01. Reported Side Effects Associated With Medication Nonadherence Among Youth With ADHD

Text version

Hi! David Rosenberg here for the Psychopharmacology Institute. In this CAP—or Child and Adolescent Psychiatry—Smart Take, we will examine if there are side effects that can reliably predict psychotropic medication nonadherence in adolescents and young adults with ADHD. This is a critical concern because you can have the best medicine or treatment in the world, but if your patients are not taking it, how will it help? However, noting and identifying side effects, ensuring they are reported, and determining which side effects best predict nonadherence is challenging. Is it the total number of side effects, their severity, or any particular side effects? This article does so well because it takes a deep dive and makes a careful analysis to identify predictors or lack thereof for psychotropic medication nonadherence in adolescents and young adults with ADHD.

So, what are the take-home points from this analysis? First of all, perhaps not surprisingly, many patients with ADHD report at least 1 side effect, almost 80%. However, this study’s real clinical relevance is that researchers found that upset stomach and vomiting significantly predicted psychotropic medication nonadherence in adolescents and young adults with ADHD. Moreover, a part of this study to note is that it used a comprehensive list of 35 possible side effects. One advantage of this approach is that it does not rely solely on the person’s recall for side effects, adverse events, or memory. Now, the approach of having a list for patients to fill out is not something I would recommend and is not likely sufficient. Furthermore, the best strategy is to couple a comprehensive list like this with open-ended questions by the clinician. The point is that clinicians cannot just decide, “I will save time and hand out a list of side effects and hope all possible side effects are covered and filled out.”

We all know that some may do this well, but others will rush to fill out a list with little time, and their goal of completing the paperwork fast may override the comprehensiveness of the report. Others may wonder if the clinician is actually going to review the paperwork. So, the best approach is combining a comprehensive list, reviewing the list with the patient, and asking open-ended questions about side effects and adverse events to elicit as much information as possible. This may also instruct the patient, the family, and others how important you take this and your interest in knowing about side effects, adverse events, and anything that will help the patient’s treatment. Time and time again, the doctor–patient relationship has been demonstrated to be critical in treatment adherence or lack thereof. And it makes sense, right? If your patient does not feel comfortable with you, is afraid of disappointing you, or does not feel comfortable opening up to you, how likely is the patient to discuss nonadherence, side effects, and particularly side effects the patient may find embarrassing or unsettling? Another exciting thing in this particular study was the side effects reported by patients. The authors of this paper note that parents of children with ADHD are not optimal reporters about medication side effects, and they often do not ask about side effects. That being said, I would not recommend just relying on patient reports and not involving parents, caregivers, family members, or spouses. More information is always better; getting as much information as possible is vital. Also, asking parents and family members can underscore how important it is to alert and ask patients about possible side effects. Hence, they are alert, involved, and engaged in recognizing how important you consider this.

This article is relevant to clinicians in the trenches, mainly because there have been reports that managing and/or minimizing adverse events can be as important as symptom reduction in achieving optimal patient outcomes. In the case of adolescents and young adults with ADHD, first, it is vital to be on the lookout for any side effects—particularly upset stomach and vomiting due to their predictive ability for nonadherence. Moreover, if these occur, it may be worth considering alternative medication because of the high rate of discontinuation and/or being on the lookout for this at the get-go, addressing it head-on with the patient and family, as well as looking into potential contributing factors, those related or unrelated to the medication, or where there might be interventions that can minimize or eliminate these effects. Finally, evaluate whether the effects are likely to be transient or longstanding. So, definitely an exciting area. This is ready for prime time, but more research is needed looking at specific medicines, their predictive value, and the risk of nonadherence as well as with nonmedication therapies. This is an important lead and well worth your reading.

Abstract

Reported Side or Adverse Effects Associated with Medication Nonadherence Among Adolescents and Young Adults with Attention-Deficit/Hyperactivity Disorder

Lucy Barnard-Brak, Carolina Kudesey

Background and Objective: The purpose of this study was to determine what side effects were most associated with medication nonadherence as reported by adolescents and young adults with attention-deficit/hyperactivity disorder (ADHD). Methods: A combination of multiple linear regression and chi-square automatic interaction detection techniques were utilized in analyzing the survey data responses of 157 adolescents and young adults with ADHD. Results: The mean number of side effects reported was M= 10.33 side effects with 77% of the sample reporting at least one side effect. In aggregate, the number or severity of side effects were not significantly associated with medication nonadherence. Rather, it was the severity of particular side effects, upset stomach and vomiting, which were significantly associated with medication nonadherence. Conclusions: Health care providers should utilize this information as an indicator that medication nonadherence will be an issue when these side effects are present.

Reference

Barnard-Brak, L., & Kudesey, C. (2022).

Reported side or adverse effects associated with medication nonadherence among adolescents and young adults with attention-deficit/hyperactivity disorder

. 

Journal of Child and Adolescent Psychopharmacology, 32

(10), 539-542.