Attitudes About Stimulant Medication for Attention-Deficit/Hyperactivity Disorder Among African American Families in an Inner City Community

dosReis, Susan; Butz, Arlene; Lipkin, Paul H.; Anixt, Julia S.; Weiner, Courtney L.; Chernoff, Robin

doi:10.1007/s11414-006-9038-y

Cited by 43 publications

(22 citation statements)

References 26 publications

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“…First, engagement with behavioral health care is often problematic. [10][11][12][13][14] Second, low-income parents, particularly those of inattentive or hyperactive/impulsive children, have an increased prevalence of depression and adult ADHD, 15 which have been associated with poorer child symptom trajectories. 16,17 Third, behavioral comorbidities, particularly oppositionality, are highly prevalent among low-income populations, and can limit the effectiveness of strategies designed to address core ADHD symptoms.…”

Section: Articlementioning

confidence: 99%

Collaborative Care for Children With ADHD Symptoms: A Randomized Comparative Effectiveness Trial

et al. 2015

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OBJECTIVES: Although many attention-deficit/hyperactivity disorder (ADHD) care models have been studied, few have demonstrated individual-level symptom improvement. We sought to test whether complementing basic collaborative care with interventions that address common reasons for symptom persistence improves outcomes for children with inattention and hyperactivity/impulsivity. METHODS:We conducted a randomized comparative effectiveness trial of 2 care management systems for 6-to 12-year-old children being evaluated for ADHD (n = 156). All participants received care management with decision support. Care managers in the enhanced care arm also were trained in motivational and parent management techniques to help parents engage in their child's treatment, address their own mental health needs, and manage challenging child behaviors. We used multivariable models to assess inattention, hyperactivity/impulsivity, oppositionality, and social skills over 1 year.RESULTS: Both treatment arms generated guideline concordant diagnostic processes in 94% of cases; 40% of children had presentations consistent with ADHD. For the entire sample, there were no differences in symptom trajectories between study arms; mean differences in change scores at 12 months were -0.14 (95% confidence interval -0.34 to 0.07) for inattention; -0.13 (-0.31 to 0.05) for hyperactivity/impulsivity; -0.09 (-0.28 to 0.11) for oppositionality; and 3.30 (-1.23 to 7.82) for social skills. Among children with ADHD-consistent presentations, enhanced arm participants experienced superior change scores for hyperactivity/impulsivity of -0.36 (-0.69 to -0.03), oppositionality -0.40 (-0.75 to -0.05), and social skills 9.57 (1.85 to 17.28).CONCLUSIONS: Among children with ADHD-consistent presentations, addressing barriers to engagement with care and challenging child behaviors has potential to improve the effectiveness of collaborative care. WHAT'S KNOWN ON THIS SUBJECT:Collaborative care is known to be an effective system to manage child behavioral health conditions in the primary care setting. WHAT THIS STUDY ADDS:Among urban children with attention-deficit/hyperactivity disorder, using lay care managers to address barriers to engagement with care and challenging child behaviors has the potential to improve the effectiveness of conventional collaborative care. Dr Silverstein conceptualized and designed the study, oversaw its implementation, and drafted the initial manuscript; Drs Hironaka and Walter conceptualized and designed the study, oversaw its clinical implementation, reviewed and revised the entire manuscript, and assisted in the interpretation of analyses; Dr Feinberg assisted in conceptualizing and designing the study, oversaw its clinical implementation at one site, assisted in the interpretation of analyses, and reviewed and revised the manuscript; Ms Sandler managed the data for the project, assisted in preparing the analyses, and reviewed and revised the manuscript; Ms Pellicer supervised the care managers for the project, and reviewed and...

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Section: Articlementioning

confidence: 99%

Collaborative Care for Children With ADHD Symptoms: A Randomized Comparative Effectiveness Trial

et al. 2015

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“…Our analysis of parent comments corroborates previous work in this area and provides a far more comprehensive collection of factors than previous studies. [4][5][6][7][23][24][25][26][27][28][29][30][31][32][33][34][35] Previous efforts implementing the American Academy of Pediatrics clinical practice guidelines for the diagnosis and treatment of ADHD demonstrated a need to augment the time-constrained efforts of physicians to educate and support parents. 36 Future studies are needed to develop and test systems to support parents facing treatment decisions for their child newly diagnosed with ADHD.…”

Section: Table 4 Domain 3: Continued Doubt and Uncertaintymentioning

confidence: 99%

Parental Angst Making and Revisiting Decisions About Treatment of Attention-Deficit/Hyperactivity Disorder

Sherman²,

et al. 2009

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WHAT'S KNOWN ON THIS SUBJECT:Initiation of medication for ADHD is variable and persistence with therapeutic regimens is poor. Parents play a key role in managing medication use for their child with ADHD. WHAT THIS STUDY ADDS:This study identifies factors that influence parent decision-making about the initiation and continuation of medication treatment. Awareness of these factors may help physicians address the concerns of families while managing ADHD.abstract 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.

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“…On the one hand, prior research has shown that very few parents believe prescription medication leads to drug abuse, and 70% feel that medication improves adult outcomes in the longterm (dosReis et al, 2006;dosReis et al, 2003). Moreover, most families believe that medication can help children (Olaniyan et al, 2007) and is safe if recommended by a physician (dosReis et al, 2006;dosReis et al, 2003). On the other hand, some parents feel that too many children are medicated (dosReis et al, 2006;dosReis et al, 2003;Pescosolido, Perry, Martin, McLeod, & Jensen, 2007).…”

Section: Introductionmentioning

confidence: 99%

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

dosReis

Myers

2008

International Review of Psychiatry

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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.

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Attitudes About Stimulant Medication for Attention-Deficit/Hyperactivity Disorder Among African American Families in an Inner City Community

Cited by 43 publications

References 26 publications

Collaborative Care for Children With ADHD Symptoms: A Randomized Comparative Effectiveness Trial

Collaborative Care for Children With ADHD Symptoms: A Randomized Comparative Effectiveness Trial

Parental Angst Making and Revisiting Decisions About Treatment of Attention-Deficit/Hyperactivity Disorder

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

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