Pilot Evaluation of the Medication Integration Protocol for Adolescents With ADHD in Behavioral Care

Abstract

Although attention-deficit/hyperactivity disorder (ADHD) is prevalent among adolescents in outpatient behavioral care, one of the few evidence-based treatment options, stimulant medication, is significantly underutilized. The Medication Integration Protocol (MIP) is a family-based intervention designed to help behavior therapists assume a lead role in educating clients about ADHD in adolescents, promoting family-centered decisions about medication initiation, and integrating medication management activities within behavioral treatment planning. This pilot study evaluated treatment fidelity and medication utilization for inner-city teens receiving MIP ( n = 14) compared with a matched Historical Control (HC) group ( n = 21) in a community clinic. Observational analyses revealed that in comparison with HC, MIP demonstrated basic protocol fidelity with regard to adherence to the MIP protocol, therapeutic alliance with the adolescent, and clinical focus on ADHD in session. MIP showed greater psychiatric evaluation completion and ADHD medication initiation than HC. Next steps in the ongoing development of MIP are outlined.

A Clinician's Guide to Co-occurring ADHD Among Adolescent Substance Users: Comorbidity, Neurodevelopmental Risk, and Evidence-Based Treatment Options

“…In Medication Management & Integration Planning , for families that initiate medication, therapists play a lead role in case coordination for medication management that is tailored to each family, with therapists and prescribers working in integrated fashion to support prescription compliance and monitor benefits and side effects. Pilot study results (Hogue et al, 2015) support the implementation feasibility of MIP and its positive impact on ADHD medication utilization (medication evaluation, acceptance, and duration) in routine outpatient behavioral care.…”

“…Thus there is growing focus on the benefits of active involvement by adolescents as well as caregivers in structured decision-making processes that target ADHD stigma and medication receptivity (Bussing et al, 2011; Schachter, Tharmalingam, & Kleinman, 2011). Several family therapy models for adolescent behavior problems contain interventions explicitly designed to engage teens in treatment participation (e.g., Liddle, 1995); such interventions are ideal candidates for boosting the effectiveness of medication decision-making (Hogue, Lichvar, & Bobek, 2015).…”

A systematic review of shared decision making interventions in child and youth mental health: synthesising the use of theory, intervention functions, and behaviour change techniques

“…Of the eight interventions designed to increase SDM in child and youth mental health settings, four were aimed for young people as the decision maker [ 33 – 36 ], three for parents/guardians [ 37 – 39 ], and one for both parents/guardian and young people [ 40 ]. In terms of overarching approaches to facilitate SDM, five interventions included decision aids [ 33 – 35 , 39 , 41 ] and three were therapeutic approaches [ 36 , 38 , 40 ].…”

“…Of the eight interventions designed to increase SDM in child and youth mental health settings, four were aimed for young people as the decision maker [ 33 – 36 ], three for parents/guardians [ 37 – 39 ], and one for both parents/guardian and young people [ 40 ]. In terms of overarching approaches to facilitate SDM, five interventions included decision aids [ 33 – 35 , 39 , 41 ] and three were therapeutic approaches [ 36 , 38 , 40 ]. Three papers came from the United States (US) [ 36 , 40 , 41 ], two from Australia [ 34 , 39 ], one from the United Kingdom (UK) [ 35 ], one from the Netherlands [ 38 ], and one from Japan [ 33 ].…”

Parental Occupational Executive Training: Feasibility and Parental Perceptions

“…As in previous reports addressing intervention feasibility for children and youth with ADHD, we used the weekly standardized reports to analyze participants' attendance rate, adherence to home-strategy use during daily activities, and acceptance (e.g., Levanon-Erez et al, 2019;Tamm et al, 2014), as well as therapist fidelity (Hogue et al, 2016). Therapist fidelity relates to therapists' ability to focus on the intervention's essential elements and avoid implementing incompatible elements (Dunn et al, 2018).…”