Date of Award

2007-08-01

Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chair; Jane M. Georges PhD, RN; A. Hunter PhD, RN, CPNP

Keywords

Attention Deficit Hyperactivity Disorder--ADHD, children & youth, nursing, parental decision-making, parents & parenting, stimulant medication

Abstract

The purpose of this study was to examine parental decision making in the administration of stimulant medication to their latency age children with Attention Deficit Hyperactivity Disorder (ADHD). Research has shown that psychostimulants, used to treat ADHD are effective for 75-90% of children (US Department of Health and Human Services, 2001), however children do not take their medication from 20-65% of the time. A qualitative study using a type of grounded theory, dimensional analysis (Schatzman, 1991), was conducted to study the experiences of fourteen parents whose children began medication treatment between the ages of 5 and 12. Semi stuctured, audiotaped interviews were utilized to obtain the narratives of parents, and the interview content was transcribed verbatim, analyzed, and placed into a matrix. The central dimension was: finding the best fit for the child specific to the school setting. A cluster of symptoms, a prompt for evaluation, and parent 's acceptance of or agreement with the diagnosis predated the treatment interval. Context/environmental dimensions included: doing what's right for my child, personal qualities of the child, parental assessment of intellectual abilities of the child, not getting along with the other children/not fitting in and public or private school setting. Conditions dimensions were: relationship of the parent with the school/school staff, stigma, and having no choice/feeling pressured. Processes or intented/unintended actions included: requesting/making modifications and learning curve, and the consequences dimension included: tradeoffs. The primary relationship of the parent was with the school, and that with the health care provider was secondary. Medication treatment was viewed as only one of several treatments utilized by parents for treatment of the condition. A disparity in power between the physician and parent may have contributed to decisions regarding medication treatment, and this is considered in the conceptual model of decision making presented in the study. The results of the study suggest that educating school staff and improving communication between the school, provider and family, making the goals for treatment explicit, and scheduling more frequent appointments have the potential to improve treatment outcomes. Further research is indicated to determine the criteria parents use to assess "fit".

Document Type

Dissertation: Open Access

Department

Nursing

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