(PS1-D99) Thematic Analysis of Focus Groups in the Development of a Customized Adherence Enhancement (CAE) Treatment Intervention

Introduction: Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by hyperactivity, inattention, impulsivity, and inhibitory executive functioning. If left untreated, ADHD can cause severe and life-long consequences. While the recommended first line of treatment for ADHD is medication, poor medication adherence is common, particularly in adolescents and young adults (AYAs). Therefore, improving medication adherence and self-management strategies in AYAs has the potential to improve function and long-term outcomes. As such, we aimed to adapt Customized Adherence Enhancement (CAE), an intervention developed to improve medication adherence in bipolar disorder, to target AYAs with ADHD.

Method: Separate focus groups were conducted for AYAs with ADHD and providers/parents of AYAs with ADHD. Participants included 9 AYAs (55% Female, M_age=18.4, SD=1.50), as well as 6 providers, and 5 parents. There were a total of five focus groups and 2 individual interviews. Discussion topics included barriers and facilitators of medication adherence, impact of ADHD, and the reasons treatment regimens may be difficult to stay on over time. Focus groups lasted 60-75 minutes and were comprised of between 2-4 AYAs or 4-6 providers/parents. Focus groups were held virtually and were led by an investigator or research assistant who followed a semi-structured interview guide. All focus groups/interviews were recorded, transcribed, and coded. The coders conducted thematic analyses to obtain common themes discussed during each session.

Results: Qualitative analyses included a summary of common themes across the groups. Main themes extracted were: AYA’s perception of ADHD and its negative impact on their work performance, sports performance, and interpersonal relationships, barriers to adhering to medication including limited access, medication side effects, difficulty following a routine of taking medication, and having co-existing conditions. Facilitators to medication adherence included having more knowledge about ADHD, experiencing benefits from adhering to medication, and the utilization of external prompts. Parent reports were congruent with AYAs' themes with an emphasis on the impact on ADHD involving interpersonal relationships and an overall lack of knowledge of how to navigate living with ADHD generally.

Conclusion: As untreated or undertreated ADHD negatively impacts morbidity and functioning, intervening early and at a critical stage of development has the potential to change the long-term outcomes of AYAs with ADHD. Getting feedback from key stakeholders of AYAs living with ADHD is essential in developing an intervention that will be acceptable and effective for the target population. The results aided in the adaptation of an intervention geared towards addressing barriers to medication adherence in AYAs with ADHD and led to the addition of other self-management elements. Clinical implications will be discussed.