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）：ADHD儿童作为青少年和年轻人，包括高中衰竭，犯罪和药物滥用的风险（Barkley等，2007; Lee等，2011; Molina等，2009; Sibley等，2011）。刺激药是多动症的最广泛使用的干预措施，并记录了青少年的急性益处（Evans等，2000； Findling等，2011； Smith等，1998）。但是，尚未记录长期益处（Molina等，2009）。到青春期结束时，ADHD的青少年中有80-90％与使用刺激性药物的使用不合规，这可以说是缺乏长期益处的主要原因（Biswas等，209； Molina等，2009）。我们建议评估针对患有多动症青少年的双重组成部分的家庭干预，以改善药物依从性（支持青少年的依从性和责任； Star）。星星将动机访谈（MI; Miller and Rollnick，2013年）与父母奖的行为合同（PTBC； Barkley，Edwards，Robin，1999）结合，以满足种族多元化的独特需求，主要是西班牙裔，ADHD的青少年。在拟议的研究中，有200名患有多动症的青少年和对ADHD药物的慢性NA史将被随机分配给药物（像往常一样：MAU+STAR）。由于大多数ADHD青年在初级保健环境中受到治疗（Rushton，Kant＆Clark，2004年），在研究期间，所有参与者都将从自己的初级保健提供者（PCC）中获得ADHD药物，所有访问将在其PCC办公室举行。为了测试干预措施的急性和长期疗效，该研究将在六个月的积极干预，一年的维护干预措施以及自然主义随访的最后一年中检查对依从性（MEMS CAP计数，每月电话日记）的治疗效果。除了每月的MEMS上限和电话日记评估依从性外，参与者的功能还将在摄入量，6个月，18个月和30个月时进行评估，以检测DBD症状学，学术功能，家庭冲突和药物使用的群体差异。具体目的是检查（1）星对药物依从性的影响，（2）干预对依从性的主持人，（3）如果干预改善了四个关键领域中的ADHD的青少年的功能：ADHD/奇数症状严重程度，学术，家庭冲突，家庭冲突和药物使用。尽管ADHD中的药物NA的速度令人震惊，但该提案是专门设计用于改善ADHD青少年药物依从性的干预措施的首次随机试验。