Although high rates of poor adherence/persistence to ADHD pharmacotherapy have been documented, there is a lack of research targeting the issue (Biederman et al., 2019). Evidence from the studies in our review shows that interventions are promising, at least in the short term. The most promising interventions involve psychoeducational, behavioural and technological interventions.

Other theoretical frameworks have been applied to medication adherence. For example, the Unified Theory of Behaviour Change (UTBC) suggests that targeting knowledge and skills through education may be an important strategy to improve adherence and persistence. For ADHD, increased knowledge and associated attitudes that using medication is safe and effective increases willingness to use medication (Bussing et al., 2012). However, while knowledge may increase willingness to try medication treatment, it is not clearly associated with long-term use (Corkum et al., 1999) - repeated educational support is likely necessary for any successful intervention.

For ADHD, combining psychoeducational and behavioural strategies has been reported as necessary to affect change in attitude and behaviour, particularly for children with comorbid conditions such as ODD (Kamimura-Nishimura et al., 2019). To date, there has been no RCT using a combined approach. However, if behavioural strategies are to be used as interventions, potential challenges in terms of cost and time need to be considered and minimised. For a successful intervention to be implemented, it must be inexpensive and not burdensome to patients and families.

In our review, there is a general lack of consistency in the measurement of adherence and persistence to pharmacotherapy, as well as in the definitions used – this challenge has been documented by other researchers (Gajria et al., 2014; Aoki et al., 2021) and makes it difficult to compare the effectiveness of individual interventions.

4.1. Synopsis of findings

2.2. Inclusion/Exclusion criteria

An extensive search for published literature was conducted including the databases of Embase, Pubmed, PsychINFO, CINAHL, the Cochrane Library and Web of Science from January 1980 until January 2021.

Although medication is safe and effective in treating ADHD, non-adherence to stimulant treatment is generally high (Adler and Nierenberg, 2010; Gajria et al., 2014; Pelsser et al., 2017), with an estimated 50% of patients choosing to discontinue pharmacotherapy (Rashid et al., 2018). Studies focused on adults only have also reported poor adherence (Olfson et al., 2007). A significant reduction in medication continuation can occur in adolescent years (Emilsson et al., 2017; Charach and Fernandez, 2013). Adolescents have been reported to regard medications for ADHD less favourably than their parents/guardians (Bussing et al., 2012).

ADHD can result in negative consequences such as social and family life problems, low educational attainment/learning disabilities, low self-esteem, impaired emotional development, occupational difficulties and relationship issues (Dias et al., 2013).

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental behavioural disorder in childhood and adolescence. The disorder tends to occur more in boys than girls (Charach et al., 2011), and is also known to persist into adulthood (Adler and Cohen, 2004; Charach et al., 2011; Pelsser et al., 2017; Elliott et al., 2020).

We believe future interventions should involve combinations of strategies, have a theoretical framework and target the most common reasons for non-adherence. Interventions should also be integratable into routine care and include patient input to maximise sustainability.

An extensive search was conducted from January 1980 until January 2021. Thirteen studies were identified involving interventions based on psychoeducation, behavioural therapy, combined psychoeducation/behavioural therapy, technology-based interventions, written informed consent and a nursing support line.

systematic review

Authors’ intent usually matters in how useful their information can be to your research project,

One of the handiest and thus most-often-used categorizations of sources is by the expertise of their intended audiences. In this categorization, sources are either meant for everybody (popular sources), for only a college-educated or otherwise well-prepared audience (substantive popular sources), for professionals in an occupation (professional sources), or for scholars, students, and other people who want a deep understanding of a subject (scholarly sources).