Exploring adolescents' and parents' experiences of pharmacological and non-pharmacological treatment in ADHD: a qualitative study.

backgroundAttention-Deficit/Hyperactivity Disorder (ADHD) presents major challenges for youth and families, including challenges related to treatment adherence and family experiences of pharmacological and non-pharmacological care. Additionally, while there is quantitative research on the efficacy of ADHD treatment, the qualitative aspects of lived experiences in youths treated, particularly in non-Western cultures, are less visible.

objectiveThis study sought to explore and understand the lived experiences of Iranian adolescents who have ADHD and their parents regarding pharmacological and non-pharmacological treatments with respect to barriers, facilitators, and conditions that affected the engagement.

methodsA descriptive phenomenological approach was used, based on Colaizzi's seven-step method. Purposive criterion-based sampling was used to recruit nine adolescents (aged 12-16) diagnosed with ADHD and their parents (n = 10) from treatment centers in Tehran, Iran, and continued sampling until data saturation was reached. Semi-structured interviews (n = 19; average duration = 38.73 min) were conducted between June and August 2024, and interviews were transcribed verbatim and analyzed with MAXQDA 2024, generating 107 refined open codes from the interview data. Rigor was established by following Guba and Lincoln's criteria for rigor, which included member checking and peer review.

resultsFrom parents' perspectives, two primary themes emerged: barriers and negative experiences (e.g., medication side effects, delays in diagnosis and treatment, and adherence challenges) and facilitators and positive experiences (e.g., increased ability to focus, trust in providers, and the role of non-pharmacological therapies). From the perspectives of adolescents, the key themes focused on the outcomes of treatment. These factors support or hinder adherence, non-pharmacological experiences, and therapeutic relationships, with considerations of benefits, such as increased concentration, and harms, such as stigma and fatigue. Cross-case comparisons identified similarities and differences in how parents and adolescents valued multi-modal approaches to ADHD treatment (e.g., medications and therapies), and the relative importance of autonomy vs. systemic support and connection with providers.

conclusionThe results highlight a clear need for person-centered, culturally sensitive approaches that account for the effects of medication side effects, stigma, and inaccessible treatment options to enhance adherence and quality of life. Implications include consideration for incorporating adolescent voices into shared decision-making and consideration of policy changes that allow access to comprehensive, subsidized ADHD care.