Pediatric psychotropic medication compliance: a literature review and research-based suggestions for improving treatment compliance
Abstract
Without good compliance the best psychiatric treatment is ineffective. This article reviews what is known or can be inferred about compliance with psychiatric medications in the pediatric population. The review includes discussions of assessment techniques, risk and protective factors, the relevant research literature, and research-based practical techniques to improve compliance. A Medline search surveying the years from 1966 to August 2000 yielded only seven peer-reviewed papers reporting on compliance with pediatric psychopharmacology. All seven studies looked at stimulant compliance among children with attention deficit hyperactivity disorder. Reported levels of compliance range from 56% to 75%. These rates, although low, are likely to be overestimates of actual compliance. We review two related areas of research for which there are small but significant bodies of knowledge: pharmacological compliance studies among adult psychiatric populations and pediatric medical populations. This literature supports the idea that medication compliance is a significant obstacle to the effective treatment of patients. Because compliance rates are lower for children as compared to adults and psychiatric patients as compared to medical patients, we suspect that children with psychiatric illness may be at great risk for poor medication compliance. Fortunately, the research literature demonstrates several simple techniques that clinicians can use to improve medication compliance among their patients. The treatment alliance; education; and medication duration, dosing, palatability, and cost can all be tailored to improve medication compliance.
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Estimated adherence rates in children with ADHD range from 56% to 75%, and more than half discontinue treatment regardless of efficacy or symptom severity.
“estimated adherence rates in children with ADHD only range from 56% to 75%, 16 and more than 50% of patients with ADHD discontinue treatment regardless of its efficacy or symptom severity.17,18”
From Medication Adherence in the MTA: Saliva Methylphenidate Samples Versus Parent Report and Mediating Effect of Concomitant Behavioral Treatment (2009) · cites this paper as [16]
Physiological adherence findings are consistent with studies that have linked poor adherence to adverse outcomes.
“Despite our high reported adherence rates, our physiological adherence findings are consistent with studies 1, 16,18,29 that have linked poor adherence to adverse outcomes.”
From Medication Adherence in the MTA: Saliva Methylphenidate Samples Versus Parent Report and Mediating Effect of Concomitant Behavioral Treatment (2009) · cites this paper as [16]
Unlike some previous studies, this study found no associations between adherence and demographic factors such as age, sex, family income, and single-parent status.
“However, unlike some previous studies, we found no associations between adherence and demographic factors such as age, sex, 17,22 family income, and single-parent status 1, 16,18,29,30”
From Medication Adherence in the MTA: Saliva Methylphenidate Samples Versus Parent Report and Mediating Effect of Concomitant Behavioral Treatment (2009) · cites this paper as [16]
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“Surveys [25][26][27] report that nearly one-half of the patients prescribed IR stimulant medication admit they are not taking the medication.”
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Logan, S. L., Carpenter, L. A., Leslie, R. S., Hunt, K. S., Garrett-Mayer, E. S., Charles, J. M., & Nicholas, J. S. (2014) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-014-2156-0 · Cited by 23 · see citing works
“2010), and the parent reported adherence which may overestimate true adherence (Hack and Chow 2001).”
BackgroundTreatment Compliance and Early Termination of Therapy: A Comparative Study
Lazaratou, H., Anagnostopoulos, D. C., Vlassopoulos, M., Tzavara, C., & Zelios, G. (2006) · Psychotherapy and Psychosomatics · doi:10.1159/000090896 · Cited by 21 · see citing works
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“Once daily dosing and the absence of side effects may increase compliance.(66) It is often advocated that children should be commenced on treatment with immediate release”
BackgroundTreatment refusal in adolescents with severe chronic illness and borderline personality disorder.
Jaunay, E., Consoli, A., Greenfield, B. J., Guilé, J.-M., Mazet, P., & Cohen, D. (2006) · PubMed Central · Cited by 21 · see citing works
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“Adolescents are among the least adherent subgroup of all other pediatric and adult populations (Hack & Chow, 2001).”
BackgroundNiemeyer, L., Schumm, L., Mechler, K., Jennen-Steinmetz, C., Dittmann, R., & Häge, A. (2018) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2018.0072 · Cited by 18 · see citing works
“In child and adolescent psychiatry, few studies have been conducted regarding predictors for nonadherence, particularly with respect to the subgroup of adolescents (Hack and Chow 2001; Ha¨ge et al. 2018).”
Pahlavanzadeh, S., Mousavi, S., & Maghsoudi, J. (2018) · Iranian Journal of Nursing and Midwifery Research · doi:10.4103/ijnmr.ijnmr_16_17 · Cited by 16 · see citing works
“Results of this study also showed fear of taking drugs and consequently delayed treatment and its adverse effects on cutting the child’s treatment.[10] Therefore, it is essential for parents to have the necessary information.”
BackgroundRisk factors for discontinuing drug therapy among children with ADHD
Bokhari, F. A. S., Heiland, F. W., Levine, P., & Ray, G. (2008) · Health Services & Outcomes Research Methodology · doi:10.1007/s10742-008-0035-x · Cited by 18 · see citing works
“Adherence to prescribed stimulant medication regimens for ADHD has been poor, with estimates ranging from 44% to 87% (Firestone, 1982, Sleator et al., 1982, Corkum et al., 1999, Hack and Chow, 2001, Thiruchelvam et al., 2001).”
BackgroundSchlander, M. (2008) · Current Medical Research and Opinion · doi:10.1185/030079908x260808 · Cited by 16 · see citing works
“These data have been reviewed by Hack and Chow (2001)105, and their key findings are summarized in Table 3.”
MethodWarrer, P., Thomsen, P. H., Dalsgaard, S., Hansen, E. H., Aagaard, L., Wallach‐Kildemoes, H., & Rasmussen, H. B. (2016) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2015.0060 · Cited by 15 · see citing works
“Although there are no obvious explanations for this, we acknowledge that noncompliance should be considered an important factor for switching patients from MPH to ATX, as noncompliance leads to reduction in the overall effectiveness of the treatment (Hack and Chow 2001).”
Background“Drugs Don’t Work in Patients Who Don’t Take Them”
Mechler, K., & Häge, A. (2019) · Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie · doi:10.1024/1422-4917/a000645 · Cited by 14 · see citing works
Poor response to treatment: beyond medication
César Carvajal, A. (2004) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2004.6.1/ccarvajal · Cited by 14 · see citing works
“Hack and Chow found that compliance with treatment was lower among children than adults, and was lower among psychiatric patients than those with other medical pathologies, leading to the inference that children with psychiatric disorders are at the highest risk for noncompliance.(5) Financial factors can also restric…”
BackgroundNanomedicine Therapies for Pediatric Diseases
Yang, S., Aggarwal, K., Jurczyszak, J., Brown, N., & Sridhar, S. (2024) · Wiley Interdisciplinary Reviews Nanomedicine and Nanobiotechnology · doi:10.1002/wnan.1996 · Cited by 14 · see citing works
Initiation and Change of Psychotropic Medication Regimens among Adolescents in Inpatient Care
Warner, L. A., Fontanella, C. A., & Pottick, K. J. (2007) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2007.0120 · Cited by 13 · see citing works
“Poor adherence, which is prevalent among adolescents (Hack and Chow 2001; Wol-raich et al. 2005) and often contributes to medication ineffectiveness (Bobier and Warwick 2005), may also factor into the decision to add a medication.”
Promoting Adherence to Psychotropic Medication for Youth—Part 1
McGuinness, T. M., & Worley, J. (2010) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20100831-03 · Cited by 13 · see citing works
Examining Factors Associated With Medication Adherence in Youth With Bipolar Disorder
Elhosary, M. Y., Merranko, J. A., Goldstein, T. R., Hafeman, D., Goldstein, B. I., Gill, M. K., Hower, H. M., Axelson, D., Hunt, J., Yen, S., et al. (2023) · JAACAP Open · doi:10.1016/j.jaacop.2023.06.001 · Cited by 12 · see citing works
“9,19 To our knowledge, this is the fi rst study to assess medication adherence prospectively, over a median of 8 years, in a large sample of youth with BD through the transition to adulthood and examine the concurrent and future predictors of poor adherence, using both univariate and multivariate…”
Gesundheitsökonomie der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung in Deutschland
Schlander, M., Trott, G.-E., & Schwarz, O. (2009) · Der Nervenarzt · doi:10.1007/s00115-009-2889-8 · Cited by 12 · see citing works
Documenting adherence to psychostimulants in children with ADHD.
Charach, A., Gajaria, A., Skyba, A., & Chen, S. (2008) · PubMed Central · Cited by 12 · see citing works
Long-acting medications for the hyperkinetic disorders
Schlander, M. (2007) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-007-0615-2 · Cited by 12 · see citing works
“Five independent analyses of administrative data extend our understanding of non-persistence with treatment in ADHD beyond those earlier studies on compliance reviewed by Hack and Chow 2001 [30].”
MethodInfluentialAmbrosini, P. J., Sallee, F. R., López, F. A., Shi, L., Michaels, M. A., & on Behalf of the LADD.CAT Study Group (2006) · Current Medical Research and Opinion · doi:10.1185/030079906x80639 · Cited by 12 · see citing works
Health Information on the Internet—A Double-Edged Sword?
Gray, N. J. (2008) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2008.02.005 · Cited by 12 · see citing works
Bridging the Gap in Psychiatric Care for Children with a School-Based Psychiatry Program
Herman, K. C., Cho, E., Marriott, B. R., & Walker, L. Y. (2017) · School Mental Health · doi:10.1007/s12310-017-9222-7 · Cited by 11 · see citing works
Mundal, I. P., Gråwe, R. W., Hafstad, H., Cuevas, C. D. L., & Lara‐Cabrera, M. L. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-039852 · Cited by 11 · see citing works
The Pharmaceutical Economics of Child Psychiatric Drug Treatment
Schlander, M. (2010) · Current Pharmaceutical Design · doi:10.2174/138161210791959917 · Cited by 9 · see citing works
Desrosiers, L., Saint-Jean, M., & Breton, J. (2014) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12033 · Cited by 9 · see citing works
Adherence to medication for attention deficit/hyperactivity disorder: does time frame matter?
Khoza, S., Oladapo, A. O., & Barner, J. C. (2011) · Journal of Pharmaceutical Health Services Research · doi:10.1111/j.1759-8893.2011.00054.x · Cited by 8 · see citing works
Facilitating Homework and Generalization of Skills to the Real World
Cummings, C. M., Kazantzis, N., & Kendall, P. C. (2014) · doi:10.1002/9781118500576.ch11 · Cited by 8 · see citing works
ADHD Medication Vacations and Parent–Child Interactions by Gender
Barnard-Brak, L., Schmidt, M., & Sulak, T. (2013) · Journal of Attention Disorders · doi:10.1177/1087054711435412 · Cited by 6 · see citing works
“As a result, an adherence rate of approximately 50% for children with ADHD receiving medication has been noted in the literature for the past 30 years (Firestone, 1982; Hack & Chow, 2001; Pappadopulos et al., 2009; Thiruchelvam, Charach, & Schachar, 2001).”
BackgroundResultInfluentialThe lived experience of Omani adolescents and young adults with mental illness: A qualitative study
Omari, O. A., Matua, G. A., Al‐Adawi, S., Shebani, Z., Harthy, I. A., Obeidat, A. A., Dameery, K. A., Qadire, M. I. A., Hashmi, I. A., Khawldeh, A. A., et al. (2023) · PLoS ONE · doi:10.1371/journal.pone.0294856 · Cited by 6 · see citing works
Compliance with psychotropic medication treatment among adolescents living in youth care centres
Laurier, C., Lafortune, D., & Collin, J. (2009) · Children and Youth Services Review · doi:10.1016/j.childyouth.2009.07.007 · Cited by 6 · see citing works
Kılıç, B. G., Bi̇lgi̇ç, A., Gürkan, K., & Aysev, A. (2007) · PubMed · Cited by 6 · see citing works
Parents' Experience Raising a Child with Attention Deficit Hyperactivity Disorder (ADHD)
Strahm, C. D. (2011) · Cited by 6 · see citing works
Froehlich, T. E. (2017) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000000513 · Cited by 5 · see citing works
Medication for Children with Attention-Deficit Hyperactivity Disorder
Jensen, C. E. (2004) · Clinical Social Work Journal · doi:10.1023/b:csow.0000024328.71427.d1 · Cited by 5 · see citing works
“For example, ( Hack & Chow, 2001 ) found that rates of non-adherence among adolescents taking MPH for ADHD often exceed 50%.”
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Evaluating mental health services in a Greek community
Anagnostopoulos, D., Vlassopoulos, M., Lazaratou, H., Tzavara, C. K., Zelios, G., & Ploumpidis, D. N. (2006) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-006-0554-3 · Cited by 4 · see citing works
“In child psychiatry, most of the studies on treatment outcome concern hospitalization and medication [5, 20].”
BackgroundAntipsychotics for aggressive adolescents: barriers tobest practice
Pappadopulos, E. A., Siennick, S. E., & Jensen, P. S. (2003) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.3.1.85 · Cited by 3 · see citing works
Promoting Adherence with Children and Adolescents with Psychosis
Gearing, R. E., Mian, I. A., & Charach, A. (2008) · Child and Adolescent Psychopharmacology News · doi:10.1521/capn.2008.13.1.5 · Cited by 3 · see citing works
Dawood, E., Mitsu, R., Fozan, H. A., & Alharbi, B. (2020) · Saudi Journal of Nursing and Health Care · doi:10.36348/sjnhc.2020.v03i12.003 · Cited by 2 · see citing works
“Parental reluctance to adhere to the prescribed psychotropic medication may intervene with the treatment [22].”
Backgroundvan Leeuwen, E., & ter Mors, E. (2023) · Anthrozoös · doi:10.1080/08927936.2023.2254553 · Cited by 2 · see citing works
“Indeed, research in the human clinical domain shows that a good alliance is the single most important factor for general patient compliance (Hack & Chow, 2001).”
BackgroundSood, K., Buddhavarapu, M., Bansal, L. R., Schaefer, D., & Parikh, P. (2024) · Bipolar Disorders · doi:10.1111/bdi.13493 · Cited by 2 · see citing works
Assessing mental health transition readiness in youth with medical conditions
Gray, W. N., Partain, L., Benekos, E., Konishi, C. Y., Alpern, A. N., & Weiss, M. (2024) · Health Care Transitions · doi:10.1016/j.hctj.2024.100077 · Cited by 2 · see citing works
Sinclair, T., Beckman, D., Cobb, M., Young, S., Baichoo, S., & Keough, L. (2014) · Journal of Forensic Psychology Practice · doi:10.1080/15228932.2014.918477 · Cited by 2 · see citing works
- Authors
- Hack, S., & Chow, B.
- Affiliations
- New York University (US)
- University of California San Diego (US)
- Venue
- Journal of Child and Adolescent Psychopharmacology
- Publisher
- SAGE Publications
- Published
- 2001-03
- Volume
- 11
- Issue
- 1
- Pages
- 59-67
- ISSN
- 1044-5463 (ISSN-L)
- 1557-8992
- OpenAlex
- W1967979227
- Cited by
- 120
- References
- 29
- Citations by year
- 2024: 5 · 2023: 5 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 4 · 2017: 4 · 2016: 5 · 2015: 1 · 2014: 7 · 2013: 4 · 2012: 5
- FWCI
- 6.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Child and Adolescent Psychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
- Keywords
- medication adherence, pediatric psychopharmacology, attention deficit hyperactivity disorder, stimulant medication, treatment alliance, patient education, drug costs, risk and protective factors
- MeSH terms
- Adult, Child, Humans, Patient Compliance, Patient Education as Topic, Psychotropic Drugs
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