versión impresa ISSN 0185-3325
PALACIOS-CRUZ, Lino et al. Knowledge and beliefs in Mexican parents about attention deficit hyperactivity disorder (ADHD). Salud Ment [online]. 2011, vol.34, n.2, pp. 149-155. ISSN 0185-3325.
Attention deficit hyperactivity disorder (ADHD) generates controversy among the general population on its diagnosis and treatment. This could be explained by the sparse level of education about mental health, which affects the parent's knowledge and beliefs about this disorder. ADHD is highly prevalent and 3-5% of school-age children can be diagnosed. In Mexico it represents 1.5 million cases. It represents more than 30% of all cases in clinical pediatric settings. The reports in health services have shown that the time gap between symptoms identification and treatment is around 8 to 15 years. Moreover, only 25% of the affected children's parents recognize conduct or emotional problems on them and 13% receive mental health care. Attention seeking has been associated with higher severity of the disorder and parent's superior educational level. Despite the advances in the research on neurobiology and psychopharmacology, understanding of the social context that surrounds the disorder is incomplete. Comparatively little is known regarding how parents conceive the symptoms and causes of ADHD and how these parental views may relate to children's treatment. Understanding these factors is important due to the central role of parents in selecting and accessing treatments and service providers for children with ADHD. For parents and children, getting information about ADHD is a lottery that depends on which professional they see and what they read or gather from television and the Internet. Mental health professionals most give complete information to parents and children, so risks and benefits of the different treatments may be considered along with the family's needs, values and cultural background. A better understanding about the parent's knowledge, beliefs and attitudes regarding ADHD would help to improve the communication mechanisms between mental health professionals and parents during the treatment. Objective To describe the knowledge, beliefs and attitudes regarding ADHD in Mexican parents. Methods The study was approved by the local investigation review board. Informed consent was obtained and parents of children and adolescents diagnosed with ADHD were recruited at four mental health facilities (three public and one private) in two cities. Each parent completed the questionnaire of knowledge and beliefs about ADHD (CASE ADHD, parent's version). The questionnaire was created for this study as an instrument with three versions: a) Parents, b) Teachers, c) Health professionals. Results of parent's version were included in this report. This questionnaire incorporates information of other instruments such as Barkley's Evaluation Questionnaire and the one used in the National Colombian Survey for the Consensus of treatment of ADHD 2008. CASE ADHD includes three parts: 1. An identification record with the mother's or father's general data, 2. The ADHD Rating Scale-IV, and 3. A 36 multiple choice questionnaire related to six main areas: a) The caretaker report of symptoms and clinical characteristics related with ADHD, b) The knowledge about ADHD, c) The pathways to care report, d) The Beliefs about ADHD treatment, e) The professional mental health's performance, and f) The parent's perceptions about ADHD. The questionnaire must be completed with the assistance of a mental health professional. The average application time is 30 minutes. For statistical analysis central tendency measures were used; as means, standard deviations and percentages. Results The total sample was integrated by 288 parents of children or adolescents. The 80.1% of the questionnaires were fulfilled by the mother. The mean age of those who answered was 40.06 years, 25.4% reported to complete professional studies. The mean age of patients was 11.15 years (SD = 3.54), 58% were children and 74% were male, their ADHDRS-IV average score was 27.5 (SD = 14.03). Knowledge about ADHD. The 85.4% (N = 246) of the surveyed sample considered ADHD as a disease and 8.3% as a rearing difficulty. The 69.2% (N = 198) of parents said they knew what is ADHD, but only 62.1% reported to receive information by the physician or psychologist about this condition. Attitudes about ADHD. When questioned about what would they do if they suspected that their child had ADHD, 35.1 % (N = 101) would consult a psychiatrist, 21.2% a psychologist, and 12.2% a neurologist or pediatric neurologist. The 28% of parents were deemed unable to manage their child's behavior problem. When we asked about who is able to diagnose ADHD, 49.5% answered that the psychologist, 48.5% the psychiatrist and 19.8% that the pediatrician. The psychiatrist was considered able to treat this condition by 45.8% of the sample followed by psychologist (19.8%), and neurologist (10.4%). Beliefs about diagnosis and treatment. Nearly 63% of the sample (N = 183) considered that the best treatment for ADHD was the combined treatment; 16.3% preferred the psychological approach and psychopharmacology was chosen by only 6.6%. Almost half (48.5%, N= 129) of the sample considered that drug treatment only supports the psychosocial treatment and does not have a therapeutic effect by itself, 46.2% (N = 133) of the sample believed that <<drugs only control the symptoms and do not cure the disorder>>. Regarding to psychological treatment, 52.4% (N= 151) of parents considered it as <<the most helpful intervention>>. So the parent's expectancies for mental health services were mainly to receive psychotherapy (42.3%) and counseling (31.0%). Experiences about mental health services. The parents of children who had already received treatment reported that they consulted 2±1.42 mental health professionals before obtaining an adequate treatment. Conclusions In this study, most surveyed parents considered ADHD as a disease. It is interesting to note that nearly half of parents reported that the psychologist was able to make the diagnosis of this condition, in numbers slightly higher than physicians. Nearly one fifth reported that the pediatrician is trained to diagnose ADHD. As far as who is qualified to treat ADHD, more than 40% declared that psychiatrist, followed by psychologist (19.8%), and neurologist (10.4%). Almost two thirds (63%) of parents reported that the best treatment for ADHD was the combined treatment. Where the psychosocial treatment was considered the most useful intervention. This point highlights the importance of training psychologists as key members in the early diagnosis and treatment of these patients.
Palabras llave : Parents; seeking of attention; knowledge; beliefs; attitudes; ADHD; multimodal treatment; psychosocial treatment; psychopharmacologic treatment.