Psychiatric and neurological predictors of early ADHD medication discontinuation across the lifespan: a multinational study - Summary - MDSpire

Psychiatric and neurological predictors of early ADHD medication discontinuation across the lifespan: a multinational study

  • By

  • Isabell Brikell

  • Aske Astrup

  • Theresa Wimberley

  • Masako Araki

  • Zheng Chang

  • Ditte Demontis

  • Zihan Dong

  • Stephen V Faraone

  • Le Gao

  • Malcolm B Gillies

  • Jan Haavik

  • Catharina Hartman

  • Henrik Larsson

  • Kenneth K C Man

  • Sallie-Anne Pearson

  • Harold Snieder

  • Melissa Vos

  • Ian C K Wong

  • Honghui Yao

  • Andrew SC Yuen

  • Yanli Zhang-James

  • Yiling Zhou

  • Helga Zoega

  • Anders Engeland

  • Søren Dalsgaard

  • Kari Klungsøyr

  • July 2, 2026

  • 0 min

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Objective:

Investigate psychiatric and neurological comorbidity as predictors of early ADHD medication discontinuation in new ADHD medication users across age groups, sex and countries/regions.

Approach:
  • Study Design: Analyzed health records from eight countries/regions, identifying 1,000,411 new ADHD medication users (2011–2020).
  • Discontinuation Definition: Defined as a ≥180 day gap between dispensations.
  • Indicators Examined: Examined 23 indicators of psychiatric or neurological comorbidity, severity, and psychotropic medication use.
  • Statistical Analysis: Used Cox regression and random-effects meta-analyses, stratified by age-at-initiation and sex.
Key Findings:
  • Discontinuation rates varied widely: children (19%–61%), adolescents (37%–68%), young adults (52%–67%), adults (38%–68%).
  • In children, predictors of earlier discontinuation included intellectual disability (HR 1.32, 95% CI 1.10 to 1.58), autism (HR 1.51, 95% CI 1.20 to 1.90), and psychotropic medication use.
  • Conduct/oppositional defiant disorder (CD/ODD) was protective in children (HR 0.83, 95% CI 0.73 to 0.94).
  • In young adults, CD/ODD predicted earlier discontinuation (HR 1.42, 95% CI 1.30 to 1.55); in adults, schizophrenia (HR 1.25, 95% CI 1.09 to 1.44) and tic disorders (HR 1.27, 95% CI 1.11 to 1.46) were predictors.
  • Statistical heterogeneity was substantial, particularly driven by US estimates.
Interpretation:

Children with neuropsychiatric comorbidity and related comedication are more likely to discontinue ADHD medication early, whereas few consistent predictors were seen from adolescence onwards.

Limitations:
  • Limited predictive value of psychiatric and neurological indicators in older age groups.
  • Cross-country differences indicate potential influences of healthcare systems on treatment patterns.
Conclusion:

Improving ADHD medication persistence will require consideration of healthcare context and age-specific strategies.

Original Source(s)

Psychiatric and neurological predictors of early ADHD medication discontinuation across the lifespan: a multinational study

  • by Isabell Brikell, Aske Astrup, Theresa Wimberley, Masako Araki, Zheng Chang, Ditte Demontis, Zihan Dong, Stephen V Faraone, Le Gao, Malcolm B Gillies, Jan Haavik, Catharina Hartman, Henrik Larsson, Kenneth K C Man, Sallie-Anne Pearson, Harold Snieder, Melissa Vos, Ian C K Wong, Honghui Yao, Andrew SC Yuen, Yanli Zhang-James, Yiling Zhou, Helga Zoega, Anders Engeland, Søren Dalsgaard, Kari Klungsøyr

  • July 2, 2026

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