Factors Associated with Medication Decision Making in African American Families of Children with ADHD: A Mixed Methods Study

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral pediatric disorder in the United States. Pharmacotherapy is a recommended component of treatment for ADHD. While medication treatment of ADHD is not optimized overall, minority groups experience medication treatment disparities. The persistently lower rates of medication treatment in minority groups may have culturally specific origins which cannot be generalized across minorities. The purpose of this dissertation was to assess and extend knowledge regarding medication decision making (MDM) in African American caregivers of children with ADHD. To assess the state of the science on ADHD disparities, a review of 41 descriptive studies exploring the relationship between ADHD diagnosis and/or treatment and race was conducted. The review concluded that despite a trend toward reduction in ADHD diagnostic disparities over time for African American children, medication treatment disparities persist. Next, a literature review was conducted to synthesize what is known about the beliefs of African Americans regarding ADHD diagnosis and treatment, and their experiences of MDM for children with ADHD. Findings from the fourteen articles yielded a preliminary framework describing factors influencing African American caregiver decision making. Factors included fundamental perspectives of ADHD and cultural norms for childhood behavior, the impact of fundamental perspectives on MDM, and ADHD as a form of social control. Subsequently, a sequential exploratory mixed method study was conducted to identify factors associated with MDM in low-income African American families of children with ADHD. Phase 1 comprised a case study of seven low-income African American caregivers of children with ADHD. Phase 2 aimed at validating the qualitative findings through secondary analysis of data from a survey of low-income African American families of children with ADHD. Qualitative themes included child safety and volatility, caregiver aggravation, caregiver mental health, sole caregiver status, receipt of shared decision making (SDM) and family centered care (FCC), and school involvement. After conducting univariate and multivariate logistic regression analyses, previous receipt of special education services, and receipt of FCC and SDM were independently associated with receiving a medication for ADHD. These findings indicate that clinicians and educators can intervene to improve health equity for children with ADHD

Predictors of illness course and health maintenance following inpatient treatment among patients with anorexia nervosa

Background Anorexia nervosa (AN) is a life-threatening psychiatric disorder associated with significant medical and psychosocial impairment. Hospital-based behavioral treatment is an effective intervention in the short-term. However, relapse rates following discharge are high and thus, there is a need to identify predictors of longitudinal outcome. The current study provides information regarding illness course and health maintenance among patients with AN over 5 years following discharge from an eating disorder inpatient unit. Methods Participants were individuals with AN who were discharged from a specialized, inpatient behaviorally-based unit. Prior to discharge, height and weight were measured and participants completed self-report measures of eating disorder severity and general psychopathology (depression, anxiety, harm avoidance). Participants were contacted annually for self-report measures of weight, eating disorder severity and clinical impairment. Outcome was defined by illness course (body mass index (BMI) and clinical impairment during the 5 years) and health maintenance (categories of weight and eating disorder symptom severity) across follow-up, using all available data. Linear mixed models were used to examine whether demographic and clinical parameters at discharge predicted BMI and clinical impairment over time. Additional analyses examined whether these variables significantly influenced an individual’s likelihood of maintaining inpatient treatment gains. Results One-hundred and sixty-eight individuals contributed data. Higher trait anxiety at discharge was associated with a lower BMI during follow-up (p = 0.012). There was a significant interaction between duration of illness and time, whereby duration of illness was associated with a faster rate of weight loss (p = 0.003) during follow-up. As duration of illness increased, there was a greater increase in self-reported clinical impairment (p = 0.011). Increased eating disorder severity at discharge was also associated with greater clinical impairment at follow-up (p = 0.004). Higher BMI at discharge was significantly associated with maintaining healthy weight across a priori BMI-based definitions of health maintenance. Conclusions Weight status (higher BMI) and duration of illness are key factors in the prognosis of AN. Higher weight targets in intensive treatments may be of value in improving outcomes

Binge Eating and Weight-Related Quality of Life in Obese Adolescents

Limited data exist regarding the association between binge eating and quality of life (QOL) in obese adolescent girls and boys. We, therefore, studied binge eating and QOL in 158 obese (BMI ≥ 95th percentile) adolescents (14.5 ± 1.4 years, 68.0% female, 59% African-American) prior to weight-loss treatment. Youth completed an interview to assess binge eating and a questionnaire measure of QOL. Controlling for body composition, binge eating youth (n = 35), overall, reported poorer QOL in domains of health, mobility, and self-esteem compared to those without binge eating (ps < 0.05). Also, girls, overall, reported poorer QOL than boys in activities of daily-living, mobility, self-esteem, and social/interpersonal functioning (ps < 0.05). Girls with binge eating reported the greatest impairments in activities of daily living, mobility, self-esteem, social/interpersonal functioning, and work/school QOL (ps < 0.05). Among treatment-seeking obese adolescents, binge eating appears to be a marker of QOL impairment, especially among girls. Prospective and treatment designs are needed to explore the directional relationship between binge eating and QOL and their impact on weight outcomes