To characterise medication initiation, discontinuation and long-term adherence patterns for children and adolescents diagnosed with ADHD in a real-world setting.
Approach:
Study Design: A nationwide retrospective cohort study including 8961 children and adolescents diagnosed with ADHD between 2010 and 2012, with follow-up until 2021.
Main Outcomes: Medication initiation rates, time to first medication discontinuation, and longitudinal adherence measured by the proportion of days covered over 9 years.
Key Findings:
Of the 8961 individuals in the cohort (mean age at diagnosis, 12 years; 69% male), 6661 (74.3%) initiated medication, with a median time from diagnosis to initiation of 106 days (IQR 17–231); 55% initiated within 90 days.
Discontinuation increased significantly with age; adolescents aged 15–17 years remained on treatment for 31.9 fewer days (95% CI −40.8 to −23.1; p<0.001) in the first year compared with children aged 5–11 years.
Females also discontinued significantly earlier than males (difference −13.2 days; 95% CI −19.8 to −6.5; p<0.001).
Interpretation:
Limitations:
The study may not account for all factors influencing medication adherence and discontinuation.
Data is limited to a specific population and may not be generalizable.
Interviews with hospital leaders and employed physicians highlighted financial pressures, perceived care-integration benefits, and unresolved operational tensions following acquisition.
