Age is a factor reported as affecting adherence, but inconsistently. It should be evaluated separately for
each condition, and, if possible, by the characteristics of the patient and by developmental age group
(i.e. children dependent on parent, adolescents, adults and elderly patients).
Adherence to treatment by children and adolescents ranges from 43% to 100%,with an average of 58%
in developed countries (7). Several studies have suggested that adolescents are less adherent than
younger children (8).The adherence of infants and toddlers to recommended treatment regimens is
largely determined by the ability of the parent or guardian to understand and follow through with the
recommended management. As age increases, children have the cognitive ability to carry out treatment
tasks, but continue to need parental supervision.
School-aged children engage in the developmental task of industry, learning to regulate their own
behaviour and control the world around them. As children enter school, they spend less time at home
with their parents and are increasingly influenced by their peers and the social environment.
At the same time, increasing numbers of single and working parents have shifted more of the responsibility
for disease management to the child. Assigning too much responsibility to a child for management
of his or her treatment can lead to poor adherence. For example, studies indicate that, like adults, children
exaggerate their adherence behaviours in their self-reports (9). Parents need to understand that
WHO 2003 28 ❘ inaccurate diary reporting may hinder appropriate disease management by clinicians.These findings underscore the value of parental supervision and guidance of children in their health behaviours. Shared
family responsibility for treatment tasks and continuous reinforcement appear to be important factors
in the enhancement of adherence to prescribed treatment for the paediatric population. In addition to
parental supervision, behavioural techniques designed to help children, such as goal-setting, cueing,
and rewards or tokens, have been found to improve adherence in the school-aged population