Family Based Approaches

Arguably, in most cases of pediatric nonadherence, the caretaker of the child needs to be involved. Family members can provide monitoring and supervision of a nonadherent child and assist in the implementation of a behavioral plan. Family members may also help address barriers to adherence, such as financial hardship, and provide useful information to the treating physician that may help guide the treatment. Conversely, a serious disruption of family structure and support (e.g., the disruption seen in families in which the child was abused in the past) is associated with severe and persistent nonad-herence (Shemesh et al. 2007). In those and other less severe cases, interventions that are aimed at the family unit become important (Patton et al. 2008). Addressing the relationships between the child and the rest of the family, with a focus on behavior modification techniques, has been investigated as a way to improve adherence and medical outcomes (Wy-socki et al. 2008) and should be attempted as indicated. Treatments that use systemic family approaches have been shown to be promising in improving medical outcomes, especially in children with diabetes (Wysocki et al. 2007, 2008), although researchers have not yet discovered whether the improvement in outcome is mediated exclusively by improvement in adherence.

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