How Do Patients With ADHD Stay Organized About Medication? Texts Can Help

For patients with attention-deficit/hyperactivity disorder (ADHD), getting and staying organized and maintaining focus on the right things at the right time is a challenge. Some solutions are touted at the start of every year in the form of “getting organized” with the latest planners, smartphones as well as smart home devices like Amazon’s Alexa and Google Home.

One of the very ways the symptoms of ADHD may play out, however, is remembering to take medication. And it is in that area that technology could play a big role in help patients remember what they need to do. While stimulant medication for ADHD is considered safe and effective and the first-line treatment, nonadherence is amongst the highest in medicine, estimated to be as high as 87% after 1 year.

The American Journal of Managed Care^® recently spoke with Ronna Fried, EdD, a supervising neuropsychologist in the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD at Massachusetts General Hospital and an instructor in psychiatry at Harvard Medical School, about this issue. A pilot study from Massachusetts General Hospital (unpublished) looked at this issue by examining electronic health records (EHRs) of a large healthcare organization.

Fried and other researchers determined whether families or caregivers renewed the first stimulant prescription for ADHD (termed a definition of engagement).

Using the EHR data, only 50% of close to 3000 pediatric patients renewed prescriptions.

While not all the reasons for poor adherence are understood, they are believed to include:

• The symptoms of ADHD itself
• The prescription environment created by the schedule II nature of stimulant medications
• The beliefs about ADHD and its treatment (including biases and prejudices about medication)

Some parents may not have understood how the medication worked, or understood that it only lasted a few hours, Fried said. When it wore off later in the day, they may have erroneously believed that the medication was not working, for example.

The researchers created a text-based disease management intervention system for adults that resulted in an 98% engagement rate. The text messages included automated twice-daily reminders about timing, frequency and dose of medication intake, re-contacting the prescriber for timely refills, and educational reminders about ADHD and its treatment.

If text messaging is useful for ADHD and other conditions, what role can technology play with ADHD overall? Fried said a lot depends on the individual patient.

It is true, she said, that people with ADHD are drawn to technology more than those without ADHD. That’s because receiving a text message, or viewing a web video, increases dopamine, which is lacking in the brains of patients with ADHD, and "adds to the rewards system circuit" in the brain.

“It’s harder for people with ADHD to stop,” she adding, “it’s always on,” referring to the Internet.

Whether or not someone decided to rely on a smartphone to keep track of to-dos or a paper-based journal is really up to the patient, she said.

“Some people like to write down their list. Some people like to see the notifications,” she said.

One possible drawback of relying on smartphones as a memory tool is the possibility of constant task switching or inability to stay focused as a results of notifications and other activities available on a mobile device. But a review of research published last year that explored many different facets between mobile technology habits and cognitive functioning, including aspects of ADHD, said such research has limitations because the data is largely self reported; technology is constantly changing; it can be difficult to assess which impacts are lasting; and it would be difficult to assess actually technology habits without intruding on the participants' actual behavior. ¹

Reference

Wilmer HH, Sherman, LE, Chein, JM. Smartphones and cognition: a review of research exploring the links between mobile technology habits and cognitive functioning. Front. Psychol. 2017(8). Published April 25, 2017.

DOI: 10.3389/fpsyg.2017.00605