Child Acceptance Increases ADHD Medication Continuity

William B. Brinkman, MD

Parental support and child acceptance of medicine for attention deficit hyperactivity disorder (ADHD) treatment can lead to higher medication continuity rates, according to recent findings.

Researchers from Cincinnati Children’s Hospital conducted a longitudinal analysis of 89 children aged 6 to 10 years with newly-treated ADHD in order to identify predictors of medication continuity. The researchers learned that patients had a median of 81% of days covered in the short term (the first 90 days) and just 54% of days covered in the long term (days 91 to 450).

Parents of the children completed questionnaires about their beliefs about ADHD and treatments. The researchers examined pharmacy dispensing records and sorted through data about sociodemographic and clinical characteristics, quality of care, and both long- and short-term medication continuity as defined by the number of days on the medication.

“Baseline factors that predicted getting off to a good start did not predict long-term continuity,” study author William B. Brinkman, MD told MD Magazine. “Rather, child acceptance of medicine and parent perception of need for and concerns about ADHD medication became important factors. This is consistent with conceptualizing adherence as a process that can change over time in response to experiences with treatment.”

Some of the most important factors that increased short term medication continuity included younger child age, greater satisfaction with the information received about the medication, presence of a medication titration in the first 90 days, greater reduction in ADHD symptoms from baseline to 3 months, and stronger parent beliefs about control over ADHD symptoms.

Long-term adherence continuity factors included the children’s acceptance of treatment and a parent’s perceived need for and concerns about the treatment. “Pediatricians can help support families early in the treatment process by providing education about treatment options and engaging in shared decision making to decrease decisional conflict,” Brinkman said. “Moreover, adjusting medicine to maximize symptom reduction and minimize side effects can improve medication continuity. Taking time to ask the child and parent about their beliefs about medicine may help identify those who are struggling with treatment.”

In past studies, factors such as non-minority race and/or ethnicity and absence of public insurance have predicted greater medication continuity, the study authors wrote. Other literature posits that greater parent satisfaction with the information about the medicine and comfort with the treatment plan are also important factors. Another important variable in predicting continuity is medication titration, which is recommended in ADHD clinical practice guidelines.

Brinkman said that more research is needed in order to assess the beliefs about long term medication. However, he added that the use of validated questionnaires could help physicians in supporting greater medication continuity and adherence, compared to the less structured techniques that physicians currently employ to do this.

The study, “Predictors of Medication Continuity in Children with ADHD,” was published online in Pediatrics in May 2018.