Concluding Comments

Nonadherence to medical treatments is a major reason for treatment failure. A substantial body of knowledge exists about the definition of, assessment of, risk factors for, and treatment of nonadher-ence (Rapoff 1999). A safe conclusion is that assess ment of adherence should be incorporated into clinical practice in any clinic that is caring for children who are chronically ill. When used as primary prevention, educational efforts may improve adherence. When nonadherence is suspected, an evaluation of risk factors and barriers should commence. Interventions can be tailored to address those risks and/or the behavioral aspect of nonadherence in and of itself. Interventions may also try to address caretaker behaviors, clinic settings, and societal impediments to adherence.

Although further research is needed, existing data suggest that many interventions could work. In the absence of conclusive evidence for the efficacy of any single treatment in pediatric nonadherence research for any disease category, clinicians should use the available information to tailor treatments. Researchers need to design and execute conclusive well-powered studies that can inform clinical care. Mental health clinicians can assist in designing and implementing clinical or research protocols to assess and treat nonadherence, or they can help in addressing specific risk factors associated with nonadher-ence. Mental health clinicians should participate in multidisciplinary teams that are charged with improving nonadherence. Such teams should expect an improvement in treatment responses, provided that adherence is indeed strongly related to outcomes in a given population. Research and practice efforts that target nonadherence have greatly expanded recently, and substantial additions to the knowledge base are likely in years to come.

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