title: Treatment dropout and missed appointments among adults with attention-deficit/hyperactivity disorder: associations with patient- and disorder-related factors.
abstract: OBJECTIVE
  Knowledge of factors associated with treatment dropout and missed appointments in adults with attention-deficit/hyperactivity disorder (ADHD) is very limited. On the basis of proposed hypotheses that past behavior patterns are more predictive of current behaviors of treatment dropout and missed appointments than are sociodemographic and clinical characteristics, we examined the associations of sociodemographic variables, clinical variables, risk-taking behavior, educational and occupational instability, and behaviors during mandatory schooling with the primary outcome measures of treatment dropout and missed appointments.
  
  
  METHODS
  In a naturalistic cohort study of 151 adult outpatients with ADHD initiating assessment in a Danish ADHD unit from September 1, 2010, to September 1, 2011, the Adult ADHD Self-Report Scale v1.1 symptom checklist (ASRS) and a thorough clinical interview were used to assess ADHD according to DSM-IV-TR criteria. Stepwise logistic regression analysis was used to estimate reported associations.
  
  
  RESULTS
  A total of 27% of patients dropped out of treatment and a total of 42% had ≥ 3 missed appointments during treatment. Mood and anxiety disorders significantly lowered the odds of treatment dropout (odds ratio [OR] = 0.18; 95% confidence interval [CI], 0.05-0.65), whereas having started but not completed 2 or more educational programs apart from mandatory schooling significantly increased the odds of dropout (OR = 3.01; 95% CI, 1.32-6.89). Variables significantly associated with most missed appointments were low educational level (OR = 2.19; 95% CI, 1.12-4.31), 3 or more employments of less than 3 months' duration (OR = 2.86; 95% CI, 1.30-6.28), and having skipped class often/very often during mandatory schooling (OR = 2.65; 95% CI, 1.29-5.43). Additionally, the predominantly inattentive ADHD (ADHD-I) subtype lowered the odds of missed appointments (OR = 0.17; 95% CI, 0.05-0.62).
  
  
  CONCLUSIONS
  Our results suggest that past behavior in terms of highest dropout rates in the educational and occupational systems and highest rates of skipping class during mandatory schooling is equally associated with current behavior of treatment dropout and missed appointments as are sociodemographic and clinical factors.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT02226445.
authors.affiliation: Psychiatric Research Unit West, Regional Psychiatric Services West, 7400 Herning, Gl. Landevej 49, Denmark hellesnd@rm.dk.
authors.forename: Helle M
authors.initials: HM
authors.lastname: Soendergaard
authors.forename: Per H
authors.initials: PH
authors.lastname: Thomsen
authors.forename: Pernille
authors.initials: P
authors.lastname: Pedersen
authors.forename: Erik
authors.initials: E
authors.lastname: Pedersen
authors.forename: Agnethe E
authors.initials: AE
authors.lastname: Poulsen
authors.forename: Jette M
authors.initials: JM
authors.lastname: Nielsen
authors.forename: Lars
authors.initials: L
authors.lastname: Winther
authors.forename: Anne
authors.initials: A
authors.lastname: Henriksen
authors.forename: Berit
authors.initials: B
authors.lastname: Rungoe
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Soegaard
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology* / Q000628:therapy; D003718:Denmark / Q000453:epidemiology; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D000067455:No-Show Patients / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D012574:Schools / Q000706:statistics & numerical data*