Understanding The Role Of Family Management In Ethnically Diverse Children With Adhd From Urban Philadelphia

Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurodevelopmental condition of childhood. Prior research shows improvement in ADHD outcomes with parental and family engagement. What is less known, however, is how caregivers from diverse families manage childhood ADHD on a daily basis and how family management factors correlate with child functioning. Guided by the family management framework, the purpose of this study was to understand how ethnically diverse caregivers manage childhood ADHD in their everyday lives and how family management is related to children’s level of functional impairment. This mixed methods study used a concurrent nested design (QUAL [quan]) to independently analyze and integrate cross-sectional qualitative and quantitative data from caregivers of children with ADHD recruited from diverse families living in urban Philadelphia (N=50). Semi-structured qualitative interviews were conducted to explore how caregivers managed ADHD in their everyday lives and identified barriers and facilitators of family management. Quantitative questionnaires were completed by caregivers to describe child, caregiver, and environmental characteristics and understand how family management factors influenced children’s functional impairment. The qualitative and quantitative data were then integrated and transformed at the level of analysis to further understand the experience of families whose children are higher and lower functioning. Qualitative results (from directed content analysis) revealed robust and descriptive themes within family management, including the child’s daily life, condition management effort, condition management ability, and view of condition impact. Barriers and facilitators were also described, including those within immediate and extended families, educational and healthcare systems, financial, policy, and insurance issues, and mental health stigma within communities. Quantitative results (using descriptive and inferential statistics) confirmed these themes in a diverse sample of caregivers and children. Family management factors and children’s functional impairment were significantly correlated (\u3c.05; weak to moderate) in hypothesized directions. Qualitative themes were complemented by quantitative results and elucidated the daily work of families who are managing ADHD at higher and lower levels of functional impairment. Findings from this study have implications for research, practice, and policy related to the complexities of treatment, experiences of caregivers, and stigma regarding in developmental and mental health conditions among children