Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that results in impairment of daily functioning American Psychiatric Association (2022). Although ADHD typically begins in childhood (American Psychiatric Association, 2022), symptoms continue into adulthood in 40 % to 90 % of cases, depending on the criteria used for diagnosis and symptom measurement (Sibley et al., 2022; Sibley et al., 2016). While prevalence declines with age, ADHD remains a significant concern in adulthood (Gardner and Gerdes, 2015). Globally, the prevalence of adult ADHD diagnosis in the general population is estimated to be 2.58 %, though 6.76 % of adults exhibit symptomatology consistent with ADHD (Song et al., 2021), reflecting individuals who may not meet full diagnostic criteria but still experience significant impairments. ADHD significantly impacts individuals, manifesting in difficulties which can include those related to executive functioning, time management, emotional regulation, and social relationships, all of which can substantially affect occupational performance and overall quality of life (Adamou, 2023; Gardner and Gerdes, 2015; Soler-Gutiérrez et al., 2023; Stern et al., 2017; Young et al., 2019).

Stimulant medications, including methylphenidate and amphetamine-based agents, are first-line treatments for ADHD (Ryan et al., 2011; Seixas et al., 2012; Wolraich et al., 2019). These medications effectively reduce core ADHD symptoms and improve functional outcomes by enhancing focus, emotion regulation, and daily functioning (Boland et al., 2020; Coghill et al., 2017; Epstein et al., 2014; Quintero et al., 2019). In recent years, prescription rates for stimulant medications in the United States have surged, with a 45.5 % increase in dispensing from 2012 to 2021, and a further 8 % increase in 2021 alone (Danielson et al., 2023; IQVIA, 2022). This trend appears driven by increased prescribing among adult populations, while rates have remained stable or declined for children and adolescents (Board et al., 2020; Danielson et al., 2023; Olfson et al., 2013).

While systemic factors—such as broader diagnostic recognition, increased public awareness, and evolving clinical guidelines—help explain these trends (Board et al., 2020; Danielson et al., 2023; Sibley et al., 2022), they offer an incomplete picture. While stimulants are recommended as first-line therapy, adults with ADHD, in conjunction with health professionals, make informed and deliberate choices about whether to incorporate them into their lives. These decisions are influenced by a range of individual factors often overlooked in population-level analyses, including personal motivations (Butler et al., 2021), drug side-effects (Adamou, 2023), stigma (Khan and Aslani, 2019) and personal beliefs (Khan and Aslani, 2021).

While quantitative research elucidates trends and patterns in stimulant use, it often fails to capture the complexities of individual experiences. In contrast, qualitative research delves into the personal contexts and lived experiences that shape decision-making. By examining how adults with ADHD navigate the benefits and challenges of stimulant treatment, qualitative studies uncover nuanced factors influencing medication use, such as when and how individuals choose to take medication and how they align treatment with personal goals and life circumstances (Monnet et al., 2022). These insights provide a deeper understanding of the rising demand for stimulants, highlighting the personal, contextual, and psychological factors driving their use.

Understanding these motivations also yields practical benefits for clinical practice. By identifying the factors that prompt adults to start and persist with stimulant treatment, clinicians can better engage with patients about their specific goals and the motivations driving their treatment decisions. Encouraging clinicians to inquire about individual goals can facilitate shared decision-making and lead to treatment recommendations that are more closely aligned with patients’ needs (Aoki et al., 2022). For instance, if individuals rely on stimulants during periods of high occupational demand, clinicians might schedule follow-ups around these times or adjust dosing strategies to better match real-world demands. Such tailored approaches can enhance adherence (McCahon et al., 2022), foster more patient-centred care (Hyrkas and Wiggins, 2014; Kwame and Petrucka, 2021), and support sustainable treatment plans that improve long-term outcomes (Muscat et al., 2021; Stacey et al., 2017).

Although previous studies have explored why adults use stimulants medically, motivations for use are often secondary findings within broader research aims (Druedahl and Kälvemark Sporrong, 2018; Ghosh et al., 2016; Godfrey-Harris and Shaw, 2023). Collating these scattered insights offers an opportunity to build a more cohesive and meaningful understanding of the factors influencing medical stimulant use in adults with ADHD.

Therefore, this systematic review aims to synthesize qualitative research on the motivations and barriers of adults with ADHD for the medical use of prescription stimulants. Specifically, it seeks to explore their initial and ongoing reasons for taking medication, as well as additional factors such as demographics, medication history, and reasons for discontinuation. By providing a thematic synthesis of these insights, this review aims to clarify the factors driving increased demand for stimulant medications and inform patient-centred clinical care.