A novel ADHD-centric digital health intervention using text messages was previously shown to be effective in improving adherence to stimulants prescribed for ADHD in adults aged 18‒55 years (Biederman et al, 2019). This study aimed to assess the effectiveness of the text message system in improving adherence to stimulant medications in children (aged 6‒12 years) with ADHD in primary care.
Children in the text-messaging intervention group had to: (a) have a diagnosis of ADHD based on either the International Classification of Diseases, 10th Revision or the Diagnostic and Statistical Manual of Mental Disorders – 5th Edition; (b) be starting or currently taking a stimulant medication; (c) be proficient in English; and (d) have a parent with a cellular phone with text-messaging capabilities. Children with ADHD receiving treatment with stimulants not enrolling in the text-messaging intervention were used as a comparison group and were matched at a 3:1 comparison based on age and gender. Text messages were individually tailored for adherence to stimulants and treatment initiation, and also provided digital support.
In total, there were 87 children in the text-message intervention group who received text messages for ≥45 days. In the comparator group, 246 children had available data for analysis. There were no significant differences between the two groups in terms of age (p = 0.86), gender (p = 0.78), median income (p = 0.35) or the type of clinic where children received their initial prescriptions (p = 0.14). With the text-messaging intervention, 85% of children adhered to stimulant treatment and refilled their prescriptions in a timely manner, compared with 62% in the comparator group (odds ratio 3.46; 95% confidence interval 1.82‒6.58; p < 0.001). These data suggest that using this text-messaging intervention, 1 in 5 children can remain adherent to their stimulant medication.
This study had some limitations. The authors noted that there was no placebo intervention or randomisation, thus non-specific effects and potential confounding bias due to variables such as ADHD severity, comorbidities or concomitant medications cannot be ruled out. In addition, the authors did not control which treatment was prescribed and all children had equal opportunity to receive a range of stimulants and doses, as well as any other forms of treatment for ADHD. Moreover, there may have been differences in the parent-selected timing of text-message delivery, so it is unclear whether the timing of the text message affected the results. Adherence to treatment was measured by the issuing of a prescription within a time window, but there is no way of knowing how many children actually took the medication. Further studies are required to assess the efficacy of the text-messaging intervention over longer time periods, especially in children with chronic use of stimulants.
The authors concluded that this novel approach of using text messaging as a digital health intervention significantly improved adherence to stimulant treatment in children with ADHD. The authors indicated that this text-messaging intervention is a readily accessible, inexpensive and widely available technology that may be useful in improving stimulant adherence in children with ADHD.
Biederman J, Fried R, DiSalvo M, et al. A novel text message intervention to improve adherence to stimulants in adults with attention deficit/hyperactivity disorder. J Clin Psychopharmacol 2019; 39: 351-356.
Fried R, DiSalvo M, Kelberman C, et al. An innovative SMS intervention to improve adherence to stimulants in children with ADHD: preliminary findings. J Psychopharmacol 2020; Epub ahead of print.