Concerns about Stigma Undermine Adolescents' Treatment for ADHD

Because ADHD frequently persists into adolescence, and continues to undermine teens' academic and social functioning, most adolescents continue to need treatment.  However, as issues of self-direction and autonomy become more important for teens, resistance to treatment for ADHD - medication or otherwise - frequently intensifies and many adolescents stop treatment prematurely.  This is a challenge that many parents struggle with.

It is thus important to understand the factors - particularly adolescents' perspectives on treatment - that affect the receipt of ADHD treatment during this critical developmental period.  Examining this issue was the focus of a study published recently in the Journal of Adolescent Health [Bussing et al (2011). Receiving treatment for Attention-Deficit Hyperactivity Disorder: Do the perspectives of adolescents matter.  Journal of Adolescent Health, 49, 7-14.]

Participants were 168 adolescents - about 50% female - and their parents recruited through a public school system in the US.  These adolescents screened positive for ADHD in elementary school and were contacted 6 years later for a follow-up assessment.  At follow-up, over 60% continued to meet full diagnostic criteria for ADHD and many others still had elevated levels of ADHD symptoms. The researchers were interested in how many adolescents had received ADHD treatment in the past year and the parent and child characteristics that predicted the receipt of treatment.

Summary and implications:

Results from this study indicate that many adolescents struggling with ADHD have not received any mental health services in the prior year.  Especially noteworthy was that even after accounting for parents' perceptions of their child's functioning and their receptivity to medication treatment, adolescents' own attitudes were important predictors of receiving treatment. 

Teens who felt they were not functioning well in their daily lives were more likely to have been treated.  And, adolescents with concerns about ADHD stigma were far less likely to have received treatment during the prior year.  In fact, this was the strongest predictor of all.

These findings highlight the importance of eliciting adolescents' perceptions of the need for ADHD treatment, and concerns related to treatment, during evaluation and treatment planning.  In particular, health professionals should discuss concerns teens may have about being stigmatized for ADHD as these concerns can substantially undermine an adolescent's willingness to initiate or continue with indicated treatment. 

These results also suggest that when a teenager refuses treatment, or protests continuing, parents should recognize that there may be more involved than their child's being oppositional, not recognizing the reality of what they require, or exercising their desire for autonomy and self-determination.  While these factors may certainly be involved, an adolescent's worries about being stigmatized can be especially important and need to be understood and addressed.  There is a need to develop effective interventions for addressing such concerns.

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