Medication Continuity in Children Treated for ADHD

描述（由申请人提供）：这个以患者为导向的指导研究职业发展奖（K23）项目旨在培养专业知识，使其成为一名独立研究者，研究在初级保健机构中照顾的患有注意力缺陷/多动障碍（ADHD）的儿童的药物连续性。这是一个至关重要的领域，因为尽管兴奋剂药物在减少多动症症状方面已被证明有效，但许多儿童停止治疗，从而使他们无法充分享受治疗的好处，这给儿童及其家人带来了不必要的痛苦。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，以改善患有多动症的儿童和青少年的药物连续性。候选人在儿科，教育和研究方面的强大研究和临床培训背景为这项工作提供了良好的基础。建议的培训目标包括提高以下方面的技能：1)纵向数据生物统计建模；2)依从性测量；3) ADHD干预措施的设计与实施；4)心理、依从性和家庭/自我管理干预措施的发展；5)科学数据的撰写和展示。实现这些培训目标对于候选人成功过渡到独立的研究者至关重要，他们追求方法上合理，技术上可行，创新的方法来进行该人群的干预研究。研究计划的目的是更好地了解促进ADHD儿童持续用药的因素。对100名6-10岁儿童进行前瞻性纵向队列研究，由他们的初级保健医生开始治疗ADHD。该队列将从7个实践的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：描述以社区为基础的ADHD儿童临床队列治疗的药物连续性。目标2：找出父母停止和重新开始孩子药物治疗的原因。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本研究中获得的知识转化为：1)对药物连续性差的风险人群进行细分；2)针对促进药物连续性的重要可改变因素制定个性化干预措施。

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.