Pediatric psychotropic medication compliance: A literature review and research-based suggestions for improving treatment compliance

Without good compliance the best psychiatric treatment is ineffective. This article reviews what is known or can be inferred about compliance with psy chiatric medications in the pediatric population. The review includes discu ssions of assessment techniques, risk and protective factors, the relevant research literature, and research-based practical techniques to improve com pliance. A Medline search surveying the years from 1966 to August 2000 yiel ded only seven peer-reviewed papers reporting on compliance with pediatric psychopharmacology. All seven studies looked at stimulant compliance among children with attention deficit hyperactivity disorder. Reported levels of compliance range from 56% to 75%. These rates, although low, are likely to be overestimates of actual compliance. We review two related areas of resea rch for which there are small but significant bodies of knowledge: pharmaco logical compliance studies among adult psychiatric populations and pediatri c medical populations. This literature supports the idea that medication co mpliance is a significant obstacle to the effective treatment of patients. Because compliance rates are lower for children as compared to adults and p sychiatric patients as compared to medical patients, we suspect that childr en with psychiatric illness may be at great risk for poor medication compli ance. Fortunately, the research literature demonstrates several simple tech niques that clinicians can use to improve medication compliance among their patients. The treatment alliance; education; and medication duration, dosi ng, palatability, and cost can all be tailored to improve medication compli ance.