As a behavioral/developmental pediatrician with over four decades of experience, I have some insider trader information to share: sell your shares of pharmaceutical companies marketing drugs like Adderall or Ritalin – dosages for children’s attention-deficit/hyperactivity disorder (ADHD) are going down or being discontinued during the Corona virus lockdown. I noticed this trend this past month as I have been refilling prescriptions for children with ADHD whose schools have closed and are now learning at home.
As I have been hearing from the parents, their children need less medicine to stay on task and behave when they are getting their lessons online and at home. Lowering the dosages of stimulants (or shortening the drug duration) improve children’s appetite, especially for lunch, and decrease problems falling asleep. So, decreasing a dose is particularly useful if these two main side effects of stimulant drugs are present.
We shouldn’t be particularly surprised. ADHD has been explained (especially in drug company supported advertisements) as a brain disorder with an underlying “chemical imbalance.” This interpretation implies that children suffer from a life-long, unchanging, permanent neurological condition requiring a chemical fix in the form of stimulant drugs like, Ritalin, Adderall or Concerta (a long acting Ritalin). But the pragmatic reality is that kids’ brains do not operate in isolation. Their brains perform within a context of the demands being made on children and the responses to them.
It has been known for years that the sales of stimulant drugs decline in June and rebound in September which happens to be the time that most children are not in school. The response to the Covid19 virus has created a similar situation but it’s not quite summer vacation. All the children that I’ve been checking in on are now receiving online or home- schooling teaching. But it still turns out they are not needing as much medicine to get their work done.
My theories on why are necessarily speculative. The children don’t have to spend as much time learning at home as they do in school. They can proceed generally at their own pace. They don’t have their peers to distract them. They may be attracted more to learning from a screen or from their teacher who is streaming rather than in person.
It may just be the novelty which is helping them get the work done now. Perhaps in a few weeks they’ll be needing the higher dosages again. Many also take the medication to help manage their behavior (hyperactivity and impulsivity). Again, so far, it seems less medicine is needed when they are at home than when they are at school. One might think their being at home could drive their parents and siblings crazy. But my experience prior to the virus suggests that families are generally more flexible and accommodating to their hyperactive child than classrooms and after-school day care. Furthermore, many of the children now have both parents home full time. The parents, even when they are working (and many are not), no longer commute to their work, saving anywhere from two to three hours on the average in this part of California (Bay Area) where I practice.
The “shelter in place” rules and the serious worrying about illness and death isn’t entirely working to reduce medication needs in children. I’ve noticed a small uptick in some children’s anxiety which may or may not need to be addressed with medicine in a few. But overall, most of my younger patients seem only vaguely aware of the specific dangers of our current pandemic and not especially worried for themselves or their families. The biggest complaint is not seeing their friends.
The drop in the dosage for ADHD children during these first weeks of shelter in place is a reminder that ADHD is better described as a biopsychosocial problem rather than one merely of brain chemistry. Children’s brains and abilities/disabilities are important but not the only factors involved in developing problems. We should not forget this lesson once the immediate consequences of our social lockdown are lifted. Among the ironic “benefits” also noticed during this period is less air and water pollution in major cities across the world. Can we somehow retain some of these insights and improvements, once our lives return to “normal”?