(002) Brain Damage from COVID-19 Infection is an Underrecognized Driver of the Adderall Shortage

Abstract: Background/Significance:
Cognitive impairment and other neuropsychiatric problems are well-documented sequelae of Covid-19 infection (Calabria, 2022). However, there is a lack of consensus as to whether Covid-19 infection is a risk factor for ADHD. Our study aims to evaluate whether a history of Covid-19 infection is correlated with ADHD diagnosis and/or treatment.

Methods:
We analyzed aggregate data from 37,344 patients ages 5-40 in a large hospital system who had at least 1 documented Covid-19 PCR test result (including both positive and negative test results) to determine whether a history of Covid-19 infection was correlated with ADHD diagnosis or being prescribed a stimulant. Patients were divided into 2 groups: those with ≥1 positive test result and those who had exclusively tested negative. The prevalence of ADHD diagnosis and stimulant prescriptions were compared between the 2 groups.

Additionally, we are currently seeking IRB approval to analyze charts of individual patients in order to determine whether Covid-19 infection preceded a patient's ADHD diagnosis, as well as to investigate whether the prevalence of ADHD is higher in patients with ≥2 Covid-19 infections. We expect to receive IRB exempt designation and have this data collected by May 2024.

Results:
In pediatric patients (ages 5-18), patients who had tested positive for Covid-19 were 50.4% more likely to have been diagnosed with ADHD (5.28% vs 3.51%) and were 51.5% more likely to have been prescribed a stimulant (5.47% vs 3.61%) compared with patients who had tested negative. In adult patients (ages 18-40), patients who had tested positive for Covid-19 were 27.3% more likely to have been diagnosed with ADHD (1.77% vs 1.39%) but had similar rates of stimulant prescriptions (4.38% vs 4.42%) compared to those who had tested negative.

Pending IRB approval, more concrete data pertaining to the incidence of ADHD after Covid-19 infection will be collected. I attest that I will have this additional data collected prior to the ACLP 2024 Annual Conference.

Discussion:
From the preliminary data we have collected, Covid-19 infection appears to be positively correlated with ADHD diagnoses in both pediatric and adult patients, as well as with stimulant prescriptions in pediatric patients. These findings are unsurprising given the number of patients who report cognitive difficulties after Covid-19 infection (Zawilska, 2022). Further data to be collected may help to clarify whether there is a causal relationship between Covid-19 and ADHD or whether these findings are the result of other confounding factors.

Conclusion/Implications:
There appears to be an association between Covid-19 and ADHD, however further data is necessary to determine if a causal relationship exists. Understanding the relationship between Covid-19 and ADHD will allow psychiatrists to provide better care to patients who have been infected with Covid-19.

References:
Calabria M, García-Sánchez C, Grunden N, et al. Post-COVID-19 fatigue: the contribution of cognitive and neuropsychiatric symptoms. J Neurol. 2022;269(8):3990-3999. doi:10.1007/s00415-022-11141-8

Zawilska JB, Kuczyńska K. Psychiatric and neurological complications of long COVID. J Psychiatr Res. 2022;156:349-360. doi:10.1016/j.jpsychires.2022.10.045

Presentation Eligibility: Not previously published or presented

Diversity, Equity, and Inclusion: Covid-19 has disproportionately affected individuals from historically marginalized groups. Thus, a lack of understanding of the long-term effects of Covid-19 is a contributor to health disparities. Our submission aims to clarify some of these long-term effects, and we hope this information will help psychiatrists provide better care to patients of marginalized backgrounds.