European Child & Adolescent Psychiatry

, Volume 21, Issue 12, pp 657–663 | Cite as

To adhere or not, and what we can do to help

  • F. McNicholas


Two factors predict treatment outcome, how effective the treatment is and whether the patient takes or follows the treatment plan. As clinicians or scientists, we strive to develop newer and more effective treatments, both pharmacological and non-pharmacological to improve treatment outcome in our patient population. Adherence is the single most modifiable factor associated with treatment outcome, yet how often is the issue of adherence addressed in clinical consultations? The best treatment is rendered useless if not adhered to. Initial adherence rates are low and get worse with time, but methodological difficulties in studies make it difficult to determine both the clinical implication of suboptimal adherence and successful strategies. Further research should apply more rigour to the area of definition and measurement, be sufficiently powered and long term, and measure possible confounders, to allow for an understanding on the link and impact between adherence and clinical outcome. This article reviews some of the main issues with regard to adherence and cost implications of suboptimal adherence and suggests future directions.


Adherence Concordance Compliance Treatment effectiveness 


Conflict of interest



  1. 1.
    Sabaté E (2001) WHO Adherence Meeting Report. Geneva, World Health Organization, Adherence to long term therapies, Policy for Action.
  2. 2.
    Hellewell JSE (1998) Antipsychotic tolerability: the attitudes and perceptions of medical professionals, patients and caregivers towards side effects of antipsychotic therapy. Eur Neuropschopharmacol 8:248Google Scholar
  3. 3.
    American Public Health Association (2004) “Adherence to HIV treatment regimens: recommendations for best practices APHA”Google Scholar
  4. 4.
    Haynes RB, Montague P, Oliver T, McKibbon KA, Brouwers MC, Kanani R (2001) Interventions for helping patients follow prescriptions for medications. Cochrane Libr (Oxford) 1 (28p) (19 ref 23 bib)Google Scholar
  5. 5.
    Bangsberg DR, Acosta EP, Gupta R, Guzman D, Riley ED, Harrigan PR, Parkin N, Deeks SG (2006) Adherence-resistance relationships for protease and non-nucleoside reverse transcriptase inhibitors explained by virological fitness. AIDS 20(2):223–231CrossRefPubMedGoogle Scholar
  6. 6.
    Bangsberg DR, Hecht F, Charlebois E, Zolopa A, Holodniy M, Sheiner L, Bamberger J, Chesney M, Moss A (2000) Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS Vol 14(4):357–366CrossRefGoogle Scholar
  7. 7.
    Charach A, Figueroa M, Chen S, Ickowicz A, Schachar R (2006) Stimulant treatment over 5 years: effects on growth. Am Acad Child Adolesc Psychiatry. 45(4):415–21Google Scholar
  8. 8.
    Weiden P (2002) Adherence to antipsychotic medication: key facts. Schizophrenia Home page 2002.
  9. 9.
    Pappadopulos E, Jensen PS, Chait AR, Arnold LE, Swanson JM, Greenhill LL, Hecthman L, Chuang S, Wells KC, Pelham W, Cooper T, Elliott G, Newcorn JH (2009) Medication adherence in the MTA: saliva methylphenidate samples versus parent report and mediating effect of concomitant behavioral treatment. J Am Acad Child Adolesc Psychiatry 48(5):501–510CrossRefPubMedGoogle Scholar
  10. 10.
    Marcus SC, Durkin M (2011) “Stimulant adherence and academic performance in urban youth with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 50(5):480–489CrossRefPubMedGoogle Scholar
  11. 11.
    Woldu H, Goldstein T, Sakolsky D, Perel J, Emslie G, Mayes T, Clarke G, Ryan ND, Birmaher B, Wagner KD, Asarnow JR, Keller MB, Brent D (2011) Pharmacokinetically and clinician-determined adherence to an antidepressant regimen and clinical outcome in the TORIDA trial. J Am Acad Child Adolesc Psychiatry 50(5):490–498CrossRefPubMedGoogle Scholar
  12. 12.
    Avins A, Pressman A, Ackerson L, Rudd P, Neuhaus J, Vittinghoff E (2010) Placebo adherence and its association with morbidity and mortality in the studies of left ventricular dysfunction. J Gen Intern Med 25(12):1275–1281CrossRefPubMedGoogle Scholar
  13. 13.
    Weis SE, Slocum PC, Blais FX, King B, Nunn MG, Matney B, Gomez E, Foresman BH (1994) The effect of directly observed therapy on the rates of drug resistance and relapse in tuberculosis. N Engl J Med 330:1179–1184CrossRefPubMedGoogle Scholar
  14. 14.
    World Health Organisation (2003) Adherence to long term therapies, evidence for action.
  15. 15.
    Haynes RB, Taylor DW, Sackett DL (1979) Compliance in Health care. Johns Hopkins University press, BaltimoreGoogle Scholar
  16. 16.
    Neil AL, Batterham P, Christensen H, Bennett K, Griffiths KM (2009) Predictors of adherence by adolescents to a cognitive behavior therapy website in school and community-based settings. J Med Internet Res 11(1):e6CrossRefPubMedGoogle Scholar
  17. 17.
    Demyttenaere K (1998) Noncompliance with antidepressants: who’s to blame? Int Clin Psychopharmacol 13(Suppl 2):S19–S25CrossRefPubMedGoogle Scholar
  18. 18.
    Peveler R, George C, Kinmonth A, Campbell M, Thompson C (1999) Effect of antidepressant drug counselling and information leaflets on adherence to drug treatment in primary care: randomised controlled trial. Br Med J 319:612–615CrossRefGoogle Scholar
  19. 19.
    Chacko A, Newcorn, J, Feirsen N, Uderman J (2010) Improving medication adherence in chronic pediatric health conditions; a focus on ADHD in youth. Curr Pharm Des 16(22):2416–2423(8)Google Scholar
  20. 20.
    Marcus SC, Wan GJ, Kemner JE, Olfson M (2005) Continuity of methylphenidate treatment for attention-deficit hyperactivity disorder. Arch Pediatr Adolesc Med 159(6):572–578CrossRefPubMedGoogle Scholar
  21. 21.
    Miller AR, Ialonde CE, McGrail KM (2004) Children’s persistence with methylphenidate therapy; a population based study. Can J Psychiatry 49:761–768PubMedGoogle Scholar
  22. 22.
    Devatharshy T, Charach A, Schachar R (2001) Moderators and mediators of long-term adherence to stimulant treatment in children with ADHD J Acad Child Adolesc Psychiatry 40(8):922–928Google Scholar
  23. 23.
    Fotheringham MSM (1995) Adherence to recommended medical regimens in childhood and adolescence. J Pediatr Child Health 31:72–78CrossRefGoogle Scholar
  24. 24.
    Brehm JW (1966) A theory of psychological reactance. Academic Press, New YorkGoogle Scholar
  25. 25.
    Bussing R, Koro-Ljungberg ME, Gary (2005) Exploring help-seeking for ADHD symptoms; a mixed methods approach. Har Rev Psychiatry 13:85–101Google Scholar
  26. 26.
    DiMatteo MR, Haskard KB, Williams SL (2007) Health beliefs, disease severity and patient adherence: a meta-analysis. Med Care 45(6):521–528CrossRefPubMedGoogle Scholar
  27. 27.
    Christensen L, Sasane R, Hodgkins P (2010) Pharmacological treatment patterns among patients with attention-deficit/hyperactivity disorder retrospective claims-based analysis of a managed care population. Curr Med Res Opin 26:977–89Google Scholar
  28. 28.
    Adler, LD, Nierenberg AA (2010) Review of medication adherence in children and adults with ADHD. Postgrad Med 122(1):184–91Google Scholar
  29. 29.
    Gau SF, Shen H, Chow M (2006) Determinants of adherence to methylphenidate and the impact of poor adherence on maternal and family measures. J Child Adolesc Psychopharm 16:286–297CrossRefGoogle Scholar
  30. 30.
    Gonzalez JS (2007) Physical symptoms, beliefs about medications, negative mood, and long-term HIV medication adherence. Ann Behav Med 34(1):46–55CrossRefPubMedGoogle Scholar
  31. 31.
    Hall JA, Roter DL, Katz NR (1988) Meta-analysis of correlates of provider behaviour in medical encounters. Med Care 26:657–675CrossRefPubMedGoogle Scholar
  32. 32.
    Schulman BA (1979) Active patient orientation and outcomes in hypertensive treatment: application of a socio-organizational perspective. Med Care 17:267–280CrossRefPubMedGoogle Scholar
  33. 33.
    Dunbar J, Agras W (1980) Compliance with medical instructions. In: Ferguson J, Taylor C (eds) The comprehensive handbook of behavioural medicine. Springer, New York, pp 115–145CrossRefGoogle Scholar
  34. 34.
    Zolnierek KB, Dimatteo MR (2009) Physician communication and patient adherence to treatment: a meta-analysis. Med Care 47(8):826–834CrossRefPubMedGoogle Scholar
  35. 35.
    Vermeire EIJJ, Wens J, Van Royen P, Biot Y, Hearnshaw H, Lindenmeyer A (2005) Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus. Cochrane Database Syst Rev Issue 2. Art. No.: CD003638. doi: 10.1002/14651858.CD003638.pub2
  36. 36.
    Haynes, RB, Ackloo, E, Sahota N, McDonald HP, Yao X (2008) Interventions for enhancing medication adherence Cochrane Database Syst Rev Issue 2. Art No: CD0000011. doi: 10.1002/14651858.CD000011.pub3
  37. 37.
    Fishbein M, Triandis H, Kanfer F (2001) Factors influencing behaviour and behaviour change. In: Baum A, Revenson T, Sing J (eds) Handbook of health psychology. Erlbaum, MahwayGoogle Scholar
  38. 38.
    Prochaska JO, DiClemente CC, Norcross JC (1992) In search of how people change. Applications to addictive behaviors. Am Psychol 47:1102–1114CrossRefPubMedGoogle Scholar
  39. 39.
  40. 40.
  41. 41.
  42. 42.
    Leininger MM, McFarland MR (2006) In: Culture care diversity and universality a worldwide nursing theory, 2nd edn. Jones and Bartlett Publishers, BostonGoogle Scholar
  43. 43.
    Corrigan PW, Penn DL (1999) Lessons from social psychology on discrediting psychiatric stigma. Am Psychol 54:765–776Google Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Our Lady’s Children’s HospitalDublinIreland

Personalised recommendations