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Cosmos Study

Number of ADHD Patients Rising, Especially Among Women

March 30, 2023
Epic Research Dual Team StudyDual-Team Study
Team A: Jim Russell, RPhBlaine Franklin, PT, DPTAlex Piff
Team B: Steve Allen, MDEric Barkley

Key Findings

  • The proportion of ADHD patients with a stimulant prescription has stayed between 61 and 64% since 2013, down from a high of 68% in 2011. 
  • New diagnoses of ADHD have risen in recent years across all age groups.  
  • The percentage of women newly diagnosed with ADHD between 23–29 and 30–49 years of age nearly doubled from 2020 to 2022.  

Recently, there have been reports of an increase in the number of prescriptions for stimulant medications, such as Adderall, for the management of attention-deficit hyperactivity disorder (ADHD).1,2 The Drug Enforcement Agency (DEA) of the United States has also proposed changes restricting the prescribing of stimulant medications in telehealth encounters, as those types of medications are considered a controlled substance in the U.S.3 Non-stimulant ADHD medications are not considered controlled substances and are therefore not impacted by the DEA’s proposed changes. However, they are not as widely prescribed as stimulant ADHD medications. 

To better understand how ADHD medication prescribing has changed over time, we analyzed 3,389,383 patients diagnosed with ADHD from 2010 through 2022. We sought to understand whether there was a change in the proportion of patients with ADHD who were prescribed medications to manage their symptoms. Our data show 61–64% of patients with ADHD diagnoses were prescribed stimulant ADHD medications, and that percentage has remained fairly consistent since 2013. The percentage of those with ADHD prescribed a stimulant ADHD medication has decreased from 68% in 2011. The percentage of patients with only non-stimulant ADHD medications prescribed hovered at 5% from 2011 to 2017 but increased slightly to 7% in 2021 and 2022. 

Figure 1
Proportion of Patients with ADHD with Stimulant and Non-Stimulant Prescriptions
Figure 1. Proportion of patients with ADHD with prescriptions for stimulant and non-stimulant ADHD medications annually from 2010 to 2022. 

While the proportion of patients prescribed medications for ADHD has remained consistent, the incidence of ADHD in our study population has tripled since 2010, from 0.19% of patients to 0.57% of patients in 2022. The most marked increase is seen from 2020 to 2022. 

Figure 2
ADHD Diagnoses Over Time
Figure 2. Incidence of patients with initial ADHD diagnosis by year. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), updated diagnostic guidelines for ADHD. 

However, this increase in incidence varies when stratified by age, as shown in Figure 3, with patients ages 6-11 most likely to be diagnosed. Even though the overall incidence of ADHD remains small in the adult population, the incidence in the 30–49-year-old group more than doubled from 0.34% in 2020 to 0.64% in 2022. 

Figure 3
Age at Initial ADHD Diagnosis Over Time
Figure 3. Incidence of patients with initial ADHD diagnosis by year stratified by age. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), updated diagnostic guidelines for ADHD. 

Much of the increased incidence in the adult age groups can be attributed to increases in new diagnoses for females. The incidence of ADHD diagnosis in the 23–29-year-old and 30–49-year-old female populations nearly doubled from 2020 to 2022. This supports previous findings that females tend to be diagnosed with ADHD later in life than males.4  

While males remain more likely to be diagnosed with ADHD than females, the disparity has decreased over the past 12 years. The ratio of males to females diagnosed with ADHD decreased nearly five-fold during that time, from males being 133% more likely to be diagnosed with ADHD than females in 2010 to 28% more likely to be diagnosed with ADHD in 2022. 

These findings suggest that an increase in the number of stimulant medication prescriptions is likely driven by the increase in new ADHD diagnoses, rather than new prescriptions for those who have previously been diagnosed with ADHD.  

These data come from Cosmos, a HIPAA-defined Limited Data Set of more than 183 million patients from 193 Epic organizations including 1,119 hospitals and more than 24,700 clinics, serving patients in all 50 states and Lebanon. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. 

References

  1. Cohen AMB. Adderall users struggle with ongoing shortage while reason — and resolution — remain uncertain. CNN. Published February 23, 2023. Accessed March 10, 2023. https://www.cnn.com/2023/02/23/health/adderall-shortage-adhd/index.html  
  2. Sharp Uptick in Adderall Prescribing for Adults Ages 22-44 Amid COVID-19 Pandemic. www.trillianthealth.com. https://www.trillianthealth.com/insights/the-compass/sharp-uptick-in-adderall-prescribing-for-adults-ages-22-44-amid-covid-19-pandemic. Accessed March 10, 2023. 
  3. DEA Announces Proposed Rules for Permanent Telemedicine Flexibilities. www.dea.gov. https://www.dea.gov/press-releases/2023/02/24/dea-announces-proposed-rules-permanent-telemedicine-flexibilities Accessed March 10, 2023. 
  4. Crawford N. ADHD: A women’s issue. https://www.apa.org. https://www.apa.org/monitor/feb03/adhd. Published February 2003. Accessed March 10, 2023. 
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