Medication adherence and influencing factors in children and adolescents with attention deficit hyperactivity disorder (ADHD): a systematic review and meta-analysis

Jianing Liu, Bingyao Kang, Weiqi Deng, Zilong Hao, Chunsong Yang, Li Zhang

Background Medication non-adherence is widely occurring in children and adolescents with ADHD, which may lead to adverse consequences. However, the pooled adherence rate and influencing factors are inconsistent in different studies. Methods We searched PubMed, Embase (Ovid), Cochrane Library, and four Chinese Databases from inception to 20 February 2024. All types of studies were included. Two researchers independently extracted data and assessed the risk of bias based on ROBINS-I, NOS, and AHRQ. A random-effects meta-analysis was conducted to pool the prevalence estimates and factors that can be combined. Results After screening 2,360 publications, 63 studies were finally included, involving 450,759 participants. The general quality of the included studies was moderate to high quality. Adherence rates were reported in 50 studies, and a pooled adherence rate was 43.6% (95% Confidence Interval [CI] 39.0%–48.3%). The sensitivity analysis shows robust study results. However, both the primary analysis and the sensitivity analysis indicated high heterogeneity. The results of Meta-analysis identified five factors influencing adherence, of which female (Odds Ratio [OR] = 1.07, 95%CI:1.03–1.11), fewer medication doses (OR = 0.45, 95%CI:0.27–0.75), parental agreement with the medication plan (OR = 1.87, 95%CI:1.16–3.02), single-child families (OR = 1.80, 95%CI:1.29–2.52), and medication education for parents (OR = 6.34, 95%CI:3.97–10.12) can improve medication adherence. Besides, we also identified seven factors influencing adherence by qualitative analysis. Conclusion Medication adherence is challenging for children and adolescents with ADHD, moreover, the meta-analysis of adherence rates showed high heterogeneity. We identified five modifiable factors by meta-analysis that are related to medication adherence, while other factors require further research. Systematic Review Registration identifier CRD42024514310.