| Chapter 2: | Background |
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High rates of nonadherence also are observed among adolescents at other large urban medical centers (Hosek, Domanico, & Harper, 2002; Murphy et al., 2003; Murphy et al., 2001).
Recent findings of an investigation of long-term outcomes in children with HIV infection (PACTG 219C) indicate that successful adherence declines with increasing age (Malee et al., 2004). Moreover, delays or impairment in cognitive, language, memory and self-regulatory functioning, which are common among children with HIV infection (Blanchette, Smith, King, Fernandea Penney, & Read, 2002; Chase et al., 2000; Mellin, Levenson, Zawadzki, Kairam, & Weston, 1994; Wolters, Brouwers, Moss, & Pizzo, 1995) may interfere with an adolescent’s ability to take medication systematically and independently. Twenty-seven percent of PACTG 219C participants, aged 3–18, have been diagnosed with at least one neurological or psychiatric disorder, and 34% require special educational services in school (Malee et al., 2004).
Recent literature indicates that developmental issues play a role in nonadherence. Normal developmental issues in adolescence, such as the struggle for independence, an exaggerated sense of immortality and invulnerability, the desire to question authority, and the need to identify with one’s peers, propel adolescents toward nonadherence (Elliott, 2001; Malee et al., 2004). The hallmarks of adolescent psychosocial development include rebellion, opposition, manipulation, and forgetfulness. These are “symptoms” of the separation and individuation process, which is the primary developmental task for the adolescent (Rothenberg, 1990).
The task of individuation and separation is motivated by the adolescent’s new cognitive capacities for complex abstract thought. Adolescents are interested in issues, and able to form their own opinions and ideas upon them, where previously they had unassumingly adopted these from their caretakers (Rothenberg, 1990).