Tolerance breaks accounted for attention-deficit/hyperactivity disorder (ADHD) medication nonadherence among one-fifth of adolescents and young adults, according to authors of a study published in the Journal of Attention Disorders.
In the setting of ADHD, medication tolerance is common and even expected. In 2019, it was proposed that instead of increasing medication dosage to address tolerance, a break from treatment may allow the brain to recover. Because tolerance breaks are a new concept in the treatment of ADHD, limited data have been collected on how often individuals with ADHD already engage in tolerance breaks.
The current study aimed to evaluate variables associated with increased medication nonadherence in adolescents and young adults 13 to 24 years of age with self-reported ADHD. The study population (N=196) was recruited using an advertisement on the Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) website. Participants responded to questions about medication treatment and adherence.
The study population comprised 75% adolescents and adults who self-identified as female and 15% who self-identified as male (with 10% either identifying as neither gender or choosing not to specify their gender). The mean age was 20.47 years (SD, 2.44), 80% were White, average duration of treatment with ADHD medications was 4.62 years (SD, 4.99), 41% reported having anxiety, 37% reported depression, and 7% reported a learning disability.
When asked if they took their medication as prescribed, 7.7% said they never missed taking it, 17.9% said they took it most of the time, 18.4% said they took it as prescribed almost all the time, 25.0% said they sometimes missed taking it because they forgot or did not feel like taking it. In addition, 5.1% said they do not take it most of the time, 1.0% said they almost never take their medication as prescribed, and 0.5% said they never took their medication as prescribed.
Motivations for not taking their ADHD medication as prescribed included wanting to feel normal or independent (38.3%), disliking the feeling of the medication generally (37.8%), forgetting (36.2%), tolerance (19.9%), logistics of filling medication (15.3%), and cost (8.2%).
Free responses reflected concerns about both medication effectiveness and dependence/addiction. In free responses, 1 participant said that if they take their medication too regularly, they build up a tolerance. Another was concerned about becoming dependent on or addicted to their medication, so they chose to skip taking it on weekends or breaks from school.
In a regression model (F[13,195], 3.51; P <.001), predictors for ADHD medication nonadherence were not liking the “feel” of their medication (β, 0.96; P <.001), forgetting (β, 0.75; P <.001), White race (β, 0.62; P =.03), and tolerance (β, 0.50; P =.045).
The major limitation of this study was the reliance on self-reporting of diagnoses and adherence to medications. In addition, the majority of patients included in the study were White, indicating that study results may not be applicable to other patient populations.
The researchers found that medication tolerance breaks are relatively common among young patients with ADHD. They concluded, “This reason for medication [nonadherence] may be considered relatively novel for the research literature among individuals with ADHD. Future research should further discern the understanding of individuals with ADHD in making these decisions regarding medication [nonadherence].”
Barnard-Brak L, Marques A, Kudesey C. Medication non-adherence and tolerance breaks among adolescents and young adults with ADHD. J Atten Disord. Published online April 11, 2023. doi:10.1177/10870547231167562