Improving Medication Adherence in ADHD Adolescents

描述（由申请人提供）：ADHD儿童在青少年和青年时期面临各种负面结果的风险，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）。兴奋剂药物是多动症最广泛使用的干预措施，并已证明对青少年有明显的益处（Evans等人，2000；Findling等人，2011；Smith等人，1998）。然而，长期效益尚未得到证实（Molina et al, 2009）。到青春期结束时，80-90%的ADHD青少年不适应兴奋剂药物的使用，这可以说是缺乏长期益处的主要原因（Biswas等人，2009；Molina等人，2009）。我们建议对ADHD青少年进行双组分家庭干预，以提高药物依从性（支持青少年依从性和责任；STAR）。STAR将动机性访谈（MI; Miller and Rollnick, 2013）与父母-青少年行为契约（PTBC; Barkley, Edwards, Robin, 1999）配对，以解决不同种族，主要是西班牙裔ADHD青少年的独特需求。在拟议的研究中，200名患有ADHD并有慢性NA史的青少年将被随机分配到单独用药组（照常用药：MAU）或MAU+STAR。由于大多数ADHD青少年在初级保健机构接受治疗（Rushton, Kant & Clark, 2004），所有参与者在研究期间将从他们自己的初级保健提供者（PCC）那里接受ADHD药物治疗，所有的访问将在他们的PCC的办公室进行。为了测试干预的急性和长期疗效，该研究将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检查治疗对依从性的影响（MEMS封盖药丸数、每月电话日记）。除了每月的MEMS帽和电话日记依从性评估外，参与者的功能将在摄入、6个月、18个月和30个月时进行评估，以检测DBD症状、学术功能、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对药物依从性的影响，(2)干预对依从性的调节效应，(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、学业、家庭冲突和药物使用。尽管ADHD患者服用药物NA的比例高得惊人，但这项建议是第一个专门设计用于改善青少年ADHD患者服药依从性的干预措施的随机试验。

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.