How Did the COVID-19 Pandemic Affect Stimulant Use in Children and Young Adults?

What you need to know

• Stimulant medication use in children and young adults in Ontario increased overall during the COVID-19 pandemic, after an initial decrease.
• The largest increases in stimulant use were seen among females, young adults aged 20-24, and those living in higher-income neighborhoods.
• Children aged 5-9 showed decreased stimulant use throughout the pandemic period compared to pre-pandemic predictions.

Background on ADHD and stimulant medications

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition that affects children and adults. People with ADHD often have difficulty paying attention, controlling impulsive behaviors, or may be overly active. Stimulant medications, such as methylphenidate and amphetamines, are frequently prescribed to help manage ADHD symptoms.

The COVID-19 pandemic disrupted many aspects of daily life, including schooling and healthcare. For individuals with ADHD, these disruptions may have exacerbated symptoms or changed how they accessed and used medications. This study aimed to examine how the pandemic affected stimulant medication use among children and young adults in Ontario, Canada.

How the study was conducted

Researchers analyzed data on stimulant prescriptions dispensed to Ontario residents aged 0-24 years between January 2013 and June 2022. They used statistical methods to identify changes in stimulant use patterns associated with the COVID-19 pandemic and compared actual medication use to predicted use based on pre-pandemic trends.

The study looked at overall stimulant use as well as differences based on age, sex, neighborhood income level, and urban vs. rural residence. This allowed the researchers to identify which groups experienced the greatest changes in stimulant use during the pandemic.

Changes in stimulant use during the pandemic

Initial decrease followed by an increase

In the early months of the pandemic (around April 2020), there was a small initial decrease in stimulant use among children and young adults. However, this was followed by a steady increase in the following months. By June 2022, stimulant use was higher than what would have been expected based on pre-pandemic trends.

Differences by age group

The study found significant differences in how stimulant use changed for different age groups:

• Young adults aged 20-24 showed the largest increase in stimulant use, with rates 7-51% higher than expected throughout the pandemic.
• Children aged 5-9 had lower than expected stimulant use throughout the entire pandemic period.
• Adolescents (ages 10-19) showed patterns closer to the overall trend, with an initial decrease followed by an increase.

Sex differences

Females experienced greater increases in stimulant use compared to males during the pandemic. From June 2020 onward, stimulant use among females was 4-37% higher than predicted based on pre-pandemic trends.

Socioeconomic differences

Children and young adults living in higher-income neighborhoods showed larger increases in stimulant use compared to those in lower-income areas. The researchers found that those in the highest income neighborhoods had the greatest increase in monthly stimulant use rates after the initial pandemic period.

Possible explanations for the changes

The researchers suggest several potential reasons for the observed changes in stimulant use during the pandemic:

1. Disrupted routines and remote learning may have made ADHD symptoms more noticeable, leading to increased diagnosis and medication use.

2. The shift to virtual healthcare may have made it easier for some individuals, particularly young adults, to access stimulant prescriptions.

3. Loss of in-school support services may have increased reliance on medication to manage ADHD symptoms.

4. Parents working from home may have become more aware of their children’s attention difficulties during remote learning, prompting them to seek medication treatment.

5. Stress and anxiety related to the pandemic may have exacerbated ADHD symptoms in some individuals.

6. For younger children, being out of the structured school environment may have reduced the perceived need for medication, explaining the decrease in use among 5-9 year olds.

Implications and future research needs

The findings of this study highlight how a major disruption like the COVID-19 pandemic can impact medication use patterns, particularly for neurodevelopmental conditions like ADHD. The increases in stimulant use among certain groups, such as young adults and females, warrant further investigation to ensure appropriate prescribing and use.

Additionally, the socioeconomic differences in stimulant use changes during the pandemic suggest potential inequities in accessing ADHD care and treatment. This may require targeted interventions to ensure all children and young adults with ADHD have equal access to support and treatment options.

Conclusions

• The COVID-19 pandemic was associated with overall increased stimulant medication use among children and young adults in Ontario, after an initial brief decline.
• Young adults, females, and those from higher-income neighborhoods showed the largest increases in stimulant use during the pandemic.
• Further research is needed to understand the reasons behind these changes and to ensure appropriate use of stimulant medications in managing ADHD.