Alliance and Mechanisms of Medication Adherence in Pediatric Psychiatric Practice

Psychiatric medications have been established as an efficacious treatment for pediatric psychopathology (Comer, Olfson, & Mojtabai, 2010), with approximately 3.9% of American children receiving psychotropic medication in a given year (Olfson, Marcus, Weissman, & Jensen, 2002). However, medication adherence for these conditions is suboptimal, with over 50% of children discontinuing treatment before the period recommended for full therapeutic benefit (e.g., Gau et al., 2006; Murray, de Vries, & Wong, 2004). This is highly problematic because pediatric psychopathology is associated with substantial functional impairment and reduced quality of life, as well as increased risk for suicidality (e.g., Bridge, Goldstein, & Brent, 2006; Kessler, Berglund, Demier, Jin, Merikangas, & Walters, 2005). Unfortunately, few empirical data exist about variables that may relate to medication adherence in pediatric pharmacotherapy. However, the psychotherapy literature has identified several potent mechanisms of behavior change that may be related to adherence, including therapeutic alliance, motivation for behavior change, and expectancies for positive treatment outcomes. We aimed to evaluate the role of these factors in a sample of 65 outpatient youth ages 7-17 years and their families, where questionnaires evaluating these constructs were administered at patients\u27 first session with a new psychiatric provider. Study results revealed several associations with adherence among these hypothesized predictors, with parental motivation for child behavior change being a particularly robust predictor of adherence. Results are discussed in the context of a new pathway to progress in pediatric psychiatry, where instead of focusing predominantly on development of new pharmacological agents, identifying methods to adjust the therapeutic relationship may be indicated in order to maximize patient outcomes in pharmacotherapy