Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Aims: Psychotropic treatment of children and adolescents increased dramatically (by some estimates 5-fold) in the last decade. For youth, clinical trials have established the efficacy and safety of some medications, yet no research has been conducted on how, in their everyday life, youth experience psychiatric medication. The aim of this NIMH funded pilot study is to adapt an anthropological adult interview schedule, the Subjective Experience Medication Instrument (SEMI), to adolescents for the purpose of exploring the SEMI's utility in collecting narratives about medication treatment (The SEMI has been used extensively with adults, Jenkins et al., 2005. Findings were used to speculate that adherence to treatment includes, among others, the myriad ways medication becomes socially and psychologically meaningful.

Methods: The study utilized a non-random, representative, outpatient clinic sample of convenience consisting of 20 adolescents who were currently taking a psychiatric medication. Using the K-SADS-PL diagnostic research instrument and standardized symptom assessment instruments (e.g., YMRS, CDRS, and CBCL), each participant's diagnostic disorder and symptom severity was assessed. The TeenSEMI, 150 open-end questions, covered five broad categories: treatment, illness, and medication experience; perceptions of medication; managing, monitoring, reporting of medication experience; parent and adolescent interaction regarding medication management; and stigma. Through the constant comparative method, the first 6 interviews were analyzed to create a codebook of narrative themes; the codebook guided the analysis of the remaining 14 cases. Finally, by relating the themes to each other, we identified common patterns in how adolescents made sense or meaning of treatment.

Results: Participants were diagnosed with bipolar spectrum illness, or ADHD, although comorbidity was high. According to clinical assessment scales, most participants presented mild symptoms at the time of the interview. The average age was 14 years, average number of prescribed medications was 2.5, and the average length of time on medications was 3.5 years. Adolescents were not always aware of the names and types of medication they were on, were only vaguely accepting of their diagnoses, although they were able to give their own practical names for medications and diagnoses. Females tended to be more worried about weight gain. Many would not tell their friends about their medication, they believed they would take medications for life, and they depended on their mothers to assist with everyday management issues. Finally, adolescents on medication since elementary school, and who had parents heavily invested in their treatment, were more likely to take ownership of their medication management, expressed that they had a mental illness, and spoke positively about their experiences.

Implications: Adolescent adherence to medication has been shown to be erratic and as a consequence, poor adherence often compromises the effectiveness of medication treatment in the community; therefore, from the adolescent's point of view, understanding how they make sense of the effects of medication and its management could strongly improve how all practitioners work with adolescents to prescribe, monitor, and manage their treatment. Although psychotropic treatment surely includes symptom reduction and the monitoring of bodily side effects, this research suggests that social and psychological effects are important.