For the purposes of this study, the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) will inform a theoretical understanding of the factors that mediate the decision-making process in selecting psychostimulants as the preferred treatment approach. In addition, the essence of this research is the exploration and insight from the perspectives of the people involved.
CHAPTER TWO
LITERATURE REVIEW AND THEORETICAL FRAMEWORK
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER: AN OVERVIEW
- PREVALENCE
However, there are no official statistics on the prevalence of ADHD in South Africa (Snyman and Truter, 2010). ADHD can be the result of chemical disturbances of the prefrontal cortex or areas of the brain that connect to it.
ASSESSING APPROACHES TO TREATMENT
- PSYCHO-STIMULANT USE
Danciu (2011, p.2968) writes: 'In addition to the central features, [ADD/ADHD] can lead to a range of associated, secondary features, such as: disorganization; poor social relationships with [siblings] and children of the same age; aggressive behavior; low self-esteem and poor self-knowledge; self-stimulation behavior; daydreaming and absent-mindedness; coordination disorders; memory problems. Chelarua, Yanga and Dafnya (2012, p. 8) state that 'methylphenidate is the most commonly used drug in the treatment of ADHD.
WITHIN A SOUTH AFRICAN CONTEXT
If methylphenidate is used, the choice of preparation should be considered: modified-release preparations are convenient due to their pharmacokinetic profile, improve compliance, reduce stigma (drug does not need to be taken at school); and immediate release preparations are preferred if more flexible dosing is required or during initial titration to determine correct dosing levels. According to Reiff (2011), most of the increase in stimulant medication use probably stems from better recognition and diagnosis of ADHD (including greater awareness of ADHD in girls) and from the tendency for children to be treated for longer periods of time, sometimes at times. through to adulthood.
TREATMENT DECISION MAKING
- NORMATIVE / PRESCRIPTIVE APPROACHES
- DESCRIPTIVE APPROACHES
- SHARED DECISION MAKING
- THE THEORY OF REASONED ACTION AND PLANNED BEHAVIOUR
Brinkman et al (2009) describe the decision-making context as one containing many parental stressors. It is well supported that people rarely conform to expectations of rational decision making (Goldstein, 2007; Eysenck, 2004).
IN SUMMARY
CHAPTER THREE
RESEARCH METHODOLOGY
- THEORETICAL FRAMEWORK
- RESEARCH DESIGN
- RESEARCH PARTICIPANTS AND SAMPLING
- DATA COLLECTION METHODS AND INSTRUMENTS
- DATA ANALYSIS METHODS
- ETHICAL CONSIDERATIONS
- VALIDITY AND RELIABILITY
- LIMITATIONS OF THE METHODOLOGY
Participants for this study were selected based on the following criteria: Participants had to be: a) the primary caregiver of a child. In terms of credibility – the results of the study reflect the participants' experiences in a plausible way (Whitemore et al, 2001).
CHAPTER FOUR
DISCUSSION OF RESULTS
TABULATED OVERVIEW OF THE SAMPLE
Her seven-year-old daughter is currently in second grade at a government school in the Kloof area of KwaZulu Natal. Her eldest child is currently in Grade 3 at a government school in the Hillcrest area of KwaZulu Natal. As he has a very stressful and demanding job, he could not commit to participating in the interview.
Both children attend the same state school in the Westville area of Kwa Zulu Natal. Dad is a hairdresser in the Pinetown area of Kwa Zulu Natal and mum stays at home and runs a small online business. Before starting medication, their 8-year-old was a very disruptive influence in the home.
She is in 3rd grade and their son attends a preschool just down the road from their house.
FACTORS THAT INFLUENCE THE DECISION MAKING PROCESS
- KNOWLEDGE OF THE DISORDER
- INFORMATION SOURCES
- THE ROLE OF THE TEACHER
- ACCEPTANCE / UNACCEPTANCE OF DIAGNOSIS
- PARENTAL BELIEFS, ATTITUDES AND PERCEPTIONS
- ALTERNATIVES TO STIMULANTS
- CONFIDENCE IN AN EXPERT OPINION
- PRESSURE TO MEDICATE
In nine out of the ten interviews, initial concerns arose about problematic functioning of the child's teacher. It was the teacher's experience of the child within their school environment that prompted feedback to parents and initiated an intervention. In nine out of the ten interviews, it was the teacher who assumed the role of raising awareness regarding the child's functioning, raising specific concerns and equating them to the extent to which the child copes with them and in the time ahead.
The teacher's role in identifying problematic behavior and thus initiating intervention is an important factor influencing the decision-making process. In addition, these experiences are further differentiated as a result of parents' personal beliefs, attitudes and perceptions. In both of these cases, the motivator to treat was the poor results of the chosen alternative.
Of the ten interviews conducted, this is the only case in which the intervention was initiated solely by the parents.
REFLECTIONS AS A CO-CREATOR
She had become so disruptive to the family unit...the behavior was just too much...it was getting worse and for the sake of our health and our youngest child, we knew we needed professional help' [R 8]. For these parents, the trigger was again the need to find a workable solution based on the understanding that the current situation could not continue as it was. In this case, the process of initiating an intervention was led by the parents and the teacher in a combined effort to address behaviors that were affecting the family unit as a whole.
In all of the above cases, the motivation to medicate was the results of a trigger which initiated a call to action. In no way has my personal position as a parent of a young child compromised any aspect of this. However, I recognize the need to acknowledge my awareness of the dual role I play, and in reflecting on the interviews themselves, I cannot dismiss the recurring question I ask myself: what would I do if it were me.
However, it should be noted that the themes discussed above are by no means a concrete and finite analysis of the raw material.
CHAPTER FIVE
ANALYSIS AND INTEGRATION OF FINDINGS
THE DECISION MAKING PROCESS
This comes in the recognition and acceptance that the identified issues have a negative impact on their child's daily functioning and that it would be beneficial for the child to help moderate or stop these behaviors. As findings indicate, some parents question whether another teacher would also have interpreted their child's behavior as problematic. However, this again relates to the individual's knowledge of the disorder (as shown in the discussion of findings) as knowledge is a determinant of perceived susceptibility. b) Perceived severity (perceived severity of the condition).
HBM proposes that an additional element related to health decision-making involves the perception of severity associated with the risks of leaving a condition untreated and the degree to which the consequences of this are undesirable (Glanz et al, 2002). Danciu (2011, p.2968) writes: 'In addition to its central features, [ADHD] can lead to a number of related, secondary features, such as: disorganization; poor social relationships with [siblings] and peers; aggressive behavior; low self-esteem and insufficient self-knowledge; self-stimulating behavior; Perceptions of severity have the potential to be positively influenced by the nature of the parent/teacher relationship, as well as the relationship the parent has with their child's physician or physicians.
These include being unconvinced about the diagnosis of their child [there is still debate about whether ADHD is overdiagnosed or underdiagnosed (Reiff, 2011)], raising concerns about whether their child really needs the medication, and considering since. effects of the medication (loss of appetite, insomnia, personality changes, aggression), wanting to explore alternatives to stimulant treatment first (in the case of two respondents) and the information parents have and where it comes from.
APPLICATION OF THE THEORY OF REASONED ACTION
An analysis and integration of findings in the context of a framework offered by theoretical models can give us insight into the factors that influence parents' decision to treat their ADHD child with stimulants. However, integration of results clearly illustrates that no single model can explain health behavior. The decision to implement a treatment intervention is the result of many different, often unpredictable, interrelated factors that do not necessarily follow a causal, well-explained step-by-step process.
CHAPTER SIX
CONCLUSIONS AND SUMMARY
- SUMMARY OF THE RESEARCH FINDINGS
- CONCLUSIONS
- CONTRIBUTIONS MADE BY THIS RESEARCH
- LIMITATIONS OF THIS RESEARCH
- RECOMMENDATIONS FOR FUTURE RESEARCH
This research is intended to offer a contribution to the field of better understanding parents' experiences when faced with ADHD treatment decisions. In addition, it makes a contribution to providing insight into the factors that motivate a decision to take medication. An important contribution of this research is to highlight the critical role that information plays in many areas - not only in decision-making, but also as an influencing factor on beliefs, perceptions and attitudes.
This research is also provided as a guide for parents to help navigate the complexities surrounding ADHD treatment decisions. The costs of medication and finances were not identified as important issues by the parents who participated in this research. Another limitation is that the small sample size and qualitative nature of this research does not allow for generalizations.
However, this was never the intention of this research, but as mentioned in the methodology chapter, more interviews could have been conducted.
Shared decision making in the medical encounter: what it means. or it takes at least two to tango). Shared decision-making and the concept of balance: the competencies to involve patients in health care choices. Drug treatment use for children with attention deficit hyperactivity disorder (ADHD): maternal views and experiences.
In: Attention deficit hyperactivity disorder (ADHD) and hyperkinetic syndrome (HKS): current ideas and ways forward. Report of the Research Group on Decision Making and Problem Solving of the National Academy of Sciences. Psychostimulant therapy among grade 3 to 6 school children with attention deficit hyperactivity disorder (ADHD) in a selected pediatric practice in the Durban metropolitan area.
The needs and experiences of children with attention deficit hyperactivity disorder from parents/caregivers receiving services from a public hospital.
APPENDIX
I mean, it's not like we were presented with all these options and had to make a choice. And this is not only in this case with this medication, it is in general, with any treatment option. Everything is more or less opinion – the doctor's opinion, the teacher's opinion about what your child should be like.
I think that's also what kept us from trying it...we never really thought Holly needed meds. It's hard to answer because it wasn't like we were presented with options and asked to choose. Dad: Well, considering that this ADHD didn't exist when we were in school, and now it's common, I.
Father: Yes, it is based on what the teacher says about how your child behaves in class. Clearly what a child eats is important, although I'm skeptical about that - it's not effective and ADHD isn't that simple. It has a huge effect on the family and it's not something that just goes away.
