More Than Half of Teens and Adults Stop ADHD Medication Within One Year of Starting
A new international study charts rates of ADHD treatment discontinuation throughout the lifespan and finds that 61% of young adults stop taking medication within a year of starting.
December 15, 2023
Teens aged 18 to 19 are more likely than any other age group to stop taking prescribed medication for the treatment of attention deficit hyperactivity disorder (ADHD), according to a new study published in The Lancet.1 The study, which sought to determine the rate of ADHD treatment discontinuation across the lifespan, found that 61% of young adults (ages 18 to 24) discontinued treatment within a year of beginning it, almost double the rate of discontinuation in kids under 12.
The retrospective, observational study analyzed population-based databases from Australia, Denmark, Hong Kong, Iceland, the Netherlands, Norway, Sweden, the UK, and the United States, to track patterns of medication initiation, persistence, and discontinuation in the five years after starting treatment. Included in the study were 1,229,972 individuals (60% males, 40% females), aged four and older.
The study revealed that one year after beginning treatment, medication was discontinued by:
- 61% of young adults (aged 18 to 24)
- 53% of adolescents (aged 12 to 17)
- 52% of adults (aged 25 and older)
- 36% of children (aged 4 to 11)
The age at which medication was most commonly discontinued was between 18 and 19 years old.
Medication Adherence Challenges
The reasons teens, adults, and children stop taking medication are plentiful and varied. According to a recent ADDitude treatment survey with more than 11,000 respondents, the top reasons cited by adults and caregivers included:
- Side effects
- Medication availability
- Comorbid conditions
- High cost
- A lack of information and metrics to gauge efficacy
- Availability of providers who understand ADHD
This last barrier to medication continuation is particularly challenging for adults, both young and old, says William Dodson, M.D., in his article “4 Reasons Adults Give Up on ADHD Medication.”
“It’s not easy for patients to find clinicians who are knowledgeable about diagnosing and treating adult ADHD,”2 Dodson explains. “Limited experience with pharmacotherapy may result in difficulty gauging a patient’s response to medication and optimizing accordingly.”
The trial-and-error process, in which patients explore the efficacy of different dosages, formulations and possibly different types of ADHD medication, is essential to discovering an optimal treatment plan for ADHD, which varies widely from person to person, even within the same family. This often onerous process can be made far less confusing and stressful when patients work with a clinician who is highly knowledgeable about ADHD. Such a clinician can address the concerns that often prevent patients from starting medication, persevering through the trial-and-error process, and continuing consistent treatment.
“If people are ambivalent and fearful about trying medication, I found they commonly give up at the first sign of difficulty,” Dodson tells ADDitude. “They are often relieved that their fears have been proven correct and that the subject of medication is off the table.”
Unique Considerations for Young Adults and Teens with ADHD
The study’s key finding — that young adults aged 18 to 24 are more likely than any other age group to stop taking medication — is one that resonates with many parents and clinicians, who often find that adolescents resist ADHD medication. This causes concern because young adulthood can be a challenging time, as teens transition to more independent living, begin navigating college, and/or start a job.
Young adults can discontinue medication for a unique set of reasons that relate to their growth and development, according to Wes Crenshaw, Ph.D., and Larry Silver, M.D., in the ADDitude article titled “When Your Teen Refuses to Take ADHD Medication.” These reasons include:
- Exerting independence
- Trying to fit in with peers
- Concerns about “flattening” of personality
- Appetite suppression and sleep trouble
“The best way to sell medication to a teen or young adult is with honesty,” explain Crenshaw and Silver. “Listen to your teen’s complaints, and validate them; Managing medication is difficult, after all. For most children, teens, and adults who have been correctly diagnosed with ADHD, part of accepting the condition is to accept the implications of treatment: On one hand, ‘We can help you,’ and on the other, ‘Treatment is not a walk in the park.’”
For teens and young adults who are resistant to medication but benefit from it, Crenshaw and Silver advise suggesting to teens that they try an experiment. Teens take their ADHD medication for a week, then skip it for a week. During both periods of time, teens should take detailed notes about how they’re doing academically, emotionally and socially. For younger teens who live at home, parents can do the same, and teachers can be enlisted to offer feedback. Have the teen compare the notes from the medicated week with the notes from the non-medicated week. This may help them see the situation more objectively and can lead to treatment continuation.
Sources
1Brikell, I. Yao, H. Li, L. Astrup, A. Gao, L. Gillies, M. (2023). ADHD medication discontinuation and persistence across the lifespan: a retrospective observational study using population-based databases. The Lancet. DOI: https://doi.org/10.1016/S2215-0366(23)00332-2
2Goodman, D. W., Surman, C. B., Scherer, P. B., Salinas, G. D., & Brown, J. J. (2012). Assessment of physician practices in adult attention-deficit/hyperactivity disorder. The primary care companion for CNS disorders, 14(4), PCC.11m01312. https://doi.org/10.4088/PCC.11m01312
