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

描述（由申请人提供）：本R34申请开发了一种由提供者管理的干预措施，以改善照顾者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（TPB） （Fishbein & Ajzen, 1975; Ajjzen & Fishbein, 1980）和传播理论（CT），我们提出了一个基于HIV研究的概念框架和干预模型。尽管不充分的依从性和持久性阻止ADHD儿童实现兴奋剂药物治疗的全部治疗益处，并导致不良的长期结果，但兴奋剂不依从率在20-65%之间（Swanson等，2003）；此外，依从性往往会随着时间的推移而下降，治疗通常只维持几个月。尽管充分解决这一临床问题的努力有限，但在制定艾滋病毒行为改变干预措施方面取得的重大理论和方法进展可能会改善患有精神健康问题的儿童的治疗结果。目前的方法将建立在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 et al., 2003）。在该研究的第一阶段（6个月），包括10名精神科医生和90名患有ADHD儿童（6-11岁）的家长，我们确定了坚持药物治疗的具体态度、信念、主观规范和障碍。在第二阶段（6-12个月），我们利用这些信息对120名家长进行横断面抽样调查。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，该干预措施是针对患有多动症的儿童及其父母的需求量身定制的。该研究有两个具体目标：目标1：利用计划行为理论（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）中的构念来识别与药物依从性和持久性相关的因素，该研究对120名ADHD儿童的父母进行了调查，这些儿童在18个月内被诊断出患有ADHD，并从公开和封闭的医疗记录中识别出来。目标2：利用目标1的信息，在一项为期6个月的随机对照试验中，开发和试点ADHD药物依从性干预和家长教育工具包，该随机对照试验包括40名未接受药物治疗的ADHD儿童的父母。

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.