Medication adherence and persistence in children and adolescents with attention deficit hyperactivity disorder (ADHD): a systematic review and qualitative update

Maite Ferrin; Alexander Häge; James Swanson; Kirstie H T W Wong; Ralf W Dittmann; Tobias Banaschewski; David Coghill; Paramala J Santosh; Marcel Romanos; Emily Simonoff; Jan K Buitelaar; European ADHD Guidelines Group (EAGG)

doi:10.1007/s00787-024-02538-z

Medication adherence and persistence in children and adolescents with attention deficit hyperactivity disorder (ADHD): a systematic review and qualitative update

Eur Child Adolesc Psychiatry. 2024 Aug 6. doi: 10.1007/s00787-024-02538-z. Online ahead of print.

Authors

Maite Ferrin^{1

2}, Alexander Häge³, James Swanson⁴, Kirstie H T W Wong^{5

6}, Ralf W Dittmann⁷, Tobias Banaschewski³, David Coghill^{8

9}, Paramala J Santosh^{10

11}, Marcel Romanos¹², Emily Simonoff¹³, Jan K Buitelaar^{14

15}; European ADHD Guidelines Group (EAGG)

Collaborators

Affiliations

¹ Child and Adolescent Mental Health Service, Barnet Enfield and Haringey NHS Trust, London, UK. [email protected].
² ReCognition Health, London, UK. [email protected].
³ Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
⁴ Department of Pediatrics, University of California, Irvine, CA, USA.
⁵ Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China.
⁶ Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London, WC1H 9JP, UK.
⁷ Paediatric Psychopharmacology, Dept of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Heidelberg, Germany.
⁸ Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
⁹ Murdoch Children's Research Institute, Melbourne, Australia.
¹⁰ Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹¹ South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK.
¹² Department of Child and Adolescent Psychiatry, Center of Mental Health, University Hospital Wuerzburg, Würzburg, Germany.
¹³ Institute of Psychiatry, Psychology and Neuroscience and Maudsley NIHR Biomedical Research Centre, King's College London, London, UK.
¹⁴ Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.
¹⁵ Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands.

PMID: 39105823
DOI: 10.1007/s00787-024-02538-z

Abstract

Low medication-adherence and persistence may reduce the effectiveness of ADHD-medication. This preregistered systematic review (PROSPERO CRD42020218654) on medication-adherence and persistence in children and adolescents with ADHD focuses on clinically relevant questions and extends previous reviews by including additional studies. We included a total of n = 66 studies. There was a lack of consistency in the measurement of adherence/persistence between studies. Pooling the medication possession ratios (MPR) and using the most common adherence definition (MPR ≥ 80%) indicated that only 22.9% of participants had good adherence at 12-month follow-up. Treatment persistence on medication measured by treatment duration during a 12-month follow-up averaged 170 days (5.6 months). Our findings indicate that medication-adherence and persistence among youth with ADHD are generally poor and have not changed in recent years. Clinicians need to be aware that various factors may contribute to poor adherence/persistence and that long-acting stimulants and psychoeducational programs may help to improve adherence/persistence. However, the evidence to whether better adherence/persistence contributes to better long-term outcomes is limited and requires further research.

Keywords: ADHD medication; Adherence; Adolescents; Children; Persistence; Systematic literature review.

Publication types

Review