This qualitative, phenomenological study used in-depth interviews to explore parents'. perceptions of raising a child with ADHD. The purpose of the present study was to explore, through in-depth interviews, parents' perceptions of raising a child with ADHD.
T HE CHANGING FACE OF ADHD
The period 1900 to the late 1950s
- Still’s view
- North American interest in ADHD
- The origins of a brain-damage syndrome
- Beginnings of child psychopharmacology with ADHD
- The emergence of a hyperkinetic syndrome
The concept of the brain-damaged child was to be born in this decade (Strauss & Lehtinen, 1947). This finding suggests that hyperactive children have a lower threshold for stimulation in the thalamic area.
The period 1960 to1969
- The decline of Minimal Brain Dysfunction
- The hyperactive child syndrome
- Europe and North America disagree
Nevertheless, it remains a milestone in the history of the disorder due to the delineation of a more specific mechanism that could give rise to hyperactivity (cortical overstimulation). These new labels were based on the child's observable and descriptive deficits, rather than on an underlying, unobservable etiological mechanism in the brain.
The period 1970 to 1979
- Wender’s theory of MBD
- The emergence of attention deficits
- Other historical developments
In this decade disenchantment developed with the exclusive focus on hyperactivity as the main feature of the disorder. These other symptoms were also seen as the main areas of influence of the stimulant drugs used to treat the condition.
The period 1980 to 1989
- The creation of an ADD syndrome
- The creation of research diagnostic criteria
- Subtyping of ADD
- ADD becomes ADHD
- ADHD as a Motivation Deficit Disorder
- Other developments in this era
However, research emerging in the early 1990s (Costello, Loeber & Stoutheimer-Loeber, 1991) indicated that differences between situational and pervasive subgroups were more the result of differences in the source of information used to classify children ( parents versus teachers) than to actual behavioral differences. This era also saw development in the area of social skills training for children with ADHD.
The 1990s
- Neuroimaging research
- Genetic research
- Essential fatty acid research
- ADHD in adults
- Other developments in the1990s
In the 1990s, a number of studies, particularly those by Biederman and colleagues, strengthened the evidence for the familial nature of ADHD. Subjects included in the study consisted of boys with ADHD and a control group of healthy boys (all between the ages of 6 and 12 years).
Beyond 2000
The authors believe that these findings can help us understand the workplaces of the medications used to treat ADHD, especially stimulant medications. The next chapter will continue to examine the prevalence of the disorder and the developmental course of ADHD.
T HE INCIDENCE OF ADHD
The number of children diagnosed and treated for ADHD has increased significantly, by some estimates doubling in the 1990s (Santrock, 2002). Other authorities argue that pseudo ADHD accounts for 50-60% of diagnosed cases (Hallowel & Ratey, 1994).
C OMORBIDITY OF ADHD WITH OTHER DISORDERS
Anxiety disorders have about 25% co-occurrence with ADHD and there is a higher incidence of ADHD in offspring of parents with Anxiety Disorder. As the authors hypothesized, the co-occurrence of externalizing behavior disorders was significantly more prevalent among subjects with combined ADHD.
T HE DEVELOPMENTAL COURSE OF ADHD
- Early childhood through to preschool
- Middle childhood
- Adolescence
- Adult outcome
Sure, siblings are often jealous of the increased amount of time these ADHD children receive from their parents. A detailed picture of the adolescent outcome of ADHD children emerged from a study by Barkley and his colleagues (Barkley, Fischer et al., 1990).
ADHD AND FAMILY LIFE
Parent-child interactions
Like the interactions of ADHD children with their parents, the interactions of these children with their teachers have also been shown to be significantly improved by administration of stimulant medication (Whalen et al., 1980). Interestingly, ADHD children appear to be more compliant and less disruptive with their fathers than their mothers (Tallmadge & Barkley, 1983).
Family functioning
The presence of comorbid ODD has also been shown to be associated with greater maternal stress and psychopathology as well as marital difficulties (Barkley, Anastopoulos et al., 1992; Barkley, Fischer et al., 1991). Yet parents of ADHD children, more than parents of normal children, seem to sense that children's disruptive behavior is internally rather than externally caused, less controllable by the child, and more stable over development (Johnston & Freeman, 1997).
Peer relations
Many have noted that it takes few social exchanges over a period of only 20 to 30 minutes between ADHD and normal children for normal children to find the ADHD children disruptive, unpredictable, and aggressive and thus respond to them with dislike, criticism, and rejection, and sometimes even counter-aggression.
T REATMENT OF ADHD
- Medical Intervention
- Educational Interventions
- Behaviour Modification
- Cognitive-Behavioural Therapy
- Academic Interventions
- Social Skills Training
- Psychotherapy
- Parent training
- Dietary Intervention
- Is there a best approach?
DuPaul and Henningson (1993) presented a case study of the effects of a whole-class peer tutoring program on students with ADHD. Children in the treatment group did better than the majority (83%) of those who did not receive treatment.
W HAT IS PHENOMENOLOGY ?
M OVEMENTS IN P HENOMENOLOGY
- Transcendental phenomenology
- Existential phenomenology
- Hermeneutical phenomenology
- Linguistical phenomenology
- Ethical phenomenology
- Phenomenology of practice
Levinas finds the phenomenological power of this question in the encounter with the face of the other who addresses us. In the vulnerability of the face of the other, Levinas says, we experience an appeal: we are called, addressed (the vocative).
P RINCIPLES OF PHENOMENOLOGY
- Fidelity to the phenomenon
- Personal interest
- Subject matter
- Lived experience
- Wholeness
- Description
- Essences of experience
What is the nature or essence of the learning experience (so that I can now better understand what this particular learning experience is like for these children)?”. According to Patton (2002), a general phenomenological perspective can be used to clarify the importance of using methods that capture people's experience of the world, without conducting a phenomenological study that focuses on the essence of shared experience.
T HE ROLE OF VALUES IN PHENOMENOLOGICAL RESEARCH
According to Patton, results obtained from a phenomenological study can then be related to and integrated with those of other phenomenologists studying the same experience, or phenomenon. Thus, according to Giorgi (1994), the relationship between neutrality and values is not dichotomous but phased.
I S QUALITATIVE RESEARCH MERELY EXPLORATORY , RATHER THAN
Osborne believes that there seems to be something to gain and little to lose by considering the contributions of phenomenological research rather than dismissing it on scientific grounds. Osborne concludes that if psychology is to be existentially relevant, it must address human experience in its fullness, not just that part of experience that is compatible with prevailing methodological biases.
N ATURALISTIC I NQUIRY
T HE P HENOMENOLOGICAL M ETHOD
Description
The reduction
Van Maanen (1982, p.16) states that the essential question in qualitative work is "What is going on here?" This is different from: "I will posit that X is happening and try to prove it, or else hope that Y is actually happening."
Search for essences
W HAT WAS THE PRIMARY PURPOSE OF THE STUDY ?
W HAT WAS THE FOCUS OF THE STUDY ?
S AMPLE
Small or large sample?
How many participants are enough?
These imperfect descriptions will certainly not invalidate the subject's experience, but they cannot reflect an essential part of the experience. By using a variety of topics, the possibility of finding underlying constants or themes in the many forms of expression that experience takes is greatly increased.
Sampling strategy
Finally, it was determined whether the potential respondent was interested in participating in the research, and a date was set for the interview. It should be noted that none of the potential participants refused to participate in the study when it was explained to them.
I NTERVIEWING
The researcher also shared the information that was later presented in the written consent form so that the participant would be familiar with all aspects of the form. The use of the tape recorder was explained to the participants during the first telephone contact and at the beginning of the interview.
A TTAINING INFORMED CONSENT
Consequently, all interviews were tape recorded so that the researcher had the verbatim responses of all respondents. Indicated that the results of the study will be included in a thesis and possibly in other future publications.
A NALYSIS OF RESEARCH INFORMATION
Qualitative analysis: holistic and inductive
Informed participants of their rights in the process, particularly the right to review material and the right to withdraw from the process. The strategy with inductive designs is to let the important dimensions of analysis emerge from patterns found in the investigated cases, without presupposing in advance what the important dimensions will be.
Phenomenological analysis
The researcher must then decide in advance which variables are important and which relationships can be expected between those variables. The qualitative analyst seeks to understand the multiple interrelationships between dimensions that emerge from the research information, without making prior assumptions or specifying hypotheses about the linear or correlative relationships between narrowly defined, operationalized variables.
Research information Analysis: Kruger’s method
- An intuitive holistic grasp of the research information
- Spontaneous emergence of Natural Meaning Units (NMUs)
- Constituent profile description
- Second order profile
- Hierarchical Categorization
- Extended description
This first-order profile is then transformed into a composite profile description, in short, a condensed summary of the original research information that contains the essence of what the participant expressed. This process is repeated until further addition of categories becomes unnecessary, since the essence of the research information is already contained in the extended description.
O BJECTIVITY VERSUS S UBJECTIVITY
After this, the researcher systematically and carefully checks the remaining categories to ensure they are compatible with the extended description. The extended description gives as concise an understanding as possible of the essential or immutable meanings of the phenomenon.
V ALIDITY
- Positivist versus Post-positivist criteria for validity
- Validity in inferential quantitative research
- Internal validity
- External validity
- Validity in qualitative research
- Validity in the current study
- The literature study
- Misinterpretation
- Testimonial validity
- Consensus among researchers
- Revealing of the researcher’s orientation
- Coherence of the report
According to Osborn and Smith (1998), the aim is not to produce a single true version of the research information. How many survey researchers go back to the research subjects and ask them to approve the reduction.
R ELIABILITY
Is it a good thing that I have experienced many of the feelings that my participants have. Validity is also determined by the coherence of the report, which can best be judged by the reader.
W HAT ABOUT THE CLAIM THAT QUALITATIVE METHODS ARE UNSCIENTIFIC ? .110
Reliability is also strengthened by reflecting the researcher's understanding back to the participants and by repeated interviews. The researcher's supervisors also read the transcripts and continuously checked the new analytical account, not to produce a final reading, but to ensure that the analysis presented was supported by the research information.
P ARTICIPANT DESCRIPTION
Fifteen of the children with ADHD were on medication and six were not; all fifteen use Ritalin. Since the pool of practitioners working with children with ADHD is very small, the same names kept coming up.
T HE INTERVIEWS
Some comments from parents were positive and might even be considered useful referrals for other parents. It is interesting that the same practitioner can be liked and disliked, and negative and positive comments can be made about him.
C ONSTITUENT PROFILE DESCRIPTIONS
During the interviews, a number of participants mentioned doctors and specialists, occupational therapists, speech therapists, psychiatrists, psychologists and schools by name. It seems that parents need to find a practitioner or school that fits their particular family, and each family's experience with a practitioner or school may differ.
C ATEGORIES DISCLOSING THE CHARACTERISTICS OF BEING THE PARENT OF AN
Interaction with medical personnel and the use of medication
- The diagnosis
- Health professionals
- Medication
Belinda found it "difficult to get Evan on Ritalin" as the family had a "very natural approach to the disease". Zelda had to consider giving Karl Ritalin - "it's not just about giving it to them".
ADHD and family life
- Parenting issues
- Spousal issues
- Sibling issues
- Extended family member issues
- The ADHD child and friends
For Angela, however, it has been a matter of learning to be a parent through trial and error. Carrie feels that it is difficult when "you look at the other parents and their perfect children".
ADHD and the school experience
- School placement
- Retention issues
- Special education services
- Change from primary to high school
- Feelings when interacting with school personnel
- Beliefs about school personnel
- Parent strategies when interacting with the school
- Sport and extra-curricular activities
Belinda trusted the school: "I knew he was in good hands." And she went with their recommendations because she felt "they know what they're doing". Samantha actually quit working before Claudia started school "to get her ready for school", and "to be there" for her.
Parents’ concerns and hopes for their ADHD child
- Parents’ concerns
- Parents’ views of the future
She wonders if he is "going to be on medication for the rest of his life". She "worries about the future" and she worries that "they're going to be one of those kids that gets caught up in the wrong things."
Getting through the day and advice for other parents
- Find the right professional
- Accept and act
- Have a support system
- Put structure and routine in place
- Discipline
- Learn and teach
- Attitudinal strategies
- School
- Ritalin
- Try alternatives to Ritalin
- It’s a process
- Stick with what works
- Tackle things together
- Let your strengths help you
- Find peace in yourself
- Listen to your child
- Be aware of what you say
- Tell them you love them
- Don’t discount them
- Time with others
- Allow your child to succeed
- Spend fun time
- Let go
- Prayer
- Escape
For Zelda "the most important thing" is that you have to "just accept it" and "then work from there". At one stage, Samantha attended an ADHASA support group, "and we'd go to the evening meetings and that was it".
E XTENDED DESCRIPTION
I MPLICATIONS FOR RESEARCH AND PRACTICE REGARDING MEDICAL ISSUES
ADHD AND FAMILY LIFE
ADHD AND THE SCHOOL EXPERIENCE
P ARENTS ’ ADVICE
C LOSING REFLECTIONS ON THIS STUDY
CONSTITUENT PROFILE – MIA’S STORY
