Abstract
Purpose
The purpose of this study was to assess the association between attention-deficit/hyperactivity
disorder (ADHD) medication adherence and adverse health outcomes in older adolescents
transitioning to adulthood.
Methods
In a cohort of 17-year-old adolescents with ADHD at Kaiser Permanente Northern California,
we assessed medication adherence (medication possession ratio ≥70%) and any medication
use and associations with adverse outcomes at 18 and 19 years of age. We conducted
bivariate tests of association and multivariable logistic regression models.
Results
Adherence declined from 17 to 19 years of age (36.7%–19.1%, p < .001). Non-white race/ethnicity, lower estimated income, and male sex were associated
with nonadherence. Model results show nonadherent females experienced several adverse
outcomes: Adherence at 18 years of age (referent: nonadherence) was associated with
lower odds of pregnancy (adjusted odds ratio [AOR]: .13, 95% confidence interval [CI]:
.03–.54). Any use (referent: nonuse) at 18 years of age was associated with lower
odds of sexually transmitted infections among females (AOR: .39, 95% CI: .19–.83),
pregnancies (AOR: .26, 95% CI: .13–.50), emergency department visits (AOR: .69, 95%
CI: .55–.85), and greater odds of injuries (AOR: 1.16, 95% CI: 1.02–1.32). Adherence
at 19 years of age was associated with lower odds of pregnancy (AOR: .13, 95% CI:
.02–.95). Any use at 19 years of age was associated with lower odds of injury in females
(AOR: .77, 95% CI: .60–.99) pregnancy (AOR: .35, 95% CI: .16–.78), and, in both sexes,
substance use (AOR: .71, 95% CI: .55–.92).
Conclusions
Late adolescence is associated with decline in ADHD medication use and adherence.
ADHD medication adherence and any ADHD medication use is associated with fewer adverse
health outcomes, particularly in females.
Keywords
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Article info
Publication history
Published online: May 28, 2021
Accepted:
April 18,
2021
Received:
February 10,
2021
Footnotes
Conflicts of interest: Dr. Campbell is supported by grants and contracts from the National Institute on Drug Abuse (UG1DA040314, R01DA047405) and the Food and Drug Administration. Dr. Campbell has received support managed through her institution from the Industry PMR Consortium, a consortium of companies working together to conduct postmarketing studies required by the Food and Drug Administration that assess known risks related to opioid analgesic use. The authors have no conflicts of interest to disclose.
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