Perceived Barriers to Medication Adherence in Adolescents and Young Adults with Attention-Deficit Hyperactivity Disorder: Adapting the Customized Adherence Enhancement Intervention.

Objective: Although the recommended first-line treatment for attention-deficit hyperactivity disorder (ADHD) is medication, poor adherence is still common, particularly in adolescents and young adults (AYAs). This study aimed to adapt Customized Adherence Enhancement (CAE), a psychosocial intervention developed to improve medication adherence in bipolar disorder, to target AYAs with ADHD.

Methods: Phase 1 included focus groups with AYAs, caregivers, and health care providers who treat AYAs with ADHD (N = 19). Prompts included barriers and facilitators of medication adherence, impact of ADHD, and reasons treatment regimens may be difficult to maintain. Focus groups were recorded, transcribed, and thematically coded. Phase 2 included cognitive interviews with AYAs with ADHD to assess acceptability and usability of the intervention (N = 6).

Results: Main themes were AYAs' perception of ADHD and its negative impact on work, sports performance, and interpersonal relationships. Barriers of adhering to medication were limited access, physiological side effects, difficulty following medication routines, and having comorbidities. Facilitators to medication adherence were having more knowledge about ADHD, benefits from medication adherence, and using external prompts.

Conclusion: As untreated or undertreated ADHD negatively affects morbidity and functioning, intervening early and at a critical stage of development has the potential to change the long-term outcomes of AYAs with ADHD. Results informed the adaptation of an existing intervention (CAE) to target AYAs with ADHD and can be applied to adherence interventions more broadly.