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Page Background European Psychiatry 41S (2017) S303–S364

Available online at


25th European Congress of Psychiatry

e-Poster Walk Part 4

e-Poster walk: Child and adolescent

psychiatry – Part 5


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.


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-



In-depth semi-structured interviews were conducted

with consenting parents of 27 children diagnosed with ADHD

(17 mothers; 10 fathers).


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.


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.


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.


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



In-depth semi-structured interviews were conducted

with 27 consenting parents; data interpreted using process theory.


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.


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.