen a rise in mental health talk on apps like tiktok and instagram. the barrage of information, often from sources that are not equipped to speak on such matters, can cloud the already muddy waters when it comes to understanding and managing adhd.
dr. marielle quint, a chartered clinical psychologist, explored the social media adhd craze in the hip and healthy blog, stating, “information is accessible, relatable, and easy to find. with many celebrities disclosing their own difficulties, it can be so helpful in demystifying and destigmatizing many conditions. however, it’s important to be wary of the sources of information that you are looking at. there are vast numbers of widely available adhd questionnaires that are not valid.”
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one study published in the sage journal echoed the same results. while there is some good information on social media, roughly 52 per cent of it contains misinformation, which, in the wrong hands, could lead to people believing they have adhd when they simply don’t.
“the traits that they’re talking about [on tiktok] are things that are not related to adhd – [they are] simple things that happen in daily life. but that gives them the wrong information,” rivera cruz said. “then you go to an appointment thinking, ‘oh, maybe this is it. this is the answer to all my problems.’ and most of them, when you do the evaluation, they don’t meet the criteria.”
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