Medication Continuity in Children Treated for ADHD

描述(由申请者提供)：这项以患者为导向的研究职业发展奖(K23)计划旨在培养专业知识，成为在初级保健环境中接受治疗的注意力缺陷/多动障碍(ADHD)儿童的用药连续性研究的独立调查者。这是一个关键领域，因为尽管兴奋剂对减少ADHD症状已证明有效，但许多儿童停止治疗，从而使他们无法充分实现治疗的益处，这给儿童及其家人造成了不必要的痛苦。最终目标是发展所需的专业知识，以开发基于证据的个性化干预措施，以改善患有ADHD的儿童和青少年的用药连续性。应聘者在儿科、教育和研究方面的研究和临床培训的深厚背景为这项工作提供了良好的基础。拟议的培训目标包括提高以下领域的技能：1)利用纵向数据进行生物统计建模；2)遵守测量；3)设计和实施针对ADHD的干预措施；4)制定心理、坚持和家庭/自我管理干预措施；5)编写补助金和提供科学数据。实现这些培训目标对于候选人成功地过渡到独立的研究人员至关重要，因为他们追求方法合理、技术可行和创新的方法来进行这一人群的干预研究。该研究计划的目标是更好地了解促进ADHD儿童用药连续性的因素。由100名6-10岁儿童组成的前瞻性纵向队列由他们的初级保健医生开始服用治疗ADHD的药物。该队列将从7个诊所的21名医生中招募。我们将在18个月内收集四波数据，以解决以下具体目标：目标1：描述接受ADHD治疗的社区临床队列中的用药连续性。目标2：找出父母停止和重新开始孩子的药物治疗的原因。目的3：确定影响家庭决策的因素与用药连续性之间的关系。候选人计划通过将从这项研究中获得的知识转化为1)细分服药连续性差的风险人群和2)开发针对对促进服药连续性至关重要的可修改因素的个性化干预措施来实现他的目标。 公共卫生相关性：这项拟议的工作意义重大，因为ADHD会导致学习、社交和家庭功能的损害。此外，患有ADHD的儿童受伤的风险更高，随着他们进入青春期，他们发生机动车事故、药物滥用和危险性行为的风险也更高。因此，药物连续性差会造成不必要的儿童、青少年和家庭痛苦。

DESCRIPTION (provided by applicant): This Mentored Patient-Oriented Research Career Development Award (K23) program is designed to develop expertise for becoming an independent investigator in the study of medication continuity in children with Attention-Deficit/Hyperactivity Disorder (ADHD) cared for in primary care settings. This is a critical area because despite the proven efficacy of stimulant medications to reduce ADHD symptoms, many children discontinue treatment, thereby preventing them from realizing the full therapeutic benefits of treatment and this contributes to unnecessary suffering for children and their families. The ultimate goal is to develop the expertise needed to develop evidence-based, personalized interventions to improve medication continuity among children and adolescents with ADHD. The Candidate's strong background of research and clinical training in pediatrics, education, and research provides an excellent foundation for this work. The proposed training goals include enhancing skills in the following areas: 1) biostatistical modeling with longitudinal data; 2) adherence measurement; 3) design and implementation of interventions for ADHD; 4) development of psychological, adherence, and family/self management interventions; 5) grant writing and presentation of scientific data. Achieving these training goals is essential to the Candidate's success in transitioning to independence as an investigator who pursues methodologically sound, technically feasible, and innovative approaches to intervention research in this population. The objective of the research plan is to better understand the factors that promote medication continuity in children with ADHD. A prospective, longitudinal cohort of 100 children 6-10 years old started on medicine for ADHD by their primary care doctor. The cohort will be recruited from 21 physicians in 7 practices. We will collect four waves of data over 18 months to address the following specific aims: Aim 1: Describe medication continuity in a community-based clinical cohort of children treated for ADHD. Aim 2: Identify reasons parents stop and re-start their child's medication treatment. Aim 3: Determine relationship between factors that influence family decision making and medication continuity. The Candidate plans to achieve his goal by translating knowledge gained from this study to 1) segment the population at risk for poor medication continuity and, 2) develop personalized interventions that target modifiable factors important to promote medication continuity. PUBLIC HEALTH RELEVANCE: The proposed work is significant because ADHD results in impairment of academic, social, and family functioning. In addition, children with ADHD are at higher risk for injury, and as they reach adolescence are at higher risk for motor vehicle accidents, substance abuse, and risky sexual behavior. Poor medication continuity, therefore, contributes to unnecessary child, adolescent, and family suffering.