Abstract
ADHD is the most pervasive pediatric psychological condition, with a worldwide prevalence of 5.3% (Polanczyk, de Lima, Horta, Biederman, & Rohde, 2007). Although current treatment guidelines stipulate a multifaceted approach to treatment (American Academy of Pediatrics [AAP], 2011; National Health and Medical Research Council [NHMRC], 2012), prescription medications, particularly stimulant agents such as methylphenidate, are considered to be first-line treatment for the disorder (Jadad et al., 1999; Kaplan & Newcorn, 2011; Singer-Leshinsky, 2011). These medications have been shown to improve symptoms of inattention, hyperactivity, and impulsivity, with consequent positive impacts on the affected child’s academic and social functioning. Although interventions such as cognitive behavioral therapy (CBT) have been shown to be useful (Bowen, Fenton, & Rappaport, 1991), the strongest evidence for the improvement of ADHD symptoms in the current literature is presented for pharmacotherapy which is effective for approximately 80% of users (Faraone, Biederman, Spencer, & Aleardi, 2006).
Despite this recognition, pharmacotherapy, and the use of stimulant agents in particular, remains the most contentious of all available treatment options for ADHD (Daley, 2006). Controversy, often sparked by negative media coverage, surrounds the appropriateness and safety of these agents for young children, with concerns raised about long-term side effects including potential for growth stunting and addiction. Such reports influence public opinion and often forge stigmatizing attitudes toward the use of such medications for ADHD treatment (Olaniyan et al., 2007; Peters & Jackson, 2009). This makes some parents of affected children reluctant to initiate medicated therapy for their children even when it is indicated as first-line treatment (Daley, 2004; dosReis et al., 2009).
For those parents who do elect to commence medicated therapy for their child’s ADHD, these controversies may account for the poor levels of adherence to treatment recommendations, observed particularly for stimulant medications (Hodgkins, Sasane, Christensen, Harley, & Liu, 2011; Lachaine, Beauchemin, Sasane, & Hodgkins, 2012; Lawson, Johnsrud, Hodgkins, Sasane, & Crismon, 2012; Spencer et al., 2011). Nonadherence levels are estimated to be between 15% (Atzori, Usala, Carucci, Danjou, & Zuddas, 2009) and as high as 83% within 6 weeks of treatment initiation (Spencer et al., 2011). In turn, treatment may be suboptimal, leading to symptom relapse and overall negative clinical outcomes in affected children (Charach, Volpe, Boydell, & Gearing, 2008; Perwien, Hall, Swensen, & Swindle, 2004).
Since parents are responsible for the administration of ADHD medications to their affected children in up to 84% of cases (Berger, Dor, Nevo, & Goldzweig, 2008), it is important to explore their views about the factors which influence their decisions to adhere to or cease pharmacotherapy. Although studies have explored the factors influencing parents’ decisions to initiate pharmacotherapy for their child’s ADHD (Ahmed, McCaffery, & Aslani, 2013), less is known about the factors that affect adherence to and persistence with pharmacotherapy. The objective of this study was to explore Australian parents’ perspectives about factors influencing their decisions to adhere to ADHD pharmacotherapy.
Method
Focus Groups
Focus group discussions were used to explore factors that affected parents’ initiation, continuation, and cessation of pharmacotherapy for their children. A qualitative method was used to allow parents to discuss their experiences and help elicit more in-depth information from them (Morton, Tong, Howard, Snelling, & Webster, 2010). Focus groups were used to encourage participants to voice their opinions by relating to or contrasting with the experiences of others.
Participants
Inclusion criteria
Parents were eligible to participate in the study if they met the following criteria: (a) their child had a diagnosis of ADHD by a clinician; (b) their child was currently taking or had (within the previous 6 months) taken one of the prescription medications, methylphenidate, dexamphetamine, or atomoxetine, for ADHD; and (c) they were able to participate in the study without the assistance of a translator.
Recruitment
All parents were recruited from metropolitan Sydney areas by a recruitment agency following approval from the institution’s Human Research Ethics Committee. Eighteen eligible parents were recruited, with 16 participating in the study. Each parent was reimbursed AUD$70 for their time and travel expenses.
Data Collection
The focus groups were conducted in three distinct geographic areas of the Sydney metropolitan to capture parents from a range of socioeconomic backgrounds. They were held in office venues commonly used for focus groups, arranged by the recruitment agency. All 16 parents provided written consent for participating in the focus groups. They then completed a demographic survey about themselves and their child(ren) with ADHD. Each focus group lasted approximately 1 to 1.5 hr and was facilitated by one of the researchers (P.A.) experienced in conducting focus groups, using a focus group guide developed to address the study objectives (available from the authors on request). The broad topics covered in the discussions included parents’ reasons for initiating pharmacotherapy, their positive and negative experiences while using the medication, and the impact this had on their adherence to and persistence with treatment. Discussions were audio-recorded with permission from all participants. The focus groups were conducted until a point of saturation (Cameron, 2005) was observed in the data collected which was at the conclusion of the third focus group.
Data Analysis
Parents’ focus group responses were analyzed by three researchers (R.A., P.A., and J.B.) independently using the framework method of analysis (Ritchie & Spencer, 1994). The first stage of this analysis involved familiarization with the data by listening to the recordings of each focus group several times in their entirety. These recordings were then transcribed verbatim and the transcripts also examined multiple times while listening to the recordings to ensure accuracy of the transcribing process. During this time, handwritten notes were made of the major themes emerging from the data, and parents’ responses were compared to identify the level of agreement or disagreement within the data. The NVivo® 9 qualitative data analysis software was then used to enhance the analysis process. This software product is commonly used in qualitative research to assist in the organization, coding, and retrieval of data according to a thematic or classification scheme (Auld et al., 2007). It also provides researchers with great flexibility in searching for and identifying relationships within the data (Bazeley & Richards, 2000). In utilizing this software, a thematic framework was developed based on the major themes identified in the data and their related subtopics. Parent responses were then coded according to these major and minor themes. The identified themes and the related codes assigned to parent statements were discussed among the study authors to ensure consensus.
Initiation, Continuation, Modification, and Cessation
During analysis of the data, the following definitions were applied to ensure the clarity and consistency of the results reported. Factors influencing initiation were those that led parents to commence pharmacotherapy either as a primary avenue of treatment, after symptomatic deterioration following a period of time off medication, or after trialing alternative treatment(s) with no effect. Factors associated with continuation were those that encouraged parents to persist with pharmacotherapy. Factors that led parents to modify dosing regimens were termed under modification factors while cessation factors referred to factors that led parents discontinue pharmacotherapy for their child altogether.
Results
Sixteen parents participated in the three focus groups conducted; their characteristics are presented in Table 1. The majority were male (56%) and were the biological parents (85%) of the affected child.
Characteristics of Focus Group Participants.
Note. AUD$: Australian dollars.
Of the major themes identified from the data, five related to the factors influencing parents’ decisions to adhere to pharmacotherapy: (a) parental motivators to commence pharmacotherapy, (b) observed benefits of pharmacotherapy, (c) parental experiences with side effects, (d) parental opinions about long-term effects of pharmacotherapy, and (e) parental experiences of stigma. The remaining themes related to parents’ ADHD-related information needs and these are reported elsewhere (submitted). For greater clarity of study findings, these five major themes were categorized according to the aforementioned aspects of adherence to pharmacotherapy, namely, initiation, continuation, and cessation, and verbatim quotes were used to illustrate each.
Pharmacotherapy Initiation
Theme 1—Parental motivators to commence pharmacotherapy
Parents identified several factors that encouraged them to commence pharmacotherapy for the management of their child’s condition. The most important factor reported by parents related to concern about the child’s poor academic performance and social isolation: “It got to a point where we had to do something about it [commence pharmacotherapy] . . . he’s not getting an education, he is falling behind, he has got no friends because no-one really wants to be with him” (Focus Group [FG] 1, Participant [P] M1).
Other parents relied on the advice of health care professionals (HCPs) as motivation to initiate pharmacotherapy, “At the time . . . no-one knew about it [pharmacotherapy] . . . you were relying on the doctor . . . giving you the right information, so you stuck to it and tried it ” (FG 2, P M6). Contact with the parents of other children on medications for ADHD was another factor that motivated some parents to initiate treatment for their own child: “The more people you see, the more people are saying, ‘Yes you need this [medication]. . . .’ So you . . . don’t want to do it, don’t really like it, but if it makes a difference and they can learn and function better, you’ve got to do it I guess” (FG 1, P F3).
Parents’ accounts revealed that these factors were not unique to their decisions to initiate pharmacotherapy, as they were also seen to influence their decisions to persist with it as explored next.
Pharmacotherapy Continuation
Theme 2—Benefits of pharmacotherapy
The positive impact of pharmacotherapy on the child’s behavior was the key motivating factor for parents’ decisions to continue treatment. Parents noted that their children had decreased hyperactivity and aggression and improved concentration after commencing treatment: “Ever since he [child] started the medication, it [inattention] stopped . . . completely, it was just a complete shutdown on his behaviour and the way he used to be” (FG 1, P M1). For some parents, the benefits of medication were observed within a short time frame: “[the medication] worked straight away . . . that’s what blew me away” (FG 2, P F2).
More importantly, parents were able to reconcile the use of pharmacotherapy with observed improvements in their child’s academic performance: “now . . . she’s doing better in school” (FG 3, P F1). The benefits of pharmacotherapy were also measured by the lack of negative comments from the child’s teacher or school personnel: “The behaviour has changed, I’m not getting phone calls from the principals or deputy principals” (FG 1, P M1).
Social progress was another benefit witnessed by the parents, with decreased aggression allowing the children to build on their social skills and establish friendships among their peers: “[medication allows child to] get on a lot better with other people . . . she doesn’t suddenly get really aggressive” (FG 3, P F1).
It is important to note that although these parents persisted with pharmacotherapy, many had the intention of discontinuing treatment at some point in the future: “You suddenly look at this [medication] when they are older and you think ‘Should they be on these drugs?’” (FG 1, P F3). They emphasized a perception that the treatment is a short-term intervention, generally targeted at improving the child’s academic performance: “That was the main focus [of the medication] . . . to get him [child] concentrating, sit down and listen to the teacher, give yourself a fair go at . . . an education—otherwise it [the medication] was out” (FG 1, P M1). This attitude was reflected in how the parents administered the medications: “Only when he’s [child] going to school” (FG 3, P M2). As described by one parent, the justification for this approach was, “You’re on it [the medication] basically for concentration purposes. . . . At home, you’re not in the classroom now mate, different rules” (FG 1, P M1).
Modification or Cessation of Pharmacotherapy
Theme 3—Parental experiences with side effects
Side effects of medications used to treat ADHD were one of the major concerns parents had about pharmacotherapy that often led to treatment modification or cessation. The majority of the parents in this study noted that their children experienced appetite suppression and consequent weight loss as a result of treatment with stimulant medications such as Ritalin® (methylphenidate).
Parents addressed this by modifying their child’s treatment- reducing the dose of the medication, following consultation with their HCP, which resulted in improved appetite and weight gain. Other parents did this of their own accord, with some ceasing the medication abruptly to help minimize the impact of side effects: “You have to take them off [the medication] because they’re not eating . . . we’d [parents] just stop them, not wean them off” (FG 3, P M1).
A medication break or holiday was another treatment modification used by parents to reduce unwanted effects, whereby parents stopped giving the child the medication during weekends or school breaks without necessarily consulting their HCP: “[During] weekends . . . we won’t let him touch it [medication]” (FG 1, P M1).
Theme 4—Potential long-term effects of medication use
Aside from the short-term side effects of the medications used to treat ADHD, parents expressed concern about how the medications would affect their children in the long term. A common concern expressed by the parents was the potential for addiction and abuse with continued use of ADHD medications especially during the adolescent years where one parent described, “The tablets were disappearing more often than he was [supposed to be] taking them” (FG 1, P M1).
Parents also feared that prolonged use of ADHD medications would increase the potential for their children to become involved with illicit drug use in the future: “It [medication] can lead them [to] being more on the side of experimenting [with] drugs” (FG 1, P F3).
Another concern held by parents was the impact the medications would have on their child’s growth, with some fearing that the observed appetite suppression and weight loss would result in irreversible growth stunting: “I think it’s quite serious with younger children, the main stage where they are growing” (FG 3, P F1).
Theme 5—Parental experiences of stigma
The parents in this study described experiencing stigma from a number of sources as a consequence of their decision to medicate their child. The most common source was members of the general public who often questioned the existence of ADHD altogether and blamed the parents for not being able to control their child’s behavior without relying on “drugs”: “That’s the negativity with people out there, they say you have got them on drugs to control them, you don’t know how to raise your kids without drugs” (FG 1, P F2).
Parents described facing criticisms of their parenting skills and reprimands from family members for giving their children medications that would “turn them into drug addicts.” The affected child’s grandparents in particular shared such views regarding medication use, questioning the need for such treatment in the first place and often blaming the parents’ parenting styles or lack of disciplinary measures for the child’s behavior: “They’ve [elderly] heard one side of the story . . . the negative side [of using medications] . . . and that’s all they’ve got in their head” (FG 1, P M1). Parents received similar criticisms of their parenting skills from friends: “We found that we were personally getting confronted with people saying that we were bad parents” (FG 3, P M1).
These stigmatizing attitudes had several consequences as described by the parents, the most apparent of which was avoiding telling others about their child’s ADHD and medication use out of fear of such negative attitudes and feedback: “You don’t wake up and advertise it [child’s medication use] . . . because then they [friends and family] look upon your kid in a different way” (FG 1, P M1).
Consequently, parents described feelings of isolation and lack of support from others while trying to deal with their child’s ADHD: “You feel really left out there and it’s like you’ve got something worse than leprosy. You’ve got the kid that’s the mongrel on the block, nobody wants to know you and you’re really left out to dry. It’s really horrible” (FG 3, P M1). For some parents, this isolation led to a sense of frustration as they described how others’ lack of empathy was difficult for them: Everyone looks at you, like you’ve got this uncontrollable child and . . . people have absolutely no idea what you have to live with, what you have to put up with. They look at you like you’re the bad parent, you know [they’ve] got no idea, and that’s how I felt. (FG 2, P F2)
Within the schooling environment, the parents of the affected child’s peers bluntly expressed concerns about the child being a negative influence on their own children. In several instances, the parents reported that this resulted in social isolation for them and their child: “My son’s social group seemed to whittle down quite significantly over time and now in hindsight . . . it’s apparent that many parents must have considered him to be a bad influence [on their own children]” (FG 3, P M2). Parents emphasized that the attitude held by other parents of the child’s peers was one of “He [child with ADHD] can’t be around my children because I can’t trust him” (FG 2, P F3). For some parents, the realization of these social consequences of ADHD was a gradual one, “You’d wonder why he wasn’t being asked to this party. It sounds petty, but social interaction issues just appeared . . . the little pieces of the jigsaw all started to fit together much too late for us” (FG 3, P M3).
Other parents noted that their children were aware of classmates being conscious of their medication taking which resulted in a form of internal stigma whereby the children recognized and questioned why they were different: “Because [of] how things are, she [affected child] says, ‘Well, I’m wondering what’s wrong with me?’” (FG 1, P F2). As a consequence, the children often felt embarrassed about their medication taking and were aware of the potential for social isolation: “The kids don’t want to have their medications if they are doing sleepovers. . . . They know it’s not an antibiotic so they are embarrassed” (FG 1, P F3).
Discussion
To our knowledge, this is the first qualitative investigation exploring Australian parents’ perspectives about the factors that affect their adherence to pharmacotherapy for the management of their children’s ADHD. In doing so, we were able to illustrate the variety of factors that influence these parents’ decisions to initiate, continue, modify, or cease treatment.
The parents in this study described a range of factors that influenced their decisions surrounding adherence to pharmacotherapy for their child’s ADHD treatment. Their accounts highlight the complexities surrounding parental decisions to remain adherent, which extend beyond whether the medication causes observable improvement in symptoms. Parents’ concern about their child’s academic and social progress was the strongest motivator for them to initiate and persist with pharmacotherapy. This motivation was strengthened as a result of the rapid symptom improvement observed after medication use. Support from HCPs and other parents of children affected by ADHD also encouraged parents to continue therapy with medications. Despite this, parents reported that medication side effects, concern about long-term consequences of medication use, and stigmatizing experiences associated with their child’s treatment often led to modification or cessation of therapy.
The short-term side effects witnessed by parents in this study reflect those described in previous studies, including appetite suppression (Bussing & Gary, 2001), weight loss (Hansen & Hansen, 2006), and sleep disturbances (Charach, Skyba, Cook, & Antle, 2006). While some parents sought HCP advice to address these side effects, for others this contributed to decisions to discontinue treatment or modify dosing regimens of their own accord even when the child showed symptomatic benefit. This parental self-adjustment of medication dosages has been highlighted in previous work (Berger et al., 2008) and can lead to, as witnessed by many of the parents in this study, an observable deterioration in ADHD symptoms.
Although these side effects may justifiably be of concern to parents, evidence in the literature indicates that they are generally short lived (Wolraich, McGuinn, & Doffing, 2007) and related to dosing time (Graham & Coghill, 2008) and strength (Ahmann et al., 1993). Parents’ diversions from agreed treatment regimens highlight that appropriate and adequate avenues for information exchange may not have been afforded to these parents. To help alleviate parental concerns, it is critical that they are informed about the dose-dependent nature of ADHD medication side effects and the need for follow-up consultations at regular intervals until an optimal dose can be reached (AAP, 2011). Parents should also be reassured that medications will be continued only in the event that their benefits outweigh unacceptable side effects and that the trial of an alternative medication may yield a more desirable response (Ahmed et al., 2013).
Another contributor to treatment cessation was the concern about the risks of long-term medication use, fuelled by ongoing public discussions regarding whether stimulant medications cause growth stunting (Swanson et al., 2007), cardiac problems (Nissen, 2006; Wilens, Prince, Spencer, & Biederman, 2006), and addiction or drug abuse predisposition (Charach et al., 2006) later in life. The findings of a recent 10-year-follow-up study examining the impact of stimulant medication on the growth of 124 children highlighted that there was no association between this treatment and negative growth outcomes (Biederman, Spencer, Monuteaux, & Faraone, 2010). Others conclude that such treatment may have minor, transient impacts on growth but that it is of little practical importance (Vitiello, 2008). Similar consensus exists about cardiovascular consequences related to ADHD pharmacotherapy use, with an understanding that changes in blood pressure and heart rate are not clinically significant and are unlikely to have negative impacts in the long term (Steifel & Besag, 2010).
Despite this, there was a general sentiment among the parents in this study that prolonged therapy with medications would be detrimental for their child in the future especially in regard to concerns about potential for addiction and substance abuse. These sentiments contradict current evidence that suggests that children who receive pharmacotherapy for the management of their ADHD are not at an increased risk of later substance use disorders or dependence (Humphreys, Eng, & Lee, 2013). In fact, the findings of a literature review concluded that children receiving treatment with stimulants are approximately two times less likely to develop subsequent drug or alcohol use disorders compared with those who do not receive such treatment for their ADHD (Wilens, Faraone, Biederman, & Gunawardene, 2003). These protective effects of stimulant medications were again demonstrated in a 5-year prospective follow-up study where it was found that this treatment reduced the risk for cigarette smoking and substance use disorders (Wilens et al., 2008).
As a result of these parental concerns, pharmacotherapy was viewed as only a temporary intervention, targeted at the improvement of school performance in particular. This perception is also in conflict with current understandings about the pervasive and far-reaching impacts of ADHD symptoms that persist into adolescence in approximately 50% of cases and adulthood in 30% to 60% of these (Barkley, 1990; Salmeron, 2008). In line with this, current practice guidelines emphasize that long-term treatment may often be indicated and stipulate that the goals of pharmacotherapy extend beyond the improvement of academic performance (NHMRC, 2012). An interesting area to consider in future work would be to examine whether parents also view alternative treatment such as behavioral therapy as a temporary intervention and to determine which treatments they perceive to have the most enduring impacts. In the meantime, however, it is essential that information addressing the purpose of pharmacotherapy and the likelihood of long-term adverse effects is given to parents, especially in the presence of controversial media reports and negative public sentiments about such treatment. Although large-scale investigations examining the long-term risks of ADHD pharmacotherapy have been conducted (Biederman et al., 2010; McCarthy, Cranswick, Potts, Taylor, & Wong, 2009), it is imperative that their findings are relayed to parents in an easily accessible and comprehensible format. By presenting to parents the facts about the likelihood of certain adverse events occurring, parents will be able to make informed choices about continuation of, and adherence to, pharmacotherapy regimens.
Parents were also concerned about how others viewed them and their children as a result of their medication use. Many parents faced personal criticisms of their parenting styles from family members and members of the public that led to the parents avoiding disclosure about their child’s condition to others and experiencing feelings of social isolation and overall lack of support. While some of the parents in this study remained unaffected by stigmatizing encounters, others began to doubt the need for their child to be on medication altogether. Such stigmatizing attitudes have been documented in previous studies (Bussing & Gary, 2001; Jackson & Peters, 2008; Singh, 2003) and stem from a lack of understanding of the causes of ADHD by members of the public that is aggravated by negative media coverage of ADHD and its treatments (Mayes, Bagwell, & Erkulwater, 2008). Interestingly, the parents in this study noted that even their children were subjected to and were conscious of stigma from their peers that at times influenced the child’s willingness to take the medication. This adds to the complexity of adherence to pharmacotherapy for ADHD, with the child’s comfort level and wishes adding another dimension to parents’ decisions to continue with or adhere to treatment, particularly as the child grows older and becomes more vocal in expressing his or her opinions about the treatment. Studies have shown that parents concerned about stigma are less likely to seek health care services for their child (Eiraldi, Mazzuca, Clarke, & Power, 2006). The impact of stigma on adherence to ADHD pharmacotherapy is therefore an important issue that requires attention in future research.
Thus, while the decision to remain adherent to pharmacotherapy for ADHD may appear simple, it is in fact a complex one for parents. Parents in this study expressed a need to do the best for their child and that their decisions to persist with medication were the result of a balancing act where the advantages and disadvantages of medication use were weighed against those associated with medication cessation, a finding corroborated by previous research (Hansen & Hansen, 2006).
The findings of this study should be viewed in light of a few limitations. As is the case for most qualitative investigations, the present study was not designed to address specific hypotheses or produce conclusions about a particular phenomenon. Rather, the use of a qualitative investigative approach was intended to allow the collation of in-depth information (Morton et al., 2010) about parents’ firsthand experiences with and perspectives about adherence to pharmacotherapy for ADHD. As this remains an area that is underreported and not well understood, particularly from an Australian perspective, in many ways this qualitative approach was the most rigorous and suitable way to establish insights into this topic (Giacomini & Cook, 2000). Hence, while the qualitative approach used may not provide definitive quantitative answers to a specific question, it can lead to the development and testing of potential hypotheses relating to the identified factors in future quantitative investigations (Giacomini & Cook, 2000).
The decision to use focus groups specifically in this study was made in preference to the use of interviews, with the intention that the experiences of other parents would encourage participants to voice their opinions. This was observed in all three focus groups whereby parents were not only able to relate to and contrast with the experiences of others, but also use the discussions as an avenue for support and reassurance. It is possible, however, that this group setting may have deterred some parents from contributing to the same extent as others who were more vocal during the discussion. To minimize the potential for this, care was taken during the focus group discussions by an experienced facilitator to ensure that each parent was given the opportunity to express his or her views.
Another potential limitation of this study is the small number of participants needed to reach data saturation and their recruitment from Sydney metropolitan areas only, which may affect the transferability of study findings to other populations. While the findings from this qualitative study are not necessarily intended to be generalized to the entire population, there was a strong level of agreement between the findings of the current study and those conducted previously, which supports their relevance. As part of this study, we did not intend to determine adherence rates for the different medications used to treat ADHD, or look at the differences in adherence due to particular agents or dosing regimens. Consequently, no specific comments can be made about the impact that different agents or dosing regimens may have on parents’ adherence decisions, which presents an interesting avenue for future research. Moreover, because all the parents who participated in the focus groups had tried or were continuing to use medications for their child, it is likely that their perspectives may differ from parents who have refused this treatment path altogether or have adopted alternative non-pharmacological treatments.
Conclusion
In summary, the findings presented here highlight the complexities associated with Australian parents’ decision-making processes about adherence to pharmacotherapy for ADHD. In utilizing a qualitative approach, we were able to provide a more in-depth insight into the largely unheard experiences of these parents and to develop an understanding of the major issues influencing their treatment decisions. By exploring how their views contrast or reconcile with current evidence and practice guidelines, this article has generated potential for further work in this area.
Parents’ desire to continue with pharmacotherapy for their child stemmed from concerns about school performance and from the advice and support of HCPs. Modification and cessation of treatment were encouraged by the observation of short-term side effects, the anticipation of long-term side effects, and also experiences of stigma. Importantly, the dynamic nature of parents’ decisions implies that targeted strategies can be developed to remedy parental concerns. It seems pertinent that future research focuses on enhancing the capacity for parents to access information especially about how to manage short-term side effects, and the risks of long-term pharmacotherapy.
The findings also emphasize the need for the development of public health awareness programs targeting stigma associated with psychological disorders such as ADHD to help minimize stigmatizing experiences faced by parents and their children. When considering the extent of medication nonadherence in ADHD, it is also clear that targeted interventions and tools to promote adherence and persistence with pharmacotherapy are also required. The development and testing of such tools can form the basis of future quantitative work in this field. Importantly, HCPs can use the information presented here to enhance communication with parents and their children about medication side effects, misconceptions about ADHD and its treatments, and the stigmatizing experiences they may face, to promote adherence and improve clinical outcomes.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.