BALTIMORE – Almost all teenagers with attention-deficit/hyperactivity disorder (ADHD) stopped their medication at some point during their teen years, a study showed.
The stoppages happened for a variety of reasons, many of which stemmed from the normal curiosity and independence of adolescence, especially as teens got older.
Further, almost three-quarters of adolescents with ADHD did not restart medication after stopping, a concerning statistic given the often poor outcomes for youth with untreated ADHD, said Dr. William Brinkman, professor of pediatrics at the University of Cincinnati.
A better understanding of the reasons why adolescents come off and on ADHD medication may help physicians and families craft smart approaches to keep youth on track during the experimental teenage years, according to Dr. Brinkman, who presented his findings at the annual meeting of the Pediatric Academic Societies.
Using data from the National Institute of Mental Health–supported Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder (MTA) trial, Dr. Brinkman and his collaborators collated and analyzed the responses of 394 participants who had ever taken medication for ADHD.
The MTA study was a 14-month randomized clinical trial with a community control group, a behavior therapy group, a medication management group, and a combined treatment group. Naturalistic longitudinal follow-up extended for 12 years. At the end of study follow-up, participants were a mean 21.0 years old; 78% were male, and most (67%) were white.
Using a self-report measure developed in the MTA study, participants reported the age when they last had stopped taking ADHD medication and/or had restarted it. They also used a 6-point Likert scale to endorse how “true” a variety of reasons were for them to have stopped, or restarted, their ADHD medication. Scale responses ranged from 1, “really true,” to 6, “not at all true.”
Dr. Brinkman and his colleagues dichotomized the responses so that responses from 1 to 3 were characterized as “true,” while responses from 4 to 6 were characterized as “not true” when descriptive statistics were used.
Nearly all teenagers – 95% (376/394) – reported stopping their medication at some point. Commonly reported reasons for stopping included “I felt I could manage without it” (81%), “I wanted to find out if I could manage without it,” (68%), and “I was doing so well I no longer needed it” (68%). Dr. Brinkman noted that these stoppage reasons all fell into the broad category of feeling the medicine was not helping, or being curious about what would happen when they stopped taking the medicine.
Another common reason was very simple, but not easily categorized: 69% of respondents who had stopped medication endorsed the statement, “I was tired of taking it.” Almost half (46%) of respondents reported that physical side effects were a contributor to stopping the medication, while others said they stopped for the summer (30%), or that their parents had made the decision to stop the medication (26%).
Only 28% of youth in the MTA study who had stopped their medication restarted it. Of those who did, most reported they did so because the medication helped them: More than 80% of respondents felt that it helped with concentration and focus at school or work, or that it made school or work easier. Some participants felt that ADHD medication helped them organize their thoughts (68%), while 36% felt it helped decrease impulsivity.
The age at which respondents reported they had stopped or restarted their medication was broken down into childhood, aged 5-12; adolescence, aged 13-17; and emerging adulthood, aged 18-22 years. This was done so that trends in the reasons for stopping and restarting could be tracked by age.
“Parent/doctor influence decreases, while teencentric reasons increase” through adolescence, said Dr. Brinkman. The effect of parental or physician decision making about stopping or restarting medication declined significantly over the course of adolescence. The steepest declines were seen in endorsements of the statements, “My parents decided to stop it” and “My parents decided to restart it” (P for both less than .0001). The reason with the steepest increase as adolescents became adults was “I was allowed to decide when to take it” (P less than .0001).
A safer way to get teens through the experimentation and drive for autonomy that are natural parts of growing up may be physician-supervised trials on/off medicine to help curious teens more objectively assess the continued need for medicine.
Study data were drawn from the National Institutes of Mental Health–funded MTA study. Dr. Brinkman reported no relevant financial disclosures.
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