Coming to terms with ADHD: How urban African-American families come to seek care for their children

Objective: This study investigated how parents' interpretations of their child's disruptive or inattentive behaviors led them to seek medical care that resulted in a diagnosis of attention-deficit hyperactivity disorder (ADHD). Methods: Qualitative, semistructured telephone interviews were conducted with parents of children who had been newly diagnosed as having ADHD (96% of the children were African American). The 26 participants were recruited from primary care, developmental and behavioral, and specialty mental health pediatric clinics affiliated with a large, urban teaching hospital. The analysis followed a grounded theory approach. Results: By the time that parents sought treatment for their child's ADHD, they had been through an extensive process to pinpoint their child's problems. Parents' conceptualizations emerged as they described their child's behavior, explained the situation, described how ADHD affected their children, and explained how they sought answers. Their reactions to the behavior and visions they had for their child's future reflected their motivation to manage the situation. Parents' conceptualization and management of the behaviors described the process of coming to terms with their child's ADHD and the need for care. Four distinct patterns describing this process emerged from the analysis: immediate resolution, pragmatic management, attributional ambivalence, and coerced conformance. Conclusions: It is likely that clinicians' awareness of the different approaches by which families come to the decision to seek care for their child's ADHD will allow clinicians to provide more responsive care and better tailor interventions to improve therapeutic outcomes for children receiving mental health treatments.