Parent Education and its Impact on Medication Adherence in ADHD

This report investigates the relationship between parent education and medication adherence in children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). It addresses the pervasive issue of non-adherence to ADHD medication regimens, which can significantly affect health outcomes. The report includes a PICO question focusing on whether parent education increases medication adherence in children with ADHD, comparing outcomes between educated and uneducated parents. It overviews guidelines for educating parents, emphasizing the importance of understanding the pathophysiology and clinical manifestations of ADHD, managing medication side effects, and utilizing adherence tools like logbooks and mobile applications. The report critiques these guidelines, considering potential harms and ethical considerations like paternalism and patient autonomy. It also discusses quality improvement strategies, dissemination plans, and the role of nurses in reinforcing therapeutic relationships and providing support to families. The conclusion highlights the necessity of developing appropriate guidelines to improve medication adherence in children with ADHD, based on evidence from electronic databases and randomized control trials.

Running head: MEDICATION ADHERENCE IN CHILDREN WITH ADHD
MEDICATION ADHERENCE IN CHILDREN WITH ADHD
Name of the Student
Name of the University
Author Note

MEDICATION ADHERENCE IN CHILDREN WITH ADHD
Introduction
Attention-deficit disorder is a chronic neuropsychiatric disorder in children that
affects 4.4 % of the US population (Ferrin et al., 2013). Medication alleviate the aspects of
the disorder but the associated difficulties with the planning and the disorganisation can have
poor adherence and treatment failure. Studies have found relationship between adherence and
parent education. However, this report will give a description of a PICO question followed by
a clinical practice guidelines for improving the medical adherence in children with ADHD.
Thesis statement- Education to parents increases medication adherence in children with
ADHD.
Topic
The topic of this paper is how parent literacy affect medication adherence in children
suffering from ADHD. Much of the ADHD symptoms in children can be treated by following
the proper treatment regimen, but the clinical studies have revealed that 80 percent of the
children with ADHD symptoms fail to comply with the ADHD medication regimen
(Marcum, Hanlon & Murray, 2017). Non adherence to the ADHD medication is a serious and
a pervasive problem that affects the overall health outcomes. Nurses are entitled to check
whether the children with ADHD are taking their medications timely and as per the dosages.
Nurses can bring a significant differences in the patient understanding related to medication
adherence. Nurses and responsible for teaching the patient and the families about the
importance of the medication adherence, which ultimately leads to better outcomes in the
patients which helps the nurses to improve their future professional practice.

MEDICATION ADHERENCE IN CHILDREN WITH ADHD
Parents are the primary decision makers for young children and there had been many
researches examining the parent perspective regarding the usage of the medicines. Parents
had described the decision to use medications for treating ADHD on their children to be a
difficult one and they are likely to start the medications, only if they found that ADHD is a
neurobiological condition. It has also been found that parents who question of the
acceptability of the medications are unlikely to accept the recommendations for the use.
Charach and Fernandez, (2013) has stated that many children do not understand or recognise
the benefits of improved schoolwork and peer relationships, however here lies the duty of the
parents to pint them out the importance of the medications. It should be remembered that the
parents and the paediatricians have a similar but no same understanding of the ADHD.
However, nurses can help to clarify the treatment preferences and discuss any available
options and maintain a treatment alliance with the family.
PICO question: Does parent education increases medication adherence in children with
ADHD.
Population (P)- Children with ADHD
Intervention (I)- parent education
Comparison (C)- parents without education about medication adherence
Outcome (O)- Medication adherence in children with ADHD.
Overview of the guidelines
The primary step for teaching the parents about medical adherence is to educate the
Parents about the pathophysiology and mainly the clinical manifestation of ADHD. The nurse
should enquire about the experiences that the child is experiencing while taking the

MEDICATION ADHERENCE IN CHILDREN WITH ADHD
medications, information should also be collected if any side effects persist. While teaching
the parents, each of the parents can be provided with a sample logbook to avoid any dosage
missing. Parents should also be encouraged to use mobile applications that can be helpful to
keep a track on the medication administration. A periodic enquiry by the nurses should also
be done by the nurses in order to ensure that children with ADHD patients are adhering to the
treatment regimen (Hong et al., 2013). The parents should be made acquainted with the
several adherence tools available and how the tools are positioned to meet the best needs of
the people.
Any guidelines or strong in interest in the patient adherence to the medications has
been considered to be to paternalistic and often oriented towards the narrow biomedical
goals, on the basis of the treatment recommendations. Ham, (2013) have stated that this
adherence paradigm encompasses a shared decision making as the ideal and autonomy and
the perspective of the patient to be the guiding goals of care. One of the potential harm for the
medical adherence guidelines is that the recommendations might be wrong or may be for
wrong patients. Apart from the human considerations like the unintentional oversights due to
the excessive workload of the guideline group, the developers of the guidelines might cause
errors while determining the best practice for the patient again. Montoya et al., (2014) have
stated that the psychostimulant medications might cause side effects like hallucination, sleep
disorders , headaches and stomach aches might cause medical non-adherence in children.
Occurrence of facial tics might be frightening for the parents with children having ADHD
problems. In such case medical adherence in the patient might be perceived as an act of
paternalism.

MEDICATION ADHERENCE IN CHILDREN WITH ADHD
Although medical adherence guidelines are meant for providing a systematic
treatment to the parents and educating the patients. It might be contradictory to the principles
of autonomy, which states that the patient’s interest should be kept in the frontline.
Critique of the guidelines
Evidence based practice is all about the finding of the evidence and using the
evidences in the clinical decision making process. The hierarchal system of the classification
of the evidence is the cornerstone of evidence based practice. To develop the guidelines
different papers were chosen by conducting a library search. MEDLINE, Cochrane Library
and CINAHL database was used to locate the evidences. In order to avoid the retrieval bias,
the search strategies were reviewed and the reference lists were searched manually to locate
any relevant articles that might have been missed out. Various systematic reviews and the
clinical practice guidelines was reviewed. The randomised control trial performed were
identified and identification of the supplementary literature was also performed. It has to be
mentioned, that the simple identification of the guidelines, the randomised control trials and
the reviews does not ensure the quality of the report hence quality assessment was performed
for the identification of the evidences (Knopf et al., 2012). A systematic review has to be
performed as the basis of the guideline development if no published reviews are available.
The systematic reviews has to be conducted by the use of a priori protocol adhering to the
standards for the conduct and reporting the meta-analysis. Furthermore, the use of the
evidence based grading system was used for addressing the strength of evidence in terms of
the internal validity, external validity and the patient oriented outcomes. For making a
clinical guidelines, patient preferences should also be included in case the evidence is weak.

MEDICATION ADHERENCE IN CHILDREN WITH ADHD
Quality improvement
One of the aim of the Institute of Medicine (IOM) is effective care that is provision of
care by ensuring that best care is offered to the patient based on the scientific knowledge.
This guideline would facilitate parent education to improve medication adherence in the
children with ADHD. According to Corkum et al., (2014), appropriate guidelines would
facilitate patient education, which in turn would increase knowledge, positive attitudes and
behaviours towards the children with ADHD. A recent randomised control trial has indicated
towards the statistically significant improvement in the medication adherence in the children
with ADHD (Montoya et al., 2013). One of the significant benefits of the clinical practice
guidelines are the potential to progress the care quality and the outcome of the patients.
Clinical practice guidelines for medication adherence intends to optimise the patient care that
are informed by the systematic review of the evidence and the assessment of the benefits and
harms of the other care options. Medical guidelines has been found to be improving the
consistency if care. It is the clinical guidelines that assists the health care professionals in
case identical clinical problem are found (Ham, 2013). Parent and patient education helps to
reinforce the therapeutic relationship between the children and the nurses. Nurses can also
provide links and support by telephone calls, home visits and other remainders facilitating the
adherence to the medications (Ham, 2013). Medication like psychostimulants has been found
to improve the quality of life of children with ADHD by increasing the academic outcome
and postponing of substance initiation. Children taking medications has shown less rate of
hospital admission and hence less utilisation of the health care costs.
Planning
The next step for the implementation of the guidelines is the dissemination of the
guidelines among the nurses in the health care setting. Dissemination of the evidence based

MEDICATION ADHERENCE IN CHILDREN WITH ADHD
research guidelines are required for understanding an overall outcome of the guidelines.
Dissemination of the guidelines can be made by setting it up on the online forums, by
publishing of the newsletters (Ham, 2013). As successful medical adherence in few patients
cannot be considered to be a successful implementation of the guidelines as it cannot be
applied to the generalised population. Emphasis should be given on the parent education
regarding the use of the specialised mobile applications. Emphasis should also be given on
changing the parent’s perception about the side effects of the ADHD medicines.
Conclusion
On a concluding note, it can be said the development of an appropriate guideline is
necessary for increasing the mediation adherence in children with ADHD. The guidelines has
been made on the basis of the levels of evidence that has been collected from the electronic
data bases. Both randomised control trials has been taken in to account for the preparation of
the guidelines. However, the guidelines has emphasised on the factors like providing
psychoeducation to the parents, forming online forums and support groups, educating the
parents regarding the use of the mobile apps to prevent medication miss.
Guideline link: https://effectivehealthcare.ahrq.gov/sites/default/files/related_files/
medication-adherence-interventions_executive.pdf

MEDICATION ADHERENCE IN CHILDREN WITH ADHD
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