Framing's Influence on Maternal Acceptability of Off-Label Risperdal in Attention-Deficit/Hyperactivity Disorder (ADHD) Treatment



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This study used framing techniques to assess whether a prescriber’s description of drug treatment influences female caregivers’ acceptability of a psychotropic prescribed to help manage their child’s attention-deficit/hyperactive disorder (ADHD) symptoms. Framing is a rhetorical construct that may explain why individuals alter decisions when changes are made to the presentation of information. Mental health professionals have recently started prescribing second-generation antipsychotics (SGAs), like Risperdal, to ADHD youth without the U.S. Food and Drug Administration’s (FDA) approval. This off-label prescribing trend is increasingly becoming common practice despite variability in knowledge regarding pediatric SGA use. Therefore, caregivers seeking medication for their child may not realize that the FDA has not approved SGAs for ADHD treatment and may accept this intervention option out of confusion caused by prescribers’ use of intentional or unintentional framing techniques. This study a) investigated whether two informational videos (i.e., experimental or control conditions) and three framed vignettes (i.e., Risperdal framed as a mood stabilizer, an antipsychotic, or a psychiatric drug) significantly influenced female caregivers’ (n = 163) acceptability of Risperdal (risperidone); b) assessed differences in the dissipation rates of significant framing effects within the post-test sample (n = 26) that completed the Treatment Evaluation Inventory-Short Form (TEI-SF) at 2 and 4 weeks post-initial exposure to the randomly assigned information video and framed vignette conditions; and c) explored whether two selected demographic factors (i.e., caregiver’s education level; child’s ADHD status) and reported parenting stress (i.e., Parenting Stress Scale [PSS] score) moderated the relationship between significant predictors and female caregivers’ reported acceptability. Results suggest that the randomly assigned information video condition significantly affected female caregivers’ acceptability of Risperdal within the IFES sample, F(1, 157) = 7.505, p < .007, whereas the randomly assigned framed vignette and the interaction between the video and vignette did not. The experimental information video was associated with a significantly lower TEI-SF mean score of 5.53 than the control video condition. Interestingly, an exploratory analysis found a significant interaction between the information video and framed vignette conditions within the ADHD subsample’s reported acceptability of the drug, F(2, 45) = 3.97, p = .026. Compared to the antipsychotic frame, caregivers in the experimental video condition presented with the mood stabilizer and psychiatric drug frames reported a mean TEI-SF score of 11.5 and .73 points, respectively, lower than those in the control video condition. Wilcoxon signed-rank tests were used to assess the dissipation of framing effects over a 4-week period following caregivers’ initial frame exposure and concluded that significant framing effects were maintained within the post-test sample. Within the IFES sample, it was found that the two selected demographic variables and self-reported parenting stress levels did not significantly moderate the relationship between the independent variables (i.e., randomly assigned information video and framed vignette conditions) and caregivers’ reported acceptability of Risperdal. Exploratory analyses were conducted to further evaluate differences in reported acceptability of Risperdal, as well as knowledge and beliefs surrounding off-label prescribing, between caregivers of a child diagnosed with ADHD (i.e., ADHD subsample) and caregivers of a child without a diagnosis of ADHD (i.e., non-ADHD subsample). Implications and future directions of this research are discussed.



Framing, Framing effect, Pediatric psychopharmacology, Maternal acceptability, Attention Deficit/Hyperactivity Disorder (ADHD), Off-label prescribing