Why cases of ADHD in young women are skyrocketing

The number of young, adult women medicated for ADHD has skyrocketed over the last decade – jumping by 344 percent, according to a new report from the Centers for Disease Control and Prevention.

The report points out that these women are of reproductive age, and that there is almost no research on the safety of medications for Attention Deficit Hyperactivity Disorder during pregnancy.

The report does not explain why the number rose so much, but experts in the field note that the public’s understanding of ADHD has been transformed since the early 2000s.

“The good news is that adult women are finally getting diagnosed,” said Dr. Edward Hallowell, a psychiatrist who has written a half-dozen books on ADHD. “I see women go from struggling and feeling so bad about themselves to – they burst into tears when they see how much better their life becomes.”

The percentage of young women who filled at least one prescription for ADHD medication climbed from just under 1 percent of the population in 2003 to 4 percent in 2015, according to the report, which looked at women ages 15-44 with private insurance.

Roughly 5 percent of the adult population is considered to have ADHD, so the increase among women suggests a rightsizing rather than over diagnosis, said Dr. Patricia Quinn, a developmental pediatrician in Washington, DC, who specializes in ADHD in women and girls.

“We’re kind of catching up now,” Quinn said, noting that ADHD used to be diagnosed 10-times more often in men than women. Now, there’s growing recognition in the field that both genders have it at nearly equal rates.

The rise in childhood diagnoses is also likely driving the spike among adult women, said Melissa Orlov, a marriage counselor who specializes in relationship issues in ADHD. As children with ADHD age into adulthood, they are taking their prescriptions with them, she said, citing her own daughter who was in fifth grade in 2001 when she was diagnosed with ADHD and is now 26 and still medicated.

Also, many women realize they have the condition after their child is diagnosed with it. “That seems to be the most common way that adults figure out they have it,” she said.

Orlov said it took more than eight years after her daughter’s diagnosis to realize that another family member had the condition, too. Now, doctors generally alert parents that ADHD is inherited.

The study found that almost all the growth in prescriptions came from women taking stimulant medications, which are considered the most effective drug treatment for ADHD.

But there are only a handful of studies, some contradictory, about the safety of these stimulant drugs during pregnancy.

One large study, published in December, found that babies born to women who used methylphenidate, a type of stimulant medication, during pregnancy, had a slightly increased risk of heart malformations. The study found no association between amphetamines, such as Adderall, and heart malformations. An earlier study had found no connection between methylphenidate and major malformations.

Other research has found a potential link between ADHD medications and a lower Apgar score – a measure of health – at birth.

Half of all pregnancies are unplanned, so women with ADHD may be taking their medications for weeks or even months before they realize they are pregnant, according to the CDC study, which called for more research into the safety of these drugs during pregnancy.

Many doctors – including Hallowell – advise their patients with ADHD to stop using the medications during or when they’re planning a pregnancy, because the risks are so little understood.

Craig Surman, a psychiatrist and associate professor at Harvard Medical School and Massachusetts General Hospital, said he usually “errs on the side of caution,” and talks his patients out of medication during pregnancy.

“Most people say, ‘it’s harder than being on medication but I’m glad I did it that way,’” he said, adding that he doesn’t want them to regret their decision in 20 years when more will likely be known about the drugs’ effects on the fetus.

But some women are emotionally erratic and struggle to function without their medication, he said, potentially endangering their child. In those cases, the immediate risk to both mother and child outweighs the long-term, hypothetical dangers from medication, said Surman. He co-chairs a professional advisory board for Children and Adults with ADD, a research and advocacy group, and has received consultation fees from a number of pharmaceutical companies.

Quinn said doctors who prescribe ADHD medication should warn young women about the risks during pregnancy, and women with ADHD should talk with their prescribing doctors if they’re thinking about getting pregnant.

ADHD can look different in women than in men. While most people associate the condition with people who can’t sit still, women with ADHD are often underachieving daydreamers, quietly lost rather than making trouble like many boys with the condition, Quinn said.

Prior to the early 2000s, these women were usually diagnosed with depression or anxiety. Correctly identifying them as having ADHD and getting them the right treatment has helped many women, said Hallowell, who has treated the condition for 30 years and has it himself.

“I know first-hand how amazingly helpful diagnosis and treatment can be … in women particularly,” he said.

Medication does not work for everyone, Hallowell noted, and anyone with ADHD needs more than just pills to function at their best. Medication “should never be the entire treatment.” Every treatment plan should include education about ADHD, coaching to learn new habits and organizational skills, a healthy diet, adequate sleep and exercise, positive social interactions, and meditation or mindfulness, he said.

Karen Weintraub, USA TODAY