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4. Non-Pharmacological Interventions

4.8 Adherence to non-pharmacological interventions

Clinical Questions

What are the most effective approaches to increasing treatment adherence in ADHD for non-pharmacological approaches?

Clinical practice gaps, uncertainties and need for guidance

Helping people with ADHD (or their parents) to adhere to evidence-based non-pharmacological treatments will likely maximise the benefit of the intervention in terms of symptom reduction and improved functioning. There are barriers and facilitators to treatment adherence that can be addressed to ensure maximal effectiveness of non-pharmacological interventions in people with ADHD.

Summary of evidence review

There is minimal evidence on adherence to non-pharmacological ADHD interventions, with most studies focusing on medication adherence. The NICE qualitative review on adherence noted a few themes relating to non-pharmacological adherence (NICE, 2018). Some parents were more likely to drop out of parent training if they did not see expected improvement quickly enough. It was noted this could be alleviated by setting realistic expectations and in helping parents to see small improvements.

Several barriers for people to access non-pharmacological treatment were reported. This included psychological barriers such as feelings of shame, embarrassment and fear of being judged. Other barriers included time commitments, inconvenient session times and locations and for parents, childcare barriers. Clinicians reported barriers to non-pharmacological adherence included a lack of education, cultural issues, domestic violence and financial difficulties.

Evidence-to-recommendation statement

There was minimal evidence regarding adherence to non-pharmacological treatment. Clinical practice points were based on the expertise of the GDG and adaptation of the NICE recommendations and evidence to the Australian context.


Clinical considerations for implementation of the recommendations

The GDG discussed that adherence to non-pharmacological treatment was an important issue that was rarely addressed. They recommended that clinicians discuss the commitment, time and organisational skills needed for successful adherence to non-pharmacological treatment.

Methods used to improve adherence are likely to be similar to any psychological or psychotherapeutic approach. A clear understanding of what the approach entails, likely effects, duration, required effort, costs, benefits and potential harms, likely outcomes, goals and desired effects are important considerations for discussion prior to initiation of any treatment.

Engagement with the clinician, perceived progress and benefit is likely to play a significant part in ongoing adherence. Ensuring that a quality therapeutic relationship is rapidly established is a core skill of the clinician. It is important to ensure that these skills are maintained and that the clinician has the opportunity for regular clinical supervision.

The feasibility for people with ADHD to access clinicians to improve adherence to non-pharmacological treatments may be limited by the availability of clinicians, cost of services and the time commitment required. Workforce development may ensure that any health inequity impacts are minimised (see Chapter 7).

Next Section 5 Pharmacological Interventions