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.

Keywords::

• attention-deficit/hyperactivity disorder
• medication adherence
• medication compliance
• medication persistence
• psychostimulant
• review

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Medication non-adherence affects therapeutic efficacy and positive health outcomes for patients across a variety of chronic conditions, including attention-deficit/hyperactivity disorder (ADHD).

• • Recent studies exploring medication utilization among patients with ADHD have emphasized that poor adherence and premature cessation of treatment are common, despite the availability of efficacious treatments.

• • A number of factors influence adherence and persistence rates including medication type, dosing frequency, patient age, racial background, family structure and the presence of comorbidities.

• • Adherence and persistence rates determined from prospective studies (which also include clinical trial populations) tend to be higher than the rates determined from retrospective prescription claims studies which draw on data relating to large community samples.

• • Differences in how adherence and persistence are defined and measured in various studies limit the potential for accurate cross-study comparisons or meta-analyses.

• • Future work should focus on the development and testing of targeted interventions to improve medication adherence among patients with ADHD.

Notes