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Predicting Use of Medications for Children with ADHD: The Contribution of Parent Social Cognitions.

ABSTRACT: Objective:To explore how well parental social cognitions, guided by the Theory of Reasoned Action (TRA), contribute to the uptake and continuation of stimulant medication for children with ADHD. No previous study has explored this model in predicting medication use in a clinical sample. Method:Sixty-nine parents of children aged 6-13 years presenting to a tertiary ADHD clinic completed questionnaires, and a clinician documented their medication usage. Results:When controlling for medication status at baseline, both of the components of the TRA (i.e., attitudes and norms) predicted medication status following initial visit. Logistic regressions indicated that parents were more likely to enroll in or continue stimulant medication if they had lower stigma related to ADHD, a higher opinion of ADHD medications, and a greater knowledge of ADHD; this model classified 72.5% of the patients who started or continued stimulant medications. Conclusions:Findings suggest that the parents' knowledge about ADHD, opinion about treatment, and ADHD-related stigma are key factors to target in order to increase the uptake and continued use of evidence-based pharmacological interventions for children with ADHD.

SUBMITTER: Boudreau A

PROVIDER: S-EPMC7065566 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Predicting Use of Medications for Children with ADHD: The Contribution of Parent Social Cognitions.

Boudreau Ainsley A Mah Janet W T JWT

Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent 20200301 1

<h4>Objective</h4>To explore how well parental social cognitions, guided by the Theory of Reasoned Action (TRA), contribute to the uptake and continuation of stimulant medication for children with ADHD. No previous study has explored this model in predicting medication use in a clinical sample.<h4>Method</h4>Sixty-nine parents of children aged 6-13 years presenting to a tertiary ADHD clinic completed questionnaires, and a clinician documented their medication usage.<h4>Results</h4>When controlli ...[more]

PMID: 32194649

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Project description:ImportanceChildren with severe neurological impairment (SNI) often take multiple medications to treat problematic symptoms. However, for children who cannot self-report symptoms, no system exists to assess multiple symptoms and their association with medication use.ObjectivesTo assess the prevalence of 28 distinct symptoms, test whether higher global symptom scores (GSS) were associated with use of more medications, and assess the associations between specific symptoms and medications.Design, setting, and participantsThis cross-sectional study was conducted between April 1, 2019, and December 31, 2019, using structured parent-reported symptom data paired with clinical and pharmacy data, at a single-center, large, hospital-based special health care needs clinic. Participants included children aged 1 to 18 years with SNI and 5 or more prescribed medications. Data analysis was performed from April to June 2020.ExposureDuring routine clinical visits, parent-reported symptoms were collected using the validated 28-symptom Memorial Symptom Assessment Scale (MSAS) and merged with clinical and pharmacy data.Main outcomes and measuresSymptom prevalence, counts, and GSS (scored 0-100, with 100 being the worst) were calculated, and the association of GSS with medications was examined. To evaluate associations between symptom-medication pairs, the proportion of patients with a symptom who used a medication class or specific medication was calculated.ResultsOf 100 patients, 55.0% were boys, the median (interquartile range [IQR]) age was 9 (5-12) years, 62.0% had 3 or more complex chronic conditions, 76.0% took 10 or more medications, and none were able to complete the MSAS themselves. Parents reported a median (IQR) of 7 (4-10) concurrent active symptoms. The median (IQR) GSS was 12.1 (5.4-20.8) (range, 0.0-41.2) and the GSS was 9.8 points (95% CI, 5.5-14.1 points) higher for those with worse recent health than usual. Irritability (65.0%), insomnia (55.0%), and pain (54.0%) were the most prevalent symptoms. Each 10-point GSS increase was associated with 12% (95% CI, 4%-19%) higher medication counts, adjusted for age and complex chronic condition count. Among the 54.0% of children with reported pain, 61.0% were prescribed an analgesic.Conclusions and relevanceThese findings suggest that children with SNI reportedly experience substantial symptom burdens and that higher symptom scores are associated with increased medication use. Paired symptom-medication data may help clinicians identify targets for personalized symptom management, including underrecognized or undertreated symptoms.

Project description:We assessed the association between the use of medications for attention-deficit/hyperactivity disorder (ADHD) and the risk of all-cause mortality and unintentional injuries leading to emergency department (ED) or hospital admission in individuals aged ≤24 years with ADHD. We conducted a population-based retrospective cohort study between 2000 and 2021 using Quebec health administrative data. Individuals were followed from the first ADHD diagnosis or ADHD medication claim until turning 25, death, or study end. Exposure was defined as mutually exclusive episodes of ADHD medication use and/or coverage under the public provincial drug plan (PDP): 1) covered and not treated with ADHD medication; 2) covered and treated with ADHD medication; and 3) not covered under the PDP. The risk of all-cause mortality and unintentional injuries associated with exposure episodes was estimated using multivariable survival analyses. The cohort included n = 217 192 individuals aged 1-24 years with a male to female ratio of close to 2:1. Compared to non-medication use, episodes of ADHD medication use, overall, were associated with reduced all-cause mortality (adjusted hazard ratio, aHR 0.61, 95% CI 0.48-0.76) and unintentional injury leading to ED (0.75, 0.74-0.77) or hospitalisation (0.71, 0.68-0.75). Episodes of stimulants were associated with a lower risk of all-cause mortality and reduced risk of unintentional injuries, while episodes with non-stimulants and with both stimulants and non-stimulants concomitantly were associated with reduced risk of unintentional injuries, but not of all-cause mortality. Although residual confounding cannot be excluded, stimulants may have a protective effect in terms of risk of all-cause mortality and both stimulants and non-stimulants for ADHD may reduce the risk of unintentional injuries. The findings of the current study should inform clinical decision making on the choice of starting a pharmacological treatment for ADHD, when a balance needs to be struck between expected benefits and possible risks.

Project description:INTRODUCTION:Attention-deficit hyperactivity disorder (ADHD) has been related to increased rates of unintentional injuries. However, the magnitude of the effect and to which extent variables such as sex, age or comorbidity can influence this relationship is unknown. Additionally, and importantly, it is unclear if, and to which degree, ADHD medications can decrease the number of unintentional injuries. Due to the amount of economic and social resources invested in the treatment of injuries, filling these gaps in the literature is highly relevant from a public health standpoint. Here, we present a protocol for a systematic review and meta-analysis to estimate the relationship between ADHD and unintentional injuries and assess the impact of pharmacological treatment for ADHD METHODS AND ANALYSIS: We will combine results from 114 bibliographic databases for studies relating ADHD and risk of injuries. Bibliographic searches and data extraction will be carried out independently by two researchers. The studies' risk of bias will be assessed using the Newcastle-Ottawa Scale. Articles reporting ORs or HRs of suffering an injury in ADHD compared with controls (or enough data to calculate them) will be combined using Robust Variance Estimation, a method that permits to include multiple non-independent outcomes in the analysis. All analyses will be carried out in Stata. Age, sex and comorbid conduct disorders will be considered as potential causes of variance and their effect analysed through meta-regression and subgroup analysis. Sensitivity analyses will exclude articles with longer follow-ups, non-stringent definitions of ADHD or controls and statistically uncontrolled/controlled outcomes. Studies implementing a self-controlled case series methodology to investigate if ADHD drugs reduce the risk of injuries will be combined with a generalised linear mixed model using the Poisson distribution and a log link function. REGISTRATION DETAILS:PROSPERO-Prospective Register of Systematic Reviews (CRD42017064967).

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Predicting Use of Medications for Children with ADHD: The Contribution of Parent Social Cognitions.

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Predicting Use of Medications for Children with ADHD: The Contribution of Parent Social Cognitions.

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