title: Parent perspectives on the decision to initiate medication treatment of attention-deficit/hyperactivity disorder.
abstract: OBJECTIVE
  Despite substantial evidence supporting the efficacy of stimulant medication for children with attention-deficit/hyperactivity disorder (ADHD), adherence to stimulant treatment is often suboptimal. Applying social/cognitive theories to understanding and assessing parent attitudes toward initiating medication may provide insight into factors influencing parent decisions to follow ADHD treatment recommendations. This report describes results from formative research that used focus groups to obtain parent input to guide development of a provider-delivered intervention to improve adherence to stimulants.
  
  
  METHODS
  Participants were caregivers of children with ADHD who were given a stimulant treatment recommendation. Focus groups were recorded and transcribed verbatim. Data were analyzed by inductive, grounded theory methods as well as a deductive analytic strategy using an adapted version of the Unified Theory of Behavior Change to organize and understand parent accounts.
  
  
  RESULTS
  Five groups were conducted with 27 parents (mean child age=9.35 years; standard deviation [SD]=2.00), mean time since diagnosis=3.33 years (SD=2.47). Most parents (81.5%) had pursued stimulant treatment. Inductive analysis revealed 17 attitudes facilitating adherence and 25 barriers. Facilitators included parent beliefs that medication treatment resulted in multiple functional gains and that treatment was imperative for their children's safety. Barriers included fears of personality changes and medication side effects. Complex patterns of parent adherence to medication regimens were also identified, as well as preferences for psychiatrists who were diagnostically expert, gave psychoeducation using multiple modalities, and used a chronic illness metaphor to explain ADHD. Theory-based analyses revealed conflicting expectancies about treatment risks and benefits, significant family pressures to avoid medication, guilt and concern that their children required medication, and distorted ideas about treatment risks. Parents, however, took pride in successfully pursuing efforts to manage their child behaviorally and to avoid medication when possible.
  
  
  CONCLUSIONS
  Focus group data identified social, cognitive, and affective influences on treatment decision making. Results support prior research comparing family/social functioning, physician characteristics, and adherence. Findings suggest that parent attitudes to psychiatric care need to be assessed comprehensively at initial evaluation to aid the development of psychoeducational messages, and a more careful consideration about how parents interpret and respond to adherence-related questioning.
authors.affiliation: Division of Psychiatry Research, North Shore-LIJ Health System, The Zucker Hillside Hospital, Glen Oaks, NY 11004, USA. dcoletti@nshs.edu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Coletti
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Pappadopulos
authors.forename: Nikki J
authors.initials: NJ
authors.lastname: Katsiotas
authors.forename: Alison
authors.initials: A
authors.lastname: Berest
authors.forename: Peter S
authors.initials: PS
authors.lastname: Jensen
authors.forename: Vivian
authors.initials: V
authors.lastname: Kafantaris
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D001294:Attitude to Health; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D011582:Psychological Theory
chemical_list: D000697:Central Nervous System Stimulants