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Family Engagement in ADHD Treatment Unfolds in 6 Stages, Study Suggests
Based on in-depth interviews with 41 parents, researchers at Boston Medical Center have identified a 6-stage framework that describes the process of engaging in care for a child’s attention-deficit/hyperactivity disorder (ADHD). They reported their findings in the journal Pediatrics.
The 6 stages—“which,” researchers observed, “unfolded like a developmental process”—are as follows: (1) normalization and hesitation; (2) fear and stigmatization; (3) action and advocacy; (4) communication and navigation; (5) care and validation; and (6) preparation and transition.
“This framework is family-centered, focused on breaking down the barriers that families face from before diagnosis to preparing children with ADHD for the future,” said study first author Andrea Spencer, MD, an adolescent and adult psychiatrist at Boston Medical Center. “This framework can help serve as a model to develop engagement interventions that will be more beneficial to families.”
Parents who participated in the study spoke English, Spanish, and Haitian Creole and had a median income of $20 000. Their children, aged 3 to 17 years, received ADHD treatment at an urban safety-net hospital. In semistructured, qualitative interviews, they talked about their family’s journey through diagnosis and treatment, community views about ADHD, and other factors influencing treatment access and decision-making.
Parent-Focused ADHD Intervention Recommended by the EAGG COVID-19 Guidelines
According to the study, barriers tended to occur when parents, providers, and systems were at different places on the 6-stage engagement framework. Moreover, family difficulty resolving an earlier stage interfered with progression through later stages.
“Parents were successful when support was provided in a way that matches their own stage of engagement,” said Dr Spencer. “Using the six stages framework could allow the health system to better match the needs of children with ADHD whose families are at different stages of their engagement process.”
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