Adherence, persistence, and medication discontinuation in patients with attention-deficit/hyperactivity disorder – a systematic literature review

Figures & data

Table 1 Selection criteria of systematic review

Inclusion criteria	Publication type
	• Full-text primary publications of real-world studies
	• Treatment guidelines for US, Canada, UK, Germany, France, Spain, Italy, Sweden, and the Netherlands – as well as any general European guidelines
	• Editorials and commentaries
	• Reviews (systematic and nonsystematic) and meta-analyses of real-world studies
	Study design of real-world studies
	• Observational studies based on real-world data (cohort studies, including both prospective and retrospective designs, cross-sectional studies, and case-control studies)
	• Phase IV clinical trials
	Population
	• At least 80% of study population (children, adolescents, or adults) have ADHD as the primary disorder
	Interventions
	• ADHD drug treatment approved as of September 2013 by a regulatory agency in North America or Europe for ADHD in monotherapy or in combination therapy, ie:
	○ Stimulants: MPH, AMPH/dexamphetamine, and lisdexamfetamine
	○ Nonstimulants: ATX, GXR, and clonidine extended release
	• Two off-label medications commonly used in ADHD:
	○ GIR and CIR
	Outcomes
	• Reported discontinuation/switching results, or
	• Reported reasons for discontinuation/switching of ADHD drug treatment
	Language: English
	Publication date: During or after 1990
Exclusion criteria	Publication type
	• Nonprimary publications of real-world studies (eg, a publication that has less data than the primary publication to report the same outcomes)
	• Conference abstracts or posters
	• Congress proceedings
	• Books/chapters/addresses/bibliographies/biographies/lectures
	• Case reports
	• Letters
	• Treatment guidelines for countries other than: US, Canada, UK, Germany, France, Spain, Italy, Sweden, and the Netherlands
	• Reviews/meta-analyses not of real-world studies
	Study design
	• Preclinical studies
	• Clinical trials (Phase I–Phase III)
	• Prognostic studies
	• Genetic studies
	Population
	• Nonhuman subjects
	• Not ADHD patients
	• <80% of study population have ADHD as the primary disorder
	Intervention
	• No drug treatment
	• Drug treatment not listed in the inclusion criteria
	Outcomes
	• Does not report discontinuation/continuation results, and
	• Does not report reasons for ADHD medication discontinuation
	Language: Non-English
	Publication date: Before 1990

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; MPH, methylphenidate; AMPH, amphetamine; ATX, atomoxetine; GXR, guanfacine extended release; GIR, guanfacine immediate release; CIR, clonidine immediate release.

Figure 1 PRISMA diagram of the literature selection criteria.

Notes: ^aNonrelevant publication type: 1) nonprimary publications of the real-world studies (eg, a publication that has less data than the primary publication to report the same outcomes); 2) conference abstracts or posters; 3) Congress proceedings; 4) books/chapters/addresses/bibliographies/biographies/lectures; 5) case reports; letters; or 6) treatment guidelines for countries other than: US, Canada, UK, Germany, France, Spain, Italy, Sweden, and the Netherlands. ^bNonrelevant study design: preclinical studies; clinical trials; prognostic studies; genetic studies; nonpopulation-based interview studies; economic studies; reviews/meta-analyses not of real-world studies. ^cNonrelevant population: nonhuman subjects; not ADHD patients; <80% of the study population have ADHD as the primary disorder. ^dNonrelevant intervention: no drug treatment; drug treatment not of interest: stimulants (methylphenidate, amphetamine: amphetamine/dexamphetamine and lisdexamfetamine), nonstimulants (atomoxetine, guanfacine immediate/extended release, and clonidine immediate/extended release). ^eNonrelevant outcome: 1) does not report discontinuation/continuation results; and 2) does not report reasons for ADHD drug discontinuation. ^fFor expert opinions (reviews, meta-analysis, editorials/commentaries, treatment guidelines), all the relevant citations for ADHD medication adherence or discontinuation were reviewed, and original papers were screened for inclusion. Reviews and meta-analyses were included for data extraction if they reported expert opinions that were not based on original studies. ^gExpert opinions refer to reviews, meta-analysis, editorials/commentaries, treatment guidelines.
Abbreviations: PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; ADHD, attention-deficit/hyperactivity disorder.

Table 2 Number of studies reporting results for subgroups

	# of studies
	Original study (n=91)	Expert opinion (n=36)
Outcome
Persistence/discontinuation	67	NA
Based on retrospective database	52
Based on patient and parent/caregiver surveys	15
Adherence	26
Based on retrospective database	13
Based on patient and parent/caregiver surveys	10
Based on physician surveys	3
Reasons for discontinuation/nonadherence	41	36
Population
Children and adolescents	62	24
Adults	7	1
Combined age group of children, adolescents, adultsa	22	11
Drug class
Stimulants	56	18
Nonstimulants	7	0
ADHD treatment including stimulants, nonstimulantsb	28	18
Geographic location
North America	45	25
Europe	33	7
Other parts of the world	13	4

Notes:

a Studies conducted in combined age group can report stratified results for children/adolescents or adults.

b Studies that included ADHD treatment can report stratified results for stimulants or nonstimulants.

Abbreviations: NA, not applicable; ADHD, attention-deficit/hyperactivity disorder.

Table 3 Studies included in quantitative analysis for persistence

First author (year)	Persistence measure	Definition	Age group	Treatment
Barner (2011)^Citation37	Treatment duration	Persistence was defined as number of days of continuous therapy (without a specified gap period) during the postindex period (12 months). Gap period was 30 days.	Children and adolescents	Stimulants (LA, SA; MPH, AMPH) and nonstimulants; results reported separately
Palli (2012)^Citation35	Treatment duration	Persistence in terms of time to discontinuation of index medication; switching from one type of preparation within the stimulant class was allowed, but switching to another class was defined as discontinuation of index stimulant. All stimulant recipients were uniformly followed for 1 year (365 days). Gap period was 30 days.	Children and adolescents	Stimulants (LA, SA); results reported separately
Hodgkins (2011)^Citation39,a	Treatment duration	Persistence was defined as number of days (out of 366; follow-up period defined as index day plus 365 days) patient remained on initial therapy. Gap period was 30 days.	Combined age group of children, adolescents, adults; results reported separately	Stimulants (LA MPH; SA MPH); results reported separately
Christensen (2010)^Citation38	Treatment duration	Persistence was calculated as number of days out of 366 (follow-up period defined as index day plus 365 days) that patient remained on index therapy. Gap period was 30 days.	Combined age group of children, adolescents, adults; results reported separately	Stimulants (LA, SA; MPH, AMPH) and nonstimulant (ATX); results reported separately
Marcus (2005)^Citation36	Treatment duration	Duration of MPH treatment episode for each patient was calculated by sequentially counting unduplicated continuous prescriptions using date of prescription and number of days of medications supplied. Episodes of treatment were considered to have terminated if a gap of 30 or more days occurred from end of last prescription supply and start of subsequent prescription.	Children and adolescents	Stimulants (LA MPH; SA MPH); results reported separately

Note:

a Hodgkins et al (2011)³⁹ was excluded from the quantitative summary because it reported fewer results than Christensen (2010) and they both reported results from the same study.

Abbreviations: LA, long acting; SA, short acting; MPH, methylphenidate; AMPH, amphetamine; ATX, atomoxetine.

Table 4 Persistence results (reported as mean treatment duration, in days) from quantitative analysis

Age group	First author (year)	Stimulants		Nonstimulants		LA		SA		MPH		AMPH
		Treatment duration	Sample size	Treatment duration	Sample size	Treatment duration	Sample size	Treatment duration	Sample size	Treatment duration	Sample size	Treatment duration	Sample size
Children and adolescents	Barner (2011)^Citation37	134.98	53,838	153.30	8,516	143.70	44,118	95.40	9,720	135.76	33,852	133.57	19,986
	Palli (2012)^Citation35	97.83	46,135	NA	NA	104.96	33,561	79.97	8,260	NA	NA	NA	NA
	Christensen (2010)^Citation38	232.39	21,386	NA	NA	232.39	21,386	NA	NA	234.40	11,077	230.23	10,309
	Marcus (2005)^Citation36	114.42	11,537	NA	NA	140.30	3,444	103.40	8,093	114.42	11,537	NA	NA
	Pooled	135.97	132,896	153.30	8,516	149.41	102,509	92.99	26,073	150.75	56,466	166.46	30,295
Adults	Barner (2011)^Citation37	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
	Palli (2012)^Citation35	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
	Christensen (2010)^Citation38	229.63	10,906	NA	NA	229.63	10,906	NA	NA	182.90	3,604	252.70	7,302
	Marcus (2005)^Citation36	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
	Pooled	229.63	10,906	NA	NA	229.63	10,906	NA	NA	182.90	3,604	252.70	7,302
Combined age group of children, adolescents, adults	Barner (2011)^Citation37	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
	Palli (2012)^Citation35	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
	Christensen (2010)^Citation38	254.20	47,018	154.30	12,992	239.50	32,292	186.70	10,069	219.20	23,862	240.60	23,156
	Marcus (2005)^Citation36	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
	Pooled	254.20	47,018	154.30	12,992	239.50	32,292	186.70	10,069	219.20	23,862	240.60	23,156

Notes: Treatment duration is defined as the number of days patients stayed on their initial therapy. All four studies use a gap period of 30 days.

Abbreviations: LA, long acting; SA, short acting; MPH, methylphenidate; AMPH, amphetamine; NA, not applicable.

Table 5 Studies included in quantitative analysis for adherence

First author (year)	Adherence measure	Definition	Age group	Treatment
12 months
Hodgkins (2011)^Citation39,a	MPR	Ratio of number of days of initial therapy (sum of days supplied for all filled prescriptions while index therapy persisted, excluding days of supply of the fill that terminated persistence) to total number of days persistent. Observational period was 12 months.	Children and adolescents	Stimulants (LA, SA; MPH, AMPH) and nonstimulant (ATX); results reported separately
Hodgkins (2011)^Citation32	MPR	Ratio of total number of days for which the medication was supplied to total number of days supplied in that year. Observational period was 12 months.	Combined age group of children, adolescents, adults; results reported separately	Stimulants (LA MPH; SA MPH); results reported separately
Christensen (2010)^Citation38	MPR	Ratio of number of days of initial therapy (sum of days supplied for all filled prescriptions while index therapy persisted, excluding days of supply of the fill that terminated persistence) to total number of days persistent. Observation period was 12 months.	Combined age group of children, adolescents, adults; results reported separately	Stimulants (LA, SA; MPH, AMPH) and nonstimulant (ATX); results reported separately
Studies excluded owing to inconsistent measures of MPR
Barner (2011)^Citation37	MPR	Ratio of sum of days of supply to 365 days.	–	–
Saloner (2013)^Citation54	APD	Ratio of days with prescribed medications multiplied by 365 to total days after first prescription. Observation period was 2 years.	–	–
Setyawan (2013)^Citation42	PDC	Ratio of number of days covered by prescribed index medication to 365 days.	–	–
6 months
Sikirica (2013)^Citation53	MPR	Ratio of sum of days of supply to days in 6-month study period.	Children and adolescents	Nonstimulant (GIR, GXR)
Lawson (2012)^Citation30	DPR	Ratio of number of days in which patient possessed medication to 180 day postindex period.	Combined age group of children, adolescents, adults; results reported separately	Stimulants (LA, SA; MPH, AMPH); results reported separately
Studies excluded owing to inconsistent measures of MPR
Sanchez (2005)^Citation24	MPR	Ratio of days of supply from index prescription to last prescription of study period to number of days patient optimally should have received medication. Observation period was 6 months.	–	–

Notes:

a Hodgkins (2011)³⁹ was excluded from the quantitative summary, because it reported fewer results than Christensen (2010). They both reported results from the same study.

Abbreviations: MPR, medication possession ratio; LA, long acting; SA, short acting; MPH, methylphenidate; AMPH, amphetamine; ATX, atomoxetine; APD, annualized prescribed days; PDC, proportion of days covered; GIR, guanfacine immediate release; GXR, guanfacine extended release; DPR, days in possession ratio.

Table 6 Adherence results (mean MPR) from quantitative analysis

Age group	First author (year)	Stimulants		Nonstimulants		LA		SA		MPH		AMPH
		MPR	Sample size	MPR	Sample size	MPR	Sample size	MPR	Sample size	MPR	Sample size	MPR	Sample size
Study period of 12 monthsa
Children and adolescents	Hodgkins (2011)^Citation32	0.64	4,801	0.67	81	0.66	419	0.64	4,382	0.64	4,775	0.56	26
	Christensen (2010)^Citation38	0.56	21,386	NA	NA	0.56	21,386	NA	NA	0.55	11,077	0.56	10,309
	Pooled	0.57	26,187	0.67	81	0.56	21,805	0.64	4,382	0.58	15,852	0.56	10,335
Adults	Hodgkins (2011)^Citation32	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
	Christensen (2010)^Citation38	0.59	10,906	NA	NA	0.59	10,906	NA	NA	0.52	3,604	0.62	7,302
	Pooled	0.59	10,906	NA	NA	0.59	10,906	NA	NA	0.52	3,604	0.62	7,302
Combined age group of children, adolescents, adults	Hodgkins (2011)^Citation32	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
	Christensen (2010)^Citation38	0.57	47,018	0.49	12,992	0.56	32,292	0.43	10,069	0.53	23,862	0.57	23,156
	Pooled	0.57	47,018	0.49	12,992	0.56	32,292	0.43	10,069	0.53	23,862	0.57	23,156
Study period of 6 months
Children and adolescents	Sikirica (2013)^Citation53	NA	NA	0.61	3,087	NA	NA	NA	NA	NA	NA	NA	NA
	Lawson (2012)^Citation30	0.49	14,457	NA	NA	0.50	13,108	0.40	1,349	0.49	10,440	0.49	4,017
	Pooled	0.49	14,457	0.61	3,087	0.50	13,108	0.40	1,349	0.49	10,440	0.49	4,017
Adults	Sikirica (2013)^Citation53	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
	Lawson (2012)^Citation30	0.49	586	NA	NA	0.47	450	0.56	136	0.45	267	0.53	319
	Pooled	0.49	586	NA	NA	0.47	450	0.56	136	0.45	267	0.53	319
Combined age group of children, adolescents, adults	Sikirica (2013)^Citation53	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
	Lawson (2012)^Citation30	0.49	15,055	NA	NA	0.50	13,570	0.41	1,485	0.49	10,707	0.49	4,348
	Pooled	0.49	15,055	NA	NA	0.50	13,570	0.41	1,485	0.49	10,707	0.49	4,348

Note:

a For 12-month studies, the MPR was defined as the ratio of number of days for which the medication was supplied to the total number of days persistent during a 12-month follow-up period.

Abbreviations: MPR, medication possession ratio; LA, long acting; SA, short acting; MPH, methylphenidate; AMPH, amphetamine; NA, not applicable.

Table 7 Most frequently reported reasons for treatment discontinuation in original studies

All original studies (41 studies)			Children and adolescents (31 studies)			Adults (five studies)			Children, adolescents, young adults (five studies)
Reason	na	%b	Reason	na	%b	Reason	na	%b	Reason	na	%b
Adverse effects	30	73	Ineffectiveness/suboptimal response	21	68	Ineffectiveness/suboptimal response	4	80	Adverse effects	5	100
Ineffectiveness/suboptimal response	27	66	Adverse effects	21	68	Adverse effects	4	80	Ineffectiveness/suboptimal response	2	40
Poor adherence	8	20	Poor adherence	7	23	Patient decision	2	40	Dislike of medication	1	20
Parent/caregiver decision	7	17	Parent/caregiver decision	6	19	Symptom relief	2	40	Lack of education	1	20
Symptom relief	7	17	Symptom relief	5	16	Misuse of medication	1	20	Parent/caregiver decision	1	20
Patient attitude	3	7	Patient attitude	3	10	Patient attitude	0	0	Poor adherence	1	20
Dislike of medication	3	7	Dosing inconvenience	3	10	Difficulties in swallowing	0	0	Social stigma	1	20
Dosing inconvenience	3	7	Dislike of medication	2	6	Dislike of medication	0	0	Symptom relief	1	20
Patient decision	3	7	Dosing inconvenience/social stigma	2	6	Dosing inconvenience	0	0	Patient attitude	0	0
Dosing inconvenience/social stigma	2	5	Health care provider decision	2	6	Dosing inconvenience/social stigma	0	0	Difficulties in swallowing	0	0
Health care provider decision	2	5	Patient decision	2	6	Drug holiday	0	0	Dosing inconvenience	0	0
Social stigma	2	5	Difficulties in swallowing	1	3	Forgetting	0	0	Dosing inconvenience/social stigma	0	0
Difficulties in swallowing	1	2	Drug holiday	1	3	Health care provider decision	0	0	Drug holiday	0	0
Drug holiday	1	2	Forgetting	1	3	Ineffectiveness/suboptimal response/adverse effects	0	0	Forgetting	0	0
Forgetting	1	2	Ineffectiveness/suboptimal response/adverse effects	1	3	Lack of access to medication	0	0	Health care provider decision	0	0
Ineffectiveness/suboptimal response/adverse effects	1	2	Lack of access to medication	1	3	Lack of education	0	0	Ineffectiveness/suboptimal response/adverse effects	0	0
Lack of access to medication	1	2	Misdiagnosed	1	3	Misdiagnosed	0	0	Lack of access to medication	0	0
Lack of education	1	2	Parent education	1	3	Parent education	0	0	Misdiagnosed	0	0
Misdiagnosed	1	2	Parent/health care provider decision	1	3	Parent/caregiver decision	0	0	Misuse of medication	0	0
Misuse of medication	1	2	Safety concern	1	3	Parent/health care provider decision	0	0	Parent education	0	0
Parent education	1	2	School factor	1	3	Poor adherence	0	0	Parent/health care provider decision	0	0
Parent/health care provider decision	1	2	Social stigma	1	3	Safety concern	0	0	Patient decision	0	0
Safety concern	1	2	Lack of education	0	0	School factor	0	0	Safety concern	0	0
School factor	1	2	Misuse of medication	0	0	Social stigma	0	0	School factor	0	0

Notes:

a Number of studies reported specified reason for discontinuation.

b Frequency of reporting specified reason for discontinuation, estimated as number of studies reporting specific reason for discontinuation divided by total number of studies in specified group.

Table 8 Most frequently reported reasons for treatment discontinuation in expert opinions

All studies with expert opinions (36 studies)			Children and adolescents (24 studies)			Adults (one study)			Children, adolescents, adults (eleven studies)
Reason	na	%b	Reason	na	%b	Reason	na	%b	Reason	na	%b
Adverse effects	24	67	Adverse effects	15	63	Dosing inconvenience	1	100	Adverse effects	8	73
Dosing inconvenience	14	39	Dosing inconvenience	10	42	Adverse effects	1	100	Dosing inconvenience	3	27
Social stigma	10	28	Patient attitude	8	33	Social stigma	1	100	Forgetting	3	27
Patient attitude	9	25	Social stigma	8	33	Patient attitude	0	0	Ineffectiveness/suboptimal response	3	27
Ineffectiveness/suboptimal response	7	19	Patient–physician communication	5	21	Clinician’s disparity	0	0	Patient attitude	2	18
Patient–physician communication	5	14	Disorder-related factor	4	17	Patient–physician communication	0	0	Difficulties in swallowing	1	9
Disorder-related factor	4	11	Inadequate monitoring	4	17	Comorbidity	0	0	Education	1	9
Forgetting	4	11	Ineffectiveness/suboptimal response	4	17	Difficulties in swallowing	0	0	Social stigma	1	9
Inadequate monitoring	4	11	Comorbidity	2	8	Disorder-related factor	0	0	Clinician’s disparity	0	0
Difficulties in swallowing	3	8	Difficulties in swallowing	2	8	Drug holiday	0	0	Patient–physician communication	0	0
Education	3	8	Education	2	8	Education	0	0	Comorbidity	0	0
Comorbidity	2	6	Lack of access to medication	2	8	Forgetting	0	0	Disorder-related factor	0	0
Lack of access to medication	2	6	Patient characteristics	2	8	Inadequate monitoring	0	0	Drug holiday	0	0
Patient characteristics	2	6	Clinician’s disparity	1	4	Ineffectiveness/suboptimal response	0	0	Inadequate monitoring	0	0
Clinician’s disparity	1	3	Drug holiday	1	4	Lack of access to medication	0	0	Lack of access to medication	0	0
Drug holiday	1	3	Forgetting	1	4	Logistic difficulties	0	0	Logistic difficulties	0	0
Logistic difficulties	1	3	Logistic difficulties	1	4	Patient characteristics	0	0	Patient characteristics	0	0
Poor adherence	1	3	Poor adherence	1	4	Poor adherence	0	0	Poor adherence	0	0
Self-esteem	1	3	Self-esteem	1	4	Self-esteem	0	0	Self-esteem	0	0
Symptom relief	1	3	Symptom relief	1	4	Symptom relief	0	0	Symptom relief	0	0

Notes:

a Number of studies reported specified reason for discontinuation.

b Frequency of reporting specified reason for discontinuation, estimated as number of studies reporting specific reason for discontinuation divided by total number of studies in specified group.

Table S1 A list of ADHD medications approved in North American and European countries

Stimulants/nonstimulants	Medication class	ADHD medications (Medication type, Formulation if available, Manufacturer)
Nonstimulants	Selective norepinephrine reuptake inhibitor	Strattera^® (ATX; Eli Lilly and Company)
		Atomoxetine Teva (ATX; Teva)
	Alpha-2 adrenergic agonist	Intuniv^® (GXR; Shire)
		Guanfacine/Guanfasiini immediate release (GIR)
		Kapvay^® (clonidine hydrochloride, extended release; Concordia Pharmaceuticals)
		Clonidine immediate release (CIR)
Stimulants	Methylphenidate	Biphentin^® (MPH; Perdue Pharma)
		Concerta^® (MPH; Janssen Pharmaceuticals/ALZA Corporation)
		Daytrana^® (MPH; Noven Therapeutics)
		Elmifiten^® (dexmethylphenidate; Alfred E Tiefenbacher Gmbh & Co.)
		Equasym XL^®/Equasym Retard^®/Equasym Depot^®/Quasym LP^® (MPH; Shire)
		Focalin^® (dexmethylphenidate; Novartis)
		Focalin XR^® (dexmethylphenidate, extended release; Novartis)
		Metadate^® (MPH; UCB Pharma)
		Metadate CD^® (MPH, extended release capsules; UCB Pharma)
		Metadate ER^® (MPH, extended release tablets; UCB Pharma)
		Medicebran^® (MPH; Laboratorios Farmacéuticos Rovi)
		Medikid (MPH)
		Medikinet/Medikinet CR^® (MPH; Medice)
		Medikinet^® XL (MPH; Medice)
		Medikinet Retard^® (MPH; Medice)
		Methylin^® (MPH; Mallinckrodt/Shionogi)
		Methylin ER^® (MPH, extended release; Mallinckrodt/Shionogi)
		Methylphenidat-1A pharma^® (MPH; 1 A Pharma)
		Methylphenidat HEXAL^® (MPH; Hexal)
		Methylphenidat-ratiopharm^® (MPH; Ratiopharm)
		Methylpheni TAD^® (MPH; TAD Pharma GmbH)
		Methylphenidat TB (MPH; Alfred E Tiefenbacher GmbH & Co.)
		Methylfenidaat HCl (MPH, hydrochloride)
		Methylfenidaat HCI AET (MPH, hydrochloride; Alfred E Tiefenbacher GmbH & Co.)
		Motiron^® (MPH; Sandoz)
		Methylphenidate Rubio (MPH; Laboratorios Rubió)
		Omozin^® (MPH; Laboratorios Rubió)
		Ritalin/Ritaline^® (MPH; Novartis)
		Ritalin LA^® (MPH, long acting; Novartis)
		Ritalin SR^® (MPH, sustained release; Novartis)
		Rubifen^® (MPH; Laboratorios Rubió)
		Tifinidat (MPH; Alfred E Tiefenbacher GmbH & Co.)
		Quillivant™ (MPH; Pfizer)
		Quillivant XR™ (MPH, extended release; Pfizer)
	Amphetamine	Adderall^® (amphetamine/dextroamphetamine; Shire)
		Adderall XR^® (AMPH/dextroamphetamine, extended release; Shire)
		Dexedrine^® SR (dextroamphetamine, sustained release; Amedra Pharmaceuticals)
		Dexedrine^® spansules^® (dextroamphetamine; Amedra Pharmaceuticals)
		Dextroamphetamine ER (dextroamphetamine, extended release)
		Desoxyn^® (methamphetamine hydrochloride; Recordati Rare Diseases, INC.)
		Dexedrine^® (dextroamphetamine; Amedra Pharmaceuticals LLC)
		Dextrostat^® (dextroamphetamine; Shire)
		Elvanse^® (lisdexamfetamine; Shire)
		LiquADD^® (dextroamphetamine; Auriga Laboratories)
		Metamina (dexamfetamin)
		Vyvanse^® (lisdexamfetamine; Shire)

Notes: Intuniv^® is approved in the US only; Biphentin^® is approved in Canada only; Attentin^® is approved in Germany only. Medikinet Retard^® (not Medikinet XL^®) and Equasym Retard^® (not Equasym XL^®) are approved in Germany. Equasym XL^® is marketed as Metadate CD^® in the US.

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; ATX, atomoxetine; GXR, guanfacine extended release; GIR, guanfacine immediate release; CIR, clonidine immediate release; MPH, methylphenidate; AMPH, amphetamine.

Table S2 List of included original observational studies and bibliographic information

ID	Primary study citation	Reported discontinuation reasons
A1	McCarthy S, Wilton L, Murray M, Hodgkins P, Asherson P, Wong IC. Management of adult attention deficit hyperactivity disorder in UK primary care: a survey of general practitioners. Health Qual Life Outcomes. 2013;11:22.	Yes
A2	Erder MH, Signorovitch JE, Setyawan J, et al. Identifying patient subgroups who benefit most from a treatment: using administrative claims data to uncover treatment heterogeneity. J Med Econ. 2012;15(6):1078–1087.	No
A3	Barner JC, Khoza S, Oladapo A. ADHD medication use, adherence, persistence and cost among Texas Medicaid children. Curr Med Res Opin. 2011;27 Suppl 2:13–22.	No
A4	Kordon A, Stollhoff K, Niederkirchner K, Mattejat F, Rettig K, Schäuble B. Exploring the impact of once-daily OROS^® methylphenidate (MPH) on symptoms and quality of life in children and adolescents with ADHD transitioning from immediate-release MPH. Postgrad Med. 2011;123(5):27–38.	Yes
A5	Mazzone L, Reale L, Mannino V, Cocuzza M, Vitiello B. Lower IQ is associated with decreased clinical response to atomoxetine in children and adolescents with attention-deficit hyperactivity disorder. CNS Drugs. 2011;25(6):503–509.	Yes
A6	Marcus SC, Durkin M. Stimulant adherence and academic performance in urban youth with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2011;50(5):480–489.	No
A7	Fernández-Jaén A, Fernández-Mayoralas DM, Pardos A, Calleja-Pérez B, Muñoz Jareño N. Clinical and cognitive response to extended-release methylphenidate (Medikinet) in attention deficit/hyperactivity disorder: efficacy evaluation. Adv Ther. 2009;26(12):1097–1110.	Yes
A8	Marcus SC, Wan GJ, Zhang HF, Olfson M. Injury among stimulant-treated youth with ADHD. J Atten Disord. 2008;12(1):64–69.	No
A9	Hervey-Jumper H, Douyon K, Franco KN. Deficits in diagnosis, treatment and continuity of care in African–American children and adolescents with ADHD. J Natl Med Assoc. 2006;98(2):233–238.	No
A10	Gimpel GA, Collett BR, Veeder MA, et al. Effects of stimulant medication on cognitive performance of children with ADHD. Clin Pediatr (Phila). 2005;44(5):405–411.	No
A11	Lage M, Hwang P. Effect of methylphenidate formulation for attention deficit hyperactivity disorder on patterns and outcomes of treatment. J Child Adolesc Psychopharmacol. 2004;14(4):575–581.	No
A12	Gormez V, Avery B, Mann H. Switching from immediate release to sustained release methylphenidate in the treatment of children and adolescents with attention deficit/hyperactivity disorder. Eur Rev Med Pharmacol Sci. 2013;17(17):2345–2349.	Yes
A13	Hautmann C, Rothenberger A, Döpfner M. An observational study of response heterogeneity in children with attention deficit hyperactivity disorder following treatment switch to modified-release methylphenidate. BMC Psychiatry. 2013;13:219.	Yes
A14	Sikirica V, et al. Immediate-release versus extended-release guanfacine for treatment of attention-deficit/hyperactivity disorder. Am J Pharm Benefits. 2013;5(4):e85–e94.	No
A15	Saloner B, Fullerton C, McGuire T. The impact of long-acting medications on attention-deficit/hyperactivity disorder treatment disparities. J Child Adolesc Psychopharmacol. 2013;23(6):401–409.	No
A16	Hodgkins P, Setyawan J, Mitra D, et al. Management of ADHD in children across Europe: patient demographics, physician characteristics and treatment patterns. Eur J Pediatr. 2013;172(7):895–906.	No
A17	Setyawan J, Hodgkins P, Guérin A, et al. Comparing treatment adherence of lisdexamfetamine and other medications for the treatment of attention deficit/hyperactivity disorder: a retrospective analysis. J Med Econ. 2013;16(7):962–975.	No
A18	Zetterqvist J, Asherson P, Halldner L, Långström N, Larsson H. Stimulant and non-stimulant attention deficit/hyperactivity disorder drug use: total population study of trends and discontinuation patterns 2006–2009. Acta Psychiatr Scand. 2013;128(1):70–77.	No
A19	Lachaine J, Beauchemin C, Sasane R, Hodgkins PS. Treatment patterns, adherence, and persistence in ADHD: a Canadian perspective. Postgrad Med. 2012;124(3):139–148.	No
A20	Braun S, Russo L, Zeidler J, Linder R, Hodgkins P. Descriptive comparison of drug treatment-persistent, -nonpersistent, and nondrug treatment patients with newly diagnosed attention deficit/hyperactivity disorder in Germany. Clin Ther. 2013;35(5):673–685.	No
A21	Pottegård A, Bjerregaard BK, Glintborg D, Kortegaard LS, Hallas J, Moreno SI. The use of medication against attention deficit/hyperactivity disorder in Denmark: a drug use study from a patient perspective. Eur J Clin Pharmacol. 2013;69(3):589–598.	No
A22	McCarthy S, Wilton L, Murray ML, Hodgkins P, Asherson P, Wong IC. Persistence of pharmacological treatment into adulthood, in UK primary care, for ADHD patients who started treatment in childhood or adolescence. BMC Psychiatry. 2012;12:219.	No
A23	van Stralen JP. The clinical impact of switching attention deficit hyperactivity disorder patients from OROS^®-MPH to Novo-MPH ER-C^®: A paediatric practice review. Paediatr Child Health. 2013;18(2):70–73.	No
A24	Lensing MB, Zeiner P, Sandvik L, Opjordsmoen S. Four-year outcome in psychopharmacologically treated adults with attention-deficit/hyperactivity disorder: a questionnaire survey. J Clin Psychiatry. 2013;74(1):e87–e93.	Yes
A25	Sikirica V, Pliszka SR, Betts KA, et al. Comparative treatment patterns, resource utilization, and costs in stimulant-treated children with ADHD who require subsequent pharmacotherapy with atypical antipsychotics versus non-antipsychotics. J Manag Care Pharm. 2012;18(9):676–689.	No
A26	Garbe E, Mikolajczyk RT, Banaschewski T, et al. Drug treatment patterns of attention-deficit/hyperactivity disorder in children and adolescents in Germany: results from a large population-based cohort study. J Child Adolesc Psychopharmacol. 2012;22(6):452–458.	No
A27	Ruggiero S, Rafaniello C, Bravaccio C, et al. Safety of attention-deficit/hyperactivity disorder medications in children: an intensive pharmacosurveillance monitoring study. J Child Adolesc Psychopharmacol. 2012;22(6):415–422.	Yes
A28	Torgersen T, Gjervan B, Nordahl HM, Rasmussen K. Predictive factors for more than 3 years’ duration of central stimulant treatment in adult attention-deficit/hyperactivity disorder: a retrospective, naturalistic study. J Clin Psychopharmacol. 2012;32(5):645–652.	No
A29	Ercan ES, Kose S, Kutlu A, Akyol O, Durak S, Aydin C. Treatment duration is associated with functioning and prognosis in children with attention deficit hyperactivity disorder. Bulletin of Clinical Psychopharmacology. 2012;22(2):148–160.	No
A30	Zoëga H, Rothman KJ, Huybrechts KF, et al. A population-based study of stimulant drug treatment of ADHD and academic progress in children. Pediatrics. 2012;130(1):e53–e62.	No
A31	Coletti DJ, Pappadopulos E, Katsiotas NJ, Berest A, Jensen PS, Kafantaris V. Parent perspectives on the decision to initiate medication treatment of attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2012;22(3):226–237.	No
A32	Goetz M, Yeh CB, Ondrejka I, et al. A 12-month prospective, observational study of treatment regimen and quality of life associated with ADHD in central and eastern Europe and eastern Asia. J Atten Disord. 2012;16(1):44–59.	Yes
A33	Georgiopoulos AM, Hua LL. The diagnosis and treatment of attention deficit-hyperactivity disorder in children and adolescents with cystic fibrosis: a retrospective study. Psychosomatics. 2011;52(2):160–166.	Yes
A34	Palli SR, Kamble PS, Chen H, Aparasu RR. Persistence of stimulants in children and adolescents with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2012;22(2):139–148.	No
A35	Lawson KA, Johnsrud M, Hodgkins P, Sasané R, Crismon ML. Utilization patterns of stimulants in ADHD in the Medicaid population: a retrospective analysis of data from the Texas Medicaid program. Clin Ther. 2012;34(4):944–956.e4.	No
A36	Rothenberger A, Becker A, Breuer D, Döpfner M. An observational study of once-daily modified-release methylphenidate in ADHD: quality of life, satisfaction with treatment and adherence. Eur Child Adolesc Psychiatry. 2011;20 Suppl 2:S257–S265.	No
A37	Döpfner M, Görtz-Dorten A, Breuer D, Rothenberger A. An observational study of once-daily modified-release methylphenidate in ADHD: effectiveness on symptoms and impairment, and safety. Eur Child Adolesc Psychiatry. 2011;20 Suppl 2:S243–S255.	Yes
A38	Green T, Avda S, Dotan I, et al. Phenotypic psychiatric characterization of children with Williams syndrome and response of those with ADHD to methylphenidate treatment. Am J Med Genet B Neuropsychiatr Genet. 2012;159B(1):13–20.	Yes
A39	Powell SG, Thomsen PH, Frydenberg M, Rasmussen H. Long-term treatment of ADHD with stimulants: a large observational study of real-life patients. J Atten Disord. 2011;15(6):439–451.	Yes
A40	Hodgkins P, Sasané R, Christensen L, Harley C, Liu F. Treatment outcomes with methylphenidate formulations among patients with ADHD: retrospective claims analysis of a managed care population. Curr Med Res Opin. 2011;27 Suppl 2:53–62.	No
A41	Wolff C, Alfred A, Lindermüller A, et al. Effect of transitioning from extended-release methylphenidate onto osmotic, controlled-release methylphenidate in children/adolescents with ADHD: results of a 3-month non-interventional study. Curr Med Res Opin. 2011;27 Suppl 2:35–44.	Yes
A42	Chen CY, Yeh HH, Chen KH, Chang IS, Wu EC, Lin KM. Differential effects of predictors on methylphenidate initiation and discontinuation among young people with newly diagnosed attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2011;21(3):265–273.	No
A43	Didoni A, Sequi M, Panei P, Bonati M; Lombardy ADHD Registry Group. One-year prospective follow-up of pharmacological treatment in children with attention-deficit/hyperactivity disorder. Eur J Clin Pharmacol. 2011;67(10):1061–1067.	Yes
A44	Hodgkins P, Sasané R, Meijer WM. Pharmacologic treatment of attention-deficit/hyperactivity disorder in children: incidence, prevalence, and treatment patterns in the Netherlands. Clin Ther. 2011;33(2):188–203.	No
A45	Niederkirchner K, Slawik L, Wermelskirchen D, Rettig K, Schäuble B. Transitioning to OROS^® methylphenidate from atomoxetine is effective in children and adolescents with ADHD. Expert Rev Neurother. 2011;11(4):499–508.	Yes
A46	Sitholey P, Agarwal V, Chamoli S. A preliminary study of factors affecting adherence to medication in clinic children with attention-deficit/hyperactivity disorder. Indian J Psychiatry. 2011;53(1):41–44.	Yes
A47	Torres A, Whitney J, Rao S, Tilley C, Lobel R, Gonzalez-Heydrich J. Tolerability of atomoxetine for treatment of pediatric attention-deficit/hyperactivity disorder in the context of epilepsy. Epilepsy Behav. 2011;20(1):95–102.	Yes
A48	van den Ban E, Souverein PC, Swaab H, van Engeland H, Egberts TC, Heerdink ER. Less discontinuation of ADHD drug use since the availability of long-acting ADHD medication in children, adolescents and adults under the age of 45 years in the Netherlands. Atten Defic Hyperact Disord. 2010;2(4):213–220.	No
A49	Scott NG, Ripperger-Suhler J, Rajab MH, Kjar D. Factors associated with atomoxetine efficacy for treatment of attention-deficit/hyperactivity disorder in children and adolescents. J Child Adolesc Psychopharmacol. 2010;20(3):197–203.	Yes
A50	Bejerot S, Rydén EM, Arlinde CM. Two-year outcome of treatment with central stimulant medication in adult attention-deficit/hyperactivity disorder: a prospective study. J Clin Psychiatry. 2010;71(12):1590–1597.	Yes
A51	Christensen L, Sasané R, Hodgkins P, Harley C, Tetali S. Pharmacological treatment patterns among patients with attention-deficit/hyperactivity disorder: retrospective claims-based analysis of a managed care population. Curr Med Res Opin. 2010;26(4):977–989.	No
A52	Atzori P, Usala T, Carucci S, Danjou F, Zuddas A. Predictive factors for persistent use and compliance of immediate-release methylphenidate: a 36-month naturalistic study. J Child Adolesc Psychopharmacol. 2009;19(6):673–681.	Yes
A53	Janols LO, Liliemark J, Klintberg K, von Knorring AL. Central stimulants in the treatment of attention-deficit hyperactivity disorder (ADHD) in children and adolescents. A naturalistic study of the prescription in Sweden, 1977–2007. Nord J Psychiatry. 2009;63(6):508–516.	Yes
A54	Winterstein AG, Gerhard T, Shuster J, Saidi A. Cardiac safety of methylphenidate versus amphetamine salts in the treatment of ADHD. Pediatrics. 2009;124(1):e75–e80.	No
A55	Banerjee S. Use of atomoxetine in children and adolescents with ADHD. Prog Neurol Psychiatry. 2009;13(2):18–20.	Yes
A56	Chou WJ, Chou MC, Tzang RF, et al. Better efficacy for the osmotic release oral system methylphenidate among poor adherents to immediate-release methylphenidate in the three ADHD subtypes. Psychiatry Clin Neurosci. 2009;63(2):167–175.	No
A57	Romano E, Thornhill S, Lacourse E. An 8-year follow-up study of profiles and predictors of methylphenidate use in a nationwide sample of boys. J Pediatr. 2009;155(5):721–727.	Yes
A58	Berger I, Dor T, Nevo Y, Goldzweig G. Attitudes toward attention-deficit hyperactivity disorder (ADHD) treatment: parents’ and children’s perspectives. J Child Neurol. 2008;23(9):1036–1042.	No
A59	Ramos-Quiroga JA, Bosch R, Castells X, et al. Effect of switching drug formulations from immediate-release to extended-release OROS methylphenidate: a chart review of Spanish adults with attention-deficit hyperactivity disorder. CNS Drugs. 2008;22(7):603–611.	No
A60	Winterstein AG, Gerhard T, Shuster J, et al. Utilization of pharmacologic treatment in youths with attention deficit/hyperactivity disorder in Medicaid database. Ann Pharmacother. 2008;42(1):24–31.	No
A61	Bokhari FAS, Heiland F, Levine P, Ray GT. Risk factors for discontinuing drug therapy among children with ADHD. Health Services and Outcomes Research Methodology. 2008;8(3):134–158.	No
A62	Kurscheidt JC, Peiler P, Behnken A, et al. Acute effects of methylphenidate on neuropsychological parameters in adults with ADHD: possible relevance for therapy. J Neural Transm. 2008;115(2):357–362.	Yes
A63	Darredeau C, Barrett SP, Jardin B, Pihl RO. Patterns and predictors of medication compliance, diversion, and misuse in adult prescribed methylphenidate users. Hum Psychopharmacol. 2007;22(8):529–536.	Yes
A64	Olfson M, Marcus SC, Zhang HF, Wan GJ. Continuity in methylphenidate treatment of adults with attention-deficit/hyperactivity disorder. J Manag Care Pharm. 2007;13(7):570–577.	No
A65	Moosa F, Lohawala A. ADHD – do guidelines translate into service? Child Adolesc Ment Health. 2007;12(2):73–75.	Yes
A66	Johnston JA, Ye W, Van Brunt DL, Pohl G, Sumner CR. Decreased use of clonidine following treatment with atomoxetine in children with ADHD. J Clin Psychopharmacol. 2006;26(4):389–395.	No
A67	Thompson AE, Nazir SA, Abbas MJ, Clarke J. Switching from immediate- to sustained-release psychostimulants in routine treatment of children with attention-deficit hyperactivity disorder. Psychiatric Bulletin. 2006;30:247–250.	Yes
A68	Charach A, Skyba A, Cook L, Antle BJ. Using stimulant medication for children with ADHD: what do parents say? A brief report. J Can Acad Child Adolesc Psychiatry. 2006;15(2):75–83.	Yes
A69	Kemner JE, Lage MJ. Impact of methylphenidate formulation on treatment patterns and hospitalizations: a retrospective analysis. Ann Gen Psychiatry. 2006;5:5.	No
A70	Concannon PE, Tang YP. Management of attention deficit hyperactivity disorder: a parental perspective. J Paediatr Child Health. 2005;41(12):625–630.	No
A71	Marcus SC, Wan GJ, Kemner JE, Olfson M. Continuity of methylphenidate treatment for attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med. 2005;159(6):572–578.	No
A72	Monastra VJ. Overcoming the barriers to effective treatment for attention-deficit/hyperactivity disorder: a neuro-educational approach. Int J Psychophysiol. 2005;58(1):71–80.	Yes
A73	Sanchez RJ, Crismon ML, Barner JC, Bettinger T, Wilson JP. Assessment of adherence measures with different stimulants among children and adolescents. Pharmacotherapy. 2005;25(7):909–917.	No
A74	Romano E, Baillargeon RH, Fortier I, et al. Individual change in methylphenidate use in a national sample of children aged 2 to 11 years. Can J Psychiatry. 2005;50(3):144–152.	No
A75	Huskamp HA, Deverka PA, Epstein AM, et al. Impact of 3-tier formularies on drug treatment of attention-deficit/hyperactivity disorder in children. Arch Gen Psychiatry. 2005;62(4):435–441.	No
A76	Bussing R, Zima BT, Mason D, Hou W, Garvan CW, Forness S. Use and persistence of pharmacotherapy for elementary school students with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2005;15(1):78–87.	Yes
A77	Perwien A, Hall J, Swensen A, Swindle R. Stimulant treatment patterns and compliance in children and adults with newly treated attention-deficit/hyperactivity disorder. J Manag Care Pharm. 2004;10(2):122–129.	No
A78	Miller AR, Lalonde CE, McGrail KM. Children’s persistence with methylphenidate therapy: a population-based study. Can J Psychiatry. 2004;49(11):761–768.	No
A79	Bauermeister JJ, Canino G, Bravo M, et al. Stimulant and psychosocial treatment of ADHD in Latino/Hispanic children. J Am Acad Child Adolesc Psychiatry. 2003;42(7):851–855.	Yes
A80	Thiruchelvam D, Charach A, Schachar RJ. Moderators and mediators of long-term adherence to stimulant treatment in children with ADHD. J Am Acad Child Adolesc Psychiatry. 2001;40(8):922–928.	Yes
A81	Grcevich S, Rowane WA, Marcellino B, Sullivan-Hurst S. Retrospective comparison of Adderall and methylphenidate in the treatment of attention deficit hyperactivity disorder. J Child Adolesc Psychopharmacol. 2001;11(1):35–41.	No
A82	Hazell PL, McDowell MJ, Walton JM. Management of children prescribed psychostimulant medication for attention deficit hyperactivity disorder in the Hunter region of NSW. Med J Aust. 1996;165(9):477–480.	No
A83	McCarthy S, Asherson P, Coghill D, et al. Attention-deficit hyperactivity disorder: treatment discontinuation in adolescents and young adults. Br J Psychiatry. 2009;194(3):273–277.	No
A84	Bowen J, Fenton T, Rappaport L. Stimulant medication and attention deficit-hyperactivity disorder. The child’s perspective. Am J Dis Child. 1991;145(3):291–295.	Yes
A85	Johnston C, Seipp C, Hommersen P, Hoza B, Fine S. Treatment choices and experiences in attention deficit and hyperactivity disorder: relations to parents’ beliefs and attributions. Child Care Health Dev. 2005;31(6):669–677.	Yes
A86	Dosreis S, Zito JM, Safer DJ, Soeken KL, Mitchell JW, Ellwood LC. Parental perceptions and satisfaction with stimulant medication for attention-deficit hyperactivity disorder. J Dev Behav Pediatr. 2003;24(3):155–162.	Yes
A87	Gau SS, Chen SJ, Chou WJ, et al. National survey of adherence, efficacy, and side effects of methylphenidate in children with attention-deficit/hyperactivity disorder in Taiwan. J Clin Psychiatry. 2008;69(1):131–140.	Yes
A88	dosReis S, Butz A, Lipkin PH, Anixt JS, Weiner CL, Chernoff R. Attitudes about stimulant medication for attention-deficit/hyperactivity disorder among African American families in an inner city community. J Behav Health Serv Res. 2006;33(4):423–430.	Yes
A89	Gau SS, Shen HY, Chou MC, Tang CS, Chiu YN, Gau CS. Determinants of adherence to methylphenidate and the impact of poor adherence on maternal and family measures. J Child Adolesc Psychopharmacol. 2006;16(3):286–297.	Yes
A90	Charach A, Gajaria A, Skyba A, Chen S. Documenting adherence to psychostimulants in children with ADHD. J Can Acad Child Adolesc Psychiatry. 2008;17(3):131–136.	Yes
A91	Ibrahim el SR. Rates of adherence to pharmacological treatment among children and adolescents with attention deficit hyperactivity disorder. Hum Psychopharmacol. 2002;17(5):225–231.	Yes

Table S3 List of included studies with expert opinions and bibliographic information

ID	Primary study citation
B1	Weiss M, Jain U, Garland J. Clinical suggestions for management of stimulant treatment in adolescents. Can J Psychiatry. 2000;45(8):717–723.
B2	Charach A, Fernandez R. Enhancing ADHD medication adherence: challenges and opportunities. Curr Psychiatry Rep. 2013;15(7):371.
B3	Rothenberger A, Rothenberger LG. Updates on treatment of attention-deficit/hyperactivity disorder: facts, comments, and ethical considerations. Curr Treat Options Neurol. 2012;14(6):594–607.
B4	Rothenberger A, Döpfner M. Editorial: Observational studies in ADHD: the effects of switching to modified-release methylphenidate preparations on clinical outcomes and adherence. Eur Child Adolesc Psychiatry. 2011;20 Suppl 2:S235–S242.
B5	Brinkman WB, Epstein JN. Treatment planning for children with attention-deficit/hyperactivity disorder: treatment utilization and family preferences. Patient Prefer Adherence. 2011;5:45–56.
B6	Graham J, Banaschewski T, Buitelaar J, et al; European Guidelines Group. European guidelines on managing adverse effects of medication for ADHD. Eur Child Adolesc Psychiatry. 2011;20(1):17–37.
B7	Chacko A, Newcorn JH, Feirsen N, Uderman JZ. Improving medication adherence in chronic pediatric health conditions: a focus on ADHD in youth. Curr Pharm Des. 2010;16(22):2416–2423.
B8	Rösler M, Casas M, Konofal E, Buitelaar J. Attention deficit hyperactivity disorder in adults. World J Biol Psychiatry. 2010;11(5):684–698.
B9	Van der Westhuuizen A. Evidence-based pharmacy practice (EBPP): attention deficit hyperactivity disorder (ADHD). SA Pharmaceutical Journal. 2010;77(8):10–14,16, 18–20.
B10	Buitelaar J, Medori R. Treating attention-deficit/hyperactivity disorder beyond symptom control alone in children and adolescents: a review of the potential benefits of long-acting stimulants. Eur Child Adolesc Psychiatry. 2010;19(4):325–340.
B11	Dopheide JA. The role of pharmacotherapy and managed care pharmacy interventions in the treatment of ADHD. Am J Manag Care. 2009;15(5 Suppl):S141–S150.
B12	Coury D. Dexmethylphenidate for attention deficit hyperactivity disorder. Expert Opin Pharmacother. 2009;10(16):2679–2685.
B13	Graham L. AHA releases recommendations on cardiovascular monitoring and the use of ADHD medications in children with heart disease. Am Fam Physician. 2009;79(10):905–910.
B14	Dopheide JA, Pliszka SR. Attention-deficit-hyperactivity disorder: an update. Pharmacotherapy. 2009;29(6):656–679.
B15	Barkley RA. Global issues related to the impact of untreated attention-deficit/hyperactivity disorder from childhood to young adulthood. Postgrad Med. 2008;120(3):48–59.
B16	Van Cleave J, Leslie LK. Approaching ADHD as a chronic condition: implications for long-term adherence. J Psychosoc Nurs Ment Health Serv. 2008;46(8):28–37.
B17	Charach A, Gajaria A. Improving psychostimulant adherence in children with ADHD. Expert Rev Neurother. 2008;8(10):1563–1571.
B18	Schlander M. Is NICE infallible? A qualitative study of its assessment of treatments for attention-deficit/hyperactivity disorder (ADHD). Curr Med Res Opin. 2008;24(2):515–535.
B19	Weisler RH. Review of long-acting stimulants in the treatment of attention deficit hyperactivity disorder. Expert Opin Pharmacother. 2007;8(6):745–758.
B20	Manos MJ, Tom-Revzon C, Bukstein OG, Crismon ML. Changes and challenges: managing ADHD in a fast-paced world. J Manag Care Pharm. 2007;13(9 Suppl B):S2–S13; quiz S14–S16.
B21	López FA. ADHD: new pharmacological treatments on the horizon. J Dev Behav Pediatr. 2006;27(5):410–416.
B22	Ashton H, Gallagher P, Moore B. The adult psychiatrist’s dilemma: psychostimulant use in attention deficit/hyperactivity disorder. J Psychopharmacol. 2006;20(5):602–610.
B23	Wolraich ML, Wibbelsman CJ, Brown TE, et al. Attention-deficit/hyperactivity disorder among adolescents: a review of the diagnosis, treatment, and clinical implications. Pediatrics. 2005;115(6):1734–1746.
B24	Dodson WW. Pharmacotherapy of adult ADHD. J Clin Psychol. 2005;61(5):589–606.
B25	Staufer WB, Greydanus DE. Attention-deficit/hyperactivity disorder psychopharmacology for college students. Pediatr Clin North Am. 2005;52(1):71–84, viii.
B26	Olfson M. New options in the pharmacological management of attention-deficit/hyperactivity disorder. Am J Manag Care. 2004;10(4 Suppl):S117–S124.
B27	Greydanus DE, Pratt HD, Sloane MA, Rappley MD. Attention-deficit/hyperactivity disorder in children and adolescents: interventions for a complex costly clinical conundrum. Pediatr Clin North Am. 2003;50(5):1049–1092, vi.
B28	Swanson J. Compliance with stimulants for attention-deficit/hyperactivity disorder: issues and approaches for improvement. CNS Drugs. 2003;17(2):117–131.
B29	Bussing R, Gary FA. Practice guidelines and parental ADHD treatment evaluations: friends or foes? Harv Rev Psychiatry. 2001;9(5):223–233.
B30	Smith BH, Waschbusch DA, Willoughby MT, Evans S. The efficacy, safety, and practicality of treatments for adolescents with attention-deficit/hyperactivity disorder (ADHD). Clin Child Fam Psychol Rev. 2000;3(4):243–267.
B31	Stine JJ. Psychosocial and psychodynamic issues affecting noncompliance with psychostimulant treatment. J Child Adolesc Psychopharmacol. 1994;4(2):75–86.
B32	Hodgkins P, Shaw M, Coghill D, Hechtman L. Amfetamine and methylphenidate medications for attention-deficit/hyperactivity disorder: complementary treatment options. Eur Child Adolesc Psychiatry. 2012;21(9):477–492.
B33	Jensen CE. Medication for children with attention-deficit hyperactivity disorder. Clin Social Work J. 2004;32(2):197–214.
B34	Garland EJ. Pharmacotherapy of adolescent attention deficit hyperactivity disorder: challenges, choices and caveats. J Psychopharmacol. 1998;12(4):385–395.
B35	Greenhill LL, Pliszka S, Dulcan MK, et al. Summary of the practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults. J Am Acad Child Adolesc Psychiatry. 2001;40(11):1352–1355.
B36	Pliszka S; AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46(7):894–921.

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