Parental Factors Associated with Child or Adolescent Medication Adherence: A Systematic Review

Electronically Monitored Antidepressant Adherence in Adolescents with Anxiety Disorders: A Pilot Study

Background: Antidepressant medication adherence patterns are inconsistent in adolescents with anxiety and related disorders, and the clinical and demographic features predicting adherence are poorly understood. Methods: In an ongoing single-site prospective trial involving adolescents (aged 12-17) with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition anxiety disorders treated with escitalopram, adherence was measured for 12 weeks using electronic monitoring caps. Adherence patterns were examined using qualitative and unsupervised clustering approaches, and predictors of adherence were evaluated using logistic regression, with demographic (age, sex, and race) and clinical variables (e.g., anxiety severity [Pediatric Anxiety Rating Scale], irritability [Affective Reactivity Index], depressive symptoms [Children's Depression Rating Scale]). Results: Among adolescents (N = 33) aged 14.5 ± 1.8 years (64% female), four adherence patterns were identified: persistent adherence, intermittent adherence, early adherence-late nonadherence, and nonadherence. In a logistic model of a 5-day moving average measure of adherence, social anxiety disorder (β = -0.68 ± 0.19, p = 0.002) and separation anxiety disorder (β = -0.61 ± 0.18, p < 0.001) were associated with lower adherence. In contrast, panic disorder, attention-deficit/hyperactivity disorder, generalized anxiety disorder, and depressive symptoms were not associated with adherence. Baseline anxiety severity was linked to lower adherence (β = -0.199 ± 0.05, p < 0.001). Older age also reduced adherence (β = -0.342 ± 0.05, p < 0.001), with each additional year of age increasing time spent nonadherent by 5% (p < 0.001). Being female (β = 0.451 ± 0.17, p = 0.011) and expecting treatment to be efficacious (β = 0.092 ± 0.04, p = 0.011) increased adherence, while greater irritability was associated with nonadherence (β = -0.075 ± 0.03, p = 0.006). Conclusions: Antidepressant adherence is variable, with distinct patterns, and those with social and separation anxiety disorders were less likely to be adherent. Factors such as older age, severe anxiety, and greater irritability predicted lower adherence, while being female and expecting treatment efficacy were associated with better adherence. Interventions that address specific symptoms or enhance treatment expectations may improve adherence.

Navigating challenges in pediatric trial conduct: integrating bayesian sequential design with semiparametric elicitation for handling primary and secondary endpoints

BACKGROUND

This study presents a Bayesian Adaptive Semiparametric approach designed to address the challenges of pediatric randomized controlled trials (RCTs). The study focuses on efficiently handling primary and secondary endpoints, a critical aspect often overlooked in pediatric trials. This methodology is particularly pertinent in scenarios where sparse or conflicting prior data are present, a common occurrence in pediatric research, particularly for rare diseases or conditions.

METHOD

Our approach considers Bayesian adaptive design, enhanced with B-Spline Semiparametric priors, allowing for the dynamic updating of priors with ongoing data. This improves the efficiency and accuracy of the treatment effect estimation. The Semiparametric prior inherent flexibility makes it suitable for pediatric populations, where responses to treatment can be highly variable. The design operative characteristics were assessed through a simulation study, motivated by the real-world case of the REnal SCarring Urinary infEction Trial (RESCUE).

RESULT

We demonstrate that Semiparametric prior parametrization exhibits an improved tendency to correctly declare the treatment effect at the study conclusion, even if recruitment challenges, uncertainty, and prior-data conflict arise. Moreover, the Semiparametric prior design demonstrates an improved ability in truly stopping for futility, with this tendency varying with the sample size and discontinuation rates. Approaches based on Parametric priors are more effective in detecting treatment efficacy during interim assessments, particularly with larger sample sizes.

CONCLUSION

Our findings indicate that these methods are especially effective in managing the complexities of pediatric trials, where prior data may be limited or contradictory. The flexibility of Semiparametric prior design in incorporating new evidence proves advantageous in addressing recruitment challenges and making informed decisions with restricted data.

Challenges and strategies for improving medication adherence among adolescent psychiatric patients: A qualitative study

Despite significant advancements in the development of psychotropic medications, increasing adherence rates remain a challenge in the treatment and management of psychiatric disorders. The purpose of this study is to qualitatively explore the challenges underlying medication adherence and strategies to improve it among adolescents with psychiatric disorders in Malaysia. This qualitative research design presents results from 17 semi-structured interviews with adolescent psychiatric patients, aged 11 to 19 years old, from public hospitals across Peninsular Malaysia. The data collected from interviews were transcribed and processed through thematic analysis using the NVivo 11 software. A total of three main themes concerning medication adherence were identified: (1) challenges; (2) coping strategies and (3) protective factors. In this study, thirteen subthemes emerge as challenges underlying medication adherence experienced by adolescent psychiatric patients. The coping strategies identified in this study fall under three broad subthemes which are problem-focused strategies, emotion-focused strategies and maladaptive strategies. This study also highlights social support and positive medicinal effects as protective factors for non-adherence issues in adolescent psychiatric patients. In conclusion, this study supports the notion that adherence is a multi-factorial phenomenon. This study can inform future development of interventions and targeted health promotion programmes in enhancing adherence.

Advancing patient care: novel scales for assessing adherence and attitudes toward medication among adolescents with psychiatric disorders and their parents

Adolescents with psychiatric disorders may struggle with medication adherence and this can lead to ineffective treatment. Subjective factors, such as attitudes, beliefs, experiences, have a greater impact on adherence in adolescents than objective factors. To better understand these subjective attitudes, self-evaluation rating scales should be developed. The study aimed to develop two scales - Pediatric Medication Adherence Scale (PMAS) and Pediatric Attitudes toward Medication Scale (PAMS) - to assess adherence and attitudes toward medication for pediatric patients and their parents. Total of 288 pediatric patients (67% female) between the ages of 12-18 (mean [standard deviation] age of 15.25 [1.59] years) with psychiatric disorders and 255 parents (83.53% mothers) were administered the scales. The validity of the scales was evaluated through the content validity index and explanatory factor analyses. To evaluate reliability, Cronbach's alpha, and test-retest methods were utilized. The validity and reliability of the PMAS (9 questions for patients, 6 questions for parents) and PAMS (18 questions for patients, 20 questions for parents), Cronbach's alpha values and intraclass correlation coefficients were found above 0.7 for each scale and showed well establishment for this particular population. Analysis revealed that anxiety scores had a greater impact on total attitude scores than necessity scores (p < 0.05). Parent and patient adherence scores were similar, and negative parental attitudes toward medication were associated with lower patient adherence. The present study represents a novel attempt to design a medication adherence and attitude questionnaire for adolescents with psychiatric disorders, along with a parental version.

[The Impact of a Picture Book to Improve Medication Compliance in Pediatric Patients: A Questionnaire Survey]

Poor medication compliance in children can affect treatment efficacy. We examined the impact of a picture book created by pharmacists to improve medication compliance in children. Our study aim was to assess the effects of the pharmacist-created picture book on medication compliance in children and their parents in collaboration with an outpatient pharmacy. This study included 74 children [recovery rate 28/74 (37.8%)] aged 3-6 years and their parents between March 2023 and March 2024. In the item "Have you experienced any difficulties in giving medication to your child?" the proportion of respondents answering, "Always" or "Sometimes" decreased from 78.3% (18/23) to 34.7% (8/23) after reading the picture book (p<0.01). When answering the question "What specific situations have you found challenging when giving medication?" the number of responses decreased from (an average/mean) of 1.5 situations before reading the picture book to 1 situation. Regarding whether guardians felt a greater appreciation for the importance of giving medication to their children after reading the book, 64.3% answered "Yes," the highest response. A positive correlation (correlation coefficient=0.77, p<0.01) was observed between "Is the child interested in taking the medication?" and "Is the child able to take the medicine? Pharmacists need to raise public awareness of the importance of medication adherence. Since picture books are likely to be repeatedly read aloud, they are considered effective. The results of this study suggest that pharmacist-created picture books may contribute to improving medication compliance in children.

Continuity of mental disorders in children with chronic physical illness

Data on the chronicity of mental disorder in children with chronic physical illness (CPI) are limited. We examined the prevalence and predictors of homotypic and heterotypic continuity of mental disorder in children with CPI. A sample of 263 children aged 2-16 years with physician-diagnosed CPI were recruited from outpatient clinics (e.g., dermatology, respiratory) at a Canadian pediatric academic hospital and followed for 24 months. Parent and child-reported mental disorders (mood, anxiety, behavioral, attention-deficit hyperactivity disorder [ADHD]) were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents at baseline, 6, 12, and 24 months. Marginal regression models were computed to identify clinical, parent, and demographic factors associated with mental comorbidity over time. Mental disorder was observed in 24-27% of children with CPI based on child reports and 35-39% based on parent reports. Parent-reported models revealed significant homotypic continuity for all mental disorders (ORs = 4.2-9.5), and heterotypic continuity between mood and anxiety disorders (OR = 2.2), ADHD and behavioral disorders (OR = 5.1), and behavioral and each mental disorder (ORs = 6.7-8.4). Child-reported models revealed significant homotypic continuity for mood (OR = 8.8) and anxiety disorder (OR = 6.0), and heterotypic continuity between anxiety and mood disorders (OR = 12.4). Child disability (ORs = 1.3-1.5) and parent psychopathology (ORs = 1.2-1.8) were the most consistent predictors of both child- and parent-reported mental disorder over time. Mental comorbidity was prevalent and persistent in children with CPI with homotypic and heterotypic continuity common across informants. Child disability and parent psychopathology may be priority targets within integrated family-centered models of care to prevent mental comorbidity in children with CPI.

Development of the medical adherence scale in adolescents using psychotropic medication and evaluation of validity and reliability in Turkish population

PURPOSE

Although treatment non-adherence is relatively high among adolescents, there is a need for standardized measurement tools that measure adherence to treatment in adolescents. This study aimed to develop a new measurement tool to assess the adherence to treatment of adolescents with mental disorders who use psychotropic medication.

METHODS

The data of this methodologically designed study were collected between 01.04.2022 and 01.07.2023 in the Department of Child and Adolescent Psychiatry of a university hospital in the Aegean Region of Turkey. The Medication Adherence Reporting Scale and Adolescent Medical Adherence Scale draft form were used for data collection. The scale items were formed from the themes, sub-themes, and statements in the qualitative study that the researchers had conducted with adolescents with mental disorders and their parents, clinicians' experiences, and systematic reviews and meta-synthesis in the literature. The study sample consisted of 95 adolescents with mental disorders. Exploratory factor analysis was performed with Varimax rotation to determine the factorial construct validity of the scale. Internal consistency analyses were performed in reliability analyses, and Cronbach's alpha coefficient was used.

RESULTS

The mean age of the adolescents was 14.18 years (1.81); 50.5% were male, and 96.8% were attending school. When the mental disorder diagnoses were analyzed, 65.3% of the adolescents were being followed up with Attention Deficit and Hyperactivity Disorder diagnoses, and 58.8% were using stimulants. The 12-item form of the Adolescent Medical Adherence Scale was found to have a three-factor structure with item-total correlation values ranging between 0.26 and 0.66, and these factors were named functionality, responsibility in treatment, and medication adherence. Factor loadings ranged between 0.44 and 0.86, and the items explained 62.98% of the total variance. The internal consistency coefficients of the scale were between 0.69 and 0.83 for the subscales and 0.82 for the total scale.

CONCLUSION

Based on the analysis and results used in this study, the Adolescent Medical Adherence Scale is a valid and reliable new measurement tool.

PRACTICE IMPLICATIONS

This tool can be used in clinical settings to evaluate adolescents' treatment adherence and prognosis. Clinical studies conducted with adolescents can also determine adherence to treatment and affecting factors.

Continuation of Treatment in Children With ADHD: A Multicenter Turkish Sample Study

OBJECTIVES

The aim of this study was to investigate the variables that may affect treatment continuation in children aged 6 to 12 years who were newly diagnosed with ADHD.

METHODS

A total of 132 children diagnosed with ADHD and their parents participated in the study. Sociodemographic and clinical risk factors affecting continuation of treatment were examined using logistic regression analysis.

RESULTS

Multiple model examination revealed that greater age increased the risk of treatment discontinuation 1.824 times (p = .003) while a lower total length of paternal education increased the risk of discontinuation (1/0.835) 1.198 times (p = .022). Other variables emerging as significant in the univariate model lost that significance in the multiple model.

CONCLUSIONS

Understanding the variables associated with medication discontinuation in ADHD in different populations and taking these variables into account in the development of health policies, will be useful in improving the long-term devastating effects of the disorder.

Psychotropic Medication Use and Polypharmacy Among Children and Adolescents Initiating Intensive Behavioral Therapy for Severe Challenging Behavior

OBJECTIVE

To evaluate the prevalence, trends, and factors associated with psychotropic medication use and polypharmacy among children and adolescents initiating intensive behavioral therapy for severe challenging behavior over a 10-year period.

STUDY DESIGN

In this retrospective observational study, we examined data from caregiver interviews and patient medical records on the number and types of psychotropic medications prescribed to patients initiating intensive behavioral therapy between January 1, 2013, and December 31, 2022. Trends in medication use and polypharmacy across the 10-year period were analyzed using regression analysis, while differences in demographics and clinical factors for patients with use and polypharmacy were analyzed using nonparametric statistical analysis with odds ratios presented for significant factors.

RESULTS

Data from all 302 pediatric patients initiating intensive behavioral therapy across the 10-year period were analyzed. Among all patients and all years, 83.8% were taking at least 1 psychotropic medication and 68.2% experienced polypharmacy. There were no changes in the prevalence of use, mean number of medications taken, or polypharmacy across the 10-year period. Patients diagnosed with attention-deficit/hyperactivity disorder or anxiety disorder, as well as those exhibiting self-injurious behavior had higher use of psychotropic medication and polypharmacy and were taking more medications overall.

CONCLUSIONS

Psychotropic medication use and polypharmacy were extremely high for children and adolescents with severe challenging behavior, but use and polypharmacy did not change over the 10-year period of data collection. Further research is needed to establish the generality of these findings to other regions of the US.

Barriers and facilitators to accessing adolescents' mental health services in Karachi: users and providers perspectives

INTRODUCTION

Adolescents' Mental Healthcare (MHC) is influenced by numerous factors, and adolescents occasionally seek professional help for mental health (MH) issues. These factors become more complex within low-middle-income countries (LMICs); therefore, this study aims to understand barriers and facilitators to access mental health services among adolescents aged 10 to 19 years old from the perspective of users (parents) and providers (Mental Healthcare Providers - MHPs).

METHOD

Using a qualitative exploratory design, a semi-structured interview guide was developed using Andersen's health service utilization model. In-depth interviews were conducted with MHPs (n = 21) and parents of adolescents (n = 19) in the psychiatry department of public and private hospitals in Karachi, from October-December 2021. Data was thematically analyzed using an inductive approach.

RESULT

The findings revealed a consensus of users and providers in all three categories of the Andersen model and referred the compulsion as the major driving force to MHC access and utilization rather than personal choices. Within pre-disposing, need, and enabling factors; the participants highlighted a unique perspective; users regarded frequent migration, daily wage loss, and women's societal status as barriers while the need for marriage and patient willingness were stated as facilitators. Whereas, MHPs indicated societal tolerance, the burden on the health system, and the absence of Child and Adolescent Mental Health (CAMH) services as major gaps in service delivery.

CONCLUSION

Service utilization is mainly facilitated by the severity of illness rather than healthy choices and beliefs, and accessibility and affordability. It is therefore imperative to prioritize adolescent MH through promotion and prevention approaches and address service delivery gaps to prevent treatment delays via task-shifting and capacity building of the health workforce.

The Lived Experience of Parent Caregivers of Adolescents with Mental Illness: A Phenomenological Study

BACKGROUND

The challenges faced by parents of adolescents with mental disorders are profound and multifaceted. Therefore, this study aimed to explore the lived experiences and concerns of parents of adolescents with mental disorders in Oman.

METHODS

Interpretative phenomenological analysis was employed in this study. In-depth interviews were done with twenty caregivers from June 2021 to the end of December 2022. Data collection continued until saturation was reached, ensuring a thorough understanding of the phenomena under investigation, and thematic analysis was applied to identify and examine the recurring patterns within the data.

RESULTS

Three primary themes emerged from the data analysis including Emotional Burden and Guilt, Treatment Concerns, and Fear of the Future. Parents' experiences during their adolescents' diagnosis revealed a profound emotional struggle, encompassing anxiety, frustration, and occasional confusion as they grappled with understanding their children's illness and navigating unpredictable behaviors. The exploration of seeking treatment highlighted the complexity of their experiences. However, a persistent sense of uncertainty regarding their children's future was a consistent thread irrespective of the chosen treatment path.

CONCLUSION

This study aimed to investigate the complex challenges faced by caregivers of adolescents suffering from mental disorders, underscoring the vital need for tailored interventions and robust support systems to address these intricate issues. The findings highlight the importance of heightened awareness, improved access to psychotherapeutic resources, and comprehensive caregiver support.

Assessing the Effects of Medical Information on Parental Self-Medication Behaviors for Children's Health: A Comparative Analysis

Background and Objectives: Health professionals have voiced concerns about the danger of self-medication in times of growing use of over-the-counter medicines and, in some contexts, the unregulated selling of them. Previous research has examined the incidence of parental self-medication as well as the use and abuse of antibiotics without medical advice. However, these studies have limited evidence on the role of family doctors and the perceived severity of self-medication in the case of parents. Based on the Health Belief Model, our research tested the effects of exposure to medical information on the parents' attitudes toward self-treating their children, without medical advice. Specifically, we aimed to assess whether exposure to information warning about the risks of treating children without a medical prescription influences parents' attitudes toward administering medicines to their children without medical advice. Materials and Methods: 210 parents engaged in the study, and were divided into two groups. One group was exposed to educational materials related to the perils of self-medication and the second one was not. All participants answered the same questionnaire and the answers were compared between the two groups. Results: The results showed that our respondents evaluated the practices of self-medication negatively (a higher score indicates a more negative evaluation), especially when it came to treating their children without medical advice (3.91 ± 1.04 for unexposed and 3.98 ± 1.08 for exposed). However, their attitudes towards self-medication varied depending on their beliefs about administering certain medications. Both those exposed to the warning information and those who were not exposed have agreed that they are unable to avoid treatment of their ill child without medical advice. Conclusions: In general, our respondents evaluate negatively the practices of self-medication, especially the treatment of their children without medical advice. Therefore, future health education campaigns need to be targeted specifically, with messages that guide how to act in particular cases depending on the medication used and the child's condition.

Prevalence, diagnosis and treatment of ADHD in Arab and Jewish children in Israel, where are the gaps?

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder affecting children and causing significant impairment. It is not clear to what extent ADHD differs between population groups. This study aims to assess prevalence, diagnosis and treatment of ADHD among Arab and Jewish children of primary school age in Israel.

METHODS

Cross-sectional survey, including 517 parents of children ages 7-10 (225 Jewish and 292 Arab) and 60 homeroom teachers of the corresponding children. Both parents and homeroom teachers completed the ADHD Rating Scale-V-RV. ADHD was defined according to DSM-5 ADHD criteria by both parents and teachers, or clinical diagnosis. In addition, parents reported ADHD medication and adherence to medication.

RESULTS

Prevalence of ADHD was similar for both groups. Yet, seeking diagnosis was lower among Arab Muslim children (9.2%) compared to Jewish children (17.8%). Arab Muslim children received significantly less medication compared to Jewish children. Parental decision to seek diagnosis was associated with education (OR = 6.14, CI 1.74-21.71), not ethnicity. Ethnicity predicted parents' decisions to pharmacologically treat their children with ADHD (OR = 7.61, CI 1.14-50.86) and adherence to medication (OR = 10.19, CI 1.18-88.01).

CONCLUSION

Education is critical in the help-seeking process, affecting the rate of ADHD diagnosis. Pharmacological treatment and adherence are correlated with ethnicity. Parents with limited education and minorities should be targeted for interventions to increase awareness regarding ADHD and treatment.

Design of a Collaborative Knowledge Framework for Personalised Attention Deficit Hyperactivity Disorder (ADHD) Treatments

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder. From the data collected by the Ministry of Public Health, Thailand, it has been reported that more than one million Thai youths (6-12 years) have been diagnosed with ADHD (2012-2018) This disorder is more likely to occur in males (12%) than females (4.2%). If ADHD goes untreated, there might be problems for individuals in the long run. This research aims to design a collaborative knowledge framework for personalised ADHD treatment recommendations. The first objective is to design a framework and develop a screening tool for doctors, parents, and teachers for observing and recording behavioural symptoms in ADHD children. This screening tool is a combination of doctor-verified criteria and the ADHD standardised screening tool (Vanderbilt). The second objective is to introduce practical algorithms for classifying ADHD types and recommending appropriate individual behavioural therapies and activities. We applied and compared four well-known machine-learning methods for classifying ADHD types. The four algorithms include Decision Tree, Naïve Bayes, neural network, and k-nearest neighbour. Based on this experiment, the Decision Tree algorithm yielded the highest average accuracy, which was 99.60%, with F1 scores equal to or greater than 97% for classifying each type of ADHD.

Behavioral and emotional difficulties and HIV treatment outcomes among HIV-infected children in rural southwestern China

BACKGROUND

Previous studies have not clearly demonstrated the impact of behavioral and emotional problems (BEDs) on treatment outcomes among HIV-infected children on antiretroviral therapy (ART). This study aimed to describe the prevalence of BEDs among this population and identify the factors associated with HIV treatment outcomes.

METHODS

This cross-sectional study was conducted in Guangxi, China, between July and August 2021. HIV-infected children answered questionnaires about BEDs, physical health, social support, and whether they have missed doses in the past month. BEDs were assessed using the Chinese version of the self-reported Strengths and Difficulties Questionnaire (SDQ-C). The self-reported survey data were linked to participants' HIV care information that was obtained from the national surveillance database. Univariate and multivariate logistic regression models were used to identify factors that were associated with missed doses in the past month and virological failure.

RESULTS

The study sample was 325 HIV-infected children. HIV-infected children had a higher proportion of abnormal scores on SDQ-C total difficulties compared to their peers in the general population (16.9 vs 10.0%; P = 0.002). An abnormal SDQ-C total difficulties score (AOR = 2.06, 95%CI: 1.10-3.88) and infrequency of receiving assistance and support from parents over the past 3 months (AOR = 1.85, 95%CI: 1.12-3.06) were significantly associated with missed doses in the past month. Between the ages of 14-17 years (AOR = 2.66, 95% CI: 1.37-5.16), female (AOR = 2.21, 95% CI: 1.20-4.08), and suboptimal adherence (AOR = 2.45, 95% CI: 1.32-4.57) were significantly associated with virological failure.

CONCLUSIONS

Children's mental health plays a role in HIV treatment outcomes. Psychological interventions should be promoted in pediatric HIV care clinics to improve children's mental health status and HIV treatment outcomes.