Mothers' decisions regarding treating their children with attention deficit hyperactivity disorder

BACKGROUND: The use of medication for attention deficit hyperactivity disorder (ADHD) differs globally, depending on ethnic group. Stimulant prescriptions for ADHD among Israeli Jewish children are four times higher than among Arab children. Ethnical differences may affect parents' perceptions and attitudes towards diagnosing and treating ADHD. This qualitative study aimed to identify mothers and teachers' attitudes regarding ADHD and what affects mothers' decisions on whether to medicate their child diagnosed with ADHD. METHODS: In-depth interviews were conducted with 23 Arab and Jewish mothers of children diagnosed with ADHD and 12 elementary school teachers. Data were analyzed using thematic analysis. RESULTS: Four themes were revealed, describing different perceptions of ADHD in the two ethnic groups: (1) medicalization of ADHD; (2) between guilt and sympathy: Mothers' feelings towards ADHD; (3) social pressure and social norms; (4) stigmatization. Jewish mothers and teachers tended to perceive ADHD as a medical problem, whereas Arab mothers and teachers perceived it more as a childhood social behavior. Arab mothers reported guilt feelings relating to ADHD, whereas Jewish mothers felt sympathy towards their child. The social environment influenced Arab mothers more than Jewish mothers. Stigmatization was reported only by Arab mothers. CONCLUSIONS: Ethnic differences in ADHD perception may explain the differences in diagnosis and treatment. Educators and school psychologists should consider cultural factors when advising parents and planning educational programs for children with ADHD. KEY MESSAGES: • Social and cultural factors are vital for understanding trends in ADHD diagnosis and treatment because cultural beliefs play a key role in determining parents’ perceptions and attitudes. • School managers, school psychologists, counseling staff and teachers should be aware of cultural factors when advising parents and planning educational programs for children with ADHD.