Do Stimulants Change Youths With ADHD's Authenticity? Perceptions of Parents and Youths with ADHD of the Effects of Stimulant Medication
Author(s):
Erez C. Miller (presenting / submitting) Amos Fleischmann
Conference:
ECER 2017
Format:
Paper

Session Information

04 SES 08 A, Particular Groups, Needs and Inclusion

Paper Session

Time:
2017-08-24
09:00-10:30
Room:
W6.13
Chair:
Gottfried Biewer

Contribution

ADHD is a common neurodevelopmental condition that begins in childhood and may continue through adolescence and adulthood. It is defined as a persistent pattern of inattention and/or hyperactivity-impulsivity that impairs an individual’s functioning and development (APA, 2013). The recommended treatment for ADHD may be educational, nutritional, psychological (Sonuga-Barke et al., 2013) ‏, and/or pharmacological. Psychopharmacological treatment (e.g., methylphenidate [MPH], is the first and most common treatment for ADHD (e.g., Millichap, 2010). The use of stimulant medications has been strongly debated because medications may alter individuals' sense of authenticity and even affect their free will (Comstock, 2011), possibly seriously compromising youths' adherence to medication management (e.g., Charach & Fernandez, 2013; McCarthy, 2014). Although some attempts have been made to understand the factors that may affect medication adherence generally (e.g., Charach & Fernandez, 2013) and the extent to which ADHD medications affects sense of authenticity particularly, the matter warrants further examination. In addition, when a treatment that may change an individual’s sense of psychological authenticity is considered, ethical issues that arise should be borne in mind and discussed with that individual and his or her family.

 The present study examined online forums in which youths' experiences with ADHD medications and their sense of control over the use and effects of the medications on authenticity, are discussed. These forums facilitate social interaction and allow individuals to disclose their experiences and opinions regarding health and disability. Online narrative presented in various platforms are a useful source of data for researching narrative of individuals with ADHD (Fleischmann & Miller, 2013).

‘Authenticity’ is an accepted term that describes an individual’s true essence (Varga & Guignon, 2016). An ethical medical treatment is one that allows its recipient to maintain his or her authenticity.

Our goal was to examine how issues of an individual's authenticity is discussed and expressed both by youths with ADHD or their parents and by professionals. Our research questions were:

1)      What are the issues regarding medication's effects on an individual's authenticity?

2)      How are these issues address by youths with ADHD and their parents, and by professionals?

Method

We investigated four Hebrew-language online forums dedicated to ADHD issues. Most people who participated in them were interested in receiving some form of consultation on various aspects of ADHD. In each forum there was a group of professionals, though some responders who were not professionals The forum sites include hundreds of pages of Q&A and discussions. We filtered them for issues that focus on ADHD treatment and, especially, psychopharmacological treatment. A second criterion for selection was the presence of some evidence of the participant’s age. Data Analysis: An ethnographic-discursive approach (Montaki & Frigerio, 2016) was applied to all posts in order to examine forms of interaction agreement and disagreement among participants and professionals. This inquiry is instrumental for understanding the power relations that evolve between participants and professional respondents. In the first stage of the data analysis, each researcher read the discussions and posts individually and profiled various themes that focus on psychopharmacological treatment (Saladana, 2012). In the second stage, commonalities and differences among the questions were identified and the themes were combined into categories. In the third stage, the responses were sorted in an attempt to uncover professionals’ hidden agendas (Potter, 2004). Ethical Aspects of the Study: The proposal for the study was examined and approved by an institutional review board (IRB). Online content, such that posted on Internet forums, may serve as research data if the forum is considered part of the public domain and has no restrictions or requirements for registration (Buchanan, 2011), giving it a status equivalent to published material in other media. In addition, none of the selected forums had restrictions on use or access. All details in the forum that may identify participants and respondents were omitted to maintain anonymity.

Expected Outcomes

The results suggest that medications for the treatment of ADHD sometimes have a dramatic effect on various psychological characteristics of individuals with ADHD, who perceive or experience them as changes in their authenticity. Interactions among participants and respondents yield a narrative that indicates a struggle for the preservation of authenticity among individuals with ADHD. To win this struggle, youths must be well informed about the medications’ benefits as well as their potential effects. The professionals in the examined forums appear to have adopted the medical model's perspective to a greater or lesser extent. Thus, participants who complained about unwanted psychological side-effects were advised to consult with physicians. Some of these professionals, aware that sometimes negative side effects cannot be avoided completely, agreed with the participants that the side effects exist but encouraged them to continue using the medication. This convergence of views, however, ceased when participants denied the legitimacy of using medications. The results of the present study indicate that youths who participated in the forum used their judgment when using medication. Furthermore, professionals who provided consultation in the forums usually supported the participants’ perspective of using the medication on the basis of need. Lay respondents similarly supported calculated decisions by youths to stop taking the medication altogether when the change that it induced in participants’ authenticity hampered their social life. In our opinion, the important question is whether youths who are treated with medication are able to express their will and maintain their authenticity.

References

American Psychiatric Association (APA) (2013) Diagnostic and statistical manual of mental disorders, APA (5th ed.), American Psychiatric Publishing, Arlington. Buchanan, E.A. (2011). ‘Internet research ethics: past, present, and future’, in Burnett, R. Consalvo, M. &‏ Ess C. (eds), The Handbook of Internet Studies, pp. 83-108, Wiley-Blackwell, UK. ‏Charach, A., & Fernandez R. (2013). ‘Enhancing ADHD medication adherence: challenges and opportunities’. Current Psychiatry Reports, 15(7), 1-8.‏ Comstock, A. J. (2011). ‘The end of drugging children: toward the genealogy of the ADHD subject’. Journal of the History of the Behavioral Sciences, 47, 44–69. Fleischmann, A. & Miller, E. C. (2013). ‘Online narratives by adults with ADHD who were diagnosed in adulthood’. Learning Disability Quarterly, 36(1), 47-60.‏ McCarthy, S. (2014). ‘Pharmacological interventions for ADHD: How do adolescent and adult patient beliefs and attitudes impact treatment adherence’? Patient Prefer Adherence, 8, 1317–1327. Millichap, J. G. (2010). ‘Medications for ADHD’. in J. G. Millichap (Ed.), Attention deficit hyperactivity disorder handbook: A physician’s guide to ADHD (2nd ed.), pp. 121–123. New York, Springer. Montaki, L. & Frigerio, A. (2016). ‘An ethnographic-discursive approach to parental self-help groups: The case of ADHD’. Qualitative Health Research, 27(7), 935-950. Potter, J. (2004). ‘Discourse analysis as a way of analysing naturally occurring talk,. In D. Silverman (ed.), Qualitative research: Theory, method and practice (2nd ed.), pp. 144–160. Sage, London. Saladana, J. (2012). The Coding Manual for Qualitative Researchers’, Sage, Thousand Oaks, CA. Sonuga-Barke, E., Brandeis, D., Cortese, S. et al. (2013). ‘Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments’. American Journal of Psychiatry, 170, 275–289.‏ Varga, S., & Guignon, C. (2016). ‘Authenticity’. In Zalta, E. N. (Ed.), The Stanford Encyclopedia of Philosophy (Summer 2016 Edition). Available from: plato.stanford.edu/archives/sum2016/entries/authenticity .

Author Information

Erez C. Miller (presenting / submitting)
Achva Academic College, Israel
Achva Academic College, Israel

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