Willingness to Use ADHD Treatments: A Mixed Methods Study of Perceptions by Adolescents, Parents, Health Professionals and Teachers

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\u27 and adults\u27 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. (C) 2011 Elsevier Ltd. All rights reserved

“A Massive Long Way”: Interconnecting Histories, a “Special Child,” ADHD, and Everyday Family Life

Focusing on one family from a study of dual-earner middle-class families carried out in Los Angeles, California, this article draws on interview and video-recorded data of everyday interactions to explore illness and healing as embedded in the microcultural context of the Morris family. For this family, an important aspect of what is at stake for them in their daily lives is best understood by focusing on 9-year-old Mark, who has been diagnosed with attention-deficit/hyperactivity disorder (ADHD). In this article, we grapple with the complexity of conveying some sense of how Mark’s condition is experienced and relationally enacted in everyday contexts. Through illuminating connections between lives as lived and lives as told, we explore the narrative structuring of healing in relation to Mark’s local moral world with the family at its center. We examine how his parents understand the moral consequences of the child’s past for his present and future, and work to encourage others to give due weight to his troubled beginnings before this child joined the Morris family. At the same time, we see how the Morris parents act to structure Mark’s moral experience and orient to a desired future in which Mark’s “success” includes an appreciation of how he is accountable to others for his actions. Through our analyses, we also seek to contribute to discussions on what is at stake in everyday life contexts for children with ADHD and their families, through illuminating aspects of the cultural, moral and relational terrain that U.S. families navigate in contending with a child’s diagnosis of ADHD. Further, given that ADHD is often construed as a “disorder of volition,” we seek to advance anthropological theorizing about the will in situations where volitional control over behavior is seen to be disordered

A Reconceptualization of Pseudohallucinations in the Case of "Kate"

In the case study of "Kate" (Shapiro, Bussing, & Nguyen, 2014), we discussed a case of a 16-year-old adolescent who initially presented with auditory hallucinations and secondary delusional thinking. A more thorough examination of the underlying dynamics of the patient and family pointed away from a diagnosis of a psychotic disorder, and the consideration of "pseudohallucinations"—conversion disorder symptoms in the form of psychiatric symptoms—was felt key by the treating child psychiatrist in tailoring treatment for Kate and her family. We  discussed potential definitions of "pseudohallucinations" and used a psychodynamic formulation as a conceptual framework to provide treatment in the form of cognitive-behavioral therapy, psychodynamic therapy, and family therapy. Kate improved during the course of treatment, and thankfully avoided long-term treatment with antipsychotic medications. In response to three thoughtful and stimulating commentaries on the original case study by Pienkos (2014), Westerman (2014), and Mertin (2014), we discuss other ways in which Kate's case can be conceptualized, and we further explore the phenomenon of non-psychotic hallucinations. We focus on the main thematic elements in these commentaries, namely, Kate’s struggle for autonomy and independence as a main driver in symptom formation; the theoretical approach to the case; and the continued focus on the hallucinatory experiences

Pseudohallucinations in an Adolescent: Considerations for Diagnosis and Treatment in the Case of "Kate"

Hallucinations are usually considered a hallmark of severe psychopathology, most commonly psychotic or thought disorders such as schizophrenia or other organic brain syndromes. However, several studies describe '"non-psychotic hallucinations" occurring in children and adolescents who experience hallucinations without other core symptoms of true psychosis, such as the presence of a thought disorder, disorganized behavior, and pervasive dysfunction. Some authors describe the controversial subject of "pseudohallucinations," which appears to be more representative of conversion disorder symptoms rather than psychotic symptoms. We present a case of "Kate," a 16-year-old adolescent female who required psychiatric hospitalization for auditory hallucinations with secondary delusional thinking. She was initially given a diagnosis of psychotic disorder, not otherwise specified (NOS), and treated with an antipsychotic and an antidepressant. At outpatient follow-up, although Kate continued to endorse hallucinations and delusional thinking, her symptoms were not felt to be part of a true psychotic disorder. The hallucinations could be viewed as a product of extreme anxiety; a diagnosis of generalized anxiety disorder (GAD) was made, and Kate was maintained on the antidepressant and antipsychotic medications. However, this did not entirely explain Kate's symptoms. The consideration of "pseudohallucinations" as conversion disorder symptoms in the form of psychiatric symptoms was key to making an accurate diagnosis, predicting prognosis, and tailoring treatment for Kate and her parents. A total of 29 months of a combination of both cognitive-behavioral and psychodynamic treatment by the first author (MAS) included both weekly individual therapy and weekly therapy with her parents for the first 12 months, biweekly individual and parents therapy for the next eight months, and monthly individual sessions for the final nine months, during which Kate was 18 years old. During the initial course of treatment, the antipsychotic was tapered and discontinued without precipitating an exacerbation of symptoms. Symptoms continued to improve throughout treatment with both patient and parents. We discuss the differences between psychosis and “pseudopsychosis” and the reasons for making the distinction in this case. We also discuss the possible explanation for these "pseudohallucinations" in Kate and how treatment was tailored. Finally, we discuss the implications for diagnosis, prognosis, and treatment of this and similar cases of non-psychotic hallucinations

Childhood ADHD symptoms: Association with parental social networks and mental health service use during adolescence

Objective: This study examines the associations of childhood attention-deficit/hyperactivity disorder (ADHD) risk status with subsequent parental social network characteristics and caregiver strain in adolescence; and examines predictors of adolescent mental health service use. Methods: Baseline ADHD screening identified children at high risk (n = 207) and low risk (n = 167) for ADHD. At eight-year follow-up, parents reported their social network characteristics, caregiver strain, adolescents\u27 psychopathology and mental health service utilization, whereas adolescents self-reported their emotional status and ADHD stigma perceptions. Analyses were conducted using ANOVAs and nested logistic regression modeling. Results: Parents of youth with childhood ADHD reported support networks consisting of fewer spouses but more healthcare professionals, and lower levels of support than control parents. Caregiver strain increased with adolescent age and psychopathology. Increased parental network support, youth ADHD symptoms, and caregiver strain, but lower youth stigma perceptions were independently associated with increased service use. Conclusions: Raising children with ADHD appears to significantly impact parental social network experiences. Reduced spousal support and overall lower network support levels may contribute to high caregiver strain commonly reported among parents of ADHD youth. Parental social network experiences influence adolescent ADHD service use. With advances in social networking technology, further research is needed to elucidate ways to enhance caregiver support during ADHD care