Influence of caregivers' experiences on service use among children with attention-deficit hyperactivity disorder

Objective: This study examined how prior experiences of caregivers of children with attention-deficit hyperactivity disorder (ADHD) leading up to treatment related to later service use. Methods: The investigators interviewed caregivers of 48 children with ADHD recruited from outpatient clinic settings and recorded the children's medication use and clinic attendance six and 12 months later. Interview transcripts were analyzed to identify characteristic experiences, or themes, felt by the caregivers before seeking treatment. The investigators also looked for patterns in the way themes were endorsed. Results: Caregivers' experiences with the children's ADHD were characterized by six main themes - caregiver strain, attribution of meaning, perception of responsibility, problem-solving approach, beliefs about ADHD treatment, and response to societal influences. Based on distinct patterns in which they endorsed the six themes, caregivers were classified as motivated by observation (high on theme of perception of responsibility and low on theme of caregiver strain; 27%), motivated by experience (positive attribution of meaning and beliefs about ADHD treatment and low on strain; 19%), motivated by strain (high on strain, uncertain attribution of meaning, and contradictory societal influences; 23%), and struggling with meaning (high on strain, nonmedical attribution of meaning; 31%). At 12 months, children of caregivers who were motivated by experience were the most likely and those struggling with meaning were the least likely to attend clinic appointments (89% and 53%, respectively, p=.017). The groups did not vary in medication use. Conclusions: Early identification of the factors influencing caregivers' use of services for children with ADHD may have implications for treatment retention.