ADHD and remembering daily medication: a routine, not willpower

This is not medication advice

This guide does not say whether you should take medication, which one, how much or when. Those are decisions for you and your prescriber. It covers one narrow problem: you have a prescription, you mean to take it as prescribed, and the daily act of taking it keeps slipping.

Why this is hard, and why it is not only memory

A daily dose asks a lot of the skills ADHD can make unreliable: remembering a future action, at a set time, every day, with no deadline pressing. Many mornings it competes with getting out of the door.

The research shows how common the difficulty is. A 2014 systematic review of 91 studies found that adherence and persistence with ADHD medication were generally poor. The most cited reason for stopping was side effects. Others included symptoms not being well controlled, the inconvenience of dosing, social stigma and the person's own attitude to the medicine. Forgetting is not on the review's list, so the research does not tell us how much of the problem it is. Some of those reasons are about routine. Some are not, and a better reminder will not fix them.

So start with an honest question: is the problem that you forget, or that something about the medicine makes you not want to take it? If it is the second, take that to your prescriber. The rest of this guide is about the first.

Tie the dose to a cue you already have

A reminder you hold in your head arrives late or not at all. A cue in the world arrives on its own. Pick something you already do at about the right time every day, and write it as an if-then line: when I put the kettle on in the morning, I take my medicine. Plans written this way have been studied in the general population, not in ADHD, and they are why the cue is something you already do rather than something you have to remember.

Then put the medicine where the cue happens, if it is safe to keep it there. Medicine kept in a drawer upstairs will not meet a kettle downstairs. Check the label for storage instructions, and keep any medicine out of reach of children.

Add an alarm as a backup, with a clear label such as take morning dose, set for a little after the cue usually happens.

When the routine breaks

Weekends, travel, illness and early starts are where a daily cue goes missing, because the kettle moment moves or disappears. Plan these on purpose:

• Weekends: if your cue changes, decide your weekend cue in advance.
• Travel: pack the medicine in your hand luggage with the prescription label, and set the alarm for the new place.
• Early starts: put the medicine with the things you will grab on the way out, if your prescriber's timing allows.

If you take your medicine at a different time from usual, or miss it, check the leaflet and ask your pharmacist rather than guessing.

A missed dose is not a broken habit

General research on habit formation, in 96 adults from the general population, found that missing one chance to do a behaviour did not materially affect how the habit formed. It was not a study of medication or ADHD. It does suggest that a missed day is less important than coming back to the routine the next day.

What to do about the missed dose itself is not something to work out alone. The leaflet, your pharmacist or your prescriber can tell you, for your medicine. Ask them before taking anything.

Current

Not sure if I took today's dose.

Next

Check the organiser; if the box is full, call the pharmacy before taking anything.

Check

Now, before lunch.

Stock, as well as doses

A good daily routine still fails when the box is empty. Keep a simple count, or note the date on which you can next request a refill and put it in your calendar with some lead time. The book's chapter on health operations treats refills as part of the same routine: the date goes outside your memory, early.

Low Power days

On a hard day, keep only two things: the cue and the mark. Everything else, tracking effects, notes for your next appointment, can wait. If hard days have made you miss several doses, tell your prescriber at your next contact, plainly. They need to know, and they will have heard it before.