Individuals with ADHD do not always adhere to prescribed medication, despite the evidence that pharmacological intervention in combination with behavioural treatment is associated with positive academic or school outcomes. Lower adherence rates have been associated with more severe symptoms of ADHD, yet individuals with ADHD may choose not to take their medication due to side effects or adverse events, or if they feel that the medication is not working. Adolescents are more likely than children to demonstrate medication non-adherence, and as a compromise between the benefits and possible undesirable effects of their medication, some individuals and their families decide to take “medication vacations”, where a planned break from prescribed medication is agreed upon, usually on weekends or during school holidays. The aim of this study was to evaluate school outcomes, as measured by grades and behaviours, among adolescents with ADHD who take medication breaks compared with those who resist medication.
Data* were obtained from the parents of 1158 adolescents (aged ≥12 years; 69% male) with ADHD who were currently taking medication for their symptoms. Approximately 29% of parents (n=332) reported that their child had resisted taking their medication in the past 12 months, whereas ~53% (n=607) of parents indicated that planned medication breaks had occurred, and of these, ~30% (n=178) reported that their child had resisted medication in addition to taking medication breaks. A medication resistance model including the following items was used in the analysis: academics/schoolwork; adverse events; age; gender; grades†; medication breaks; poverty level‡; school behaviours§; severity of symptoms; social interactions; relationship with parents; and resisting medication. Standardised path coefficients (β) were evaluated to assess the associations between the items in this model.
The results showed that medication resistance was significantly associated with less positive school behaviours and lower grades (β= -0.29, p<0.001 and β= -0.31, p<0.001, respectively). However, medication breaks were not significantly associated with positive school behaviours and grades (β= 0.07, p>0.05), but positive school behaviours were associated with grades (β= 0.21, p<0.001), suggesting that planned medication breaks would be preferable compared with medication resistance among adolescents. Further analyses showed that the presence of adverse events was positively associated with medication resistance (β= 0.23, p<0.01), but was not associated with medication breaks (p>0.05). Males were more likely than females to exhibit medication resistance (p<0.01); however, gender was not significantly associated with medication breaks (β= 0.04, p>0.05). Age and relationship with parents were not significantly associated with medication resistance (p>0.05 for both). The severity of ADHD symptoms was significantly associated with lower school grades and negative school behaviours (β= -0.15, p<0.01 and β= -0.13, p<0.01, respectively), and increasing poverty level was significantly associated with lower grades (p<0.01) but not school behaviours (p>0.05).
The fact that this study was based on parent-reported data could be considered a limitation, as parents may not have always had accurate information on the formal diagnosis of ADHD, and may not have accurately reported medication adherence. Moreover, detailed information on the presence of comorbid or coexisting psychiatric disorders, which could have also affected school outcomes, was not included in this study.
The findings of this study indicated that adolescents with ADHD who took a break from their medication were more likely to exhibit more positive school outcomes in terms of behaviour and grades, compared with those who resisted medication. The authors suggested that if an adolescent resists taking their ADHD medication, then the introduction of “medication vacations” may be a compromise strategy for families; however, the issue of side effects should be discussed with the individual’s healthcare provider first.
*This study used data from the National Survey of Diagnosis and Treatment of ADHD and Tourette Syndrome, in which ~84% (2495/3018) of children were identified as having ADHD by their parents. This sample was delimited to include 1158 individuals with ADHD aged ≥12 years who were currently taking medication for their ADHD. Variables such as age, gender, side effects and the parent’s relationship with their child were controlled for in the analysis
†Grades were reported by the parent as whether their child was an A, B, C, D or F student, with grades distributed normally as 19%, 38%, 30%, 8% and 3%, respectively
‡Household poverty level was based upon the Department of Health and Human Services and ranged from 1 “not at all” to 4 “a lot”
§To assess school behaviours associated with medication, parents were asked to rate their child’s behaviour with respect to homework, classroom behaviours and interactions with friends and adults on a 4-point scale ranging from 1 “not at all” to 4 “a lot”
Barnard-Brak L, Roberts B, Valenzuela E. Examining breaks and resistance in medication adherence among adolescents with ADHD as associated with school outcomes. J Atten Disord 2018; Epub ahead of print.