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Attrition in Randomized Controlled Trials for Pediatric Chronic Conditions
Abstract
OBJECTIVE: To examine attrition variables in randomized controlled trials of cognitive behavioral interventions for children with chronic illnesses. METHODS: We examined attrition rates reported on 40 randomized cognitive behavioral interventions published in six pediatric research journals, during the years 2002-2007. Intervention focus was limited to children with a chronic medical condition, such as asthma, obesity, arthritis, diabetes, cancer, sickle cell disease, and cystic fibrosis. RESULTS: Mean rate of enrollment refusal was 37% (range 0-75%). Mean attrition rate was 20% (range 0-54%) for initial follow-up and 32% (range 0-59%) for extended follow-up. Of the reviewed articles, 40% included a CONSORT diagram. CONCLUSIONS: Strategies that can be used to limit attrition include tailoring recruitment to the study population, providing personalized feedback, maintaining consistent study procedures, providing incentives, and using intensive tracking measures. There is a need for standardized definitions and reporting of attrition rates in randomized cognitive behavioral intervention studies.
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“More than one-third decline traditional cognitive behavioral therapy (CBT)”
From Promoting resilience in adolescents and young adults with cancer: Results from the PRISM randomized controlled trial (2018) · cites this paper as [21]
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“and an additional one-third discontinue participation because of CBT's typical time commitment.21”
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“First, although this study contributes to the literature by examining changes in RSA in the context of psychological treat-ment up until 18 months postbaseline, longer follow-ups tend to incur greater attrition (Karlson & Rapoff, 2009).”
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“…to address the challenges of attrition and the related problem of diminished treatment effects, such as making repeated contact with 6 participants, offering incentives for participation, and implementing a culturally sensitive intervention in a convenient location (Karlson & Rapoff, 2009).”
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“The attrition rate from T2 to T3 was high (from N¼ 61 to N¼ 46, 24.6%), but similar to attrition rates in longitudinal trials of pediatric populations (Karlson & Rapoff, 2009).”
ResultInfluentialvan Driessche, A., Beernaert, K., Deliëns, L., Kars, M. C., Lyon, M. E., Barrera, M. E., Dussel, V., Bidstrup, P. E., Rosenberg, A. R., Akard, T. F., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-2499448/v1
Ways to Advance Pediatric Medical Adherence Research
Rapoff, M. A., Duncan, C. L., & Karlson, C. (2023) · Issues in clinical child psychology · doi:10.1007/978-3-031-27484-8_9
Self-citationRoddy, M. K., El-Rifai, M., LeStourgeon, L. M., Aikens, J. E., Wolever, R. Q., Greevy, R. A., & Mayberry, L. S. (2023) · Chronic Illness · doi:10.1177/17423953231203734
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“While three of seven adolescent participants who consented did not ultimately take part in the technical usability study, such high attrition rates are common in pediatric clinical research studies [29,30].”
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MacKenzie, N. E., Rana, R., Isaac, L., Tyrrell, J., & Ruskin, D. A. (2025) · Healthcare · doi:10.3390/healthcare13131527 · Cited by 1
“Indeed, attrition rates are a common challenge in child health and behaviour change research, typically near 20% [53,54]; however, additional factors such as surgery dates and competing priorities during planning for surgery may have elevated the present attrition rates.”
Wege zur Förderung der pädiatrischen medizinischen Adhärenzforschung
Rapoff, M. A., Duncan, C. L., & Karlson, C. (2025) · Springer eBooks · doi:10.1007/978-3-031-86845-0_9
Self-citationGaunt, D., Brooks, C. P., Pedder, H., Crawley, E. M., Horwood, J., & Metcalfe, C. (2023) · Figshare · doi:10.6084/m9.figshare.23519960
Balsamo, L. M., Kairalla, J. A., Hibbitts, E., Rodwin, R. L., Devidas, M., Dreyzin, A., Winick, N. J., Carroll, W. L., Hunger, S. P., Raetz, E. A., et al. (2026) · Pediatric Blood & Cancer · doi:10.1002/1545-5017.70029
“Attrition from T1 to T4/T5 limited sample size, with response rates dropping to 60%–70% by the end of therapy, consistent with the expected attrition in longitudinal studies of children with chronic illness [ 47 ].”
Rode, J. B., Ogle, S. B., Khoury, J. C., Allen, D. L., Black, J., Miller, R., Michalsky, M. P., Jenkins, T. M., Brandt, M. L., Figueroa, A., et al. (2026) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2026.01.011
Yavaş, S., & Tezcan, S. (2026) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2026.105292
van Leuven, L., Enebrink, P., Lalouni, M., & Forster, M. (2026) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2026.06.018
Worrell, C., Pérez, C., Alford, S., Pollard, R., Sforzini, L., Sommeling, C., Hotham, J., Rodney, A., Sadiq, Z., Shah, H., et al. (2026) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.70215
“Attrition issues may be more likely related to individual factors such as age, ethnic minority status, and socioeconomic status (Karlson & Rapoff, 2009), making some individuals (for example, those from an ethnic minority group) more likely to drop out of research, illustrating the complexity of…”
Willeboordse, M. (2014) · Research Publications (Maastricht University) · doi:10.26481/dis.20141107mw
Metadata
- Authors
- Karlson, C. W., & Rapoff, M. A.
- Affiliations
- University of Kansas (US)
- ORCID
- Karlson, C. W.
- Venue
- Journal of Pediatric Psychology
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-12-08
- Volume
- 34
- Issue
- 7
- Pages
- 782-793
- ISSN
- 0146-8693 (ISSN-L)
- 1465-735X
- OpenAlex
- W2117776447
- Cited by
- 162
- References
- 72
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 10 · 2023: 15 · 2022: 9 · 2021: 7 · 2020: 10 · 2019: 10 · 2018: 15 · 2017: 10 · 2016: 10 · 2015: 9 · 2014: 15 · 2013: 10 · 2012: 10
- FWCI
- 4.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Pediatric Psychology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics in Clinical Research
- Keywords
- attrition, randomized controlled trials, pediatric chronic conditions, cognitive-behavioral intervention, children, attrition rates, CONSORT flow diagram, reporting guidelines, recruitment strategies, incentives, asthma, cystic fibrosis, sickle cell disease, diabetes mellitus, obesity, arthritis, childhood cancer
- MeSH terms
- Analysis of Variance, Child, Chronic Disease, Follow-Up Studies, Humans, Pediatrics, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Patient Selection, Research Subjects
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