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Stimulants are used to treat ADHD because they increase levels of dopamine and other chemicals that help people pay attention and think more clearly, among other benefits.Ryan Remiorz/The Canadian Press
The number of people in Ontario who were prescribed stimulants to treat attention deficit hyperactivity disorder skyrocketed more than 150 per cent between 2015 and 2023, a new study has found, with the greatest increases among women.
The prescriptions spiked from the beginning of the pandemic onward, increasing nearly four times faster each year from 2020 to 2023 compared with 2015 to 2019.
The data were published Thursday in JAMA Network Open by researchers at ICES, the non-profit group formally known as the Institute for Clinical Evaluative Sciences in Toronto, along with North York General Hospital and the Hospital for Sick Children.
The trend likely reflects a better understanding of how ADHD affects different age groups and genders – but may also be a warning sign that some people are being misdiagnosed, said one of the study’s authors.
“The good news story here is that I think there have been groups of people who’ve been historically underdiagnosed with ADHD,” said Daniel Myran, a family physician, ICES scientist and researcher in family and community medicine at North York General. He co-authored the study with Yeron Finkelstein, a staff physician at SickKids.
“When you increase social discourse about ADHD, when you make it more accessible to get diagnosed for ADHD, then people who do have ADHD start getting diagnosed,” Dr. Myran said.
Using data from Ontario’s Narcotics Monitoring System, a database that tracks dispensing prescriptions for narcotics and controlled substances, the researchers were able to track increases in prescriptions for stimulants, the vast majority of which were for ADHD.
Stimulants are used to treat ADHD because they increase levels of dopamine and other chemicals that help people pay attention and think more clearly, among other benefits.
The researchers found a 157.2-per-cent increase in people with a new stimulant prescription between 2015 and 2023. The largest increases were among women.
Females between the ages of 25 and 44 saw a 421.3-per-cent surge, while the rate for males of the same age was up 219.7 per cent.
Rates among younger women also increased dramatically, with a 368.7-per-cent rise among women 18 to 24. For males in that age range, the increase was 127.6 per cent.
“Among people 18 and older, there’s a higher number of females with stimulant prescriptions than males in Ontario as of 2023, which is a real reversal in who historically has been prescribed these medications,” Dr. Myran said.
Rates have also accelerated since the pandemic, the researchers found.
The stimulant prescription rate rose 29.2 per cent per year between 2020 and 2023, compared with 7.4 per cent between 2015 and 2019.
The loss of routines and supports many people experienced during pandemic lockdowns helped bring awareness of ADHD to the fore, said Heidi Bernhardt, founder of the Centre for ADHD Awareness Canada, a national charity.
“Through COVID we saw a lot more people becoming aware of their ADHD,” she said.
That greater awareness has led to more discussion of the neurodevelopment disorder on social media and elsewhere, she said.
The proliferation of online services that allow people to more easily access a diagnosis has also likely contributed to the increase, said Ms. Bernhardt, a psychiatric nurse by training.
More women are now being diagnosed with ADHD because of a better understanding of how the condition presents in females.
The stereotype of ADHD is of a boy struggling to sit still in the classroom. Often, however, young girls with ADHD struggle with attention issues, said Anita Parhar, the director of women’s health at the ADHD Centre for Women.
They frequently aren’t singled out for diagnosis at a young age because they aren’t disruptive at school.
The increasing rates of prescriptions to treat ADHD in women is welcome news, Dr. Parhar said. “That means more women are being heard, understood, believed and then being treated for something they’ve always had.”
But the overall increase in stimulant prescriptions may mean that some people are being misdiagnosed, and Dr. Myran worries it may leave the actual condition causing symptoms, such as an anxiety disorder, to go untreated.
Jane Liddle, an Ottawa-based pediatrician and board member of the Canadian ADHD Resource Alliance, a non-profit association, said we must also be aware of the consequences of not treating ADHD, which can include increased rates of depression, anxiety, academic challenges and addiction.
