Real-World Remote Monitoring of ADHD Medication Side Effects in Adults

Medication side effects are common during pharmacological treatment for attention deficit hyperactivity disorder (ADHD) and frequently contribute to treatment discontinuation and reduced quality of life (QoL). Here, we comprehensively characterised ADHD medication side effects in a large, longitudinal real-world cohort, examining their reporting rates, severity, co-occurrence, and associations with QoL and wearable-derived features. We analysed data from the ADHD Remote Technology study of cardiometabolic risk factors and medication adherence (ART-CARMA), which recruited adults from ADHD clinic waiting lists in the United Kingdom and Spain and combined a weekly app-based side-effect questionnaire with continuous wearable monitoring over 12 follow-up months. Of the 305 enrolled participants, 210 contributed 4,434 weekly questionnaires during medication use and were included in the analytic sample (mean age 37.2 years [s.d. 10.4]; 62.9% women). Nearly all participants reported at least one side effect, with multiple symptoms frequently co-occurring into clinical meaningful groups (e.g., emotional, gastrointestinal, sleep-related and cardiovascular). Side effects differed markedly in their associations with self-rated QoL, with emotion-related symptoms showing the strongest negative relationships. Several side effects showed significant associations with wearable-derived features; notably, cardiovascular side effects (heart palpitations and blood pressure changes) were linked to higher electrodermal activity, and sleep difficulties to delayed wearable-measured sleep timings, both key clinical concerns during stimulant treatment. Exploratory analyses further suggested heterogeneity in side-effect burden across individuals. Together, these findings indicate that remote monitoring, integrating app-based self-reports with continuous wearable sensing, can inform real-world assessment of medication safety, tolerability, and burden in adults with ADHD.