Indian Journal of Psychological Medicine
  Home | About Us | Editorial Board | Search | Ahead of print | Current Issue | Archives | Instructions | Contact | Advertise | Submission | Login 
Users Online: 738 
Wide layoutNarrow layoutFull screen layoutHome Print this page Email this page Small font sizeDefault font sizeIncrease font size


 
 Table of Contents    
COMMENTS ON PUBLISHED ARTICLE
Year : 2019  |  Volume : 41  |  Issue : 5  |  Page : 497-498  

Comments on “Factors associated with treatment adherence in children with attention deficit hyperactivity disorder”


1 Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
2 Department of Psychiatry, D Y Patil Medical College, Kolhapur, Maharashtra, India

Date of Web Publication5-Sep-2019

Correspondence Address:
Prof. Chittaranjan Andrade
Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bengaluru - 560 029, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPSYM.IJPSYM_276_19

Rights and Permissions

How to cite this article:
Andrade C, Harshe D. Comments on “Factors associated with treatment adherence in children with attention deficit hyperactivity disorder”. Indian J Psychol Med 2019;41:497-8

How to cite this URL:
Andrade C, Harshe D. Comments on “Factors associated with treatment adherence in children with attention deficit hyperactivity disorder”. Indian J Psychol Med [serial online] 2019 [cited 2019 Sep 22];41:497-8. Available from: http://www.ijpm.info/text.asp?2019/41/5/497/266105



Sir,

Safavi et al.[1] identified factors related to treatment adherence in a 'convenience' sample of children with attention deficit/hyperactivity disorder (ADHD). We believe that there are several reasons why their findings should be interpreted with reservations.

Studies may be exploratory (hypothesis generating) or confirmatory (hypothesis testing) in design.[2] Hypothesis-testing studies need to state primary and secondary outcome measures in advance.[3] Safavi et al.[1] neither stated a priori outcome measures nor admitted that their study was exploratory. Consequently, readers may not realize that their findings should be interpreted as speculative, not definitive.

Curiously, Safavi et al.[1] did not even outline a plan of analysis; rather, they enthusiastically examined the association between every sociodemographic, clinical, and instrumental variable for which they had collected information and adherence, as operationalized by Medication Adherence Report Scale scores. When a large number of statistical associations are indiscriminately tested, the risk of a Type 1 (false positive) error is magnified. This means that some or many of the significant findings reported in the paper[1] may have been false-positive findings, and the average reader would not know that this was so because the authors did not declare that their plan of analysis was exploratory in nature. The absence of a plan of analysis and such testing of all possible associations between variables is, unfortunately, a common failing in scientific studies and publications.

The multivariable regression analysis described by the authors[1] does not address the false-positive risk because no correction of the P value is applied in regression, regardless of the number of variables entered into the equation.[4],[5] Additionally, given that the variables entered by the authors in their regression were chosen because they were significant or near significant in univariate testing, that some variables remained significant in multivariable testing is hardly surprising and will not mean that the associations identified in the sample are true for the population.

Last but not least, the authors conducted their study in patients who had been on treatment for at least 6 months; that is, in patients for whom a reasonable degree of adherence was established by virtue of retention in follow-up. So, this is an extreme example of a convenience sample and one that is very likely not representative of the population of children with ADHD.

As a take-home recommendation, we suggest that all original studies describe their primary and secondary outcomes if these were set a priori; else, the exploratory nature of the study should be declared in both abstract and text so that readers can interpret the findings with caution.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Safavi P, Saberzadeh M, Tehrani AM. Factors associated with treatment adherence in children with attention deficit hyperactivity disorder. Indian J Psychol Med 2019;41:252-7.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Andrade C. Describing research design. Indian J Psychol Med 2019;41:201-2.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Andrade C. The primary outcome measure and its importance in clinical trials. J Clin Psychiatry 2015;76:e1320-3.  Back to cited text no. 3
    
4.
Andrade C. Multiple testing and protection against a type 1 (false positive) error using the Bonferroni and Hochberg corrections. Indian J Psychol Med 2019;41:99-100.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Andrade C. Author's response to 'Multiple testing and protection against type I error using P value correction: Application in cross-sectional study designs'. Indian J Psychol Med 2019;41:198.  Back to cited text no. 5
    




 

Top
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References

 Article Access Statistics
    Viewed75    
    Printed0    
    Emailed0    
    PDF Downloaded6    
    Comments [Add]    

Recommend this journal