Improving Medication Adherence in ADHD Adolescents

提高多动症青少年的药物依从性

• 批准号: 8791345
• 负责人: WILLIAM E PELHAM
• 金额: $ 65.05万
• 依托单位: FLORIDA INTERNATIONAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-01-15 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8791345
• 关键词: Acculturation; Acute; Address; Adherence; Adolescence; Adolescent; Adolescent and Young Adult; Age; Alcohol or Other Drugs use; Attention deficit hyperactivity disorder; Behavioral; Belief; Central Nervous System Stimulants; Child; Childhood; Chronic; Conflict (Psychology); Contracts; Cost of Illness; Data; Drops; Electronics; Ethnic Origin; Failure; Family; Florida; Fostering; Hispanics; Impairment; Individual; Intake; Intervention; Life; Literature; Long-Term Effects; Maintenance; Measures; Mediator of activation protein; Medical; Mental Health; Minority; Monitor; Motivation; Outcome; Parents; Participant; Pharmaceutical Preparations; Pharmacological Treatment; Pharmacotherapy; Phase; Population; Primary Health Care; Provider; Randomized; Recording of previous events; Recruitment Activity; Regimen; Reporting; Risk; Robin bird; Schools; Services; Severities; Substance abuse problem; Symptoms; System; Teenagers; Telephone; Testing; Time; Treatment outcome; Unemployment; United States; Visit; Work; Youth; active method; base; comparison group; demographics; depressive symptoms; design; diaries; experience; follow-up; high school; improved; improved functioning; intervention effect; medication compliance; motivational enhancement therapy; non-compliance; novel; pill; preference; prevent; primary care setting; public health relevance; randomized trial; therapy adherence; treatment effect; uptake

DESCRIPTION (provided by applicant): ADHD children are at risk for a variety of negative outcomes as adolescents and young adults, including high school failure, delinquency, and substance abuse (Barkley et al, 2007; Lee et al, 2011; Molina et al, 2009; Sibley et al, 2011). Stimulant medication is the most widely used intervention for ADHD and has documented acute benefits for adolescents (Evans et al, 2000; Findling et al., 2011; Smith et al, 1998). However, long-term benefits have not been documented (Molina et al, 2009). By the end of adolescence, 80-90% of teens with ADHD are noncompliant with stimulant medication use, arguably the primary cause of the lack of long-term benefit (Biswas et al., 209; Molina et al, 2009). We propose to evaluate a dual component family-based intervention for adolescents with ADHD to improve medication adherence (Supporting Teen Adherence and Responsibility; STAR). STAR pairs Motivational Interviewing (MI; Miller and Rollnick, 2013) with parent-teen behavioral contracting (PTBC; Barkley, Edwards, Robin, 1999) to address the unique needs of ethnically diverse, primarily Hispanic, adolescents with ADHD. In the proposed study, 200 adolescents with ADHD and a history of chronic NA to their ADHD medication will be randomly assigned to medication alone (medication as usual: MAU) or MAU+STAR. As most ADHD youth are treated in primary care settings (Rushton, Kant & Clark, 2004), all participants will receive ADHD medication from their own primary care provider (PCC) for the duration of the study, and all visits will be held in the offices of their PCC. To test the intervention's acute and long-term efficacy, the study will examine treatment effects on adherence (MEMS cap pill count, monthly phone diaries) across six months of active intervention, one year of maintenance intervention, and a final year of naturalistic follow-up. In addition to monthly MEMS cap and phone diary assessments of adherence, participants' functioning will be assessed at intake, 6 months, 18 months, and 30 months in order to detect group differences in DBD symptomatology, academic functioning, family conflict, and substance use. The specific aims are to examine (1) the impact of STAR on medication adherence, (2) moderators of intervention effects on adherence, (3) if the intervention improves the functioning of adolescents with ADHD in four key domains: ADHD/ODD symptom severity, academics, family conflict, and substance use. Despite the alarmingly high rates of medication NA in ADHD, this proposal is the first randomized trial of an intervention specifically designed to improve medication adherence in adolescents with ADHD.

描述（由申请人提供）：ADHD儿童在青少年和年轻人中存在各种不良结局的风险，包括高中学业失败、犯罪和药物滥用（Barkley et al，2007; Lee et al，2011; Molina et al，2009; Sibley et al，2011）。兴奋剂药物是ADHD最广泛使用的干预措施，并且已经记录了对青少年的急性益处（Evans等人，2000; Findling等人，2011; Smith等人，1998）。然而，尚未记录长期获益（Molina等人，2009）。到青春期结束时，80-90%的ADHD青少年不依从兴奋剂药物的使用，这可以说是缺乏长期益处的主要原因（Biswas et al.，209; Molina等人，2009）。我们建议对ADHD青少年进行以家庭为基础的双重干预，以提高药物依从性（支持青少年依从性和责任;星星）。星星将动机性访谈（MI;米勒和Rollnick，2013）与父母-青少年行为契约（PTBC;巴克利，爱德华兹，罗宾，1999）配对，以解决种族多样性的独特需求，主要是西班牙裔，患有ADHD的青少年。在拟议的研究中，200名患有ADHD且有ADHD药物慢性NA病史的青少年将被随机分配至单独药物治疗（常规药物治疗：MAU）或MAU+星星。由于大多数ADHD青少年在初级保健机构接受治疗（Rushton，Kant & Clark，2004），所有参与者将在研究期间从他们自己的初级保健提供者（PCC）接受ADHD药物治疗，所有访视将在他们的PCC办公室进行。为了测试干预的急性和长期疗效，该研究将检查在六个月的积极干预、一年的维持干预和最后一年的自然随访中对依从性的治疗效果（MEMS帽药丸计数、每月电话日记）。除了每月的MEMS上限和电话日记依从性评估外，还将在入学、6个月、18个月和30个月时评估参与者的功能，以检测DBD症状、学习功能、家庭冲突和药物使用方面的组间差异。具体目的是检查（1）星星对药物依从性的影响，（2）干预对依从性的调节作用，（3）干预是否改善了ADHD青少年在四个关键领域的功能：ADHD/ODD症状严重程度，学术，家庭冲突和物质使用。尽管ADHD的药物NA率高得惊人，但该提案是第一个专门设计用于改善ADHD青少年药物依从性的干预措施的随机试验。