Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition in children. Although ADHD is treatable, barriers remain to engagement in treatment, especially among socioeconomically disadvantaged and racial and ethnic minority families. Our goal was to examine the process by which families engage in ADHD treatment and to identify targets for an intervention to improve engagement in care.

We conducted in-depth semistructured qualitative interviews with 41 parents of diverse youth aged 3 to 17 years old in treatment of ADHD at an urban safety net hospital. Parents were asked about their journey through diagnosis and treatment, community attitudes about ADHD, and other factors influencing treatment access and decision-making. Transcripts were analyzed by using thematic analysis.

Of children with ADHD, 69.2% were male, 57.7% were Black or African American, and 38.5% were of Hispanic, Latino, or Spanish origin. Parents were 92.7% female, were 75.6% English speaking, and had a median income of $20 000. Parents described 6 stages to the process of engaging in care for their child’s ADHD, which unfolded like a developmental process: (1) normalization and hesitation, (2) fear and stigmatization, (3) action and advocacy, (4) communication and navigation, (5) care and validation, and (6) preparation and transition. Barriers often occurred at points of stage mismatch between parents and providers and/or systems. Difficulty resolving an earlier stage interfered with the progression through subsequent stages.

The 6 stages framework could be used to develop new strategies to measure engagement and to design family-centered interventions to facilitate engagement in ADHD treatment.

注意缺陷/多动障碍 (ADHD) 是儿童常见的神经发育疾病。尽管 ADHD 是可以治疗的，但参与治疗仍然存在障碍，尤其是在社会经济弱势群体和少数民族家庭中。我们的目标是检查家庭参与 ADHD 治疗的过程，并确定干预措施的目标以改善对护理的参与。

我们对 41 名在城市安全网医院治疗 ADHD 的 3 至 17 岁不同青少年的父母进行了深入的半结构化定性访谈。父母被问及他们的诊断和治疗过程、社区对 ADHD 的态度以及影响治疗机会和决策的其他因素。通过使用主题分析来分析转录本。

在患有多动症的儿童中，69.2% 为男性，57.7% 为黑人或非裔美国人，38.5% 为西班牙裔、拉丁裔或西班牙裔。父母中有 92.7% 是女性，75.6% 会说英语，收入中位数为 20,000 美元。父母描述了参与照顾孩子 ADHD 的过程的 6 个阶段，这就像一个发育过程：(1) 正常化和犹豫，(2) 恐惧和污名化，(3) 行动和宣传，(4) 沟通和导航，(5) 关怀和验证，以及 (6) 准备和过渡。障碍通常发生在父母与提供者和/或系统之间的阶段不匹配点。解决早期阶段的困难会干扰后续阶段的进展。

6 个阶段的框架可用于制定新的策略来衡量参与度并设计以家庭为中心的干预措施以促进参与 ADHD 治疗。