Adolescent perceptions of factors related to engagement in ADHD care: A qualitative study at an urban safety net hospital

The treatment engagement experiences of adolescents from diverse backgrounds and with Attention Deficit Hyperactivity Disorder (ADHD) are largely absent from the literature on ADHD. Guided by what research exists on ADHD in adolescence and on how adolescents engage with ADHD care, the present study explored what factors and experiences adolescents in treatment for ADHD at an urban safety-net hospital in Boston perceived as affecting their engagement with care. As part of the larger study, Assessing Preferences for and Barriers to ADHD Treatment Among Diverse Families, a cross-case, secondary analysis of eleven interviews with adolescents from underserved and minority families was conducted. Thematic analysis delineated by Braun and Clarke (2006) revealed that “engagement in care,” as it is traditionally defined in the literature, ought to be redefined to incorporate the unique life circumstances and self-esteem and insight levels of adolescents. Four styles of engagement –proactive, anxious, apathetic and actively rejecting engagement – were identified and their clinical implications were discussed. These findings confirm the importance of treating adolescents as a population with unique clinical needs and invite future researchers to investigate how to optimally transition adolescents with ADHD into adult care.