Adolescents are routinely treated with psychiatric medications; however, little is known about their attitudes toward pharmacological intervention. The authors used a concurrent triangulation, mixed methods design to assess whether the Drug Attitude Inventory (DAI), developed for adults, is suitable for measuring adolescent attitudes toward psychiatric medications. Factor analytic techniques and qualitative data were used to investigate whether the instrument provides comprehensive measurement of medication-related constructs in adolescents. Findings suggest that the DAI contributes to knowledge of youth attitudes toward psychotropic treatment; however, limitations were uncovered by the mixed methods approach. This study enhances the measurement and mixed methods literature by showing how qualitative and quantitative techniques served as parallel data reduction strategies for examining an instrument’s utility with a new population.
Ajzen, I. ( 1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179-211.
2.
Ajzen, I., & Fishbein, M. ( 1980). Understanding attitudes and predicting social behavior . Upper Saddle River, NJ: Prentice Hall.
3.
Albarracin, D., Johnson, B.T., Fishbein, M., & Muellerleile, P.A. (2001). Theories of reasoned action and planned behavior as models of condom use: A meta-analysis. Psychological Bulletin, 127, 142-161.
4.
Axelson, D., Birmaher, B., Strober, M., Gill, M.K., Valeri, S., Chiapetta, L., et al. (2006). Phenomenology of children and adolescents with bipolar spectrum disorders. Archives of General Psychiatry , 63, 1139-1148.
5.
Banaschewski, T., Roessner, V., Dittmann, R.W., Santosh, P.J., & Rothenberger, A. (2004). Non-stimulant medications in the treatment of ADHD. European Journal of Child and Adolescent Psychiatry, 13(Suppl. 1), 102-116.
6.
Braun, V., & Clarke, V. ( 2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77-101.
7.
Brook, O., van Hout, H., Nieuwenhuyse, H., & Heerdink, E. ( 2003). Impact of coaching by community pharmacists on drug attitude of depressive primary care patients and acceptability to patients: A randomized controlled trial. European Neuropsychopharmacology, 13, 1-9.
8.
Brown, R.T., Borden, K.A., & Clingerman, S.R. (1985). Adherence to methylphenidate therapy in a pediatric population: A preliminary investigation. Psychopharmacology Bulletin, 21, 28-36.
9.
Browne, M.W., & Cudeck, R. ( 1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 136-162). Newbury Park, CA: SAGE.
10.
Buston, K. ( 2002). Adolescents with mental health problems: What do they say about health services? Journal of Adolescence, 25, 231-242.
11.
Buston, K.M., & Wood, S.F. ( 1999). Non-adherence amongst adolescents with asthma: Listening to what they tell us about. Family Practice, 17, 134-138.
12.
Byrd, T.L., Peterson, S.K., Chavez, R., & Heckert, A. ( 2004). Cervical cancer screening beliefs among young Hispanic women. Preventive Medicine, 38, 192-197.
13.
Chen, E.Y.H., Tam, D.K.P., Wong, J.W.S., Law, C.W., & Chiu, C.P.Y. ( 2005). Self administered instrument to measure the patient’s experience of recovery after first episode psychosis: Development and validation of the Psychosis Recovery Inventory. Australian and New Zealand Journal of Psychiatry, 39, 493-499.
14.
Conrad, P. ( 1994). The medicalization of society: On the transformation of human conditions into treatable disorders. Baltimore : Johns Hopkins University Press.
15.
Creswell, J.W., Fetters, M.D., & Ivankova, N.V. (2004). Designing a mixed methods study in primary care. Annals of Family Medicine, 2, 7-12.
16.
Cromer, B.A., & Tarnowski, K.J. (1989). Non-adherence in adolescents: A review. Journal of Developmental & Behavioral Pediatrics , 10, 207-215.
17.
DeVellis, R. ( 2003). Scale development: Theory and applications (2nd ed.). Thousand Oaks, CA: SAGE.
18.
Emslie, G.J., Rush, A.J., Weinberg, W.A., Kowatch, R.A., Carmody, T., & Mayes, T.L. ( 1998). Fluoxetine in child and adolescent depression: Acute and maintenance treatment. Depression and Anxiety, 7, 32-39.
19.
Fenton, W.S., Blyler, C.R., & Heinssen, R.K. (1997). Determinants of medication compliance in schizophrenia: Empirical and clinical findings. Schizophrenia Bulletin, 23, 637-651.
20.
Findling, R.L., McNamara, N.K., Gracious, B.L., Youngstrom, E.A., Stansbrey, R.J., Reed, M.D., et al. (2003). Combination lithium and divalproex sodium in pediatric bipolarity. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 895-901.
21.
Findling, R.L., McNamara, N.K., Youngstrom, E.A., Stansbrey, R., Gracious, B.L., Reed, M.D., et al. (2005). Double-blind 18-month trial of lithium versus divalproex maintenance treatment in pediatric bipolar disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 409-417.
22.
Floersch, J., Townsend, L., Longhofer, J., Munson, M., Winbush, V., Kranke, D., et al. (2009). Adolescent experience of psychotropic treatment. Transcultural Psychiatry, 46, 157-179.
23.
Ford, C.A., Jaccard, J., Millstein, S.G., Viadro, C.I., Eaton, J.L., & Miller, W.C. ( 2004). Young adults’ attitudes, beliefs, and feelings about testing for curable STDs outside of clinic settings. Journal of Adolescent Health, 34, 266-269.
24.
Fortney, J., Rost, K., Zhang, M., & Pyne, J. ( 2001). The relationship between quality and outcome in routine depression care. Psychiatric Services, 52, 56-62.
25.
Gearing, R.E., Mian, I., Sholonsky, A., Barber, J., Nicholas, D., Lewis, R., et al. (2009). Developing a risk-model of time to first-relapse for children and adolescents with a psychotic disorder. Journal of Nervous and Mental Disease, 197, 6-14.
26.
Geller, B., Tillman, R., Craney, J.L., & Bolhofner, K. ( 2004). Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. Archives of General Psychiatry, 61, 459-467.
27.
Gervin, M., Browne, S., Garavan, J., Roe, M., Larkin, C., & O’Callaghan, E. (1999). Dysphoric subjective response to neuroleptics in schizophrenia: Relationship to extrapyramidal side effects and symptomatology. European Psychiatry, 14, 405-409.
28.
Hack, S., & Chow, B. ( 2001). Pediatric psychotropic medication adherence: A literature review and research-based suggestions for improving treatment adherence. Journal of Child and Adolescent Psychopharmacology, 11, 59-67.
29.
Harpaz-Rotem, I., & Rosenheck, R.A. (2004). Changes in outpatient psychiatric diagnosis in privately insured children and adolescents from 1995 to 2000 . Child Psychiatry & Human Development, 34, 329-340.
30.
Hogan, T.P., Awad, A.G., & Eastwood, R. ( 1983). A self-report scale predictive of drug compliance in schizophrenics: Reliability and discriminative validity. Psychological Medicine, 13, 177-183.
31.
Jeste, S.D., Patterson, T.L., Palmer, B.W., Dolder, C.R., Goldman, S., & Jeste, D.V. ( 2003). Cognitive predictors of medication adherence among middle-aged and older outpatients with schizophrenia. Schizophrenia Research , 63, 49-58.
32.
Kampman, O., Lehtinen, K., Lassila, V., Leinonen, E., Poutanen, O., & Koivisto, A.M. (2000). Attitudes towards neuroleptic treatment: Reliability and validity of the Attitudes towards Neuroleptic Treatment (ANT) questionnaire. Schizophrenia Research, 45, 223-234.
33.
Kaplan, D. ( 2000). Structural equation modeling: Foundations and extensions . Thousand Oaks, CA: SAGE.
34.
Klein, R.G., Mannuzza, S., Koplewicz, H.S., Tancer, N.K., Shah, M., Liang, V., & Davies, M. ( 1998). Adolescent depression: Controlled desipramine treatment and atypical features. Depression and Anxiety, 7, 15-31.
35.
Little, T. ( 2006, June 4-8). Structural equation modeling: Foundations and extended applications., Quantitative Training Program, University of Kansas.
36.
Lloyd, A., Horan, W., Borgaro, S.R., Stokes, J.M., Pogge, D.L., & Harvey, P.D. ( 1998). Predictors of medication adherence after hospital discharge in adolescent psychiatric patients. Journal of the American Academy of Child & Adolescent Psychiatry, 8, 133-141.
37.
Muller-Oerlinghausen, B., Muser-Causemann, B., & Volk, J. ( 1992). Suicides and parasuicides in a high risk patient group on and off lithium long-term treatment. Journal of Affective Disorders, 25, 261-269.
38.
O’Connor, B. ( 2000). SPSS and SAS programs for determining the number of components using parallel analysis and Velicer’s MAP test. Behavioral Research Methods, Instruments, & Computers, 32, 396-402.
39.
Pae, C.U., Lee, K.U., Kim, J.J., Lee, C.U., Bahk, W.M., Lee, S.J., et al. (2004). Switching to quetiapine in patients with acute mania who were intolerant to risperidone. Human Psychopharmacology and Clinical Experiments, 19, 47-51.
40.
Pelham, W.E., Hoza, B., Pillow, D.R., Gnagy, E.M., Kipp, H.L., Greiner, A.R., et al. (2002). Effects of methylphenidate and expectancy on children with ADHD: Behavior, academic performance, and attributions in a summer treatment program and regular classroom settings. Journal of Consulting and Clinical Psychology, 70, 320-335.
41.
Riekert, K.A., & Drotar, D. ( 2002). The Beliefs about Medications Scale: Development, reliability, and validity. Journal of Clinical Psychology in Medical Settings , 9, 177-184.
42.
Rossi, A., Arduini, L., Stratta, P., & Pallanti, S. ( 2000). Subjective experience and subjective response to neuroleptics in schizophrenia. Comprehensive Psychiatry, 41, 446-449.
43.
Ryan, N.D., & Varma, D. ( 1998). Child and adolescent mood disorders: Experience with serotonin-based therapies. Biological Psychiatry, 44, 336-340.
44.
Safer, D.J., Zito, J.M., & dos Reis. (2003). Concomitant psychotropic medication for youths. American Journal of Psychiatry, 160, 438-449.
45.
Sajatovic, M., Rosch, D.S., Sivec, H.J., Sultana, D., Smith, D.A., Alamir, S., et al. (2002). Insight into illness and attitudes toward medications among inpatients with schizophrenia. Psychiatric Services, 53, 1319-1321.
46.
Scott, C.S., Lore, C., & Owen, R.G. ( 1992). Increasing medication compliance and peer support among psychiatrically diagnosed students. Journal of School Health , 62, 478-480.
47.
Skinner, T.C., & Hampson, S.E. ( 2001). Personal models of diabetes in relation to self-care, well-being, and glycemic control. Diabetes Care, 24, 828-833.
Spector, P. ( 1992). Summated rating scale construction: An introduction. Newbury Park, CA: SAGE.
50.
Swanson, J. ( 2003). Adherence with stimulants for attention deficit/hyperactivity disorder: Issues and approaches for improvement. CNS Drugs , 17, 117-131.
51.
Swanson, J., Wigal, S., Greenhill, S., Browne, R., Waslick, B., Lerner, M., et al. (1998). Objective and subjective measures of the pharmacodynamic effects of Adderall in the treatment of children with ADHD in a controlled laboratory setting. Psychopharmacology Bulletin , 34, 55-60.
52.
Thomas, C.P., Conrad, P., Casler, R., & Goodman, E. ( 2006). Trends in the use of psychotropic medications among adolescents, 1994 to 2001. Psychiatric Services, 56, 63-69.
53.
Timlin-Scalera, R.M., Ponterotto, J.G., Blumberg, F.C., & Jackson, M.A. ( 2003). A grounded theory study of help-seeking behaviors among white male high school students. Journal of Consulting Psychology , 50, 339-350.
54.
Townsend, L. (in press). How effective are interventions to enhance adherence to psychotropic medications? Practice implications for social workers working with adults diagnosed with severe mental illness. Journal of Evidence-Based Social Work.
55.
Townsend, L., Demeter, C.A., Wilson, M., & Findling, R.L. , (2007). Update on pediatric bipolar disorder. Current Psychiatry Reports, 9, 529-534.
56.
Townsend, L.D. ( 2009) How effective are interventions to enhance adherence to psychotropic medications? Practice implications for social workers working with adults diagnosed with severe mental illness. Journal of Human Behavior in the Social Environment, 19(5), 512-530.
57.
Weiden, P., & Glazer, W. ( 1997). Assessment and treatment selection for ‘‘revolving door’’ inpatients with schizophrenia. Psychiatric Quarterly, 68, 377-392.
58.
Weiden, P.J., & Olfson, M. ( 1995). Cost of relapse in schizophrenia. Schizophrenia Bulletin, 23, 419-429.
59.
Wigal, T., Swanson, J.M., Regino, R., Lerner, M.A., Soliman, I., Steinhoff, K., Gurbani, S., & Wigal, S. ( 1999). Stimulant medications for the treatment of ADHD: Efficacy and limitations. Mental Retardation and Developmental Disabilities Research Reviews, 5, 215-224.
60.
Wozniak, J., Biederman, J., Kiely, K., Ablon, J.S., Faraone, S.V., Mundy, E., & Mennin, D. ( 1995). Mania-like symptoms suggestive of childhood-onset bipolar disorder in clinically referred children. Journal of the American Academy of Child & Adolescent Psychiatry, 34, 867-876.
