Factors Associated with Attention Deficit Hyperactivity Disorder Medication Use in Community Care Settings.

OBJECTIVES: To examine patient- and provider-level factors associated with receiving attention-deficit/hyperactivity disorder (ADHD) medication treatment in a community care setting. We hypothesized that the likelihood of ADHD medication receipt would be lower in groups with specific patient sociodemographic (eg, female sex, race other than white) and clinical (eg, comorbid conditions) characteristics as well as physician characteristics (eg, older age, more years since completing training). STUDY DESIGN: A retrospective cohort study was conducted with 577 children (mean age, 7.8 years; 70% male) presenting for ADHD to 50 community-based practices. The bivariate relationship between each patient- and physician-level predictor and whether the child was prescribed ADHD medication was assessed. A multivariable model predicting ADHD medication prescription was conducted using predictors with significant (P < .05) bivariate associations. RESULTS: Sixty-nine percent of children were prescribed ADHD medication in the year after initial presentation for ADHD-related concerns. Eleven of 31 predictors demonstrated a significant (P < .05) bivariate relationship with medication prescription. In the multivariable model, being male (OR, 1.34; 95% CI, 1.01-1.78; P = .02), living in a neighborhood with higher medical expenditures (OR, 1.11 for every $100 increase; 95% CI, 1.03-1.21; P = .005), and higher scores on parent inattention ratings (OR, 1.06; 95% CI, 1.03-1.10; P < .0001) increased the likelihood of ADHD medication prescription. CONCLUSIONS: We found that some children, based on sociodemographic and clinical characteristics, are less likely to receive an ADHD medication prescription. An important next step will be to examine the source and reasons for these disparities in an effort to develop strategies for minimizing treatment barriers.

A systematic review examining caregivers' of color experiences with the diagnostic process of autism spectrum disorder.

LAY ABSTRACT: Children of color are diagnosed with autism later than White children. Caregivers of color are also more likely than White caregivers to report that their child's healthcare providers do not treat them as a partner, spend enough time with them, or respect their culture and values. We wanted to better understand the experiences of caregivers of color with the diagnostic process of autism spectrum disorder, from the time they discuss developmental concerns with their child's primary care provider to when the diagnosis is shared with them. We systematically reviewed the literature and found 15 articles that explored the experiences of caregivers of color. Caregivers of color described that they faced large-scale barriers, such as the cost of appointments, transportation, and long wait lists. They also reported negative experiences with providers, including providers not taking their concerns seriously, making assumptions about caregivers, and delaying referrals for an evaluation. Caregivers stated that their own lack of knowledge of autism spectrum disorder, stigma, their family's thoughts and opinions, and cultural differences between providers and caregivers served as barriers during the diagnostic process. Communication challenges were discussed and included use of medical and technical jargon, a lack of follow-up, language barriers, and difficulty obtaining high-quality interpreters. Some families described providers, other individuals, community networks, and self-advocacy as helpful during the diagnostic process. Large-scale changes are needed, such as increases in the number of providers who are trained in diagnosing Autism. Provider-level changes (e.g. implicit bias training) are also important for improving caregivers' experiences.

Latino-to-Latino: Promotores' Beliefs on Engaging Latino Participants in Autism Research.

BACKGROUND: In Latino(a) communities, promotores de salud (i.e., community health workers; promotores) are becoming critical participants in prevention, health promotion, and the delivery of health care. Although involving culturally diverse participants in research is a national priority, recruitment and retention of research participants from these groups is challenging. Therefore, there is an increased need to identify strategies for successful recruitment of participants from underrepresented minority backgrounds. Our overall study purpose was to gain promotores' perspectives on recruiting Latino(a) immigrant community members for an intervention study on autism spectrum disorders (ASD). The goal of this paper is to explore insider promotores' views on the barriers and facilitators to research participation in the Latino(a) community and learn strategies for recruiting Latino(a) participants in a nontraditional destination city. METHODS: We conducted qualitative focus groups with an established group of promotores known as Latinos Unidos por la Salud (LU-Salud), who were members of a community-academic research team. Fifteen LU-Salud promotores participated in the focus groups. Focus group interviews were analyzed by using Leininger's data analysis enabler. These results will inform our partnerships with promotores and Latino(a) neighborhood agencies to increase recruitment for community-based research on promoting awareness of ASD among Latino(a) families. RESULTS: Promotores were credible community members able to gain community trust and committed to improving the health and well-being of their Latino(a) community, including involving them in research. Latino(a) research involvement meant facilitating community members' engagement to overcome barriers of distrust around legal and health care systems. Challenges included legal uncertainties, language and literacy barriers, health knowledge, and economic hardship. Promotores also voiced the diversity of cultural practices (subcultures) within the Latino(a) culture that influenced: (1) research engagement, (2) guidance from promotores, (3) immersion in the Latino(a) community, and (4) health and well-being. Experienced promotores, who are living in a nontraditional migration area, believe the primary facilitator to increasing research involvement is Latino(a)-to-Latino(a) recruitment. CONCLUSIONS: These findings will aid in building partnerships to recruit participants for future studies that promote early recognition of ASD in the Latino(a) community.

Predictors of Stimulant Medication Continuity in Children with Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: The objective of this study was to examine the simultaneous impact of patient-related and parent-related factors, medication-related factors, and health care system-related factors on attention-deficit/hyperactivity disorder (ADHD) medication continuity. METHOD: Stimulant-naïve children (N = 144, M age = 8 yrs, 71% male) with ADHD completed a methylphenidate (MPH) trial and were followed for 1 year after trial completion and return to community care. Multivariable analysis investigated predictors of (1) having at least 1 filled ADHD prescription after return to community care versus none and (2) having more days covered with medicine after return to community care. Predictors included race; age; sex; income; baseline ADHD symptom severity; MPH trial experience; child and parent mental health conditions; and parent beliefs about ADHD, ADHD medications, and therapeutic alliance. RESULTS: One hundred twenty-one children (84%) had at least 1 filled ADHD medication prescription (mean = 178 d covered by medication) in the year after return to community care. Multivariable models found that a weaker perceived clinician-family working alliance predicted not filling any ADHD prescriptions. Among those who filled ≥1 prescription, factors linked to fewer days of ADHD medication coverage included child sociodemographic factors (non-White race, older age, being female, and lower income), lower parent beliefs that the child's ADHD affects their lives, and higher parent beliefs that medication is harmful, while child oppositional defiant disorder and parental ADHD predicted having more days of medication coverage. CONCLUSION: Child demographic factors, parent beliefs, and medication-related factors are associated with continuation of ADHD medication. These findings may facilitate the development of effective strategies to improve ADHD medication continuity for children from diverse groups.

Validation of a susceptibility, benefits, and barrier scale for mammography screening among Peruvian women: a cross-sectional study.

BACKGROUND: Perceived beliefs about breast cancer and breast cancer screening are important predictors for mammography utilization. This study adapted and validated the Champion's scale in Peru. This scale measures perceived susceptibility for breast cancer and perceived benefits and barriers for mammography. METHODS: A cross-sectional study was conducted among women ages 40 to 65 attending outpatient gynecology services in a public hospital in Peru. A group of experts developed and pre-tested a Spanish version of the Champion's scale to assess its comprehensibility (N=20). Factor analysis, internal consistency, and test-retest reliability analyses were performed (N=285). Concurrent validity compared scores from participants who had a mammogram and those who did not have it in the previous 15 months. T-test and multiple regression analysis adjusting for socio-demographic factors, mammography knowledge and other preventive behaviors were performed. RESULTS: The construct validity and reliability were optimal. Cronbach-Alpha coefficients were 0.75 (susceptibility), 0.72 (benefits) and 0.86 (barriers). Concurrent validity analysis showed an association between barriers and mammography screening use in bivariate (22.3±6.7 vs. 30.2±7.6; p<0.001) and multiple regression analysis (OR=0.28, 95% CI=0.18-0.43). Ages 50-60 years (OR=2.35, 95% CI=1.19-4.65), history of prior Papanicolaou test (OR=3.69, 95% CI=1.84-7.40), and knowledge about breast cancer and mammography (OR=3.69, 95% CI=1.84-7.40) were also independently associated with mammography screening use. CONCLUSION: Concurrent validity analysis showed that the Champion's scale has important limitations for assessing perceived susceptibility for breast cancer and perceived benefits for mammography among Peruvian women. There is still a need for developing valid and reliable instruments for measuring perceived beliefs about breast cancer and mammography screening among Peruvian women.

Strategies for improving ADHD medication adherence.

To maximize outcomes, understand and address the factors that affect adherence.