College Health Centers and ADHD

by Ruth Hughes, PhD

This week we have seen yet another story from New York Times journalist Alan Schwarz about ADHD and stimulant abuse linked with a story of suicide. Like many of the recent media articles on this serious issue, there is a more complex and I think more compelling story. Unfortunately, too many readers, clinicians, and institutions are ending up fearful of treatment for legitimately diagnosed ADHD while the issue of reducing stimulant abuse and diagnosing ADHD accurately often goes by the wayside.
 
While stimulant abuse is a very serious and out-of-control problem, the consistent link to suicide in many of these stories is highly misleading. When there is suicidal behavior there are always serious mental health problems and often substance abuse as well. Appropriate use of stimulants is not causally related to suicide. But reading the spate of media on this topic, you would easily be convinced that they are related. Creating an atmosphere of fear does not help us to rationally and effectively address the problem of stimulant abuse.

I was very dismayed at the description of college health centers that have stopped diagnosing and treating ADHD because it takes too much time to do it right. Do we stop diagnosing cancer, depression, appendicitis, or any other medical problem because it takes too much time? Proper and thorough evaluation combined with multimodal treatment within a university setting is one of the important things that a university can do to control stimulant abuse on campus. It seems to me that some of the knee-jerk reaction is more out of concern about liability and reputation, than about good medical treatment.

When working on this story, Alan Schwarz contacted CHADD and asked for our take on this issue. I would like to share with all of you the written comments I gave to the New York Times in their entirety.
 
[Text of comments to NYT]

At CHADD we are very concerned about stimulant abuse for a series of reasons. First, no one should be using any prescription drug that has not been prescribed for them. There are the consequences of side effects, drug interactions and other problems that may place a person at risk. If an individual feels it’s okay to use a stimulant, it is too easy to then take an opiate that has not been prescribed and is then entering even more dangerous practices. Prescription abuse is never acceptable.

Second, stimulant abuse and the emotional reaction that it have engendered has many adverse consequences for people who need stimulant treatment for ADHD. It makes it more unacceptable to seek diagnosis and treatment and creates a culture of fear and stigma. Many of our members reported during the drug shortage last year that they were treated like drug addicts when they had to go to more than one pharmacy to find who had stimulant medications.

CHADD strongly advocates for a good diagnostic and evaluation process which entails spending extensive time with a patient, getting an in depth history of the patient and the family, asking for reports from family members, teachers, or employers, as well as observation of the patient directly and utilization of symptom checklist. This cannot be done in ten minutes. If a physician is unable or unwilling to do an in depth evaluation, then a patient should be referred to a specialist who will do this level of evaluation.

Looking at the information you provided about college response to this issue, it seems to me a very mixed group of interventions. Here are the questions I would urge a college to consider when making policy about stimulant abuse:

1. Any policies related to stimulant abuse should be consistent for all controlled medications. So if a college health center asks a student to attend sign an agreement about abuse, it should also be used for a student prescribed a pain killer given for a sports injury. 
2. Are the actions proposed going to both help the patient as well as reduce the possibility of stimulant misuse?
3. Are there other disorders that have the same or higher level of risks, and are those disorders being treated in a similar fashion?
4. And are the policies in the best interest of the student presenting with the symptoms?
5. What other actions need to be taken to reduce stimulant misuse on campus?

 

Requiring students to sign a release to allow the physician to contact parents for a history is good medical practice and should always be happening. A proper evaluation for ADHD should ALWAYS include the reports of other key informants, a lifetime history of either treatment for ADHD or the symptoms of ADHD and an in-depth evaluation that cannot be done in ten minutes. For the same reason CHADD understands the requirement of monthly counseling sessions. This is always a component of good, multimodal treatment for ADHD. I hope these treatment sessions are designed to help the student with the challenges of college life and ADHD, and are not just centered on stimulant misuse.

I am very concerned about any university health center that refuses to diagnose students with ADHD or does not allow a clinician to prescribe stimulants. It appears to me that these schools are more concerned about liability issues than good medical treatment or controlling abuse of stimulants. And I would also suggest that this deviates significantly from the established standards of care and practice guidelines for physicians dealing with ADHD. It is also discriminatory if the health center does not do the same for all controlled medications. The abuse of pain medications is a much larger problem with much more serious consequences. Are they also refusing to treat pain related to injury, treatment, or illness? If a university is very concerned about stimulant abuse, I would think the worst thing they could do is to relinquish this responsibility to unknown community practitioners. Nonprescribed use of stimulant medications on campus is a serious problem that can’t just be punted to someone else outside the school grounds.

CHADD is deeply concerned about the misuse of stimulants. We work with our members and young adults to learn how to more safely manage the medications, and how to deal with peer pressure to share. We are also concerned that legitimate diagnosis and treatment of ADHD in young people in particular is endangered, because of concerns about stimulant misuse.

[End of comments to NYT]

I share my written comments to the New York Times here primarily to inform our members about CHADD’s take on the issue of health care on college campuses as well as to provide insight into CHADD’s outreach efforts with the media.

CHADD will continue to provide evidence-based information about ADHD. We will strive to increase understanding of the complex issues of ADHD diagnosis and treatment. The press doesn’t always get it right, and in the case of a medical condition like ADHD, may do unintentional harm by adding to the stigma and fear associated with the disorder or the treatment. For all of you who have ADHD or have a loved one with ADHD, it is imperative that we set the record straight, and help our communities understand that ADHD is a real neurological disorder that can be accurately diagnosed and effectively treated.


Ruth Hughes, PhD, is CEO of CHADD.
 

Preventing Harm on All Fronts

Guest blog by Ann Abramowitz, PhD, and Theresa E. Laurie Maitland, PhD

The tragic story of Richard Fee, as told by New York Times reporter Alan Schwarz, is one of the most disturbing pieces either of us has ever read. As the chair and co-chair, respectively, of CHADD’s Professional Advisory Board, we decided to share our own thoughts with the hope that we may enrich the discussion and help to prevent similar tragedies in the future.

First, a word about CHADD’s PAB: We are a group of professionals, mostly in academic settings, who also work clinically with children, teens, and adults with ADHD. Our task is to provide CHADD with scientific guidance, so that the information provided to the public is scientifically accurate and up-to-date. One of us is a clinical psychologist and full-time faculty member at a university, involved in the training of both clinical psychologists and child and adolescent psychiatrists, and also with a clinical practice. The other is an ADHD/LD specialist and coach who coordinates a university program for college students with ADHD and/or LD. The article describing Richard Fee’s situation left us with a number of questions and reactions.

The first question we had was whether Richard had ADHD. The article strongly suggests that he did not, based on his parents’ conviction that he had not had symptoms until after college, and we have to speculate whether the difficulty concentrating that arose at that time was more likely attributable to some other disorder. One of us is a psychologist, and the other is an educator. We are not physicians and cannot prescribe medication, but all professionals who work with people with ADHD should have knowledge of all evidence-based treatments for ADHD, including medication. It is well known that very rarely psychotic symptoms are triggered by stimulant medication, and it is also well known that stimulant medication must be avoided in individuals who present with psychotic symptoms. Careful assessment and diagnosis are crucial.

As Dr. Keith Conners explains in the New York Times article, the practice standards for the diagnosis of ADHD in adults call for corroborative evidence, and go far beyond the completion of self-report symptom checklists. If a clinician (psychiatrist, psychologist, or other health professional) relies only on self-report, the likelihood of misdiagnosis is significant. One reason is that it would be relatively easy to report having the symptoms of ADHD in order to obtain medication; a second reason is that the individual may have serious psychopathology, yet might lack insight into that fact. But even corroborative reports of symptoms by others are not sufficient evidence upon which to base a diagnosis; the history given by the parents, provided in school records, and the completion of psychological testing all enable the clinician to achieve the essential understanding for making an accurate diagnosis. ADHD does not first appear in adulthood. Misdiagnosing another mental disorder as ADHD can be catastrophic, particularly if psychosis is involved.

How can it be that a careful history may not always be done? We don’t know what happened in Richard’s case, but if the diagnosis was made based only on self-report this would be completely inconsistent with practice standards. Unfortunately, there may still be professionals who diagnose adults, including college students, without completing a careful history and conducting a comprehensive assessment to rule out other co-existing conditions. As the tragic story of Richard Fee demonstrates, this must change.

Let’s speculate that Richard refused to allow his parents to be involved. Perhaps he also refused to allow current corroborative report, such as instructors, roommates, or employers. How does a clinician conducting an evaluation of a young adult obtain the background information and current corroborative information while respecting his or her wishes and privacy? The answer, while never simple, must rest on this simple truth: Self-report of symptoms cannot be considered sufficient. By requiring new patients to provide corroborative information, clinicians may reduce the possibility of diagnosing individuals who are seeking to obtain stimulants or who may have other serious conditions. Our experiences working extensively with young adults, including many college students, suggest that it is important to help them understand why this is needed. We believe that working together with a caring clinician, those with ADHD find ways to obtain the information that is needed to reach a careful and accurate diagnosis. This often happens as trust builds, and as the young adult recognizes, and is grateful for, how much care and time are going into the evaluation.

A final, wrenching question nags at the reader: How can it be that the parents, describing their son’s severe psychopathology and Adderall abuse to the prescribing psychiatrists, went unheard? Even acknowledging the requirements of HIPAA, we cannot find an answer. The lack of involvement of families in the treatment of mental illness is a serious problem that professionals must grapple with, not just those specializing in ADHD. When working with young adults who are still dependent upon their parents for their livelihood and care, professionals need to create respectful methods for protecting the young adult’s confidentiality while designing ways to integrate in the input of family members and significant others. Given the potential lack of self-awareness in individuals with ADHD, it is essential to elicit feedback from others who may have more accurate observations and may also need help in learning about their loved one’s condition. Hopefully, we will learn from this tragedy as well as others that even given the boundaries of HIPAA there are ways to obtain information that is crucial for accurate diagnosis and appropriate treatment, and that harm can be done when this does not occur.

Yet, in our work with college students, we also cannot deny that stimulant abuse/misuse is a real problem on college campuses. This tragic story brings this situation to light. Hopefully, this article will be a wake-up call for professionals who are not following the standards for diagnosis of young adults with ADHD. The pressures for success and competition at college may drive some to seek medication to quickly improve their performance rather than choose the much slower process of changing their behavior and study habits.

The reality of stimulant abuse/misuse and the media’s continual focus on situations like Richard Fee’s can spawn other tragedies. The self-perception of many young adults who have or suspect they have ADHD can be adversely impacted. Painful stories like these can add to the misunderstanding and misinformation on ADHD that makes many of them reluctant to use medication or seek help. Although there are obviously young adults who feign ADHD symptoms just to get the medication, people working in campus learning centers may not ever meet them. Since these programs do not offer a quick fix, but offer ongoing help in learning to accept ADHD and learning how to live life productively with it, professionals tend to meet students who wait until they have “hit bottom” and are humiliated, devastated, and feeling as if they have “lost their smarts.” At this low point they are finally willing to find more effective ways of living with the chaos and challenges created by ADHD.

Many times young adults are not seeking help or not using prescribed medication because they report wanting to be “normal” and view help seeking negatively. They have adopted the beliefs from society that they “should” be able to control their attention on their own and that ADHD is not real. Yet they discover, with great trepidation, that they cannot seem to control their attention or behavior. When talking about the issue of students who may be feigning ADHD just to get medication, one student said, “I just don’t get it, who would want to fake having a life like mine?” Although stories abound about students whose lives were dramatically improved by Adderall or other medications, these are not typically covered in the media because they lack the sensationalism that the tragic stories have. There are thousands of young adults who truly have ADHD and use medication responsibly, and the media focus on those who were incorrectly diagnosed or treated can tragically undermine their confidence and hinder their decision to seek help.



Ann Abramowitz, PhD, is a professor in the department of psychology at Emory University and supervises residents in the division of child and adolescent psychiatry at the university's medical school. Theresa E. Laurie Maitland, PhD, is the coordinator of the Academic Success Program for Students with LD and ADHD at the University of North Carolina at Chapel Hill.
Visit CHADD's web page on Medication Abuse and Diversion.

Substance Abuse, ADHD, and Medications: The Real Issues

by Ruth Hughes, PhD

The story of Richard Fee, as reported in the New York Times on Sunday, February 3, is as heart-wrenching as it is atypical in ADHD treatment. This was not a story about ADHD or about Adderall, but rather about substance abuse and our highly stressed and fragmented mental health system. As the mother of a young adult in college, my heart went out to this young man’s parents, who tried so valiantly to stop the downward spiral of his addiction.

Anyone who works in mental health or who has attempted to use mental health services can attest to the fact that there are multiple barriers to receiving effective treatment. There are simply not enough providers to address the many patients needing services in a timely way. The HIPAA privacy laws make it impossible for clinicians to speak with family members or with other providers, especially when a young adult refuses to sign a release of information request. Payment rates through insurance are so low for mental health services that many providers will no longer participate. And no one is willing to pay for the time needed for the outreach and collaboration that is so necessary for proper diagnosis and treatment. When the symptoms of mental illness (or addiction) interfere with good judgment or accurate reporting by the patient, the effects of these problems are multiplied many times over.

This is not an excuse for the careful evaluation and collaboration that appeared to be missing in the treatment of Richard Fee, but rather a statement of the disarray of our health care system. CHADD, along with many other mental health advocacy organizations, continues to fight for a better health care system, for parity in mental health services, and for better coverage of treatment for all mental health disorders. And we work with our professional counterparts to ensure training of mental health professionals in the diagnosis and treatment of ADHD is easily available and of high quality.

Unfortunately, the scary tone of this article misrepresents the danger of stimulant medications. Stimulant medications that are taken as prescribed are highly unlikely to lead to addiction. In fact, the director of the National Institute on Drug Abuse, Dr. Nora Volkow, states, “Methylphenidate treatment for children with ADHD does not increase their risk for later substance abuse,” in an article summarizing NIDA research on stimulants and abuse.

It is important to separate several related but different issues on substance abuse, ADHD, and medications:

• Stimulant medications are often an integral part of treatment for ADHD, but the most effective treatment will include parent/family training, behavioral interventions, and school/work support as well as medications. Stimulants can help a person’s brain work more efficiently, but medication does not teach coping skills.
  
  
• Anyone with ADHD has a higher risk of substance abuse. This is not because of the medication, but because the disorder itself is characterized by impulsivity and poor recognition of consequences. Few people with ADHD choose stimulants as the substance of abuse. Alcohol, cigarettes, and drugs will be more of a temptation for a person with ADHD. We must help anyone with ADHD be forewarned that there is a higher risk of substance abuse and we must be vigilant for early warning signs.
  
  
• Misuse of stimulant medication as a study aid is unfortunately a regular occurrence on college campuses. CHADD is strongly opposed to the diversion of stimulants, which undermines the legitimate use of stimulants for the treatment of ADHD. We regularly warn parents and young people of both the criminal and health outcomes associated with diversion. The federal government’s most recent survey of substance abuse (page 15) indicated that misuse of stimulant medication is present in about 0.4% of the population, or 1.1 million people over the age of 12. Although the incidence of misuse has declined from 0.6% in 2003, it remains a serious problem that CHADD is very concerned about.
  
  
• Misuse is not the same as addiction. Stimulant medications may become addictive when taken in very large dosages or when injected intravenously. Few addicts choose stimulants as their drug of choice. As the New York Times article reported, “Very few people who misuse stimulants devolve into psychotic or suicidal addicts.” That said, one person who becomes addicted is one too many. It is crucial that our health care systems do everything possible to prevent the misuse or addiction of any prescription drugs.

One final comment. A meeting of a local CHADD group was referenced at the end of the article. Unfortunately, comments made by CHADD board member Jeffrey Katz, PhD, were selectively reported, and crucial information that both CHADD and Dr. Katz always include was not reported. When asked about the safety of stimulant medications, Dr. Katz reminded the audience that he was not a physician and that an individual’s response to medication can vary dramatically. At all times, a person thinking about or taking any medication for ADHD should work closely with his or her physician. In general, the potential side effects of stimulant medications when taken as prescribed are relatively mild and can be safely managed.

The science of ADHD, investigating the causes, diagnosis, and treatment, has improved dramatically over the past decade. It is absolutely crucial that our clinical practice and our public policy be based on the most recent and most sound facts. It is for this reason that we need to continue and/or increase funding support for better research in mental health and improved treatment in our health care systems. CHADD is committed to ensuring that evidence-based information from research is at the forefront of any discussions about ADHD treatment.

CHADD will continue to fight for better health care services, better training of providers, and the elimination of diversion of prescription medications. We want to be certain that all our members and the general public have accurate, science-based information about ADHD and any of the related disorders that often accompany a diagnosis of ADHD.


Visit CHADD's web page on Medication Abuse and Diversion.


Ruth Hughes, PhD, is CEO of CHADD.

Brilliant and Three Years Younger

As my son Chris was growing up with ADHD and learning disabilities, one of the priceless pieces of information that sustained me was my understanding that most children with ADHD have a developmental lag of about thirty percent, or approximately three years.

Every time I was ready to tear my hair out, I would remind myself that Chris was not really his chronological age, but was three years younger. This always served to help me calm down and see the situation in a new light. With this insight his “inappropriate behavior” was not so inappropriate after all. And my response then could be geared to what he could understand and appreciate.

Dr. Martha Denckla, our closing plenary speaker at the CHADD conference in San Francisco earlier this month, added a new twist to this insight. She suggested we consider our children with ADHD as both absolutely brilliant and three years younger than their actual age. What a fantastic combination.

Your precocious and delightful seven-year-old is hiding in the body of a ten-year-old. That sixteen-year-old teen who wants desperately to get his driver’s license is really a twelve-year-old who wants to do what all the big kids do. No wonder there is such a sense of disconnect with what is expected in life and what our kids do.

Today my twenty-five-year-old son is a well-grounded and successful twenty-one-year-old. He is thriving as a junior in college who has found his passion in life. He is my late bloomer. And he is blooming beautifully.

Ruth Hughes, PhD, is the CEO of CHADD.

CHADD—A Shame-Free Zone

Just back from CHADD’s conference in San Francisco, and it was incredible. More than 1300 people heard fantastic presentations and information. And then there was all the connecting with old and new friends.

Mark Katz, a clinical psychologist and contributing editor of the Promising Practices column in CHADD’s Attention magazine, was our inspiring plenary speaker on Friday with the intriguing proposition that “There’s never anything so wrong with us that what’s right with us can’t fix.”

Mark’s presentation reminded me that part of the purpose of CHADD is to provide a “shame-free zone.” It doesn’t matter how inadequate you often feel as a parent or as an adult with ADHD.

CHADD is the place where everyone understands what it is like to live with ADHD. In the CHADD community we can talk freely about our lives. We can celebrate our many, many strengths. And we can laugh at our ADHD moments.

In our struggling with what is wrong each day, we often forget to recognize what is right. So today build a “shame-free” zone or time in your life. Maybe the kitchen is the place where only the positive is allowed. Or maybe there is a time of the day when you routinely reflect on your strengths and what is right with the world—at dinner or when you tuck the kids in bed at night. The power of positive thinking and positive feedback is absolutely amazing and it is simple. Harness this power and reap the rewards in your own life and in the lives of your family members. You will increase the feelings of hope and happiness for everyone involved. And you will be learning and teaching an enormously important coping skill for dealing with life’s challenges.

Thanks, Mark, for reminding all of us how important it is to see what is good in ourselves and in each other.


Ruth Hughes, PhD, is CEO of CHADD.

Girls, ADHD, and Suicide

This week is National Suicide Prevention Week, and it reminds me once again of the risk to all of our young people. As a mother, I can think of nothing more devastating than losing a young person to suicide. Almost 16 percent of students in grades 9 to 12 report having seriously considered suicide, and 7.8 percent report having attempted suicide one or more times in the past twelve months, according to U.S. Surgeon General Regina Benjamin. These are sobering statistics for all of us.

To make matters more alarming for CHADD members, a ten-year longitudinal study of girls with ADHD suggests the risk for girls with combined-type ADHD is significantly higher than for others. Steve Hinshaw and his colleagues (2012) found that the girls with ADHD had higher risk of both suicide and self-injurious behavior than girls without ADHD. Twenty-two percent of the girls with combined-type ADHD (attention problems, impulsivity, and hyperactivity) had made a suicide attempt compared to 6 percent of the control group and 8 percent of girls diagnosed with inattentive-type ADHD. Self-injury was significantly more likely with 51 percent of the ADHD-combined group reporting self-injurious behavior compared to 19 percent of the control group. The researchers suggest the higher incidence may be related to impulsivity, depression, and difficulties with emotional regulation.

So, what is a parent to do? First, don’t hide your head in the sand. Every parent needs to know about the signs of suicidal behavior and what help is available. There are great resources available to help you learn more. Check out the list at the end of this blog. The most important thing to know is suicidal symptoms are treatable.

   

Second, work at maintaining a close relationship with your adolescent and young adult. Can they talk with you about problems as well as achievements? Can you listen without jumping in and making a judgment or trying to fix everything? Sometimes what they need most of all is for us to listen and understand what they are experiencing.

Third, know what the danger signs are:

• Persistent unhappiness
• Withdrawal from friends and activities
• Feelings of sadness and hopelessness
• Over-reactions to criticism
• Preoccupation with death and dying
• Changes in eating and sleeping patterns
• Self-destructive behavior
• Suicidal thoughts, plans, or attempts

Fourth, don’t be afraid to talk with your teen or young adult about depression and suicide. Really listen to what he or she is telling you. Let her know you hear how bad she is feeling. Help him understand that you are there to help him get through this. Don’t be afraid to ask directly about suicide—it can open the door. And don’t allow yourself to be sworn to secrecy—you will need to enlist the help of others.

Fifth, if you feel there is a chance your child may be depressed and suicidal, then take action. Make a plan and get help immediately. Call 1-800-273-8255, the National Suicide Prevention Lifeline for immediate guidance. Seek out an appointment with a qualified mental health professional right away. Make sure that any weapons or dangerous substances are locked up and unavailable. And let your teen know that you have heard him or her and are taking these steps to help.

To learn more, here are some great resources:

• A Parent’s Guide to Recognizing and Treating Depression in Your Child
• National Suicide Prevention Lifeline
• Reachout.com
• ADHD and Coexisting Conditions: Depression

 

Ruth Hughes, PhD, is the CEO of CHADD.

Stimulant Medication Shortages Update: You Helped CHADD to Make a Difference

It has been a very long year of dealing with medication shortages across the country. The information you shared with us last winter was often heartbreaking, as you described the incredible steps you were forced to take to obtain medication for yourself or your child, the skyrocketing prices charged by some pharmacies, and the awful consequences of not having medication.

CHADD has worked hard to address the shortages, and we are seeing some real changes take place—both in resolving the immediate shortages and in solving the problem long-term. We have been working closely with legislators, peer associations, government agencies, and pharmaceutical companies to get to the causes and to address them.

The Drug Enforcement Agency appears to have a key role in the shortages. Their mission is to ensure stimulant medications are not abused or misused. Every year they set a quota for each pharmaceutical company, and the company may not manufacturer even a single pill above this limit. If the quota does not accurately reflect the legitimate need, or if medications are diverted for nonmedical use, then a shortage can occur. Until now there has been no mechanism for a shortage to be addressed once it occurs. That is about to change.

Over the last six months, CHADD has been busy addressing this serious problem:

• CHADD’s survey in January collected more than 5,500 responses. Forty-nine percent of our respondents were having serious difficulty getting prescriptions filled, and eighteen percent were forced to change to a new medication. Your participation in the survey gave us more information on the shortage than anyone else in the country. Thank you.
• CHADD and the American Academy of Child and Adolescent Psychiatry formed a coalition of concerned associations, which included several pharmacist groups as well as the American Academy of Pediatrics, the American Psychiatric Association, and a number of mental health and ADHD groups.
• CHADD has been in regular communication with all the major pharmaceutical companies to understand the obstacles to manufacturing sufficient quantities of medication.
• CHADD leadership has met with staff for every key committee in both the US House of Representatives and the US Senate to make them aware of the seriousness of the problem.
• CHADD leadership and members of the coalition met with the staff of the Food and Drug Administration to determine their role.
• CHADD worked with the media to get the story out to the larger community. Literally hundreds of media outlets covered the story.
• And the coalition repeatedly asked for a meeting with the Drug Enforcement Agency. We are still waiting.

Have we made a difference? You bet we have.

• In January, the DEA increased the quota for stimulant medications significantly. Because the pharmaceutical companies need time to then manufacture the medications, an increase in the availability of medications did not begin until this spring.
• The House Energy and Commerce Health Subcommittee is investigating the role of the DEA in the shortage and has not yet released a report.
• Senator Chuck Grassley from Iowa has asked the General Accounting Office to investigate the DEA’s role and report on their findings. While such a report can take up to a year, the GAO is known for even-handed, nonpartisan reports and good recommendations.
• The Prescription Drug User Fee Act of 2012 (PDUFA) was approved by the House last week and now faces one last vote in the Senate before going to the President. It instructs the Secretary of Health and Human Services to address medication shortages within thirty days. When the shortage involves a controlled medication, like stimulants, the Secretary has the authority to contact the Attorney General (the Secretary’s counterpart in the Department of Justice, which includes the DEA) and ask that the quota be increased. The Attorney General and the DEA must respond by either taking action or responding with a clear rationale for not increasing the quota. And all of this information must be made public. This is the first time a mechanism has been put in place to address a shortage before it becomes chronic.

But we want to be really, really sure that all of CHADD’s members and all people with ADHD have access to their medication. So we are asking each of you to take five minutes and fill out another survey. It is just as important to know that the problem has disappeared as it is to know whether you are still having difficulty getting prescriptions filled. We will not trust that the crisis has passed until you tell us. Please take a moment to let us know.

Ruth Hughes, PhD

Ruth Hughes, PhD, is the CEO of CHADD.