Phase-specific strategies and interventions to enhance medication adherence across different phases in ADHD: a systematic review and meta-analysis

Figures & data

Table 1. Study characteristics.

Authors, year	Country	Study design	Sample size	Study duration	Adherence measure	Adherence phase	Medication
Bai et al., 2015	China	Randomised trial	Intervention = 44 Control = 45	3 months	Medication possession ratio	Discontinuation	Stimulants Non-stimulants
Biederman et al., 2019	US	Non-randomized study	Intervention = 92 Control = 460	1.5 months	Prescription refill	Implementation	Stimulants
Biederman et al., 2020	US	Non-randomized study	Intervention = 112 Control = 336	1.5 months	Prescription refill	Implementation	Stimulants
Carvalho et al., 2023	Brazil	Randomised trial	Intervention 1 = 25 Intervention 2 = 24 Control = 24	3 months	Medication possession ratio	Implementation	Stimulants
Enns et al., 2017	Canada	Non-randomized study	Intervention = 485 Control = 1884	3–6 months	Medication possession ratio	Implementation	Stimulants Non-stimulants
Fried et al., 2020	US	Non-randomized study	Intervention = 87 Control = 246	1.5 months	Prescription refill	Implementation	Stimulants
Gau & Zhu, 2015	China	Non-randomized study	Intervention = 245 Control = 149	6 months	Self-report (telephone) Prescription refill	Initiation Discontinuation	Stimulants Non-stimulants
Hernani et al., 2017	Spain	Non-randomized study	Intervention = 73 Control = 68	6 months	Self-reported (evaluated on follow-up visit)	Discontinuation	Methylphenidate (Stimulant)
Hogue et al., 2016	US	Non-randomized study	Intervention = 14 Control = 21	Not clear	Self-reported (FT Adherence scale)	Initiation	Stimulants Non-stimulants
Meyers et al., 2017	US	Non-randomized study	*Cohort size = 165	6 months or earlier in case of discontinuation	Medication possession ratio	Implementation	Stimulants Non-stimulants
Monastra, 2005	US	Non-randomized study	*Cohort size = 658	Three 90 min sessions followed up for 2 years	Self-reported (evaluated on follow-up visit)	Discontinuation	Stimulants Non-stimulants
Montoya et al., 2014	Canada	Randomised trial	Intervention = 144 Control = 126	Five weekly 90-minute sessions followed up for 1 year	Self-reported (evaluated on follow-up visit)	Discontinuation	Stimulants Non-stimulants
Nagae et al., 2019	Japan	Non-randomized study	Intervention = 17 Control = 24	Five 90-minute sessions followed up at 3 months	Self-reported (CAQ)	Implementation	Stimulants Non-stimulants
Quiroga et al., 2008	Spain	Non-randomized study	*Cohort size = 70	6 months	Self-reported (SMAQ)	Implementation	Stimulants
Weisman et al., 2018	Israel	Randomised trial	Intervention = 19 Control = 20	2 months	Pill count (log book)	Implementation	Stimulants
Williams et al., 2021	UK	Randomised trial	Intervention = 21 Control = 23	12 weeks	Parents-reported log book	Initiation	Stimulants
Zheng et al., 2020	China	Randomised trial	Intervention = 116 Control = 95	6 months	Self-reported (MARS)	Implementation	Stimulants Non-stimulants

*There was only one group which was followed after the intervention; hence no separate control group was applicable.

Table 2. Type of interventions and their impact.

Authors, year	Type of intervention	Intervention delivered by	Intervention delivered to	Major element of intervention	Intervention outcome
Bai et al., 2015	Educational	Healthcare professional	Parents	Psychoeducation (expert lecture and parent manual, group sessions, online community engagement).	Intervention group People who adhered = 37 (n = 44) Control group People who adhered = 24 (n = 45)
Biederman et al., 2019	Behavioural	Digital	Adults	Text messages	Intervention group People who adhered = 62 (n = 92) Control group People who adhered = 156 (n = 460) AOR = 4.04
Biederman et al., 2020	Behavioural	Digital	Adults	Text messages	Intervention group People who adhered = 96 (n = 112) Control group People who adhered = 144 (n = 336)
Carvalho et al., 2023	Multifaceted (Educational+behavioural)	Digital	Adults	Digital application (treatment information, therapeutic plan, educational content, pill reminders)	Intervention group 1 People who adhered = 25 (n = 25) Intervention group 2 People who adhered = 24 (n = 24) Control group People who adhered = 24 (n = 24)
Enns et al., 2017	Multifaceted (Educational+behavioural +affective)	Healthcare professional	Children (5–17 years) Parents	Individual therapy, parent support, group therapy, education, and medication management	Intervention group Crude rate = 0.36 (n = 485) Control group Crude rate = 0.23 (n = 1884) ARR = 1.42
Fried et al., 2020	Multifaceted (Educational+behavioural)	Digital	Parents	Text messages (Refill reminder + educational content)	Intervention group People who adhered = 74 (n = 87) Control group People who adhered = 152 (n = 246) OR = 3.46
Gau & Zhu, 2015	Educational	Healthcare professional	Parents	Two group parent education sessions	Intervention group People who adhered at: Initiation Phase = 226 (n = 245) Discontinuation Phase = 193 (n = 226) Control group People who adhered at: Initiation Phase = 119 (n = 149) Discontinuation Phase = 15 (n = 119)
Hernani et al., 2017	Behavioural	Healthcare professional	Parents	Use of written informed consent for treatment with methylphenidate	Intervention group People who adhered = 62 (n = 67) Control group People who adhered = 48 (n = 63) RRR = 0.67
Hogue et al., 2016	Multifaceted (Educational+affective)	Healthcare professional	Children (13–17 years) Parents	The Medication Integration Protocol: Family ADHD psychoeducation (education), Family-based medication decision-making interventions (attitudes)	Intervention group People who adhered = 6 (n = 14) Control group People who adhered = 1 (n = 21)
Meyers et al., 2017	Behavioural	Healthcare professional	Children (6–17 years)	Add guanfacine to the regimen	After intervention People who adhered = 129 (n = 165) Before intervention All were non-adherent n = 165
Monastra, 2005	Multifaceted (Educational+affective)	Healthcare professional	Parents	Neurologic assessment and series of ‘“lessons”’ for parents, presenting information about ADHD and its medication and co-developing support plan.	After intervention People who adhered = 632 (n = 658) Before intervention All were non-adherent n = 658
Montoya et al., 2014	Educational	Healthcare professional	Parents	Psychoeducation (lectures, small-group and large-group discussions, shared learning from previous sessions, and homework)	Intervention People who adhered = 125/144 Control People who adhered = 108/126
Nagae et al., 2019	Educational	Healthcare professional	Parents Children (8–15 years)	Lecture, Discussion, Recreation, and Homework.	Intervention Adherence value (Median) increased: 4 to 6 (n = 15) Control Adherence value (Median) increased: 2 to 4 (n = 18)
Quiroga et al., 2008	Behavioural	Healthcare professional	Adults	Switch from IR to OROS	Intervention People who adhered = 68 (n = 70) Before intervention People who adhered = 32 (n = 70)
Weisman et al., 2018	Behavioural	Digital	Parents Children (6–16 years)	Reminders, information to parents/children, communication with physician	Intervention (Pill count) Median = 20.74 Adherence = 0.92 (out of 1) (n = 19) Control (Pill count) Median = 13.40 Adherence = 0.72 (out of 1) (n = 20)
Williams et al., 2021	Behavioural	Healthcare professional	Children (6–17 years) Parents	Qb Test medication monitoring intervention	Intervention People who adhered = 7 (n = 8) Control People who adhered = 9 (n = 9)
Zheng et al., 2020	Multifaceted (Educational+behavioural)	Healthcare professional	Parents Teachers	Education about ADHD and its medication, behavioural strategy to manage ADHD	Intervention People who adhered = 82 (n = 116) Control People who adhered = 35 (n = 95)

Figure 1a. Forest plot of randomized control trials.

Figure 1b. Forest plot of randomized control trials (Discontinuation phase).

*Proportion.

Figure 2. Forest plot of non-randomized control trials presenting proportion of people adhered to the treatment.