Efficacy of a parent-youth teamwork intervention to promote adherence in pediatric asthma.

OBJECTIVE: To determine whether a parent-youth teamwork intervention improved medication adherence and related outcomes among youth with asthma. METHODS: We used a randomized clinical trial with 48 youth (aged 9-15 years) assigned to 1 of 3 groups: Teamwork Intervention (TI), Asthma Education (AE), or Standard Care (SC). Treatment occurred across 2 months, with a 3-month follow-up assessment. Adherence to inhaled corticosteroids was assessed via the MDILog-II. Parent-adolescent conflict, asthma functional severity, and spirometry assessments were obtained pre-treatment, post-treatment, and on follow-up. Mixed linear model analysis was used to evaluate group and time effects for outcome measures. RESULTS: TI group had significantly higher adherence and lower functional severity scores than AE or SC conditions, and lower parent-reported conflict and a trend for higher spirometry values compared with the SC group. CONCLUSIONS: Results suggest support for the efficacy of TI for improving medication adherence as youth acquire more responsibility for their asthma management.

Is insulin pump therapy better than injection for adolescents with diabetes?

BACKGROUND AND AIMS: Insulin pump therapy is a commonly used alternative to multiple daily injections (MDI) in the treatment of pediatric type 1 diabetes. The aim of the current study was to examine whether there are different medical and psychosocial outcomes for adolescents using MDI versus pump therapy as experienced in a naturally occurring context of self- or doctor-chosen insulin regimens. METHODS: Adolescents and their parents completed questionnaires assessing quality of life and parenting stress. A1C levels were obtained from the medical record. RESULTS: Metabolic and psychosocial outcomes did not differ significantly between adolescents using pump therapy and adolescents using MDI. Higher parental stress was associated with older children, lower quality of life, and higher A1C levels. CONCLUSIONS: Physicians might present this information to families along with the potential advantages and disadvantages of pumps and injections.

The efficacy of adherence interventions for chronically ill children: a meta-analytic review.

OBJECTIVES: To provide quantitative information about the overall effectiveness of adherence interventions to improve adherence and health outcomes for children with chronic illnesses. To evaluate statistically the potential moderators. METHODS: A meta-analysis was performed on 71 adherence intervention studies. RESULTS: Weighted-mean effect size (ES) across all the adherence outcomes for group design studies was in the medium range (mean d = 0.58) and for single-subject design studies was in the large range (mean d = 1.44). The weighted mean ES across all health outcome measures for studies using group designs was in the medium range (mean d = 0.40) and for studies using single-subject designs was in the large range (mean d = 0.74). CONCLUSIONS: Adherence interventions for children with chronic illnesses effectively increase adherence and result in some positive health benefits. Intervention and methodological variables had significant impact on ESs. High levels of heterogeneity characterized the data.

Volitional nonadherence in pediatric asthma: parental report of motivating factors.

Volitional nonadherence is thought to be common among patients with chronic health conditions, including pediatric asthma. To date, no data have been published on the extent to which, and reasons why, families purposefully adjust their child's asthma regimen. This study provides descriptive data for parental report of volitional nonadherence in a sample of 101 children (ages 1-17 years) with asthma. Families tended to decrease rather than increase use of controller medication, but were more likely to increase rather than decrease preventive medication. Motivating factors for increasing medications centered around achieving better symptom control, whereas reasons for decreasing medications involved a perception of less need (ie, asthma was better) and desire to reduce treatment burden. Our results suggest it is important to better understand volitional nonadherence so that behavioral interventions aimed at promoting adherence and health outcome can be more effective.

Examining the influence of the Journal of Pediatric Psychology: an empirical approach.

OBJECTIVE: To empirically examine whether research published in the Journal of Pediatric Psychology (JPP) guides research both within and outside the field of pediatric psychology. METHODS: Articles published in JPP from 2000 to 2004 were evaluated to determine the frequency with which articles in JPP from 2000 influenced subsequent research. Citation rates by other journals were also examined. RESULTS: Articles in JPP from 2000 were frequently cited in subsequent research, but authors rarely cited previous research as being instrumental in the development of their study design. Articles in JPP from 2000 were also frequently cited by outside journals. Specifically, journals classified as "medical and medical subspecialties" had the highest rates of citing JPP articles. CONCLUSIONS: The finding that JPP is cited both within JPP and other journals provides further evidence that pediatric psychology is a thriving interdisciplinary field.

Adherence in young children with asthma.

PURPOSE OF REVIEW: To discuss the unique challenges of managing asthma in young children and to review the literature over the past year with regard to regimen adherence in this relatively understudied population. RECENT FINDINGS: Young children and their families face unique challenges in dealing with asthma and these have the potential to affect regimen adherence. They include the time and effort required by asthma-management activities (e.g. nebulizer use), dependency on parents for asthma care, and the limited ability of children to communicate about their symptoms. Five published studies were found for the past year. They covered three areas: adherence assessment (e.g. electronic monitoring versus diary cards), device impact on adherence (e.g. influence of the novelty of medication-delivery device), and adherence interventions (e.g. parental education regarding symptoms). SUMMARY: Research suggests that several components need to be considered when designing interventions to improve adherence for young children with asthma: to consider the strain in the caregiver role when developing the treatment regimen, to provide devices that parents and children can use, to monitor adherence with electronic monitoring, and to address parents' concerns and perceptions about treating prodromal symptoms of an asthma exacerbation. Because many parents are hesitant to treat cough symptoms, an additional training component may need to be added to address this concern.