Abstract
As a first-line treatment for the primary symptoms of attention deficit hyperactivity disorder (ADHD), such as impulsivity, overactivity, and inattention, safe and effective medication is readily available. Many people stop taking their medications during adolescence, even though their functioning is reduced. Parents typically make healthcare decisions for young children, while older kids make their own choices. Attitudes and beliefs can vary greatly. While some families recognise that ADHD is a neurological disorder and agree that medication may be necessary, others find such therapy intolerable. There is a growing body of information that highlights unfavourable opinions about the hassle of taking medications and worries about possible short- and long-term side effects. Adverse effect experiences are, in fact, a common reason why young people quit. Optimising outcomes is expected to involve finding ways to enhance shared decision-making between professionals, parents, and young people as well as monitoring efficacy, safety, and the emergence of new concurrent challenges.
Introduction
The patterns of ADHD medication use are summarised and the factors that are known to affect adherence to ADHD medication are described in the following chapter. The decision to use medication is a complicated one, and more recent research has concentrated on the attitudes and beliefs that influence patient preferences. We also go into the distinctions between popular ADHD drugs and their effectiveness and side effects, which are also significant considerations. We conclude with a talk about the potential and problems that doctors who work with young people with ADHD face. There is still much to learn about helping more young people with ADHD reach their full potential. The topic is still underresearched.
Background
The neurological condition known as attention deficit hyperactivity disorder (ADHD) is typified by impulsivity, hyperactivity, and inattention [1]. ADHD is thought to impact 5% of children globally. Boys are diagnosed with the disorder almost twice as often as girls, and primary school-aged children are diagnosed with it roughly twice as often as adolescents [1].
Patterns of Medication Use
There is information available regarding the variations in provider types and the ensuing prescribing trends. The practice habits of primary care physicians and specialists differ. Even once comorbid disorders are taken into account, children diagnosed by psychiatrists are less likely than those identified by primary care physicians to receive a prescription within the first six months of their diagnosis [27]. Psychiatrists are more likely to administer stimulant dose titration, indicating enhanced monitoring, with three or more visits in the first ninety days, a higher maximal dose, and a lower starting dose [28]. Comorbid conditions, particularly bipolar disorder, schizophrenia, or autism, reduced the use of ADHD medications but increased the use of other psychotropic medications, which were mostly administered by neurologists and psychiatrists [27]. One possible explanation for why specialised treatment results in longer medication usage over time is the methods that experts employ to start medications [29]. A more nuanced approach to medication adherence is necessary, given the high rate of non-refill following the initial prescription, the variability by geography, provider characteristics, and the child’s age, ethnicity, and socioeconomic status. The safety and efficacy of pharmacological agents are important for continued use.
Medication Adherence
A model like the trans-theoretical model of change describes the significance of experience and associated changes in attitude over time. Empirically based models of health behaviour provide the chance to investigate social, cognitive, and experiential factors that influence medication adherence. Cognitive behavioural models, like the health beliefs model, take into account characteristics of the particular disorder, patient beliefs and attitudes, and the efficacy and safety profile of the medication [12]. Although the idea of treatment adherence has changed over the last 20 years, it is still not well operationalized or quantified, which causes patients and healthcare professionals to interpret it in different ways [32•]. The parent’s opinions and experiences are crucial since they are typically the ones who make healthcare decisions for young children with ADHD. Nonetheless, parents frequently take into account what they know about their child’s experiences.
Factors That Influence Use of ADHD Medications
In general, we can categorise features of parents or families, children, practitioners or the health system, and drug-related factors into groups that are linked to the use of medication for ADHD (Table 1). Treatment start is significantly influenced by parents’ views towards treatment and their perceptions about ADHD [34]. For instance, parents who see their child’s problems as a medical condition requiring biological intervention will support long-term pharmaceutical use [35]. Nonetheless, a lot of people would rather use behavioural techniques and other non-pharmaceutical techniques, such eating differently, exercising, or receiving counselling [36, 37]. When a full psychological evaluation is part of the diagnostic process, families are more receptive to stimulant trials [36]. Some parents may not want to utilise medication to treat their child’s ADHD behaviours because they believe it is inappropriate [35]. When initiating medication, many parents have conflicting emotions and frequently balance their worries about side effects and social rejection against the possible positive impacts on behaviour and academic performance [12, 38]. Willingness to use medicine improves with increased understanding of ADHD and the attitudes that go along with it, such as the belief that using medication is safe, effective, and socially acceptable.
Medication Effects
The two main aspects of medication that have an impact on adherence are tolerability and effectiveness. Cost, ease of usage, and a streamlined dosage schedule are also crucial [33••]. Over the past ten years, the variety of psychostimulant formulations has increased dramatically, particularly in the United States when compared to other countries. Studies of four psychostimulant preparations (methylphenidate immediate release, amphetamine, OROS methylphenidate, and mixed amphetamine salts) as well as a discontinuation trial evaluating atomoxetine were found in a recent review of ADHD treatment studies that looked at ADHD medication use for more than a year [1]. There haven’t been many head-to-head trials comparing stimulant formulations, despite the best data suggesting that they’re all effective when compared to placebo. On the other hand, compared to immediate release methylphenidate, which needs several doses per day to be effective, the once-daily formulation of OROS methylphenidate is more likely to be taken regularly [25, 26]. Not every child benefits equally from psychostimulants and atomoxetine, despite the fact that both treatments lessen symptoms of ADHD and enhance social and academic functioning in placebo-controlled trials.
Challenges and Opportunities
The main goal of examining adherence to ADHD medication is to optimise long-term mental health, psychosocial, and economic outcomes for children and youth with ADHD by providing the best care available. Solid proof that pharmacological interventions offer long-lasting, long-term benefits, however, is still elusive despite thorough investigation. Large-scale population-based administrative databases are currently being used to solve this puzzle by fusing information on health care and educational services with prescription renewal rates. These research, which employ sophisticated statistical techniques, hold potential for characterising health care utilisation trends and related consequences in communities. However, the details of each child’s unique characteristics, such as their clinical diagnosis, the interactions between families and providers, and the co-interventions they got, are rarely recorded, leaving front-line practitioners with little in the way of useful advice. Alternative research methodologies are needed to gather the details needed to inform daily practice. Research employing a combination of qualitative and quantitative techniques, for instance, has started to address intricate inquiries on treatment compliance that are pertinent to primary care physicians. Surprisingly consistent descriptions of parent attitudes and views regarding childhood ADHD and pharmaceutical therapy are provided by convergent evidence derived from diverse populations. Adverse impact experiences continue to be a major and common cause of medication cessation. As with other fields of personalised medicine, genetic indicators may soon be available to help determine which treatments are most likely to be efficient and tolerable for a given individual. Growing knowledge about the way the brain develops and evolves over time as a result of treatment will lead to new insights on long-term brain health maintenance. This kind of information could also help determine the best manner to take ADHD meds.
Conclusion
For children with ADHD, medication is a crucial part of evidence-based management, and treatment adherence habits vary widely. Even while many young people exhibit reduced functioning well into adolescence, many patients who start treatment with medication may stop and resume the medicine over a period of years or stop using it completely. Patient perspectives reflecting numerous negative responses to the recommendation of medication use are one explanation for the low adherence to ADHD medication treatment. Furthermore, the healthcare provider frequently collaborates with multiple family members who participate in decision-making. Patients and families frequently experience less-than-optimal effectiveness and tolerance of side effects, which both result in cessation. The clinician’s capacity to preserve a productive working partnership is critical in this situation. It’s also critical to keep an eye out for emerging or concurrent issues, as these could take precedence over symptoms of ADHD and necessitate different or additional interventions. More strategies to assist youth in taking care of themselves will likely surface as our understanding of brain development and health expands. These strategies may include a stronger emphasis on good sleep hygiene, stress reduction, a healthy diet, and regular exercise—all of which are proven to promote mental wellness.
