Predictors of Stimulant Medication Continuity in Children with Attention-Deficit/Hyperactivity Disorder

Abstract

:Objective:The objective of this study was to examine the simultaneous impact of patient-related and parent-related factors, medication-related factors, and health care system-related factors on attention-deficit/hyperactivity disorder (ADHD) medication continuity.Method:Stimulant-naïve children (N = 144, Mage = 8 yrs, 71% male) with ADHD completed a methylphenidate (MPH) trial and were followed for 1 year after trial completion and return to community care. Multivariable analysis investigated predictors of (1) having at least 1 filled ADHD prescription after return to community care versus none and (2) having more days covered with medicine after return to community care. Predictors included race; age; sex; income; baseline ADHD symptom severity; MPH trial experience; child and parent mental health conditions; and parent beliefs about ADHD, ADHD medications, and therapeutic alliance.Results:One hundred twenty-one children (84%) had at least 1 filled ADHD medication prescription (mean = 178 d covered by medication) in the year after return to community care. Multivariable models found that a weaker perceived clinician-family working alliance predicted not filling any ADHD prescriptions. Among those who filled ≥1 prescription, factors linked to fewer days of ADHD medication coverage included child sociodemographic factors (non-White race, older age, being female, and lower income), lower parent beliefs that the child's ADHD affects their lives, and higher parent beliefs that medication is harmful, while child oppositional defiant disorder and parental ADHD predicted having more days of medication coverage.Conclusion:Child demographic factors, parent beliefs, and medication-related factors are associated with continuation of ADHD medication. These findings may facilitate the development of effective strategies to improve ADHD medication continuity for children from diverse groups.

Social gradient in use of health services and health‐related quality of life of children with attention‐deficit/hyperactivity disorder: A systematic review

“…Among the 25 included studies, two were systematic reviews (Green & Langberg, 2021 ; Wright et al., 2015 ) and one was a narrative review (Lindly et al., 2021 ). The rest were primary studies of which 11 (44% of total) were cohort studies (Bussing et al., 2003 ; Bussing et al., 1998 ; D'Amico et al., 2014 ; deJong et al., 2016 ; Enns et al., 2017 ; Ghosh et al., 2017 ; Jablonska et al., 2020 ; Kemper et al., 2013 ; Laugesen et al., 2018 ; Owens, 2020 ; Sayal et al., 2015 ), eight (32%) were cross‐sectional studies (Cuffe et al., 2009 ; Kendall et al., 2005 ; Nasol et al., 2019 ; Ronis et al., 2015 ; Stevens et al., 2005 ; Toomey et al., 2012 ; Tzang et al., 2014 ; van der Kolk et al., 2014 ), one (4%) was a mixed method study (Laugesen et al., 2020 ), one (4%) was a randomised controlled trial (RCT) (Kamimura‐Nishimura et al., 2022 ), and one (4%) was a comparative study (Lee et al., 2022 ).…”

“…Of 22 primary studies, 12 studies were from the US (54%) (Bussing et al., 1998 , 2003 ; Cuffe et al., 2009 ; deJong et al., 2016 ; Kamimura‐Nishimura et al., 2022 ; Kemper et al., 2013 ; Kendall et al., 2005 ; Nasol et al., 2019 ; Owens, 2020 ; Ronis et al., 2015 ; Stevens et al., 2005 ; Toomey et al., 2012 ), six studies were from Europe (D'Amico et al., 2014 ; Jablonska et al., 2020 ; Laugesen et al., 2020 ; Laugesen et al., 2018 ; Sayal et al., 2015 ; van der Kolk et al., 2014 ) and there was one study each from Canada (Enns et al., 2017 ), Taiwan (Tzang et al., 2014 ), Australia (Ghosh et al., 2017 ), and South Korea (Lee et al., 2022 ). These countries were categorised based on the healthcare system as follows (OECD, 2023 ; OECDiLibrary, 2023 ; The Commonwealth Fund, 2023 ):…”

“…( 2012 ) found no statistical difference in the rate of medication discontinuation by income and education, Kamimura‐Nishimura et al. ( 2022 ) reported low‐income was associated with poor medication continuity.…”

“…For example, Cuffe et al (2009) found children aged 9-13-year-olds had more medical visits than those aged 14-17year-olds. Kamimura-Nishimura et al (2022) reported that older age factored in fewer days of medication use in children with ADHD.…”

“…Twenty‐three studies examined the association between SES and service use among children with ADHD (Bussing et al., 2003 ; Bussing et al., 1998 ; Cuffe et al., 2009 ; D'Amico et al., 2014 ; deJong et al., 2016 ; Enns et al., 2017 ; Ghosh et al., 2017 ; Green & Langberg, 2021 ; Jablonska et al., 2020 ; Kamimura‐Nishimura et al., 2022 ; Kemper et al., 2013 ; Kendall et al., 2005 ; Laugesen et al., 2020 ; Laugesen et al., 2018 ; Lindly et al., 2021 ; Nasol et al., 2019 ; Owens, 2020 ; Ronis et al., 2015 ; Sayal et al., 2015 ; Stevens et al., 2005 ; Toomey et al., 2012 ; Tzang et al., 2014 ; Wright et al., 2015 ). A broad range of indicators of family SES were used across studies including parental educational status, income, and occupation.…”