Young Adults With ADHD Frequently Skip Medication During College Transition

Young adults with attention-deficit/hyperactivity disorder (ADHD) have more treatment options than ever, but all those choices won’t help if patients can’t overcome a big hurdle: remembering to take their medication.

A new study in the Journal of Developmental & Behavioral Pediatrics finds that the transition from living at home to going to college is the worst period for medication adherence for young adults with ADHD, and that young adults in the midst of transition only took 53.53% of their medication doses.

Young adults often have trouble managing a chronic condition as they leave home for the first time—clinicians who treat those with type 1 diabetes (T1D), for example, have long observed that this age group has the worst glycemic control. But ADHD poses particular difficulties, the authors wrote.

“Many of the skills necessary to adhere to treatment (e.g., organization, planning) are impaired in those with ADHD,” wrote Wendy Gray, PhD, of Auburn University, and co-authors.

To conduct the study, the researchers tracked 51 undergraduate students with ADHD during an academic semester. Multilevel modeling looked at each student’s individual trajectories, both in monthly medication adherence and self-reported executive functioning.

The lowest levels of adherence were seen among undergraduates first transitioning to independence (34.17%), compared with those who have made the transition (67.63%). In fact, a student’s point in the transition process could predict medication adherence, the researchers found.

“It increased from the beginning of the semester to midterms before subsequently declining through the rest of the semester, including during final exams. Executive functioning did not predict adherence,” the authors wrote.

Researchers are paying more attention to the challenges that students with ADHD face during the transition to college, noting that even those students with solid high school academic records drop out at higher-than-normal rates. In a 2016 paper, researchers proposed an advising method that combines elements of coaching, which might remove some of the stigma associated with students asking for “accommodations” under the Americans with Disabilities Act.

Beyond counseling, technologies are under development that could alert a student health office or caregiver if a young adult with ADHD is not taking medication. Proteus Digital Health is working on an ingestible sensor that would send a signal that the patient has taken the pill. This technology has drawn interest from clinicians who treat a range of conditions with poor medication adherence rates, from mental health disorders to diabetes.

Reference

Gray WN, Kavookjian J, Shapiro SK, et al. Transition to college and adherence to prescribed attention deficit hyperactivity disorder medication [published online October 4, 2017]. J Dev Behav Pediatr. 2017. doi: 10.1097/DBP.00000000.