Effectiveness of Parent Group Intervention for Reducing Medication Nonadherence in Children with ADHD: A Pilot Study

Main Article Content

จินิส สีห์รา
วัลลภ อัจสริยะสิงห์
ชุติมา แจ้งจิตร
ชาญวิทย์ พรนภดล

Abstract

Objective : To study the effectiveness of parental group intervention for reducing
medication nonadherence in children with ADHD.
Methodology : A quasi-experimental study was conducted at the child and adolescent
outpatient unit, Siriraj Hospital. Subjects were children with newly diagnosed ADHD age
6 to 12 years who were treated with immediate-release methylphenidate. Patients in the
experimental group received medication plus a parental group intervention which
consisted of parental psychoeducation about ADHD and techniques for positive
parenting, whereas patients in the control group received standard medication alone.
Both groups were followed for 6 months. The primary objective was to measure the
percentage of pills taken calculated from pill counts. Secondary objectives included
the change in ADHD symptom severity and functional outcome measured by Thai ADHD
Screening scale (THASS) and Weiss Functional Impairment Rating Scale (WFIRS).
Results : A total of 39 cases completed the study. There was no significant difference
between the experimental and control groups in the percentage of pills taken at 6 months
(81.8% versus 86.5%, respectively; p = 0.545). The experimental group had a significant
reduction in hyperactive/impulsive symptoms compared to controls (percentage of
reduction from baseline 35.4% versus 7.4%, respectively; p = 0.019), but no difference
in reduction in inattentive symptoms nor functional impairment.
Conclusion : The parental group intervention had no significant effect in reducing
medication nonadherence. Further studies are needed to follow up long term outcomes
in larger samples.

Article Details

How to Cite
สีห์รา จ., อัจสริยะสิงห์ ว., แจ้งจิตร ช., & พรนภดล ช. (2019). Effectiveness of Parent Group Intervention for Reducing Medication Nonadherence in Children with ADHD: A Pilot Study. Journal of the Psychiatric Association of Thailand, 64(1), 3–20. Retrieved from https://he01.tci-thaijo.org/index.php/JPAT/article/view/180499
Section
Original Articles

References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, DC: American Psychiatric Publishing; 2013.

Boon-yasidhi V. Attention Deficit Hyperactivity Disorder: Diagnosis and Management. Journal of the Psychiatric Association of Thailand 2012; 57:373-86.

Visanuyothin T, Pavasuthipaisit C, Wachiradilok P, Arunruang P, Buranasuksakul T. The prevalence of attention deficit/hyperactivity disorder in Thailand. Journal of the Mental Health of Thailand 2013; 21: 66-75.

American Academy of Pediatrics. ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/ hyperactivity disorder in children and adolescents. Pediatrics 2011; 128: 1007-22.

The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Arch Gen Psychiatry 1999; 56: 1073-86.

Maia CR, Cortese S, Caye A, Deakin TK, Polanczyk GV, Polanczyk CA, et al. Long-Term Efficacy of Methylphenidate Immediate- Release for the Treatment of Childhood ADHD: A Systematic Review and Meta-Analysis. J Atten Disord 2017; 21: 3-13.

Abikoff H, Hechtman L, Klein RG, Weiss G, Fleiss K, Etcovitch J, et al. Symptomatic improvement in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. J Am Acad Child Adolesc Psychiatry 2004; 43: 802-11.

Van der Oord S, Prins PJ, Oosterlaan J, Emmelkamp PM. Efficacy of methylphenidate, psychosocial treatments and their combination in school-aged children with ADHD: a meta-analysis. Clin Psychol Rev 2008; 28:783-800.

Amy R. Perwien, Jennifer Hall, Andrine Swensen, Ralph Swindle. Stimulant Treatment Patterns and Compliance in Children and Adults With Newly Treated Attention-Deficit/ Hyperactivity Disorder. J Manag Care Pharm 2004; 10:122-9.

Charach A, Ickowicz A, Schachar R. Stimulant treatment over five years: adherence, effectiveness, and adverse effects. J Am Acad Child Adolesc Psychiatry 2004; 43: 559-67.

Jihyung H, Diego N, Tamas T, William M, Virginia S H, Shenghu W, et al. Predictors and consequences of adherence to the treatment of pediatric patients with attention-deficit/ hyperactivity disorder in Central Europe and East Asia. Patient Prefer Adherence 2013; 30: 987-95.

Ahmed R, Aslani P. Attention-deficit/ hyperactivity disorder: an update on medication adherence and persistence in children, adolescents and adults. Expert Rev Pharmacoeconomics Outcomes Res 2013; 13: 791-815.

Julien H, Anna P, Ridha J, Natalie G. Adherence to Psychostimulant Medication in Children with Attention-Deficit/Hyperactivity Disorder: The Role of Attitudes. J Can Acad Child Adolesc Psychiatry 2013; 22: 317-23.

DosReis S, Mychailyszyn MP, Evans-Lacko SE, Beltran A, Riley AW, Myers MA. The Meaning of Attention-Deficit/Hyperactivity Disorder Medication and Parents’ Initiation and Continuity of Treatment for Their Child. J Child Adolesc Psychopharmacol 2009; 19: 377-83.

Charach A, Fernandez R. Enhancing ADHD Medication Adherence: Challenges and Opportunities. Curr Psychiatry Rep 2013; 15: 371.

Bussing R, Koro-Ljungberg M, Noguchi K, Mason D, Mayerson G, Garvan WC. Willingness to use ADHD treatments: a mixed methods study of perceptions by adolescents, parents, health professionals and teachers. Soc Sci Med 2012; 74: 92-100.

Toomey SL, Sox CM, Rusinak D, Finkelstein JA. Why Do Children With ADHD Discontinue Their Medication?. Clin Pediatr (Phila) 2012; 51: 763-9.

Athipongarporn A, Limsuwan N. Reasons of Poor Treatment Adherence in Children and Adolescents with ADHD. Journal of the Psychiatric Association of Thailand 2018; 63: 33-46.

Bussing R, Zima BT, Mason DM, Porter PC, Garvan CW. Receiving treatment for attention-deficit hyperactivity disorder: do the perspectives of adolescents matter? J Adolesc Health 2011; 49: 7-14.

C h a r a c h A , G a j a r i a A . I m p r o v i n g psychostimulant adherence in children with ADHD. Expert Rev Neurother 2008; 8: 1563-71.

Singh I, Kendall T, Taylor C. Young People’s experience of ADHD and stimulant medication: a qualitative study for the NICE guideline. Child Adolesc Ment Health 2010; 15: 186-92.

Montoya A, Hervás A, Fuentes J, Cardo E, Polavieja P, et al. Cluster-randomized, controlled 12-month trial to evaluate the effect of a parental psychoeducation program on medication persistence in children with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment 2014; 10: 1081-109.

Bai G, Wang Y, Yang L, Niu W. Effectiveness of a focused, brief psychoeducation program for parents of ADHD children: improvement of medication adherence and symptoms. Neuropsychiatric Disease and Treatment 2015; 11: 2721-35.

Pornnoppadol C, Piyasilp V, Jittorn J, Chanpen S. The Development of Screening Scales for Attention Deficit Hyperactivity Disorder (ADHD) in Thai Children and Adolescents Age of 3-18 Years. Journal of the Psychiatric Association of Thailand 2014; 59: 335-54.

Punyapas S, Pornnoppadol C, Boon-yasidhi V, Likhitkiatikhachorn P. Reliability and Validity of Weiss Functional Impairment Rating Scale (WFIRS)-Thai version in Children and Adolescents with Attention Deficit Hyperactivity Disorder. Journal of the Psychiatric Association of Thailand 2015; 60: 111-26.

Dickson RA, Lee B, Turgay A, et al. Change in ADHD symptoms during 1 year of atomoxetine treatment. Presented at the 57th Annual Conference of the Canadian Psychiatric Association, November 15-18, 2007, Montreal, QC, Canada.

Atzori P, Usala T, Carucci S, Danjou F, Zuddas A. Predictive Factors for Persistent Use and Compliance of Immediate-Release Methylphenidate: A 36-Month Naturalistic Study. J Child Adolesc Psychopharmacol 2009; 19: 673-81.

Yang J, Yoon BM, Lee MS, Joe SH, Jung IK, Kim SH. Adherence with electronic monitoring and symptoms in children with attention deficit hyperactivity disorder. Psychiatry Investig 2012; 9: 263-8.

Lachaine J, Beauchemin C, Sasane R, Hodgkins PS. Treatment patterns, adherence, and persistence in ADHD: a Canadian perspective. Postgrad. Med 2012; 124: 139-48.

Gau SS, Shen HY, Chou MC, Tang CS, Chiu YN, Gau CS. Determinants of adherence to methylphenidate and the impact of poor adherence on maternal and family measures. J Child Adolesc Psychopharmacol 2006; 16: 286-97.

Corkum P, Rimer P, Schachar R. Parental Knowledge of Attention-Deficit Hyperactivity Disorder and Opinions of Treatment Options: Impact on Enrolment and Adherence to a 12-Month Treatment Trial. Can J Psychiatry 1999; 44: 1043-8.

Monastra VJ. Overcoming the barriers to effective treatment for attention-deficit/ hyperactivity disorder: A neuro-educational approach. Int J Psychophysiol 2005; 58: 71-80.