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.

Figure 1

Undesirable effects of empirically supported ADHD interventions and of counseling Legend of axial codes as described by adolescents, parent, teachers, and health providers: Selective code of perceived ineffectiveness of treatment- Axial codes: 1= Ineffective treatment, Axial code 2= Ineffective treatment until combined with other treatments Selective code of burden of treatment- Axial codes: 3= Cost, 4= Disruption of daily activities, 5=Forgetting to take medicine, 6= Dosing concerns, 7= Medication wears off prematurely, 8= Supervision needed to follow the treatment regimen, 9= Treatment requires consistency Selective code of psychological side-effects- Axial codes: 10= Sadness, depression, 11= Irritability, 12= Increased conflict, 13= Low self-esteem Selective code of dependence-Axial codes: 14= Medicine addiction, 15= Treatment dependence, 16= Reward dependence *Counseling is not categorized as an empirically supported ADHD treatment (Pelham & Fabiano, 2008) Note: A thick line indicates more than 20 participant responses

Graph 1

Willingness to use medications

Graph 2

Willingness to use psychosocial treatments