Predictors of Stimulant Medication Continuity in Children with Attention-Deficit/Hyperactivity Disorder.
Kelly I Kamimura-Nishimura, William B Brinkman, Jeffery N Epstein and 5 others
PMID 35316245WHAT IT FOUND
Children whose families felt a strong working alliance with their initial prescriber were more likely to fill any ADHD medication after leaving a clinical trial.
Among those who started, non-White race, female gender, low income, older age, and believing medication is harmful predicted fewer days of coverage.
Key findings
01A weaker perceived working alliance with the clinician during the initial medication trial was the only factor in the multivariable model that predicted not filling any ADHD prescriptions in the following year.
02Among children who did fill at least one prescription, non-White race, female gender, and low income were associated with 67, 23, and 18 fewer days of medication coverage, respectively.
03Children who showed less improvement in ADHD symptoms during the initial trial, and parents who believed medication was harmful, had fewer days of medication coverage.
STILL TO COME
How it was doneWhat they found
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What it does not show
Pharmacy records track medication supply, not actual consumption or adherence to instructions. The participants came from a rigorous clinical trial, which may have excluded families with fewer resources, limiting applicability to lower-income populations. The study did not capture reasons for non-adherence, such as choosing behavioral therapy instead. Working alliance was measured with the trial clinician, not the subsequent primary care provider, which may affect generalizability. The trial used brand-name methylphenidate, which may differ pharmacologically from generic versions prescribed in the community.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the lack of association between adverse events and medication discontinuity as evidence that side effects do not matter. The children in this study had already undergone a careful titration process to optimize efficacy and minimize side effects before returning to community care, which may have removed this barrier.