A 12-month remote monitoring study of patterns and predictors of medication adherence in adults with attention-deficit hyperactivity disorder (ADHD)

Introduction to research question:Pharmacological treatment (medication) is the first line treatment for adults with attention deficit hyperactivity disorder (ADHD) [1]. Despite demonstrated efficacy in short-term symptom reduction, non-adherence to and discontinuation from ADHD medication is common within the first year following titration [2,3]. Previous research has typically utilised registry and prescription-based data which, while insightful, alone, can only indicate when an individual fulfils their prescription or is in possession of their medication, not necessarily when and why they take their medication on a daily basis. The ADHD Remote Measurement Technology (RMT) Study of Cardiometabolic Risk Factors and Medication Adherence (ART-CARMA) [4] collected real-world medication use data within approximately the first year following ADHD medication initiation, obtaining daily granular data on whether or not an individual took their ADHD medication, their reasons for (not) taking medication and associated environmental and clinical factors.

Project aims:This project aimed to identify clusters of medication use patterns within a 12-month post-treatment initiation period and determine whether medication use differed by demographic and clinical baseline groups.

Methods

Over a 12-month period, 123 adults with ADHD, recruited from clinic waiting lists in the UK and Spain, completed daily and weekly questionnaires pertaining to their medication usage via a smartphone app. Participants also conducted several interviews and questionnaires at baseline to determine demographic characteristics and presence of co-occurring clinical disorders. Medication data were subject to sequence analysis to identify clusters of medication use, with discrepancy analysis then utilised to determine baseline variables associated with differences in medication use clusters.

Results

Three clusters of medication adherence emerged: (1) 41% of participants experienced frequent and/or prolonged bouts of medication discontinuation (2) 36% of participants flexibly engaged with their medication (i.e. they typically took their medication within a given week, but not every day) and (3) only 24% of the sample displayed a consistent pattern of medication use (i.e. they typically took their medication every day as prescribed). Autistic traits (p = 0.006), ethnicity (p = 0.001), country of residence (UK or Spain) (p = 0.003), and lifetime prevalence of panic disorder (p = 0.027) significantly explained differences between medication use pattern displayed, individually explaining between 1.6% and 7.4% of the overall discrepancy between medication use patterns.

Conclusions

Overall, this study highlights the high prevalence of both discontinuation and flexible medication use amongst adults with ADHD in the first year following treatment initiation. This novel design enabled the identification of real-world patterns of medication use, with application for future clinical practice. This study also identified numerous demographic and clinical factors explaining differences in medication use displayed, informing the facilitation of treatment engagement where appropriate. Finally, this study highlights the feasibility of utilising RMT to collect medication adherence data in real-time, showing promise for future research and, ultimately, clinical application during the treatment process.

References

1. National Institute for Health and Care Excellence (NICE), NG87, 2018. Attention deficit hyperactivity disorder: diagnosis and management. Available from: https://www.nice.org.uk/guidance/ng87https://www.nice.org.uk/guidance/ng87. [Accessed 05 May 2026]
2. Brikell, I., Yao, H., Li, L., Astrup, A., Gao, L., Gillies, M. B., Xie, T., Zhang-James, Y., Dalsgaard, S., Engeland, A., Faraone, S. V., Haavik, J., Hartman, C., Ip, P., Jakobsdóttir Smári, U., Larsson, H., Man, K. K., de Oliveira Costa, J., Pearson, S. A., Hostrup Nielsen, N. P., … Chang, Z. 2024. ADHD medication discontinuation and persistence across the lifespan: a retrospective observational study using population-based databases. The lancet. Psychiatry, 11(1), 16–26.
3. Ferrin, M., Häge, A., Swanson, J., Wong, K. H. T. W., Dittmann, R. W., Banaschewski, T., Coghill, D., Santosh, P. J., Romanos, M., Simonoff, E., Buitelaar, J. K., & European ADHD Guidelines Group (EAGG). 2025. Medication adherence and persistence in children and adolescents with attention deficit hyperactivity disorder (ADHD): a systematic review and qualitative update. Eur. Child Adolesc. Psychiatry, 34(3), 867–882.
4. Denyer, H., Ramos-Quiroga, J. A., Folarin, A., Ramos, C., Nemeth, P., Bilbow, A., Woodward, E., Whitwell, S., Müller-Sedgwick, U., Larsson, H., Dobson, R. J., & Kuntsi, J. 2022. ADHD Remote Technology study of cardiometabolic risk factors and medication adherence (ART-CARMA): a multi-centre prospective cohort study protocol. BMC psychiatry, 22(1), 813.