Review Article

Psychotropic Medication Adherence in Children and Adolescents

Authors: Shikha Verma, MD, Ruchita Agrawal, MD

Abstract

Researchers believe that almost 20% of children and adolescents struggle with chronic and persistent mental health concerns. Mental health is the leading cause of disability in the United States. Youth can struggle with several impairing mental health disorders, such as attention-deficit/hyperactivity disorder, mood disorders, psychotic disorders, and autism spectrum disorder. Inadequately treated chronic mental illnesses can adversely affect the growing brain profoundly, including academic decline, early school dropout, cognitive deficits, interpersonal relationship concerns, aggression, suicide attempts or completion, substance use disorders, frequent hospital admissions, and inability to maintain employment. Even if diagnosed early in their course of illness, many of these individuals struggle to continue medications as prescribed. The factors predicting adherence to medications are underresearched in children and adolescents. Psychotropic medication compliance is a complicated issue that is tied to various aspects of caring for a minor individual. Hence, it is relevant to discuss factors that are predicted to contribute to noncompliance in this age group. The purpose of this review is to carefully consider the gaps in knowledge, suggesting interventions by using established instruments and clinical strategies to resolve the identified barriers for improving medication adherence. Compliance should be targeted at various levels, including the entire family tree and the treatment team.
Posted in: Mental Health43

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Iglehart JK. The mental health maze and the call for transformation. N Engl J Med 2004;350:507–514.
 
2. MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Arch Gen Psychiatry 1999;56:1073–1086.
 
3. Townsend L, Floersch J, Findling RL. The conceptual adequacy of the drug attitude inventory for measuring youth attitudes toward psychotropic medications: a mixed methods evaluation. J Mixed Methods Res 2010;4:32–55.
 
4. Cromer BA, Tarnowski KJ. Non-adherence in adolescents: a review. Develop Behav Pediatr 1989:10:207–215.
 
5. Lloyd A, Horan W, Borgaro SR, et al. Predictors of medication adherence after hospital discharge in adolescent psychiatric patients. J Am Acad Child Adolesc Psychiatry 1998;8:133–141.
 
6. Friedman RM, Katz-Levey JW, Manderschied RW, et al. Prevalence of serious emotional disturbance in children and adolescent. In Manderscheid RW and Sonnenschein MA, (ed.) Rockville, MD: Center for Mental Health Services. J Ment Health 1996:71–88.
 
7. Centers for Disease Control and Prevention. Psychotropic medication use among adolescents: United States, 2005-2010. https://www.cdc.gov/nchs/products/databriefs/db135.htm. Published December 2013. Accessed August 2, 2020.
 
8. Pampallona S, Bollini P, Tibaldi G, et al. Patient adherence in the treatment of depression. Br J Psychiatry 2002;180:104–109.
 
9. Hamrin V, McCarthy EM, Tyson V. Pediatric psychotropic medication initiation and adherence: a literature review based on social exchange theory. J Child Adolesc Psychiatr Nurs 2010;23:151–172.
 
10. O’Brien M, Crickard E, Lee J, et al. Attitudes and experience of youth and their parents with psychiatric medication and relationship to self-reported adherence. Community Ment Health J 2013;49:567–575.
 
11. Moses T. Adolescents’ commitment to continuing psychotropic medication: a preliminary investigation of considerations, contradictions, and correlates. Child Psychiatry Hum Dev 2011;42:93–117.
 
12. Kinzie JD, Leung P, Boehnlein JK, et al. Antidepressant blood levels in Southeast Asians: clinical and cultural implications. J Nerv Ment Dis 1987;175:480–485.
 
13. Kroll J, Linde P, Habenicht M, et al. Medication compliance, antidepressant blood levels, and side effects in Southeast Asian patients. J Clin Psychopharmacol 1990;10:279–283.
 
14. Yang LH, Corsini-Munt S, Link B, et al. Beliefs in traditional Chinese medicine efficacy among Chinese Americans: implications for mental health service utilization. J Nerv Ment Dis 2009;197:207–210. .
 
15. Yang LH, Kleinman A. “Face” and the embodiment of stigma: schizophrenia and AIDS in China. Social Sci Med 2008;67:398–408.
 
16. Lin KM, Miller MH, Poland RE, et al. Ethnicity and family involvement in the treatment of schizophrenic patients. J Nerv Ment Dis 1991;179:631–633.
 
17. Spencer MS, Chen J. Effect of discrimination on mental health service utilization among Chinese Americans. Am J Public Health 2004;94:809–814.
 
18. Gau SSF, Shen H-Y, Chou M-C, et al. Determinants of adherence to methylphenidate and the impact of poor adherence on maternal and family measures. J Child Adolesc Psychopharmacol 2006;16:286–297.
 
19. Dean AJ, Wragg J, Draper J, et al. Predictors of medication adherence in children receiving psychotropic medication. J Paediatr Child Health 2011;47:350–355.
 
20. Bullock A, Patten C. Non-adherence with psychotropic medications in the general population. Soc Psychiatry Epidemiol 2010;45:47–56.
 
21. Brown RT, Amler RW, Freeman WS, et al. Treatment of attention-deficit/ hyperactivity disorder: overview of the evidence. Pediatrics 2005;115: e749–e757.
 
22. Faraone SV, Sergeant J, Gilberg C, et al. The worldwide prevalence of ADHD: is it an American condition? World Psychiatry 2003;2:104–113.
 
23. Gau SS, Chen SJ, Chou WJ, et al. National survey of adherence, efficacy, and side effects of methylphenidate in children with attention-deficit/ hyperactivity disorder in Taiwan. J Clin Psychiatry 2008;69:131–140.
 
24. Thiruchelvam D, Charach A, Schachar RJ. Moderators and mediators of long-term adherence to stimulant treatment in children with ADHD. J Am Acad Child Adolesc Psychiatry 2001;40:922–928.
 
25. Logan SL, Carpenter LA, Leslie RS, et al. Rates and predictors of adherence to psychotropic medications in children with autism spectrum disorders. J Autism Develop Disorders 2014;44:2931–2948.
 
26. World Health Organization. Adherence to long-term therapies—evidence for action. https://www.who.int/chp/knowledge/publications/adherence_report/en. Published 2003. Accessed May 10, 2021.
 
27. Chacko A, Newcorn J, Feirsen N, et al. Improving medication adherence in chronic pediatric health conditions: a focus on ADHD in youth. Curr Pharm Des 2010;16:2416–2423.
 
28. Thompson C, Peveler RC, Stephenson D, et al. Compliance with antidepressant medication in the treatment of major depressive disorder in primary care: a randomized comparison of fluoxetine and a tricyclic antidepressant. Am J Psychiatry 2000;157, 338–343.
 
29. Cañas F, Alptekin K, Azorin JM, et al. Improving treatment adherence in your patients with schizophrenia: the STAY initiative. Clin Drug Investig 2013;33:97–107.
 
30. Mitchell W, Scheeier L, Baker SA. Adherence to treatment in children with epilepsy: who follows “doctor’s orders?” Epilepsia 2000;41:616–625.
 
31. Faught E, Duh MS, Weiner JR, et al. Non-adherence to antiepileptic drugs and increased mortality: findings from the RANSOM Study. Neurology 2008;17:1572–1578.
 
32. Drotar D, Neff Greenley R, Demeter CA, et al. Adherence to pharmacological treatment for juvenile bipolar disorder. J Am Acad Child Adolesc Psychiatry 2007;46:831–839.
 
33. Rickles NM, Svarstad BL. Relationships between multiple self-reported non-adherence measures and pharmacy records. Res Social Adm Pharm 2007;3:363–377.
 
34. Lam WY, Fresco P. Medication adherence measures: an overview. Biomed Res Int 2015;2015:217047.
 
35. Svarstad BL, Chewning BA, Sleath BL, et al. The Brief Medication Questionnaire: a tool for screening patient adherence and barriers to adherence. Patient Educ Couns 1999;37:113–124.
 
36. Alegria M, Polo A, Gao S, et al. Evaluation of a patient’s activation and empowerment intervention in mental health care. Med Care 2008;46:247–256.
 
37. Deegan PE, Drake RE. Shared decision making and medication management in the recovery process. Psychiatr Serv 2006;57:1636–1639.
 
38. Dilallo JJ, Weiss G. Motivational interviewing and adolescent psychopharmacology. J Am Acad Child Adolesc Psychiatry 2009;48:108–113.
 
39. Townsend L, Floersch J, Findling RL. Adolescent attitudes toward psychiatric medication: the utility of the Drug Attitude Inventory. J Child Psychol Psychiatry 2009;50:1523–1531.
 
40. Floersch J, Townsend L, Longhofer J, et al. Adolescent experience of psychotropic treatment. Transcult Psychiatry 2009;46:157–179.
 
41. Hogan TP, Awad AG, Eastwood R. A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychol Med 1983;13:177–183.
 
42. O’Connor AM. User manual—Decision Self-Efficacy Scale. https://decisionaid.ohri.ca/docs/develop/user_manuals/UM_decision_selfefficacy.pdf. Updated 2002. Accessed May 10, 2021.
 
43. Parchman ML, Zeber JE, Palmer RF. Participatory decision making, patient activation, medication adherence, and intermediate clinical outcomes in type 2 diabetes: a STARNet study. Ann Fam Med 2010;8:410–417.
 
44. Hunsley J. Development of the Treatment Acceptability Questionnaire. J Psychopathol Behav Assess 1992;14:55–64.
 
45. Coyne I. Consultation with children in hospital: children, parents’ and nurses’ perspectives. J Clin Nurs 2006;15:61–71.
 
46. Kelsey J, Abelson-Mitchell N, Skirton H. Perceptions of young people about decision making in the acute healthcare environment. Paediatr Nurs 2007;19:14–18.
 
47. Alderson P, Sutcliffe K, Curtis K. Children’s competence to consent to medical treatment. Hastings Cent Rep 2006;36:25–34.
 
48. Hammonds T, Rickert K, Goldstein C, et al. Adherence to antidepressant medications: a randomized controlled trial of medication reminding in college students. J Am Coll Health 2015;63:204–208.
 
49. Longhofer J, Floersch J. Desire and disappointment: adolescent psychotropic treatment and adherence. Anthropol Med 2010;17:159–172.
 
50. Longhofer J, Floersch J, Okpych N. Foster youth and psychotropic treatment: where next? Child Youth Serv Rev 2011;33:395–404.
 
51. King G, Currie M, Petersen P. Child and parent engagement in the mental health intervention process: a motivational framework. Child Adolesc Ment Health 2014;19:2–8.
 
52. Mucka L, Hinrichs J, Upton F, et al. Barriers to adherence to child assessment recommendations. J Child Fam Stud 2017;26:1029–1039.
 
53. Hébert J, Polotskaia A, Joober R, et al. Adherence to psychostimulant medication in children with attention-deficit/hyperactivity disorder: the role of attitudes. J Can Acad Child Adolesc Psychiatry 2013;22:317–323.
 
54. Schwalbe CS, Gearing RE, MacKenzie MJ, et al. A meta-analysis of experimental studies of diversion programs for juvenile offenders. Clin Psychol Rev 2012;32:26–33.
 
55. Ran M, Xiang M. A study of schizophrenic patients’ treatment compliance in a rural community. J Ment Health 1995;4:85–89.
 
56. Ran M-S, Xiang M-Z, Chan CL-W, et al. Effectiveness of psychoeducational intervention for rural Chinese families experiencing schizophrenia: a randomised controlled trial. Soc Psychiatry Psychiatr Epidemiol 2003;38:69–75.
 
57. Tay S-EC. Compliance therapy: an intervention to improve inpatients’ attitudes toward treatment. J Psychosoc Nurs Ment Health Serv 2007;45:29–37.
 
58. Li Z, Arthur D. Family education for people with schizophrenia in Beijing, China: randomised controlled trial. Br J Psychiatry 2005;187:339–345.
 
59. Xiang M, Ran M, Li S. A controlled evaluation of psychoeducational family intervention in a rural Chinese community. Br J Psychiatry 1994;165:544–548.
 
60. Chan SW-C, Yip B, Tso S, et al. Evaluation of a psychoeducation program for Chinese clients with schizophrenia and their family caregivers. Patient Educ Couns 2009;75:67–76.
 
61. Maneesakorn S, Robson D, Gournay K, et al. An RCT of adherence therapy for people with schizophrenia in Chiang Mai, Thailand. J Clin Nurs 2007;16:1302–1312.
 
62. Fancher TL, Lee D, Cheng JKY, et al. Interventions to improve adherence to psychotropic medication in clients of Asian descent: a systematic review. Asian Am J Psychol 2014;5:22–34.