title: Examining why patients with attention-deficit/hyperactivity disorder lack adherence to medication over the long term: a review and analysis.
abstract: OBJECTIVE
  To investigate the reasons why patients with attention-deficit/hyperactivity disorder (ADHD) adhere poorly to medications over the long term (≥ 1 year).
  
  
  METHODS
  PubMed was reviewed for studies between 1997 and January 2015 citing the reasons for medication nonadherence using these main keywords: ADHD, amphetamine, methylphenidate, atomoxetine, guanfacine, clonidine, long term, and adverse effects. Non-English language articles were excluded as were those that had a follow-up of < 1 year.
  
  
  METHODS
  Of 1,137 entries, 41 published articles citing reasons for subject withdrawal from treatment were included. None were included for clonidine.
  
  
  METHODS
  Similar reasons for drug or study withdrawal were grouped together for analysis using a normalized numerical average, while unique reasons were analyzed individually.
  
  
  RESULTS
  Reasons for discontinuing Food and Drug Administration (FDA)-approved medication after 1 year included "own wish/remission/don't need" (19.9%; 95% CI, 9.0-30.80), "withdrew consent" (16.2%; 95% CI, 10.0-22.5), "adverse effects" (15.1%; 95% CI, 10.4-19.8) and "suboptimal effect" (14.6%; 95% CI, 8.5-20.6), with the most common adverse event being "reduction in weight/appetite" (19.2%; 95% CI, 5.1-33.4). Other important factors included age, long- versus short-acting medication, psychosocial stressors, and "stop feeling like him/herself" on medication.
  
  
  CONCLUSIONS
  The reasons why patients do not adhere to stimulant medication remain poorly studied and understood, especially over the long term. Standardizing the way studies evaluate patients who stop treatment and including more qualitative measures should lead to better treatment outcome and adherence to medication over the long term.
authors.affiliation: 3940 Cote Des Neiges #B72, Montreal, Quebec, H3H 1W2, Canada elliot.frank@mail.mcgill.ca.
authors.forename: Elliot
authors.initials: E
authors.lastname: Frank
authors.forename: Cristina
authors.initials: C
authors.lastname: Ozon
authors.forename: Vinitha
authors.initials: V
authors.lastname: Nair
authors.forename: Karandeep
authors.initials: K
authors.lastname: Othee
mesh_terms: D000293:Adolescent; D000662:Amphetamines / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D016903:Drug Monitoring
chemical_list: D000662:Amphetamines; D000697:Central Nervous System Stimulants; D008774:Methylphenidate