European Psychiatry - Volume 41 - April 2017

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25th European Congress of Psychiatry
e-Poster Walk Part 4
e-Poster walk: Child and adolescent
psychiatry – Part 5
EW0576
Parenting a child with attention
deficit hyperactivity disorder:
Qualitative study from a developing
nation, India
R. Shah ∗, A. Sharma , S. Grover , N. Chauhan , S. Jhanda
Postgraduate institute of medical education and research,
department of psychiatry, Chandigarh, India
∗ Corresponding author.
Introduction Like elsewhere, studies from developing countries
suggest that parents of children with attention deficit hyperacti-
vity disorder (ADHD) report significant stress. Besides symptoms,
parental stress stems from experiences in interpersonal, schooling
and societal domains, which may in turn be influenced by socio-
cultural factors. This is a highly under-studied area.
Objectives and aims Exploring experiences in familial, schooling
and societal areas amongst Indian parents and understanding these
in a cultural context using experiential qualitative research metho-
dology.
Methods In-depth semi-structured interviews were conducted
with consenting parents of 27 children diagnosed with ADHD
(17 mothers; 10 fathers).
Results All parents reported experiencing moderate to high
degree of stress, feeling worried and frustrated due to child’s pro-
blems. 19 parents reported being “short-tempered”, while 1mother
expressed feeling “lost”. Majority reported strained relations with
spouse and extended family. Mothers reported higher stress, more
difficulties in family life, faced criticism from immediate family and
community regarding handling of child, felt more embarrassment,
guilt and sense of failure as a mother. Half of the parents avoided
attending social gatherings. Other than 2 parents, all had nega-
tive experiences with schooling. Experiential descriptions included
those of teachers being highly critical of child and parents, puni-
tive, dismissive and discriminatory. Teacher had advised seeking
treatment in only 6 children. Themes of blame, discrimination and
rejection were identified.
Conclusions We conclude that cultural factors such as stigma, bla-
ming of parent (especiallymother) and lack of knowledge regarding
ADHD amongst teachers and society may be responsible for these
experiences and needs further investigation.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EW0577
Parental causal explanations and
treatment seeking in attention deficit
hyperactivity disorder: Perspectives
from a developing nation based on
process theory
R. Shah ∗, A. Sharma , S. Grover , N. Chauhan , S. Jhanda
Postgraduate institute of medical education and research,
department of psychiatry, Chandigarh, India
∗ Corresponding author.
Introduction Cultural factors have an important role in causal
model of symptoms, threshold for treatment seeking and accep-
tability of professional help in ADHD.
Objectives and aims To explore causal explanations and treat-
ment seeking amongst parents of children with ADHD and
understand these in context of a largely collectivistic culture as in
India.
Methods In-depth semi-structured interviews were conducted
with 27 consenting parents; data interpreted using process theory.
Results Initial reaction to psychiatric referral revealed themes
of disbelief/surprise, feeling confused/offended and lag of
6–36months to consultation. Parents most commonly attributed
causality to psychosocial reasons (lack of motivation/volitional,
inadequate disciplining), while few gave one or more biomedical
explanations (epilepsy, brain damage, low birth weight, nutri-
tional deficiency, maternal ill health, low intelligence) alone or
with a psychosocial reason. Despite the initial reaction, all but 1
parent was relieved with medical explanation, accepted diagnosis,
and perceived need for treatment. Most parents were willing to
start/continue medication if doctor suggested so as “he/she would
know the best”. All parents expressed that counseling was needed.
Conclusions Initial reactions and delay in treatment seeking is
understood in light of cultural attitudes towards mental illnesses
and psychiatric consultation in developing nations. More impor-
tantly, despite initial reluctance, most parents accepted biomedical
explanation and treatment. The doctor patient relationship mode-
led on a guru-chela relation of complete trust in authority can
explain this process change. We conclude that cultural attitudes
not only influence causal models and initial treatment seeking, but
also modify process of help seeking.
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