Willingness to use ADHD treatments: A mixed methods study of perceptions by adolescents, parents, health professionals and teachers

Abstract

Little is known about factors that influence willingness to engage in treatment for attention deficit/hyperactivity disorder (ADHD). From 2007 to 2008, in the context of a longitudinal study assessing ADHD detection and service use in the United States, we simultaneously elicited ADHD treatment perceptions from four stakeholder groups: adolescents, parents, health care professionals and teachers. We assessed their willingness to use ADHD interventions and views of potential undesirable effects of two pharmacological (short- and long-acting ADHD medications) and three psychosocial (ADHD education, behavior therapy, and counseling) treatments. In multiple regression analysis, willingness was found to be significantly related to respondent type (lower for adolescents than adults), feeling knowledgeable, and considering treatments acceptable and helpful, but not significantly associated with stigma/embarrassment, respondent race, gender and socioeconomic status. Because conceptual models of undesirable effects are underdeveloped, we used grounded theory method to analyze open-ended survey responses to the question: “What other undesirable effects are you concerned about?” We identified general negative treatment perceptions (dislike, burden, perceived ineffectiveness) and specific undesirable effect expectations (physiological and psychological side-effects, stigma and future dependence on drugs or therapies) for pharmacological and psychosocial treatments. In summary, findings indicate significant discrepancies between teens’ and adults’ willingness to use common ADHD interventions, with low teen willingness for any treatments. Results highlight the need to develop better treatment engagement practices for adolescents with ADHD.

Stigmatization and self-perception of youth with attention deficit/hyperactivity disorder

“…51,52,54,57 Bussing et al used a mixedmethods approach combining vignette responses and open-ended answers to study ADHD treatment willingness and perceptions of undesirable treatment side effects among four stakeholder groups for ADHD treatment of adolescents, namely 148 youth, 161 caregivers, 132 healthcare providers, and 122 teachers. 57 Stigma associated with medication and behavioral therapies emerged as a significant treatment barrier in the qualitative analysis. The study also demonstrated that adolescents were significantly less willing than adults to consider medication or psychosocial treatments for ADHD.…”

“…The study also demonstrated that adolescents were significantly less willing than adults to consider medication or psychosocial treatments for ADHD. 57 One vignette study sought to explore the impact of diagnostic/psychiatric labeling on the attitudes and behavioral intentions of school-age children towards a hypothetical peer presenting with ADHD symptoms. 52 Law et al recruited 120 children from schools in the UK and found that the majority of participants held predominantly negative attitudes towards the vignette child with ADHD symptoms, with no additional effect of diagnostic/psychiatric labeling on children's attitudes and social behavioral intentions.…”

“…Adults' perceptions of public stigma were addressed in six qualitative/mixed-methods studies [57][58][59][60][61][62] and three quantitative studies. 53,55,63 The six qualitative/mixed-methods studies were conducted by various independent research groups focused on caregivers' public stigma experiences, whereas all quantitative studies originated from the 2002 General Social Survey, which contained a nationally representative sample of adults who completed the National Stigma StudyChildren (NSS-C).…”

“…58,60,61 Public stigma was prompted by the child's behavior as well as by various treatments intended to help the disorder, and stigma was seen as a reason not to initiate or to stop treatment. [57][58][59] Public stigma contributed to the fear of producing lifelong damage by having a child "labeled" with ADHD. 62 Caregivers' perceptions of high prevalence of public stigma surrounding ADHD were confirmed in the NSS-C studies.…”

Conocimientos y creencias sobre el trastorno por déficit de atención con hiperactividad en maestros de tres países latinoamericanos

“…22 A su vez, una reciente investigación en el sureste de Estados Unidos demostró que los maestros de adolescentes con TDAH estaban dispuestos a que los alumnos recibieran tratamiento psicosocial y farmacológico. 23 La información acerca de los conocimientos y creencias de los maestros sobre el TDAH en Latinoamérica es escasa. Un estudio realizado en Puerto Rico evaluó los conocimientos sobre la enfermedad en 132 maestros de escuelas pú-blicas y privadas, donde 35% reportó tener conocimientos previos respecto al TDAH y 72% mostró un nivel bajo de conocimientos.…”