Executive Function and Medication Compliance in ADHD

Medication noncompliance affects individuals across all walks of life. Medication noncompliance may be especially evident in individuals with Attention Deficit Hyperactivity Disorder (ADHD), however. An understanding of the struggles of ADHD, particularly in the area of executive functioning, may help improve medication compliance and overall functioning.

ADHD presents with many signs and symptoms. These may include, but are not necessarily limited to daydreaming, forgetfulness, fidgeting, talking too much, risky behavior, poor impulse control, and social difficulties (Center for Disease Control, 2024). Individuals may receive diagnoses predominantly inattentive, predominantly hyperactive-impulsive, or combined. A hallmark of all forms of ADHD is the struggle with executive functioning, or “the cognitive abilities needed to achieve goals” (ADDA Editorial Team, 2023). This is important to note when considering medication noncompliance (Christie, 2023; Rostain, 2024). Individuals with ADHD may be choosing not to take their medication. They may also lack the skills needed to achieve the goal of medication compliance.

When considering medication compliance strategies for individuals with ADHD, then, it is important to consider supports for executive functions. These supports can be scaffolded in order to help individuals build up to full compliance on their own, or may need to remain in place for the long-term. Supports can include psychoeducation to help individuals understand the benefits of medications and consequences of noncompliance, and/or tracking (Thongseiratch et al., 2024). Place and time cues can be used, as well as habit stacking (Hester, 2021). There are also a number of ways to use technology to help remind individuals to take their medication, including, but not limited to alarms, reminders, apps, smart pill bottles and dispensers, and smart pill packaging (Marotta, 2018). Individual involvement in the medication compliance plan, especially in the case of children and teens, can also be highly beneficial (Gardiner & Dvorkin, 2006). In short, if the main cause of medication compliance is due to executive functioning, it would behoove caregivers and providers to support that faculty.

People are of course medication noncompliant for more reasons than executive functioning deficits. Caregivers, providers, and individuals should explore these reasons, too. Executive functioning support may be a helpful in the organization and processing of those thoughts as well.