What Are the Experiences of Adults With ADHD of Engaging in ADHD Medication Treatment? A Systematic Review and Meta-Ethnography.

Abstract

Background: This review aimed to systematically review and synthesize qualitative evidence of the experiences of adults with ADHD who engage in stimulant medication treatment. A secondary aim was to establish the factors that influence adherence behavior regarding stimulant medication treatment for ADHD and appraise the quality of existing research.

Methods: Psych Info, Academic Search Complete, Embase, and Medline were searched between the 20th and 28th June 2024 for qualitative studies that explored the experiences of adults who had been prescribed stimulant medication for ADHD. A modified Critical Appraisal Skills Programme checklist was used to assess the risk of bias in included studies and a meta-ethnographic approach was used to synthesize the results.

Results: Forty-seven second-order constructs were identified from the 13 included papers (263 participants). Four third-order themes were identified: 1. Fitting in with society: Performance. 2. The impact of ADHD versus the side effects of stimulants. 3. Fitting in with society: Social functioning. 4. Difficulty accessing medication and specialist care. Further synthesis of these themes highlighted that access to a specialist doctor who was willing to "tweak" medication and dosage was both a key stimulus that triggered adherence behavior and a factor that influenced other stimuli for adherence behavior.

Discussion: Adults consistently found ADHD medications to be effective at reducing symptoms of ADHD, but their experience of taking the medications varied greatly due to the range of social, psychological, and physical side effects that could occur. All participants spoke about their experiences of taking ADHD medications in the context of "fitting in" with society: Being able to perform academically and in the workplace, as well as being able to meet familial and friendship obligations. However, "fitting in" could be both a motivation for adherence and non-adherence to medication. Societal perceptions and stigma around ADHD and ADHD medications was also discussed as important context regarding "fitting in" and medication adherence. When the results were viewed through the lens of the Health Belief Model, it was highlighted that the four themes identified could be considered stimuli for adherence behavior. A potential methodical limitation of the review was the weighted synthesis approach, which prevented themes being generated from lower quality, less relevant studies. However this approach could also be considered a strength.