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Cited by 113Attention Deficit Hyperactivity DisorderMedication Adherence and ComplianceBehavioral and Psychological Studies

Medication Adherence in the MTA: Saliva Methylphenidate Samples Versus Parent Report and Mediating Effect of Concomitant Behavioral Treatment

Open access
Pappadopulos, Elizabeth, Jensen, Peter S., Chait, Alanna R., Arnold, L. Eugene, Swanson, James M., Greenhill, Laurence L., Hechtman, Lily, Chuang, Shirley +5 more·2009·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1097/chi.0b013e31819c23ed
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Abstract

Objective Although research supports the use of appropriately administered stimulant medication to treat children with ADHD, poor adherence and early termination undermine the efficacy of this treatment in real-world settings. Moreover, adherence measures often rely on parent report of medication use, and their validity and reliability are unknown.Method Drawing on data from 254 participants in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder, we examine the discrepancy between parents' verbal reports of medication adherence and physiological adherence measures determined via methylphenidate saliva assays collected at four time points during the 14-month treatment period. In addition, we examine the impact of physiologically documented medication adherence on parent- and teacher-reported outcomes through 14 months.Results Overall, nearly one fourth (24.5%) of the saliva samples indicated nonadherence. Among subjects, 63 (24.8%) of the 254 participants were nonadherent on 50% or more of their repeated saliva assays. Only 136 (53.5%) of the subjects were adherent at every time point at which saliva assays were taken, indicating that some degree of nonadherence characterized nearly half of all other NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder-treated children. Findings also indicated that nonadherence produced greater deleterious effects in children in the medication-only condition compared with those receiving both medication and behavioral treatment.Conclusions Same-day saliva methylphenidate assays suggest that nearly half of the parents are inaccurate informants of their child's ADHD medication adherence and that parents may overestimate actual (physiological) adherence. This finding suggests the need for interventions to improve accuracy of parental report. Clinicians need to focus on adherence enhancement strategies to improve outcomes of children being treated with medication, particularly when benefits are suboptimal.

AI snapshot

Written from the paper’s full text.

TL;DR

In the MTA medication-treated sample, same-day saliva methylphenidate assays indicated that nearly one fourth of samples and about one fourth of children were nonadherent, while parent report identified only 3.1% as nonadherent. Physiological nonadherence was associated with worse ADHD symptom outcomes, especially in medication-only treatment.

Key findings

  • Among 254 children with readable saliva assays, 63 (24.8%) were physiologically nonadherent on ≥50% of assays; 136 (53.5%) were adherent at every available time point, and 31 (12.2%) were nonadherent on all collected samples. The abstract reports 24.5% of saliva samples as nonadherent, while the Results report 176 of 748 (23.5%) samples below the detectable threshold.
  • Parent report was much more optimistic: 228 of 254 parents (89.8%) reported adherence on all occasions, and only 8 (3.1%) reported nonadherence using the same ≥50% threshold. Concordance was “slight” (reported κ = 0.12, p < .001); parent report had 10.3% sensitivity (14/136) and 80.3% specificity (496/618) for detecting physiological nonadherence.
  • Physiological adherence mediated ADHD symptom outcomes: significant effects were found for time × adherence (F₁,₄₆₈ = 12.2, p < .0005) and treatment × adherence (F₁,₄₆₈ = 5.73, p = .017), with nonadherence producing greater deleterious effects in medication-only (MedMgt) than in combined medication plus behavioral treatment (Comb). The triple interaction time × treatment × adherence was not significant.

Methods

  • Secondary analysis of the NIMH MTA 14-month randomized trial. The present study focused on 289 children in MedMgt and Comb; 254 had one or more readable saliva assays, providing 748 usable assays (average 2.9 assays/participant, range 1–4).
  • Saliva methylphenidate swabs were collected at 1, 3, 9, and 14 months without prenotification, after parent verbal report. Physiological adherence was defined by detectable MPH; subject-level adherence required >50% positive assays. Parent verbal adherence was obtained from monthly medication visits.
  • Analyses included cross-tabulation of parent report versus saliva assay concordance and random-effects regression on parent- and teacher-rated SNAP-IV ADHD symptom scores, testing site, time, adherence, treatment, and interactions.

Limitations

  • The paper states that saliva assays may miss MPH if the last dose was taken ≥8 hours earlier, that uncertainty remains about the detection window and appropriate threshold, and that findings apply only to the MTA sample (combined-type ADHD, ages 7–10) and principally immediate-release MPH t.i.d.; newer long-acting formulations may yield different adherence rates.
  • The paper also notes possible parent overreporting due to social desirability, therapeutic expectations, and stigma, and that same-day assays cannot capture adherence between visits.
  • Evident from the text: assays per child varied from 1 to 4, and the subject-level >50% threshold is a pragmatic binary classification rather than a continuous measure of adherence.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1097/chi.0b013e31819c23ed

Cites

42 of 42 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 52 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Just more than half of subjects (n=136, 53.5%) were physiologically adherent on all available samples.

    “just more than half of the subjects (n = 136 [53.5%]) were physiologically adherent on all of their available samples.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The MedMgt and Comb groups did not differ significantly in rates of physiological adherence.

    “The MedMgt and Comb groups did not differ significantly in rates of physiological adherence.”
    Quote in the paperSubstantial claim
  • Findingown data

    Among 254 children, 24.8% (n=63) were classified as physiologically nonadherent, defined as 50% or fewer of their saliva samples below detectable MPH.

    “When findings were grouped by children (rather than by records), 24.8% (n = 63) of 254 children's medication regimens were classified physiologically nonadherent (i.e., e50% of their saliva samples below detectable 3 ng/mL).”
    Quote in the paperSubstantial claim
  • Findingown data

    Across all children, 31 subjects (12.2%) were nonadherent on all collected saliva samples.

    “across all children, 31 subjects (12.2%) were nonadherent on all collected saliva samples”
    Quote in the paperNot a substantial claim
  • Findingown data

    Using the same 50% or less nonadherence threshold for parent reports as for physiological adherence, only 8 of 254 parents (3.1%) reported nonadherence.

    “Thus, applying the same definition for nonadherence to parental reports (e50%) as for physiological adherence, only 8 (3.1%) of the parents reported nonadherence.”
    Quote in the paperSubstantial claim
  • May combine two claims. 28
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 19

  • May combine two claims.

    Findingown data

    Greater physiological medication adherence was associated with white ethnicity and having a mother who worked outside the home.

    “two factors were differentially related to greater physiological medication adherence, ethnicity (more adherence in whites), and having a mother who was working outside of the home.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Most parents reported that their child took the study medication during the day; 228 of 254 (89.8%) reported adherence on all occasions.

    “A total of 228 (89.8%) of 254 parents reported their children as taking the study medication on all occasions”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    ADHD symptoms decreased significantly over time, and this decrease was mediated by physiological adherence, with adherent subjects showing greater improvement over time.

    “These findings demonstrated that ADHD symptoms decreased significantly over time and was mediated by physiological adherence (adherent subjects showed greater improvement over time).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The significant treatment by adherence effect indicates that the main effect of adherence on ADHD ratings differed between Comb and MedMgt groups, but the lack of a time by treatment by adherence interaction indicates the groups did not differ significantly in the effect of adherence on rates of improvement over time.

    “The significant effect of treatment  adherence suggests that the main effect of adherence on ADHD ratings was different in the Comb versus MedMgt groups, as seen in Figure 1, but the lack of a triple interaction (time  treatment  adherence) indicates that the MedMgt and Comb groups did not show a significant differential effect of adherence on the rates of improvement over time.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Greater physiological nonadherence was found among children of minority ethnic status and among children whose mothers were not employed.

    “In contrast, we did find somewhat greater physiological nonadherence as a function of minority ethnic status, as well as among children whose mothers were not employed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Agreement between parent-reported adherence and physiological adherence was better than chance but only slight (kappa < 0.20).

    “concordance of parental reports of adherence with physiological measures was substantially better than chance, but actual agreement was only ''slight'' (i.e., 0's < 0.20), using the rating system of Landis and Koch, 28”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28] Landis, 1977, The measurement of observer agreement for categorical data, Biometrics source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    In the parent-teacher composite SNAP analysis over 14 months, significant effects were found for time (F 1,248 = 754.8, p < .0001), treatment × adherence (F 1,468 = 5.73, p = .017), and time × adherence (F 1,468 = 12.2, p < .0005).

    “Significant differences found for time (F 1,248 = 754.8,p < .0001),treatment  adherence (F 1,468 = 5.73, p = .017),and time  adherence (F 1,468 = 12.2, p < .0005).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Poor adherence and early termination can reduce the real-world effectiveness of stimulant medication for ADHD, leading to suboptimal outcomes.

    “poor treatment adherence and early termination can undermine the effectiveness of this treatment in real-world settings, producing suboptimal outcomes, 10Y12 a problem recognized even two decades ago.13”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites 10Y12

      Not checked in the free run.

    • cites [13] Sleator, 1985, Measurement of compliance, Psychopharmacol Bull

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the MTA, medication use mediated changes in ADHD symptom ratings from baseline to 14 months and from 14 to 24 months, supporting the initial 14-month randomized trial finding that carefully monitored t.i.d. stimulant medication, with or without behavioral therapy, produced better outcomes than community care or behavioral therapy alone.

    “In the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA), medication use mediated the degree of baseline to 14-month, and 14-to 24-month changes in ADHD symptom ratings, buttressing the initial 14-month randomized clinical trial findings 4,5,15 that the use of a carefully monitored t.i.d.schedule of stimulant medication (with or”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [4] MTA Cooperative Group, 1999, A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Multi-modal Treatment Study of Children with ADHD, Arch Gen Psychiatry source

      Not checked in the free run.

    • cites [5] 1999, Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder: the Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder, Arch Gen Psychiatry source

      Not checked in the free run.

    • cites [15] MTA Cooperative Group, 2004, National Institute of Mental Health Multi-modal Treatment Study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder, Pediatrics source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    The protocol specified four saliva assays per MTA medication-treated child during the 14-month treatment period, with no prenotification to families about whether assays would be drawn at a particular visit.

    “The protocol specified that four saliva assays would be conducted on each MTA medication-treated child during the course of the 14-month treatment period (at follow-up visits 2, 6, 9, and 14), with no prenotification given to families of whether saliva assays would be drawn during that particular visit.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Of the remaining 258 children, 254 had one or more readable saliva assays; 32 saliva vials were broken in transit or otherwise not readable.

    “Of the remaining 258 children (123 MedMgt and 135 Comb subjects), 254 had one or more readable saliva assays (32 saliva vials were broken in transit or otherwise not readable).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    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”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [16] Hack, 2001, Pediatric psychotropic medication compliance: a literature review and research-based suggestions for improving treatment compliance, J Child Adolesc Psychopharmacol source

      Not checked in the free run.

    • cites [17] Firestone, 1982, Factors associated with children's adherence to stimulant medication, Am J Orthopsychiatry source

      Not checked in the free run.

    • cites [18] Perwien, 2004, Stimulant treatment patterns and compliance in children and adults with newly treated attention-deficit/hyperactivity disorder, J Manag Care Pharm source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The experimental interventions in MTA were delivered by MTA staff for 14 months and were carefully monitored for treatment fidelity.

    “The experimental interventions (MedMgt, Beh, and Comb) were delivered by MTA staff for 14 months and were carefully monitored for treatment fidelity.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    In MTA, medication management and combination subjects began with a 28-day, double-blind, daily-switch titration of MPH hydrochloride using five randomly ordered repeats each of placebo, 5, 10, and 15 or 20 mg, with the higher dose determined by weight.

    “subjects in the medication management and combination groups started with a 28-day, double-blind, daily-switch titration of MPH hydrochloride, using 5 randomly ordered repeats each of placebo, 5, 10, and 15 or 20 mg, with the higher dose, 15 mg versus 20 mg, being determined on the basis of the child's weight (threshold Q26 kg).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] MTA Cooperative Group, 1999, A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Multi-modal Treatment Study of Children with ADHD, Arch Gen Psychiatry source

      Not checked in the free run.

    • cites [5] 1999, Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder: the Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder, Arch Gen Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In one study of children aged 3-7 years taking immediate-release methylphenidate, 54.0% received only one prescription and 10.9% received five or more prescriptions over one year.

    “one study of children (N = 1,635; aged 3Y7 years) taking methylphenidate (MPH) immediate-release revealed that 54.0% of the subjects received only one prescription, and only 10.9% received five or more prescriptions during a 1-year period.19”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Olfson, 2003, National trends in the treatment of attention deficit hyperactivity disorder, Am J Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Recent national data suggest that problems with ADHD treatment adherence and persistence may be increasing, possibly partly because many youths receive insufficient medication treatment visits.

    “recent national data concerning ADHD treatment suggest that such problems may be increasing, perhaps in part because of many youths receiving insufficient medication treatment visits.1,19Y21”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 1,19Y21

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Planned nonmedication days are unlikely to account for all reported nonadherence.

    “Nevertheless, it is unlikely that such planned nonmedication days would account for all reported nonadherence.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Random-effects regression was used for longitudinal analyses because it has advantages over traditional ANOVA for clinical trials data.

    “Given the advantages of random-effects regression (RR) techniques over traditional analyses of variance for longitudinal clinical trials data, 4,11 we used RR for subsequent analyses”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [4] MTA Cooperative Group, 1999, A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Multi-modal Treatment Study of Children with ADHD, Arch Gen Psychiatry source

      Not checked in the free run.

    • cites [11] MTA Cooperative Group, 2004, National Institute of Mental Health Multi-modal Treatment Study of ADHD follow-up: changes in effectiveness and growth after the end of treatment, Pediatrics source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The present study focuses on 289 subjects in the medication-only and combined treatment groups, who were assigned to systematic, carefully titrated, monitored, and adjusted medication.

    “The present study focuses on the 289 subjects in the medication-only and combined treatment groups, who were assigned to systematic, carefully titrated, 26 monitored, and adjusted medication.27”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [26] Greenhill, 2001, Impairment and deportment responses to different methylphenidate doses in children with ADHD: the MTA Titration Trial, J Am Acad Child Adolesc Psychiatry source

      Not checked in the free run.

    • cites [27] Vitiello, 2001, Methylphenidate dosage for children with ADHD over time under controlled conditions: lessons from the MTA, J Am Acad Child Adolesc Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The available 254 subjects (87.9%) provided 780 assays, with 748 usable assays (average 2.9 per participant).

    “The available 254 subjects (87.9%) provided a total of 780 assays (3.1 assays/participant; range 1Y4 assays, with 748 (2.9/ participant) usable assays.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Saliva swabs were collected only after the parent had verbally reported the child's medication adherence.

    “Saliva swabs were gathered from the child only after the parent had verbally reported about the child's medication adherence.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Nonadherence in ADHD has been linked to factors ranging from practical aspects of medication administration and side effects to family socioeconomic status and ethnicity.

    “Nonadherence has been linked to a variety of factors, ranging from proximal and practical aspects of medication administration and/or immediately recognized side effects to more distal factors, including family socioeconomic status and ethnicity.3,22,23”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [3] Wolraich, 2001, Randomized, controlled trial of OROS methylphenidate once a day in children with attention-deficit/hyperactivity disorder, Pediatrics source

      Not checked in the free run.

    • cites [22] Swanson, 2003, Compliance with stimulants for attention-deficit/hyperactivity disorder: issues and approaches for improvement, CNS Drugs source

      Not checked in the free run.

    • cites [23] Marcus, 2005, Continuity of methyl-phenidate treatment for attention-deficit/hyperactivity disorder, Arch Pediatr Adolesc Med source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    No significant differences were found between the MedMgt and Comb groups in medication participation, swab frequency, or study retention.

    “No significant differences were found between the two medication groups in medication participation, swab frequency, or study retention.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Another study found that 74% of children with ADHD initially assigned to stimulants took at least half of their pills for 12 months, and 52% continued stimulant medication for 3 consecutive years.

    “Another study found that only 74% of children with ADHD initially assigned to stimulants took 50% or more of their pills for 12 months, 20 and only 52% continued to use stimulant medication for 3 consecutive years.21”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [20] Corkum, 1999, Parental knowledge of attention-deficit hyperactivity disorder and opinions of treatment options: impact on enrollment and adherence to a 12-month treatment trial, Can J Psychiatry source

      Not checked in the free run.

    • cites [21] Thiruchelvam, 2001, Moderators and mediators of long-term adherence to stimulant treatment in children with ADHD, J Am Acad Child Adolesc Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Stigma around medication may also help explain the gap between self-reported and biological measures of adherence.

    “Stigma associated with medication therapy may also contribute to the discrepancy between self-report and biological measures of adherence.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The saliva assays used in the study fairly represent whether the child took medication on the day parents reported compliance.

  • May combine two claims.

    Interpretationown data

    Same-day saliva methylphenidate assays suggest that nearly half of parents are inaccurate informants of their child's ADHD medication adherence and that parents may overestimate actual physiological adherence.

    “Same-day saliva methylphenidate assays suggest that nearly half of the parents are inaccurate informants of their child's ADHD medication adherence and that parents may overestimate actual (physiological) adherence.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A study of HIV treatment adherence found that many young patients saw their providers as powerful authorities and admitted giving inaccurate adherence information to avoid blame and criticism.

    “one study of youths' adherence to human immunodeficiency virus therapy found that many participants viewed their health care providers as powerful authorities and admitted to giving them inaccurate adherence information to avoid blame and criticism.37”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] Rao, 2007, Stigma and social barriers to medication adherence with urban youth living with HIV, AIDS Care source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Verbal adherence in this study (89.8% across all visits) is higher than generally seen in longitudinal studies, likely because of intensive follow-up procedures used to facilitate adherence during 14 months.

    “our results of verbal adherence (89.8% across all visits) are higher than generally seen in longitudinal studies, 16Y21 likely because of the intensive follow-up procedures put in place to facilitate adherence during 14 months.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 16Y21

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Published studies disagree about ethnic disparities in adherence: some report that minority youths are more likely to stop treatment early and to use psychiatric services and medication less, while others find no ethnic differences in mental health prescribing, referrals, or counseling after diagnosis.

    “The current literature on ethnic disparities in adherence is somewhat inconsistent: some studies indicate that minority youths are at increased risk for premature treatment discontinuation and lower use of psychiatric services and medication, 23,31 but other studies suggest no ethnic disparities in mental health prescription rates, referrals, and counseling once a diagnosis is made.32,33”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [23] Marcus, 2005, Continuity of methyl-phenidate treatment for attention-deficit/hyperactivity disorder, Arch Pediatr Adolesc Med source

      Not checked in the free run.

    • cites [31] Leslie, 2003, Racial/ethnic differences in the use of psychotropic medication in high-risk children and adolescents, J Am Acad Child Adolesc Psychiatry source

      Not checked in the free run.

    • cites [32] Zito, 1999, Psychotherapeutic medication patterns for youths with attention-deficit/hyperactivity disorder, Arch Pediatr Adolesc Med source

      Not checked in the free run.

    • cites [33] Kelleher, 1999, Patient race and ethnicity in primary care management of child behavior problems: a report from PROS and ASPN, Med Care source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Short-acting formulations have been mostly replaced by newer longer-acting profiles, so adherence and compliance rates for newer formulations may differ from those reported here.

    “Short-acting formulations have been mostly replaced by newer longer-acting profiles, so the adherence/ compliance rates for newer formulations may differ from those reported here.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Conclusions about adherence are uncertain because it is unclear how long saliva values are detectable on chromatographic analysis and whether the threshold used is appropriate for adherence.

    “our conclusions should be tempered by the uncertainty about how long saliva values are detectable (Q3 ng/mL) on chromatographic analysis and whether that constitutes an appropriate threshold for adherence.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    The results apply only to the MTA sample, which had combined type ADHD and ages 7-10 years, and to a medication regimen principally based on immediate-release MPH t.i.d.

    “Caution is also warranted, to the extent that our results apply only to the MTA sample (combined type ADHD, age 7Y10 years) and medication regimen, principally based on immediate-release MPH t.i.d.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    The mismatch between parent reports and saliva levels may arise from both deliberate actions and unintentional patterns such as forgetting.

    “the present discrepancy between parental reports and saliva levels may have resulted from both intentional (purposeful actions) and unintentional (patterned behaviors, such as forgetting) variables.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Horne, 2001, Anglo-Scandinavian Cardiac Outcomes Trial. Do hypertensive patients' beliefs about their illness and treatment influence medication adherence and quality of life?, J Hum Hypertens source

      Not checked in the free run.

    • Rests on an assumption: The saliva assays used in the study fairly represent whether the child took medication on the day parents reported compliance.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Recent work shows that the therapeutic relationship affects adherence reports and behavior, and suggests that a stronger parent-therapist bond predicts greater treatment acceptability and persistence.

    “Recent literature has similarly demonstrated the impact of the therapeutic relation on adherence reports and behaviors, suggesting that a more positive parentYtherapist relationship predicts greater treatment acceptability and persistence.38”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Kazdin, 2005, The therapeutic alliance in cognitive-behavioral treatment of children referred for oppositional, aggressive, and antisocial behavior, J Consult Clin Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior research indicates that wrong information about treatment, embarrassment, and expected disapproval from family and peers can cause patients or parents to miss doses or stop treatment early.

    “Previous research indicates that inaccurate information about treatment, embarrassment, and anticipated disapproval from family and peers can lead patients or parents to skip medication doses or prematurely discontinue treatment.37,39”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [37] Rao, 2007, Stigma and social barriers to medication adherence with urban youth living with HIV, AIDS Care source

      Not checked in the free run.

    • cites [39] Richardson, 2001, Experience and covariates of depressive symptoms among a cohort of HIV infected women, Soc Work Health Care source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The meaning of the ethnic and maternal employment adherence finding is unclear and may result from different types of subjects who participate in long-term treatment studies versus those drawn from more naturalistic service use databases and short-term studies.

    “The meaning of this finding is unclear and may result from the different types of subjects who participate in longterm treatment studies versus those drawn from more naturalistic service use databases and short-term studies.”
    Quote in the paperNot a substantial claim
36 of 36

  • The paper relies on this without support.

    The saliva assays used in the study fairly represent whether the child took medication on the day parents reported compliance.

    “To the extent that our saliva assays were a fair representation of the child's having taken medication on the day that parents reported compliance”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Specificity is calculated using the wrong denominator

    Minor

    With parental reports of nonadherence treated as a positive test, Table 3 shows 496 true negatives among 505 physiologically adherent assays. Specificity is therefore 98.2%; 496/618 instead measures the proportion of parental adherence reports that matched the assay.

    Reported 80.3 · recomputed 98.217822

  • Percentage for four children is incorrect

    Minor

    Four of 254 children is 1.6%, not 1.2%.

    Reported 1.2 · recomputed 1.574803

2 of 2

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Authors
Pappadopulos, E., Jensen, P. S., Chait, A. R., Arnold, L. E., Swanson, J. M., Greenhill, L. L., Hechtman, L., Chuang, S., Wells, K. C., Pelham, W., Cooper, T., Elliott, G., & Newcorn, J. H.
Affiliations
Realistic Education in Action Coalition to Foster Health (US)
Corresponding author
Jensen, Peter S.
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2009-05
Volume
48
Issue
5
Pages
501-510
ISSN
0890-8567 (ISSN-L)
DOI
10.1097/chi.0b013e31819c23ed
OpenAlex
W2129144665
Semantic Scholar
1af07e1468f22d0d0b85f547c03c395ca309d959
Cited by
112
References
42
Citations by year
2026: 2 · 2025: 5 · 2024: 6 · 2023: 3 · 2022: 5 · 2021: 6 · 2020: 4 · 2019: 6 · 2018: 7 · 2017: 6 · 2016: 4 · 2015: 4 · 2014: 5 · 2013: 9 · 2012: 12
FWCI
8.25
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • U.S. Department of Health and Human Services
  • U.S. Department of Justice
  • U.S. Department of Education
  • Ohio State University
  • University of Pittsburgh (U01 MH50467, N01MH 12010)
  • McGill University (N01MH12008)
  • York University
  • National Institutes of Health (n01mh12011-0-0-1, n01mh012009-007, n01mh12008-0-0-1, n01mh12010-0-0-1, n01mh12004-0-0-0, n01mh12007-0-0-0, n01mh012012-001)
  • University of Illinois at Urbana-Champaign
  • School of Medicine, New York University
  • Medical Center, University of Pittsburgh
  • University of California, Irvine (N01MH 12004)
  • National Institute of Mental Health (N01MH 12011, U01MH50461, N01 MH12007, N01MH-12012, U01MH50440, N01MH12008,, U01MH050467, MH-50467, U01 MH50477, U01MH050440, N01 MH12009, U01MH050453, U01MH50467, U01MH050461, N01MH 12004, U01MH50453, N01MH 12010, 12010)
  • National Institute of Nursing Research
  • Office of Juvenile Justice and Delinquency Prevention
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
Keywords
medication adherence, attention deficit hyperactivity disorder, methylphenidate, multimodal therapy
MeSH terms
Assessment of Medication Adherence, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Behavior Therapy, Behavioral Symptoms, Child, Combined Modality Therapy, Female, Humans, Male, Methylphenidate, Parents, Regression Analysis, Saliva, Reproducibility of Results, Treatment Outcome, Drug Monitoring, Medication Adherence

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