Attention-deficit/hyperactivity disorder: an update on medication adherence and persistence in children, adolescents and adults

Abstract

Suboptimal adherence to treatment regimens is a major obstacle to treatment efficacy and positive outcomes for patients. While poor adherence is common across a variety of chronic conditions, an area which presents unique challenges to clinicians and researchers is non-adherence among pediatric populations. These challenges are well illustrated by the management of attention-deficit/hyperactivity disorder (ADHD), a pervasive pediatric psychiatric condition. The average rates of non-adherence in children and adults ranged between 15 and 87%. Factors predicting increased adherence/persistence included the use of long-acting formulations, younger age, Caucasian background, family structure and the presence and treatment of comorbidities. Decreased adherence/persistence were predicted by multiple daily dosing, family history of ADHD, experiences of adverse effects, stigma and treatment inefficacy. The broad range of non-adherence rates identified reflects the complexities of adherence research in ADHD, and highlights the need for better standardization of adherence/persistence definitions and measurement approaches.

Do parents of children with attention-deficit/hyperactivity disorder (ADHD) receive adequate information about the disorder and its treatments? A qualitative investigation

“…Therefore, although this qualitative investigation may not be generalizable to the entire population, the rich data collected can be used as the basis of future quantitative investigations. For example, the findings of this exploratory study can be used to develop interventions targeted at parents of children with ADHD to promote access to information and address issues surrounding suboptimal adherence to therapy 32,48…”

Attention-deficit hyperactivity disorder (ADHD), substance use disorders, and criminality: a difficult problem with complex solutions

“…Moreover, one prominent feature of ADHD treatment is that the discontinuation of medication is common especially in adolescence and early adulthood (171,172). This is of particular importance in adolescents and younger adults with severely disruptive or criminal behaviors, who are likely to have more severe and pervasive symptoms of ADHD, and less likely to adhere or comply to treatment (173). Furthermore, although importance of treatment discontinuation for criminality and other longer-term outcomes is largely unknown (157), it may increase the risk to fall into a "revolving door" between prison and probation, and the community (8).…”

Parent-reported symptoms, impairment, helpfulness of treatment, and unmet service needs in a follow-up of outpatient children with attention-deficit/hyperactivity disorder

“…Overall, the findings of our short-and long-term follow-up showed that the outpatient sample of children with ADHD was highly symptomatic and impaired, despite a high rate of persistent medication treatment (84.7%) compared to other studies (35,36). Although high persistence rates of symptoms and impairment into adolescence have been reported in previous outcome studies (37,38), comparisons between studies are challenging because of the use of different criteria for persistence and remission of ADHD (7,9,10).…”