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

In the paper

“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.”

In the paper

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

In the paper

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

In the paper

“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.”

In the paper

“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.”

In the paper

“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”

What the sources say

• Not checked yetcites [28] Landis, 1977, The measurement of observer agreement for categorical data, Biometrics source

In the paper

“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).”

In the paper

“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”

What the sources say

• Not checked yetcites 10Y12
• Not checked yetcites [13] Sleator, 1985, Measurement of compliance, Psychopharmacol Bull

In the paper

“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”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [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

In the paper

“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.”

In the paper

“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).”

In the paper

“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”

What the sources say

• Not checked yetcites [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 yetcites [17] Firestone, 1982, Factors associated with children's adherence to stimulant medication, Am J Orthopsychiatry source
• Not checked yetcites [18] Perwien, 2004, Stimulant treatment patterns and compliance in children and adults with newly treated attention-deficit/hyperactivity disorder, J Manag Care Pharm source

In the paper

“The experimental interventions (MedMgt, Beh, and Comb) were delivered by MTA staff for 14 months and were carefully monitored for treatment fidelity.”

In the paper

“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).”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“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”

What the sources say

• Not checked yetcites [19] Olfson, 2003, National trends in the treatment of attention deficit hyperactivity disorder, Am J Psychiatry source

In the paper

“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”

What the sources say

• Not checked yetcites 1,19Y21

In the paper

“Nevertheless, it is unlikely that such planned nonmedication days would account for all reported nonadherence.”

In the paper

“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”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“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”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“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.”

In the paper

“Saliva swabs were gathered from the child only after the parent had verbally reported about the child's medication adherence.”

In the paper

“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”

What the sources say

• Not checked yetcites [3] Wolraich, 2001, Randomized, controlled trial of OROS methylphenidate once a day in children with attention-deficit/hyperactivity disorder, Pediatrics source
• Not checked yetcites [22] Swanson, 2003, Compliance with stimulants for attention-deficit/hyperactivity disorder: issues and approaches for improvement, CNS Drugs source
• Not checked yetcites [23] Marcus, 2005, Continuity of methyl-phenidate treatment for attention-deficit/hyperactivity disorder, Arch Pediatr Adolesc Med source

In the paper

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

In the paper

“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”

What the sources say

• Not checked yetcites [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 yetcites [21] Thiruchelvam, 2001, Moderators and mediators of long-term adherence to stimulant treatment in children with ADHD, J Am Acad Child Adolesc Psychiatry source

In the paper

“Stigma associated with medication therapy may also contribute to the discrepancy between self-report and biological measures of adherence.”

In the paper

“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.”

In the paper

“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”

What the sources say

• Not checked yetcites [37] Rao, 2007, Stigma and social barriers to medication adherence with urban youth living with HIV, AIDS Care source

In the paper

“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.”

What the sources say

• Not checked yetcites 16Y21

In the paper

“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”

What the sources say

• Not checked yetcites [23] Marcus, 2005, Continuity of methyl-phenidate treatment for attention-deficit/hyperactivity disorder, Arch Pediatr Adolesc Med source
• Not checked yetcites [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 yetcites [32] Zito, 1999, Psychotherapeutic medication patterns for youths with attention-deficit/hyperactivity disorder, Arch Pediatr Adolesc Med source
• Not checked yetcites [33] Kelleher, 1999, Patient race and ethnicity in primary care management of child behavior problems: a report from PROS and ASPN, Med Care source

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

What the sources say

• Not checked yetcites [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

In the paper

“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”

What the sources say

• Not checked yetcites [38] Kazdin, 2005, The therapeutic alliance in cognitive-behavioral treatment of children referred for oppositional, aggressive, and antisocial behavior, J Consult Clin Psychol source

In the paper

“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”

What the sources say

• Not checked yetcites [37] Rao, 2007, Stigma and social barriers to medication adherence with urban youth living with HIV, AIDS Care source
• Not checked yetcites [39] Richardson, 2001, Experience and covariates of depressive symptoms among a cohort of HIV infected women, Soc Work Health Care source

In the paper

“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.”