407 BITESIZE | 80% of People Diagnosed with ADHD Forgo Treatment in the First Year

Summary

Podcast Summary: I Have ADHD Podcast – Episode 407 BITESIZE

Title: 80% of People Diagnosed with ADHD Forgo Treatment in the First Year
Host: Kristen Carder
Date: May 28, 2026

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Episode Overview

This bite-sized episode, curated by host and ADHD coach Kristen Carder, delivers essential insights into why the majority of people diagnosed with ADHD stop treatment within the first year. Kristen draws from recent research—including a major systematic review—and her own experiences, tying them into the broader issues of ADHD diagnosis, treatment accessibility, and motivation. The tone is candid, relatable, and driven by a desire to empower ADHDers and those who support them.

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Key Discussion Points & Insights

1. Shocking Treatment Dropoff: 80% Discontinue ADHD Medication in Year One

[03:00 - 08:25]

• Systematic Review Findings: Kristen shares findings from a systematic review of 147 studies over 29 years:

  “Within the first year, 80% of people discontinue their medications across all ages and all genders. There’s an 80% first year discontinuation rate. What? This is wild to me. When I learned this, I like almost fell off of my chair because this is extremely concerning and very important for us to know.”
  — Kristen Carder [04:35]

• Implications:

  • Even those who take the difficult steps to get diagnosed and begin medication are unlikely to continue.
  • ADHD left untreated is tied to higher risks: incarceration, substance abuse, divorce, car accidents, unemployment.

• Reasons for Discontinuation:

  • Side effects
  • Suboptimal response (wrong dosage, often too low)
  • Social stigma:

    “There’s just still a stigma around taking ADHD medication… There is so much social stigma around, like, ‘oh everybody has ADHD, you’re weak, you’re overtreated, it’s basically meth,’ like all of the myths out there about the medication.”
    — Kristen [06:55]

  • Inconvenience & Access:
    • Difficulties in obtaining prescriptions due to regulations, supply chain issues, and the executive dysfunction inherent to ADHD make continued treatment even harder.

    "It is so difficult for those of us who are actually diagnosed and prescribed medication from a medical doctor. It's so difficult for us to access the medication that we have a diagnosis and a prescription for. It's absolutely ridiculous."
    — Kristen [07:32]

  • Personal Story:
    Kristen reflects on her own experience discontinuing medication, not because it didn’t work, but because it was burdensome to manage:

    “I stopped taking it for quite a while because I was like, this is too hard, it's too hard to get. …I didn't know how to ask for help… I was just like, eh, it's probably not a big deal. I'm not in school anymore, so I probably don't need it. Right? Wrong.”
    — Kristen [09:10]

• Insight:
  Stopping medication is often a “system” problem (lack of support, education, and access), not an individual failure:

  “When the statistic says that about 80% of people discontinue their medication, it doesn’t mean that it didn’t work. It often means that the system didn’t work.”
  — Kristen [09:55]

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2. Flawed Diagnostic Criteria for Adults & Others

[11:10 - 15:12]

• Adult ADHD Criteria Lacking:

  • Current diagnostic criteria are based on children (under 16), leaving adults, women, and older adults under-served.
  • Adult ADHD only formally recognized in recent decades; criteria lag behind reality.

• No Female- or Elderly-Specific Guidance:

  • ADHD presents differently in women; menopause in particular is overlooked.
  • No guidelines for elderly individuals, which leads to inappropriate recommendations (e.g., discontinuing meds solely due to age).

    “It is not okay to just look at someone's age and say, oh, you're done, what, performing for your life. So you don't need to have full access, access to your frontal lobe. That is not true.”
    — Kristen [14:30]

• Hope for Change:

  • Kristen advocates for the next DSM iteration to include criteria for adults, women, and elderly people.
  • Recognition that ADHD changes across the lifespan and diagnostic/treatment approaches must evolve.

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3. Motivation for Diagnosis Often Comes from External Pressures

[15:13 - 19:13]

• External vs Internal Motivation:

  • Many seek diagnosis/treatment because of pressure from others—parents, spouses, bosses, therapists—not personal desire.

    “Many people are seeking ADHD diagnosis and treatment because someone else wants them to. It's not their own motivation.”
    — Kristen [15:19]

  • External motivation can “get people in the door,” but sustaining progress requires internal motivation.

    “There has to be some sort of internal motivation... External motivation can get the patient in the door... but the internal motivation is what keeps someone [in treatment].”
    — Kristen [18:42]

• Childhood Diagnosis:

  • Children typically enter treatment at their parents’ insistence. If not educated about its value, they may abandon treatment as adults.

• Adult Diagnosis:

  • Often preceded by spouse or work pressures, which may not translate to lasting commitment without personal buy-in.

• Concern:

  • Low internal motivation is both a symptom of ADHD and a barrier to long-term treatment outcomes.

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Notable Quotes & Memorable Moments

• On Systemic Barriers:

  “Those of us who struggle with executive dysfunction are going to have an even harder time accessing these medications that are difficult, difficult to acquire.”
  — Kristen [08:10]

• On Ageism in Treatment:

  “People are living so much longer now. So 70 is not old, right? Like 80. If I'm going to live to 100, which I plan to do, you best believe that I'd be taking those medications until that age, because I want to have full access to my entire frontal lobe for the entirety of my life, thank you very much.”
  — Kristen [14:40]

• On Treatment Discontinuation:

  “It doesn't mean that it didn’t work. It often means that the system didn’t work.”
  — Kristen [09:55]

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Actionable Takeaways for ADHDers

• If you want better odds of sticking with treatment:
  • Seek a supportive, empathetic clinician.
  • Ask for help – from friends, family, partners.
  • Learn about typical medication titration, side effects, and advocate for follow-up care.
  • Prioritize internal motivation—reflect on why you want to treat your ADHD for yourself.

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Important Timestamps

• 03:00 – Systematic review about medication discontinuation
• 06:55 – Social stigma and barriers to medication
• 09:55 – Systemic failures, not medication failures
• 11:10 – ADHD diagnostic criteria problems
• 14:30 – Ageism and lack of guidelines for elderly
• 15:19 – External vs internal motivation for diagnosis
• 18:42 – Why internal motivation is necessary for long-term success

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Summary

Kristen Carder delivers a passionate, research-backed exploration of the key barriers affecting ADHD diagnosis and ongoing treatment. She highlights both the systemic failings—diagnostic gaps, healthcare access struggles, social stigma—and the nuances of human motivation. Her advice is direct, compassionate, and actionable, urging listeners not to internalize statistics as personal failure, but instead to advocate for better care and more supportive systems.

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Transcript

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This episode is sponsored by Batch. I want to talk to you about something that doesn't get said enough. Sometimes you just stop feeling like yourself. Not in a dramatic way, just in a quiet, constant feeling of being a little off. Your patience is thinner, your energy is lower, but you're still expected to show up for everything. And that's why Batch caught my attention. Batch is a hemp wellness brand founded by chemical engineers, not marketers, and they focus on clean ingredients and full transparency. You can actually see what's in their products and why. I've been learning about their micro Mints, which are designed for daily calm and mood support. They dissolve under your tongue for fast absorption and the goal isn't to knock you out, it's to feel more like yourself. They also offer options like their CBD nighttime gummies, designed for deeper, more restorative sleep, or their THC gummies, which are formulated for a little more balanced, controlled experience. What I appreciate is that this isn't about escaping your life, it's about supporting yourself so that you can stay present in it. Right now, batch is offering 30% off site wide. And yes, that applies to subscriptions too. Go to hellobatch.com ihaveadhd and use code I have ADHD at checkout. This episode is sponsored by Talkiatry. Trying to figure out the right kind of mental health support can feel really overwhelming. There's therapy, coaching, medication strategies, and it's hard to know what you actually need. Talkiatry helps simplify that. Talkiatry is a fully online psychiatry practice that provides comprehensive evaluations, diagnoses and ongoing medication management for mental health conditions like adhd, anxiety, depression and more. This isn't therapy, it's psychiatry. You're meeting with a licensed psychiatrist who can diagnose mental health conditions and prescribe medication when it's appropriate. You'll work with the same provider over time so you're not starting over at every visit. Your care evolves with you, which helps you make real progress. They have over 800 clinicians, all in network with major insurers. Making care more accessible and getting started is simple. I can personally attest to this myself. It's a short online assessment matched with clinicians who fit your needs and appointments are available in days. More than 300,000 patients have already found care through tochiatry. Head to tokyotry.com ihaveadhd to complete the assessment and get matched in minutes. Hey, what's up? This is Kristin Carter and you are listening to a bite sized episode of the I have ADHD podcast. I am medicated, caffeinated, regulated and ready to roll. This little episode is one of my favorite clips clips from the podcast.

[B]

It's perfect if you're not in the

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mood for a full hour long listen

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because let's be real, some of us

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ADHD years just don't have the patience for all of that.

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But if you are a die hard

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listener, think of this as your midweek pick me up.

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It's Thursday y'. All, Friday is right around the corner. If you love this clip, check out

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the show notes for a link to the full episode. And remember my friend, drink your water,

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take your meds, grab a snack.

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Now let's get rolling.

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There are some things about ADHD and it's treatment and it's understanding that like I just really want us to fully, fully understand because ADHD is widely misunderstood even, or maybe even especially among professionals and clinicians. And these misunderstandings directly impact the diagnosis, the treatment, the outcomes and, and like how we treat ADHD as a society. And so I want this episode to be very educational for you and just really help you to understand more about adhd. So we're gonna be talking about five concerning research backed facts that everyone with ADHD should know, or everyone who loves someone with ADHD, or just everyone in the world should know. Number one, most people stop taking ADHD medication within a year. I was floored when I learned this. There was a systematic review by this person, whose name I cannot pronounce, of 147 studies. So a systematic review is a review that looks at a bunch of studies at one time and it gathers the information and the findings from the various studies. So there was 140, 47 studies that were looked at across 29 years. And what that found is that within the first year, 80% of people discontinue their medications across all ages and all genders. There's an 80% first year discontinuation rate. What? This is wild to me. When I learned this, I like almost fell off of my chair because this is extremely concerning and very important for us to know. In the first year, 80% of people who start taking medication stop. Okay? So what this tells us is that even the people who are accessing care, who do the work of like finally going to get a diagnosis and finding the right clinician, finding someone who will prescribe them medication, even the people who are doing all of that work, they don't stay in treatment. Okay? And when you think about the research that tells us how effective ADHD treatment is and how dangerous it is to live with ADHD untreated, which, you know, it raises the rate of incarceration, of substance use, abuse, it raises the divorce rate, car accident rate, unemployment and underemployment rate. Like there are so many issues that those of us who are untreated face. It's extremely concerning to know that for like only 20% of us who start medication continue to take it. That's wild. Now what are the reasons for this? Why are people stopping? And what's interesting is that like talking to you, like I wonder if you fall into this statistic Dodson listed or like from the studies, but he listed reasons including the side effects. People didn't like the side effects, suboptimal response, usually meaning the dose is too low, too low. Social stigma, like there's just still a stigma around taking ADHD medication. It's kind of lumped in with other psychiatric medications obviously. And I mean I scroll Instagram and TikTok just like you do and there is so much social stigma around like, oh, everybody has adhd, you're weak, you like, it's over treated. It's basically meth. Like all of the myths out there about the medication. So of course there's resistance then socially to taking medication and then also which is so huge, like inconvenience around acquiring medication. You've heard me rant on this before, but it is absolutely infuriating and it, it boils my blood that it is so difficult for those of us who are actually diagnosed and prescribed medication from a medical doctor. It's so difficult for us to access the medication that we have a diagnosis and a prescription for. It's absolutely ridiculous that it is difficult that it is such a controlled substance that we have to make 17 phone calls and go to 42 different pharmacies to get the medication that we need. Not to mention then there are supply chain issues and all kinds of restrictions around it. So yeah, those of us who struggle with executive dysfunction, my hand is in the air. Those of us who struggle with executive dysfunction are going to have an even harder time accessing these medications that are difficult, difficult to acquire. So yeah, I, I understand. And actually I fell into that statistic in some ways when I moved out of my parents house and I was on my own and I was like, what's the cost benefit analysis here? Do I actually really need this medication? And I stopped taking it for quite a while because I was like, this is too hard, it's too hard to get. And there weren't even supply chain issues at the time. But it was just like really hard to remember to refill my prescription and I didn't know how to ask for help from my husband and I was just like, eh, it's probably not a big deal. I'm not in school anymore, so I probably don't need it. Right? Wrong. So instead I laid on my couch and watched daytime tv. Okay, when, when we say like when the statistic says that about 80% of people discontinue their medication, it doesn't mean that it didn't work. It often means that the system didn't work. So there was something going on with the system either. Maybe the clinician wasn't helping them to understand how long it takes to find a medication that works well, maybe the dosage was incorrect and there was no education around, like what it's going to feel like if the dosage is too high or what it's going to feel like if the dosage is too low. And like how to track that and figure it out. And there's just so little follow up. Like a clinician will write a prescription to be like, okay, bye. And you're just like, bye. And then you're left to your own devices. And we know how that goes. So I think it's very important for us to understand that within a year 80% of first timers are going to discontinue their medication. And if you don't want to fall into this statistic, that word is very difficult to say. So don't judge me if you don't want to fall into this statistic. I'm curious what you might be able to do to support yourself so that it is not so hard for you. Can you ask someone to help? Can you rely on your clinician a little bit more? Can you actually find a clinician who is more empathetic and helpful, et cetera, et cetera, et cetera. Okay, so that was concerning fact number one. Number two, concerning fact about adhd. I don't know if you know this, but the diagnostic criteria falls shockingly short, meaning that we do not have correct diagnostic criteria for adults. Did you know this? We don't have adult specific diagnostic criteria. All of the diagnostic criteria that is still being used in 2026 was originally established for individuals 16 years or younger. That's some bullshit. That's absolutely crazy. Now this is really interesting. When the diagnostic criteria was originally established, it was established for children because ADHD was thought to be a childhood diagnosis. And I have previously said on this podcast that adult ADHD wasn't recognized as an adult disorder until 1994. That is still what the Google says. However, in his presentation, Dodson said that it was in 1980 in the DSM 3 that was the first to acknowledge that ADHD persists into adulthood. So I'm a little fuzzy on those numbers, whether it was 1980 or 1994. Either way, it is newly thought of as an adult disorder. ADHD as an adult condition is pretty new. Pretty new, but not that new. Like, we still should absolutely, by this time have AD specific diagnostic criteria. We also don't have female specific diagnostic criteria, which is wild because ADHD often presents differently in females than it does in typical males. We also don't have therapeutic guidance for the elderly, which is concerning because a lot of doctors erroneously recommend that older adults discontinue their medication for fear that it may interact with, you know, their heart or just because they're older. So they don't need it. I'm using air quotes for the listening audience like they just, you don't need it. Like you're 70. You don't need to have a fully functioning brain. Like, that is absolutely ridiculous. So we should have some guidance for the elderly, of course, taking into consideration blood pressure and heart condition, et cetera, et cetera. But it is not okay to just look at someone's age and say, oh, you're, you're done, what, performing for your life. So you don't need to have full access, access to your frontal lobe. That is not true. That's not true. And people are living so much longer now. So 70 is not old. Right? Like 80. Like, if, if I'm going to live to 100, which I plan to do, you best believe that I'd be taking those medications until that age because I want to have full access to my entire frontal lobe for the entirety of my life, thank you very much. Okay, so the diagnostic criteria focuses on children, but ADHD presents in adults and it can shift dramatically throughout the different phases of adulthood. So we really should have some established criteria for, of course, for children, for adolescents, for young adults, for adults in midlife, especially, especially women who are going through the transition hormonally of menopause. Etc. Okay, so we need to understand ADHD across the lifespan. And I hope if there is ever another iteration of the DSM that it will include these different criteria. We should absolutely have diagnostic criteria for women specifically. And elderly individuals should. We should have therapeutic guidelines for elderly individuals because what's happening is they're withdrawing from treatment because clinicians are uncomfy about it because there's no clear guidelines about it. And so if we had the guidelines, then the clinicians would be able to follow the guidelines and the people who are in their senior years would be able to access medication if it is, you know, warranted and healthy enough for

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them, which I think they deserve.

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And I will be demanding it in my older years as well. Okay, Number three, I think this is really important and I had not considered this as an issue prior to Dodson's talk. Here it is. Many people are seeking ADHD diagnosis because someone else wants them to. Many people are seeking ADHD diagnosis and treatment because someone else wants them to. It's not their own motivation. Now why is this a concerning fact about adhd? Well, this is concerning because a lot of people who initiate treatment, initiate diagnosis and treatment are not internally motivated to continue. Like kids don't bring themselves to the pediatrician. Right. Parents do. Parents are like, something's up with my kid. We need to get them assessed. And parents are leading the charge in that. That's appropriate, of course. But if the parent and the pediatrician are not educating their child on how this is going to be helpful to them, what the differences are in their ability to function, how much hope that medication and treatment and coaching and all of the different things can give to somebody with adhd, if you're not educating the child about that, then as soon as they're out of the parents home, they're going to discontinue treatment. Right. And when we think about adults, this is so fascinating. A lot of adults seek help, seek a diagnosis and treatment because it's the other people in their life that are pressuring them to do so. Right. A spouse is like, I can't deal with you anymore. You have to go do something about this. A boss is like, you're going to lose your job if you don't figure this out. A therapist is like, hey, I think this is an issue. I think this is an issue. It is often outside forces that are kind of influencing the ADHD to seek treatment. And sometimes that means that they're not internally motivated. And that's a problem because. Because in order to like, have success and move forward and continue with like the hard road of self development when it comes to adhd, there has to be some sort of internal motivation is ADHD obviously affects our relationships. Right? So the people around us, ADHDers, they often feel the impact, maybe even more than we do. It just depends on the scenario. But there are times when, like the ADHD is kind of like blissfully ignorant to the impact that they are causing in their own home or at work or in their relationships in the community. And so it may be pressure from other people. There has to be like an education and an internal self reflection of like, oh, this is something that I actually want to change myself. Obviously some of us ADHDers do have low internal motivation so we might not be ready to engage in long term treatment. And that. That's concerning. That's concerning. Obviously this means that it's like a major contributor to dropping out of care and discontinuing treatment. External motivation can get people in the door, right? Like if your spouse is like you need to take care of this or if your boss is like you're about to be fired or you're going to be put on performance improvement program. Like external motivation can get the patient in the door, but the internal motivation is what keeps someone. Thanks for listening to this bite sized

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episode of the I have ADHD Podcast. If you enjoyed this clip, you'll find a link to the first full episode in the show notes. And don't Forget to visit ihaveadhd.com for tons of adult ADHD support. All right my friends, I had a great time with you today and I cannot wait to talk to you again next week. Bye bye. This episode is sponsored by AG1. If you have ADHD, you probably know this about yourself. It's not that you don't care about your health, it's that consistency is really hard. For me, it's never about not knowing what to do. It's about actually doing the things that I know I should do every day,

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especially when life gets busy.

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