Academic journal article Ethical Human Psychology and Psychiatry

The Burden of Treatment: Listening to Stories of Adolescents with ADHD about Stimulant Medication Use

Academic journal article Ethical Human Psychology and Psychiatry

The Burden of Treatment: Listening to Stories of Adolescents with ADHD about Stimulant Medication Use

Article excerpt

Objective: Stimulant medications are considered an effective treatment for attention deficit hyperactivity disorder (ADHD), and their prescription is consistently on the rise. However, research showed a limited adherence to ADHD medication regimens. This study explores the experiences of using stimulant medication from the understudied perspective of adolescents. Method: Fourteen semistructured interviews were conducted with adolescents diagnosed as having ADHD, and the data was analyzed according to the principles of qualitative interpretative phenomenological analysis. Results: Participants were passive actors in the diagnostic process. Following the medical treatment, half of the interviewees described improvement in their concentration while studying and during exams. However, most of the interviewees discussed the difficulties of taking medication especially in terms of emotional side effects, identity loss, and interpersonal relationships. Those who reached high school stopped, fully or selectively, taking the medication on their own initiative. Conclusion: The results of this study points to the importance of considering the burden of treatment for children and adolescents who take stimulant medications.

Keywords: attention deficit hyperactivity disorder; adolescents; stimulant medications; methylphenidate; treatment

Attention deficit hyperactivity disorder (ADHD) is one of the most common mental health disorder diagnoses for children and adolescents (Fulton et al., 2009). The disorder is defined by difficulties in attention, concentration, and motor restlessness (Diagnostic and Statistical Manual of Mental Disorders [5th ed.; DSM-5]; American Psychiatric Association, 2013).

Stimulant medications are the most commonly used psychotropic medication for children (Zuvekas & Vitiello, 2012). Between the mid-1980s and mid-1990s, the use of stimulant medications increased by more than 250% (Meaux, Hester, Smith, & Shoptaw, 2006) and has continued to rise ever since (Holden et al., 2013; Zuvekas & Vitiello, 2012). Many studies show that stimulants medication leads to a significant reduction in the symptoms of ADHD (e.g., Hechtman, 2004; Singh, 2008; Swanson, Baler, & Volkow, 2011) and a significant improvement in learning and behavioral and social functioning (Evans & Pelham, 2001; Powers, Marks, Miller, Newcorn, & Halperin, 2008; Prasad et al., 2013).

However, research showed a limited adherence to ADHD medication regimens (Leslie, Plemmons, Monn, & Palinkas, 2007), especially following the onset of adolescence (Meaux et al., 2006). The reasons for nonadherence are unclear, whether it is a dislike of the medication (Moline & Frankenberger, 2001), declining parental control over adolescents' health behavior, and/or negative attitudes held by adolescents toward mental health treatment (Bussing, Zima, Mason, Porter, & Garvan, 2011). Although research has highlighted the burden of illness associated with ADHD (Minkoff, 2009), the burden associated with treatment has received little attention (Bussing et al., 2012; Leslie & Wolraich, 2007; Meaux et al., 2006) especially from the adolescents' point of view.

Much of the research on ADHD medical treatment for adolescents is based on parental reports. However, when studies included both parents and adolescents, discrepancies could be discerned in their perceptions. Parents expressed a significantly higher tolerance than adolescents toward the use of ADHD medications (Bussing et al., 2012). Parents reported ADHD medications to be more beneficial than their children reported, especially in terms of academic functioning; the children and adolescents reported more serious consequences, especially in terms of side effects including feeling disconnected and personality change because of medication (Efron, Jarman, & Barker, 1998; Harpur, Thompson, Daley, Abikoff, & Sonuga-Barke, 2008; McNeal, Roberts, & Barone, 2000). …

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