Improving Medication Adherence in ADHD Adolescents

提高多动症青少年的药物依从性

基本信息

批准号：
8791345
负责人：
WILLIAM E PELHAM
金额：
$ 65.05万
依托单位：
FLORIDA INTERNATIONAL UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-01-15 至 2016-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8791345
关键词：
Acculturation Acute Address Adherence Adolescence Adolescent Adolescent and Young Adult Age Alcohol or Other Drugs use Attention deficit hyperactivity disorder Behavioral Belief Central Nervous System Stimulants Child Childhood Chronic Conflict (Psychology)Contracts Cost of Illness Data Drops Electronics Ethnic Origin Failure Family Florida Fostering Hispanics Impairment Individual Intake Intervention Life Literature Long-Term Effects Maintenance Measures Mediator of activation protein Medical Mental Health Minority Monitor Motivation Outcome Parents Participant Pharmaceutical Preparations Pharmacological Treatment Pharmacotherapy Phase Population Primary Health Care Provider Randomized Recording of previous events Recruitment Activity Regimen Reporting Risk Robin bird Schools Services Severities Substance abuse problem Symptoms System Teenagers Telephone Testing Time Treatment outcome Unemployment United States Visit Work Youth active method base comparison group demographics depressive symptoms design diaries experience follow-up high school improved improved functioning intervention effect medication compliance motivational enhancement therapy non-compliance novel pill preference prevent primary care setting public health relevance randomized trial therapy adherence treatment effect uptake

项目摘要

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.

描述（由申请人提供）：多动症儿童在青少年和年轻人时面临各种负面结果的风险，包括高中失败、犯罪和药物滥用（Barkley 等人，2007 年；Lee 等人，2011 年；Molina 等人），2009；西布利等人，2011）。兴奋剂药物是最广泛使用的 ADHD 干预措施，并已证明对青少年有显着益处（Evans 等人，2000 年；Findling 等人，2011 年；Smith 等人，1998 年）。然而，长期效益尚未被记录（Molina 等，2009）。到青春期结束时，80-90% 的多动症青少年不遵守兴奋剂药物的使用，这可能是缺乏长期益处的主要原因（Biswas 等人，209；Molina 等人，2009）。我们建议评估针对 ADHD 青少年的双重家庭干预措施，以提高药物依从性（支持青少年依从性和责任；STAR）。 STAR 将动机访谈（MI；Miller 和 Rollnick，2013）与亲子行为契约（PTBC；Barkley、Edwards、Robin，1999）结合起来，以满足多动症青少年（主要是西班牙裔）的独特需求。在拟议的研究中，200 名患有 ADHD 且对其 ADHD 药物有慢性 NA 病史的青少年将被随机分配至单独药物组（照常用药：MAU）或 MAU+STAR。由于大多数 ADHD 青少年在初级保健机构中接受治疗（Rushton、Kant & Clark，2004 年），因此所有参与者在研究期间都将从自己的初级保健提供者 (PCC) 处获得 ADHD 药物，并且所有就诊都将在初级保健机构中进行。他们的 PCC 办公室。为了测试干预措施的急性和长期疗效，该研究将检查六个月的主动干预、一年的维持干预和最后一年的自然随访对依从性的治疗效果（MEMS 帽药丸计数、每月电话日记）。向上。除了每月 MEMS 上限和电话日记依从性评估之外，还将在入学时、6 个月、18 个月和 30 个月时评估参与者的功能，以检测 DBD 症状、学业功能、家庭冲突和物质使用方面的群体差异。具体目的是检查 (1) STAR 对药物依从性的影响，(2) 干预对依从性影响的调节因素，(3) 干预措施是否改善 ADHD 青少年在四个关键领域的功能： ADHD/ODD 症状严重程度、学术、家庭冲突和药物滥用。尽管多动症患者的药物不适用率惊人地高，但该提案是第一个专门针对改善多动症青少年药物依从性而设计的干预措施的随机试验。