Specialized Treatments

Nonadherence can be managed in several ways once diagnosed, or even when suspected but not confirmed. Available treatment strategies may be clas sified as 1) treatments that focus on patient education and awareness, 2) treatments that focus on the adherence behavior itself, and 3) treatments that seek to reduce risk factors (e.g., psychopathology, poor social supports) that are considered to be the main reason for the patient's nonadherence. Approaches to treatment vary, and in addition to sin-gle-themed approaches addressing the patient may include family-based interventions, multicompo-nent interventions, and approaches that address social and contextual factors.

Although several evidence-based treatments do exist, Lemanek et al. (2001) concluded a review by stating that none should be considered "well established." Indeed, pediatric adherence intervention research is more often than not underpowered, performed in single centers, and unblinded, all of which severely limit the degree to which conclusions may be drawn. Nevertheless, in the following sections, we highlight some of the more promising approaches for which there is some evidence base.

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