Purpose: Examine the relationship between factors that influence parent decision-making about treatment of their child with Attention-Deficit/Hyperactivity Disorder (ADHD) and their child’s subsequent medication use.
Method: Longitudinal cohort of children newly diagnosed with ADHD who completed an N-of-1 trial of stimulant medication (i.e. 4-week randomized double-blind placebo-controlled trial of methylphenidate at low, medium, and higher dosages). Parent and teacher ratings of the child’s ADHD symptoms were obtained at baseline (e.g. before starting medicine) and after each dosage and placebo week. After completing the medication trial, parents completed validated surveys about their perceptions about ADHD, their beliefs about medicine, and their decisional conflict about continuing medicine (predictor variables). Six months later, pharmacy records were obtained for each child to calculate the number of days covered with medicine (outcome measure). Pearson correlation coefficients (r) between predictors and the outcome measure were calculated. 24 children (mean age = 7.9+/-1.2 years; 68% male, 78% Caucasian, 19.5% African-American) completed the N-of-1 trial and had 6 months of pharmacy dispensing records. Parents who completed scales were mainly mothers (89%) mean age 35.9 +/- 5.6 years.
Results: Greater parent belief that ADHD severely affected their child’s life (r = 0.45, p=0.05) or their own life (r = 0.55, p=0.02) predicted more days covered with medicine. Interestingly, concerns specific to ADHD medicines (e.g. side effects, long-term effects, etc.) was not a significant predictor. However, the more strongly parents endorsed beliefs about the harmfulness of medication (r = -0.60, p=0.004) and overuse of medicines in general (r = -0.43, p=0.05) the fewer days covered with medicine. The higher the parent’s decisional conflict about continuing medicine (r = -0.5, p=0.02) and the higher the decisional conflict resulting from not feeling supported in their decision to continue medicine (r = -0.66, p=0.001), the fewer days covered with medicine. Of note, the child’s initial response to medication (e.g. difference in symptom ratings from baseline to the best week of medication during the N-of-1 trail) did not predict continued medication use.
Conclusions: Parent decisions about continued medication use for their child with ADHD may be driven more by parent beliefs about ADHD/medication and decisional conflict than the child’s actual response to medication. Interventions to support family/self management of ADHD need to address these factors.
Candidate for the Lee B. Lusted Student Prize Competition