Receiving Treatment for Attention-Deficit Hyperactivity Disorder: Do the Perspectives of Adolescents Matter?

Department of Psychiatry, University of Florida, Gainesville, Florida 32610-0234, USA.
Journal of Adolescent Health (Impact Factor: 3.61). 07/2011; 49(1):7-14. DOI: 10.1016/j.jadohealth.2010.08.014
Source: PubMed


This study describes the perspectives of parents and adolescents regarding clinical need for and attitudes toward care for attention-deficit hyperactivity disorder (ADHD). In addition, it explores as to how these views relate to past year usage of mental health services.
Parents and adolescents were interviewed 6 years after the school district was screened for ADHD. Using standardized measures, mental health service usage, adolescent and parent perceived clinical needs (ADHD symptoms, disruptive behavior disorders, anxiety and/or depression, functioning), and enabling attitudes (treatment receptivity, ADHD stigma), as well as parent factors (caregiver strain, distress, instrumental social support) were assessed. Nested logistic regression modeling was used to determine the hierarchical contribution of parent and adolescent perspectives on past year service usage, after adjusting for previous usage of mental health services. Stepwise regression was conducted to identify the variables that were most predictive of service usage.
Among the adolescents who were at a high risk for ADHD, 79% had a history of lifetime mental health service usage, but only 42% had received any kind of mental health services in the past year. In hierarchical modeling, only parent inattention ratings and medication receptivity and adolescent ADHD stigma perceptions contributed significantly toward improved model fit. Stepwise regression confirmed these three variables to be predictors (OR: 1.2, 3.8, and .2, respectively) and identified adolescents-reported functioning as an additional predictor of service usage (OR: 1.1).
Perceptions of adolescents regarding the stigma related to ADHD are influential in treatment receipt. Quality improvement interventions for adolescents with ADHD should include psychoeducational interventions for adolescents and their parents that target medication receptivity and the stigma related to ADHD.

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Available from: Regina Bussing
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    • "However, this study also found that the perceptions of older children and adolescents have an equally powerful effect on accessing services . For example, having a 'medication receptive' parent increased the odds of using mental health services by 3.8, but perceived stigma on the part of the adolescent reduced these odds by a factor of five (Bussing et al., 2011). Bussing et al. (2012) expanded on the role of adolescent opinion in a mixed methods enquiry. "
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    • "Children rate themselves as having fewer symptoms than their parents rate them [21] and may see themselves as functioning well compared with how others see them [22]. Parent and teen attitudes about treatment for ADHD can differ, [15] and these differences likely contribute to youth refusing to take medication as directed, [13] and ultimately discontinuation of stimulant treatment. To date, socio-cognitive models of behavior regarding use of medications to treat ADHD have focused primarily on the role of parental choice [10,23]. "
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    ABSTRACT: Young adolescents' and their parents' experiences with Attention-Deficit/Hyperactivity Disorder (ADHD) and its treatment were explored to investigate beliefs and attitudes regarding use of stimulant medication, and their influence on treatment decisions. Using in-depth qualitative interviews, 12 adolescents with ADHD aged 12 - 15 years, and their parents described their experiences of ADHD and its treatment. Twenty four interviews, 12 with adolescents and 12 with their parents elicited detailed descriptions of beliefs about ADHD, attitudes about stimulant use and the circumstances surrounding treatment decisions. Verbatim transcripts were iteratively analyzed by a team of researchers following an interpretive interactionist framework. Young people offered three themes describing ADHD: 1) personality trait, 2) physical condition or disorder, and 3) minor issue or concern. Regarding medication use, youth described 1) benefits, 2) changes in sense of self, 3) adverse effects, and 4) desire to discontinue use. Parents' beliefs were more homogeneous than youth beliefs, describing ADHD as a disorder requiring treatment. Most parents noted benefits from stimulant use. Themes were 1) medication as a last resort, 2) allowing the child to reach his or her potential; and 3) concerns about adverse and long-term effects. Families described how responsibility for treatment decisions is transferred from parent to adolescent over time. Young adolescents can have different beliefs about ADHD and attitudes about medication use from their parents. These beliefs and attitudes influence treatment adherence. Incorporating input from young adolescents when making clinical decisions could potentially improve continuity of treatment for youth with ADHD.
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    • "The young person’s evaluation of how peers perceive them is very important. Some youth feel ostracized socially due to ADHD behaviors and therefore find taking medications helpful while others may avoid treatment because of fears medication use will create stigma [33••, 42, 44••]. University-aged young people with ADHD described greater medication use when they made the treatment decision themselves, often with the goal to increase academic success [16]. "
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