Parental angst making and revisiting decisions about treatment of attention-deficit/hyperactivity disorder.
BACKGROUND
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral conditions of childhood and adolescence. Despite availability of effective treatment options, initiation of treatment is variable and persistence with therapeutic regimens is poor.


OBJECTIVE
We sought to better understand how parents make decisions about treatment for their child or adolescent with ADHD.


METHODS
We conducted a qualitative study among parents of children and adolescents; 52 parents participated in 1 of 12 focus groups. Parents answered questions about decision-making, information sharing, and sources of conflict and uncertainty. Sessions were audiotaped and transcribed verbatim. Themes were coded independently by 4 of the investigators, who then agreed on common themes.


RESULTS
Parents in our study made decisions about treatment for their child with ADHD in the midst of experiencing a variety of emotions as they witnessed child functional impairments at home and at school. In addition, parents felt stress as a result of their daily efforts to manage their child's struggles. Multiple factors influenced the decision to initiate medication. Subsequently, revisiting the decision to give their child medicine for ADHD was common. Many parents contrasted time on and off medicine to help inform management decisions. Trials stopping medication were almost always parent- or child-initiated.


CONCLUSIONS
Decisions about medication use for children and adolescents with ADHD are made and frequently revisited by their parents. Choices are often made under stressful conditions and influenced by a variety of factors. Striking a balance between benefits and concerns is an ongoing process that is often informed by contrasting time on and off medication. Development of strategies to support families across the continuum of decisions faced while managing ADHD is warranted.
Brinkman
William B
WB
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA. bill.brinkman@cchmc.org
Sherman
Susan N
SN
Zmitrovich
April R
AR
Visscher
Marty O
MO
Crosby
Lori E
LE
Phelan
Kieran J
KJ
Donovan
Edward F
EF
D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D009820:Ohio; D010290:Parents / Q000523:psychology*; D012017:Referral and Consultation; D016896:Treatment Outcome; D035501:Uncertainty; D055815:Young Adult
D000697:Central Nervous System Stimulants