Review of barriers and interventions to promote treatment engagement for pediatric attention deficit hyperactivity disorder care

作     者：Raman Baweja Cesar A Soutullo James G Waxmonsky 

作者机构：Department of Psychiatry and Behavioral HealthPenn State College of MedicineHersheyPA 17033United States Louis A.FaillaceMD Department of Psychiatry and Behavioral SciencesThe University of Texas Health Science Center at HoustonHoustonTX 77054United States 

出 版 物：《World Journal of Psychiatry》 (世界精神病学杂志)

年 卷 期：2021年第11卷第12期

页      面：1206-1227页

核心收录：

学科分类：1002[医学-临床医学] 1011[医学-护理学（可授医学、理学学位）] 10[医学] 

主　　题：Attention deficit hyperactivity disorder Treatment engagement Barriers Interventions Children Adolescents 

摘      要：Attention deficit hyperactivity disorder(ADHD)is a common and impairing behavioral health disorder,impacting over 5%of children worldwide.There are multiple evidence-based pharmacological and psychosocial treatments for ADHD,and greater service utilization is associated with improved acute and long-term outcomes.However,long-term outcomes are suboptimal as multimodal treatments are often not accessed and most care ends prematurely.This narrative review discusses barriers to engagement for children and adolescents with ADHD and their families as well as interventions to overcome these barriers.Families face a variety of structural and attitudinal barriers,ranging from cost and access to stigma and low self-efficacy to successfully implement change.There are multiple interventions that may enhance engagement with ADHD care including psychoeducation,integration of behavioral services in general medical settings,telehealth as well as specific adaptations to existing ADHD treatments,such as the use of motivational interviewing or shared decision making.Integration of behavioral health into general medical settings and telehealth have been found in controlled studies to increase access by reducing both structural and attitudinal barriers.Adding motivational interviewing,shared decision making and other engagement interventions to evidence-based ADHD treatments has been found to reduce attitudinal barriers that translates into improved participation and satisfaction while enhancing outcomes.However,little is known about how to promote extended engagement with ADHD services even though a chronic care model for ADHD is recommended.