Perception of ADHD and Compliance in Relation to ADHD Medication

Introduction: ADHD medication has proven effective for treating ADHD in adults. Large registry-based studies have generally reported high discontinuation rates over time and focused on different risk factors, including comorbidity, gender, and socioeconomic status. The present mixed-model study examines self-reported factors related to the discontinuation of ADHD medication in Danish adults. It specifically focuses on themes such as the perception of ADHD and the perceived beneficial and adverse effects of the medication, with the aim of identifying patients' reasons either for continuing or discontinuing the prescribed medication overall and in relation to gender. Objective: The present study explores patients' self-reported reasons for continuing or discontinuing ADHD medication, as well as the factors that influence their decision to live with or without medication despite having ADHD. Methods: The present study employed a mixed-model design and consisted of 1050 Danish adults who redeemed a prescription for ADHD medication for the first time between 2017 and 2019. Questionnaires were distributed by Statistics Denmark to 4748 adults, a representative sample of the 16,284 Danish adults who redeemed a prescription within that period. Discontinuation was defined as a gap of 12 months between redemptions, and questionnaires were sent to an equal number of patients who continued or discontinued ADHD medication. A series of 2 (continuation vs. discontinuation) × 2 (male vs. female) two-way ANOVA was conducted for different main themes, all of which were derived from six patient interviews. Results: The patients who continued medical treatment were more likely to perceive ADHD as a biological illness, whereas those who discontinued treatment were more likely to perceive ADHD as an illness constructed by society. Furthermore, patients who continued medical treatment reported that the medication had a more positive influence on their lives, whereas those who discontinued the medication reported experiencing more negative feelings. Finally, males were more likely than females to perceive ADHD as a socially created illness, while females reported higher scores than males for taking ADHD medication for themselves, being able to work or attend school, being social, and being able to enjoy peaceful alone. Conclusions: The present findings suggest that the perception of ADHD as either a biological or a social construct is central to patients' decisions to continue or discontinue ADHD medication. Moreover, interesting gender differences were found regarding the perception of ADHD and the reasons for taking ADHD medication. From a clinical perspective, these findings underscore the importance of understanding the individual patient's perception of ADHD and highlight the need for relatively close clinical monitoring of patients with ADHD due to their high risk of discontinuing medication.