Poor adherence with medical care is a relatively common problem in pediatric patients, with potentially serious side-effects. This article describes a four-phase inpatient intervention program for such cases. Patients are first identified and admitted to the unit: careful preparation is essential in this phase. In the assessment phase, factors related to the illness and treatment regimen, as well as characteristics of the individual child and family, are evaluated to determine their contributions to the adherence problem. In the third phase, an intervention program is implemented, consisting of: (i) education of the patient and family regarding the illness and medical regimen; (ii) improvement of self-management skills; (iii) behavioral intervention using contingent reinforcement; and (iv) treatment of additional barriers to adherence such as psychopathology and family dynamics. The fourth phase focuses on transfer of care to home through gradually increasing the patient’s and family’s responsibility for care.
Dunbar, J.
(1983). Compliance in pediatric populations: A review. In P.J. McGrath & P. Firestone (Eds.). Pediatric and adolescent behavioral medicine: Issues in treatment (pp. 210-230). New York: Springer.
2.
Friedman, I.M.
, Litt, I.F., King, D.R., Henson, R., Holtzman, D., Halverson, D., & Kraemer, H.C. (1986). Compliance with anticonvulsant therapy with epileptic youth. Journal of Adolescent Health Care, 7, 12-17.
3.
Hauser, S.T.
, Jacobson, A.M., Lavori, P., Wolfsdorf, J.I., Herskowitz, R.D., Milley, J.E., Bliss, R., Gelfand, E., Wertlieb, D., & Stein, J. (1990). Adherence among children and adolescents with insulin-dependent diabetes mellitus over a four-year longitudinal follow- up: II. Immediate and long-term linkages with the family milieu. Journal of Pediatric Psychology, 15, 527-542.
4.
Jacobson, A.M.
, Hauser, S.T., Lavori, P., Wolfsdorf, J.I., Herskowitz, R.D., Milley, J.E., Bliss, R., Gelfand, E., Wertlieb, D., & Stein, J. (1990). Adherence among children and adolescents with insulin-dependent diabetes mellitus over a four-year longitudinal follow- up: I. The influence of patient coping and adjustment. Journal of Pediatric Psychology, 15, 511-526.
5.
Jamison, R.N.
, Lewis, S., & Burish, T.G. (1986). Cooperation with treatment in adolescent cancer patients. Journal of Adolescent Health Care, 7, 162-167.
6.
Johnson, S.B.
(1995). Managing insulin dependent diabetes mellitus: A developmental perspective. In J. Wallander & L. Siegel (Eds.). Adolescent health problems: Behavioral perspectives (pp. 265-288). New York: Guilford Press.
7.
Korsch, B.M.
, Fine, R.N., & Negrete, V.F. (1978). Noncompliance in children with renal transplants. Pediatrics, 61, 872-876.
8.
Kovacs, M.
, Goldston, D., Obrosky, S., & Iyengar, S. (1992). Prevalence and predictors of pervasive noncompliance with medical treatment among youths with insulin-dependent diabetes mellitus. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 1112-1119.
9.
La Greca, A.M.
, & Schuman, W.B. (1995). Adherence to prescribed medical regimens. In M.C. Roberts (Ed.). Handbook of pediatric psychology (pp. 55-83). New York: Guilford.
10.
Litt, I.F.
, & Cuskey, W.R. (1980). Compliance with medical regimens during adolescence. Pediatric Clinics of North America, 27(1), 3-15.
11.
Litt, I.F.
, & Cuskey, W.R. (1984). Satisfaction with health care: A predictor of adolescents’ appointment keeping. Journal of Adolescent Health Care, 5, 196-200.
