Gau Susan S F, Shen Hsin-Yi, Chou Miao-Churn, Tang Ching-Shu, Chiu Yen-Nan, Gau Churn-Shiouh
Department of Psychiatry, National Taiwan University, No. 1 Jen-Ai Road Section 1, Taipei, Taiwan 10051.
J Child Adolesc Psychopharmacol. 2006 Jun;16(3):286-97. doi: 10.1089/cap.2006.16.286.
The aim of this study was to examine the association between adherence to immediate-release methylphenidate (IR MPH) and maternal psychological distress, parenting style, parent- child relationship, and perceived family support.
The sample consisted of 307 children with attention-deficit hyperactivity disorder (ADHD) (271 boys and 36 girls), 6-17 years of age, who had been treated with IR MPH for the past 6 months. The measures included the Chinese Health Questionnaire, Parental Bonding Instrument, Family APGAR, and Home Behaviors of the Social Adjustment Inventory for Children and Adolescents.
Reasons for poor adherence (n = 79; 25.7%) included forgetting medication (72.7%), the medication having no effect (20.0%), and refusing medication (12.7%). Increased age and three-times-daily administration were the major predictors for poor adherence to IR MPH. Poor adherence was associated with increased degree of maternal psychological distress, indifferent parenting, maternal overprotection/control, poor family support, decreased interaction with parents, and increased problems at home.
Findings indicate that multiple daily dosing of MPH increases the likelihood of poor adherence, particularly in adolescents, and that poor adherence is associated with impaired maternal/family process. Once-daily administration of MPH is necessary to improve adherence and to decrease the possible exacerbation of tense parent-child relationships caused by poor drug adherence.
本研究旨在探讨速释型哌甲酯（IR MPH）的服药依从性与母亲心理困扰、育儿方式、亲子关系及感知到的家庭支持之间的关联。
样本包括307名6至17岁患有注意力缺陷多动障碍（ADHD）的儿童（271名男孩和36名女孩），他们在过去6个月接受了IR MPH治疗。测量工具包括中国健康问卷、父母教养方式问卷、家庭APGAR问卷以及儿童青少年社会适应量表中的家庭行为部分。
依从性差的原因（n = 79；25.7%）包括忘记服药（72.7%）、药物无效（20.0%）和拒绝服药（12.7%）。年龄增长和每日三次服药是IR MPH服药依从性差的主要预测因素。依从性差与母亲心理困扰程度增加、冷漠的育儿方式、母亲过度保护/控制、家庭支持不足、与父母互动减少以及家庭问题增多有关。
研究结果表明，MPH每日多次给药会增加依从性差的可能性，尤其是在青少年中，且依从性差与母亲/家庭过程受损有关。MPH每日一次给药对于提高依从性以及减少因药物依从性差导致的紧张亲子关系可能加剧的情况是必要的。
