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Improving Adherence and Compliance in Adults and Adolescents With ADHD

Authors: William W. Dodson, MDFaculty and Disclosures



The diagnosis and medical management of ADHD is only the beginning of a course of treatment that should last a lifetime but rarely does. Several recent large studies show that the rigor with which people take their ADHD medications (compliance) and whether they continue treatment at all (adherence) are shockingly low.[1-3]

For example, Capone and colleagues[1] followed 5659 patients taking extended-release mixed amphetamine salts (MAS-XR), extended-release methylphenidate, long-acting methylphenidate, or atomoxetine for 15 months. Within the first 3 months of treatment, 50% were no longer taking medication and, by the end of the 18-month observation period, an astonishing 80% had dropped out. Even more striking, it did not matter which of the 4 medications the patients were prescribed; the attrition rates were identical for all 4 agents (Figure). Furthermore, no other parameter seemed to matter; the same dramatic lack of adherence was evident regardless of race, age, gender, or payor source. It appeared to be a function almost solely of the ADHD itself (there was a minor increased attrition in low-income patients). These data confirmed 2 previous studies: Perwien and associates[2] found that 85% of children and 88% of adults were adherent for less than 2 months; and Sanchez and colleagues[3] demonstrated dropout rates of 50% to 63% in 9549 children with ADHD during a single school year.


Percentage of patients continuing ADHD medications during 9-month observation.

To be sure, treatment compliance and adherence are important issues in the management of all chronic medical and psychiatric conditions. ADHD shares many of the impediments to adequate compliance that are common to any lifelong condition, but it also includes features and therapeutic responses that are probably unique to people with ADHD.

Even the most conscientious of individuals may not be able to follow the directions and suggestions of their clinician exactly. The degree of compliance that is "good enough" will change depending on the medical condition and the consequences that go along with nontreatment of the disorder. By any measure, however, medication treatment compliance and adherence in ADHD is abysmal even when compared with other mental health disorders.