An Open Letter to the FTC Regarding the Shortage of ADHD Medication

I am a mental health therapist who also has a diagnosis of ADHD. In my practice of 10 other clinicians, we utilize the QB Check to confirm our suspicions of any case in question. We also offer this test to providers in the surrounding area. I urge the FTC to closely examine the lack of competition and contracting practices that may be influencing the shortages of ADHD medication in the US. We need this medication and we WILL be needing even more as more cases are being diagnosed than ever before. Here's why:

We have UNDER diagnosed a very high number of adults in our society.

Remember when it used to be said in the 80s that ADHD was over diagnosed in children? Maybe that did happen... but here's the flipside. Most of the QB Checks we administer in the office are not for children, but for adults in their 20's to late 50's, who learn they have ADHD for the first time ever. A good portion of adults never diagnosed are currently sitting in prison, having found alternate ways to self-medicate their dopamine-deprived brains for stimulation. Many others have gone on to become successful entrepreneurs, engineers, or have found success in the arts and entertainment industries.

Many others are MISdiagnosed and on medications that may help related diagnoses, but fail to treat the root cause.

The middle ground- those who haven't succeeded wildly, nor found themselves homeless or behind bars, suffer in silence. It is now suspected that ADHD is just as likely to effect females as males. However, women are more likely to be misdiagnosed with a mood disorder such as anxiety (and all its forms from eating disorders to OCD, depression, bipolar, and/or borderline personality disorder. A book that came out only two months ago in December 2023 finally brings this knowledge to the general public

Beneath most ADHD diagnoses is a history of intergenerational trauma, and ADHD is suspected to be an evolutionary trait for survival.

We have long known that ADHD is highly heritable (as heritable as height, it is often said). What we are now learning is that it is likely that ADHD has been carried through the generations by those humans best adapted to respond to crises (read: more likely to survive catastrophic events), and traveled the globe by migrant humans who were drawn to novelty and exploration.

Modern epigenetic studies influence how environment can effect how DNA is expressed, and traumatic environments are more likely to trigger very pronounced ADHD symptoms. We see this in childhood trauma and, of course, in intergenerational trauma when previously traumatized/untreated children grow up to parent a new generation in the best ways they know how.

Covid has made everything worse.

The global pandemic was an effective two year trauma for the entire human population. Child abuse surged, despite being underreported (since it was under-witnessed due to isolation).

And even a "healthy", "normal" life can spiral into ADHD. People living in society with ADHD (many undiagnosed) are generally subject to a phenomenon called Rejection Sensitive Dysphoria (RSD), a symptom that can cause both severe emotional and PHYSICAL pain for even simple rejections (ie "I can't hang out. I'm busy Friday night.") Experiencing this repeated internal pain can be akin to being beaten one's entire life. We just don't notice or validate it because it is an internal experience. And many a person with ADHD (both diagnosed and undiagnosed) will experience complex PTSD even those from healthy homes.

People with ADHD are often highly empathetic, taking on the pain of others, compounding their own internal pain. Left undiagnosed and untreated, most people with ADHD will seek to self-medicate with risky behaviors, substance abuse, and a smorgasbord of addictions.

Diagnoses will continue to skyrocket as people with ADHD are often able to "sense" ADHD in others.

Ever connect with someone and feel you were on the same wavelength? In ADHD, that is a literal phenomenon. Recognizing kindred spirits in each other, people with ADHD are often able to point it out to their peers. Obviously, this should not be taken as a medical diagnosis, but it leads many people to seek out further information and testing to explore the possibility.

Things MUST change. And its possible.

Having untreated ADHD is associated with a twofold increase to a person's mortality, on average, reducing any given patient's lifespan by 13 years. Not good for people with ADHD. Additionally, there is a high likelihood that an undiagnosed or untreated person with ADHD will seek to self-medicate with various anti-social methods- substance use, crime, abuse, etc. Not good for anyone with a pulse.

Medication and promising trauma treatments.

Properly diagnosed and treated at an early age, a person with ADHD is more likely to harness the gifts of ADHD than to suffer the debilitating consequences associated with the diagnosis. Medications MUST be made more readily available, despite the concerns about controlled substances. Some medications such as lisdexamfetamine are designed to be less abused by only activating in combination with enzymes in the gut. Diagnoses of ADHD need to be validated as accurate and then supported (if not celebrated) by patients and their care teams. Shame and denial of ADHD diagnoses by patients and their personal supports only serves to compound the disorder due to additional internalized trauma.

Modern trauma techniques are able to heal the legacy of trauma for people with ADHD across the lifespan. EMDR, BSOTR, ART and AT for example, are all promising techniques that have specific protocols that can bring significant relief in as little as one session (assuming there is a trusting rapport between client and therapist). New trauma treatments using ketamine and other psychedelic medicines are yielding additional promising data in the ability to rapidly regrow the dendrites in the brain that have previously been blunted due to floods of cortisol released during stress responses.