Abstracts

Rationale: Antiepileptic drug (AED) nonadherence is a significant issue for pediatric epilepsy patients, with prevalence rates as high as 60% among children aged 2 to 12 and up to 79% in adolescents (Carbone et al., 2013; Modi et al., 2011; 2014).Despite the complexity of AED nonadherence and associated negative health outcomes (e.g., increased morbidity and mortality, reduced quality of life, higher healthcare expenditures, inaccurate clinical decision making), limited research has examined interventions targeting adherence among pediatric epilepsy patients (Modi & Guilfoyle, 2011; Wu et al., 2014). This study evaluated the efficacy of behavioral intervention on the AED adherence of a pediatric epilepsy patient, with the goal of informing clinical practice and future research.   Methods: An 8-year-old male diagnosed with intractable epilepsy, autism spectrum disorder, receptive-expressive language disorder, and global developmental delay was included in this case study. The patient was referred for inpatient consultation-liaison services due to longstanding AED nonadherence, resulting in multiple seizures per day, and the risk of undergoing an invasive procedure (i.e., gastrostomy tube for AED administration). The patient received an evaluation and five, 45-minute treatment sessions across hospital and outpatient clinic settings. An informal functional behavioral assessment (FBA) was first conducted to identify environmental variables maintaining the patient’s AED nonadherence. A multicomponent behavioral intervention was then developed involving psychoeducation, compliance training, shaping, modeling, verbal prompting, positive reinforcement, learning trials, and home rehearsal. To evaluate the efficacy of treatment, a single-subject AB design was utilized whereby continuous data was collected on the patient’s response to intervention based on direct observation.   Results: An informal FBA suggested the patient’s AED nonadherence was primarily due to behavioral noncompliance and was exacerbated by longstanding issues with food selectivity. During the first two treatment sessions centered on compliance training, the patient’s rate of compliance with simple commands significantly increased from 20% to 90%. Following a third treatment session that involved all intervention components, the patient’s AED adherence improved from 0% to 100%, which was maintained across follow-up sessions and a six-week phone consultation.   Conclusions: This case study provides preliminary evidence for the efficacy of behavioral intervention on AED adherence rates of pediatric epilepsy patients with or without developmental and/or behavioral difficulties. Given high rates of AED nonadherence and the associated negative health outcomes, validating the results of this case study and conducting further research on adherence interventions appears imperative. This case study highlights the pivotal role pediatric psychologists can serve in assisting medical providers to assess and treat the complex nature of AED nonadherence to ensure optimal disease management.  Funding: None