title: Pediatric psychotropic medication initiation and adherence: a literature review based on social exchange theory.
abstract: OBJECTIVE
  Psychotropic medication initiation and adherence is an identified problem. This literature review explores factors that determine families' decisions to initiate, sustain, or discontinue use of psychotropic medication in children and adolescents. Social exchange theory is used as a framework to explore decisions to initiate and adhere to psychotropic medications.
  
  
  OBJECTIVE
  Contributing factors related to psychotropic medication initiation, adherence, and discontinuation are explored. Themes in the literature encompassing costs and benefits of psychotropic medication adherence include family experiences with adverse effects, previous psychotropic medication experience, medication psychoeducation, stigma, societal views about psychotropic medication, particular diagnosis, the effect of comorbid diagnosis on adherence, attitudes and beliefs about medication by both children and parents, and relationships with the provider. The impact of family demographics including parent gender, age of the child, ethnicity, and parent educational level on psychotropic medication adherence is evaluated.
  
  
  METHODS
  International and U.S. studies from Medline, Cumulative Index for Nursing and Allied Health Literature and PsychInfo evaluating medication initiation and adherence in the pediatric psychiatric population and social exchange theory was incorporated from relevant textbook resources.
  
  
  CONCLUSIONS
  Rewards experienced from medication treatment include improvement in symptoms, school performance and family relationships, and reduced level of parenting stress. Identified costs include impact of adverse side effects, social stigma, lack of response, fears of addiction, and changing the child's personality. Acceptance of the diagnosis influences adherence while medication education has varying effects. Families' attitudes, beliefs and perceptions about psychiatric illness and treatment play a large role in medication treatment decisions. A trusting provider relationship has a positive effect on adherence. Psychosocial treatment alternatives are preferred. With maturation, adolescents have more influence on decisions related to adherence.
authors.affiliation: Yale University School of Nursing, Yale Univsersity, New Haven, Connecticut, USA. Vanya.Hamrin@yale.edu
authors.forename: Vanya
authors.initials: V
authors.lastname: Hamrin
authors.forename: Erin M
authors.initials: EM
authors.lastname: McCarthy
authors.forename: Veda
authors.initials: V
authors.lastname: Tyson
mesh_terms: D000293:Adolescent; D002648:Child; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D001523:Mental Disorders / Q000188:drug therapy*; D010290:Parents; D011368:Professional-Family Relations; D011582:Psychological Theory; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D011619:Psychotropic Drugs