Moderators and mediators of long-term adherence to stimulant treatment in children with ADHD
Abstract
Objective To identify moderators and mediators of long-term adherence to stimulant medication in children with attention-deficit hyperactivity disorder (ADHD).Method Seventy-one children with ADHD were prescribed methylphenidate, followed prospectively on an annual basis for 3 years, and evaluated for adherence to stimulant treatment. The study occurred in Toronto between 1993 and 1997. Adherents were those who took methylphenidate, or another psychostimulant, for 5 or more days per week throughout the follow-up period, except for "drug holidays." Children who adhered at consecutive evaluations were compared with those who did not. Severity of ADHD, presence of oppositional defiant disorder/conduct disorder, learning difficulties, anxiety, age, family dysfunction, and socioeconomic adversity at baseline were investigated as moderators of adherence. Response to treatment at school, measured at 12 months, was investigated as a mediator of adherence.Results Fifty-two percent of children adhered to stimulant treatment for 3 years. Absence of teacher-rated oppositional defiant disorder, more teacher-rated ADHD symptoms, and younger age at baseline predicted adherence.Conclusions Adherence to stimulant medications is a significant factor in the long-term treatment of children with ADHD.
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Another study found that 74% of children with ADHD initially assigned to stimulants took at least half of their pills for 12 months, and 52% continued stimulant medication for 3 consecutive years.
“Another study found that only 74% of children with ADHD initially assigned to stimulants took 50% or more of their pills for 12 months, 20 and only 52% continued to use stimulant medication for 3 consecutive years.21”
From Medication Adherence in the MTA: Saliva Methylphenidate Samples Versus Parent Report and Mediating Effect of Concomitant Behavioral Treatment (2009) · cites this paper as [21]
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- Authors
- THIRUCHELVAM, D., CHARACH, A., & SCHACHAR, R. J.
- Affiliations
- University of Toronto (CA)
- Corresponding author
- SCHACHAR, RUSSELL J.
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2001-08
- Volume
- 40
- Issue
- 8
- Pages
- 922-928
- ISSN
- 0890-8567 (ISSN-L)
- OpenAlex
- W2061256954
- Cited by
- 172
- References
- 33
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 4 · 2022: 4 · 2021: 6 · 2020: 3 · 2019: 6 · 2018: 7 · 2017: 5 · 2016: 5 · 2015: 14 · 2014: 13 · 2013: 9 · 2012: 13
- FWCI
- 3.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- attention deficit hyperactivity disorder, methylphenidate, children, oppositional defiant disorder, conduct disorder, ADHD symptom severity, age at baseline, socioeconomic adversity, family dysfunction, learning difficulties, anxiety
- MeSH terms
- Adolescent, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Child, Educational Measurement, Female, Follow-Up Studies, Humans, Male, Methylphenidate, Patient Compliance, Prospective Studies, Psychiatric Status Rating Scales, Severity of Illness Index
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