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Understanding the Role of Family Management in Ethnically Diverse Children with Adhd from Urban Philadelphia

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Understanding the Role of Family Management in Ethnically Diverse Children with Adhd from Urban Philadelphia University of Pennsylvania ScholarlyCommons Publicly Accessible Penn Dissertations 2017 Understanding The Role Of Family Management In Ethnically Diverse Children With Adhd From Urban Philadelphia Cynthia Paidipati University of Pennsylvania, [email protected] Follow this and additional works at: https://repository.upenn.edu/edissertations Part of the Nursing Commons, and the Psychiatric and Mental Health Commons Recommended Citation Paidipati, Cynthia, "Understanding The Role Of Family Management In Ethnically Diverse Children With Adhd From Urban Philadelphia" (2017). Publicly Accessible Penn Dissertations. 2510. https://repository.upenn.edu/edissertations/2510 This paper is posted at ScholarlyCommons. https://repository.upenn.edu/edissertations/2510 For more information, please contact [email protected]. Understanding The Role Of Family Management In Ethnically Diverse Children With Adhd From Urban Philadelphia Abstract Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurodevelopmental condition of childhood. Prior research shows improvement in ADHD outcomes with parental and family engagement. What is less known, however, is how caregivers from diverse families manage childhood ADHD on a daily basis and how family management factors correlate with child functioning. Guided by the family management framework, the purpose of this study was to understand how ethnically diverse caregivers manage childhood ADHD in their everyday lives and how family management is related to children’s level of functional impairment. This mixed methods study used a concurrent nested design (QUAL [quan]) to independently analyze and integrate cross-sectional qualitative and quantitative data from caregivers of children with ADHD recruited from diverse families living in urban Philadelphia (N=50). Semi-structured qualitative interviews were conducted to explore how caregivers managed ADHD in their everyday lives and identified barriers and facilitators of family management. Quantitative questionnaires were completed by caregivers to describe child, caregiver, and environmental characteristics and understand how family management factors influenced children’s functional impairment. The qualitative and quantitative data were then integrated and transformed at the level of analysis to further understand the experience of families whose children are higher and lower functioning. Qualitative results (from directed content analysis) revealed robust and descriptive themes within family management, including the child’s daily life, condition management effort, condition management ability, and view of condition impact. Barriers and facilitators were also described, including those within immediate and extended families, educational and healthcare systems, financial, policy, and insurance issues, and mental health stigma within communities. Quantitative results (using descriptive and inferential statistics) confirmed these themes in a diverse sample of caregivers and children. Family management factors and children’s functional impairment were significantly correlated (<.05; weak to moderate) in hypothesized directions. Qualitative themes were complemented by quantitative results and elucidated the daily work of families who are managing ADHD at higher and lower levels of functional impairment. Findings from this study have implications for research, practice, and policy related to the complexities of treatment, experiences of caregivers, and stigma regarding in developmental and mental health conditions among children. Degree Type Dissertation Degree Name Doctor of Philosophy (PhD) Graduate Group Nursing First Advisor Bridgette M. Brawner Keywords ADHD, Children, Ethnically Diverse, Family Management, Health Equity, Mental Health Subject Categories Nursing | Psychiatric and Mental Health This dissertation is available at ScholarlyCommons: https://repository.upenn.edu/edissertations/2510 UNDERSTANDING THE ROLE OF FAMILY MANAGEMENT IN ETHNICALLY DIVERSE CHILDREN WITH ADHD FROM URBAN PHILADELPHIA Cynthia P. Paidipati A DISSERTATION in Nursing Presented to the Faculties of the University of Pennsylvania in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy 2017 Supervisor of Dissertation __________________________ Bridgette M. Brawner, PhD, APRN Assistant Professor of Nursing Graduate Group Chairperson __________________________ Salimah H. Meghani, PhD, MBE, RN, FAAN, Associate Professor of Nursing Dissertation Committee Janet A. Deatrick, PhD, RN, FAAN Professor Emerita of Nursing Ricardo Eiraldi, PhD Associate Professor of Clinical Psychology in Pediatrics Connie Ulrich, PhD, RN, FAAN Associate Professor of Nursing and Bioethics UNDERSTANDING THE ROLE OF FAMILY MANAGEMENT IN ETHNICALLY DIVERSE CHILDREN WITH ADHD FROM URBAN PHILADELPHIA COPYRIGHT 2017 Cynthia Priya Paidipati This work is licensed under the Creative Commons Attribution- NonCommercial-ShareAlike 3.0 License To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/3.0/us/ Dedication This dissertation is dedicated to children with ADHD (Attention Deficit Hyperactivity Disorder) and their devoted caregivers, who help them survive and thrive in a world that has yet to fully understand children with mental health conditions and their families. iii ACKNOWLEDGMENT I would like to acknowledge my wonderful dissertation committee, including Janet Deatrick, Bridgette Brawner, Ricardo Eiraldi, and Connie Ulrich, for their ongoing support, encouragement, and commitment to this work. I also would like to thank my readers, Sharon Irving and Lisa Lewis, for their contributions to this work, and my study intern, Jamil Lane, who dedicated his master’s public health practicum to working on this research project. Additional acknowledgements are extended to Drs. Barbara Medoff- Cooper, Lisa Lewis, and Marilyn Sommers for the NIH/NINR-sponsored T32 fellowship for Vulnerable Women, Children, and Families at the University of Pennsylvania School of Nursing. I would also like to recognize Debbie Tiller, the administrative support for the T32 fellows, in the health equity collaborative. Furthermore, I would like to acknowledge my clinical partners at The Children’s Hospital of Philadelphia for which this research would not be possible. I want to personally thank the chair of the Department of Child and Adolescent Psychiatry and Behavioral Sciences, Dr. Tami Benton, and the senior director of administrative leadership Missey Thompson, for their incredible confidence and trust in me as the first pediatric psychiatric nurse practitioner in the institution and a burgeoning mental health researcher. Many thanks and appreciation are afforded to Chris Gantz and Lindsey DeMarco within CHOP’s Recruitment Enhancement Core (REC) for their amazing services. In addition, I would like to thank Dr. Nate Blum and Karla Varrell, the program director and administrative support in the division of Developmental and Behavioral Pediatrics, and Dr.Terri Behin, the medical iv director of the South Philadelphia CHOP Primary Care location, and the lovely nurses, for their recruitment recommendations and support. Recognition is also due to Caroline Baker for coordinating and scheduling rooms for research participants within our outpatient Behavioral Health Clinic. I also would like to extend my appreciation to Dr. Tom Power, the program director for the Center for Management of ADHD, and the outstanding clinicians, staff, and resources within the center. Finally, I would like to thank my family, friends, peers, coworkers, dance teacher, fitness trainers, boxing coach, and yoga instructor for their unconditional love, support, guidance, and encouragement over the last four years. v ABSTRACT UNDERSTANDING THE ROLE OF FAMILY MANAGEMENT IN ETHNICALLY DIVERSE CHILDREN WITH ADHD FROM URBAN PHILADELPHIA Cynthia P. Paidipati Bridgette Brawner, PhD, APRN Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurodevelopmental condition of childhood. Prior research shows improvement in ADHD outcomes with parental and family engagement. What is less known, however, is how caregivers from diverse families manage childhood ADHD on a daily basis and how family management factors correlate with child functioning. Guided by the family management framework, the purpose of this study was to understand how ethnically diverse caregivers manage childhood ADHD in their everyday lives and how family management is related to children’s level of functional impairment. This mixed methods study used a concurrent nested design (QUAL [quan]) to independently analyze and integrate cross-sectional qualitative and quantitative data from caregivers of children with ADHD recruited from diverse families living in urban Philadelphia (N=50). Semi-structured qualitative interviews were conducted to explore how caregivers managed ADHD in their everyday lives and identified barriers and facilitators of family management. Quantitative questionnaires were completed by caregivers to describe child, caregiver, and environmental characteristics and understand how family management factors influenced children’s functional impairment. The vi qualitative and quantitative data were then integrated and transformed at the level of analysis to further understand the experience of families whose children are higher and lower functioning. Qualitative results (from directed content analysis) revealed robust and descriptive themes within family management, including the child’s daily life,
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