The Perceptions of Mothers of Sons with ADHD

This article describes mothers' own reports of bringing up a son diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). The effects of this widely misunderstood condition on the child, the family, and the wider social network (including medical and education systems) are many and complex. Although there is evidence for a biological basis for this condition, ADHD symptoms are also seen in children of abusive, or other disordered parenting. Children showing ADHD symptoms are often seen to be undisciplined, and their parents assumed to be either abusive or overindulgent. Many problems suffered by these families, particularly the mothers, may be due to the confusion of these two aetiologies. Rather than being seen as suffering from brain dysfunction, children are responded to with generalised social disapproval and ultimately ostracism. The article will describe the effects of the behavioural symptomatology as it influences the thinking, in accordance with the beliefs of casual observers, about its underlying causes.     

THE EFFECTIVENESS OF FAMILY THERAPIES FOR SELECTED BEHAVIORAL DISORDERS OF CHILDHOOD

This article reviews the scientific evidence for the effectiveness of family-based aproaches in the treatment of selected childhood behavioral disorders. Although limitations certainly exist, family interventions have consitently improved child and, in some cases, parent functioning in families with children presenting with conduct disorder (CD) and autism. Parents and other family members also directly benefit from child-focused interventions, gaining in knowledge, child management skills, and attitudinal improvements. Longh-term follow-ups indicate that CD and autistic children achieved lasting gains. Similarly, the research on attention-deficit/hyperactivity disorder (ADHD) indicates that parent training improves child noncompliance and aggression yet does not consistently affect core symptoms of ADHD. There is no evidence that adding short-term family interventions improves ADHD child functioning beyond improvements from the use of psychostimulant medications. Some tentative support for family involvement in the treatment of childhood anxieties and fears is reviewed, but clear conclusions await future investigations. Finally, several methodological limitations and needed areas of research are discussed.     

Bipolar disorder in children

This article presents an overview of bipolar disorder (BPD) in children, a condition that only recently has been recognized as a legitimate diagnosis. Bipolar disorder in children is underrecognized for many reasons including lack of awareness, diagnostic confusion, and the different clinical picture in children. Available data strongly suggest that prepubertal childhood BPD is a non-episodic, chronic, rapid cycling, mixed manic state. It may be comorbid with attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) or it may demonstrate features of ADHD and CD, further complicating recognition and subsequent treatment. Treatment issues are discussed, and some reasons for the urgency of early recognition and treatment are explained.     

Long‐term use of methylphenidate continues to confer benefits

Patients continue to receive benefits from treatment for attention‐deficit/hyperactivity disorder (ADHD) with methylphenidate after long‐term use, researchers have found. Some patients may be withdrawn from the medication, however. Therefore, all patients should be assessed periodically to determine whether they continue to need the medication. The study, published in the American Journal of Psychiatry, was conducted because, while long‐term use of methylphenidate for children with ADHD is frequent clinical practice, its benefits are unclear. They looked at whether the medication remains beneficial after 2 years. Methylphenidate, a stimulant, has been controversial in some quarters because it is a controlled substance, However, the first‐line treatment for ADHD is psychostimulant medication, such as methylphenidate. How long children should take is is a question, but 60% of children receive stimulant treatment for ADHD for more than 2 years, and this is increasingly common, extending even into adolescence and adulthood. This is partly due to the awareness that ADHD is not a pediatric‐only condition. The study, “Continued benefits of methylphenidate in ADHD after 2 years in clinical practice: A randomized placebo‐controlled discontinuation study,” was published online May 21 by the American Journal of Psychiatry.     

Pemoline in Adult Attention Deficit Hyperactivity Disorder: Predictors of Nonresponse

Abstract

The psychostimulants are the most widely used treatment modality for attention deficit/hyperactivity disorder (ADHD). Although positive responses to psychostimulants have been demonstrated, 46% of adults with ADHD, on average, are nonresponsive or cannot tolerate the medications because of adverse effects. We reviewed the charts of 43 students treated with pemoline and studied parameters of nonresponse. Sixteen (37%) met the study definition of nonresponse. Of these, 5 (12%) were symptom nonresponders and 11 (25%) were nonresponders because of adverse effects. We found a significant relationship between age and nonresponse resulting from adverse effects, yet no other factors predicted nonresponse to pemoline. Clinicians should consider using smaller starting doses of pemoline in adults to minimize adverse effects.     

Medication for Children with Attention-Deficit Hyperactivity Disorder

When making assessments and planning interventions, social workers adopt a biopsychosocial perspective. One important area where biologically based treatments influence psychosocial functioning is the area of psychopharmacology. However, even though many clients take medications, social workers often feel poorly prepared to address a subject that could be very important to their clients; that subject is the meaning of the medication to the client. The meanings that clients ascribe to medication can have a significant impact on medication adherence. Using attention-deficit/hyperactivity disorder (ADHD) to illustrate, I provide an overview of ADHD and common forms of treatment, discuss the possible meanings and acceptability of stimulant treatment for ADHD, provide practice guidelines for helping families reduce ambivalence about medication, present two clinical vignettes, and suggest resources for social workers and families.     

Attention Deficit Hyperactivity Disorder (ADHD) and Diverse Populations

Attention Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed behavioral disorder of childhood. Given the high prevalence of ADHD and its significant impact on children and families, it is important for social workers to understand and know how to respond. This paper looks at Attention Deficit Hyperactivity Disorder, explores its causes, and gives special attention to its effect on diverse populations. In addition, it discusses empirically supported treatment interventions used for children with ADHD, particularly the role of parent training in the management of ADHD. Finally, it discusses the applicability of using parent-training programs with diverse populations.     

Potential effects of antidepressant agents on the growth and development of children and adolescents

The regulatory bodies of both the United States and United Kingdom have issued cautionary statements about prescribing antidepressant medications to treat major depressive disorder (MDD) in children younger than age 18. Despite these cautions, antidepressant agents, particularly SSRIs and serotonin activators, are regularly used to treat MDD in this age group, and increasingly so in very young children. This article considers the possible effects of antidepressant agents on the growth and development of children younger than age 18 and provides recommendations for the use and careful monitoring of these medications, including screening for physiological effects, selfinjurious behavior, and suicidal ideation. Guidelines for use of antidepressant agents with these populations include incorporating medications into comprehensive, holistic treatment, assessing for onset of severe akathesia as a marker of increased risk for self-harm, and advocating for more clinical trials of these medications in different childhood age groupings.     

Nonmedication Treatments for Adult ADHD: Evaluating Impact on Daily Functioning and Well-Being

Abstract

Professor J. Russell Ramsey has written a short book aimed at practicing mental health clinicians, describing various non-medication approaches to the treatment of adult attention-deficit/hyperactivity disorder (ADHD). It includes a variety of strategies, some of which are validated and others of which are currently being developed but do not yet demonstrate effectiveness, alongside the documented effectiveness of medications for the treatment of core symptoms of ADHD, especially inattention, hyperactivity and impulsivity. He includes an up-to-date bibliography and critical evaluations of effectiveness for each treatment, especially functional outcomes. Given the high rate of postsecondary students with ADHD, the book should be helpful for college health professionals who are trying to assist such students.     

Psychosocial interventions used to treat children with ADHD: safety and efficacy

Although stimulant therapy is the most common treatment for attention-deficit/hyperactivity disorder (ADHD) in children, it is not always effective in reducing behavioral symptoms. As a result, research on psychosocial interventions has progressed in recent years. This article provides a synopsis of psychosocial interventions for childhood ADHD, with an emphasis on basic behavior management principles, evidence-based interventions, and safety issues. Developmental issues that distinguish psychosocial interventions for children and adolescents are highlighted, and practical recommendations for collaborating with mental health professionals are provided.     

Helping parents decide on ADHD treatment for their children

In the United States, medication is often the first intervention used to treat attention-deficit/hyperactivity disorder (ADHD). Yet psychosocial interventions with both parents and teachers working together to shape the child's behavior can also be an effective approach, enabling smaller amounts of medication to be used with fewer side effects. An overview of behavioral interventions is provided with a focus on parent training in child behavior management and teacher training in classroom management. Key nursing interventions on behalf of children with ADHD include assessing parental knowledge about treatment, listening supportively to parents, and promoting partnerships among parents, teachers, and providers.     

Attention deficit disorder: Problems with preconceived diagnosis

The diagnosis of attention-deficit/hyperactivity disorder (ADHD) has become a household term with many inaccurate conceptions and expectations. The label is being applied to children with a broad range of mental health problems and developmental disorders. This study looks at the impact of preconceived diagnosis on assessment and treatment of children and adolescents. Alarming trends of overidentification of ADHD, which lead to inappropriate treatment and management, are identified. Other causes of the target symptoms are discussed. The impact of preconceived diagnosis on treatment outcome, patient functioning, and other areas are addressed. The need for greater community awareness of the broad spectrum of disorders of childhood and adolescence is identified.     

Childhood mental health and adult family relationships: How ADHD shapes experiences with intimate unions and parenthood

Increasingly recognized as a chronic condition that can endure across the life course, childhood attention-deficit/hyperactivity disorder (ADHD) is associated with less stable family formation and more strain around intimate unions (dating, cohabitation and marriage) and parenthood. This article reviews and evaluates multidisciplinary research on childhood ADHD, intimate unions and parenthood, with the purpose of motivating future sociological research in this area. The paper is organized into three general sections. First, I provide an overview of information on ADHD including its diagnosis and treatment, cross-disciplinary etiologies, and sociodemographic correlates. Next, I blend sociological perspectives on labeling and stigma, social stress, and the life course to consider the role of ADHD-related stigma in shaping associations of childhood ADHD with family formation processes (intimate unions and parenthood) and family functioning (relationship quality and communication) in adulthood. Finally, I discuss opportunities for future sociological research on childhood ADHD and adult family relationships that have the potential to contribute both to empirical research on childhood ADHD and adult family relationships, as well as to sociological research at the intersection of family and health.     

Parents of Children with Attention Deficit/Hyperactivity Disorder: A Meta-Synthesis,Part II

In 2011 6.4 million children in the United States ages four to 17 years had a diagnosis of ADHD. Quantitative studies have indicated that parenting stress for parents of children diagnosed with ADHD is high. The purpose of the current meta-synthesis was to conduct a comprehensive review of both the published and unpublished qualitative studies involving the experience of parents raising children diagnosed with ADHD. Searches in online scholarly databases yielded an initial 1217 hits, which were narrowed down to eighty studies that met the criteria. A “meta-ethnography” framework was used for the synthesis. Results of the first part of the analysis were reported in Corcoran et al. (2016) and had to do with the personal impact on parents. The themes in Part II have to do with the processes parents go through in accepting the diagnosis of ADHD and in deciding whether their children should take medication. Parents struggled to make sense of their child’s problems and came to terms with the diagnosis in a series of stages. Regarding medication use, parental attitudes varied greatly, with both costs and benefits noted. Though there was considerable ambivalence towards medication use, some parents reported relief after their child began using medication. Implications from this study are that providers should recognize the processes involved in making decisions about an ADHD diagnosis and the use of medication. Social workers should allow sensitive exploration of parents’ attributions and understanding of their children’s behavior and level of acceptance of the diagnosis. Keeping an ethical and critical stance toward the use of medication, social workers should also have full exploration with parents around the potential benefits and risks associated with the treatment of their children’s ADHD, taking into account parents’ preferences.     

DISCIPLINING DOMESTICITY: Framing the ADHD Parent and Child

This article is a qualitative analysis of the literature that has been directed at parents of children with attention deficit hyperactivity disorder (ADHD). The analysis explores the manner in which texts embodying etiological and treatment discourses surrounding ADHD and its diagnostic precursors (hyperactivity, hyperkinesis, minimal brain dysfunction, ADD, etc.) provide frameworks for an administration of discipline in domestic life. Through the examination of a cross-section of six popular ADHD parenting guides and supplemental textual data sources, this study analyzes how such texts gain credibility with their audience, "frame" the experience of ADHD, and prescribe methods in which the domestic sphere may regulate ADHD-related behaviors. The textual data for the present study should be understood as "ideological representations"(Smith 1990), the analysis of which resonates with much of the disciplinary critique in contemporary social theory, especially the work of Michel Foucault (1977).     

Toward a standard of care for child ADHD: implications for marriage and family therapists

In this article, we briefly review the etiology of Attention Deficit Hyperactivity Disorder (ADHD) and describe the most current scientifically supported theory about the nature of this disorder. Based on the research literature, several organizations have established standards of care for its diagnosis and treatment, which involves a multimodal strategy for treatment at the biological, individual, family, school, and community levels. Assessment and treatment guidelines are provided for Marriage and Family Therapists (MFTs), and specific areas of competency are proposed for MFTs who are working with children who have ADHD.     

ADHD and Brain Anatomy: What Do Academic Textbooks Used in the Netherlands Tell Students?

Studies of brain size of children classified with ADHD appear to reveal smaller brains when compared to ‘normal’ children. Yet, what does this mean? Even with the use of rigorously screened case and control groups, these studies show only small, average group differences between children with and without an ADHD classification. However, academic textbooks used in the Netherlands often portray individual children with an ADHD classification as having a different, malfunctioning brain that necessitates medical intervention. This conceptualisation of ADHD might serve professional interests, but not necessarily the interests of children.     

Impact of age and symptom severity on parent-child relationships and self-perception among Chinese children with Attention Deficit Hyperactivity Disorder

Little information is available on the effect of parent-child relationships on self-perception among Chinese children with Attention Deficit Hyperactivity Disorder (ADHD) in Hong Kong. This study examined the impact of children’s age and symptom severity on the linkage of quality parent-child relationships to perceived competence/hope among children with ADHD. A clinical sample of 81 school-age children (ages 5–11, mean age = 8.38) who were diagnosed with ADHD were recruited in this study. Separate questionnaires were employed to collect data among children and their parents in the pre-treatment phase. Parent-child relationships were positively correlated with self-perception of children with ADHD, with physical competence to be father-child specific. Children’s age had moderated the correlation between mother-child relationship and children’s hope. Maternal role on children’s hope was significant for the mild symptom group; paternal role on children’s hope was significant for the severe symptom group. No moderation effect was found for symptom severity on the correlation between parent-child relationship and children’s self-perception. The study’s findings helped mental health professionals in a Chinese context to develop psychosocial interventions to foster quality parent-child relationships, which in turn will maintain children’s self-perception. Implications for social work practice are discussed.     

Fathering an ADHD child: an examination of paternal well-being and social support

The purpose of this study was to examine the influence of having a child diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) on the social and emotional well-being of fathers. While mothers have been carefully scrutinized in ADHD-related literature, fathers have been largely excluded from research designs developed to explore the effects of raising a child with ADHD. Prior research has been primarily based on small, clinically referred and homogenous samples, often without comparisons or controls. This research utilizes a nationally representative sample from the 2001 U.S. National Health Interview Survey to determine differences between fathers of children with ADHD and control fathers and to analyze how the ADHD status of the child, problematic behavior, use of medication, and paternal social support influences fathers’ sense of well-being. This research is also designed to determine whether there are child and family contexts in which the effect of ADHD status on paternal well-being is moderated. Contrary to previous findings about the emotional and social burden associated with raising an ADHD child, few differences between fathers were found.     

Parents of Children with Attention Deficit/Hyperactivity Disorder: A Meta-Synthesis,Part I

In 2011 6.4 million children in the United States ages four to 17 years had a diagnosis of Attention-deficit/hyperactivity disorder (ADHD). Quantitative studies have indicated that parenting stress for parents of children diagnosed with ADHD is high. This meta-synthesis compiled and analyzed a systematic review of the qualitative studies of parents’ lived experience of having a child with ADHD. Searches in online scholarly databases yielded an initial 1217 hits, which were narrowed down to seventy-three studies that met the criteria. A “meta-ethnography” framework was used for the synthesis. One major finding involved the emotional burden of caring for a child with ADHD. Parents struggled with a variety of intense and painful emotions as they attempted to manage family routines. Disciplining children only worked in a limited way and took constant effort throughout the day. The challenges of parenting spilled into other areas of the parents’ lives, such as their health, psychological, marital, and occupational functioning. Implications for practitioners are discussed, including the need to validate parental stress and the difficulty of applying behavioral management strategies with their children, the need for increased support of partner relationships, and the need to connect parents with support to prevent poorer outcomes for the child.