Results of a prospective longitudinal cohort study published in Pediatrics suggest that long-term medication adherence among children with attention-deficit/hyperactivity disorder (ADHD) is correlated with treatment acceptance and parent perception of medication need.
Researchers conducted a cohort study with 89 children aged 6 to 10 years newly treated for ADHD by 1 of 44 participating pediatricians. Researchers audited charts and pharmacy dispensing records; parents completed validated surveys on their beliefs about ADHD and medication. Sociodemographic and clinical characteristics, along with care quality and parental belief measures, were tested as predictors of short-term (90 days) and long-term (91-450 days) medication continuity, quantified as number of days covered with medication.
In the first 90 days after initiating medication, children had a median of 81% of days covered with medicine; between 91 and 450 days after initiation, children had a median of 54% of days covered with medicine. The strongest predictors of adherence during the first 90 days were younger child age, greater satisfaction with information received about medication, presence of a medication titration, greater ADHD symptom reduction, stronger belief about control over symptoms, lower uncertainty about medication, and lower working alliance between pediatrician and parent.
Between 91 and 450 days, the most significant predictors of medication continuity were higher child’s acceptance of medication and higher differential between parent-perceived need for and concerns about medication. Notably, adherence during this period was not predicted by baseline factors. As such, researchers concluded that adherence is an ongoing process subject to fluctuations over time as treatment acceptance and parental perceptions change.
Medication continuity in youth with ADHD is thus affected by several potentially modifiable factors that could be productive targets of intervention for pediatricians. Further research on treatment adherence with this demographic may elucidate further predictive factors of note.
Brinkman WB, Sucharew H, Hartl Majcher J, Epstein JN. Predictors of medication continuity in children with ADHD. Pediatrics. 2018;141(6):e20172580.