A Scoping Overview of Medication Non-Adherence to ADHD Medications

ADHD (Attention Deficit Hyperactivity Disorder)

• Definition: Mental condition that begins in childhood and often persists into adulthood marked by consistent difficulty in maintaining attention and concentration; frequently accompanied by hyperactivity and impulsivity.¹

Up to 80% of adults prescribed ADHD medications, fail to adhere to their treatment plan within the first year.² Reasons include the following … 

Inherent Nature of ADHD → The symptoms accompanying ADHD can create deficits in executive functioning such as …²

• Working memory²
• Self-regulation²
• Time management²

Unpleasant Side Effects of Stimulant Medications → Many medications include undesirable side effects that may reduce individuals willingness to take their medication as prescribed, such as significant appetite suppression, rebound effects, insomnia or restlessness, stomachaches, headaches, & tics.^{2, 3} 

• About 80% of patients report appetite suppression, which can lead to weight loss, especially among youth.^{4, 5, 6} 
• As many as 50% of children with ADHD have a tic disorder that can be exacerbated or first exhibited when they begin taking stimulant medications.^{7, 8} 

Dosing Complexity → Research suggests that as the complexity of one’s medication regimen increases, adherence subsequently decreases.⁹ For instance, while non-adherence across chronic conditions is estimated to be 20% for once daily dosing, medications that must be administered numerous times throughout the day result in lower levels of adherence: twice daily = 30%, three times daily = 60%, and four times daily = 70%.⁹ 

• Short-acting stimulants often require multiple doses due to their short half-life.¹⁰ This introduces a series of challenges, such as one needing to remember to bring their medication with them wherever they go, having to remember to take their medication at specific hours, and fear of experiencing stigma due to having to potentially take medication in public settings. 
• Long-acting stimulants must be taken in the morning for symptom control throughout the day; high-fat meals and citrus can delay or reduce absorption.¹⁰ Consequently, even for medications that require once-daily dosing, such as long-acting stimulants, forgetting to take these medications in the morning or consuming these medications alongside specific breakfast foods and beverages, may lead to reduced symptom control and impair one’s ability to function. 

Lack of Immediate Symptom Control  

• Up to 30% of patients do not respond to first-line stimulants, like Concerta and Rialin.¹¹ This may lead to frustrations with lack of tangible benefits associated with taking medication and/or frequent medication switches, which reduce the likelihood of consistent adherence.
  • It can take 3-6 months of trial and error to find the right regimen, frustrating enough to potentially lead to non-adherence.¹²

Stigma Regarding ADHD 

Societal Stigma from an ADHD Diagnosis → Some individuals consider ADHD to be a made-up or an industry-driven diagnosis aimed at increasing pharmaceutical sales.^{13, 14, 15}

• 77% of parents note their children experiencing stigma before they received a diagnosis.⁵ 
• An estimated 50% of parents reported worrying about the labels or rejection their children may face due to societal misconceptions of ADHD.¹⁶ 
• There is a long-withstanding misconception that ADHD predominantly impacts children, and individuals will “grow out of it” over time.^{17, 18}
  • This has led to many individuals diagnosed with ADHD in adulthood facing backlash regarding their diagnosis. ^{17, 18 19}

The Implications of the Recent Stimulant Shortage 

• An ADDitude survey from March of this year found 38% of ADHD medication users felt like they were treated like addicts or criminals when trying to get refills for their medications.²⁰ 
• Patients have reported experiencing “wariness, annoyance, and even … hostility”²⁰ when attempting to refill their medications from pharmacies.
  • Some experiences were described as so unpleasant or bad that patients reconsidered whether it was worth continuing to take their medication at all.²⁰ 

ADHD: Is it Overdiagnosed and Overtreated? 

Has There Truly Been an Increase in ADHD’s Prevalence?

• 4.5% → 6% of population
  • The recent rise in ADHD diagnoses over the past few decades likely reflects increased awareness and recognition of the condition, particularly among adults who were not diagnosed in childhood. ^{19, 21, 22}  
• There are many concerns regarding whether clinicians are equipped to evaluate adult ADHD appropriately.¹⁹ 
  • About ⅔ of providers treating adults reported being poorly equipped to address the condition.^{19, 23} This gap can lead to suboptimal diagnosis or over-reliance on prescribing medications to see if they help, with can contribute to the perception of overtreatment.¹⁹ 
• There is a dire need for additional research to improve access, accuracy, and provider education for adult ADHD.
  • Currently, there is a $36 million dollar gap in funding between pediatric and adult ADHD research.^{19, 24} Despite, when adult ADHD is diagnosed and treated properly, it can significantly improve individuals’ quality of life.¹⁹ 

Unintentional v. Intentional Non-Adherence 

Unintentional Non-Adherence

• Definition: When someone wants to take their medication, but can’t due to forgetfulness, access issues, or other practical barriers.²⁵
  • This form of non-adherence is common in individuals diagnosed with ADHD due to executive functioning difficulties.² 
• For example, research highlights that some individuals diagnosed with ADHD have difficulty remembering an object if they cannot see, hear, or touch it.²⁶
  • Misplacing medication, forgetting when one is meant to take their medication, or experiencing distractions that take precedence over taking one’s medication, may all result in an individual not taking their medication and becoming unintentionally non-adherent.²⁶
    • This likely becomes increasingly difficult the more doses an individual is required to take in a day.^{27, 28} 

Intentional Non-Adherence 

• Definition: Involves a conscious decision to not follow one’s prescribed regimen, which is deliberate and driven by motivation.²⁵
  • In ADHD, we commonly see and hear about two forms of intentional non-adherence:
    • Diversion is when a person gives away or sells their prescribed medication instead of taking it as instructed.²⁹ 
    • Misuse can entail taking more or less medication than prescribed by a provider.³⁰
      • Individuals without a prescription who obtain and take stimulants illegally are engaging in non-adherence behaviors, outside the bounds of any medical supervision.³⁰

Misuse and Diversion of Stimulant Medications 

Misuse and Diversion 

• One in every 5 people report misusing their stimulant medications.³¹
  • Researchers believe rates of misuse among college students are above 43% for those taking stimulants without a prescription.³² Over 30% of college students with a prescription admit to taking higher or more frequent doses of their prescribed stimulant medication.³²
    • 66-91% of individuals misusing stimulants reported getting stimulant medications from a friend, peer, or family member with a legitimate prescription.³²
  • Increased prevalence of misuse and diversion among college students due to …^{32, 33}
    • Pressure to succeed academically
    • Lack of parental supervision for medication management
    • Stimulant misuse and diversion often normalized by peers.
  • Nonmedical use of prescription stimulants is the most common form of illicit drug use among college students, aside from marijuanna.³⁴
    • Estimates suggest that the rate of misuse may be as high as 20%, or 1 in every 5 college students.³⁵ 
    • Up to 50% of students with ADHD report being approached to sell or share their medications, highlighting the severity of this issue.³²

Consequences: 

• Stimulants are classified as schedule II controlled substances (which fall under the same category as cocaine and meth).³⁶ As a result, the consequences for selling or misusing ADHD medications are high, for example …
  • In California, the penalty for selling stimulant medications can carry a $10,000 fine and 10 years of jail time.³⁶ 
  • In California, unlawful possession of Adderall is a misdemeanor charge, with maximum penalties resulting in up to a year in county jail and a $1,000 fine.³⁷ 
• Beyond legal implications, misuse and diversion can result in potential disciplinary action and/or expulsion from school.³⁶
• Furthermore, the misuse of ADHD medications can lead to serious, negative health effects, including seizures, psychosis, addiction, and heart failure. 

Immediate v. Extended Release 

• Extended-release stimulants may reduce the likelihood of misuse due to slower onset, less euphoria, and difficulty with using via non-oral routes.³⁸
  • A study from Harvard University found that Concerta (extended-release), despite being equally effective, was less likely to be abused than drugs containing methylphenidate (immediate-release), which can produce an immediate high.³⁹ 

How Can AdhereTech Support Stimulant Adherence for Patients Living with ADHD?

Addressing Executive Functioning Challenges 

• Real-time adherence tracking to balance patient autonomy and accountability. 
• Emission of a gentle glow and chime when a patient’s dosing time arrives, which reduces the likelihood of an individual misplacing their medication and being unable to find it. 
• Escalation in reminders, beginning with a gentle glow, next auditory chimes, and then text-based notification if a patient misses their dosing window, ensures that regardless of potential distractions, patients receive numerous, consistent reminders to help them remember to take their medication. 

AdhereTech’s Promise in Mitigating Stimulant Medication Misuse and Diversion

• Devices log every device opening in real-time with time stamps, so frequent unscheduled openings or patterns of missed doses can raise red flags to providers and clinical trial sites. 
• The smart pill bottle’s electronic field can detect when large or inappropriate withdrawals of medication occur, signifying potential misuse or diversion.
• Visual, auditory, and text-based alerts can create a sense of risk and accountability for those diverting or misusing stimulants by signaling that their medication use is being monitored, which may increase the perceived likelihood of detection, subsequently reducing these risks. 
• Unlike video monitoring, which only provides a snap-shot into patients adherence behaviors, AdhereTech balances surveillance and patient privacy. By passively monitoring medication-taking behaviors, patients remain autonomous over their medication, while enabling providers to potentially detect red flags of misuse and discourage it in real-time.

References 

¹ Centers for Disease Control and Prevention. (2024, November 19). Data and statistics on ADHD. https://www.cdc.gov/adhd/data/index.html 

² Rostain, A. L. (2025, October 2). How to improve medication adherence in adults and teens with ADHD. ADDitude. https://www.additudemag.com/add-medication-adherence/?srsltid=AfmBOorrR1edSTWUemGekqJyv4iPZLqMVCGvxQqHZowytgkZpM2z36qm 

³ Cleveland Clinic. (2025, March 12). Attention-deficit/hyperactivity disorder (ADHD). https://my.clevelandclinic.org/health/diseases/4784-attention-deficithyperactivity-disorder-adhd

⁴ Cleveland Clinic. (2022, October 6). ADHD medications: How they work & side effects. https://my.clevelandclinic.org/health/treatments/11766-adhd-medication

⁵ Kresge, K. (2025, January 22). 6 common nutrient deficiencies linked to ADHD. Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-approach-to-treating-adhd 

⁶ Hope, C., & Whitbourne, K. (2024, June). Adderall side effects. WebMD. https://www.webmd.com/add-adhd/adderall-side-effects 

⁷ ADDitude. (2019, September 16). ADHD medication side effects no one should tolerate. https://www.additudemag.com/adhd-medication-side-effects-that-no-one-should-tolerate/

⁸ Silver, L. (2025, July 19). How to tame the tics associated with ADHD medication. ADDitude. https://www.additudemag.com/adhd-treated-tics-tamed/?srsltid=AfmBOoql0olv0JqX7G_2QcqEQhaxBHWoWIw3DcpQkzyeySYSlNg_ocal 

⁹ Aljofan, M., Oshibayeva, A., Moldaliyev, I., Saruarov, Y., Maulenkul, T., & Gaipov, A. (2023). The rate of medication nonadherence and influencing factors: A systematic Review. Electronic Journal of General Medicine, 20(3).

¹⁰ Rostain, A. L. (2025, October 2). Short-acting stimulants vs. long-acting stimulants: Comparing ADHD medications and durations. ADDitude. https://www.additudemag.com/short-acting-stimulants-long-acting-stimulants/

¹¹  McClure, P. (2025, April 14). ADHD meds don’t work for everyone – a new study reveals why. New Atlas. https://newatlas.com/adhd-autism/ritalin-stimulant-adhd-medication-dopamine-receptors/.

¹² Watson, S. (2022, July 13). What are noradrenergic medicines for ADHD?. WebMD. https://www.webmd.com/add-adhd/adult-adhd-noradrenergic-agents

¹³ Mueller, A. K., Fuermaier, A. B., Koerts, J., & Tucha, L. (2012). Stigma in attention deficit hyperactivity disorder. Attention deficit and hyperactivity disorders, 4(3), 101–114. https://doi.org/10.1007/s12402-012-0085-3

¹⁴Washington, I., & Yilma, H. (2025, February 13). Federal health communications and ADHD skepticism. KFF. https://www.kff.org/health-information-trust/skepticism-surrounding-adhd-diagnoses-and-medication/ 

¹⁵Cleveland Clinic. (2024, May 13). 7 myths (and the facts) about ADHD. Health Essentials. https://health.clevelandclinic.org/myths-about-adhd

¹⁶DosReis, S., Barksdale, C. L., Sherman, A., Maloney, K., & Charach, A. (2010). Stigmatizing experiences of parents of children with a new diagnosis of ADHD. Psychiatric services (Washington, D.C.), 61(8), 811–816. https://doi.org/10.1176/ps.2010.61.8.811 

¹⁷Sherman, C. (2025, May 8). Coping with the stigma of ADHD. ADDitude. https://www.additudemag.com/overcoming-adhd-stigma/?srsltid=AfmBOooLMMIIlzXYUUQu8UT_4wlghIcIskU7E19RityQisXHm7udpU_m 

¹⁸WebMD. (2024, September 13). Adult ADHD: Facts & statistics. Retrieved [Date you accessed the page], from https://www.webmd.com/add-adhd/adult-adhd-facts-statistics

¹⁹Weiner, S. (2024, November 19). Adult ADHD: Overdiagnosed? Or finally getting the attention it deserves? AAMCNews. https://www.aamc.org/news/adult-adhd-overdiagnosed-or-finally-getting-attention-it-deserves (aamc.org)

²⁰ ADDitude Editors. (2025, October 2). “Stop treating us like we’re addicts!”. ADDitude. https://www.additudemag.com/adderall-shortage-controlled-substance-adhd-meds-shortage/?srsltid=AfmBOopyJfZlVO7owcxkzMMhE-U64BSYJ_sQPPc5Uh237EV1UCiU8ui4 

²¹Abdelnour, E., Jansen, M. O., & Gold, J. A. (2022). ADHD Diagnostic Trends: Increased Recognition or Overdiagnosis?. Missouri medicine, 119(5), 467–473.

²² ABC News. (2014, March 11). Missed ADHD diagnosis, lost childhood. https://abcnews.go.com/Health/missed-adhd-diagnosis-lost-childhood/story?id=22858720 

²³National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Health Sciences Policy, Forum on Neuroscience and Nervous System Disorders, & Forum on Drug Discovery, Development, and Translation. (2024, August 14). Adult Attention-Deficit/Hyperactivity Disorder: Diagnosis, Treatment, and Implications for Drug Development: Proceedings of a Workshop. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK606341/

²⁴Sibley, M. H., Faraone, S. V., Nigg, J. T., & Surman, C. B. (2023). Sudden increases in US stimulant prescribing: alarming or not?. Journal of attention disorders, 27(6), 571-574.

²⁵ Molloy, G. J., Messerli-Bürgy, N., Hutton, G., Wikman, A., Perkins-Porras, L., & Steptoe, A. (2014). Intentional and unintentional non-adherence to medications following an acute coronary syndrome: a longitudinal study. Journal of psychosomatic research, 76(5), 430–432. https://doi.org/10.1016/j.jpsychores.2014.02.007 

²⁶Lewsley, J. (2013, February 17). What to know about object permanence and ADHD. MedicalNewsToday. https://www.medicalnewstoday.com/articles/object-permanence-adhd 

²⁷ Kamimura-Nishimura, K. I., Brinkman, W. B., & Froehlich, T. E. (2019). Strategies for improving ADHD medication adherence. Current psychiatry, 18(8), 25–38.

²⁸Charach, A., & Fernandez, R. (2013). Enhancing ADHD medication adherence: challenges and opportunities. Current psychiatry reports, 15(7), 371. https://doi.org/10.1007/s11920-013-0371-6

²⁹Centers for Medicare & Medicaid Services. (2015, March 31). What is a prescriber’s role in preventing the diversion of prescription drugs? https://www.cms.gov/files/document/prescriber-role-drugdiversion-033115pdf

³⁰ Forrest, J., Chen, W., & Jagadheesan, K. (2025). Misuse and diversion of stimulant medications prescribed for the treatment of ADHD: a systematic review. Frontiers in psychiatry, 16, 1612785. https://doi.org/10.3389/fpsyt.2025.1612785 

³¹ Forrest, J., Chen, W., & Jagadheesan, K. (2025). Misuse and diversion of stimulant medications prescribed for the treatment of ADHD: a systematic review. Frontiers in psychiatry, 16, 1612785. https://doi.org/10.3389/fpsyt.2025.1612785

³²Laurie Maitland, T. E. (2025, September 12). Teaching teens the dangers of sharing ADHD medications. ADDitude. https://www.additudemag.com/adhd-medication-diversion-teens-sharing-stimulants/?srsltid=AfmBOoqM1fKQzu_Z0kfaC-xj84pQKg0LtKpmJEOnzXqRUki2NeAyuYNl 

³³Holt, L. J., Looby, A., Schepis, T. S., & Stimulant Norms and Prevalence (SNAP) Study Team (2023). Sources for prescription stimulant misuse: A person-centered approach to understanding links to substance use and psychiatric impairment. Experimental and clinical psychopharmacology, 31(2), 498–506. https://doi.org/10.1037/pha0000586 

³⁴Lakhan, S. E., & Kirchgessner, A. (2012). Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effects. Brain and behavior, 2(5), 661–677. https://doi.org/10.1002/brb3.78 

³⁵Kennedy S. (2018). Raising Awareness About Prescription and Stimulant Abuse in College Students Through On-Campus Community Involvement Projects. Journal of undergraduate neuroscience education : JUNE : a publication of FUN, Faculty for Undergraduate Neuroscience, 17(1), A50–A53.

³⁶Copper, J., & ADDitude Editors. (2025, February 26). “I sold my ADHD medication and got caught.” ADDitude. https://www.additudemag.com/medication-diversion-adhd-prescription/?srsltid=AfmBOoqpvgnAab4Sfdk08G6xY6Ao9DJTrE_aw_Sg3fE076JW-DCu7H_Z 

³⁷Hindin, B. (2024, August 30). What happens when you get caught with Adderall?. The Recovery Village. https://www.therecoveryvillage.com/adderall-addiction/what-happens-getting-caught/ 

³⁸Mariani, J. J., & Levin, F. R. (2007). Treatment strategies for co-occurring ADHD and substance use disorders. The American journal on addictions, 16 Suppl 1(Suppl 1), 45–56. https://doi.org/10.1080/10550490601082783 

³⁹Saathoff, K. G. (2006, March 16). ADHD drug less prone to abuse. The Harvard Crimson. https://www.thecrimson.com/article/2006/3/16/adhd-drug-less-prone-to-abuse/ 2/story/harnessing-digital-health-solutions-to-improve-patients-lives/.