title: Factors associated with caregiver burden among pharmacotherapy-treated children/adolescents with ADHD in the Caregiver Perspective on Pediatric ADHD survey in Europe.
abstract: BACKGROUND
  Burden on caregivers of children/adolescents with attention-deficit/hyperactivity disorder (ADHD) is multidimensional, but incompletely understood.
  
  
  OBJECTIVE
  To analyze caregiver burden across the concepts of work, social/family life, and parental worry/stress, in relation to selected contributing factors.
  
  
  METHODS
  The online Caregiver Perspective on Pediatric ADHD survey was fielded in ten European countries. Analysis included children/adolescents (6-17 years) who were receiving/had received ADHD pharmacotherapy in the previous 6 months. Caregivers recorded their child's/adolescent's symptoms "on"/"off" medication (ie, when the caregiver reported that the child/adolescent forgot/chose not to take medication, before the onset of medication effect, or medication worn off). Effects of ADHD severity, comorbidities, and medication adherence on each burden outcome were assessed (multiple regression models).
  
  
  RESULTS
  In total, 2,326 caregivers were included (children/adolescents' mean age: 11.5 years, 80% male). Caregivers reported missed/altered work, avoiding social activity, increased parental worry/stress, and strain on family life, despite using ADHD pharmacotherapy. Child/adolescent comorbidities and ADHD severity were significantly related to all burden concepts measured; the strongest comorbidity associations were with altered work (odds ratios [ORs] =1.68 [95% confidence interval {CI} 1.33, 2.12], 1.87 [1.37, 2.54], 3.47 [2.51, 4.78] for 1, 2, 3+ comorbidities, respectively) and planning the day around the child/adolescent (OR =1.42 [95% CI 1.17, 1.72], 1.73 [1.33, 2.15], 2.65 [1.99, 3.53]); the strongest severity associations were: quitting a job (OR =1.41 [95% CI 1.26, 1.59]) and planning a day around the child/adolescent (OR =1.26 [95% CI 1.20, 1.32]). Increased medication adherence was most associated with reducing the caregiver burden for altered work (OR =0.57 [95% CI 0.45, 0.72]), worrying about how they are being perceived as a parent (OR =0.68 [0.56, 0.83]), and avoiding social activity (OR =0.56 [0.45, 0.68]), but not family or stress burden.
  
  
  CONCLUSIONS
  Burdens related to work, social activity, family life, and parental worry/stress were experienced by the caregivers of children/adolescents with ADHD, despite using ADHD pharmacotherapy. Better understanding of clinical/treatment characteristics most associated with the components of caregiver burden may help improve ADHD management and may ease caregiver burden.
authors.affiliation: AMF Consulting, Inc., Los Angeles, CA, USA.
authors.forename: Moshe
authors.initials: M
authors.lastname: Fridman
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Banaschewski
authors.affiliation: Global Health Economics Outcomes Research and Epidemiology, Shire, Wayne, PA, USA.
authors.forename: Vanja
authors.initials: V
authors.lastname: Sikirica
authors.affiliation: Psychiatry Department, Hospital Universitario Infanta Leonor, Complutense University, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Quintero
authors.affiliation: Global Health Economics Outcomes Research and Epidemiology, Shire, Wayne, PA, USA.
authors.forename: M Haim
authors.initials: MH
authors.lastname: Erder
authors.affiliation: Global Health Economics Outcomes Research and Epidemiology, Shire, Lexington, MA, USA.
authors.forename: Kristina S
authors.initials: KS
authors.lastname: Chen
keywords: attention-deficit/hyperactivity disorder; burden of illness; caregivers; treatment