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Predictive factors for persistent use and compliance of immediate-release methylphenidate: a 36-month naturalistic
Paola Atzori1, Tatiana Usala, Sara Carucci
1Centre for Pharmacological Therapies in Children and Adolescent NeuroPsychiatry, Department of Neuroscience, University of Cagliari, Cagliari, Italy.
Insights
Predictors for long-term methylphenidate (MPH) treatment adherence in children with ADHD were identified. Factors like associated disorders, age, gender, and family structure influence continued MPH use or discontinuation for remission or other reasons.
Area of Science:
- Pediatric Psychiatry
- Neurodevelopmental Disorders
- Pharmacological Treatments
Background:
- Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children.
- Long-term adherence to stimulant medication, such as methylphenidate (MPH), is crucial for managing ADHD symptoms but can be challenging.
- Identifying predictors of treatment adherence is essential for optimizing therapeutic outcomes.
Purpose of the Study:
- To evaluate predictors of long-term adherence to methylphenidate (MPH) treatment in children diagnosed with ADHD.
- To understand factors influencing continued MPH use, discontinuation due to functional remission, and discontinuation for other reasons.
Main Methods:
- A cohort of 134 children (ages 4-16) with ADHD underwent monthly assessments for up to 36 months.
- Diagnostic protocols included semistructured interviews, rating scales, cognitive evaluations, and self-reports for anxiety/depression.
- Statistical analyses included chi-squared tests, Mann-Whitney-U, t-tests, and Cox proportional hazards models to identify predictive factors.
Main Results:
- After 36 months, 46% of children remained on MPH, 24% discontinued due to functional remission, and 30% discontinued for other reasons (e.g., poor compliance, decreased efficacy, side effects).
- Predictors for continuing MPH included associated disorders, younger age, female gender, and not living with both parents.
- Predictors for discontinuation due to remission were absence of associated disorders and older age; older age and hyperactive subtype predicted discontinuation for other reasons.
Conclusions:
- Treatment outcomes for ADHD with MPH are variable, with identifiable clinical and social predictors for long-term use and compliance.
- Personalized clinical interventions tailored to individual child characteristics are critical for achieving positive treatment outcomes in ADHD.
Aim:
The objective of this study was to evaluate predictors of long-term adherence to treatment with methylphenidate (MPH).
Methods:
A total of 134 children (ages 4-16) with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) determined by specific protocols, including a semistructured parent interview, Conners' Teacher/Parent Rating Scales, cognitive and learning evaluation, and child self-reports for anxiety and depression, were assessed monthly for up to 36 months. At the end of the study (36 months), three outcomes were evaluated (continuing medication, medication withdrawn due to functional remission, and medication withdrawn for other reasons including poor compliance). Outcomes were first analyzed by mean of the chi-squared test, Mann-Whitney-U test, or t-test, and predictive models were subsequently generated using Cox proportional hazards model analysis. Age, ADHD subtype, co-morbidity, cognitive functioning, side effects, and family and social characteristics were considered as independent variables.
Results:
Thirty-six months after starting MPH, 62 children (46%) were still on treatment, 32 (24%) had stopped MPH due to functional remission, and 40 (30%) had suspended MPH for other reasons. Within the last group, 20 suspended for poor compliance, 10 for decrease of efficacy, 5 for side effects, and 5 because they entered in an atomoxetine clinical trial. The presence of associated disorders, younger age, female gender, and not living with both parents were predictors for continuing medication until end of the study (36 months); absence of associated disorders and older age were predictors of discontinuation medication due to functional remission before the end of study, older age, and hyperactive subtype were predictors of discontinuing medication for other reasons.
Conclusion:
Clinical outcome of ADHD treatment is heterogeneous: Specific clinical and social predictive parameters for long-term MPH use and compliance can be identified. An accurate tailoring of clinical intervention to the individual child appears crucial for good outcome.
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