Teachers’ Reports of Attention-Deficit/Hyperactivity Disorder Medication Changes During Stimulant Shortages: National Survey Results

Attention-deficit/hyperactivity disorder (ADHD), a common childhood onset disorder, is associated with impulsivity, impaired attention and executive function, and poor academic performance.¹ Stimulants, the first-line medication treatment for ADHD, are associated with better academic functioning and decreased injury risk.²

In October 2022, a nationwide shortage of dextroamphetamine/amphetamine (Adderall^®) was announced.³ Subsequent media coverage reported on families and clinicians struggling to navigate the shortage,⁴ raising concerns about the well-being of affected children. One recent study of children aged 5 to 17 years found that, following the shortage announcement, there was a decline in immediate-release mixed amphetamine salts, offset partially by an increase in methylphenidate dispensing.⁵ We are unaware of other studies that have examined the shortage’s magnitude and impact among youth.⁵

This study reports results from a nationally representative survey to understand teachers’ perceptions of how the stimulant shortage affected medication use by students with ADHD, which could affect their academic performance. Assessing teachers’ perspectives helps clarify the scope of the shortage and understand whether there were differential impacts across students with different characteristics.

METHOD

We used data from RAND’s American Teacher Panel, a nationally representative panel of public K-12 teachers. Questions on teachers’ experiences with students with ADHD were fielded in the Fall 2023 Survey, administered in October and November. There were 1014 completed surveys and 80 partially completed surveys; 44 respondents were screened out as ineligible, yielding 1020 respondents who received weights and a 41.5% completion rate. Among respondents, 957 reported teaching a student diagnosed with ADHD in the 2022–2023 academic year.

We asked teachers if any students stopped or changed their ADHD medication because they could not obtain it. The survey included additional information about the school, including grade level (elementary, middle, or high school), number of students, whether the majority of students received free/reduced-price lunch, and whether the majority were White.

We computed proportions using Stata/MP 18.5, applying survey weights to produce national estimates. Chi-squared tests assessed statistical significance of differences in outcomes between groups.

RESULTS

Of the 957 teachers who reported teaching a student with ADHD, 70% taught in schools with more than 450 students, approximately 40% taught in schools where most students received free/reduced price lunch, and 51.1% taught in schools where most students were White.

Teachers were more commonly from elementary schools (46.0%) and suburban school districts (39.4%) than other grade levels and locations. Teachers were more aware of students with ADHD discontinuing ADHD medications (67.7%) than changing medications (54%).

Among teachers with knowledge of their students’ medication status, about 72% reported having students who discontinued their medication because they could not get it; a similar percentage reported having students who changed ADHD medication (Table 1). Rates of teachers reporting students stopping medications were significantly higher in schools where most students were racial/ethnic minorities (77.2% vs. 67.7%, p=0.009) and in schools where most students received free/reduced price lunch (76.4% vs. 68.3%, p=0.032). Middle school teachers were significantly more likely than elementary or high school teachers to report students stopping their ADHD medication (82.8% vs. 68.9% (elementary) and 68.7% (high school), p=0.006) or changing their ADHD medication (83.7% vs. 67.1% (elementary) and 70.9% (high school), p=0.006). No other school characteristics were significant.

Table 1.

Teachers’ Reports of Students With Attention-Deficit/Hyperactivity Disorder (ADHD) Stopping or Changing Their ADHD Medication

	Teachers reporting that they had at least one student with ADHD
	(1) Stop taking medication (n=646)		(2) Change their medication (n=506)
	%	p-value for difference	%	p-value for difference
Total	72.0		71.6
School level
Elementary	68.9	0.006**	67.1	0.006**
Middle School	82.8		83.7
High School	68.7		70.9
Urbanicity
Urban	74.6	0.676	70.8	0.722
Suburban	72.0		70.3
Town/Rural	70.3		74.1
School size
449 or less	71.2	0.731	68.2	0.242
450 or more	72.5		73.4
Racial/ethnic distribution
Majority white	67.7	0.009**	72.0	0.867
Majority racial/ethnic non-white minority	77.2		71.3
Free/reduced price lunch
Most students receive	76.4	0.032*	71.3	0.907
Most students do not receive	68.3		71.8

Note: p-values for differences based on Pearson chi-squared test corrected for the survey design with the second-order correction of Rao and Scott. Column (1) is restricted to the 646 teachers who reported teaching at least one student with ADHD during the 2022–2023 academic year and knew whether their students had or had not stopped their medication. Column (2) is restricted to the 506 teachers who reported teaching at least one student with ADHD during the 2022–2023 academic year and knew whether their students had or had not changed their medication regimen.

^*p<0.05;

^**p<0.01;

^***p<0.001.

DISCUSSION

The dextroamphetamine/amphetamine and stimulant shortage raised concerns about the ability of families to obtain ADHD medications for their children. In this national survey of K-12 public school teachers one year after the shortage announcement, more than 70% reported a student had stopped or changed their ADHD medication in the prior year. Study limitations include that many teachers do not know their students’ ADHD medication status; we do not know the sociodemographic status of specific students; and we cannot assess how the shortage affected academic outcomes or student behavior, critical areas for future research. Furthermore, we speculate teachers may be more aware of students discontinuing medication than changing medication, a limitation necessary to consider when interpreting study findings.

Despite these limitations, this study highlights teachers’ perspectives on the scope of students with ADHD facing medication issues in the first academic year during the stimulant shortage. Of note are the significantly higher rates of discontinuation in schools with a higher percentage of socioeconomically disadvantaged and racial/ethnic minority students, populations already facing challenges receiving ADHD medications. Recognizing that patients in such environments may be more likely to discontinue medications than other patients, child psychiatrists serving such populations may consider efforts such as enhanced pharmaco-education, helping parents identify pharmacies continuing to dispense stimulants, and connecting families with behavioral or educational supports.

Data Sharing:

Amy C. Mahler and Rosanna Smart had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.