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Parents of Children With ADHD View Stimulant Medications More Favorably Than Other Parents

RELEASED: March 16, 2006

Dr. William Frankenberger
Dr. William Frankenberger

EAU CLAIRE — The parents of children diagnosed with attention deficit hyperactivity disorder rate stimulant medications used to treat ADHD more positively and the side effects of the medications as less severe than parents of children who have not been diagnosed with the disorder, a team of UW-Eau Claire faculty and student researchers have found.

"On every measure, there were significant differences in the knowledge and attitudes between the two groups of parents," Dr. William Frankenberger, a psychology professor who has researched ADHD and stimulant medications for more than two decades, said of the most recent findings. "The parents with the kids who have ADHD rated medications far more favorably than the other parents. They thought the side effects were less severe and less of a concern. This is a really important finding."

The parents of children with ADHD continue to have favorable attitudes toward the stimulants despite multiple studies that document the medications' negative side effects and a recent FDA panel recommendation that black box warnings appear on all the stimulant medications, Frankenberger said.

"The findings make sense from a psychological perspective because it's natural for parents who make the decision to treat their child with medications to focus on the positive impact of the medication and to minimize the risks," Frankenberger said. "And if a child's behavior has improved with the use of stimulants, parents are even more likely to discount new information about the medications."

The fall 2005 survey included 510 families with children who attended two Eau Claire elementary schools. Forty-six — or 32 percent — of the 145 families who responded to the survey had a child with ADHD. Of the 46 families with a child with ADHD, 80 percent of them had a child using a stimulant medication.

In the survey, a majority of all parents indicated that while they were aware of some of the issues surrounding ADHD and stimulant medications, they did not know that the medications can cause side effects such as tics or a reduced growth rate, said Jennifer Stroh, a graduate student leading the research effort. The parents also didn't know that the medications lose their effectiveness over time, that the drugs can be abused much like cocaine or methamphetamine, or that improved attention after taking a stimulant is not a confirmation of ADHD, she said.

"The parents who had a child with ADHD were more convinced than the other parents that long-term side effects of stimulants were well known, a belief that's not supported by research," Stroh said.

The survey also found that parents of children with ADHD were more likely to believe that the disorder is the result of a chemical imbalance in the brain, while parents of other children believed that environmental stressors and conflicts in the home can cause ADHD type symptoms, Stroh said.

"There is a lot of research out there that shows stress in the home can lead to inattentive behaviors, poor impulse control and hyperactivity," Stroh said. "But parents with a child with ADHD were less inclined to believe stress played a role in the behaviors."

Parents in both groups believed that interventions other than medications should be part of a treatment plan for children with ADHD, but parents who had a child with ADHD rated behavioral interventions as less effective than stimulants, Frankenberger said.

"Studies have demonstrated that behavior modification can be as effective as medications, but the use of stimulants far exceeds treatment with behavioral programs," Frankenberger said, adding that while many parents of children with ADHD indicated that behavior modification is important, few included it as part of their child's treatment plan.

The increasing reliance on medication is troubling because once a parent has made the commitment to using stimulant medications, they often attribute every problem the child has as a medication related issue, Frankenberger said.

"If they view ADHD as a chemical imbalance, they can boil down all a child's issues to the medications," Frankenberger said. "They believe it's not school, their home life or any other environmental factor causing the ADHD symptoms, but only biological issues that can be treated with medications. As a result, children can end up taking multiple medications."

Both groups of parents believed the stimulant medications helped improve school performances and interpersonal relationships, and both groups believed that children would not need to continue the medications into adulthood, Stroh said.

Of particular concern is that parents of children with ADHD indicated in the survey that the resources they most relied on for information about ADHD and treatment options were their doctors and the promotional information displayed in doctors' offices, Stroh said.

"The promotional materials are put there by pharmaceutical companies," Frankenberger said. "It's put there by the companies that make the drugs and the companies that make money from the medications. It's alarming to find out that parents consider these materials to be one of their primary resources for information."

On a more positive note, doctors can be influenced by new information about the drugs, Frankenberger said. "When the warning went on Strattera, the number of doctors prescribing it dropped significantly," he said. "The physicians understand it and the parents can be convinced by their doctors."

Not surprising, the survey found that doctors were the biggest influencers in determining treatment plans for children with ADHD, Stroh said. But teachers were the second biggest influencers when it came to deciding on treatments, she said.

"It's surprising and concerning that teachers are right up there with doctors as far as who is influencing decisions about treatment," Stroh said, noting that most referrals for evaluations for ADHD come from teachers. "Teachers want to manage their classrooms but they don't have the training to recommend treatments."

Frankenberger and Stroh will present the research at the National School Psychology conference in late March.

Dr. La Vonne Cornell-Swanson, assistant professor of social work, was a faculty collaborator on the research project. UW-Eau Claire undergraduate student collaborators on the project were Stephanie Pahl, Tessa Root, Katie Schultz and Courtney Wood. These undergraduate researchers — all Blugold Scholars — will present the research findings during the UW System's "Posters in the Rotunda: A Celebration of Undergraduate Research" in April in the state Capitol in Madison. They also will present the research during UW-Eau Claire's Student Research Day in April.



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