Improving Medication Adherence in ADHD Adolescents

描述(由申请人提供)：ADHD儿童在青少年时期面临各种负面后果的风险，包括高中失败、犯罪和药物滥用(Barkley等人，2007年；Lee等人，2011年；Molina等人，2009年；Sibley等人，2011年)。兴奋剂是ADHD最广泛使用的干预措施，并已证明对青少年有急性益处(Evans等人，2000年；Findling等人，2011年；Smith等人，1998年)。然而，长期效益还没有记录在案(Molina等人，2009年)。到青春期结束时，80%-90%的青少年ADHD患者不遵守兴奋剂药物的使用，这可以说是缺乏长期益处的主要原因(Biswas等人，209；Molina等人，2009年)。我们建议对青少年ADHD患者进行双成分家庭干预以提高服药依从性(支持青少年的依从性和责任感；STAR)。明星对励志访谈(MI；Miller和Rollnick，2013)与父母-青少年行为契约(PTBC；Barkley，Edwards，Robin，1999)，以解决种族多样化，主要是西班牙裔，患有ADHD的青少年的独特需求。在这项拟议的研究中，200名患有ADHD并有慢性NA病史的青少年接受ADHD药物治疗，他们将被随机分配到单独用药组(照常用药：MAU)或MAU+STAR组。由于大多数ADHD青少年在初级保健环境中接受治疗(Rushton，Kant&Clark，2004年)，在研究期间，所有参与者都将从他们自己的初级保健提供者(PCC)那里获得ADHD药物，所有探视都将在其PCC的办公室举行。为了测试干预的急性和长期效果，这项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(MEMS帽药片计数、每月电话日记)的治疗效果。除了每月对遵守情况进行MEMS帽和电话日记评估外，参与者的功能将在摄入时、6个月、18个月和30个月进行评估，以确定DBD症状、学习功能、家庭冲突和药物使用方面的组间差异。具体目的是检验(1)STAR对服药依从性的影响，(2)干预效果对服药依从性的调节，(3)干预是否在四个关键领域改善ADHD青少年的功能：ADHD/奇怪症状严重程度、学术、家庭冲突和药物使用。尽管ADHD的药物NA比率高得令人震惊，但这项提案是专门为改善ADHD青少年的用药依从性而设计的第一项干预的随机试验。

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.