INTERVENTIONS TO PROMOTE
IN CHILDHOOD CHRONIC ILLNESS
The development of empirically supported intervention to promote adherence to treatment in pediatric chronic illness is an important research need. Section VII showcases the efforts of investigators who are conducting such research.
In chapter 14, Rapoff describes adherence to medical treatment regimens for pediatric rheumatoid diseases (PRD), reviews previous studies designed to improve adherence to treatment regimens for these conditions, and proposes a prevention model to facilitate adherence to treatment for PRD. Rapoff and colleagues' research has documented the different patterns of problems experienced by children with PRD in following various elements of treatment regimens, such as medications, therapeutic exercises, and wearing joint splints to prevent contractures.
Rapoff describes the findings from his and his colleagues' single-subject designs and recently completed randomized trial to test the efficacy of educational and behavioral strategies for improving adherence to regimens for PRDs. Their single-subject design studies involved monitoring adherence in a group of patients and experimentally evaluating interventions for those with the lowest levels of adherence and those identified by pediatric rheumatologists as experiencing compromised function. Case series have generally indicated positive effect for a parent-managed token reinforcement program in improving treatment adherence for children with PRD.
Rapoff and colleagues also tested the effects of less complex and laborintensive behavioral strategies, such as self-monitoring and positive verbal