Objective: To examine the reasons underlying treatment changes among pediatric patients with ADHD.

Methods: Data were obtained through online medical chart abstraction (August–September, 2021). Eligible patients with ADHD had initiated a treatment regimen at ages 6–17 and within 1–5 years of chart abstraction. Reasons contributing to treatment discontinuation were analyzed for a randomly selected treatment episode. ADHD/treatment-related complication rate was also described. Physicians’ perspective on adherence to ADHD treatment was assessed through an online survey. Results were reported overall and among children (ages 6–12) and adolescents (ages 13–17), separately.

Results: A total of 156 physicians abstracted 434 patient charts (235 children; 199 adolescents). Mean patient age was 11.3 years and 68.7% were male. Treatment regimens analyzed included stimulants (83.2%), nonstimulants (11.3%), and combination therapy (5.1%); average treatment duration was 23.3 months. Among patients who discontinued treatment (N=83), inadequate/suboptimal symptom management (60.2%) was the most common reason for discontinuing treatment, while 25.3% reported a treatment discontinuation due to ADHD/treatment-related complications. The most common ADHD/treatment-related complications leading to treatment discontinuation were anxiety (19.0%), insomnia/sleep disturbances (19.0%), and emotional impulsivity (19.0%). Overall, 42.4% of patients had ≥1 documented ADHD/treatment-related complication, and this proportion reached 54.5% among patients receiving combination therapy. Insomnia/sleep disturbance was the most common ADHD/treatment-related complication and occurred in 9.7% of patients. Notably, 75.5% of patients reported the experience or fear of complications had a negative impact on their adherence to ADHD treatment. Physicians reported taking actions toward patients’ non-adherence by further educating patients (81.0%), closer monitoring (59.9%), and changing the prescribed ADHD medication (38.1%). Results were similar among children and adolescents.

Conclusion: Lack of effectiveness and ADHD/treatment-related complications are important reasons for treatment changes among children and adolescents with ADHD, highlighting the need for more effective and tolerable treatments to mitigate the burden of ADHD.