Factors Associated with Medication Decision Making in African American Families of Children with ADHD: A Mixed Methods Study

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral pediatric disorder in the United States. Pharmacotherapy is a recommended component of treatment for ADHD. While medication treatment of ADHD is not optimized overall, minority groups experience medication treatment disparities. The persistently lower rates of medication treatment in minority groups may have culturally specific origins which cannot be generalized across minorities. The purpose of this dissertation was to assess and extend knowledge regarding medication decision making (MDM) in African American caregivers of children with ADHD. To assess the state of the science on ADHD disparities, a review of 41 descriptive studies exploring the relationship between ADHD diagnosis and/or treatment and race was conducted. The review concluded that despite a trend toward reduction in ADHD diagnostic disparities over time for African American children, medication treatment disparities persist. Next, a literature review was conducted to synthesize what is known about the beliefs of African Americans regarding ADHD diagnosis and treatment, and their experiences of MDM for children with ADHD. Findings from the fourteen articles yielded a preliminary framework describing factors influencing African American caregiver decision making. Factors included fundamental perspectives of ADHD and cultural norms for childhood behavior, the impact of fundamental perspectives on MDM, and ADHD as a form of social control. Subsequently, a sequential exploratory mixed method study was conducted to identify factors associated with MDM in low-income African American families of children with ADHD. Phase 1 comprised a case study of seven low-income African American caregivers of children with ADHD. Phase 2 aimed at validating the qualitative findings through secondary analysis of data from a survey of low-income African American families of children with ADHD. Qualitative themes included child safety and volatility, caregiver aggravation, caregiver mental health, sole caregiver status, receipt of shared decision making (SDM) and family centered care (FCC), and school involvement. After conducting univariate and multivariate logistic regression analyses, previous receipt of special education services, and receipt of FCC and SDM were independently associated with receiving a medication for ADHD. These findings indicate that clinicians and educators can intervene to improve health equity for children with ADHD