title: Contrasting parents' and pediatricians' perspectives on shared decision-making in ADHD.
abstract: OBJECTIVE
  The goal was to compare how parents and clinicians understand shared decision-making (SDM) in attention-deficit/hyperactivity disorder (ADHD), a prototype for SDM in pediatrics.
  
  
  METHODS
  We conducted semi-structured interviews with 60 parents of children 6 to 12 years of age with ADHD (50% black and 43% college educated) and 30 primary care clinicians with varying experience. Open-ended interviews explored how pediatric clinicians and parents understood SDM in ADHD. Interviews were taped, transcribed, and then coded. Data were analyzed by using a modified grounded theory approach.
  
  
  RESULTS
  Parents and clinicians both viewed SDM favorably. However, parents described SDM as a partnership between equals, with physicians providing medical expertise and the family contributing in-depth knowledge of the child. In contrast, clinicians understood SDM as a means to encourage families to accept clinicians' preferred treatment. These findings affected care because parents mistrusted clinicians whose presentation they perceived as biased. Both groups discussed how real-world barriers limit the consideration of evidence-based options, and they emphasized the importance of engaging professionals, family members, and/or friends in SDM. Although primary themes did not differ according to race, white parents more commonly received support from medical professionals in their social networks.
  
  
  CONCLUSIONS
  Despite national guidelines prioritizing SDM in ADHD, challenges to implementing the process persist. Results suggest that, to support SDM in ADHD, modifications are needed at the practice and policy levels, including clinician training, incorporation of decision aids and improved strategies to facilitate communication, and efforts to ensure that evidence-based treatment is accessible.
authors.affiliation: Pediatric Research Consortium, Children's Hospital of Philadelphia, 3535 Market St, Room 1546, Philadelphia, PA 19104, USA. fiks@email.chop.edu
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Fiks
authors.forename: Cayce C
authors.initials: CC
authors.lastname: Hughes
authors.forename: Angela
authors.initials: A
authors.lastname: Gafen
authors.forename: James P
authors.initials: JP
authors.lastname: Guevara
authors.forename: Frances K
authors.initials: FK
authors.lastname: Barg
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity; D002648:Child; D003256:Community Participation; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents; D010372:Pediatrics