Medication adherence in the MTA: Saliva methylphenidate samples versus parent report and mediating effect of concomitant behavioral treatment

Peter S. Jensen, Elizabeth Pappadopulos, Alanna R. Chait, L. Eugene Arnold, James M. Swanson, Laurence L. Greenhill, Lily Hechtman, Shirley Chuang, Karen C. Wells, William Pelham, Thomas Cooper, Glenn Elliott, Jeffrey H. Newcorn

Research output: Contribution to journalArticle

68 Citations (Scopus)

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.Clinical trial registration information-The NIMH MTA study.

Original languageEnglish (US)
Pages (from-to)501-510
Number of pages10
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume48
Issue number5
DOIs
StatePublished - May 2009
Externally publishedYes

Fingerprint

Pemetrexed
Methylphenidate
Medication Adherence
Saliva
National Institute of Mental Health (U.S.)
Combined Modality Therapy
Parents
Attention Deficit Disorder with Hyperactivity
Therapeutics
Reproducibility of Results
Clinical Trials

Keywords

  • Medication
  • Methylphenidate
  • Pharmacotherapy
  • Saliva levels

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Developmental and Educational Psychology

Cite this

Medication adherence in the MTA : Saliva methylphenidate samples versus parent report and mediating effect of concomitant behavioral treatment. / Jensen, Peter S.; Pappadopulos, Elizabeth; Chait, Alanna R.; Arnold, L. Eugene; Swanson, James M.; Greenhill, Laurence L.; Hechtman, Lily; Chuang, Shirley; Wells, Karen C.; Pelham, William; Cooper, Thomas; Elliott, Glenn; Newcorn, Jeffrey H.

In: Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 48, No. 5, 05.2009, p. 501-510.

Research output: Contribution to journalArticle

Jensen, PS, Pappadopulos, E, Chait, AR, Arnold, LE, Swanson, JM, Greenhill, LL, Hechtman, L, Chuang, S, Wells, KC, Pelham, W, Cooper, T, Elliott, G & Newcorn, JH 2009, 'Medication adherence in the MTA: Saliva methylphenidate samples versus parent report and mediating effect of concomitant behavioral treatment', Journal of the American Academy of Child and Adolescent Psychiatry, vol. 48, no. 5, pp. 501-510. https://doi.org/10.1097/CHI.0b013e31819c23ed
Jensen, Peter S. ; Pappadopulos, Elizabeth ; Chait, Alanna R. ; Arnold, L. Eugene ; Swanson, James M. ; Greenhill, Laurence L. ; Hechtman, Lily ; Chuang, Shirley ; Wells, Karen C. ; Pelham, William ; Cooper, Thomas ; Elliott, Glenn ; Newcorn, Jeffrey H. / Medication adherence in the MTA : Saliva methylphenidate samples versus parent report and mediating effect of concomitant behavioral treatment. In: Journal of the American Academy of Child and Adolescent Psychiatry. 2009 ; Vol. 48, No. 5. pp. 501-510.
@article{476df2c98ba645638451ce77ca2e2403,
title = "Medication adherence in the MTA: Saliva methylphenidate samples versus parent report and mediating effect of concomitant behavioral treatment",
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.Clinical trial registration information-The NIMH MTA study.",
keywords = "Medication, Methylphenidate, Pharmacotherapy, Saliva levels",
author = "Jensen, {Peter S.} and Elizabeth Pappadopulos and Chait, {Alanna R.} and Arnold, {L. Eugene} and Swanson, {James M.} and Greenhill, {Laurence L.} and Lily Hechtman and Shirley Chuang and Wells, {Karen C.} and William Pelham and Thomas Cooper and Glenn Elliott and Newcorn, {Jeffrey H.}",
year = "2009",
month = "5",
doi = "10.1097/CHI.0b013e31819c23ed",
language = "English (US)",
volume = "48",
pages = "501--510",
journal = "Journal of the American Academy of Child and Adolescent Psychiatry",
issn = "0890-8567",
publisher = "Elsevier Limited",
number = "5",

}

TY - JOUR

T1 - Medication adherence in the MTA

T2 - Saliva methylphenidate samples versus parent report and mediating effect of concomitant behavioral treatment

AU - Jensen, Peter S.

AU - Pappadopulos, Elizabeth

AU - Chait, Alanna R.

AU - Arnold, L. Eugene

AU - Swanson, James M.

AU - Greenhill, Laurence L.

AU - Hechtman, Lily

AU - Chuang, Shirley

AU - Wells, Karen C.

AU - Pelham, William

AU - Cooper, Thomas

AU - Elliott, Glenn

AU - Newcorn, Jeffrey H.

PY - 2009/5

Y1 - 2009/5

N2 - 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.Clinical trial registration information-The NIMH MTA study.

AB - 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.Clinical trial registration information-The NIMH MTA study.

KW - Medication

KW - Methylphenidate

KW - Pharmacotherapy

KW - Saliva levels

UR - http://www.scopus.com/inward/record.url?scp=67650308856&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67650308856&partnerID=8YFLogxK

U2 - 10.1097/CHI.0b013e31819c23ed

DO - 10.1097/CHI.0b013e31819c23ed

M3 - Article

C2 - 19307987

AN - SCOPUS:67650308856

VL - 48

SP - 501

EP - 510

JO - Journal of the American Academy of Child and Adolescent Psychiatry

JF - Journal of the American Academy of Child and Adolescent Psychiatry

SN - 0890-8567

IS - 5

ER -