WHAT'S KNOWN ON THIS SUBJECT:Initiation of medication for ADHD is variable and persistence with therapeutic regimens is poor. Parents play a key role in managing medication use for their child with ADHD. WHAT THIS STUDY ADDS:This study identifies factors that influence parent decision-making about the initiation and continuation of medication treatment. Awareness of these factors may help physicians address the concerns of families while managing ADHD.abstract BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral conditions of childhood and adolescence. Despite availability of effective treatment options, initiation of treatment is variable and persistence with therapeutic regimens is poor. OBJECTIVE:We sought to better understand how parents make decisions about treatment for their child or adolescent with ADHD. METHODS:We conducted a qualitative study among parents of children and adolescents; 52 parents participated in 1 of 12 focus groups. Parents answered questions about decision-making, information sharing, and sources of conflict and uncertainty. Sessions were audiotaped and transcribed verbatim. Themes were coded independently by 4 of the investigators, who then agreed on common themes. RESULTS:Parents in our study made decisions about treatment for their child with ADHD in the midst of experiencing a variety of emotions as they witnessed child functional impairments at home and at school. In addition, parents felt stress as a result of their daily efforts to manage their child's struggles. Multiple factors influenced the decision to initiate medication. Subsequently, revisiting the decision to give their child medicine for ADHD was common. Many parents contrasted time on and off medicine to help inform management decisions. Trials stopping medication were almost always parent-or child-initiated. CONCLUSIONS:Decisions about medication use for children and adolescents with ADHD are made and frequently revisited by their parents. Choices are often made under stressful conditions and influenced by a variety of factors. Striking a balance between benefits and concerns is an ongoing process that is often informed by contrasting time on and off medication. Development of strategies to support families across the continuum of decisions faced while managing ADHD is warranted.

Introduction of PCV13 for universal infant use was associated with significant reductions in nasopharyngeal carriage of PCV13 serotypes and resistant strains. Carriage of non-PCV13 serotypes increased modestly, particularly serotype 35B. Further investigation is warranted to determine whether nonvaccine pneumococcal serotypes carried in the nasopharynx are associated with significant replacement disease.

Objective Up to 90% of adolescents with ADHD remain functionally impaired, yet less than half continue to take medication. The objective of this study was to gain a detailed understanding of how adolescents with ADHD contribute to medication treatment decisions. Methods 44 adolescents with ADHD aged 13 to 18 years old participated in 1 of 7 focus groups. An experienced facilitator used a semi-structured focus group guide to prompt discussion which was audio-recorded and transcribed verbatim. We coded transcripts using an inductive approach. Thematic saturation was reached after the seventh focus group. Results Adolescents assumed increased responsibility for managing medication as they matured and developed insight into the functional impact of ADHD and medication on their lives. Insights were often formed by contrasting time spent on and off medication. ADHD impacted functioning in the following domains: academics, social interactions and relationships, creativity, and driving skills. Select domains were relevant for some adolescents but not others. Adolescents described different roles that they played in managing medication as well as strategies they employed to exert autonomy over medication use. Side effects were common and contributed to negative feelings toward medication. Some adolescents had begun to use medication selectively. Many expressed uncertainty about future use of medication. Conclusions Adolescents assume an increasing role in managing medication for ADHD. Well-structured and coordinated trials stopping medication and measuring outcomes relevant to adolescents, parents, teachers, doctors, and/or other stakeholders may help ensure a developmentally appropriate transition from family to self-management of ADHD.

ObjectivesThe objective was to apply and evaluate a screening tool to identify victims of child sex trafficking (CST) in a pediatric emergency department (PED) population.MethodsThis prospective, observational study was conducted from July 2017 to November 2017 at the PED of a free‐standing, inner‐city children's hospital. Patients 10 to 18 years of age presenting with chief complaints related to high‐risk social or sexual behaviors were recruited in a representative convenience sampling. A previously developed six‐item screening tool was administered verbally to participants. A positive screen was defined as two positive answers from the six items. A patient was considered a “true” CST victim if any information obtained during the visit indicated that their circumstances fulfilled the federal definition of CST. Descriptive statistics were calculated for all variables of interest. CST screening tool analysis included sensitivity, specificity, and positive and negative predictive values (PPV, NPV). Those patients identified as positive for CST were referred to social services and received the current standard of care.ResultsA total of 254 patients met chief complaint screening criteria and eligibility; 215 were approached to participate and 203 agreed to participate. Of the 203 participants, 100 screened positive with the tool (49%). The total number of CST victims identified was 11 (5.4%), 10 of whom screened positive. With a cutoff score of two positive answers the tool demonstrated a 90.9% (95% confidence interval [CI] = 58.7%–99.8%) sensitivity, 53.1% (95% CI = 45.6%–60.4%) specificity, 10.0% (95% CI = 5.0%–17.6%) PPV, and 99.0% (95% CI = 94.7%–99.9%) NPV.ConclusionsApplied to an inner‐city PED population of 203 participants with high‐risk chief complaints, the screening tool has high sensitivity and high NPV. This makes it appropriate for an initial screening to rule out CST in this high‐risk population. Applicability for broader use and additional practice settings are warranted given the significant positivity rate among those presenting with high‐risk concerns.

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