Using freelisting to understand shared decision making in ADHD: Parents’ and pediatricians’ perspectives
OBJECTIVE: To compare and contrast notions of ADHD among pediatricians and parents of affected children to understand the perspectives they bring to shared decision making (SDM).
METHODS: In this freelisting study, 60 parents of children with ADHD and 30 primary care pediatricians listed words reflecting their understanding of (1) Attention Deficit Hyperactivity Disorder (ADHD), (2) getting/offering help for ADHD, (3) talking to doctors/families about ADHD, and (4) "mental health." Smith's salience score established terms that were salient and cultural consensus analysis identified variation within subgroups of participants.
RESULTS: Parents' terms reflected ADHD's effects on the child and family, while clinicians often mentioned school. Lists suggested differing needs and goals for clinicians and subgroups of parents in SDM: "time" for clinicians, "learning" and "understanding" for non-college educated parents, and "comfort" and "relief" for college educated parents. Neither parents nor clinicians framed ADHD in the same way as "mental health."
CONCLUSION: Parents and clinicians, who conceptualize ADHD differently, should negotiate a shared understanding of ADHD as a basis for SDM. Treatment discussions should be tailored to encompass families' varied emotional and educational needs.
PRACTICE IMPLICATIONS: Fostering SDM in primary care is consonant with notions of ADHD as distinct from mental health.