Medication Adherence a Major Issue for Children with ADHD

While ADHD rates continue to rise among children, medication adherence remains a stumbling block for many patients.

A team based in Australia, led by Dr. Daryl Efron, Health Services, Murdoch Children's Research Institute, described the patterns of ADHD medication use for Australian children, while characterizing the patterns of use in a 3537-patient study.

Adherence to ADHD medication is notoriously suboptimal, particularly with children, and can compromise patient outcomes.

The team analyzed dispensing data for all redeemed prescriptions of methylphenidate, dexamphetamine and atomoxetine between May 2002 and March 2015 from the first 6 waves of the Longitudinal Study of Australian Children. In the first wave, there were 4634 participants aged 4-5 years old.

The investigators defined medication coverage as the proportion of time between the first and last redeemed prescriptions where the child was taking medication. Using regression analysis, the investigators examined the associations between predictor variables such as child sex, ADHD symptom severity, age at first prescription, family socioeconomic status, single parent status, parent education, and parent mental health and medication coverage.

A total of 166 (3.6%) children had redeemed a prescription for an ADHD medication at some point in time.

The investigators found that males had higher odds of having taken ADHD medication than female children (OR, 3.9; 95% CI, 2.7-5.7). The mean medication coverage was 59.8% and medication coverage overall was lower in children from families of lower socioeconomic status (β = 4.0; 95% CI, .2-7.8, P = .04).

The team also found that medication coverage was relatively high in the first year of prescription, but decreased progressively after. However, eventually, after 5 or 6 years of treatment, the rates of medication coverage increased.

The average medication coverage was 81% in the first 90 days, but decreased to 54% after 90 days.

Efron and colleagues said the information regarding the link between medication adherence and socioeconomic status could drive regulatory changes.

“Children with ADHD from socially disadvantaged families were less likely to receive medication consistently,” the authors wrote. “Prescribers need to continue to support families over many years to ensure medication is used consistently for children with ADHD.”

According to Efron, lower socioeconomic families find it more difficult to attend medical appointments for a number of reasons, including appointment costs, transportation difficulties, and the inability to miss work.

Efron also noted approximately 90% of children with ADHD respond well to at least 1 of the stimulant ADHD medications.

According to a 2019 study, ADHD is one of the most common behavioral health conditions among children in the US with an increase of more than 30% in the number of commercially insured children diagnosed with the disorder between 2010-2017.

While it’s known that children with ADHD have difficulty paying attention and struggle to control their impulses, claims data reveals that these behaviors were most prevalent among middle school students, particularly boys, who are twice as likely as girls to be diagnosed with the disorder.

The study, “Patterns of long-term ADHD medication use in Australian children,” was published online in Archives of Disease in Childhood.