Treatment Drop-out and Missed Appointments Among Adults With ADHD
Condition: Attention-Deficit/Hyperactivity Disorder; Drop-out; Non-adherence
MeSH terms: Hyperkinesis; Attention Deficit Disorder with Hyperactivity
Study type: Observational

Summary: 
      The investigators knowledge of factors associated with treatment drop-out and missed
      appointments among adults with Attention-Deficit/Hyperactivity Disorder (ADHD) within a
      naturalistic, clinical setting is very limited. Drop-out rates among adult ADHD patients in
      randomised controlled trials (RCT´s) have been reported to be 26.6% - 50%, and similar rates
      are reported in two naturalistic studies of medication adherence.

      Based on proposed hypotheses that past behaviour patterns are more predictive of current
      behaviours of treatment drop-out and missed appointments than are sociodemographic and
      clinical characteristics, the aim of the present study is to examine the associations of 1)
      sociodemographic variables, 2) clinical variables, 3) risk-taking behaviour 4) educational
      and occupational instability and 5) behaviours during primary/lower secondary school with
      treatment drop-out and number of missed appointments.

      The target group of the study consists of all patients who initiates assessment at the adult
      ADHD Clinic at Regional Psychiatric Services West, Herning, Central Denmark Region in the
      period from September 1, 2010 to September 1, 2011. The patients are referred to this Clinic
      from general practitioners and specialised psychiatric authorities. The investigators study
      is designed as an observational, cohort study in which the patients are offered medical and
      non-manualised psychosocial treatment as it is usually offered in this tertiary ADHD Clinic
      from which the data are collected.

      Data regarding sociodemography, clinical symptoms and impairments, risk-taking behaviour,
      educational and occupational instability and behaviours during primary/lower secondary school
      are collected using a semistructured protocol.

      In the investigators study the investigators define treatment drop-out as premature
      termination of ongoing treatment, without any prior clinical or agreed resolution. No
      standardized definition of treatment drop-out is used through out the literature of adherence
      to treatment among patients in the psychiatric care system.
    


Intervention name(s): Combined ADHD medication and psychosocial counseling
Intervention type(s): Other
Intervention description(s): The patients are offered as well ADHD medication as non-standardized psychosocial treatment, the latter including psychoeducation (i.e. information about ADHD aetiology and symptoms plus management of symptoms) and counselling regarding emotional-, family- and social rehabilitation-related problems.
ADHD medication:
First choice of medication is methylphenidate immediate release, initially 5 mg 2-3 times a day increasing with 10-20 mg per week up to stabilization of symptoms.
When stabilized a shift to extended release methylphenidate. Alternatively dexamphetamine, initially 2.5 mg 2-3 times a day increasing with 5-10 mg per week up to stabilization of symptoms.
If there is no adequate effect of central stimulants then a shift to atomoxetine, initially 18 mg a day, increasing during a period of 6-10 weeks up to max. 100 mg a day.
If the patients have a substance use, an anxiety problem or other contraindications then first choice of medication is atomoxetine.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients referred to a tertiary ADHD Clinic at Regional Psychiatric Services West, Central
        Denmark Region
      
Keywords: Adults; Outpatients