Parental attitudes and involvement in psychopharmacological treatment for ADHD: A conceptual model

Abstract

Current evidence strongly points to significant parental concerns about exposing their children to psychopharmacological medications. This is true even with stimulant medications for attention deficit/hyperactivity disorder (ADHD), an evidence-based treatment for children. Theory and prior evidence would predict that parents' hesitancy to give their children psychopharmacological medication is likely due to what they hear from family and friends about medication's untoward effects. That social networks impact problem definition, treatment evaluation, and service use is well established. However, it is not known how parents make treatment decisions as they cope with the reality that their child might benefit from psychopharmacological medication. The qualitative research described in this paper addresses this gap. A conceptual model is presented that describes parents' treatment decisions and participation in their children's care as they shift from parenting a child with behavioural problems to parenting a child who eventually requires psychopharmacological medication. Further research is needed to evaluate how this model can offer a more comprehensive understanding of how parents respond to a diagnostic label and various treatment options. It is hoped that this research will stimulate innovative approaches for tailoring treatments that are respectful of the individual needs of children and their families.

How Parents Make Decisions to Use Medication to Treat Their Child’s ADHD

“…The progressive increase in disruption to family life was pivotal to parents' decision to initiate medication. Previous studies have also noted that family stress associated with efforts to respond to their child's difficulties is a key factor that prompts parents to try medication, often as a last resort (Brinkman et al, 2009;DosReis & Myers, 2008;Leslie et al, 2007). Similar to findings in other studies, parents were initially resistant to using psychotropic medication and wanted to pursue alternative treatment options first (DosReis et al, 2003;Jackson & Peters, 2008;Taylor et al, 2006).…”

“…However, although professional practice guidelines exist, viewpoints of what constitutes appropriate treatment for ADHD are mixed, with some advocating stimulant medication as the most efficacious treatment and others favoring alternative approaches, including those who believe that stimulant therapy is overprescribed, unsafe, or unethical (Koelch, Schnoor, & Fegert, 2008;Taylor, O'Donoghue, & Houghton, 2006). Furthermore, despite evidence of efficacy, literature suggests that a substantial percentage of children who have been diagnosed with ADHD either do not begin medication prescribed for their core symptoms or fail to continue treatment (Jensen et al, 2007;MTA Cooperative Group, 2004 Studies examining barriers to initiation/maintenance of medication treatment of ADHD by parents have identified a plethora of factors, most notably lack of information, conflicting opinions (e.g., family members, teachers and health care providers), cost of medication, unsatisfactory experiences with health care providers, side effects, fear that prescription medicine leads to drug abuse, cultural beliefs, social stigma, and negative media portrayals of medication (Bussing, Gary, & Mills, & Garvin, 2003;Charach, Volpe, Boydell, & Gearing, 2008;DosReis & Myers, 2008;Johnston, Hommersen, & Siepp, 2008;Lazaratou, Anagnostopoulos, Alevizos, Haviara, & Ploumpidis, 2007;Leslie, Plemmons, Monn, & Palinkas, 2007;McNeal, Roberts, & Barone, 2000;Monastra, 2005;Pastor & Ruben, 2005;Stroh, Frankenberger, Cornell-Swanson, Wood, & Pahl, 2008). In essence, the literature to date suggests that parents' views of psychopharmacological treatment for ADHD are mixed, that misconceptions are common, and that making decisions regarding the use of medication is difficult.…”

Enhancing ADHD Medication Adherence: Challenges and Opportunities

“…Parent beliefs about ADHD and attitudes toward treatment are significant determinants of initiation [34]. For example those parents who view the child’s difficulties as a medical disorder that requires a biological intervention will agree with using medication and encourage long term use [35].…”

Evolution of Child Mental Health Services in Primary Care

“…In contrast to many other chronic conditions where adherence is a problem in a minority of patients21-22, long term adherence for pediatric patients with psychiatric drug treatment is very low. New studies underscore parent concerns about the potential for the development of drug dependence, and uncertainty about long term changes to brain function and stigma are all sufficient to instill powerful ambivalence among parents about psychiatric drugs for their children 23-24…”