Measurement-Based Care: Medication Adherence Among Youth with ADHD

Attention-deficit/hyperactivity disorder (ADHD) is the most common youth neurobehavioral disorder, causing substantial functional impairment. Pharmacological treatments are effective, yet adherence is often suboptimal. Measurement-based care (MBC) enables systematic monitoring of adherence and symptoms. This study analyzed ADHD symptom trajectories and tested whether non-adherence and clinically elevated symptoms were associated.

Youth participating in the Child and Adolescent Mood Disorders Program with ADHD and data at baseline and ≥1 follow-up visit were included (N = 62). Adherence was assessed at baseline (BL), Visit 2 (V2), and Visit 3 (V3) using a modified proportion of days covered (PDCm), with PDCm <80% considered non-adherent. Parent-rated severity was measured with the NICHQ Vanderbilt ADHD Rating Scale Total at the initial evaluation (PBV; pre-baseline visit) and subsequent visits. Mixed-effects linear and logistic models evaluated changes in NICHQ scores and elevated symptom status across visits. Additional mixed-effects logistic regression models examined the bidirectional association between non-adherence and elevated ADHD symptoms across visits.

ADHD symptoms decreased from the initial evaluation to baseline and remained relatively stable across subsequent follow-up visits. Similarly, the proportion of youth with clinically elevated ADHD symptoms declined substantially from the initial evaluation and remained lower during follow-up. There was no clear evidence that medication non-adherence was associated with having elevated ADHD symptoms. Likewise, elevated ADHD symptoms did not appear to be associated with subsequent medication non-adherence.

Parent-rated symptoms reduced significantly, with their highest score at the initial evaluation and stable from BL through V3, likely reflecting treatment initiation before baseline. Bidirectional adherence–symptom association was insignificant, though wide confidence intervals indicate limited power. Larger follow-up samples are needed to determine whether adherence tracks symptom courses.