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

描述(由申请人提供)：这个R34应用程序开发了一种由提供者管理的干预措施，以提高照顾者及其患有注意力缺陷多动障碍(ADHD)的儿童的用药依从性和持久性。利用计划行为理论(TPB)和沟通理论(CT)，我们从HIV研究中提出了一个概念框架和干预模式。尽管不充分的依从性和持久性使ADHD儿童无法实现兴奋剂药物疗法的全部治疗益处，并导致较差的长期结果，但兴奋剂的不依从率从20%到65%不等(Swanson等人，2003年)；此外，依从性往往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步可能会改善患有心理健康问题的儿童的治疗结果。目前的办法将建立在对TPB和CT进行调整的基础上，将父母和提供者确定为关键的变革推动者(Jaccard&Dittus，2003年；Jammot等人，2003年)。在拟议研究的第一阶段(6个月)，包括10名精神病学家和90名患有ADHD儿童(6-11岁)的父母的焦点小组，我们确定了具体的态度、信念、主观规范和坚持药物治疗的障碍。在第二阶段(6-12个月)，我们利用这些信息对120名父母的横断面样本进行调查和管理。在第三阶段(12-36个月)，我们利用调查结果创建临床医生发起的干预措施，以满足ADHD儿童及其父母的需求。本研究针对两个具体目标：目标1：通过对120名ADHD儿童父母的调查，利用计划行为理论的结构(即态度、期望、主观规范、自我效能和障碍)和经典的沟通理论(说什么、怎么说、说给谁、什么时候说)来确定与用药依从性和持久性有关的因素。目的2：利用来自目标1的信息开发和试点ADHD用药依从性干预和家长教育工具包，对40名用药不成熟的ADHD儿童的父母进行为期6个月的随机对照试验。

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.