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


METHODS
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.
Pappadopulos
Elizabeth
E
Jensen
Peter S
PS
Chait
Alanna R
AR
Arnold
L Eugene
LE
Swanson
James M
JM
Greenhill
Laurence L
LL
Hechtman
Lily
L
Chuang
Shirley
S
Wells
Karen C
KC
Pelham
William
W
Cooper
Thomas
T
Elliott
Glenn
G
Newcorn
Jeffrey H
JH
D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000523:psychology; D001521:Behavior Therapy; D001526:Behavioral Symptoms; D000697:Central Nervous System Stimulants / Q000032:analysis / Q000627:therapeutic use*; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000032:analysis / Q000627:therapeutic use*; D010290:Parents; D012044:Regression Analysis; D015203:Reproducibility of Results; D012463:Saliva / Q000737:chemistry*; D016896:Treatment Outcome; D016903:Drug Monitoring
D000697:Central Nervous System Stimulants; D008774:Methylphenidate