ADHD Medication Adherence: A Parent-Provider Intervention Modeled From HIV

描述（由申请人提供）：此R34应用程序开发了一种提供者管理的干预措施，以改善护理人员及其患有注意缺陷多动障碍（ADHD）的儿童的药物依从性和持久性。利用计划行为理论（Theory of Planned Behavior，TPB）（Fishbein & Ajzen，1975; Ajzen & Fishbein，1980）和传播理论（Communication Theory，CT），我们提出了一个概念框架和干预模型。虽然不充分的依从性和持久性阻止患有ADHD的儿童实现刺激性药物疗法的全部治疗益处并且导致不良的长期结果，但刺激性不依从率范围为20-65%（Swanson等人，2003年）;此外，依从性往往随着时间的推移而下降，治疗往往只维持几个月。虽然充分解决这一临床问题的努力是有限的，但在艾滋病毒行为改变干预措施的发展方面取得的重大理论和方法学进展可能会改善有心理健康问题的儿童的治疗结果。本方法将建立在TPB和CT的适应基础上，将父母和提供者确定为关键的变革推动者（Jaccard & Dittus，2003; Jammot等人，2003年）。在拟议研究的第一阶段（6个月），涉及10名精神科医生和90名ADHD儿童（6-11岁）的父母，我们确定了特定的态度，信仰，主观规范和坚持药物治疗的障碍。在第二阶段（6-12个月），我们利用这些信息开发和管理调查的120名家长的横截面样本。在第三阶段（12-36个月），我们使用调查结果来创建一个临床医生发起的干预措施，该干预措施针对ADHD儿童及其父母的需求。该研究解决了2个具体目标：目的1：使用计划行为理论（即，态度、期望、主观规范、自我效能和障碍）和经典沟通理论（说什么、怎么说、谁对谁说、什么时候说），对120名ADHD儿童的父母进行了调查，这些儿童在18个月内被诊断为ADHD，并从公开和封闭的医疗记录中确定。目标2：使用目标1中的信息，在40名未接受过药物治疗的ADHD儿童的父母中进行为期6个月的RCT，以开发和试点ADHD药物依从性干预和家长教育工具包。

DESCRIPTION (provided by applicant): This R34 application develops a provider-administered intervention to improve medication adherence and persistence in caregivers and their children with Attention Deficit Hyperactivity Disorder (ADHD). Utilizing the Theory of Planned Behavior (TPB) (Fishbein & Ajzen, 1975; Ajjzen & Fishbein, 1980) and Communication Theory (CT), we propose a conceptual framework and intervention modeled from HIV research. Although inadequate adherence and persistence prevents children with ADHD from realizing the full therapeutic benefits of stimulant pharmacotherapy and contributes to poor long-term outcomes, stimulant noncompliance rates range from 20-65% (Swanson et al., 2003); moreover, compliance tends to decline over time and treatments are often maintained for only a few months. Although efforts to adequately address this clinical problem are limited, major theoretical and methodological advances in the development of HIV behavior change interventions could potentially improve treatment outcomes in children with mental health problems. The present approach will build on adaptations of TPB and CT, identifying parents and providers as key change agents (Jaccard & Dittus, 2003; Jammot et al., 2003). During Phase I of the proposed study (6 months), which involves focus groups with 10 psychiatrists and 90 parents of children (6-11 years) with ADHD, we identify specific attitudes, beliefs, subjective norms, and barriers that underlie adherence to medication treatments. In Phase II (6-12 months), we utilize this information to develop and administer surveys to a cross-sectional sample of 120 parents. In Phase III (12-36 months), we use survey results to create a clinician-initiated intervention that is tailored to needs of children with ADHD and their parents. The study addresses 2 specific aims: AIM 1: To identify factors associated with medication adherence and persistence using constructs from the Theory of Planned Behavior (i.e., attitudes, expectancies, subjective norms, self-efficacy, and barriers) and classic communication theory (what is said, how it is said, who says it to whom, when it is said) in a survey of 120 parents of children with ADHD who have been diagnosed within an 18 month period and identified from open and closed medical records. AIM 2: To use information from Aim 1 to develop and pilot an ADHD medication adherence intervention and parent educational toolkit in a 6-month RCT of 40 parents of medication naive children with ADHD.