Clinical Research Coordinator II Cincinnati Children's Hospital Medical Center Cincinnati Children's Hospital Medical Center Cincinnati, Ohio, United States
Background: Medication is an efficacious treatment strategy for patients with attention-deficit/hyperactivity disorder (ADHD), however use significantly declines during adolescence when the consequences of ADHD are most severe (e.g., dropping out of school, delinquency, etc.). The Unified Theory of Behavior Change (UTBC) (Fishbein et al., 2001) has been proposed as a conceptual model to explain the mechanisms underlying ADHD medication continuity.
Objective: We sought to examine the relationship between adolescent UTBC-informed pre-intention factors and the intention to take medicine regularly (see left side of figure 1). We hypothesized that positive adolescent expectations of ADHD medicine (i.e., still feeling like self, feeling social) will be positively related with the intention to take ADHD medicine on school days (outcome).
Design/Methods: We conducted cross-sectional analyses of data from 40 adolescents with ADHD aged 11-15 years old. We measured the 5 pre-intention factors and the intention to take ADHD medicine using self-report questionnaires. We calculated correlation coefficients to examine bivariate associations between demographic and pre-intention factors and adolescent’s intention to take ADHD medicine. We conducted a multivariate regression including those factors significantly (p < 0.05) associated in bivariate analyses.
Results: Adolescents reported a mean total ADHD symptom score = 29.8/54 (SD=10.94) and mean total impairment score = 18.7/52 (SD=10.90) and had a mean proportion of days covered with medicine in past year = 0.34 (SD=0.20). Table 1 summarizes all variables examined. In bivariate analyses, adolescent male sex (r=-0.34, p < 0.05), ADHD self-concept consistent with biomedical model (r=0.36, p < 0.05) and confidence being able to take medicine regularly (r=0.49, p < 0.01) were significantly associated with the outcome. Our multivariable model (F(3,36)=5.57, p < 0.01) explained a significant amount of variance in the outcome (R2=0.32). Confidence remained significantly related to the intention to take ADHD medicine (β=0.29, p < 0.05) while male sex (β=-0.40, ns) and ADHD self-concept (β=0.17, ns) did not. Conclusion(s): Counter to our hypothesis, adolescent confidence taking medication was the most important factor, of those assessed, related to the intention to take ADHD medicine every school day among our minority, low income patient population. Future research should examine the relationship between confidence and implementation factors (right side of UTBC model) such as organizational skills and daily routines.
Authors/Institutions: Anne E. Berset, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States; Jeffery N. Epstein, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States; Kevin A. Hommel, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States; William Brinkman, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States