Parental narratives online about ADHD

ABSTRACT

Contemporary parents turn to social media to discuss parental issues. The aim of the present study was to analyze 198 posts on online discussion forums posted by parents whose adolescents had been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) or who suspected that their adolescent would meet the diagnostic criteria for an ADHD diagnose. Narrative thematic method was used to explore whether parents used a medical discourse for making meaning of their adolescents’ behaviors. The results showed that parental narratives were predominantly influenced by the medical discourse where adherence to the neurobiological framework provided a sense of coherence that guided parents’ meaning-making of adolescent hardship. Parents used an ADHD diagnosis to reconstruct the personal narrative of the adolescent into a more socially accepted identity. Additionally, parents envisioned a dark future if ADHD went undetected, leading parents to engage in intense battles to obtain diagnoses. Narrators in the present study viewed a responsible parent as a parent who would fight for the right to an ADHD diagnosis and medication on behalf of the adolescent. Social workers should be aware of that parents may on online discussion forums encourage each other to interpret adolescent development within a medical framework.

KEYWORDS:

• Adolescence
• parenting
• ADHD
• online discussion forum

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association (APA, 2013). The symptoms of ADHD include inattention, hyperactivity, and impulsivity. These symptoms have been associated with restlessness, difficulties screening out distractions, and poor organizational skills. Medicine is a common treatment for these symptoms (Bachmann et al., 2017). However, longitudinal studies that assess long-term effects of medications for ADHD on children and adolescents are scarce (Bachmann et al., 2017; Zito & Burcu, 2016).

Diagnosing ADHD

Worldwide, about 3–10% of children and adolescents are diagnosed with ADHD (Polanczyk, Salum, Sugaya, Caye, & Rohde, 2015; Skounti, Philalithis, & Galanakis, 2007). The number of people diagnosed with ADHD has increased rapidly during the last couple of decades (LeFever Watson, Arcona, Antonuccio, & Healy, 2014; Polanczyk, Willcutt, Salum, Kieling, & Rohde, 2014; Visser et al., 2014), as has the consumption of medicines aimed at treating ADHD symptoms (Bachmann et al., 2017; Burcu, Zito, Metcalfe, Underwood, & Safer, 2016; Dalsgaard, Nielsen, & Simonsen, 2013; Johansen, Matic, & McAlearney, 2015). Diagnoses are made based on subjective assessments of behaviors and coping-difficulties in various situations. No single test for ADHD exists (Batstra, Nieweg, & Hadders-Algra, 2014). Many researchers have therefore questioned the validity of the diagnosis, consequently initiating a debate, within the research community, about whether or not ADHD is a legitimate diagnosis (Erlandsson, Lundin, & Punzi, 2016; Frances, 2013; Timimi, 2015).

The increase in ADHD diagnoses is partly due to the continuous changes in DSM diagnostic criteria since the 1960s (APA, 1968, 1980, 1987, 1994, 2000, 2013; Sheppard, 2015). For example, the diagnostic criteria were broadened in the fifth and latest version of the DSM (APA, 2013) so that more behaviors can be interpreted in line with the ADHD diagnosis. Challenges that interfere with or reduce performance in various areas in life are sufficient as symptoms of ADHD, and clinically significant impairment is no longer necessary. Furthermore, the necessary diagnostic criteria have been relaxed with regard to age, allowing for a later onset of ADHD symptoms. In previous editions of the DSM, functional impairments and symptoms were required to have an onset before the age of seven. However, in the DSM-5 (APA, 2013), onset of symptoms is required before the age of 12, making criteria more liberal and inclusive. Hence, adolescents can receive an ADHD diagnose even if they did not experience inattention, impulsivity, and hyperactivity earlier in childhood.

Adolescence and ADHD

Puberty and adolescence are times of identity exploration and potential identity crises (Kroger, 2007). The changes in the DSM-5 (APA, 2013), which allow for a later onset of symptoms associated with ADHD, may color the interpretation of adolescent behavior. Normal developmental processes, such as identity exploration and pubertal restlessness and distractibility, could be interpreted as symptoms of ADHD. The medical discourse of how to understand adolescent behavior may influence parents, which is why investigating how parents understand and make meaning of potential challenges during adolescence is important. Research in this area is scant and requires further investigation.

The medical discourse model and the social context model

The medical discourse model of ADHD proposes that people diagnosed with ADHD are suffering from a biomedical brain disorder (Singh, 2013). A medical discourse has dominated when discussing impulsivity, restlessness, and inattention in children, and accounts of social structures, family situations, and contexts have been scant (Singh, 2008). However, several studies have found that children from families facing various disadvantages, such as unstable home environments, divorce, low socioeconomic status, parental mental illness, and/or substance abuse are diagnosed with ADHD more frequently than children who are not disadvantaged (Dallos, Denman, Stedmon, & Smart, 2012; Pheula, Rohde, & Schmitz, 2011; Russell, Ford, Williams, & Russell, 2016; Rydell, 2010). These results provide support for the importance of the social context model emphasizing the social context around the child (Singh, 2013).

While problems with focusing, learning, planning, and reflecting on actions cause legitimate distress, the meaning of these behaviors and experiences vary depending on culture and history (Batstra et al., 2014). People can have different pre-dispositions, temperaments, and personalities that stimulate them to be more active and impulsive, which in turn interacts with reactions to challenges faced in life. Neurobiological interpretations of challenges and difficulties in life shape not only how people perceive themselves in the present and how they make sense of their past, but also what they expect in the future (Vidal, 2009). Viewing behaviors and reactions through a neurobiological lens can thus have profound consequences on self-understanding and perceived self-determined autonomy (Singh, 2013). Specifically, the ADHD diagnose establishes the brain as the locus of human behavior and suffering (Rose & Abi-Rachel, 2013).

Parenting and ADHD

Bringing up children and adolescents who display hyperactive, distracted, inattentive, and impulsive behaviors can pose serious challenges for parents. Research shows that parents of children and adolescents diagnosed with ADHD experience more parenting stress than parents of children not diagnosed with ADHD (Deault, 2010). Family dysfunctions and maladaptive parenting styles further aggravate the child’s difficulties (Sollie, Mørch, & Larsson, 2016). A child’s behavioral problems also negatively impact the parents’ marital and social lives, increasing the risk of negative parental feelings and attitudes toward the child (Fleck et al., 2015; Lambek et al., 2014; Pearl, French, Dumas, Moreland, & Prinz, 2014). Furthermore, problems worsen if social support from family and relatives is not available (Akcinar & Baydar, 2016).

Parenting and online forums

While parents in the past would have mainly turned to their own parents for support and advice on child rearing, contemporary parents increasingly turn to the Internet (Dworkin, Connell, & Doty, 2013; Niela-Vilén, Axelin, Salanterä, & Melander, 2014). The Internet has become an everyday social arena for parents that is universally accessible, regardless of time constraints or geographical distances. Parents can search for expert advice on the Internet and even have discussions online with other parents on open Internet forums. Research reveals that parents who are active Internet users mainly go online in order to obtain parental information and social support (Niela-Vilén et al., 2014; Pehora et al., 2015; Walker, Dworkin, & Connell, 2011).

Online discussion forums may pose certain advantages to parents worried about their children, such as anonymity, reduced fear of being judged, a sense of belonging, and breaking of social isolation. Such factors may be especially important for parents who fear stigma and rejection from other parents in face-to-face interactions (Niela-Vilén et al., 2014). Peer support is distinct from other forms of support in that the source of support and advice is a person who is in a similar situation as the person receiving the support.

Adolescence, ADHD, and online parental support

There is a shortage of systematic studies about how parents whose adolescents have been diagnosed with ADHD or who suspect that their adolescent would meet the diagnostic criteria for an ADHD diagnose seek support online and what characterizes the content of such online discussions. Terbeck and Chesterman (2012) analyzed parental discussions that took place on the five most popular international Internet forums about concerns related to the diagnosis ADHD. They identified some negative aspects of seeking support in online discussion forums. For example, Terbeck and Chesterman (2012) found that parents encouraged each other to try to attain an ADHD diagnose for their children despite being discouraged to do so by professionals. Furthermore, some parents reinforced negative attitudes toward medical professional decisions not to diagnose children.

Aim of the study

Given that the Internet is increasingly utilized as a source of healthcare information and support by parents and may influence perceptions and choices it is important to learn more about how parents use online resources and what characterizes the content parents encounter on online discussion forums on the topic of ADHD. Online discussion forums provide an opportunity to investigate parental online social networking as well as how parents organize and make meaning of adolescent hardship. Online parental narratives can provide researchers with an inside, parental perspective. The aim of the present study was to focus on the meaning-making processes of parents whose adolescents had been diagnosed with ADHD or who suspected that their adolescents meet criteria for an ADHD diagnose to explore whether parents used a medical discourse for making meaning of their adolescents’ behaviors. Narratives are influenced by social, cultural, historical, and institutional discourses. This study is the first to systematically analyze parental meaning-making of adolescent hardship as narrated online.

Method

The researcher examined international online discussion forums on health issues that involved parental discussions on the topic of ADHD. From the first 10 online forums that were found, two forums were randomly chosen in order to be able to study them in-depth. The researcher used search engines for parental issues related to ADHD and all messages and replies that involved parental discussions about adolescents were analyzed. Messages and conversations on these sites are called posts. A post can be replied to by anyone and by as many people as so wish. Posts are referred to as online narratives. A total of 198 posts involving 156 usernames between 2013 and 2019 were reviewed and analyzed.

Ethical considerations

Communicators in an open online discussion forum do not reasonably expect a researcher to gather their posts as data to be analyzed, which raises obvious ethical concerns. Accordingly, ethical considerations in the present study were in line with previous similar studies (Eysenbach & Till, 2001; Pestello & Davis-Berman, 2008; Pfeil & Zaphiris, 2010; Ravert & Cromwell, 2008; Seale, Charteris-Black, MacFarlane, & McPherson, 2010). The online forums from which posts were collected and analyzed were not password protected but open to the general public, meaning that no consent was necessary because online content is permitted for research purposes if it is considered to be in the public domain (Appleton, Fowler, & Brown, 2014; Eysenbach & Till, 2001). Furthermore, the selected websites did not have restrictions on use or access but were intended for the use of the general public. In order to protect the privacy of the users on the online forums, the websites are not identified. The study was conducted in line with the appropriate ethical research standards applied at the university where the study was completed, ensured by the head of the department and by a professor at the same department.

Data analysis

The method adopted to analyze the narrated experiences of parents was guided by approaches to narrative thematic analysis outlined by (Crossley, 2000) and (Riessman, 2008). The approach of narrative inquiry examines the life stories that people construct. The stories people tell about their lives are shaped by their lived experiences for the purpose of making sense of the ambiguity and complexity of living. In this study, parental narration reflected the meaning-making of experiences of being a parent to an adolescent experiencing hardship and difficulties; an adolescent who had received an ADHD diagnose in adolescence or whom parents suspect meet the criteria for a diagnosis. Narrative inquiry accounts for the relationship between individual experience and cultural and social contexts via the richness of the social reality conveyed by the narrator. Narrative researchers thus attend to how content in personal narratives are also situated in social, cultural, historical, and institutional discourses (Riessman, 2008). Discourses create and frame peoples’ subjective experiences, emotions, and interpretations. Narratives also function socially to create possibilities for group belonging and positive identity. Subjective meanings and identities are negotiated as narratives unfold, and the narratives are told to a particular audience for a certain purpose (Crossley, 2000; Riessman, 2008). Stories reveal what values and beliefs guide the narrator’s interpretations of the past and the present, as well as their plans and hopes for the future.

All narratives were read thoroughly several times in order for the researcher to become familiar with the data and to gain a general sense of what parents were discussing, topically, online (Crossley, 2000; Riessman, 2008). Data were then organized in a meaningful and systematic way by reducing data into smaller codes of meaning contributing to uncovering parents’ experiences with their adolescents. Each segment of the data that was relevant to the research question was coded by highlighting recurrent words and phrases. Codes were then grouped into categories, i.e., circulation around similar networks of ideas and belief systems were identified and sorted into categories (Crossley, 2000). Repetition of these ideas and beliefs indicated recurring patterns in the parental narratives. These patterns suggested themes, each theme expressing an underlying meaning found in two or more categories (Crossley, 2000; Riessman, 2008). The themes were subsequently re-checked several times against the previously created codes and categories, as well as the entire original dataset of online narratives gathered, to reflect on and refine the initial analysis in order to ensure that themes provided insight into parental experiences (Crossley, 2000; Riessman, 2008). Themes were defined and subsequently assigned final names to express their underlying meaning. The themes were: a) sense of coherence; b) socially accepted identity; c) prevention of future problems; and d) responsible parents.

Once a working map of themes had emerged the next step was to further explore whether parents used the medical discourse of ADHD as a framework for understanding and making meaning of the experiences they had with their adolescent children. Attention was thus focused on the ties between parental experiences, beliefs, ideas, attitudes and understandings of ADHD and interpretations of their adolescent children as well as reasons for seeking diagnoses and medical treatment. Narratives are not constructed by individuals in isolation, but are influenced by social, cultural, historical, and institutional discourses (Riessman, 2008). The meaning-making by parents thus uncovered their psychological, cultural, and social realities. It is the ties among events, experiences, behaviors, beliefs, ideas, emotions, and interpretations that construct meaning and uncover reasons for acts and happenings (Riessman, 2008). Parents perceived, interacted, and made moral choices according to organized narrative structures. In the present study the aim was to interpret and understand whether, and in that case how, the medical discourse was inscribed in parental online narratives, invisibly working to create certain versions, interpretations, and images of their adolescents.

The results are presented by themes in the results section where each theme is supported by several online narratives. The wording and punctuation were left intact in the online narratives displayed below. Names and emojis were removed. Names were replaced with“xxxxxx.”

Research reflexivity

Research is a human endeavor, which is why a researcher’s background, such as professional history, impacts what research questions are deemed worthy of exploration, what methods are judged most adequate, and the framing of interpretation and conclusions. The researcher’s professional background as a researcher within clinical and developmental psychology motivated to examine the parental perspective of challenges raising an adolescent child and the relational aspects, instead of biomedical aspects, surrounding ADHD. The narrative method of online narratives was chosen to position parents as tellers of their own stories. In the field of psychology, researchers sometimes tend to focus on individuals and to disregard contextual factors. In the present study, the researcher took a host of steps to enhance self-awareness of how the researcher’s professional history in psychology could influence the research process and the conclusions drawn from the results. For instance, a reflective journal was kept. After reading every post time was spent noting immediate thoughts and interpretations. The researcher reflected around automatic attitudes and reactions to each post before incorporating the posts into the narrative thematic analysis. Care was taken not to focus on individual parents but to be reflective about the many interacting contextual factors that could influence parental decisions and attitudes. Part of the process of developing questions in qualitative research is being reflective about how the research will affect the lives of those participating in the study, an ethical question that is especially important when studying marginalized populations.

Results

Sense of coherence

One recurring theme found in the parental narratives was that ADHD functioned for parents as a framework for understanding and, in this way, gaining a sense of coherence with regard to a variety of past and current problems experienced by their adolescents. In the narratives below, parents express how the ADHD diagnosis received by their adolescent confirmed something that parents had suspected: that something was wrong with their child. An explanation was finally provided that could help reconstruct complex and ambiguous experiences into a coherent story. In the first narrative, a parent revealed that problems starting during the teenage years were interpreted as having a neurobiological explanation. Despite high confidence and good grades at school during earlier years, the parent stated that changes beginning at the age of 13 must be explained by an adamant brain dysfunction waiting to be discovered. Current problems with overeating, drinking alcohol, and talking too much were also incorporated into the neurobiological framework of understanding. If only the diagnose had been identified earlier. However, despite the ADHD diagnosis providing a coherent framework within which various problematic behaviors could be understood, the parent also revealed the somewhat contradicting information that a psychiatrist had told parents that their daughter would grow out of ADHD in a few years. The parent wrote:

Our 17 year old daughter has only just been diagnosed with ADHD. It is a huge relief to her, and us. As a child, she was confident and academic. From the age of 13 her grades at school fell, she fell out with friends and became extremely anxious and depressed. If only we had had an earlier diagnosis, she and we could have been saved much heart ache. We are noticing, now she has turned 18, that her symptoms are worsening. She is eating too much, especially sweet things and drinking too much alcohol when out with friends. The problem is, she doesn’t have the ability to know when to stop ….stop talking, stop eating, stop drinking. I’d love to hear from anyone else in a similar situation. We’ve had no help from school or our GP and feel very alone. Her psychiatrist intimated that she will grow out of ADHD in her early 20’s; is this indeed a possibility?

The narrative below is an additional example of how changes in the child’s behavior during the teenage years were interpreted as fitting a diagnosis of ADHD. The mother revealed how she was following her instinct to have the boy assessed even though academic personnel at the boy’s school did not see cause for worry. She wrote:

I have a 14 yrs son who when he was young was very hyper. I noticed quite a change when he was around 11 and half 12 years old where he seemed to switch from hyper to almost a depressed state, .much quieter and mellow, although at the same time was beginning to get into more and more trouble at school. Im just wondering if anyone else on here can relate to this? I think I have been battling to get him diagnosed because of the switch and his current school does not believe there is too much to worry about but i’m going with my mummy instinct to get him assest.

In addition, some parental narratives portrayed the adolescent receiving the diagnosis as feeling relieved to be diagnosed. In the following narrative, an explanation for the long-standing feeling of never fitting in anywhere was proposed: “Anyhow, she is so much happier now she knows why she felt how she felt for those years at Senior School.”

The narratives above display how parental experiences were reconstructed and formed according to a neurological framework of understanding. Research indicates an increased search for diagnoses in order to explain human behaviors, reactions, suffering, emotions, and transitional developments (Brinkman, 2016).

Socially accepted identity

Some parental posts reveal reconstructions of how they narrate the identity of the adolescent. One parent, whose narrative is seen below, stated that her 18-year-old son had been using cannabis for about 4 years. The parent proposed that drug use served the purpose of self-medication to help the young man feel normal. Despite expressing some doubts about the ADHD diagnosis, previous experiences could now be interpreted within a new model of understanding. The mother felt guilty that her son could have inherited ADHD from her, although she herself had never received a diagnosis. However, the mother was able to reinterpret her son’s past behaviors due to the diagnosis; he had not been lazy and unmotivated. As the parental narrative unfold, the boy’s identity is negotiated and reconstructed. Instead of self-medicating on cannabis, the son could now receive legal prescription drugs for ADHD. If there was a neurological explanation, the son was not a drug addict. The abbreviation “NHS” included in the post below stands for National Health Service:

My 18 year old has just been diagnosed with ADHD (inattentive). He’s been self medicating with cannabis for about 4 Years. He said it helped him sleep and feel normal. We obviously didn’t know about him using cannabis until last year and were totally against him doing this. We had also at the time consoled ourselves that he was just experimenting. We didn’t know it was becoming a daily habit. After a visit to our GP as our son became very depressed (I blamed the cannabis) the GP said that it wasn’t unusual for a YP to self medicate this way. He suspected an underlying condition and said that these YP showed up in surgeries depressed and distressed and everyone suspecting it was through cannabis/alcohol use. This surprised me. My son was then assessed privately as no help from NHS. He was given a diagnosis of ADHD last week. (Shouldn’t it be ADD if no hyperactivity?) During assessment I recognised some of the traits in myself and the Psychologist thinks it’s come from me! I feel incredibly guilty and have mixed feelings about this. In some ways I’m pleased even at this late stage we know for my son and he isn’t just lazy and a bit unmotivated.

In the following narrative, one parent was comforting another parent whose child had recently been diagnosed with ADHD. If their children were previously interpreted as being lazy, the diagnosis had now provided parents with the appropriate understanding of the medical characteristics of the difficulties experienced by their children: “Hi, it’s easy to think the way they behave is just lazy, until a diagnosis no one would be any the wiser including me, please don’t blame yourself, it is hard accepting any disability and seeing your child suffer.”

These narratives reveal how acceptance of a diagnosis can result in transformation of identity into a more socially acceptable identity.

Prevention of future problems

Some parental narratives revealed fear of leaving ADHD undetected and untreated which could then lead to future problems. One parent wrote: “I believe I understand what happens if ADHD goes untreated and wouldn’t want anyone to go through it, least of all my daughter.”

The narrative below shows the type of problems parents might expect if ADHD goes undetected and untreated. The writer’s child was at risk of facing criminality, mental health problems, and substance abuse:

It is never too late to turn a life around. It will be tough at his age, because of learned helplessness and already being in a bad pattern, but it’s possible and totally worth it. What you’re experiencing now is untreated ADHD – which carries risks like criminality, anxiety, depression, substance abuse, etc.

Concerns voiced by parents revealed that they feared that if their children were sufferers of an unidentified disorder that went untreated, this disorder would negatively influence their children’s life choices and have detrimental effects on their futures.

Responsible parents

Several accounts showed parents attempting to receive an ADHD diagnose for their children despite medical professionals and personnel at school advising them not to. The other parents were encouraging these struggling parents not to give up the fight for the right to a diagnosis and medicine. Below is the narrative of one parent’s positive reaction to receiving a diagnose and medication for her 14-year-old son:

At last, someone who got it! Lovely man who had us all laughing with recognition (and relief) with his descriptions of ADHD behaviour. Half an hour later he handed us a prescription for Concerta XL. It was sooooooooooooo easy!“ “So HURRAH!!!! Something went right!

Other parents in similar situations expressed how happy they were for the family who now had the ADHD diagnosis and prescription for medicating their child, saying: “WONDERFUL NEWS!!! – and – you actually HAVE the prescription in your hands – wow – am gobsmacked!!”

The parent who had struggled so hard to receive a diagnosis and medication for her boy received support and praise for winning a huge battle for her boy, such as another parent’s comment that said:

Well done you – should be v proud of yourself for winning this battle for your boy I hope he got on ok with them today. … . What a shame the guy didn’t deal with adults too. Hurray hurray for you and him – just need you sorted now xxxxxx

A diagnose and medication were perceived as the solution to all problems. Furthermore, if the dose was set too low, encouragements were made to just keep going back for a higher dose, as seen in the following post:

excellent news – what nice guy fitting you in had to laugh at the week early – number of times I’ve done that know what you gotta do now in it – (if hopefully that dose works ok for him) keep going back saying he needs higher dose – get all info and stuff about why from posts on here – get highest dose for him you can – then share it problem solved

The mother who wrote the first post to which the others had replied kept the other parents up to date about the boy’s positive reaction to the news of diagnosis and medicine and how the boy told his teacher and the pupils in his class during a lesson at school. The boy had obviously learned that receiving a diagnosis and medicine was something wonderful. His parent wrote: “Yesterday, he walked into his maths class, flung his arms wide and said in front of the whole class, ‘I got the drugs!’”

Throughout the posts, parents narrated expectations around what medicine could accomplish, and medicine was thus perceived as something to fight hard for. A responsible parent should battle for the right to a diagnosis and medication on behalf of the child.

Discussion

Despite the controversy around ADHD diagnoses, the diagnostic rates of ADHD have burgeoned over the past decades (LeFever Watson et al., 2014; Polanczyk et al., 2014; Visser et al., 2014). As criteria for meeting an ADHD diagnosis are increasingly stretched and expanded, a growing number of young people experiencing challenges of various kinds will start to meet diagnostic criteria for this disorder. The narratives in the present study may well reflect the potential impact of medical discourses of ADHD symptoms on parents’ interpretations and understandings of adolescent development.

Sense of coherence

The narratives analyzed in the present study revealed that ADHD served as an explanatory framework that could guide parental interpretation of various challenges in the life of adolescents and, in turn, provide a sense of coherence and explanation of behaviors and difficulties as revealed in the theme sense of coherence. When the adolescent was assigned the ADHD diagnose, it seemed to be a turning point in how the behaviors of the adolescent were interpreted. Parents adhered to the ADHD categorization when making sense of the past, and they created new meaning by organizing information through a neurobiological belief system. A diagnosis could name and clarify what adolescent difficulties and challenges were all about. Adherence to the neurobiological framework provided a sense of coherence that guided the interpretation of adolescent hardship (Vidal, 2009). Chaos and confusion were replaced with order and comprehensibility. These results are in line with findings by Fleischmann and Miller (2013) who analyzed online narratives of adults diagnosed with ADHD in adulthood. Once diagnosed, these adults narrated the ability to reconstruct their perceptions to create a more coherent and comprehensible view of their difficulties in the past and in the present. In a study by Winter, Moncrieff, and Speed (2015) women diagnosed with ADHD positioned themselves on YouTube in the medical discourse by using vocabulary adapted from the medical discourse when describing themselves.

When human life is understood through the medical lens, previous experiences tend to be reinterpreted within a pathological framework (Sheppard, 2015). Various problematic situations and challenges in life are transformed into disorders of the brain (Rose & Abi-Rachel, 2013). Instead of interpreting the changes observed in child behavior a result of going through puberty and identity exploration, parents were adopting a medical explanation. Developmental changes and transitions were interpreted as biological dysfunctions, and parental discussions in the present study were thus proposedly influenced by a medical discourse.

Socially accepted identity

Some parents reconstructed the identity of their adolescent after receiving the diagnosis, such as reconstructing drug use as revealed in the theme socially accepted identity. The ADHD diagnosis was hereby laden with potential promises. The adolescent, and perhaps the whole family, could potentially be recognized differently. Accepting a diagnosis meant receiving an explanation for emotional suffering and laziness as well as being able to substitute illegal drug use for legal drug use. The deviant identity of being a drug addict or of being lazy could be revised into a more socially accepted identity. To do so, a biomedical explanation for the adolescent’s previous difficulties, emotional suffering, and unacceptable behaviors was put forward. The personal narrative of the adolescent could hereby be reconstructed in a more socially acceptable way. ADHD can serve as an explanatory framework enabling a person to reinterpret failures and shortcomings in a more positive light (Fleischmann & Miller, 2013). The ADHD diagnosis provides categorization that helps recreate self-image and identity. Receiving an ADHD diagnosis may reduce stigma, and previous difficulties in living up to society’s norms and values could be normalized. These results are in line with Fleischmann and Fleischmann (2012) who analyzed online narratives of adults diagnosed with ADHD. These adults reported having developed more positive self-perceptions, less self-blame, and more self-forgiving attitudes toward themselves after being diagnosed. Winter et al. (2015) similarly found that women diagnosed with ADHD optimistically proposed on YouTube that ADHD enabled them to live more productive lives and that medication maximized their potential.

Normalization is a social process by which stigmatized individuals become included in normal life (Goffman, 1968). Such reconstruction of the self-narrative dismisses the responsibility for the stigmatized position. Furthermore, social status can be enhanced by transforming various problems into biologically based explanations, and diagnoses can thus provide guilt relief for parents and protect against a stigmatized identity for the adolescent and for the family. A diagnosis can also provide access to support, treatment, privileges, and empathy.

Prevention of future problems

Undetected ADHD was perceived to pose serious threats to the development and future of adolescents, and parents had to take preventative actions by fighting for a diagnosis and treatment, as seen in the theme prevention of future problems. Parental narratives reflected that parents believed that if their adolescent did have ADHD that was left undetected and untreated, the adolescent would have an increased risk of criminality, mental health problems, and substance abuse in the future. These results are in line with previous research revealing that parental views about the appropriateness and anticipated effects of medication for ADHD guide treatment decisions (dosReis et al., 2009).

Responsible parents

Learning about ADHD offered parents an empowering position as experts of their children. Instead of feeling like bad parents, they were able to portray themselves as good parents who fought for their children, as revealed in the theme responsible parents. Many parents were determined to receive an ADHD diagnosis for their adolescent despite sometimes being discouraged by medical professionals and educational personnel. These results are in line with Terbeck and Chesterman (2012), who similarly found that parents encouraged each other to strive for an ADHD diagnosis despite being discouraged by medical professionals and that some parents reinforced negative attitudes toward professional decisions not to diagnose children. Once the diagnosis was set, parents could finally relax because an explanation had been provided regarding what was “wrong” with their child. Receiving the diagnosis and medicine was perceived as winning a huge battle. Parents would congratulate each other on finally achieving what they had strived for as well as praise each other for working hard for their children’s right to receive an ADHD diagnosis and medicine. Furthermore, some parents ruminated over the misfortune that a diagnosis had not been received earlier in the child’s life.

These findings are in line with previous research showing that parents who choose to medicate their children believe medication benefits the full potential of their children (Coletti et al., 2012; dosReis et al., 2009). The parents knew best and believed they should battle until the child received a diagnosis and accompanying medicine in order to prevent a negative future for the child (Terbeck & Chesterman, 2012). Such narratives positioned the adolescents as vulnerable and at-risk and parents as experts. A responsible parent was a parent who went out of his or her way to fight for the right to a diagnosis and medication on behalf of the child. Ensuring recognition of impairment was done in the best interest of the adolescent. In the study by Winter et al. (2015), ADHD was similarly put forward as a diagnosis that the women being studied, on YouTube, had a right to and that they should fight for.

Adolescents diagnosed and adolescents undiagnosed

Generally, the results showed that parents who had an adolescent who had been diagnosed with ADHD were relieved to have information about what was wrong with their child. Current and past experiences could be explained by the medical framework. Parents who suspected their adolescent might have ADHD were afraid that ADHD would go undetected since they had learned that undetected ADHD was associated with criminal behavior and mental health problems. The results of the present study suggest that the medical discourse may be perceived by parents to pose promises, leading parents to embrace the medical framework and to strive to receive an ADHD diagnose for their adolescents (Terbeck & Chesterman, 2012). Diagnoses can be sought out and embraced for a variety of reasons. An ADHD diagnosis could explain who the adolescent was and, in turn, serve a normalizing function that also protects the identity of the adolescent and the family from social stigmatization. With a diagnosis, deviant behavior was transformed into pathological inheritance that required treatment and afforded special privileges and support.

Implications for social workers

Given that parents increasingly turn to online social platforms for support and information on health issues it is important to learn more about the content on these platforms. Results from the present study revealed that the meaning-making of adolescent hardship was influenced by the parents’ biomedical viewpoint and understanding of ADHD. Parents face the challenge of trying to make decisions that are in the best interest of their children. Distressed parents in search of support may be encouraged or persuaded on these online platforms to perceive their children through the medical discourse lens in which medication becomes the perceived primary solution to complex problems (Vidal, 2009). Social workers come into daily contact with adolescents and parents in various settings and must frequently make referrals for further evaluation. Social workers are encouraged to recognize the power medical discourses can have on how parents perceive their children and that online discussion forums may constitute platforms where parents form positive identity ties by encouraging each other to interpret and understand adolescent development within a medical framework.

Parental rating scales are central elements in DSM criteria. Paying attention to parental perceptions, beliefs, attitudes, and understandings of ADHD and reasons for seeking diagnoses and medical treatment is important when planning appropriate interventions. Understanding which factors make diagnosis and medicine more acceptable from the perspective of the parent can be helpful to avoid over-diagnosis and overtreatment with medicine. The aim of the present study was not to blame parents. Undoubtedly, many parents and adolescents need help. However, the tendency to increasingly understand more and more challenges and difficulties associated with child and adolescent development within a medical framework should be problematized (Singh, 2013). Social workers are advised to make well-reasoned and critical decisions about how best to respond to and support parents and their children and adolescents.

Non-diagnostic approach

Suffering is hardly ever caused by one factor. Instead, people are influenced by multiple interacting factors. The problem with the broadening of diagnostic criteria is that the boundaries of what was previously considered normal within natural development and identity crises may shift. Furthermore, difficulties are reduced to individual characteristics without consideration of contextual factors. A life course approach that considers human beings as social, psychological, cultural, and biological all at the same time may be a more responsible approach (Singh, 2008). If all focus is directed toward medical explanations, then alternative approaches such as psychotherapy or educational and social support, which are not associated with risks for physical side effects on a developing brain, may be overlooked.

Timimi (2017) developed a non-diagnostic approach called the Relational Awareness Program for parents of children displaying behaviors characterized as impulsive, hyperactive, and emotionally intense. In this approach, parents are encouraged to build a positive and reciprocal relationship with children and adolescents. The priority should be to understand the young person at an emotional level instead of concentrating on controlling symptoms and behaviors. This model is thus a relational model that focuses on the importance of attachment and relationships for children and adolescents. Attachment processes contribute to the development of attention skills and of emotional self-regulation and behavioral self-control. Parents and other adults, such as teachers and social workers, should provide a warm, supportive, empathetic, and responsive relationship with the young person, which in turn helps young people develop the ability to understand and regulate emotions. Interactions with accessible and responsive adults provide contexts in which children and adolescents can gradually learn to recognize affective signals, understand feelings, put feelings into words, self-soothe, and calm down. Accurate and marked mirroring of affective states is important for healthy emotional development (Fonagy, Gergely, Jurist, & Target, 2005).

Limitations

The present study contained a number of limitations, which need to be acknowledged. The choice of using only two online forums produced a small sample size that may compromise the generalizability of the results of the study. Parents who are more critical of the ADHD diagnosis may be less likely to visit online forums aimed at discussing parental issues on the topic and they may consider more contextual factors when constructing sense of coherence and making meaning of the behaviors of their adolescents. However, narrative inquiry is a methodology used to describe personal narratives and explore the meanings people derive from their experiences as told by those people at a particular time in their lives and with a certain audience in mind. Gaining an inside perspective on how parents organize and create meaning from their experiences can provide researchers with an understanding of how parents are influenced by dominant discourses in society with regard to how adolescent development and human suffering are to be understood.

Disclosure statement

I have no conflict of interest to disclose.