Psy-Q: Why are individuals with attention deficit hyperactive disorder and co-occurring psychiatric disorders more likely to stop taking their ADHD medication? Matthew Edelstein, PsyD, BCBA-D, answers.

Matthew Edelstein, PsyD, BCBA-DAnswer: People with ADHD often experience deficits in their attention, organization skills, and working memory. This can impact their ability to take their medication, according to Matthew Edelstein, PsyD, BCBA-D, a licensed psychologist and behavior analyst who practices in Maryland.

ADHD, Comorbidities, and Daily Function

“As it takes considerable organization to remember to take the right medication at the right dosage each day, people with an ADHD diagnosis may be predisposed to have difficulty with medication compliance,” he explains, adding that having other, co-existing behavioral health diagnoses can compound this problem.

“Generally speaking, the more diagnoses that an individual meets criteria for, the higher the likely degree of their functional impairment. In other words, complex and varied clinical presentations (ie, having ADHD and a mood or substance use disorder) typically means that there is a larger effect on the individual’s daily life,” Dr. Edelstein points out. This can cause difficulty following “the basic activities of daily living, even those that could actually be helpful if accomplished – for instance, regular exercise, hygiene routines, or taking medication.”

ADHD Stimulants and Side Effects

Stimulants often used to treat ADHD can also cause uncomfortable side effects, and the discomfort can be magnified for people with multiple diagnoses. “Even though stimulants are extremely useful for reducing the symptoms of ADHD, research on their use suggests that they can also increase feelings of irritability and anxiety,” he says. “In addition, some people find stimulant medication can increase the likelihood of tics (ie, quasi voluntary motor and/or vocal behaviors [tardive dyskinesia]), which can be significantly distressing and socially stigmatizing,” he adds.

Since stimulants don’t ‘build up in one’s system’ the way other types of medication do, people must continue taking them every day in order to get the benefits, Dr. Edelstein says. This makes it important that clinicians help their patients with ADHD and other diagnoses to stick to their treatment plan. In addition, he stresses the need for maintaining consistent coordination of care with prescribing physicians.

See a recent study on ADHD medication non-adherence in those with co-occurring psychiatric disorders.

Mental health care professionals can support patients at risk for medication non-adherence by “creating systems to help them remember to fill and take their daily medication,” he adds. They can also monitor side effects and help patients to manage them, as well as to develop ways to cope with life stressors.

Additional ADHD Resources for Clinicians

Last Updated: Sep 9, 2021