Continuity of Methylphenidate Treatment for Attention-Deficit/Hyperactivity Disorder

Marcus, Steven C.; Wan, George J.; Kemner, Jason E.; Olfson, Mark

doi:10.1001/archpedi.159.6.572

Cited by 151 publications

(143 citation statements)

References 41 publications

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“…11,37,38 Qualitative methods, such as those employed in the current study, are essential to develop a richer understanding of this phenomenon. Parents in the current study and others 6,7,39,40 continue to experience fears and worries related to the potential for long-term adverse effects, even if their child shows marked improvement.…”

Section: Table 4 Domain 3: Continued Doubt and Uncertaintymentioning

confidence: 99%

“…Despite the efficacy of medication to reduce ADHD symptoms, 10 medication initiation is variable, 1 and medication continuity is poor because many children stop taking medicine and/or have extended gaps in medication supply. 11,12 Although studies have identified child characteristics (eg, age, race) [11][12][13][14][15][16] and medication management factors (eg, dosing regimen) 11,16 related to medication continuity, factors that influence family decision-making have not been fully elucidated. The objective of this study was to better understand how parents make decisions about treatment for their child or adolescent with ADHD.…”

mentioning

confidence: 99%

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Parental Angst Making and Revisiting Decisions About Treatment of Attention-Deficit/Hyperactivity Disorder

Sherman²,

et al. 2009

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WHAT'S KNOWN ON THIS SUBJECT:Initiation of medication for ADHD is variable and persistence with therapeutic regimens is poor. Parents play a key role in managing medication use for their child with ADHD. WHAT THIS STUDY ADDS:This study identifies factors that influence parent decision-making about the initiation and continuation of medication treatment. Awareness of these factors may help physicians address the concerns of families while managing ADHD.abstract BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral conditions of childhood and adolescence. Despite availability of effective treatment options, initiation of treatment is variable and persistence with therapeutic regimens is poor. OBJECTIVE:We sought to better understand how parents make decisions about treatment for their child or adolescent with ADHD. METHODS:We conducted a qualitative study among parents of children and adolescents; 52 parents participated in 1 of 12 focus groups. Parents answered questions about decision-making, information sharing, and sources of conflict and uncertainty. Sessions were audiotaped and transcribed verbatim. Themes were coded independently by 4 of the investigators, who then agreed on common themes. RESULTS:Parents in our study made decisions about treatment for their child with ADHD in the midst of experiencing a variety of emotions as they witnessed child functional impairments at home and at school. In addition, parents felt stress as a result of their daily efforts to manage their child's struggles. Multiple factors influenced the decision to initiate medication. Subsequently, revisiting the decision to give their child medicine for ADHD was common. Many parents contrasted time on and off medicine to help inform management decisions. Trials stopping medication were almost always parent-or child-initiated. CONCLUSIONS:Decisions about medication use for children and adolescents with ADHD are made and frequently revisited by their parents. Choices are often made under stressful conditions and influenced by a variety of factors. Striking a balance between benefits and concerns is an ongoing process that is often informed by contrasting time on and off medication. Development of strategies to support families across the continuum of decisions faced while managing ADHD is warranted.

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Section: Table 4 Domain 3: Continued Doubt and Uncertaintymentioning

confidence: 99%

mentioning

confidence: 99%

Parental Angst Making and Revisiting Decisions About Treatment of Attention-Deficit/Hyperactivity Disorder

Sherman²,

et al. 2009

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“…40 In retrospective studies, stimulant persistence ranged from 59% at 4 months to 12%-43% at the end of 1 year. 10,13,[41][42][43] Antipsychotics might help to improve persistence to stimulant treatment through control of psychiatric comorbidities or behavioral symptoms of ADHD. On the other hand, the use of AAPs might lead to reduced efficacy of stimulants due to their opposite mechanism of action on the dopaminergic system.…”

Section: Predictors Of Concomitant Use Of Antipsychotics and Stimulanmentioning

confidence: 99%

“…The study cohort was identified using prescription claims for LAS (methylphenidate, dexmethylphenidate, mixed amphetamine salts, pemoline, and lisdexamfetamine dimesylate) and with at least 1 medical claim with a diagnosis of ADHD (ICD-9-CM code 314.xx) during the study period. 8,42,47,48 Index date was defined as the first prescription fill date of the first LAS from July 2004-December 2006. Cohort selection was limited to ADHD patients using LAS only because LAS are more frequently used in children and adolescents with ADHD than the other types of stimulants.…”

Section: Study Populationmentioning

confidence: 99%

“…The maximum gap of 30 days was allowed between consecutive refills of the index LAS. 42 When the gap exceeded the permissible limit of 30 days, the treatment episode for the patient was terminated even if the patient was persistent with stimulant therapy at a later stage. The objective of the study was to examine the index LAS persistence in terms of time to discontinuation of the index LAS medication.…”

Section: Medication Use Variablesmentioning

confidence: 99%

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Predictors of Concomitant Use of Antipsychotics and Stimulants and Its Impact on Stimulant Persistence in Pediatric Attention Deficit Hyperactivity Disorder

Bali

Kamble²,

Aparasu³

2015

JMCP

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Motor Vehicle Crash Risk Among Adolescents and Young Adults With Attention-Deficit/Hyperactivity Disorder

et al. 2017

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IMPORTANCE Attention-deficit/hyperactivity disorder (ADHD) often persists into adolescence, when motor vehicle crash risk peaks. We know little about when adolescents with ADHD get licensed and, once they do, the extent to which they have increased crash risk compared with adolescents without ADHD.OBJECTIVES To examine the association between ADHD and both driver licensing and crash involvement and whether it varies by sex, licensing age, and/or being prescribed ADHD medication at licensure. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study was conducted at 6 primary care practices of the Children's Hospital of Philadelphia, a large pediatric health care network in southeastern Pennsylvania and southern New Jersey. Using electronic health records, we defined a cohort of 2479 adolescents and young adults with ADHD and 15 865 without ADHD who were (1) born from 1987 to 1997; (2) residents of New Jersey and patients at 1 of 6 New Jersey primary care practices at age 12 years or older; and (3) age-eligible to obtain a driver's license from 2004 through 2014. Electronic health records data were then linked with New Jersey's statewide driver licensing and crash databases for 2004 through 2014.MAIN OUTCOMES AND MEASURES Acquisition of a driver's license and first involvement as a driver in a police-reported crash. Survival analysis was used to estimate adjusted hazard ratios for licensing and crash outcomes through age 25 years. RESULTSThe median age of individuals at the end of the study was 22.2 years (interquartile range, 19.7-24.8). Compared with individuals without ADHD, the licensing probability of individuals with ADHD 6 months after eligibility was 35% lower (for males: adjusted hazard ratio, 0.65; 95% CI, 0.61-0.70; females: adjusted hazard ratio, 0.64; 95% CI, 0.58-0.70). Among individuals with a driver's license, 764 of 1785 with ADHD (42.8%) and 4715 of 13 221 without ADHD (35.7%) crashed during the study period. The adjusted risk for first crash among licensed drivers with ADHD was 1.36 times higher than for those without ADHD (95% CI, 1.25-1.48) and did not vary by sex, licensing age, or over time. Only 129 individuals with ADHD (12.1%) were prescribed medication in the 30 days before licensure.CONCLUSIONS AND RELEVANCE Adolescents with ADHD get licensed less often and at an older age. Once licensed, this cohort has a greater risk of crashing. Additional research is needed to understand the specific mechanisms by which ADHD influences crash risk.

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Continuity of Methylphenidate Treatment for Attention-Deficit/Hyperactivity Disorder

Cited by 151 publications

References 41 publications

Parental Angst Making and Revisiting Decisions About Treatment of Attention-Deficit/Hyperactivity Disorder

Parental Angst Making and Revisiting Decisions About Treatment of Attention-Deficit/Hyperactivity Disorder

Predictors of Concomitant Use of Antipsychotics and Stimulants and Its Impact on Stimulant Persistence in Pediatric Attention Deficit Hyperactivity Disorder

Motor Vehicle Crash Risk Among Adolescents and Young Adults With Attention-Deficit/Hyperactivity Disorder

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