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Chris Langer for msnbc.com

Kate Skinn, 32 of Sheffield Lake, counts out the remaining doses of Adderall that treat her attention-deficit hyperactivity disorder. Skinn is among millions of Americans affected by a lingering shortage of vital medications.

After nearly 10 months, the nationwide shortage of ADHD drugs has taken a toll on Kate Skinn.

The 32-year-old Ohio woman had to take a medical leave from college because she can’t focus on her reading. She’s lost income from her job as a waitress because she’s distracted at work. And she’s had to struggle even harder than usual juggling the needs of her boyfriend and their four children, all because she can’t reliably get the Adderall that helps her cope.

“It’s impossible to manage all the facets of my life and do my schoolwork,” said Skinn, of Sheffield Lake, Ohio, who was diagnosed with attention-deficit hyperactivity disorder three years ago. “When I can’t take my medicine, I can’t concentrate. I’ll start everything I need to do, but never complete any of it.”

She’s among millions of Americans struggling to deal with the worst drug shortage in United States history. ADHD drugs such as Adderall and Ritalin, first reported as scarce last spring, are only a fraction of the 251 medications in short supply so far this year, up from 211 in 2010, according to University of Utah Drug Information Service.

The issue drew renewed attention Thursday, when the White House issued an interim rule that requires drugmakers that are the only producers of certain critical medications to report to the Food and Drug Administration all manufacturing interruptions that could disrupt supplies.

It follows an October executive order in which President Barack Obama directed the FDA and the Department of Justice to take bolder steps to resolve the worsening scarcity.

Shortages of life-saving drugs, such as those used to treat cancer, and medically necessary drugs, such as anesthetics and painkillers, have sparked the most dire concerns, experts say.

But shortages of the ADHD drugs widely used to help an estimated 5.4 million children and 1.5 million adults concentrate daily are also worrisome, especially as the problem continues.

“We get those reports from patients saying I had to drive three hours to get my ADHD prescription and this is the third, fourth or fifth time,” said Erin Fox, manager of the Drug Information Service, which tracks drug supply issues. “We’re hearing from moms who are so worried and upset about not getting the drugs their kids need every day.”

FDA officials, too, say the ADHD drug shortage has drawn a lot of attention.

“We’re hearing the same thing: that patients aren’t able to get these drugs,” said Valerie Jensen, associate director of the FDA’s drug shortage program. “We’re continuing to check with the companies about their expected resolution dates.”

Drugmakers say that increased demand and difficulty obtaining supplies of the raw materials used to manufacture the drugs are behind the ongoing ADHD pill shortages. But an official with the government agency that allocates those controlled substances says from his vantage, there’s plenty of raw material out there.

Chris Langer for msnbc.com

Kate Skinn watches TV with her 4-year-old son, Markus, who also needs medication to treat his ADHD.

The DEA allocates an aggregate amount of medically necessary supplies of controlled drugs -- for instance, 56 million grams of methylphenidate in 2011 -- and then doles out confidential portions to each drugmaker.

“We’ve given them quota sufficient to meet the needs and then it’s up to them how they manufacture their product,” said Gary Boggs, a supervisory special agent for the Office of Diversion for the federal Drug Enforcement Agency.

Company business decisions surrounding competition, marketing -- and profit margins -- are behind many of the troubles that patients have encountered, Boggs added. Manufacturers might make more of an expensive brand-name drug and not enough of a generic version. Or they may distribute too much product in one place, causing a shortage somewhere else.

“This isn’t just a clean there is either product or not product,” Boggs said. “There’s a whole lot of different dynamics in here.”

Drugmakers declined to discuss specifics of their DEA allocations.

Still, those dynamics have reshaped Kate Skinn’s life.

In the past 10 months, she’s had to drive to multiple pharmacies trying to get the different ADHD drugs used by four members of her family, including her 4-year-old son, Markus.

“I have to actually block out a whole day of my life to figure out if I’m going to have medication for the next day,” said Skinn.

Because the drugs are controlled substances, she and other patients have to follow strict rules governing prescriptions and refills. Skinn sometimes skips a dose at night in order to hoard them for times when she might run out.

“For people with ADHD, there’s already a stigma attached to it,” she said. “You end up feeling like you’re drug-seeking. It doesn’t make you feel good.”

In recent weeks, the ADHD shortage has shown signs of easing. Brand-name Adderall XR, the extended-release version produced for the drug company Shire Pharmaceuticals, has been logged as available in “adequate” supplies. Company spokesman Matt Cabrey said that’s because the DEA granted an increase in the firm’s allocation of amphetamine mixed salts used to make the drug.

Other firms, as well, say that as they receive their new DEA allocations in the new year, the shortages may subside.

That would be welcome news for patients like Skinn, but drug supply experts say they've heard that before -- and no one should count on it.

Related stories:

Shortage of ADHD drugs sends parents scrambling

Price-gougers hike drug costs during shortage

Drug shortages slam patients, health workers, surveys show

Half of hospitals buy back-door drugs, survey shows

While more boys than girls are treated for ADHD, a new report shows that among adults, the numbers have flipped. Women’s use of medications for the condition has soared in the past decade, surpassing that of men.

From 2001 to 2010, the number of American women ages 20 to 44 who took ADHD drugs skyrocketed more than 250 percent, according to the report from Medco Health Solutions. Researchers analyzed trends in the use of mental health medications among about 2.5 million insured Americans.

Among all 20- to 44-year-olds, about one in 50 took ADHD medications in 2010 — 1.9 percent of women, and 1.8 percent of men, whose use increased more than 150 percent from 2001 to 2010. One factor for the rise in adults taking ADHD drugs might be that all five medications indicated for treating the condition have been approved since 2001.

Since ADHD doesn’t pop up all of a sudden in adulthood, it's likely that women who started taking meds in the past decade flew under the radar until they became adults, says Dr. Lenard Adler, director of the Psychiatry and Neurology Adult ADHD Program at the New York University School of Medicine.

That’s because girls are less likely than boys to exhibit the “H”—for hyperactivity—in ADHD, so boys with the condition are more likely to be noticed, says Adler, who was not involved with the Medco report. But as children grow into adulthood, he says, the “attention deficit” component of ADHD becomes more prominent, because grown-ups have a lot more to keep track of.

The girls whose ADHD had gone unrecognized, chalked up to laziness or lack of motivation in school, grow into women who stumble when they encounter the real world of work and family. They can’t hold jobs, and, because they are so disorganized, they pay their bills late, if at all, lose track of appointments and misplace their kids’ school permission slips.

Parenthood often leads to adults finally getting an ADHD diagnosis, Adler says. “Many times for a parent, what will bring them in to be diagnosed is they have a child who’s been diagnosed.” The parents might recognize that their child’s symptoms are ones they themselves have dealt with for years.

When a child is diagnosed with ADHD, he says, there’s a 30 percent to 40 percent chance that a parent has it, too. Of those parents, the moms are more likely to seek professional help than the dads, explains Russell Barkley, a clinical professor of psychiatry at the Medical University of South Carolina who’s long studied ADHD in adults. And in the last couple of years, Barkley says, he’s been interviewed for a number of articles about ADHD in women, which have probably heightened awareness.

Adler says he’s glad the data show more women are seeking treatment, but since 4.5 percent of adults are thought to have ADHD, it's clear that less than half are getting help. “There’s a large group out there still not being treated,” he says.

Rachael Rettner
MyHealthNewsDaily

BOSTON — Attention-deficit hyperactivity disorder (ADHD) can now be diagnosed in children as young as 4 and as old as 18, according to the nation's largest organization of pediatricians.

The new guidelines from the American Academy of Pediatrics (AAP) expand the age range over which doctors can diagnose and manage ADHD in children, and are based on recent research; previous guidelines released in 2000 and 2001 covered children ages 6 to 12.

"Treating children at a young age is important, because when we can identify them earlier and provide appropriate treatment, we can increase their chances of succeeding in school," said Dr. Mark Wolraich, a pediatrician at the University of Oklahoma Health Sciences Center and lead author of the report.

The guidelines were released today in Boston at the pediatricians' annual conference.

But with ADHD now the most common neurobehavioral disorder in children, some experts worry about changes that could lead to even more kids being diagnosed -- and medicated.

A text-message survey of 100  U.S. pediatricians conducted by Truth On Call for msnbc.com found that 60 of them think ADHD is overdiagnosed in kids, 35 feel it’s diagnosed appropriately and 5 think it might be underdiagnosed.

As of 2007, 9.5 percent of U.S. children had been diagnosed with ADHD, according to the Center for Disease Control and Prevention. And cases of ADHD are already on the rise; between 2003 and 2007, rates of ADHD diagnoses increased 5.5 percent per year, the CDC says.

Any child ages 4 to 18 who has behavioral problems or problems in school and has symptoms of inattention, hyperactivity and impulsivity should be evaluated for ADHD, Wolraich said. To be diagnosed as having the condition, the child must display these problems in more than one setting (for instance, both at home and at school).

Although the new guidelines allow for children as young as 4 can be diagnosed with ADHD, there are challenges in diagnosing these kids, Wolraich said. For instance, children too young to have started school may be under the supervision of only their parents, in which case, there are no teachers or daycare providers to confirm behaviors.

In making diagnoses in these young kids, doctors should look for symptoms to last at least 9 months, instead of the 6 months required for older children, Wolraich said.

"These are the kids who are really getting into trouble," and may have been kicked out of two or three preschool programs, Wolraich said.

In some cases, parents could undergo training to help manage behavior problems in their kids before a diagnosis is made, he said.

Diagnosing teens, on the other hand, likely requires talking to adults other than their parents, who may have little contact with them, Wolraich said. Doctors should try to obtain information from teachers, couches, counselors and other community leaders who may interact with the teen.

In children ages 4 and 5, doctors should first try to treat ADHD with behavioral therapies. Only if such therapies fail, and a child has problems functioning in everyday life because of ADHD, should doctors prescribe the ADHD drug methylphenidate (known by its brand names Ritalin, Concerta and others) to kids in this age group, according to the new guidelines.

For elementary school children and adolescents, both behavioral therapy and FDA-approved ADHD medications are recommended.

The guidelines emphasize that ADHD is a long-term condition that may last into adulthood.

"As a chronic illness, you have to do all the things that are important to managing a chronic condition," including educating the family and following the children closely as they grow up, Wolraich said.

The new guidelines will be published in the November issue of the journal Pediatrics.

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