When Maggie O’Riley, a senior English education major at Colorado State University, sits down at a cafe table, she brings a carbonated drink, pink Beats headphones and a phone in a rainbow unicorn case. Miniature coffee cups even dangle from her ears. After just a few moments with her warm and personable nature, it’s obvious she’s pursuing a career in teaching.

O’Riley is also one of many at CSU who have attention-deficit/hyperactivity disorder. When the Adderall shortage started in October 2022, she was lucky to still receive her medication relatively easily. Though she didn’t have to ration or scour pharmacies, O’Riley still weaves through the normal annoyances of long wait times, phone calls and insurance difficulties to receive her medications.

“That’s medicine that people genuinely need,” O’Riley said.

Yet with no official end in sight, the shortage has become a nuisance well known to pharmacies and patients. For many, necessary prescriptions have been redirected, back-ordered or rationed to an excessive extent. Navigating this has become part of a larger, more foreboding beast. It is a chronic issue within the medical industry that has been growing sorer with time.

This is especially true for neurodivergent people assigned female at birth. In a 2023 study from the Journal of Attention Disorders, Darby Attoe and Emma Climie found a considerable gender bias in the research that informs ADHD diagnostic criteria.

There’s a significant lack of proper research into the medical efficacy of ADHD pharmacotherapy for AFAB people overall. Cynthia Hartung, the lead researcher on a 1998 study published in the Psychological Bulletin, found that in 70 out of 243 relevant empirical studies on ADHD, 81% of participants were male, while only 19% were female. Of single-sex-focused studies, 99.6% were about male children.

Francien Kok, the lead researcher of a Public Library of Science One journal 2020 study, found that in 14 pharmacological impact studies about ADHD, each had at least one sex difference in the effects of ADHD pharmacotherapy. Her team also identified seven prescription rate studies that all showed AFAB people receiving significantly fewer prescriptions than people assigned male at birth.

This adds further concerns when, for any type of medication, AFAB people are linked to a 1.5-1.7 times higher risk of developing adverse drug reactions, according to Kok’s study. Because medications aren’t properly tested for AFAB people, sex-related differences like body mass or hormonal factors are often neglected. Kok’s study suggests this creates dangerous disparities in effectiveness for patients.

This is where the system shows signs of dysfunction. Long-standing confusion about ADHD and the pervasive disparities for AFAB people have led many to struggle through an institution that simply is not built for them.

Enter Jolie Beth Boudreaux, a licensed counselor with ADHD who specializes in neurodivergent coaching: When clients come to her, they come for hope. These are people who’ve read that those with ADHD shouldn’t be allowed to drive or cannot sustain long-term relationships. One reason people visit her is their medications aren’t working as expected.

And why aren’t they working? Medication is not a fix-all solution.

“I feel that we are so entrenched in this ‘medication solves problems’ that people are still going to look at how do we make that sustainable?” Boudreaux said. “The way that I coach is we’re not trying to make you neurotypical. We’re trying to find ways for you to work with your brain.”

This mindset seems like common sense. But in today’s medical system, it’s almost trailblazing — especially when much of the current system stems from a deficiency bias Boudreaux finds widely evident in research.

“It’s like, ‘Oh, let’s figure out more ways in which people with ADHD are jacked up,’ as opposed to, ‘Let’s just see how the brain works differently so we can make sure there’s equity in academics,’” Boudreaux said.

Boudreaux said she believes this stems from the static brain theory, which says the brain is analyzed in exclusion from its environment. Without considering the dynamic functions and layers involved, neurodivergence is viewed as needing to be fixed, not understood. The analogy Boudreaux uses is that mental health is not fixed like a broken bone. It can’t be found on X-ray, given a splint, then healed weeks later.

So while many are confused as to why diagnosis rates for ADHD have risen, perhaps the real question ought to be: What behaviors do we find so nonconformative that we cannot tolerate them as anything except abnormal?

That’s what Boudreaux addresses as CEO and founder of ReVision ADHD Coaching and Consulting and in her Fort Collins practice, Jolie Beth ADHD Counseling and Coaching. She’s not looking for that easy fix-all approach that can confine neurodivergent brains to neurotypical ways of thinking and being.

Are institutions capable of doing the same?

Boudreaux said that when parents come to her for help getting their kid to sit still in class, they’re not necessarily looking to understand the way their kid’s brain works. They just want it to work the way it’s expected to. But then their kid grows up in a medication shortage and finds themselves battling insurance or rationing their medication to achieve supposed normality.

O’Riley sees an opportunity for change in the curriculums taught to future educators like herself. Growing up with ADHD and a learning disability meant O’Riley was often placed in remedial classes despite excelling in certain subjects like language arts. Her self-esteem suffered because of it until a 10th grade teacher at Cherokee Trail High School became her advocate.

O’Riley said this plays a part in why she’s majoring in English education and why she firmly believes there could be far more built into curriculums to properly teach educators about neurodivergence.

O’Riley and Boudreaux both see the need to shift from the short-term fix to a long-term solution — for neurodivergence to be treated not as an outlier in society but as something worth embracing.

Reach Abigail Weaver at science@collegian.com or on Twitter @CSUCollegian.