Knowledge and attitudes about ADHD and its treatment - Moldavsky et. al. - 2013 - Article

A lot of parents, teachers and health care professionals find that despite of the large amount of research on ADHD, the disorder is often over-diagnosed and children get over-medicated. They question the validity of diagnosis and emphasis the importance of collaboration between health care professionals, the educational system and family. The knowledge and perspectives on ADHD of all individuals involved highly influences the process of identification, referral, diagnosis and treatment of children with ADHD. It’s essential to address differences in perspectives in order to achieve a common goal and shared understanding.

There still seem to be a lot of misunderstanding about ADHD, even among teachers, physicians and parents. Some still believe ADHD to be the result of bad upbringing, think a chaotic and dysfunctional family is the etiology of ADHD, don’t know about the importance of genetic factors, believe in a sugar etiology or think children with ADHD misbehave because they don’t want to obey rules.

Research into the perspectives of children against ADHD found that some children viewed ADHD as a disorder of academic achievement (performance niche)while the others thought it to be a disorder of aggression and anger (conduct niche). The study was performed amongst 151 children who were diagnosed with ADHD or did not have any psychiatric diagnosis. The children in the performance niche (mostly found in the USA) wanted to do well and felt that medication helped their academic achievement. Children in the conduct niche (mostly found in the UK) wanted to be ‘good’ and expected stimulants to improve their self-control.

Children and adolescents with ADHD and their parents often feel stigmatized which greatly influences their self-esteem and the effect of their treatment. Especially adolescents seem to be more prejudiced and less accepting towards individuals with ADHD. Parents often show their concerns about the fact that they feel they and their child are being labelled by society and thereby rejected and isolated. New insights into the experience of stigmatization amongst children was found in the VOICES study. The children in the performance niche didn’t experience a lot of stigmatization, bit did fear it. Children in the conduct niche did experience stigma related to having an ‘anger problem’. Children with ADHD are increasingly using online social networks to neutralize stigma. Parents sometimes felt stigmatized for having a child with the diagnose of ADHD and accepting medication as a treatment (courtesy stigma). In teachers, the label ADHD increases the perception that the behavior of a child is disruptive and that they would have trouble handling the child. On the other hand, it elicited more willingness to help implement learning assistance, medication and changes to the classroom environment.

A lot of international studies have showed evidence for the improvement of knowledge on ADHD by educational interventions. Workshops about ADHD, not-attendance education, and web-based interventions have shown to provide at least short-term effectiveness. It remains unclear if there is any long-term maintenance in the behavior of professionals because there are little to no follow-ups.

There seem to be differences in the way parents, teachers, children and health care professional view a shared decision-making process (SDM). Parents ought to think that it’s an equal partnership and want clinicians to provide them with information about all treatment options, while clinicians see it as a process of explaining their own views on treatment options and encourage parents to accept them by providing supporting information. These differences emphasize the need to negotiate a common understanding and shared goals in from the beginning of a SDM process.

Researchers concluded that adolescents with ADHD should be involved in the informed consent process, but consideration should be given to their cognitive abilities. It’s important to involve adolescents in their own treatment plan because it appears that their willingness to consider treatment is significantly lower than that of their teachers and parents.

A multidisciplinary approach to the diagnosis of ADHD is recommended by the guidelines, but often fails to be followed. Pediatricians often diagnose ADHD and subscribe medication without consulting a psychiatrist, while when psychiatrist diagnose ADHD they don’t communicate this with the pediatricians who have to refill prescriptions.

To identify the obstacles to treatment success, a tool has been developed that includes a medication preference scale, a goal scale and a behavior therapy preference scale which can be filled in by parents and children. Other tools are the Questionnaire on Attitudes Towards Treatment of ADHD and the ADHD Medication Attitude Scale. The latter has shown that treatment adherence is lower in adolescents.

Thus, there is a need for continued education of teachers, health care professionals and the public about ADHD, and especially about its etiology and treatment. These areas seem to provide the most misconceptions and reinforce stigma attached to ADHD.