New prescriptions for stimulant medications used to treat attention-deficit/hyperactivity disorder (ADHD) doubled during the COVID-19 pandemic compared with the years before it, with the largest increases among adults aged 18 to 34 and among women.

Dr. Tara Gomes, a professor at the University of Toronto and principal investigator of the Ontario Drug Policy Research Network, discusses findings from the CMAJ research article Patterns of prescription stimulant initiation before and during the COVID-19 pandemic. Her team found that the number of Ontarian adults newly starting stimulants rose rapidly after an initial drop early in the pandemic. The interval between a first ADHD-related health care encounter and a stimulant prescription also fell from about seven years before the pandemic to less than one year during it. Gomes suggests the increase likely reflects both improved recognition of ADHD in adults and easier access through virtual care, which may be shortening the pathway from first expression of concern by a patient to prescription.

Dr. Ashley White, a family physician who treats many patients with ADHD and received her own diagnosis in adulthood, reflects on how the condition can go unrecognized in high-performing adults. While she explored her own diagnosis through an online clinic, she emphasizes the importance of careful assessment that accounts for overlapping conditions such as anxiety or trauma, which can benefit from different treatment.

The episode highlights a genuine tension: better recognition of adult ADHD is overdue, but the speed of the shift raises real questions about diagnostic rigour.

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Ontario’s expansion of online gambling and legalization of single-event sports betting were followed by a sharp rise in help-seeking for gambling problems, particularly among young men. A new CMAJ study, Help seeking for gambling problems following expansion of Ontario's online gambling market and legalization of single event sports betting, analyzes calls to Ontario's 24-hour mental health and addiction hotline before and after the 2022 policy changes. The findings suggest that increased accessibility, private-sector expansion, and in-play betting may be amplifying gambling-related harm.

Dr. Daniel Myran, a family physician, research chair in family and community medicine at North York General Hospital, and co-author of the study, reports that hotline contacts among males aged 15 to 24 tripled after the market opened to private operators. By the end of the study period, more than 70% of callers cited online gambling. He describes how legalization of single-event sports betting and in-play betting reduced friction and increased immediacy, features linked to higher addiction risk.

Dr. Daniela Lobo, medical lead of the Problem Gambling and Tech Use Clinic at CAMH and an assistant professor of psychiatry at the University of Toronto, describes seeing younger patients since the introduction of iGaming, including individuals in their late teens and early twenties. She explains how in-play betting mirrors other high-risk formats by offering rapid, repeated opportunities to wager. Gambling disorder shares features with substance use disorders, including tolerance, withdrawal symptoms, concealment, financial strain, and suicidal ideation. She also highlights medication-related risk, noting that dopamine agonists and certain atypical antipsychotics have been linked to new gambling behaviours.

Clinicians should consider gambling when patients present with unexplained financial stress, relationship conflict, mood symptoms, or suicidality, and remain alert to medication-induced behavioural change. Resources like ConnexOntario offer anonymous referral support for patients and providers.

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Child physical abuse often presents first with injuries that appear minor, but missing these early warning signs can have devastating consequences. Two recent CMAJ papers examine how sentinel injuries in infants may signal escalating risk and how patterns of severe maltreatment shifted during the COVID-19 pandemic. Together, they offer practical guidance on when clinicians should escalate concerns and highlight system factors that shape risk for vulnerable children.

Dr. Megan Cooney, a child maltreatment pediatrician at Health Sciences Centre Winnipeg and co-author of “Five things to know about sentinel injuries and indicators of child physical abuse”, explains why medically minor injuries in pre-cruising infants require careful scrutiny. She notes that more than one quarter of children who experience catastrophic abuse had previously been seen for minor injuries. Any unexplained or poorly explained injury in a non-cruising infant should raise concern. She also reviews the validated TEN-4-FACESp clinical decision rule to help clinicians identify bruising patterns that warrant further action.

Dr. Matthew Carwana, a pediatrician at BC Children’s Hospital and clinical investigator at the BC Children’s Hospital Research Institute, discusses findings from “Hospital admissions for maltreatment among children younger than 2 years during the COVID-19 pandemic in Canada”. He describes an early drop in maltreatment hospitalizations during the first 16 weeks of the pandemic, followed by a return to expected levels. However, ICU admissions rose above baseline for roughly the following year, raising concern that children may have been presenting with more serious injuries. Carwana suggests reduced early detection and loss of family and community supports during periods of isolation may have contributed.

For physicians, the message is to remain objective and act early. Injuries in pre-cruising infants should be treated as potential red flags, validated tools such as TEN-4-FACESp can support clinical judgment, and concerning cases should prompt timely reporting to child welfare agencies rather than waiting for certainty.

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