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The Journal continues to publish reports from the Treatment of Severe Childhood Aggression study, and I urge you to read Farmer et al.'s article describing no noticeable attention and short-term memory effects of stimulant and risperidone treatment in children with attention-deficit/hyperactivity disorder (ADHD) and aggression. The takeaway is worth mentioning here. “Clinicians may find the null effects of combined treatment on cognition to be reassuring,” the authors write. “Likewise, the lack of effects observed here, together with generally benign findings in other studies of antipsychotic monotherapy, may be reassuring to parents, guardians, and practitioners alike.”
Readers may also be interested in the international perspective on medication treatment of youth offered in Sawyer et al., which describes stimulant and antidepressant use in a representative survey of Australian youth. As may be expected, overall rates of medication use are lower than in the United States, but the authors identified a familiar trend toward treatment unsupported by rigorous diagnosis. “The majority of children in the present survey who were using stimulant medication or antidepressant medication did not have the symptoms required to meet the criteria for a diagnosis of ADHD or MDD,” the authors write.
Finally, given last month's focus on common factors in the treatment of youth with psychiatric disorders, I draw your attention to the article by Hamrin et al. describing motivational interviewing (MI) and its effects on medication adherence, which the authors claim is the first study of its kind. The results are certainly heartening given adherence rates in youth, which according to the authors range from a mediocre 89% down to a dismal 34%. This need not be a foregone conclusion, and the MI intervention appears to affect not just adherence but also medication attitudes.
“Two MI sessions by the patient's prescribing clinician significantly improved adolescent adherence mean scores,” Hamrin et al. write. “MI improved adolescents' self-management of medication,” moreover, and “24 hours of evidence-based MI training for prescribers were sufficient to obtain both adequate proficiency in skills.” And additionally, the study data suggest “that the MI intervention may have had some influence on overall drug attitude in those who were not adherent,” improving attitudes toward treatment that are prime predictors of adherence.
Thank you for your attention to these investigations; I trust they will be of use to those in clinical practice and inspire new lines of research.