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10 June 2017

Hart KC et al. Child Psychiatry Hum Dev 2017; Epub ahead of print

With increasing numbers of pre-school children coming to clinical attention for ADHD, it is imperative that medical professionals have an understanding of parental perceptions of pharmacological treatments, as these perceptions may influence treatment acceptance, adherence and satisfaction. This study aimed to:

  • Examine pre-school parents’ perceptions and openness to pharmacotherapy
  • Examine the degree to which family background, child age or child gender was related to openness to pharmacotherapy
  • Assess the degree to which diagnostic symptoms, behavioural functioning and functional impairment predicted openness to pharmacotherapy.

Children (n=151; mean age, 5.05 years) and their respective caregivers (n=100), who were participating in a larger, intensive behavioural Summer Treatment Programme for Pre‑Kindergartners (STP-PreK), were recruited from local pre-schools and mental health agencies in Southeastern USA. Caregivers were administered one of two semi-structured diagnostic interviews: the Kiddie-Disruptive Behaviour Disorder Schedule for pre-school children or the NIMH Diagnostic Interview Schedule for Children Version IV. During the clinical interview, if their child was not currently receiving pharmacotherapy, parent(s) were asked about their healthcare provider’s treatment recommendations and their openness to the possibility of medication.*

Parents and teachers were asked to complete the Disruptive Behaviour Disorder Rating Scale (DBD), and in order to assess the children’s behavioural functioning and ability to function across ADHD symptom domains, they were asked to complete the Behaviour Assessment System for Children, 2nd Edition (BASC-2) and the Impairment Rating Scale (IRS),§ respectively.

Preliminary analysis indicated that 45% of parents were receptive to pharmacotherapy (n=68), and that the likelihood of parental openness to pharmacotherapy could not be predicted based on the child’s age (odds ratio [OR] 0.69), gender (OR 0.70), ethnicity (OR 0.97) or family socioeconomic status (OR 1.01).

  • Parents open to pharmacotherapy reported higher levels of oppositional defiant disorder (ODD) symptoms on the DBD compared with parents not open to pharmacotherapy (mean [standard deviation (SD)] = 1.09 [0.67] vs 0.87 [0.54]; p<0.05).
  • Parents open to pharmacotherapy reported only marginally higher levels of ADHD symptoms on the DBD compared with parents not open to pharmacotherapy (mean [SD] = 1.61 [0.66] vs 1.43 [0.59]; p=0.08).
  • No significant differences on teacher-rated ADHD or ODD symptoms were noted.
  • According to the BASC-2, parents open to pharmacotherapy reported higher levels of aggression compared with parents not open to pharmacotherapy (mean [SD] = 63.75 [15.53] vs 57.72 [11.45]; p<0.01).
  • No significant differences on parent-rated hyperactivity and attention issues were noted between parents open to and parents not open to pharmacotherapy.
  • No significant differences on teacher-rated behavioural functioning were noted.
  • According to the IRS, parent- and teacher-rated functional impairment were not significantly different between children of parents open to and children of parents not open to pharmacotherapy (parent-rated: mean [SD] open to treatment = 4.63 [1.18] vs not open treatment = 4.31 [1.16], Cohen’s d=0.27; teacher-rated: mean [SD] open to treatment = 4.73 [1.40] vs not open to treatment = 4.72 [1.27], Cohen’s d=0.01).

Limitations of the study include: 1) the study sample did not include children currently receiving pharmacological treatment; 2) data collection regarding parental perceptions to pharmacotherapy were collected at only one time point prior to intervention; 3) the pharmacotherapy perceptions questionnaire contained only one item; and 4) the homogeneity of the study sample, which was predominantly Latino boys.

The authors concluded that the findings from this study are important for physicians and other healthcare providers to consider, particularly given that increasing numbers of pre-school children are presenting with ADHD symptoms; however, additional research is required to determine the extent to which: 1) perceptions of pharmacotherapy change over time; 2) there are differences in caregiver perceptions; and 3) these perceptions affect the rate of pharmacotherapy in children with ADHD.

Read more about parent perceptions of ADHD medication here

 

*Parents were presented with the following options: “never suggested medication, but open to the possibility”; “never suggested medication, not open to the possibility”; “has suggested medication but chose against that option”; “has taken medication in the past but is not anymore because he/she is doing better”; “has taken medication in the past but is no longer due to side effects”

ADHD and ODD symptoms on the DBD scale are rated on a 4-point scale of “not at all”, “just a little”, “pretty much”, or “very much”

Items on the BASC-2 are rated on a 4-point scale of “never”, “sometimes”, “often” or “almost always”, and afford scores on internalising, externalising, adaptive and social functioning domains

§The IRS measures severity of children’s impairment in academic functioning, classroom functioning, self-esteem, relationships with peers/teachers/family, and overall functioning, on a Likert scale ranging from “no impairment” to “extreme impairment”

Hart KC, Ros R, Gonzalez V, et al. Parent perceptions of medication treatment for preschool children with ADHD. Child Psychiatry Hum Dev 2017; Epub ahead of print.

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