DISCUSSION OF RESULTS
4.3 FACTORS THAT INFLUENCE THE DECISION MAKING PROCESS
4.3.1 KNOWLEDGE OF THE DISORDER
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Page 61 of 150 (b) Etiology
In an attempt to assess the level of knowledge respondents have regarding more specific aspects of ADHD, each respondent was asked what they knew about causes of ADHD.
Nine out of the ten respondents replied not knowing anything about what causes ADHD. One of these nine respondents replied that it (ADHD) is possibly caused by a ‘change in lifestyle’ and ‘related to the food we eat’ [R 7]. There was only one respondent out of the ten interviewed that indicated having some knowledge related to etiology. This respondent offered the following:
‘There doesn’t seem to be a clear cut cause. In most of the reading I have done, it seems to be a combination of diet, genetics, environment, individual personality traits’ [R 6].
The response above contains several interesting elements: Use of the word ‘seems’ appears suggestive of having no definitive answer, a measure of uncertainty, of not being fully sure. There is evidence of further information being accessed: ‘in most of the reading…’, indicating that this respondent has embarked on a search for more knowledge. The words ‘I have done’ suggest this additional information sought has been done independently, possibly not guided by a medical practitioner and not in conjunction with a friend or partner. This respondent also recognizes inter-related contributing factors, showing an awareness of there being no single attributing cause.
From the nine respondents who were not able to answer this question, it is evident that knowledge relating to etiology is lacking. Reflecting on responses given there is a high incidence of an absence of accurate information.
(c) Diagnosis
Assessing respondent information relating to diagnosing ADHD suggests respondents are not fully informed as to the process of diagnosis – knowledge in this area is limited. As illustrated in table 6
(tabulated overview of the sample) seven of the ten respondents had their children diagnosed by a GP, two of the ten had their children diagnosed by a specialist pediatrician and only one respondent had their child diagnosed by a psychologist. The respondent whose child was diagnosed by a psychologist states the process of diagnosis was explained ‘very carefully’ [R 5]. This respondent showed a clear understanding as to how ADHD should be diagnosed.
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All of the respondents whose children were diagnosed by a GP relayed a similar experience where they spent an extended period of time in an appointment with their family doctor where he / she observed the child and answered many parental questions. In conjunction with teacher reports and / or feedback, diagnosis was then made.
The respondent whose children were diagnosed by a specialist pediatrician relayed a similar experience to those whose children were diagnosed by their GP:
‘…there is a kind of check list that you go through with the doctor, something like
‘does your child have or do x, y, z’. Also observation – the doctor spent about 45 minutes to an hour observing her while we were in the appointment’ [R 8].
‘He (the doctor) asked us loads of questions about all sorts of things and was continually watching our son throughout the consultation. Before coming to the appointment we had been asked to fill out this paperwork, a Connors Rating Scale.
In our appointment he (the doctor) showed us one the teacher had also completed…we just kind of went along with things, doing what we were told before the appointment and then when in the appointment’ [R 1].
Findings suggest the respondents are not fully informed and do not adequately understand the process of diagnosing ADHD. In addition to this, it is evident that ADHD is diagnosed largely by the family doctor and that this diagnosis is the result of an extended consult with the parents and child where the doctor has a single interacting encounter with the child.
(d) Treatment
Assessing respondent information relating to ADHD treatment options, findings reveal respondents to be significantly familiar with the two psycho-stimulants (Ritalin and Concerta) prescribed most frequently in the pharmaceutical treatment of ADHD. All of the ten respondents stated specifically Ritalin and
Concerta. Although respondents are familiar with the trade names Ritalin and Concerta, it is doubtful that their understanding goes beyond that. Specific to this sample, ADHD treatment knowledge is clearly defined by and limited to knowing the trade names Ritalin and Concerta.
It is clear from the findings that the respondents interviewed have some significant gaps in their knowledge based regarding all aspects related to ADHD. All participants reside within the Upper Highway area of KwaZulu Natal (an area extending from approximately Westville up to and including Hillcrest). This is a well-established urban residential area encompassing some affluent suburbs such as
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Kloof for example. The children referred to by the parents interviewed attend either local government or private schools. In addition to this, the medical intervention received was via private health care
practitioners: the family GP, a specialist pediatrician or a psychologist. It is interesting that despite having access to premium health care facilities; a significant gap in acquiring accurate information exists.
As a significantly researched and publically discussed disorder (to the point where parents are noticeably familiar with, and able to correctly name, the leading drug treatments), how do we explain such an
absence of accurate information and what are the implications of this as an influencing factor in treatment decision making?
Jackson and Peters (2008, p.2731) believe ‘it is important that parents are able to access accurate
information’ relating to an understanding of specifically what ADHD is, etiology, diagnosis and treatment options. Brinkman and Epstein (2011, p.52) maintain that decisions related to treatment preferences are significantly influenced ‘by information (and / or misinformation) received from a variety of sources, including social networks, the media, and health care providers’.