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Attention deficient hyperactivity disorder (ADHD) affects up to 7% of school-age youths globally, and its symptoms, such as inattention and impulsivity, can impair academic performance as well as social development. This impairment often presents additional challenges in adolescence, a period known for heightened emotional turbulence, which also coincides with increased rates of ADHD medication discontinuation.¹

While such a trend has been observed clinically, little is known about why adolescents stop their treatment. According to prior studies, social stigma is definitely part of it. And, with recent evidence suggesting increased rates of treatment discontinuation among ethnic minorities,² cultural-specific perspectives may be important to consider. 

A largely non-White population is recruited

A recent study by Hill and colleagues published in the Journal of Child and Adolescent Psychopharmacology sheds light on ADHD treatment utilization patterns among some of the least-studied youth populations, to provide a more holistic view on improving patient compliance within a demographic at higher risk for treatment discontinuation.¹

Hill and colleagues defined ADHD symptom management as strategies that include either pharmacological routes, nonpharmacological interventions, or both, where pharmacological agents can often be a stimulant, like an amphetamine or methylphenidate derivative. This study included 218 students鈥攎ost of whom were male (73.9%)鈥攎atriculating into the sixth or the ninth grade at baseline and followed them over a 4-year period. The study population consisted of mostly underrepresented ethnic groups: 72.5% Latinx, 17.4% Black or African American, 6.4% White, 2.8% mixed race, and 0.9% Asian. These students met the criteria for a diagnosis of ADHD per the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), with no prior diagnosis of autism.

Most eligible patients sought ADHD treatments

Over the course of the study, 80.7% of respondents (n=176) reported that they had received any type of ADHD treatment in the past 4 years, compared to only 45.9% of respondents who reported that they were receiving treatment at the beginning of the study.¹ More than half (50.6%) of the 176 treated participants reported that they pursued both pharmacological and nonpharmacological interventions, while only 29.5% reported opting for either one or the other.

Of the treated participants, 43.8% said they had taken ADHD medications to manage their symptoms at some point during the study period. But by the 4-year follow-up, only 29.5% of respondents were still using their ADHD medication, and the average age of patients at their reported discontinuation was 15.4 years.

The authors previously looked at comorbidity profiles among the group, categorizing them as ADHD simplex, ADHD with internalizing domains like anxiety and/or depression (ADHD + internalizing), and ADHD with externalizing domains like severe executive function problems (disruptive ADHD). The data revealed that the ADHD simplex subgroup had the highest rate of discontinuation (55.3%), while ADHD + internalizing had the lowest (11.1%), suggesting that psychiatric comorbidities could predict persistence of medication use (P=.029). 

Parents and kids have different reasons for discontinuation

Study participants were asked why they stopped their ADHD medication, and while the answers from both parents and adolescents weren鈥檛 always in agreement, the most common reasons from each group were:

• 鈥�Was tired of taking it鈥� (parents 31.8%, adolescents 25.8%)
• 鈥淢ade the teen feel 鈥榙rugged鈥欌�� (parents 18.2%, adolescents 9.7%)
• 鈥淢ade the teen feel bad physically鈥� (parents 9.1%, adolescents 9.7%)

Further analysis found there was little difference in discontinuation reasoning across racial/ethnic backgrounds and comorbidity profiles.

On another note, even though nearly all (97.3%) of the pharmacological treatment received in this study was in the form of a stimulant, rates of medication abuse were very low. Specifically, 3.9% of participants reported that a parent had taken their ADHD medication, while the same percentage (3.9%) of teens admitted that they had knowingly diverted their own medicine to their peers.

Educational interventions remain popular

While most families looked to educational (53.4%) and psychotherapeutic (37.5%) interventions, nonevidence-based approaches like ADHD coaching (13.6%) and nutritional supplements (8.0%) were also sought. Hill and colleagues also found little correlation between racial/ethnic background, family adversity, and comorbidity profiles and preference of nonpharmacological options. 

In any case, the authors asserted, the data are not generalizable to diverse groups of ethnic minorities. Considering the impact of cultural-specific norms in how patients may assess treatment utilization, more studies involving other underrepresented cohorts, like Asian Americans and Native Americans, as well as broader geographic distributions of study participants, should be considered, they say. Other social components that could influence a patient鈥檚 or caretaker鈥檚 decision, like cultural beliefs, should also be explored to create a more holistic and inclusive view to promote treatment persistence, according to the authors.

鈥淯ltimately, it is critical to consider these factors to design culturally appropriate evidence-based treatment strategies for Latinx and Black youth with ADHD,鈥� Hill and colleagues concluded.

Published: May 01, 2024