ADHD - a family focused approach
Parents of children with Attention-Deficit/Hyperactivity Disorder (ADHD) are often lacking critical information about the chronic nature of the condition. The results, based on a survey conducted in the United States last year, and presented at the American Academy of Child and Adolescent Psychiatry (AACAP), showed that most parents know that ADHD can be inherited and typically presents before a child is 10 years old. What concerned the researchers, who are based at the University of California in Los Angeles, was that 60% of parents were not aware that ADHD can persist into adulthood. 75% believed that dietary manipulation would improve ADHD symptoms and 61% were reluctant to start their children on medical therapy.
“The findings show the urgent need for family education about ADHD,” says Dr Bonnie Zima who presented the findings at AACAP. Clinicians need to know the families' attitudes and knowledge base about ADHD so that they can work with the family to build an effective therapeutic alliance and maximize adherence to the treatment plan.
Another similar study, conducted at the Mount Saint Vincent University in Halifax, Nova Scotia, which was published in the Canadian Journal of Psychiatry, found that parents' knowledge of ADHD and opinions of treatments play a significant role in whether they are wiling to consider treatment for their children with ADHD. It found that providing information to parents regarding ADHD prior to offering them treatment options could have a favourable impact on treatment enrollment and therefore, treatment adherence.
ADHD, which is characterized by inattention, over activity and impulsivity, is a chronic set of symptoms often persisting throughout children and into adulthood. Moreover, it is a disorder affecting many aspects of a child's life including academic performance, social functioning and parent-child relations. Pharmacological and behavioral interventions, used separately or in conjunction, have been shown to be effective in treating ADHD. Nonetheless, adherence to recommended pharmacological interventions for ADHD are fair to poor.
Parents' views regarding medication, their care-seeking strategies, and their family-life situations all influence their willingness to consider medical therapy for their children with ADHD. Parents often have ambivalent attitudes about potential interventions, particularly medication. Problem severity has also been found to predict treatment acceptability in some cases. When parents decide to use medical therapy, the decision occurs after the parent establishes alliances with clinicians and other healthcare professionals, and knowledge and understanding about ADHD is shared.
“I fully endorse the family focus when managing ADHD. We have been guilty in the past of meticulously maximizing therapy for optimal success in the academic hours of the day, whilst neglecting the other six to eight hours of the awake-time. Yes and the night-time too,” says Dr Michael Lippert, a Paediatric Neurologist from Centurion.
Other hindrances to parents accepting that medication might be a reasonable option for their child suffering from ADHD are the various misunderstandings that exist about ADHD. Public perceptions of ADHD are full of myths, misconceptions and misinformation about the nature, course and treatment of the disorder.
While barriers to treatment have been reduced in recent years, there is still a climate of blame, shame, embarrassment and stigmatism that discourages some patients, and parents' of patients, from seeking help for disorders such as ADHD. Some much misconceptions include that ADHD is not a disorder, that it is over-diagnosed and over-medicated and that it is caused by bad parenting. Other factors that could affect a parent's decision to medicate their child with ADHD could include a lack of perceived need, system barriers including availability, cost and language, the stigma associated with seeking help for “mental illnesses”, length of treatment and cost of medication.
“Regarding the pervading information levels in families, nuclear and extended families, our concern is huge. There is as much lack of appropriate information as there is misinformation, and frank untruth, floating about. We commit ourselves to walk arm-in-arm with all who seek to spread accurate, empowering knowledge, truthfully,” says Dr Lippert.
Recognition of ADHD, as well as pharmacologic treatments for this disorder, have significantly increased during the past decade. It is estimated that between 3% and 7% of school-aged children may have ADHD, with the American Academy of Pediatrics ADHD treatment guideline suggesting a prevalence rate of up to 8% to 10%. Up until recently, psychostimulant medication has been considered the primary pharmacotherapy for ADHD. While these are generally efficacious, a significant number of patients exhibit an inadequate response or cannot tolerate their use. A non-stimulant medication, launched into South Africa three years ago, has made available another treatment option, which has been shown in studies to be effective, and well tolerated, for the treatment of children with ADHD.
When clinicians or healthcare practitioners know the parents' preferences, and what prejudice they might initially have, they can then establish an association with the parents and maximize the likelihood that the parent and patient will adhere to the treatment.
For more information about ADHD, go to www.connecting-to-life.co.za.
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