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24 June 2017

Schaefer MR et al. J Adolesc Health 2017; 60: 706–713

ADHD is one of the most common chronic illnesses among adolescents and young adults; however, there is currently limited knowledge of disease management and adherence in this age group. This study investigated medication adherence and disease management in adolescents with ADHD transitioning to young adulthood during college.

A total of 10 adolescents with ADHD receiving pharmacotherapy (aged ≤21 years) were recruited from a large, public Southeastern US university. Participants initially completed pen-and-paper questionnaires, followed by a 20-question semi-structured interview guided by the Health Belief Model (HBM). The HBM consists of six primary constructs,* which influence whether or not a participant will engage in health behaviours such as taking prescribed medications.

Participants’ management of ADHD was measured using a questionnaire allowing them to rate their control of ADHD symptoms and indicate the level of parental involvement prior to and following transitioning to college. They then completed the Adolescent Medication Barriers Scale (AMBS), a 17-item scale used to assess participants’ perceived barriers to taking medication.

Participants rated their control of ADHD symptoms as 6.10 ± 2.73, and the level of parental involvement prior to and following transitioning to college as 6.80 ± 3.04 and 2.80 ± 3.46, respectively, where 0 = not controlled/no involvement and 10 = fully controlled/completely involved.

In terms of transitioning concerns, analysis of participant responses highlighted the following themes:

  • Transitions to independence are often abrupt and many adolescents lack medication self-management skills – 7 participants (70%) reported a high level of parental involvement in medication management prior to transitioning to college, e.g. refilling prescriptions, and indicated that they found the abrupt shift in responsibilities challenging.
  • Inaccurate disease beliefs, perceived academic demands and medication side effects were reported to influence volitional non-adherence – 10 participants (100%) reported intentional non-adherence. Inaccurate participant beliefs about ADHD (e.g. that they should/would “outgrow” ADHD) and when medication is necessary, as well as the desire to avoid side effects, were the primary reasons given for non-adherence.
  • Poor self-management was perceived as having had negative implications on school performance – 9 participants (90%) indicated that they regretted their suboptimal ADHD management during their first semester, and acknowledged that it may have contributed to poorer academic outcomes.
  • Pressure from peers to share medication was perceived as frequent and could negatively affect social functioning and adherence – 9 participants (90%) described feeling pressurised to share or sell their ADHD medication, particularly by friends and sorority/fraternity associates. Under these circumstances, participants described their perceived dilemma of either losing a significant friendship by refusing to divert their medication or accepting that their daily functioning would be affected by agreeing to divert their medication.
  • Social support was expressed as a perceived need – 8 participants (80%) reported that the initial transition to college could be made more manageable through mentorship from a more experienced college student with ADHD. Additionally, participants expressed a wish for academic counsellors specialising in students with ADHD.

In addition to the above themes, the authors were interested in non–medication-related management, and were surprised that only 4 participants (40%) were registered for academic accommodations. Responses from the remaining participants highlighted that they had not sought accommodations because they were not aware of this option, felt shame in receiving additional academic support, felt stigmatised by the ADHD label or believed that their ADHD symptoms were not severe enough to receive additional academic support.

Limitations of this study include: 1) the potential selection bias; 2) as this was a single-site study, the results may not be generalisable to other college settings; 3) the study measured participants’ perceptions, rather than their actual skills or experience, and as such difficulties may have been minimised due to perceived social desirability; 4) the small study sample; 5) differences in experiences between ADHD subtypes could not be determined because participants were unable to report their subtype.

The authors concluded that the participants in this study were not prepared to manage their ADHD symptoms in the context of their new-found independence within the college setting, and highlight the need for intervention programmes aimed at helping adolescents with ADHD self-manage their medication during the transition to college.

Read more about transitioning to college with ADHD here


*The HBM consists of six primary constructs: 1) perceived susceptibility; 2) perceived severity; 3) perceived benefits; 4) perceived barriers; 5) cues to action; and 6) self-efficacy

For each item of the AMBS, participants were presented with a particular barrier, e.g. “I believe that this medicine has too many side effects”, and were then asked to rate their agreement with each barrier using 1 of 5 responses, from strongly disagree to strongly agree

Schaefer MR, Rawlinson AR, Wagoner ST, et al. Adherence to attention-deficit/hyperactivity disorder medication during the transition to college. J Adolesc Health 2017; 60: 706–713.

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