ABSTRACT
Objectives:
In our research, we aimed to determine treatment adherence and examine socio-demographic and clinical factors that affect it in pediatric patients firstly given medical treatment for the diagnosis of attention deficit hyperactivity disorder (ADHD).
Materials and Methods:
Between 2018 and 2020, children and adolescents who were first diagnosed with ADHD were enrolled in our study and factors that affect treatment adherence were investigated. A data form including socio-demographic, ADHD and clinical data of patients was created. Those data were extracted by retrospective search of clinical records. Patients who continued the treatment for six or more months were accepted as adherent, those who did not continue were accepted as non-adherent. Factors affecting treatment adherence were evaluated.
Results:
Three hundred and thirty-eight patients were included in our research. At the end of the sixth month, adherence rate was 48.2%. The average age was higher in the non-adherent group. Between the adherent and non-adherent groups, age, psychiatric disorder and psychiatric treatment in family, time of the onset of side effects, presence of comorbid destructive behavior disorders, presence of multiple comorbid disorders, and change in academic achievement with treatment were statistically significant differences. As a result of the regression analysis, the relationship between the presence of psychiatric disorders in the family, change in the course success with treatment, time of the onset of side effects and treatment compliance remained significant in the model.
Conclusion:
After the diagnosis of ADHD, age, psychiatric disorder and treatment in family, time of the onset of side effects, change in course success with treatment, presence of comorbid destructive behavior disorders, and presence of multiple comorbid disorders could affect the treatment adherence. This situation should not be ignored when the treatment was started to patients.
References
1American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington DC: American Psychiatric Publishing; 2013.
2Thomas R, Sanders S, Doust J, Beller E, Glasziou P. Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics. 2015;135:e994-e1001.
3Ercan ES, Polanczyk G, Akyol Ardıc U, Yuce D, Karacetın G, Tufan AE, Tural U, Aksu H, Aktepe E, Rodopman Arman A, Başgül S, Bılac O, Coşkun M, Celık GG, Karakoc Demırkaya S, Dursun BO, Durukan İ, Fidan T, Perdahlı Fiş N, Gençoğlan S, Gökçen C, Görker I, Görmez V, Gündoğdu ÖY, Gürkan CK, Hergüner S, Tural Hesapçıoğlu S, Kandemir H, Kılıç BG, Kılınçaslan A, Mutluer T, Nasiroğlu S, Özel Özcan Ö, Öztürk M, Öztop D, Yalın Sapmaz S, Süren S, Şahin N, Yolga Tahıroglu A, Toros F, Ünal F, Vural P, Perçinel Yazıcı İ, Yazıcı KU, Yıldırım V, Yulaf Y, Yüce M, Yüksel T, Akdemir D, Altun H, Ayık B, Bilgic A, Hekim Bozkurt Ö, Demirbaş Çakır E, Çeri V, Üçok Demir N, Dinç G, Irmak MY, Karaman D, Kınık MF, Mazlum B, Memik NÇ, Foto Özdemir D, Sınır H, Ince Taşdelen B, Taşkın B, Uğur Ç, Uran P, Uysal T, Üneri Ö, Yilmaz S, Seval Yılmaz S, Açıkel B, Aktaş H, Alaca R, Alıç BG, Almaidan M, Arı FP, Aslan C, Atabay E, Ay MG, Aydemir H, Ayrancı G, Babadagı Z, Bayar H, Çon Bayhan P, Bayram Ö, Dikmeer Bektaş N, Berberoğlu KK, Bostan R, Arıcı Canlı M, Cansız MA, Ceylan C, Coşkun N, Coşkun S, Çakan Y, Demir İ, Demir N, Yıldırım Demirdöğen E, Doğan B, Dönmez YE, Dönder F, Efe A, Eray Ş, Erbilgin S, Erden S, Ersoy EG, Eseroğlu T, Kına Fırat S, Eynallı Gök E, Güler G, Güles Z, Güneş S, Güneş A, Günay G, Gürbüz Özgür B, Güven G, Çelik Göksoy Ş, Horozcu H, Irmak A, Işık Ü, Kahraman Ö, Kalaycı BM, Karaaslan U, Karadağ M, Kılıc HT, Kılıçaslan F, Kınay D, Kocael Ö, Bulanık Koç E, Kadir Mutlu R, Lushi-Şan Z, Nalbant K, Okumus N, Özbek F, Akkuş Özdemir F, Özdemir H, Özkan S, Yıldırım Özyurt E, Polat B, Polat H, Sekmen E, Sertçelik M, Sevgen FH, Sevince O, Süleyman F, Shamkhalova Ü, Eren Şimşek N, Tanır Y, Tekden M, Temtek S, Topal M, Topal Z, Türk T, Uçar HN, Uçar F, Uygun D, Uzun N, Vatansever Z, Yazgılı NG, Miniksar Yıldız D, Yıldız N. The prevalence of childhood psychopathology in Turkey: a cross-sectional multicenter nationwide study (EPICPAT-T). Nord J Psychiatry. 2019;73:132-140.
4Childress AC, Berry SA. Pharmacotherapy of attention-deficit hyperactivity disorder in adolescents. Drugs. 2012;72:309-325.
5Öner Ö, Yilmaz EŞ, Karadağ H, Vural M, Vural EH, Akbulat A, Gürsöz H, Türkçapar H, Kerman S. ADHD Medication Trends in Turkey: 2009-2013. J Atten Disord. 2017;21:1192-1197.
6ADDISS. A report based on research amongst children and parents illustrating the impact of ADHD on the school day. School report: Perspectives on ADHD – A New Source of Information (2004). Unpublished Data Available from: http://www.addiss.co.uk/schoolreport.pdf
7Sonuga-Barke EJS, Halperin JM. Developmental phenotypes and causal pathways in attention deficit/hyperactivity disorder: potential targets for early intervention?. J Child Psychol Psychiatry. 2010;51:368-389.
8Evans SW, Pelham WE, Smith BH, Bukstein O, Gnagy EM, Greiner AR, Altenderfer L, Baron-Myak C. Dose-response effects of methylphenidate on ecologically valid measures of academic performance and classroom behavior in adolescents with ADHD. Exp Clin Psychopharmacol. 2001;9:163-175.
9Pelham WE Jr, Fabiano GA, Massetti GM. Evidence-based assessment of attention deficit hyperactivity disorder in children and adolescents. J Clin Child Adolesc Psychol. 2005;34:449-476.
10Whalen CK, Henker B, Buhrmester D, Hinshaw SP, Huber A, Laski K. Does stimulant medication improve the peer status of hyperactive children? J Consult Clin Psychol. 1989;57:545-549.
11Ercan ES, Kose S, Kutlu A, Akyol O, Durak S, Aydin C. Treatment Duration is Associated with Functioning and Prognosis in Children with Attention Deficit Hyperactivity Disorder. Bulletin of Clinical Psychopharmacology. 2012;22:148-160.
12Biederman J, Wilens T, Mick E, Spencer T, Faraone SV. Pharmacotherapy of attention-deficit/hyperactivity disorder reduces risk for substance use disorder. Pediatrics. 1999;104:e20.
13Chang Z, Lichtenstein P, Halldner L, D’Onofrio B, Serlachius E, Fazel S, Långström N, Larsson H. Stimulant ADHD medication and risk for substance abuse. J Child Psychol Psychiatry. 2014;55:878-885.
14Barkley R, Murphy KR, Fischer M. ADHD in Adults: What the Science Says UMASS Study. 2008:279.
15Robin AL, Payson E. The impact of ADHD on marriage. The ADHD Report. 2002;10:9-14.
16Chang Z, Lichtenstein P, D’Onofrio BM, Sjölander A, Larsson H. Serious transport accidents in adults with attention-deficit/hyperactivity disorder and the effect of medication: a population-based study. JAMA Psychiatry. 2014;71:319-325.
17Barner JC, Khoza S, Oladapo A. ADHD medication use, adherence, persistence and cost among Texas Medicaid children. Curr Med Res Opin. 2011;27:(Suppl 2)13-22.
18Drotar D. Promoting adherence to medical treatment in chronic childhood illness: Concepts, methods, and interventions. Lawrence Erlbaum Associates Publishers;2000.
19Rapoff MA. Adherence to Pediatric Medical Regimens. NewYork, NY: Kluwer Academic/Plenum Publishers; 1999.
20DiMatteo MR, Giordani PJ, Lepper HS, Croghan TW. Patient adherence and medical treatment outcomes: a meta-analysis. Med Care. 2002;40:794-811.
21Simpson SH, Eurich DT, Majumdar SR, Padwal RS, Tsuyuki RT, Varney J, Johnson JA. A meta-analysis of the association between adherence to drug therapy and mortality. BMJ. 2006;333:15.
22Charach A, Ickowicz A, Schachar R. Stimulant treatment over five years: adherence, effectiveness, and adverse effects. J Am Acad Child Adolesc Psychiatry. 2004;43:559-567.
23Adler LD, Nierenberg AA. Review of medication adherence in children and adults with ADHD. Postgrad Med. 2010;122:184-191.
24Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Leibson CL, Jacobsen SJ. Long-term stimulant medication treatment of attention-deficit/hyperactivity disorder: results from a population-based study. J Dev Behav Pediatr. 2006;27:448-457.
25Wehmeier PM, Dittmann RW, Banaschewski T. Treatment compliance or medication adherence in children and adolescents on ADHD medication in clinical practice: results from the COMPLY observational study. Atten Defic Hyperact Disord. 2015;7:165-174.
26Ayaz M, Ayaz AB, Soylu N, Yüksel S. Medication persistence in Turkish children and adolescents with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2014;24:442-447.
27Kiliç BG, Bilgiç A, Gürkan K, Aysev A. Sociodemographic and clinical factors associated with compliance to methylphenidate treatment in children with attention deficit hyperactivity disorder. Turk Psikiyatri Derg. 2007;18:207-213.
28Brinkman WB, Sucharew H, Majcher JH, Epstein JN. Predictors of Medication Continuity in Children With ADHD. Pediatrics. 2018;141:e20172580.
29Miller AR, Lalonde CE, McGrail KM. Children’s persistence with methylphenidate therapy: a population-based study. Can J Psychiatry. 2004;49:761-768.
30Sanchez RJ, Crismon ML, Barner JC, Bettinger T, Wilson JP. Assessment of adherence measures with different stimulants among children and adolescents. Pharmacotherapy. 2005;25:909-917.
31Bahmanyar S, Sundström A, Kaijser M, von Knorring AL, Kieler H. Pharmacological treatment and demographic characteristics of pediatric patients with Attention Deficit Hyperactivity Disorder, Sweden. Eur Neuropsychopharmacol. 2013;23:1732-1738.
32Emilsson M, Gustafsson PA, Öhnström G, Marteinsdottir I. Beliefs regarding medication and side effects influence treatment adherence in adolescents with attention deficit hyperactivity disorder. Eur Child Adolesc Psychiatry. 2017;26:559-571.
33Weiss G, Minde K, Werry JS, Douglas V, Nemeth E. Studies on the hyperactive child. 8. Five-year follow-up. Arch Gen Psychiatry. 1971;24:409-414.
34Toomey SL, Sox CM, Rusinak D, Finkelstein JA. Why do children with ADHD discontinue their medication? Clin Pediatr (Phila). 2012;51:763-769.
35van den Ban E, Souverein PC, Swaab H, van Engeland H, Egberts TC, Heerdink ER. Less discontinuation of ADHD drug use since the availability of long-acting ADHD medication in children, adolescents and adults under the age of 45 years in the Netherlands. Atten Defic Hyperact Disord. 2010;2:213-220.
36Hébert J, Polotskaia A, Joober R, Grizenko N. Adherence to psychostimulant medication in children with attention-deficit/hyperactivity disorder: the role of attitudes. J Can Acad Child Adolesc Psychiatry. 2013;22:317-323.
37Safavi P, Saberzadeh M, Tehrani AM. Factors Associated with Treatment Adherence in Children with Attention Deficit Hyperactivity Disorder. Indian J Psychol Med. 2019;41:252-257.
38Rieppi R, Greenhill LL, Ford RE, Chuang S, Wu M, Davies M, Abikoff HB, Arnold LE, Conners CK, Elliott GR, Hechtman L, Hinshaw SP, Hoza B, Jensen PS, Kraemer HC, March JS, Newcorn JH, Pelham WE, Severe JB, Swanson JM, Vitiello B, Wells KC, Wigal T. Socioeconomic status as a moderator of ADHD treatment outcomes. J Am Acad Child Adolesc Psychiatry. 2002;41:269-277.
39Gau SS, Chen SJ, Chou WJ, Cheng H, Tang CS, Chang HL, Tzang RF, Wu YY, Huang YF, Chou MC, Liang HY, Hsu YC, Lu HH, Huang YS. National survey of adherence, efficacy, and side effects of methylphenidate in children with attention-deficit/hyperactivity disorder in Taiwan. J Clin Psychiatry. 2008;69:131-140.
40Bhang SY, Kwack YS, Joung YS, Lee SI, Kim B, Sohn SH, Chung US, Yang J, Hong M, Bahn GH, Choi HY, Oh IH, Lee YJ, Hwang JW. Factors that Affect the Adherence to ADHD Medications during a Treatment Continuation Period in Children and Adolescents: A Nationwide Retrospective Cohort Study Using Korean Health Insurance Data from 2007 to 2011. Psychiatry Investig. 2017;14:158-165.
41Ahmed R, Aslani P. Attention-deficit/hyperactivity disorder: an update on medication adherence and persistence in children, adolescents and adults. Expert Rev Pharmacoecon Outcomes Res. 2013;13:791-815.
42Kortekaas-Rijlaarsdam AF, Luman M, Sonuga-Barke E, Oosterlaan J. Does methylphenidate improve academic performance? A systematic review and meta-analysis. Eur Child Adolesc Psychiatry. 2019;28:155-164.
43Marcus SC, Durkin M. Stimulant adherence and academic performance in urban youth with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2011;50:480-489.
44Hong J, Novick D, Treuer T, Montgomery W, Haynes VS, Wu S, Haro JM. Predictors and consequences of adherence to the treatment of pediatric patients with attention-deficit/hyperactivity disorder in Central Europe and East Asia. Patient Prefer Adherence. 2013;7:987-995.
45Charach A, Yeung E, Volpe T, Goodale T, Dosreis S. Exploring stimulant treatment in ADHD: narratives of young adolescents and their parents. BMC Psychiatry. 2014;14:110.
46Faraone SV, Biederman J, Zimmerman B. An analysis of patient adherence to treatment during a 1-year, open-label study of OROS methylphenidate in children with ADHD. J Atten Disord. 2007;11:157-166.
47Thiruchelvam D, Charach A, Schachar RJ. Moderators and mediators of long-term adherence to stimulant treatment in children with ADHD. J Am Acad Child Adolesc Psychiatry. 2001;40:922-928.
48Bhang SY, Hwang JW, Kwak YS, Joung YS, Lee S, Kim B, Sohn SH, Chung US, Yang J, Hong M, Bahn GH, Choi HY, Oh IH, Lee YJ. Differences in Utilization Patterns among Medications in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: a 36-Month Retrospective Study Using the Korean Health Insurance Review and Assessment Claims Database. J Korean Med Sci. 2016;31:1284-1291.
49Christensen L, Sasané R, Hodgkins P, Harley C, Tetali S. Pharmacological treatment patterns among patients with attention-deficit/hyperactivity disorder: retrospective claims-based analysis of a managed care population. Curr Med Res Opin. 2010;26:977-989.
50Marcus SC, Wan GJ, Kemner JE, Olfson M. Continuity of methylphenidate treatment for attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med. 2005;159:572-578.
51Atzori P, Usala T, Carucci S, Danjou F, Zuddas A. Predictive factors for persistent use and compliance of immediate-release methylphenidate: a 36-month naturalistic study. J Child Adolesc Psychopharmacol. 2009;19:673-681.
52Larson K, Russ SA, Kahn RS, Halfon N. Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics. 2011;127:462-470.
