Perceptions of adults with ADHD on pharmacological treatment initiation and subsequent adherence: a thematic analysis

Following a diagnosis of attention deficit hyperactivity disorder (ADHD), many engage with pharmacological treatments to manage symptoms. However, despite efficacy in short-term ADHD symptom improvements, approximately half of adults discontinue pharmacological treatment within the first year, while others do not entirely adhere to treatment as prescribed. This study aimed to investigate experiences of adults with ADHD in the first year of pharmacological treatment, and how this impacted treatment engagement.

Twenty-five adults with ADHD completed semi-structured interviews. The interviews investigated perspectives of pharmacological treatment including response to medication, experiences of titration, treatment adherence and decisions for (dis)continuation. Inductive thematic analysis was conducted to generate themes.

Analysis generated four themes pertaining to pharmacological treatment engagement. (1) Processing diagnosis reflected the processing of one's diagnosis throughout treatment. (2) Managing expectations outlined how expectations at the outset of treatment can impact perceptions of treatment efficacy. (3) Accessing support highlighted areas of pharmacological treatment in which many felt support was lacking and the impact; (4) Balancing costs and benefits outlined the process that individuals undertook when balancing whether medication was worth continuing.

This study contextualised the high rates of treatment non-adherence and discontinuation for adults with ADHD, highlighting how ongoing processing of the diagnosis, high expectations of the medication's impact, available guidance from healthcare services and the ultimate balance of positives against negatives, contribute to an individual's treatment compliance and continuation. Ultimately, this study highlights the need for personalised treatment and the importance of the availability also of non-pharmacological treatment options.