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1yr
Addressing treatment nonadherence in children with ADHD

Adherence to Attention Deficit Hyperactivity Disorder (ADHD) medication among the pediatric population is low (≈64%). Nonadherence is related to various factors, including those involving caregivers, the healthcare system, medications, and children themselves. It’s important to address these factors to enhance long-term outcomes.

Experts recommend various interventions to address factors that contribute to nonadherence, including:

  • Family education in cases when parents believe that the symptoms are not due to a psychiatric etiology
  • Family education when the use of ADHD medication is stigmatized by the family
  • Behavior strategies (eg, Cognitive-Behavioral Therapy) when there is conflict between the caregiver and child regarding treatment or when the child refuses to take the ADHD medication
  • Behavior strategies (eg, behavioral parent training, multisystemic therapy for conduct disorder) when comorbidities (eg, oppositional defiant disorder, conduct disorder) interfere with the child’s ability to take ADHD medication
  • Clinician intervention in cases of medication ineffectiveness, adverse events, multiple daily doses/onerous medication regimen, and a paucity of medication titration

When ADHD drugs are more effective, medication adherence improves. Dosing factors and medication titration are also associated with improved adherence. Using a streamlined dose regimen can increase adherence, with patients prescribed long-acting formulations having higher rates of adherence than those prescribed short-acting formulations.

Long-acting stimulants may yield more balanced and sustained effects on ADHD symptoms throughout the day. The burden of taking multiple daily doses and the stigma of mid–school-day dosing could also attenuate adherence in children taking short-acting formulations.

What is your clinical experience with long-acting stimulants for ADHD? What factors could boost adherence in your patients?

  • 1yr
    Short or frequent dosed medications worsen compliance compared to extended release options.
  • 2yr
    I’m always surprised by the number of my patients that don’t fill their scripts.
  • 2yr
    In my experience with adults and young adults, patients are about 70 to 80% treatment-adherent, and patients usually fill their prescriptions somewhat late. I understand that long-acting medications might well increase adherence since the pediatric patients cant take their medications at home.
  • 2yr
    I'm a bit surprised that medication adherence is found to be low among adolescents. In my experience, they are actually compliant in terms of taking their ADHD medication regularly.
    Counselling starts before we even write the prescription. Discuss any potential side effects so patient and caregivers are aware. Also, invite them to voice all their concerns and ask any questions. This will lessen any barriers that they may have regarding the medication.
  • 2yr
    Medication non-compliance in general is not uncommon in adolescent patients and is the usual cause of adolescent diabetic patients presenting to the ER in DKA. It is not suprising that some adolescent patients stop taking their ADHD meds. As the saying goes, "you can lead a horse to water but you can't make them drink". John
  • 2yr
    Long acting medications provide a better steady state level of medication. Also improves adherence to regimen.
  • 2yr
    Using long-acting stimulants is far preferable and improves compliance. Rarely my patients have needed a boost from short-acting stimulants at mid-day.
  • 2yr
    Long acting stimulants always bettet
  • 2yr
    New MOA can not only be effective in treatment of syndrome but can also aid compliance
  • 2yr
    I routinely write for long acting stimulants. I have not found non adherence to be a problem. Typically not taking medication has negative consequences in the school setting that are quickly pointed out to the family. So making sure patient truly needs the medication and explaining how the medication is suppose to be taking and effects will help wit adherence
  • 2yr
    I need to be able to write more than a 30 day supply. So when my patients find it in a pharmacy, they can get a larger amount.
  • 2yr
    Most prescriptions are written for long acting stimulants. Supposedly less daytime variability but everyone's intestinal system is not the same and there is different absorption rates. Issue is that many times it does not last to the evening hours to assist at home with homework and tasks. This will sometime cause parents to complain that the medicine is not effective.
  • 2yr
    prefer long-acting medications only. Anything other than this simply is a recipe for failure
  • 2yr
    Long acting stimulants are standard of care due to effectiveness and convenience and help with school.
  • 2yr
    I have much better success with long acting. It eliminates the neeed for two medications. Compliance with two meds is so much worse than one. As with most conditions compliance is always a significant problem. Perhaps more non-medical intervention would obviate the need for medications.
  • 2yr
    long actiing stimulants have become the standard of care for treatment. Parents are able to supervise dosing before their leave for school. There is no afternoon crash and there is less homework apathy. They are well tolerated and preferred by caregivers and educators.
  • 2yr
    Long-acting stimulants are much better choice and have better patient compliance. It is difficult for teenagers and children to remember to take medication mid-day. One dose in the morning before school is much easier to adhere to.
  • 2yr
    Long acting treatments are very helpful especially with very busy families that have to balance school and after school activities. Adherence is generally better the simpler the requirements, such as taking medication first thing in the morning and/or right before leaving the house in the morning.
  • 2yr
    My experience has likewise been quite positive, and I have also found compliance to be much better with the longer acting stimulants. It is important to have thoughtful and engaging discussions with the parents of these children as their cooperation and support will be instrumental in continuing to ensure good compliance with prescribed therapy.
  • 2yr
    positive experience overall. Long-acting stimulants are better tolerated and promote compliance
  • 2yr
    positive experience overall. Long-acting stimulants are better tolerated and promote compliance
  • 2yr
    Have had positive results for the most part with these medications. To help with adherence would recommend longer acting versions, fewer doses needed.
  • 2yr
    Long-acting stimulants are much preferred for ease of use and better patient compliance. I make sure before starting meds that all adults caretakers understand benefits and are on board with giving these meds. We discuss safety issues and side effects in detail; in particular, that these meds are not habit-forming when used correctly. It's often helpful if they can keep an extra bottle at school for school to administer in the morning on weekdays (pharmacy splits rx into multiple bottles.)
  • 2yr
    I reinforce the body of evidence supporting the use of stimulants in adhd and the significant improvement in outcomes. Patient and family education is critical to overcome the stigmatization of these medications, including educating the caregivers.
  • 2yr
    Generally, good experience with both kids and adults. Generally, they are well-tolerated and improve focus and concentration. Need to titrate cautiously and impress the need for complaince with this with patients and caregivers, as well.
  • 2yr
    My overall experience of using long acting stimulants is good. It really helps with adherence, especially in the pediatric population. Regular follow up (monthly initially at start up) often helps to improve adherence.
  • 2yr
    I have cared for many adults who were diagnosed with ADD and not treated due to parental denial. Many did not complete their education and have struggled in life. Once treated it is life-changing. However, many years were wasted. Multiple interventions as above are needed to address non-compliance.
  • 2yr
    I prefer longer acting/slow release agents for several reasons. First, fewer doses improves outcomes. Second, slow release preparations are associated with fewer peaks and drop offs, so there should be fewer side effects. And, lastly, they are less likely to be abused/manipulated, which is always an issue to keep in mind with controlled prescriptions.
  • 2yr
    we are very strict with the adherence and regulation. We require visits every three months and urine drug screens. Also heavy into counselling.
  • 2yr
    I highly suspect the rate of noncompliance is higher than what is reported. Breaking away from class, sports, activities or social settings to take medications is difficult. The need for long acting stimulants is critical for compliance, reduction of side-effects, and ADHD control. Assuming the cost and availability is not an issue, I would advocate for long-acting stimulants dramatically more.
  • 2yr
    Long acting medications promote adherence…less doses, also less stigma as all doses can be administered at home
  • 2yr
    Good efficacy when the patient is patient with titration. The parents and child find the benefit of efficacy keeps compliance.
  • 2yr
    Education and motivation are important. However also have to be certain that the medication is helping the patient and not causing untoward side effects.
  • 2yr
    Patient motivation is the key for the older kids and parental routines are the key for the younger ones. Set an alarm for every day on the phone at the same time and don't deviate from that schedule. Small routine changes like that can be very helpful.
  • 2yr
    There is a definitely better compliance with longer acting rx/ less burden pill. But for younger patient population, the compliance/adherence really comes down to a self motivation. While some pts see the medication as a burdensome routine while others see it as an important health enhancing part of routine. Also the decreased in adherence could be seen in inadequate or suboptimal response to medications as well.
  • 2yr
    Definitely starting with correct diagnosis is important. Proper engagement of children and the parent/s before initiating the medication and setting appropriate expectations and treatment goals improve adherence. long acting forms improve adherence for sure. analyzing social situation and addressing other comorbidities can improve adherence as well
  • 2yr
    The meds need to be taken Every just school days...the meds have different durations in different kids. the indications that the med has quit is mood swings, crying, or lack of focus. If the child needs an additional dose, this should be considered - whether it be an LA preparation or a SA. Sleep impacts must be addressed - can use clonidine or benadryl or trazadone, etc.
  • 2yr
    I speak to both the patient and the parents at length about adherence to treatment. Many young people are going between two households so it’s critical that both parents are on board. Using a pillbox for an older teen is a great way for a parent to check in on compliance without nagging.
  • 2yr
    Teenagers especially do not want to be different from their peers so any steps to make taking medications easier tends to increase compliance. Back in the day having to go to the principal’s office to get a lunch dose of Ritalin definitely decreased compliance. Long acting stimulants and various dosing forms that could be sprinkled etc were a Godsend!
  • 2yr
    i also prefer long acting stimulants to decrease side effects, simplify schedules.
  • 2yr
    I prefer the use of long acting stimulants with improved compliance and tolerance noted. In addition the use of agents that often are combinations of IR/XR allow for immediate benefit which allows patients to notice the improvement easier and help with early morning hours which tends to be the hardest time of year. Long acting options can also be given the night before if easier l, given as chewable/dissolvable form, and liquid to drink to help with compliance.
  • 2yr
    Long acting stimulants also help with adherence, reminders on phone to take med and message Dr for refill helps also.
  • 2yr
    I am somewhat surprised by the percentage reported for non adherence. I do think that it's a challenge to get families to agree to take meds daily, even when not in school.
  • 2yr
    positive overall
    less mood swing or feeling "crashed" at end of day
    improved tolerability with less side effect may boost adherence
    cost and availability may be an issue for medication access
    app to remind patient or caregiver to take/administer their medicine

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