- The rate of first-time ADHD diagnoses has increased since 2021. The largest increases in first-time ADHD diagnosis rates were seen in the 30-44-year-old and 45-64-year-old age groups. Age groups under 30 years old did not see increases in first-time ADHD diagnosis rates during the study period.
- Amongst people with first-time ADHD diagnoses, in 2018, the proportion of first-time diagnoses was highest for people in the 18–29-year-old age group (27.7%). As of 2023, this trend has shifted, and 30–44-year-olds make up the largest proportion of people with first-time ADHD diagnoses (30.7%).
In October 2022, the US Food and Drug Administration (FDA) announced a shortage of a combination of amphetamine and dextroamphetamine drugs commonly found in Adderall and used to treat ADHD and narcolepsy (US Food & Drug Administration, 2022). We’ve previously explored rates of prescription fills over time within a population of people who would be eligible to receive the drug (i.e., people who have received a dispense of the drug within the prior two years).
The FDA cites an increase in demand as the reason for the continued shortage (US Food & Drug Administration, 2023). Building upon our previous analyses and in collaboration with The New York Times, we were curious to understand if there were increases in ADHD diagnoses that may be contributing to the rise in demand.
You can also explore this study directly within Truveta Studio.
Methods
We included a population of people who had an encounter within the previous two years. We then calculated the monthly rate of first-time ADHD diagnoses per 10,000 eligible people between January 2021 and October 2024. People were eligible if they had no prior evidence of an ADHD diagnosis, and they had an encounter with the health system in the prior two years.
Rates were calculated overall and for seven age groups (0-11 years old, 12-14 years old, 15-17 years old, 18-29 years old, 30-44 years old, 45-64 years old, and 65+ years of age). Linear regression models were used to test for changes in the first-time ADHD diagnosis rate and first-time amphetamine/dextroamphetamine prescription rate over time.
We also compared the yearly proportion of first-time diagnoses by age group.
Results
First-time ADHD diagnoses
Overall, 1,033,117 people received a first-time ADHD diagnosis within the study period. Across the study period, we observed a significant increase in the rate of first-time ADHD diagnoses (p<0.001), with an average increase of 0.04 new diagnoses per 10,000 people per month.
In January 2021, 0.063% – or 6.3 per 10,000 – of the eligible population had a first-time diagnosis. This increased to 0.080% – or 8.0 per 10,000 – in October 2024. This represents an increase of 27% across the study period.
When stratifying by age groups, the highest rates of first-time diagnoses occurred for 12-14- and 15-17-year-olds. However, there was no evidence of an increase in diagnosis rates over time for any age groups under 30 years of age during the study period. Increases in the rate of first-time diagnoses were seen in each of the age groups over 30 years of age (p<0.001).
The greatest increase in the first-time ADHD diagnosis rate was seen for the 30-44-year-old population, with an increase of 0.1 new diagnoses per month per 10,000 eligible people.
In 2018, the proportion of first-time diagnoses was highest for people in the 18-29-year-old age group; out of 100 first-time ADHD diagnoses, 27.7 were amongst people 18-29 years old.
As of 2023, this trend has shifted, and 30-44-year-olds make up the largest proportion of people with first-time ADHD diagnoses.
So far in this year (2024), 30-44-year-olds made up 30.7% of all people with first-time ADHD diagnoses.
Over time, the proportion of first-time ADHD diagnoses has also increased amongst people between 45-64 years of age and over 65 years of age.
Discussion
In this analysis, we built upon our previous understanding of the amphetamine/dextroamphetamine shortage, but added details about first-time ADHD diagnoses.
We found an increase in ADHD diagnoses within our population since 2021; however, these increases were seen only in age groups over 30 years old. Specifically, people between age 30-64 had the greatest rates of new diagnoses. We also observed increased diagnosis rates for people under 30 in the spring; additional research is needed to more fully understand this trend, but it may align with previous work showing increased diagnoses during this time of the year due to school patterns (Leache et al., 2021).
The prevalence of ADHD amongst adults (18-44 years of age, different age definition than in the present study) is estimated at 4.4%; however, previous studies have reported a potential under-diagnosis of ADHD in the adult population (Asherson et al., 2012; Morrill, 2009). Within the population of people with first-time diagnoses, we see a growing proportion of those who are adults.
There are a few limitations associated with this analysis. First, in this analysis we reported in 2018 the highest rates of first-time ADHD diagnoses within the population 18-29 years old. This analysis is dependent on which age groups we select; for example, if we were to combine all age groups under 18, they would make up the largest percentage of first-time ADHD diagnoses in 2018. Second, diagnoses that were not captured within a Truveta member health system were not included. Therefore, we may be under capturing the total number of people with ADHD.
These are preliminary research findings and not peer reviewed. Data are constantly changing and updating. These findings are consistent with data accessed on Nobember 13, 2024.
Citations
Asherson, P., Akehurst, R., Kooij, J. J. S., Huss, M., Beusterien, K., Sasané, R., Gholizadeh, S., & Hodgkins, P. (2012). Under Diagnosis of Adult ADHD: Cultural Influences and Societal Burden. Journal of Attention Disorders, 16(5_suppl), 20S-38S. https://doi.org/10.1177/1087054711435360
Leache, L., Arrizibita, O., Gutiérrez-Valencia, M., Saiz, L. C., Erviti, J., & Librero, J. (2021). Incidence of Attention Deficit Hyperactivity Disorder (ADHD) Diagnoses in Navarre (Spain) from 2003 to 2019. International Journal of Environmental Research and Public Health, 18(17), 9208. https://doi.org/10.3390/ijerph18179208
Morrill, M. I. (2009). Issues in the diagnosis and treatment of adult ADHD by primary care physicians. Primary Psychiatry, 16(5), 57–63.
National Institute of Mental Health. (2023, September). Attention-Deficit/Hyperactivity Disorder. https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd
US Food & Drug Administration. (2022). FDA Drug Shortages (Current and Resolved Drug Shortages and Discontinuations Reported to FDA – Amphetamine Aspartate Monohydrate, Amphetamine Sulfate, Dextroamphetamine Saccharate, Dextroamphetamine Sulfate Tablet). https://www.accessdata.fda.gov/scripts/drugshortages/dsp_ActiveIngredientDetails.cfm?AI=Amphetamine%20Aspartate%20Monohydrate,%20Amphetamine%20Sulfate,%20Dextroamphetamine%20Saccharate,%20Dextroamphetamine%20Sulfate%20Tablet&st=c
US Food & Drug Administration. (2023). FDA Announces Shortage of Adderall. https://www.fda.gov/drugs/drug-safety-and-availability/fda-announces-shortage-adderall