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Sleath B, Beznos B, Carpenter D, Thomas K, Annis I, Tudor G, Garcia N, Adjei A, Anastopoulos A, Leslie L, Coyne I. A pre-visit video/question prompt list intervention to increase youth question-asking about attention deficit hyperactivity disorder during pediatric visits. PATIENT EDUCATION AND COUNSELING 2024; 127:108320. [PMID: 38851012 DOI: 10.1016/j.pec.2024.108320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 04/09/2024] [Accepted: 05/10/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE To conduct a pragmatic randomized controlled trial to test the effectiveness of an ADHD question prompt list with video intervention to increase youth question-asking and provider education about ADHD during visits. METHODS English-speaking youth ages 11-17 with ADHD and their caregivers were enrolled from two pediatric clinics. Youth were randomized to intervention or usual care groups. Intervention group adolescents watched the video and then completed an ADHD question prompt list before their visits. Multivariable regression was used to analyze the data. RESULTS Twenty-one providers and 102 of their patients participated. Intervention group youth were significantly more likely to ask one or more questions about ADHD and its treatment than usual care youth (odds ratio=5.4, 95 % Confidence Interval (CI)= 1.8, 15.9). Providers were significantly more likely to educate youth who asked one or more questions during visits about more ADHD medication areas (unstandardized beta=0.98, 95 % CI=0.31 to 1.64) and more non-medication strategies for ADHD (unstandardized beta=0.50, 95 % CI=0.13 to 0.88). CONCLUSION The intervention increased youth question-asking about ADHD and its treatment. Providers provided more education to youth who asked one or more questions about ADHD and its treatment. PRACTICE IMPLICATIONS Providers and practices should consider having youth complete ADHD question prompt lists and watch the video before visits to increase youth question-asking during visits.
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Affiliation(s)
- Betsy Sleath
- Department of Pharmaceutical Outcomes and Policy, University of North Carolina Chapel Hill, Chapel Hill, NC, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC, USA.
| | - Bethany Beznos
- Department of Pharmaceutical Outcomes and Policy, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
| | - Delesha Carpenter
- Department of Pharmaceutical Outcomes and Policy, University of North Carolina Chapel Hill, Chapel Hill, NC, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC, USA.
| | - Kathleen Thomas
- Department of Pharmaceutical Outcomes and Policy, University of North Carolina Chapel Hill, Chapel Hill, NC, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC, USA.
| | - Izabela Annis
- Department of Pharmaceutical Outcomes and Policy, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
| | - Gail Tudor
- Southern New Hampshire University, Manchester, NH, USA.
| | - Nacire Garcia
- Department of Pharmaceutical Outcomes and Policy, University of North Carolina Chapel Hill, Chapel Hill, NC, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC, USA.
| | - Abena Adjei
- Department of Pharmaceutical Outcomes and Policy, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
| | | | - Laurel Leslie
- American Board of Pediatrics, Chapel Hill, NC, USA; Tufts University School of Medicine, Boston, MA, USA.
| | - Imelda Coyne
- Trinity College Dublin, College Green, Dublin 2, Ireland.
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Nicholson T, Lee R. Parental illness work across the attention deficit hyperactivity disorder diagnostic journey. SOCIOLOGY OF HEALTH & ILLNESS 2024. [PMID: 39023845 DOI: 10.1111/1467-9566.13817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 05/15/2024] [Indexed: 07/20/2024]
Abstract
The process of referral, assessment, and diagnosis of attention deficit hyperactivity disorder (ADHD) within the UK is often protracted. Given that parents are frequently the instigators of the diagnostic process, understanding the experience of parents is important. Drawing on findings from a longitudinal study, this article explores how the parental experience of the ADHD diagnostic journey includes three significant and distinct forms of 'illness work'. Twenty-one semi-structured serial interviews were conducted over a 2-year period with seven parents of children on the ADHD diagnostic journey in North East England. We present three significant forms of parental illness work: (1) The 'diagnostic quest', parental work recognising and fighting for their children's needs and selfhood, seeking diagnosis and engaging with systems, (2) 'self-biographical illness work', the personal parental biographical response to the diagnostic journey and (3) 'child biographical illness work and recontextualizing the child', parental biographical adjustment and recontextualisation of their children. We advance Rasmussen et al.'s (2021) model by demonstrating its usefulness in understanding how parents with a personal ADHD diagnosis experience biographical disruption or cohesion in response to their children's diagnosis. That a child's diagnosis leads parents with ADHD to experience a self-biographical cohesive or disruptive response is a unique and significant finding.
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Affiliation(s)
- Tom Nicholson
- Faculty of Health & Life Sciences, Northumbria University, Newcastle, UK
| | - Richard Lee
- Faculty of Health & Life Sciences, Northumbria University, Newcastle, UK
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Liu TL, Hsiao RC, Chou WJ, Yen CF. Parenting stress, anxiety, and sources of acquiring knowledge in Taiwanese caregivers of children with attention-deficit/hyperactivity disorder. BMC Public Health 2024; 24:1675. [PMID: 38914984 PMCID: PMC11195007 DOI: 10.1186/s12889-024-18761-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/02/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND This survey study investigated the types of sources other than medical professionals (e.g., social media) that the caregivers of children with attention-deficit/hyperactivity disorder (ADHD) use to acquire knowledge about ADHD and investigated the association between the use of such information sources and caregiver parenting stress and anxiety in Taiwan. METHODS A total of 213 caregivers of children with ADHD participated in this study. The sources that the caregivers used to acquire knowledge about ADHD other than medical professionals were investigated. Caregiver parenting stress was assessed using the Parenting Stress Index, and caregiver anxiety was assessed using the Beck Anxiety Inventory. The associations of the types of sources used and total number of source use with caregiver parenting stress and anxiety were investigated using multivariate linear regression analysis. RESULTS The most common source of knowledge other than medical professionals was teachers (55.4%), followed by social media (52.6%), traditional media (50.7%), friends (33.8%), caregivers of other children (21.1%), and family members (18.3%). The caregivers' mean total number of using sources of knowledge about ADHD other than medical professionals was 2.32. Acquiring knowledge about ADHD from social media was significantly associated with caregiver parenting stress. Additionally, acquiring knowledge about ADHD from caregivers of other children was significantly associated with caregiver parenting stress and anxiety, as was the frequency of using sources of knowledge about ADHD other than medical professionals. CONCLUSION The caregivers of children with ADHD acquired knowledge about ADHD from multiple sources. Acquiring knowledge about ADHD from social media was significantly associated with caregiver parenting stress. The number of sources of knowledge about ADHD was significantly associated with caregiver parenting stress and anxiety.
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Affiliation(s)
- Tai-Ling Liu
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, and Department of Psychiatry, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, 80708, Taiwan
| | - Ray C Hsiao
- Department of Psychiatry, Seattle Children's, Seattle, and Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Wen-Jiun Chou
- Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, 32 Dapi Rd. Niaosong Dist, Kaohsiung, 83341, Taiwan.
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, and School of Medicine College of Medicine, Kaohsiung Medical University, 100 Tzyou 1st Road, Kaohsiung, 80708, Taiwan.
- College of Professional Studies, National Pingtung University of Science and Technology, Pingtung, Taiwan.
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Laurin E, Andersson L. Emotion work and emotional labour, neglected facets of parental health information work. Analysing mothers of neurodivergent children. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:1023-1053. [PMID: 38568719 DOI: 10.1111/1467-9566.13775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 03/12/2024] [Indexed: 06/21/2024]
Abstract
The neoliberal and biomedical 'good caregiver' discourse neglects the many facets of everyday information work that parents of children with special needs are required to do as they seek, receive and share information concerning their children's health and wellbeing. Along with time and skills, one such neglected facet is emotion work, the management of feelings in relation to societal norms. The purpose of this article is to explore emotion work, as a facet in parental health information work in the care and education sector, among mothers of neurodivergent children. Our analysis draws on interviews with 50 Swedish mothers of neurodivergent children. We present three primary insights. 1. Emotion work, on the self as well as on others, is pivotal to the information work that the mothers carry out in the education and care sector as they strive to ameliorate their children's situation. 2. Contested diagnoses, such as diagnoses associated with neurodivergent conditions, result in intense parental information and emotion work. 3. Fragmented and complex education and care systems, alongside traditional gender structures, compel mothers to undertake extensive information and emotion work.
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Affiliation(s)
- Emma Laurin
- Department of Education, Uppsala University, Uppsala, Sweden
| | - Lisa Andersson
- Department of Archival Science, Library & Information Science, and Museum & Heritage Studies, Uppsala University, Uppsala, Sweden
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Alsubaie MA, Alshehri ZY, Alawadh IA, Abulreesh RY, Altaweel HM, Alateeq DA. Treatment Adherence and Related Factors Among Children with Attention-Deficit/Hyperactivity Disorder in Saudi Arabia. Patient Prefer Adherence 2024; 18:337-348. [PMID: 38327726 PMCID: PMC10849136 DOI: 10.2147/ppa.s443481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Attention-deficit/hyperactivity disorder (ADHD) is a common childhood psychiatric disorder. It frequently persists into adulthood and is a risk factor for other mental disorders and adverse outcomes, mainly if not managed optimally. This study aimed to assess ADHD treatment adherence and explore the underlying causes of non-adherence in ADHD children in Saudi Arabia. Methods A cross-sectional study of a convenience sample of 221 participants. The survey included demographic characteristics of the child and parents, the child's medical history, quality of services evaluation, as well as medication adherence assessment by Medication Adherence Report Scale (MARS), the general beliefs about medicines questionnaire (General-BMQ), in addition to assessing the parents' beliefs about ADHD and provided/recommended treatment. Results The sample was primarily 6 to 8-year-old children (32.81%) and males (78.52%). Most subjects were prescribed extended-release agents (45.7%), and overall, high-quality services were provided to the patients. The adherence rate of ADHD patients to their medication was 89.77%. The mother's education correlated significantly with patient adherence (p=0.029), and the mother's age correlated significantly with their beliefs (p=0.021), in addition to the family income (0.033). Children on Methylphenidate Immediate Release had good compliance with the medication (p=0.008). Moreover, Methylphenidate Extended Release has shown continuity results, increasing the adherence rates (p=0.035). Conclusion ADHD medication adherence was high and associated with older age, educational status, and type of medication used. Physicians should consider these factors to improve adherence in their patients.
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Affiliation(s)
- Maha Ali Alsubaie
- Internal Medicine Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, 16711Saudi Arabia
| | - Zainah Yahya Alshehri
- Internal Medicine Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, 16711Saudi Arabia
| | - Ibtihaj Abdullah Alawadh
- Internal Medicine Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, 16711Saudi Arabia
| | - Razan Yasser Abulreesh
- Internal Medicine Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, 16711Saudi Arabia
| | | | - Deemah Ateeq Alateeq
- Internal Medicine Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, 16711Saudi Arabia
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Sharma P, Kularatna S, Abell B, Eagleson K, Vo LK, Halahakone U, Senanayake S, McPhail SM. Preferences in the Design and Delivery of Neurodevelopmental Follow-Up Care for Children: A Systematic Review of Discrete Choice Experiments. Patient Prefer Adherence 2023; 17:2325-2341. [PMID: 37745632 PMCID: PMC10517687 DOI: 10.2147/ppa.s425578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/31/2023] [Indexed: 09/26/2023] Open
Abstract
Neurodevelopmental disorders are a significant cause of morbidity. Early detection of neurodevelopmental delay is essential for timely diagnosis and intervention, and it is therefore important to understand the preferences of parents and clinicians for engaging with neurodevelopmental surveillance and follow-up care. Discrete choice experiment (DCE) may be an appropriate method for quantifying these preferences. This review systematically examined how DCEs have been designed and delivered in studies examining neurodevelopmental care of children and identified the preferred attributes that have been reported. PubMed, Embase, CINAHL, and Scopus databases were systematically searched. Studies were included if they used DCE to elicit preferences for a neurodevelopmental follow-up program for children. Two independent reviewers conducted the title and abstract and full-text screening. Risk of bias was assessed using a DCE-specific checklist. Findings were presented using a narrative synthesis. A total of 6618 records were identified and 16 papers were included. Orthogonal (n=5) and efficient (n=5) experimental designs were common. There was inconsistent reporting of design-related features. Analysis was primarily completed using mixed logit (n=6) or multinomial logit (n=3) models. Several key attributes for neurodevelopmental follow-up care were identified including social, behavioral and emotional support, therapy, waiting time, and out-of-pocket costs. DCE has been successfully used as a preference elicitation method for neurodevelopmental-related care. There is scope for improvement in the design and analysis of DCE in this field. Nonetheless, attributes identified in these studies are likely to be important considerations in the design and implementation of programs for neurodevelopmental care.
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Affiliation(s)
- Pakhi Sharma
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Karen Eagleson
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Linh K Vo
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ureni Halahakone
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
- Digital Health and Informatics Directorate, Metro South Health, Brisbane, QLD, Australia
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Scholze DA, Gosdin MM, Perez SL, Schweitzer JB. Identifying the Information Needs and Format Preferences for Web-Based Content Among Adults With or Parents of Children With Attention-Deficit/Hyperactivity Disorder: Three-Stage Qualitative Analysis. JMIR Form Res 2023; 7:e47409. [PMID: 37695648 PMCID: PMC10520768 DOI: 10.2196/47409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent childhood and adult behavioral disorder. Internet searches for ADHD information are rising, particularly for diagnosis and treatment. Despite effective ADHD treatments, research suggests that there are delays in seeking help for ADHD. Identifying ways to shorten delays is important for minimizing morbidity associated with ADHD. One way to shorten these delays is to improve internet health information resources. Research shows that parents of children with ADHD feel that much of the information available is technical and not tailored for their child's needs and verbal instructions given by health care providers were too pharmacologically focused with limited information about how to manage and support ADHD symptoms in daily living. A majority of parents search the internet for general and pharmacological information for ADHD and prefer web-based resources for learning about ADHD, but web-based resources may be inaccurate and of low quality. Ensuring accurate information through the internet is an important step in assisting parents and adults in making informed decisions about the diagnosis and treatment of ADHD. OBJECTIVE Although a great deal of information regarding ADHD is available on the internet, some information is not based on scientific evidence or is difficult for stakeholders to understand. Determining gaps in access to accurate ADHD information and stakeholder interest in the type of information desired is important in improving patient engagement with the health care system, but minimal research addresses these needs. This study aims to determine the information needs and formatting needs of web-based content for adults with ADHD and parents of children with ADHD in order to improve user experience and engagement. METHODS This was a 3-phase study consisting of in-depth phone interviews about experiences with ADHD and barriers searching for ADHD-related information, focus groups where participants were instructed to consider the pathways by which they made decisions using web-based resources, and observing participants interacting with a newly developed website tailored for adults with potential ADHD and caregivers of children who had or might have ADHD. Phase 1 individual interviews and phase 2 focus groups identified the needs of the ADHD stakeholders related to website content and format. Interview and focus group findings were used to develop a website. Phase 3 used think-aloud interviews to evaluate website usability to inform the tailoring of the website based on user feedback. RESULTS Interviews and focus group findings revealed preferences for ADHD website information and content, website layout, and information sources. Themes included a preference for destigmatizing information about ADHD, information specific to patient demographics, and evidence-based information tailored to lay audiences. CONCLUSIONS ADHD stakeholders are specifically seeking positive information about ADHD presented in a user-friendly format.
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Affiliation(s)
- Danielle A Scholze
- MIND Institute, University of California, Davis, Sacramento, CA, United States
- Department of Pediatrics, University of California, Davis, Sacramento, CA, United States
| | - Melissa M Gosdin
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, United States
| | - Susan L Perez
- Department of Kinesiology and Health Science, California State University, Sacramento, CA, United States
| | - Julie B Schweitzer
- MIND Institute, University of California, Davis, Sacramento, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
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May T, Birch E, Chaves K, Cranswick N, Culnane E, Delaney J, Derrick M, Eapen V, Edlington C, Efron D, Ewais T, Garner I, Gathercole M, Jagadheesan K, Jobson L, Kramer J, Mack M, Misso M, Murrup-Stewart C, Savage E, Sciberras E, Singh B, Testa R, Vale L, Weirman A, Petch E, Williams K, Bellgrove M. The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder. Aust N Z J Psychiatry 2023; 57:1101-1116. [PMID: 37254562 PMCID: PMC10363932 DOI: 10.1177/00048674231166329] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The objective of this article was to provide an overview of the development and recommendations from the Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder (ADHD). The guideline aims to promote accurate and timely identification and diagnosis, and optimal and consistent treatment of ADHD. METHODS Development integrated the best available evidence with multidisciplinary clinical expertise and the preferences of those with lived experience, underpinned by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. The 23 guideline development group members included psychiatrists, paediatricians, general practitioners, psychologists, speech pathologists, occupational therapists, educators, Indigenous psychologists, and people with a lived experience; with two independent chairs and a methodologist. Where appropriate, evidence reviews from the National Institute for Health and Care Excellence (NICE) 2018 'Attention Deficit Hyperactivity Disorder: Diagnosis and Management' guideline were updated. Fifty prioritised clinical questions were addressed in 14 systematic reviews (new and updated from NICE 2018) and 28 narrative reviews. RESULTS The 113 clinical recommendations apply to young children (5 years and under), children, adolescents and adults. They provide guidance for clinicians on identification, screening, diagnosis, multimodal treatment and support, including pharmacological and non-pharmacological interventions. The guideline and supporting information are available online: https://adhdguideline.aadpa.com.au/. CONCLUSIONS The guideline was approved by the National Health and Medical Research Council (NHMRC) of Australia and relevant medical and allied health professional associations. It is anticipated that successful implementation and uptake of the guideline by organisations, health care providers and other professionals will increase delivery of evidence-based treatment and improve health outcomes for the more than 800,000 Australians with ADHD.
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Affiliation(s)
- Tamara May
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | | | | | - Noel Cranswick
- Clinical Pharmacology Unit, Department of Medicine and Melbourne Children’s Trials Centre, Royal Children’s Hospital, Parkville, Vic, Australia
- Murdoch Children’s Research Institute, Parkville Vic, Australia
- University of Melbourne, Parkville, VIC, Australia
| | - Evelyn Culnane
- The Royal Children’s Hospital Melbourne, Parkville, VIC, Australia
| | - Jane Delaney
- Speech Pathology Australia, Melbourne, VIC, Australia
| | | | - Valsamma Eapen
- South Western Sydney Local Health District and Ingham Institute for Applied Medical Research, UNSW Sydney, Liverpool, NSW, Australia
| | | | - Daryl Efron
- Murdoch Children’s Research Institute, Parkville Vic, Australia
- The Royal Children’s Hospital Melbourne, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Tatjana Ewais
- Faculty of Medicine, University of Queensland, Herston, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
| | - Ingrid Garner
- ADHD Guideline Development Group, Melbourne, VIC, Australia
| | - Michael Gathercole
- Youth Justice, Department of Community and Justice, Grafton, NSW, Australia
| | - Karuppiah Jagadheesan
- NWAMHS–North West Area Mental Health Services, Melbourne, VIC, Australia
- Bi-National ADHD Network Committee, RANZCP - Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia
- Swinburne University, Melbourne, VIC, Australia
| | - Laura Jobson
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - John Kramer
- ADHD, ASD and Neurodiversity Special Interest Group, Faculty of Special Interests, RACGP
- Rural Medical School, UNSW Medicine & Health, Coffs Harbour, NSW, Australia
| | - Martha Mack
- Applied Neuroscience Society of Australasia (ANSA)
| | - Marie Misso
- The Knowledge Synthesis Lab, Melbourne, VIC, Australia
| | - Cammi Murrup-Stewart
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | | | - Emma Sciberras
- Murdoch Children’s Research Institute, Parkville Vic, Australia
- School of Psychology, Deakin University, Burwood, VIC, Australia
| | - Bruce Singh
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Renee Testa
- Department of Mental Health, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Psychology, Monash University, Melbourne, VIC, Australia
| | - Lisa Vale
- Occupational Therapy Australia, Splash Paediatric Therapy, Melbourne, VIC, Australia
| | - Alyssa Weirman
- ADHD Guideline Development Group, Melbourne, VIC, Australia
| | - Edward Petch
- Hakea Prison, Department of Justice, Perth, WA, Australia
- University of Western Australia, Perth, WA, Australia
| | - Katrina Williams
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
- Monash Children’s Hospital, Clayton, VIC, Australia
| | - Mark Bellgrove
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- AADPA Australian ADHD Professionals Association, Melbourne, VIC, Australia
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Bisset M, Brown LE, Bhide S, Patel P, Zendarski N, Coghill D, Payne L, Bellgrove MA, Middeldorp CM, Sciberras E. Practitioner Review: It's time to bridge the gap - understanding the unmet needs of consumers with attention-deficit/hyperactivity disorder - a systematic review and recommendations. J Child Psychol Psychiatry 2023; 64:848-858. [PMID: 36651107 PMCID: PMC10952204 DOI: 10.1111/jcpp.13752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Understanding the unmet needs of healthcare consumers with attention-deficit/hyperactivity disorder (ADHD) (individuals with ADHD and their caregivers) provides critical insight into gaps in services, education and research that require focus and funding to improve outcomes. This review examines the unmet needs of ADHD consumers from a consumer perspective. METHODS A standardised search protocol identified peer-reviewed studies published between December 2011 and December 2021 focusing on consumer-identified needs relating to ADHD clinical care or research priorities. RESULTS 1,624 articles were screened with 23 studies that reviewed examining the needs of ADHD consumers from Europe, the U.K., Hong Kong, Iran, Australia, the U.S.A. and Canada. Consumer-identified needs related to: treatment that goes beyond medication (12 studies); improved ADHD-related education/training (17 studies); improved access to clinical services, carer support and financial assistance (14 studies); school accommodations/support (6 studies); and ongoing treatment efficacy research (1 study). CONCLUSION ADHD consumers have substantial unmet needs in clinical, psychosocial and research contexts. Recommendations to address these needs include: improving access to and quality of multimodal care provision; incorporating recovery principles into care provision; fostering ADHD health literacy; and increasing consumer participation in research, service development and ADHD-related training/education.
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Affiliation(s)
- Matthew Bisset
- School of PsychologyDeakin UniversityMelbourneVICAustralia
- The Royal Children's HospitalParkvilleVICAustralia
- Murdoch Children's Research InsitituteMelbourneVICAustralia
| | | | - Sampada Bhide
- School of PsychologyDeakin UniversityMelbourneVICAustralia
- Murdoch Children's Research InsitituteMelbourneVICAustralia
- The Royal Melbourne HospitalParkvilleVICAustralia
| | - Pooja Patel
- School of PsychologyDeakin UniversityMelbourneVICAustralia
| | - Nardia Zendarski
- Department of PaediatricsUniversity of MelbourneParkvilleVICAustralia
| | - David Coghill
- The Royal Children's HospitalParkvilleVICAustralia
- Murdoch Children's Research InsitituteMelbourneVICAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVICAustralia
| | - Leanne Payne
- Child Health Research CentreUniversity of QueenslandBrisbaneQLDAustralia
- Child and Youth Mental Health ServiceChildren's Health Queensland Hospital and Health ServiceBrisbaneQLDAustralia
| | - Mark A. Bellgrove
- Turner Institute for Brain and Mental Health and School of Psychological SciencesMonash UniversityMelbourneVICAustralia
| | - Christel M. Middeldorp
- Child Health Research CentreUniversity of QueenslandBrisbaneQLDAustralia
- Child and Youth Mental Health ServiceChildren's Health Queensland Hospital and Health ServiceBrisbaneQLDAustralia
| | - Emma Sciberras
- School of PsychologyDeakin UniversityMelbourneVICAustralia
- Murdoch Children's Research InsitituteMelbourneVICAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVICAustralia
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Osako M, Yamaoka Y, Takeuchi C, Fujiwara T, Mochizuki Y. Benefits and Challenges of Pediatric-to-Adult Health Care Transition in Childhood-Onset Neurologic Conditions. Neurol Clin Pract 2023; 13:e200130. [PMID: 37064588 PMCID: PMC10101709 DOI: 10.1212/cpj.0000000000200130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/14/2022] [Indexed: 03/21/2023]
Abstract
Background and Objectives Although the importance of pediatric-to-adult health care transition (HCT) has been recognized, individuals with childhood-onset neurologic conditions often encounter challenges during pediatric-to-adult HCT, and HCT benefits for this population remain elusive. We assessed the current HCT situation in individuals with childhood-onset neurologic conditions to develop an improved transition system that incorporates patient perspectives. Methods This cross-sectional study was conducted at the Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled from November 2020 to December 2020. We targeted adults with childhood-onset neurologic conditions who visited the Department of Internal Medicine and their families. Questionnaires provided to 127 patients asked them about their experiences with pediatric-to-adult HCT (i.e., educational opportunities regarding HCT during pediatric visits, difficulties in transition, and the merits/demerits of adult practice) and their families' perspectives regarding pediatric-to-adult HCT. We also reviewed the patients' medical records to examine the severity of their disabilities. Results Responses were collected from 111 patients (response rate: 87%). Most patients had both severe physical and intellectual disabilities, and approximately half had a physical disability level of Gross Motor Function Classification System V and a profound intellectual disability. Half of the respondents were not transitioned through pediatric-to-adult HCT by their pediatricians, and they visited adult departments by themselves without a formal referral process. They experienced difficulties during HCT, such as a lack of knowledge regarding adult health care providers and consultants. However, those who underwent HCT benefited from it in terms of their health, experience, and service use, such as age- and condition-appropriate care, seeing adult specialists, and the introduction of adult services. They also addressed challenges in managing appointments and having adult doctors understand their medical history. Nonetheless, they were not informed about diseases and medical and welfare resources for adulthood during pediatric visits and desired to discuss future plans with pediatricians. Discussion Systems that provide sufficient pediatric-to-adult HCT for individuals with childhood-onset neurologic conditions are required. Lifelong education for patients and families, training for pediatricians on HCT and neurologists on childhood-onset conditions and disabilities, and clinical practice and human resources that support patients and families are warranted.
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Affiliation(s)
- Miho Osako
- Department of Neurology (MO, CT, YM), Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled; and Department of Global Health Promotion (YY, TF), Tokyo Medical and Dental University
| | - Yui Yamaoka
- Department of Neurology (MO, CT, YM), Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled; and Department of Global Health Promotion (YY, TF), Tokyo Medical and Dental University
| | - Chisen Takeuchi
- Department of Neurology (MO, CT, YM), Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled; and Department of Global Health Promotion (YY, TF), Tokyo Medical and Dental University
| | - Takeo Fujiwara
- Department of Neurology (MO, CT, YM), Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled; and Department of Global Health Promotion (YY, TF), Tokyo Medical and Dental University
| | - Yoko Mochizuki
- Department of Neurology (MO, CT, YM), Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled; and Department of Global Health Promotion (YY, TF), Tokyo Medical and Dental University
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11
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D’Helft J, Caccialanza R, Derbyshire E, Maes M. Relevance of ω-6 GLA Added to ω-3 PUFAs Supplements for ADHD: A Narrative Review. Nutrients 2022; 14:nu14163273. [PMID: 36014778 PMCID: PMC9416383 DOI: 10.3390/nu14163273] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 12/02/2022] Open
Abstract
The use of polyunsaturated fatty acids in Attention-Deficit/Hyperactivity Disorder (ADHD) and developmental disorders has been gaining interest with preparations containing different dosages and combinations. Gamma-linolenic acid (GLA) is an ω-6 fatty acid of emerging interest with potential roles as an adjuvant anti-inflammatory agent that could be used with ω-3 PUFAs in the treatment of ADHD and associated symptoms. A narrative review was undertaken to examine the potential role(s) of the ω-6 fatty acid GLA. PubMed, Google Scholar, and Scopus were searched to examine the potential role(s) of the ω-6 fatty acid GLA as (1) an antioxidant and anti-inflammatory agent, (2) a synergistic nutrient when combined with ω-3 PUFAs, and (3) a potential etiological factor in ADHD and its treatment. The results show that GLA exerts anti-inflammatory effects by increasing dihomo-gamma-linolenic acid in immune cells. ω-3 PUFAs, such as EPA and DHA, are often co-administered with GLA because these ω-3 PUFAs may prevent the accumulation of serum arachidonic acid in response to GLA administration without limiting the storage of DGLA in immune cells. The administration of ω-3 PUFAs alone might not be sufficient to effectively treat patients with ADHD and developmental disorders. Overall studies point towards a combination of EPA and DHA with GLA in a 9:3:1 ratio appearing to be associated with ADHD symptom improvement. A combination of PUFAs may lead to better outcomes.
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Affiliation(s)
- Jelle D’Helft
- Springfield Nutraceuticals, Managing Director, Research & Development, Veldenstraat 23, 2220 Heist-op-den-Berg, Belgium
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | | | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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12
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Ceyhun HA, Gürbüzer N. New Hematological Parameters as Inflammatory Biomarkers: Systemic Immune Inflammation Index, Platerethritis, and Platelet Distribution Width in Patients with Adult Attention Deficit Hyperactivity Disorder. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2022; 6:211-223. [PMID: 35573104 PMCID: PMC9091147 DOI: 10.1007/s41252-022-00258-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The potential role of neuroinflammation in adult attention deficit hyperactivity disorder (ADHD) patients has been investigated with peripheral hemogram-related inflammatory markers. Systemic immune inflammation index (SII) is defined as a new index that has been developed for the balance of inflammatory and immune status. METHODS Our study was based on a prospective routine complete blood count(CBC) analysis of 74 Adult ADHD patients and 70 healthy participants. The DSM-5-Clinician version and Barratt impulsivity scale-11 were used to evaluate the participants. RESULTS There was no statistical difference in the comparison of the SII ratios, platelet distribution width (PDW), and plateretritis (PCT) (p>0.05 for each) in a group of a young adults with ADHD and in a comparison control group. These inflammatory indicators were found to be similar between patients newly diagnosed with ADHD (n=40) and patients using methylphenidate (n=34) (p>0.05 for each). The relationship between ADHD clinical symptoms and severity and inflammation was evaluated. A significant negative correlation was observed between attention deficit scores and PCT (r=-0.301, p=0.009). A positive significant correlation was found between hyperactivity scores and SII (r=0.247, p=0.034). A significant positive correlation was found between Barrat motor scores and PDW(r=241, p=0.038). In the regression analysis, the PCT variable changed the attention deficit variable (β=.33, t(70)= -2.703, p=.009, pr 2= .094) predicted negatively and significantly. CONCLUSIONS We demonstrated the association of SII, which is independently associated with adverse outcomes in many diseases, and the severity of hyperactivity symptoms in adult ADHD. The fact that PCT predicts attention deficit negatively and decisively shows the importance of inflammatory assessments specific to clinical presentations. The critical importance of platelets in inflammatory processes in ADHD has been demonstrated once again with inflammatory markers such as SII, PLT, and PDW, which can be accessed by an easily applicable complete blood count method.
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Affiliation(s)
- Hacer Akgül Ceyhun
- Department of Psychiatry, Ataturk University School of Medicine, Atatürk University, 25 240 Erzurum, Turkey
| | - Nilifer Gürbüzer
- Department of Psychiatry, Regional Training and Research Hospital, University of Health Sciences, Erzurum, Turkey
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Zhao X, Coxe SJ, Timmons AC, Frazier SL. Mental Health Information Seeking Online: A Google Trends Analysis of ADHD. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:357-373. [PMID: 34553276 DOI: 10.1007/s10488-021-01168-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 01/03/2023]
Abstract
Health information influences consumer decision making to seek, select, and utilize services. Online searching for mental health information is increasingly common, especially by adolescents and parents. We examined historical trends and factors that may influence population-level patterns in information seeking for attention-deficit/hyperactivity disorder (ADHD). We extracted Google Trends data from January 2004 to February 2020. Keywords included "ADHD," "ADHD treatment," "ADHD medication," and "ADHD therapy." We examined trends (systematic change over time) and seasonality (repeating pattern of change) via time-series analyses and graphics. We also used interrupted time-series analyses to examine the impact of celebrity and pharmaceutical events. Queries of "ADHD medication" increase, while queries for "ADHD therapy" remain relatively low despite a positive linear trend. Searches for "ADHD treatment" displayed a downward trend in more recent years. Analyses on seasonality revealed that holiday breaks coincided with a decrease in search interest, while post-break periods illustrated a rise, and the ADHD Awareness Month (October) coincided with a rise of public interest in all four search terms. Celebrity effects were more prominent in earlier years; the "Own It" pharmaceutical campaign may have increased ADHD awareness and the specificity of searches for "ADHD medication." The anonymous, accessible, and low-cost nature of seeking information online makes search engines like Google important sources of mental health information. Changing search patterns in response to seasonal, advocacy, and media events highlight internet-based opportunities for raising awareness and disseminating empirically supported information.
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Affiliation(s)
- Xin Zhao
- Department of Psychology, College of Arts, Sciences, & Education, Florida International University, 11200 SW 8th Street, Miami, USA.
| | - Stefany J Coxe
- Department of Psychology, College of Arts, Sciences, & Education, Florida International University, 11200 SW 8th Street, Miami, USA
| | - Adela C Timmons
- Department of Psychology, College of Arts, Sciences, & Education, Florida International University, 11200 SW 8th Street, Miami, USA
| | - Stacy L Frazier
- Department of Psychology, College of Arts, Sciences, & Education, Florida International University, 11200 SW 8th Street, Miami, USA
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14
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Song Y, Lu M, Yuan H, Chen T, Han X. Mast cell-mediated neuroinflammation may have a role in attention deficit hyperactivity disorder (Review). Exp Ther Med 2020; 20:714-726. [PMID: 32742317 PMCID: PMC7388140 DOI: 10.3892/etm.2020.8789] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/29/2020] [Indexed: 12/12/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental and behavioral disorder with a serious negative impact on the quality of life from childhood until adulthood, which may cause academic failure, family disharmony and even social unrest. The pathogenesis of ADHD has remained to be fully elucidated, leading to difficulties in the treatment of this disease. Genetic and environmental factors contribute to the risk of ADHD development. Certain studies indicated that ADHD has high comorbidity with allergic and autoimmune diseases, with various patients with ADHD having a high inflammatory status. Increasing evidence indicated that mast cells (MCs) are involved in the pathogenesis of brain inflammation and neuropsychiatric disorders. MCs may cause or aggravate neuroinflammation via the selective release of inflammatory factors, interaction with glial cells and neurons, activation of the hypothalamic-pituitary adrenal axis or disruption of the blood-brain barrier integrity. In the present review, the notion that MC activation may be involved in the occurrence and development of ADHD through a number of ways is discussed based on previously published studies. The association between MCs and ADHD appears to lack sufficient evidence at present and this hypothesis is considered to be worthy of further study, providing a novel perspective for the treatment of ADHD.
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Affiliation(s)
- Yuchen Song
- Institute of Pediatrics of Traditional Chinese Medicine, First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
| | - Manqi Lu
- Institute of Pediatrics of Traditional Chinese Medicine, First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
| | - Haixia Yuan
- Institute of Pediatrics of Traditional Chinese Medicine, First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
| | - Tianyi Chen
- Institute of Pediatrics of Traditional Chinese Medicine, First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
| | - Xinmin Han
- Institute of Pediatrics of Traditional Chinese Medicine, First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
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15
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Price A, Newlove-Delgado T, Eke H, Paul M, Young S, Ford T, Janssens A. In transition with ADHD: the role of information, in facilitating or impeding young people's transition into adult services. BMC Psychiatry 2019; 19:404. [PMID: 31847827 PMCID: PMC6918680 DOI: 10.1186/s12888-019-2284-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/11/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Many national and regional clinical guidelines emphasise the need for good communication of information to young people and their parent/carers about what to expect during transition into adult services. Recent research indicates only a minority of young people in need of transition for Attention Deficit Hyperactivity Disorder (ADHD) experience continuity of care into adulthood, with additional concerns about quality of transition. This qualitative study explored the role that information plays in experiences of transition from the perspectives of parent/carers and young people. METHODS Participants were recruited from 10 National Health Service Trusts, located across England, with varying service configurations. Ninety two qualitative interviews were conducted: 64 with young people with ADHD at different stages relative to transition, and 28 with parent/carers. Thematic analysis of data was completed using the Framework Method. RESULTS Interviewees reported a range of experiences; however reliance on parent/carers to gather and translate key information, and negative experiences associated with poor communication of information, were universal. Three themes emerged: Navigating information with help from parents; Information on ADHD into adulthood; Information about the transition process. The first revealed the essential role of parent in the translation and application of information, the other two explored distinct types of information necessary for a smooth transition. Interviewees made recommendations for clinical practice similar to UK (United Kingdom) National Institute for Health and Care Excellence (NICE) guidelines, with an additional emphasis on providing nuanced information on ADHD as a potentially long term condition. It was important to interviewees that General Practitioners had a basic understanding of adult ADHD and also had access to information about service provision. CONCLUSIONS Our findings illustrate that the availability and communication of information to young people and their parent/carers is an essential component of the transition process between child and adult ADHD services. How and when it is provided may support or impede transition. This study constitutes a substantial contribution to the evidence base, drawing on interviews from a range of participants across England and from Trusts offering different types of services.
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Affiliation(s)
- Anna Price
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | | | - Helen Eke
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Moli Paul
- Stratford CAMHS, Coventry and Warwickshire Partnership Trust, Stratford Healthcare, Stratford upon Avon, CV37 6NQ UK
- Honorary Associate Clinical Professor of Psychiatry, University of Warwick, Coventry, CV4 7AL UK
| | | | - Tamsin Ford
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Astrid Janssens
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
- Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, DK-5000 Odense, Denmark
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16
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Leitch S, Sciberras E, Post B, Gerner B, Rinehart N, Nicholson JM, Evans S. Experience of stress in parents of children with ADHD: A qualitative study. Int J Qual Stud Health Well-being 2019; 14:1690091. [PMID: 31713473 PMCID: PMC6853214 DOI: 10.1080/17482631.2019.1690091] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 11/01/2022] Open
Abstract
Purpose: Qualitative research aimed at understanding the stress of parents of children with ADHD is limited and few interventions have been designed to directly target their stress. The study aim was to explore the stress of parents of children with ADHD using qualitative methodology.Methods: Thirteen parents of children with ADHD participated in two focus groups. Open-ended questions explored parents' experiences of stress. Focus groups were recorded, transcribed, and coded using thematic analysis. Parents also completed the Parenting Stress Index-Short Form.Results: Four primary themes were identified: The child's behaviour feels like a "wrecking ball"; Coping with the "war at home"; A divided family: "relationships don't survive"; and Craving support: "it's goddamn hard work". Five of eleven participants who completed the PSI-SF scored in the clinically significant range indicating levels of stress that require professional support.Conclusions: Parents attribute their high stress to their children's behaviour, unmet needs for support, and social stigma. Parents request support to enable them to cope and appear to represent a clinical population who require mental health care and support themselves. Future interventions directly targeting the stress of parents of children with ADHD may provide wide-ranging benefits for their children and families.
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Affiliation(s)
- Sophie Leitch
- School of Psychology, Deakin University, Burwood, Australia
| | - Emma Sciberras
- School of Psychology, Deakin University, Burwood, Australia
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
| | - Brittany Post
- School of Psychology, Deakin University, Burwood, Australia
| | - Bibi Gerner
- School of Psychology, Deakin University, Burwood, Australia
| | | | - Jan M. Nicholson
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
| | - Subhadra Evans
- School of Psychology, Deakin University, Burwood, Australia
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Dunn GA, Nigg JT, Sullivan EL. Neuroinflammation as a risk factor for attention deficit hyperactivity disorder. Pharmacol Biochem Behav 2019; 182:22-34. [PMID: 31103523 PMCID: PMC6855401 DOI: 10.1016/j.pbb.2019.05.005] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 05/08/2019] [Accepted: 05/14/2019] [Indexed: 01/08/2023]
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is a persistent, and impairing pediatric-onset neurodevelopmental condition. Its high prevalence, and recurrent controversy over its widespread identification and treatment, drive strong interest in its etiology and mechanisms. Emerging evidence for a role for neuroinflammation in ADHD pathophysiology is of great interest. This evidence includes 1) the above-chance comorbidity of ADHD with inflammatory and autoimmune disorders, 2) initial studies indicating an association with ADHD and increased serum cytokines, 3) preliminary evidence from genetic studies demonstrating associations between polymorphisms in genes associated with inflammatory pathways and ADHD, 4) emerging evidence that early life exposure to environmental factors may increase risk for ADHD via an inflammatory mechanism, and 5) mechanistic evidence from animal models of maternal immune activation documenting behavioral and neural outcomes consistent with ADHD. Prenatal exposure to inflammation is associated with changes in offspring brain development including reductions in cortical gray matter volume and the volume of certain cortical areas -parallel to observations associated with ADHD. Alterations in neurotransmitter systems, including the dopaminergic, serotonergic and glutamatergic systems, are observed in ADHD populations. Animal models provide strong evidence that development and function of these neurotransmitters systems are sensitive to exposure to in utero inflammation. In summary, accumulating evidence from human studies and animal models, while still incomplete, support a potential role for neuroinflammation in the pathophysiology of ADHD. Confirmation of this association and the underlying mechanisms have become valuable targets for research. If confirmed, such a picture may be important in opening new intervention routes.
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Affiliation(s)
| | - Joel T Nigg
- Oregon Health and Science University, United States of America
| | - Elinor L Sullivan
- University of Oregon, United States of America; Oregon Health and Science University, United States of America; Oregon National Primate Research Center, United States of America.
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18
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Ponnou S, Haliday H, Gonon F. Where to find accurate information on attention-deficit hyperactivity disorder? A study of scientific distortions among French websites, newspapers, and television programs. Health (London) 2019; 24:684-700. [PMID: 30854900 DOI: 10.1177/1363459319831331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Attention-deficit/hyperactivity disorder is the most frequent mental disorder among school-age children. This condition has given rise to a large mediatic coverage, which contributed to the shaping of the lay public's perceptions. We therefore conducted two studies on the way attention-deficit/hyperactivity disorder was portrayed in the TV programs and the lay-public press in France between 1995 and 2015, but the growing part played by the Internet required an additional study to analyze and compare the scientific material which is available to the French lay public depending on the source of information used. We studied the 50 first French websites dedicated to attention-deficit/hyperactivity as indexed by Google® search engine using a structured quantitative content analysis for the web. We illustrate our results with excerpts derived from the websites. The conceptions of attention-deficit/hyperactivity disorder available on the Internet are essentially biomedical and comprise an important level of scientific distortion. Findings concerning other mass media such as television programs and the press also demonstrate massive and systematic distortions caused by the role of experts and the pharmaceutical industry. Furthermore, the most consulted media present the highest level of scientific distortions.
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Affiliation(s)
- Sébastien Ponnou
- Evreux Institute of Technology, Interdisciplinary Research Center for Education and Training (CIRNEF - EA 7454), University of Rouen Normandy, France
| | | | - François Gonon
- Institute of Degenerative Disease, CNRS UMR5293, University of Bordeaux, France
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Mofokeng M, van der Wath AE. Challenges experienced by parents living with a child with attention deficit hyperactivity disorder. J Child Adolesc Ment Health 2018; 29:137-145. [PMID: 28974169 DOI: 10.2989/17280583.2017.1364253] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this South African study was to explore parents' experiences of living with a child with attention deficit hyperactivity disorder (ADHD). METHODS A qualitative research design was followed. Purposive sampling was used to select ten parents living with children diagnosed with ADHD receiving outpatient treatment at a psychiatric facility. Data, collected through unstructured individual interviews, were analysed using open coding. Measures to ensure trustworthiness and ethical research practices were applied. RESULTS Five themes emerged: burden of care; emotional effects; social effects; impact of the educational challenges, and attempts to cope with the burden of care. CONCLUSION Parents living with a child with ADHD experience stress as they struggle to cope with the child's symptoms amidst the stigmatising attitudes from family and community members. Parents experience burdensome emotions and impaired social and occupational functioning. Health care practitioners need to take note of the challenges inherent to parenting a child with ADHD in order to provide multi-disciplinary interventions aimed at empowering and supporting parents.
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Affiliation(s)
- Meisie Mofokeng
- a Department of Nursing Science , University of Pretoria , Pretoria , South Africa
| | - Anna E van der Wath
- a Department of Nursing Science , University of Pretoria , Pretoria , South Africa
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Rashid MA, Lovick S, Llanwarne NR. Medication-taking experiences in attention deficit hyperactivity disorder: a systematic review. Fam Pract 2018; 35:142-150. [PMID: 28973393 PMCID: PMC5892172 DOI: 10.1093/fampra/cmx088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 08/10/2017] [Accepted: 08/17/2017] [Indexed: 11/14/2022] Open
Abstract
Background Although attention deficit hyperactivity disorder (ADHD) is a common condition for which pharmacotherapy is considered an effective treatment, guidelines on the treatment of ADHD have been challenging to implement. Considering the views of patients and caregivers involved in medication-taking could help shed light on these challenges. Objective This review combines the findings of individual studies of medication-taking experiences in ADHD in order to guide clinicians to effectively share decisions about treatment. Methods Five databases (MEDLINE, Embase, PsycINFO, SCOPUS and CINAHL) were systematically searched for relevant published research articles. Articles were assessed for quality using a Critical Appraisal Skills Programme checklist, and synthesis was performed using meta-ethnography. Results Thirty-one articles were included in the final synthesis, comprising studies of caregivers, paediatric patients and adult patients across seven countries. Findings were categorized into five different constructs, including coming to terms with ADHD, anticipated concerns about medication, experiences of the effects of medication, external influences and the development of self-management. The synthesis demonstrates that decisions surrounding medication-taking for ADHD evolve as the child patient enters adulthood and moves towards autonomy and self-management. In all parts of this journey, decisions are shaped by a series of 'trade-offs', where potential benefits and harms of medication are weighed up. Conclusions This review offers a comprehensive insight into medication-taking experiences in ADHD. By considering the shifting locus of decision-making over time and the need for individuals and families to reconcile a variety of external influences, primary care and mental health clinicians can engage in holistic conversations with their patients to share decisions effectively.
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Affiliation(s)
| | - Sophie Lovick
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Nadia R Llanwarne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Sage A, Carpenter D, Sayner R, Thomas K, Mann L, Sulzer S, Sandler A, Sleath B. Online Information-Seeking Behaviors of Parents of Children With ADHD. Clin Pediatr (Phila) 2018; 57:52-56. [PMID: 28183190 DOI: 10.1177/0009922817691821] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes ( a) parent questions about ADHD (attention deficit/hyperactivity disorder), ( b) parent Internet use to seek ADHD information, and ( c) associations between type of Internet access and ADHD information-seeking. Seventy parents of children (ages 7-17 years) with ADHD completed questionnaires after their child's visit with their pediatrician. Bivariate relationships were assessed using chi-square statistics, Pearson correlation coefficients, or t tests. Parents identified an average of 8.9 questions about ADHD for their child's provider. Common questions were related to medication and long-term implications of ADHD. A majority of parents searched the Internet for general ADHD information (87%) and ADHD medication information (81%). White parents accessed the Internet significantly more via home computer, mobile phone, and tablet, and significantly less via public library than non-White parents. Parents who accessed the Internet via home computers and tablets were more likely to search the Internet for ADHD medication information than parents who did not.
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Affiliation(s)
- Adam Sage
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Robyn Sayner
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathleen Thomas
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Larry Mann
- 2 Jeffers, Mann & Artman Pediatrics and Adolescent Medicine, Raleigh, NC, USA
| | - Sandy Sulzer
- 3 Xavier University of Louisiana, New Orleans, LA, USA
| | | | - Betsy Sleath
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Sleath B, Carpenter DM, Sayner R, Thomas K, Mann L, Sage A, Sulzer SH, Sandler AD. Youth Views on Communication About ADHD and Medication Adherence. Community Ment Health J 2017; 53:438-444. [PMID: 28074407 DOI: 10.1007/s10597-016-0078-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 12/23/2016] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to examine youth perceptions of attention deficit hyperactivity disorder (ADHD) communication with their pediatric providers, their reported adherence to their ADHD medications, and their desired location for an ADHD educational program. Youth ages 7 through 17 with an ADHD diagnosis were recruited. A research associate interviewed the youth. Parents completed demographic questionnaires. Seventy families participated. One-third of the youth wanted more discussion about ADHD with their providers during visits. The average youth had over eight questions about ADHD and its treatment. Most youth wanted to learn about ADHD at their provider's office. Non-white and older youth were significantly more likely to be less adherent to their ADHD medications. Youth want their providers to engage them more during visits. Providers should take advantage of this interest to engage youth more in discussions regarding ADHD and its treatment during pediatric ADHD visits.
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Affiliation(s)
- Betsy Sleath
- UNC Eshelman School of Pharmacy and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Campus Box 7573, Chapel Hill, NC, 27599-7573, USA.
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Campus Box 7573, Chapel Hill, NC, 27599-7573, USA
| | - Robyn Sayner
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Campus Box 7573, Chapel Hill, NC, 27599-7573, USA
| | - Kathleen Thomas
- Cecil G. Sheps Center for Health Services Research and Department of Health Policy and Management, University of North Carolina at Chapel Hill, Campus Box 7573, Chapel Hill, NC, 27599-7573, USA
| | - Larry Mann
- Jeffers, Mann & Artman Pediatric and Adolescent Medicine, 2406 Blue Ridge Rd, Raleigh, NC, 27607, USA
| | - Adam Sage
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Campus Box 7573, Chapel Hill, NC, 27599-7573, USA
| | - Sandra H Sulzer
- Department of Family Medicine, University of Wisconsin-Madison, 1100 Delaplaine Ct., Madison, WI, 53715-1896, USA
| | - Adrian D Sandler
- Olson Huff Center, Mission Health System, 11 Vanderbilt Park Drive, Asheville, NC, 28803, USA.,Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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Fridman M, Banaschewski T, Sikirica V, Quintero J, Chen KS. Access to diagnosis, treatment, and supportive services among pharmacotherapy-treated children/adolescents with ADHD in Europe: data from the Caregiver Perspective on Pediatric ADHD survey. Neuropsychiatr Dis Treat 2017; 13:947-958. [PMID: 28408828 PMCID: PMC5384740 DOI: 10.2147/ndt.s128752] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders and negatively impacts caregivers' lives. Factors including barriers to accessing care, dissatisfaction with support services, and lack of caregiver resources may contribute to this. OBJECTIVES To report caregivers' experiences of ADHD diagnosis, behavioral therapy (BT), and supportive care for children/adolescents with ADHD. METHODS The Caregiver Perspective on Pediatric ADHD (CAPPA) survey included caregivers of children/adolescents (6-17 years) from ten European countries who were currently receiving/had received ADHD pharmacotherapy in the previous 6 months. Caregivers reported experiences of obtaining an ADHD diagnosis, access to BT, availability of caregiver resources, and level of health care/school support. Pan-EU and country-specific descriptive statistics are reported; responses were compared across countries. RESULTS Of 3,616 caregivers, 66% were female. Mean age of children/adolescents was 11.5 years; 80% were male. Mean time from the first doctor visit to diagnosis was 10.8 (95% confidence interval 10.2, 11.3) months; 31% of caregivers reported the greatest degrees of difficulty in obtaining an ADHD diagnosis; 44% of children/adolescents did not receive BT. Forty-seven percent of caregivers reported that sufficient resources were available, 44% were "very satisfied"/"satisfied" with medical care, and 50% found health care providers "very supportive"/"somewhat supportive". Mainstream schools were attended by 82% of children/adolescents. Of those, 67% of caregivers thought schools could help more with the child/adolescent's ADHD and 48% received extra help/special arrangement. Results varied significantly between countries (P<0.001, all parameters). CONCLUSION Almost a third of caregivers reported a high degree of difficulty in obtaining an ADHD diagnosis for their child/adolescent, less than half felt that sufficient resources were available, and gaps in support from health care providers/schools were identified. Findings underscore the need to improve access to diagnosis and provision of supportive services to enable better standards of care, and potentially reduce the impact of child/adolescent ADHD on caregivers' lives.
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Affiliation(s)
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Vanja Sikirica
- Global Health Economics Outcomes Research and Epidemiology, Shire, Wayne, PA, USA
| | - Javier Quintero
- Psychiatry Department, Hospital Universitario Infanta Leonor, Complutense University, Madrid, Spain
| | - Kristina S Chen
- Global Health Economics Outcomes Research and Epidemiology, Shire, Lexington, MA, USA
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Ahmed R, McCaffery KJ, Silove N, Butow P, Clarke S, Kohn M, Aslani P. The evaluation of a question prompt list for attention-deficit/hyperactivity disorder in pediatric care: A pilot study. Res Social Adm Pharm 2017; 13:172-186. [DOI: 10.1016/j.sapharm.2016.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
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Ahmed R, McCaffery KJ, Aslani P. Development and validation of a question prompt list for parents of children with attention-deficit/hyperactivity disorder: a Delphi study. Health Expect 2015; 19:234-52. [PMID: 25597620 DOI: 10.1111/hex.12341] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2014] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Question prompt lists (QPLs) are structured lists of disease and treatment-specific questions intended to encourage patient question-asking during consultations with clinicians. The aim of this study was to develop a QPL intended for use by parents of children affected by attention-deficit/hyperactivity disorder (ADHD). METHODS The QPL content (111 questions) was derived through thematic analysis of existing ADHD- and QPL-related resources. A modified Delphi method, involving a three-round web-based survey, was used to reach consensus about the QPL content. Thirty-six experts were recruited into either a professional [paediatricians, child and adolescent psychiatrists, psychologists, researchers (n =28)] or non-professional panel [parents of children diagnosed with ADHD, ADHD consumer advocates (n = 8)]. Panel members were asked to rate the importance of the QPL content using a five-point scale ranging from 'Essential' to 'Should not be included'. RESULTS A total of 122 questions, including 11 new questions suggested by panellists, were rated by both panels. Of these, 88 (72%) were accepted for inclusion in the QPL. Of the accepted questions, 39 were re-rated during two follow-up survey rounds and 29 (74%) were subsequently accepted for inclusion. The questions covered key topics including diagnosis, understanding ADHD, treatment, health-care team, monitoring ADHD, managing ADHD, future expectations and support and information. CONCLUSIONS To our knowledge, this is the first ADHD-specific QPL to be developed and the first use of the Delphi method to validate the content of any QPL. It is anticipated that the QPL will assist parents in obtaining relevant, reliable information and empowering their treatment decisions by enhancing the potential for shared decision making with clinicians.
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Affiliation(s)
- Rana Ahmed
- Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | | | - Parisa Aslani
- Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia
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Ahmed R, Raynor DK, McCaffery KJ, Aslani P. The design and user-testing of a question prompt list for attention-deficit/hyperactivity disorder. BMJ Open 2014; 4:e006585. [PMID: 25515843 PMCID: PMC4275667 DOI: 10.1136/bmjopen-2014-006585] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study involved the development of a question prompt list (QPL) booklet designed to facilitate communication and shared decision-making between parents/carers of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) and their clinicians; and user-testing of the QPL to assess its usability. DESIGN Best practice in information writing and design was used to format the QPL content into a 16-page booklet. We then applied user-testing, which uses mixed methods to assess document performance with small cohorts of participants and then improves it in an iterative process. Individual interviews assessed the ability of QPL users to locate and understand key points of information, followed by a semistructured questionnaire, to ascertain their general views about the booklet. SETTING AND PARTICIPANTS Testing was undertaken with two cohorts of 10 parents/carers of children with ADHD (n=20); matched on age, gender and educational attainment. TESTED DOCUMENTS In round 1, we tested 15 key points of information related to the QPL. Participant responses and feedback from round 1 informed a revised version of the booklet, tested in a subsequent round. PRIMARY OUTCOME MEASURE The target was for 8/10 of the participants to be able to find and demonstrate an understanding of all key information points, in accordance with European guidelines for medicine leaflet testing. RESULTS After round 1, problems related to 4/15 information points were identified (booklet purpose; preparing for appointments; asking about a second medical opinion; selecting which questions to ask). Participants also made suggestions regarding the booklet's layout and design. After round 2, all information points were located and understood by at least 8/10 participants. CONCLUSIONS This is the first study to have developed a usable ADHD-specific QPL for use by parents/carers of children with ADHD during clinical consultations, and the first demonstration of the utility of user-testing methods in ensuring QPL usability.
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Affiliation(s)
- Rana Ahmed
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | | | - Kirsten J McCaffery
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Parisa Aslani
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
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