ADHD Medication Shortages: Your Information Needed Today

As you know, CHADD is very concerned about the current shortage of medications to treat ADHD. No one seems to have a good handle on the extent of the shortages. If you would take just a moment to answer a few questions about your personal experience with the availability of your medication, then CHADD will know much more about the extent of the problem, all the medications being affected, and the geographic distribution. It is important that we hear from people who are not having problems as well as those who are. We need both sides of the picture.

Answer this quick, anonymous survey, which includes the following questions:

• What is the name of the ADHD medication you normally use and the dosage?
• Are you having any problems with getting your prescriptions filled?
• What city and state do you live in?
• Have you had to change medications because of the shortages?

As CHADD works in Washington to address the causes and management of the shortage, it is important that we have as much accurate information as possible. CHADD’s mission is to provide its membership with a unified and strategic voice to policymakers. We are also partnering with other organizations to determine the extent of this issue and to amplify our voice in effecting positive change.

We will keep you updated on the results of the survey, our meetings with key policymakers in Washington, and what you can do to advocate for a more effective system of dealing with shortages. And we will keep you informed about CHADD’s concerns about diversion of medication and what you can do to keep medications from being used inappropriately.

If you would like some tips on how to find a pharmacy that can fill your prescription, check out "Shortages of ADHD Medications."

If you want information on what has led to the shortages, read "Why Can’t I Get My ADHD Medications?"

Completing the survey will take you less than a minute. Thank you for your help in this matter, and for your immediate cooperation.

Ruth Hughes, PhD
CHADD CEO

Robert Tudisco, JD
CHADD Public Policy Committee

Why Can’t I Get My ADHD Medications?

by Ruth Hughes, PhD

Are you having difficulty getting your prescription for stimulant medication filled? Particularly if you have a prescription for amphetamine mixed salts (the Adderall generics), or more recently for immediate-release methylphenidate (Ritalin generics), you may find that your pharmacy is out and unable to tell you when they will get more.

In a previous blog, CHADD’s Tim MacGeorge developed some guidance on what to do if you are in this dilemma. This blog will explain what is causing the problem and what CHADD is doing to address it.

The shortages began last spring and all parties thought it would be a short-term problem. But now it is six months later and the problem is getting bigger, not smaller. To understand the problem, it helps to understand the process:

• Stimulant medications are considered Schedule II controlled substances and their production comes under the purview of the Drug Enforcement Agency (DEA). The DEA’s mission is to ensure that controlled medications are not used for nonmedical purposes.
• Pharmaceutical companies that manufacture stimulants apply to the DEA for permission to purchase a certain amount of the "active pharmaceutical ingredient" (API). This is the controlled substance within the stimulant medications.
• At the beginning of each calendar year, the DEA approves each company for a certain amount of the API. It is normally less than requested by each company, and the aggregate of all awards is the DEA’s best guess of the legitimate need for the year.
• Once approved, the company purchases the API and begins manufacturing the medications. It usually takes 8 to 12 weeks for the medications to be manufactured.
• And then they go to market.

Where Does It Go Wrong?

It only takes one company that has a problem in delivering its portion of the market share for the dominoes to begin to fall. Because each company is limited to a certain portion of the active ingredient, the companies are unable to step in when another company is having problems. Or if the DEA is wrong in its estimates of the number of legitimate prescriptions that will be written, then a shortfall can occur. Or the amount of medication may be correct, but the geographical distribution of the medications by all the companies involved may not lead to an even distribution across the country. The shortage continues until the original problem is solved.

Companies can go back to the DEA and request more of the API, but the application process is long and cumbersome. If the shortage occurs close to the end of the calendar year, companies are more likely to wait for the new annual award of API.

When all goes well, each pharmaceutical manufacturer has enough inventory to carry over into the new year until spring, when the production started in January actually reaches the market. This year the inventories are very low or nonexistent, raising concerns that there will not be sufficient medications available to make it until spring.

If the shortage continues for a while, as it has for ADHD medications, then other things begin to happen. Over time, physicians begin to change prescribing habits to other medications that are more readily available, such as the short-acting methylphenidate medications. But again, production of these medications is limited by the DEA. As a result, the shortage is spread to a new group of medications.

Some pharmacies or chain store distribution centers may begin to stockpile the medications, in anticipation of the shortages. This then aggravates the shortages in other areas.

Unfortunately, no one agency or manufacturer owns the problem. The Food and Drug Administration has responsibility for addressing medication shortages, but has no authority with the Drug Enforcement Agency. The DEA feels that it has a limited role of ensuring only the amount of medication legitimately needed is manufactured and the possibilities for diversion are reduced. And the manufacturers cannot respond quickly to shortages caused by internal problems or by other manufacturers because their production is limited by the DEA. As a result, there is a fair amount of finger pointing and little problem solving.

What Is the Short-Term Outlook?

Not great. Many of the companies that manufacture the short-acting stimulant medications report they have no inventory left or limited inventory. Given the manufacturing time lag of 8 to 12 weeks, it is unlikely that the 2012 DEA-approved medications will get to market until March at the earliest. No one seems to be able to estimate the amount of medications currently in pharmacies across the country. You should anticipate that getting your prescriptions filled for short-acting stimulants in particular, and all stimulant medications in general, may get more difficult as we move into the new year. So plan ahead.

Work closely with your physician and allow enough time before your current prescription is gone to actively search for a pharmacy that has your medication. Prescribing physicians and patients may need to consider long-acting, time-release medications rather than short-acting medications. If you have been purchasing the less expensive generic medications, you may need to consider the more expensive, name-brand medications. And you might need to consider a different delivery method such as the skin patch or liquid medication. Another option may be to try one of the nonstimulant medications that treat ADHD.

What Is CHADD Doing?

Given the manufacturing time lag, our current shortage seems destined to play out. But we can work to make sure this does not happen again. CHADD has been speaking out about the problems to the media to help raise awareness of the issue. Almost every day we are contacted by a major media outlet covering the story. We have been in touch with all the major and many smaller pharmaceutical manufacturers who make stimulant medications to clearly understand the scope of the problem and what steps might make it better. And we are organizing a coalition of concerned groups with the American Academy of Child and Adolescent Psychiatry. Other groups who have joined with us include patient advocacy, clinician, and pharmacy-related associations. The larger our coalition, the more power we will have to influence the agencies involved and Congress.

In early 2012, we will be meeting again with officials from the FDA and the DEA, and ultimately, with key senators and congressmen who can influence the policy of these agencies. We are determined to make sure this problem is solved. CHADD will continue to keep you informed about the shortages and what you can do to help us address this issue. While we may need to weather this storm, we will do all we can to make sure it does not happen again.


Ruth Hughes, PhD, is the CEO of CHADD.

PHOTO: Wikimedia Commons

Coaching Can Empower Youth with ADHD

Today's guest blog is by Jodi Sleeper-Triplett, MCC, SCAC.

I am counting the days until the CHADD conference in Orlando and imagine that you are equally excited! There are many reasons for my excitement—reconnecting with friends and colleagues, meeting new people and learning from the many ADHD experts from around the world. I am especially pleased to have the opportunity to share my passion for coaching youth with ADHD with the conference attendees. My breakout session, Empowering Youth with ADHD: Coaching Toward Success, is on Friday morning, following a must-see opening session with Rick Green, Patrick McKenna, and Umesh Jain.

For many adolescents and young adults with ADHD, coaching helps them learn techniques to become more focused, stay on task, and improve time management and organizational skills.

Coaching is a beneficial tool for many young people. At this stage of life, adolescents and young adults are yearning for independence, but they lack the basic skills for success. Life skills can be fostered through coaching and may include self-care, socialization, financial responsibility and self-advocacy. Each client is an individual, with unique needs. The coaching process is designed to meet the needs of the individual. This is not a one-size-fits-all process.

Choosing a coach who has experience working with adolescents and who understands the intricacies of the ADHD brain, medications and co-existing conditions is of the utmost importance. It is essential to work with a coach who has a good rapport with the client. The connection between coach and client, of any age, is essential for coaching to be a success.

Attendees will learn how starting the coaching process with adolescents and young adults with ADHD leads to improved executive functioning skills and self-confidence, leading also to greater success in adulthood. Through coaching, we are able to increase motivation, self-awareness, independence and self-worth. I will share the JST coaching model for successful youth coaching, focused on the whole person, not just on academics. As adults, if we don’t pay attention to ourselves and manage both our personal and professional lives, we struggle. Young people with ADHD experience the same problems and coaching helps!

This interactive session will provide background on the common difficulties faced by adolescents and young adults with ADHD. We will discuss the importance of confidentiality between coach and client and how parents can adjust to their role outside of the coaching partnership. Coaching demonstrations will provide concrete examples of the value of coaching for adolescents and young adults with ADHD. Young adults considering coaching are encouraged to attend.

I enjoy the opportunity for Q & A at the end of my sessions and throughout the conference. Often times you can find me chatting with others in the hallways between sessions, answering questions about coaching and learning from others what works and does not work for them or their children. So, when you see me at the conference, please tug at my sleeve and let’s chat!

See you in Orlando!

Jodi Sleeper-Triplett, MCC, SCAC, is the president of JST Coaching, LLC and the author of Empowering Youth With ADHD (Specialty Press/ADD Warehouse, 2010).

Stress and Kids with ADHD

Today’s guest blog is by Jerome Schultz, PhD.

I have often said it’s fairly easy to diagnose ADHD and LD. What’s difficult is explaining the results of testing to students at a developmentally appropriate level so that they have a clear understanding of their challenges.

Way too many kids with ADHD and LD have no clue about how to conquer their challenges. Too many of them think of themselves as stupid. They confront challenges with an “I can’t” attitude. This way of greeting a task triggers the stress response in the child’s brain. You can hear the brain singing this tune now: We gotta get outta this place…if it’s the last thing we ever do! Even when kids hear teachers and adults say “I know you can do it,” this vote of confidence often puts them under more pressure. They think: “Easy for YOU to say, Mrs. Johnson!” I’ve been there—and I’ve failed.” So why are we surprised when they fight or flee? For kids under the chronic stress of ADHD and LD, there’s simply nowhere to run… nowhere to hide.

I invite you to attend my session at the CHADD conference in Orlando next week to learn how stress gets in the way of learning, and how if it’s not addressed, can lead to a deterioration in actual brain function.(Talk about going from the frying pan to the fire!) Learn how the DE-STRESS Model can turn this around and head kids in the direction of success. You’ll like what you hear. This approach costs NO money and it WORKS!

Want more of a preview? Check out my website and learn about my new book, Nowhere to Hide: Why Kids with ADHD and LD Hate School and What We Can Do About It, which forms the basis for this stress-reducing, cartoon-laced session at CHADD's conference. There will be a book signing after the event. Hope to see you there. Sign up early. Rumor has it that this will be a standing-room-only event!


Jerome Schultz, PhD, is a clinical neuropsychologist who specializes in the diagnosis and treatment of children and young adults with learning disabilities, ADHD, and other special needs. He is on the faculty of Harvard Medical School.

Beyond Medications

Today’s guest blog is by J. Russell Ramsay, PhD.

If adults with ADHD could only have one treatment for their symptoms, research indicates that pharmacotherapy, particularly the use of stimulant medications, is the single most effective option for reducing the core symptoms of ADHD. However, medications alone may represent insufficient treatment for the many difficulties experienced by adults with ADHD, such as disorganization, procrastination, poor time management, mood and anxiety issues, and low self-esteem, to name a few.

During CHADD’s Annual International Conference on ADHD, my session on adjunctive treatments for adult ADHD will be held on Thursday, November 10. The session will cover the current status of various non-medication treatments for adult ADHD that are often used in combination with medications in order to help individuals achieve improved overall well-being and functioning in addition to symptom relief. Here is a brief overview of those treatments.

Psychosocial treatments. Many standard psychotherapy approaches have been modified in order to more effectively address the typical coping difficulties faced by adults with ADHD. In general, cognitive-behavioral therapy (CBT) approaches for adult ADHD, which focus on modifying self-defeating thought and behavioral patterns, have been found to be a useful adjunct to medications in several published studies, including recent randomized controlled designs comparing CBT with other active treatments. Sessions focus on the development and consistent implementation of coping skills in daily life. Psychosocial treatment, namely CBT for adult ADHD, stands out as the adjunctive treatment with the strongest research support.

Coaching. Although not the same as CBT, ADHD coaching shares the goal of helping adults with ADHD to employ more effective coping strategies to fulfill their personal goals. ADHD coaches target specific coping difficulties, such as disorganization and poor time management, and help clients develop and follow through on action plans. While the benefit of coaching support makes logical sense and it is an increasingly available option, to date there has been only one published study of its effectiveness for adults with ADHD adults.

Academic support and accommodations. Similar to ADHD coaching, while academic accommodations targeting specific areas of impairment make logical sense, such as extended time to complete an exam, these adjustments do not have research support. There are many informal steps that students can take to manage the effects of ADHD on their academic performance. However, there are preliminary studies of learning support and coaching approaches for college students with ADHD that have yielded positive results, making it a promising option.

Workplace support and accommodations. Workers with ADHD whose impairments fulfill the legal definition for a disability may be entitled to reasonable workplace accommodations, though most adults with ADHD do not pursue official accommodations. As with students, there are many informal adjustments in the work setting, assistive technologies, and other coping tools that may be helpful for adults with ADHD. As with academic accommodations, the effectiveness of these coping efforts has not been systematically studied.

Relationship treatment. Research on the effects of ADHD throughout the lifespan has increasingly identified its negative impact on family and social life for both children and adults with ADHD. The parents and caregivers usually participate in treatment programs for their children with ADHD, though they are rarely screened for ADHD despite high heritability rates. In fact, parental ADHD (even in sub-clinical form) is likely a common reason for dropout in family treatment programs for child ADHD and/or oppositional behavior.

Similarly, there may be unique difficulties faced in marriages and committed relationships in which one or both partners has ADHD. No studies have yet been published on either marital or family therapy involving adults with ADHD.

Neurofeedback and working memory training. Proponents of neurofeedback training cite numerous studies of its effectiveness, though there have been few studies using samples of adults with ADHD. Critics of neurofeedback, on the other hand, point out that many of the studies are case reports or have serious methodological flaws that cast doubts on their findings. A review of the few studies involving adults with ADHD suggests a middle-ground conclusion that neurofeedback has tentative support. There have been some recent studies of neurofeedback for children with ADHD that used improved research designs.

Computerized working memory training has yielded some positive results in samples of children with ADHD and such training would seem to be helpful for adults, though there have not yet been published reports involving adults with ADHD. However, as with neurofeedback, even if the therapeutic effects are reliable it remains unclear precisely how these interventions work and whether the positive effects generalize to improved functioning in day-to-day life.

Complementary and alternative treatments. There is a wide array of what are deemed “alternative” treatments for ADHD, such as nutritional supplements, specialized exercise programs targeting certain brain regions, dietary approaches, etc. There is preliminary evidence that omega-3 fatty acid supplementation may result in mild improvements in some ADHD symptoms, though these are based on studies of children. Likewise, pilot research of mindfulness meditation suggests it is associated with some improvements for adults with ADHD. There are obvious health benefits of mineral supplementation in cases of identified deficiencies; likewise, exercise, healthy diet, and other good health practices should be part of an overall wellness plan rather than being considered “treatments” for adult ADHD.


There are a number of treatment options for adult ADHD that can be used in combination with medications to target specific areas of impairment. A few of the treatment options have relatively strong support and some others have promising but preliminary evidence for their use while still others have not been found to be helpful. It is important to personalize the combination of treatments to meet the needs of the adult with ADHD in order to optimize functioning and well-being.



J. Russell Ramsay, PhD, is associate professor of clinical psychology in psychiatry and co-director of the Adult ADHD Treatment and Research Program at the University of Pennsylvania Perelman School of Medicine.

Making Homework Simple

Today's guest blog is by Ann Dolin, MEd.

Helping with homework can be a humbling experience, and this is especially true when you are the parent of a child with ADHD. All too often, parents find themselves cast in the role of the nightly homework police, and the divide this role creates can be one of the most painful aspects of parenting.

My presentation during CHADD’s Annual International Conference on ADHD in Orlando this November will bring you proven solutions for even the most challenging homework issues.

In this workshop, parents and professionals will learn specific strategies for each of the common, yet challenging homework profiles that students present when pressured by homework. They are:

o The Disorganized
o The Rusher
o The Procrastinator
o The Avoider
o The Inattentive
o The Easy Frustrated

Novel strategies to address each issue will be shared. These include:

• Easy solutions for setting up the Simple Solution binder system, including an accordion file and one dedicated homework folder.
• Identifying optimal homework spaces (there should be more than one!) and organizing portable materials.
• Simple tips for encouraging students to record their assignments accurately whether it be a paper assignment notebook or one of the cutting-edge electronic calendars.
• Prioritizing, planning, and managing long-term assignments. Quite often, students with ADHD have great difficulty breaking down large tasks into smaller increments.
• Ways to reduce procrastination and eliminate last-minute stress by using a timer, study groups, and other self-regulation strategies.
• Novel study skills for academic success such as easy note-taking ideas, using color for comprehension, creating study guides, and proofreading strategies.
• Strategies to encourage on-task behavior such as the use of the Tangle Jr., Wikki Stix, timers, and software.
• Solutions for finding the balance between helping too much and not enough.
• And for educators, best practices for assigning homework to ADHD students.

Above all, participants will learn how to help children do the most important things when it comes to homework – focusing and finishing!

I look forward to seeing you on Saturday, November 12th from 3:30 to 5:00. This workshop is DEFINITELY worth staying for until the end of the day!

Most sincerely,

Ann Dolin, MEd


A recognized expert in education and learning disability issues, Ann Dolin, MEd, sits on the board of CHADD of Northern Virginia and the International Dyslexia Association. She is the author of Homework Made Simple — Tips, Tools and Solutions for Stress-Free Homework.

“Hey, I Need Help Too!"

SURVIVAL TIPS FOR THE NON-ADHD SPOUSE

Today's guest blog is by Terry Dickson, MD, ACG.

The profound impact ADHD can have on marriage is well known. Less emphasis has been directed toward what a non-ADHD spouse married to an ADHD spouse truly experiences and what competencies, skills, and techniques are most effective for strengthening the relationship with a partner who has ADHD. A few of the questions a non-ADHD spouse may have are:
1. How can I understand the hard-wiring of my ADHD spouse? What are the traits of ADHD that tend to get in the way of the relationship?
2. How can I effectively communicate with my ADHD spouse when he/she has challenging communication skills?
3. How can I effectively cope with the frustrations of daily life with my ADHD spouse?
4. How can I work with my ADHD spouse to reach his/her full potential in the context of a healthy marriage?
5. Am I to blame for my ADHD spouse’s behavior?

Who are non-ADHD spouses? What do they experience that brings them to their wits end, that makes them want to divorce, or yell, feel unloved, tense up in a ball of frustration, or scream in anger?

Come join me as we explore these questions and more on Thursday, November 10, 2011 for a pre-conference institute from 9 am until noon at CHADD's 23rd Annual International Conference in Orlando, Florida.

During the presentation, my wife (who is a non-ADHD spouse) will talk about her experience being married to a person with ADHD (me). We will discuss how we have been able to work together effectively to strengthen our relationship. You will also hear the experiences of other non-ADHD spouses I have videotaped. You will gain a better understanding of the impact the behaviors of a person with ADHD has on a non-ADHD spouse and tips for strengthening your relationship for a lifetime.

To your success,

Terry M. Dickson, MD, ACG

Terry M. Dickson, MD, ACG, is an ADD Relationship Coach. He is also the founder and director of the Behavioral Medicine Clinic of NW Michigan, and has been principal study investigator for several clinical ADHD medication trials.