Child and Caregiver Issues In the Treatment of Attention Deficit–Hyperactivity Disorder: Education, Adherence and Treatment Choice

Abstract

There is much more to successful drug treatment than writing a prescription. In this article, we describe some of the ‘holistic’ aspects of the pharmacological treatment of attention deficit–hyperactivity disorder, with an emphasis on helping families to decide between psychological and pharmacological treatment and on the process of psychoeducation. Detailed accounts of drug and behavioral treatment in various circumstances are available elsewhere; however, the value and process of psychoeducation is sometimes underestimated or referred to in a cursory statement of the need for a good doctor–patient relationship. There has been little in the way of controlled trials, so no meta-analysis is attempted. Where possible (e.g., in reviewing the effects of psychological therapy and prediction of drug response), PubMed/Medline was searched for systematic reviews and randomized trials, but this article’s conclusions should be taken as personal. These subjective views are based chiefly on experience in clinical practice, participation in focus groups with young people and their families and work with support groups.

What is the level of evidence for the use of currently available technologies in facilitating the self-management of difficulties associated with ADHD in children and young people? A systematic review

“…The review found that the evidence demonstrates that technology shows promise in self-managing difficulties related to ADHD in children and YP. However, this claim is based on evidence that often consists of small sample sizes, use a wide variety of outcome measures (many of which are not validated) and provide little support for the importance of the role of psychoeducation in children and YP with ADHD that has been so widely reported and encouraged elsewhere [19][20][21][22][23]64]. For example, the European Guidelines suggest psychoeducation for parent/carer and child with ADHD as a first step to treatment [23].…”

“…For example, the European Guidelines suggest psychoeducation for parent/carer and child with ADHD as a first step to treatment [23]. One systematic review even stated that psychoeducation for YP with ADHD and their families could provide an expert understanding of their condition could lead to more positive individual choices [20].…”

“…It has been suggested that psychoeducaiton for parents and the YP with ADHD is the first step to treatment [23]. A systematic review has emphasised the value of psychoeducation for children and YP with ADHD can lead to an expert understanding of their condition and lead them to making more positive individual choices [20]. Public Heath England [19] and the Mental Health Taskforce's Five Year Forward View for Mental Health [22] states that early intervention avoids YP falling into crisis and expensive and longer-term interventions into adulthood.…”

“…However, as they transit into adulthood, the support is not as readily available or indeed wanted by the individual [18]. It is, therefore, imperative that children and YP learn to self-manage their condition and indeed be educated about their condition and how to manage it [19][20][21][22][23]. Individuals with ADHD often experience crises and access to their usual services may not be immediately available.…”

Evaluation of attitudes towards treatment in adolescents with attention deficit hyperactivity disorder (ADHD)

“…Very little has been studied about insight in the paediatric psychiatric population; one study found that treatment adherence was associated with insight in children and adolescents with psychosis [43]. Because friends and families may reinforce at the same time insight and both positive and negative viewpoints towards medication, it is important to develop educational strategies where families are adequately informed about the disorder and the specific mechanisms and effects of medications [23]. In addition, future studies should specifically assess the effect of psycho-educational strategies to enhance positive attitudes while dissipating non-rational concerns in these patients and their respective families.…”