Supporting Medication Adherence and Patient-Centered Care for Attention-Deficit Hyperactivity Disorder in Taiwan: A Pharmacist-Oriented Perspective Informed by Targeted Evidence.

Despite the broad coverage offered by Taiwan's National Health Insurance system, attention-deficit/hyperactivity disorder (ADHD) care continues to face a critical "leaky pipeline" problem. There is a clear gap between diagnostic prevalence and long-term treatment retention. This perspective article applies the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework to synthesize evidence on the multidimensional factors that contribute to medication non-adherence among Taiwanese children and adolescents. The barriers are grouped into five domains. These domains include medication-related issues such as dosing complexity, child-level developmental challenges related to growing autonomy, family dynamics that reveal a distinctive "socioeconomic status paradox", stigma within school environments, and vulnerabilities at the healthcare system level. Together, these factors demonstrate that existing hospital-centered care models alone may not sufficient to support sustained treatment engagement. To address this gap, we propose a pharmacist-driven precision approach to improving adherence in ADHD. This approach redefines the pharmacist's role and emphasizes proactive involvement in ADHD management rather than passive medication dispensing. The proposed approach includes regimen optimization, digital tools that support adolescent self-management, and shared decision-making strategies that respond to family-specific concerns. Because community pharmacists are highly accessible, they can serve as continuity anchors across care settings and developmental stages and help strengthen treatment persistence and therapeutic outcomes.