Post on 04-Feb-2023
Originally published in: Young, S., Gray, K. & Bramham, J. (2009). A phenoimenological analysis of
the experience of receiving a diagnosis and treatment of ADHD in adulthood: a partner’s perspective.
Journal of Attention disorders, 12, 299-307. A Phenomenological Analysis of the Experience of Receiving a Diagnosis and Treatment of ADHD in
Adulthood: A Partner's Perspective Susan Young, Katie Gray and Jessica Bramham
Journal of Attention Disorders 2009 12: 299 originally published online 14 February 2008 DOI: 10.1177/1087054707311659
A Phenomenological Analysis of the Experience
of Receiving a Diagnosis and Treatment of
ADHD in Adulthood
A Partner’s Perspective
Susan Young Institute of Psychiatry, United Kingdom Katie Gray Broadmoor Hospital, United Kingdom Jessica Bramham Institute of Psychiatry, United Kingdom
Objectives: The objectives are to explore the experience of living with a person who has undergone a process of diagnosis in his
or her adult years and to examine, from the partner‟s perspective, how diagnosis and treatment with medication affects the
ADHD patients‟ understanding of themselves, their behavior, and their relationships with others. Method: Participants were the
partners of eight patients who had been diagnosed with ADHD in adulthood. Semistructured interviews were conducted, and the
data were analyzed according to interpretative phenomenological analysis. Results: Three master themes emerged from the
analysis: perceptions of inadequacy of the ADHD partner, emotional impact of diagnosis, and medication not a panacea.
Conclusion: Results indicate a need for psychological treatment to be provided to clients following diagnosis. Information
leaflets for partners will also help partners‟ ability to facilitate their own knowledge and understanding, which in turn will help
them better support their AD/HD partners. (J. of Att. Dis. 2009; 12(4) 299-307) Keywords: ADHD; AD/HD; diagnosis; IPA; partner
ADHD is becoming increasingly recognized as a dis-
order that can persist into adulthood. Yet for many individuals, despite the presence of ADHD symptoms in childhood, they do not receive a diagnosis until their adult years. In an analysis of interviews with adults diagnosed and treated for ADHD in adulthood, Young, Bramham, Gray, and Rose (in press) found that master themes emerged, suggesting that patients with ADHD tend to engage in a psychological process involving (a) a review of the past when they think about how they had differed from others, (b) an emotional process toward acceptance of their diagnosis, and (c) consideration of their future with ADHD.
Receiving the diagnosis for the first time in adulthood
had a strong emotional impact on the ADHD patient who
experienced a process of psychological adjustment com-
posing six distinct stages: (a) relief and elation, (b) confu-
sion and emotional turmoil, (c) anger, (d) sadness and
grief, (e) anxiety, and (f) accommodation and acceptance.
Little is known about how this affects the interpersonal
relationships of close family who are living with the
individual. Marital dissatisfaction has been reported in
ADHD families regardless of the gender of the affected
person (Minde et al., 2003). Partners also reported higher
rates of psychiatric problems compared to control non-
ADHD dyads. Women were reported to be more
supportive and willing to compensate for their ADHD
partner‟s shortcomings; only 2 out of 21 spouses had left
their ADHD husbands, whereas 7 out of 12 men had
divorced or left their ADHD partner. Authors’ Note: The authors would like to thank the participants for
giving their time to participate in the study and Esther Rose for
reviewing the transcripts for the purpose of reliability. Address
correspondence to Susan Young, Department of Forensic Mental Health
Science, Institute of Psychiatry PO 23, De Crespigny Park, London SE5
8AF, United Kingdom; e-mail: Susan.Young@iop.kcl.ac.uk.
299
Following diagnosis and treatment, the quality of
intimate relationships may improve and parallel
symptom reduction. There is some support for this
suggestion in the childhood literature, which indicates
that improvement in social behavior is associated with
symptom improvement (e.g., Chacko et al., 2005; de
Boo & Prins, 2007). In a large multimodal treatment
study of children with ADHD, peer ratings of children‟s
behavior were shown to be superior for groups who had
received medication (Hoza et al., 2005). Nevertheless,
children from all groups were significantly impaired
with regard to peer relationships. Little is known
regarding adult relationships in this respect or how the
reported psychological and emotional process of
acceptance of the diagnosis and treatment with
medication impacts on partners, who are supporting and
living with people undergoing this process. Nearly all investigations into the comorbid and
psychosocial problems of adults with ADHD have done so
applying a quantitative methodology. Little research has
adequately explored the subjective experience and the
impact of diagnosis on the individual and even less from
the partner‟s perspective. Thus, this study applied a
qualitative approach to understand the meanings that are
attached to the event of an adult diagnosis of ADHD and
experience of treatment with medication, specifically from
the perspective of a partner. This method focuses on the
individual‟s personal perception and account as opposed to
an attempt to form a general and objective description of
the event (Smith, Jarman, & Osborn, 1999). The
interpretative phenomenological approach (IPA) was
considered to be the most appropriate method of analysis
for the present study, as it explores and makes sense of the
participants‟ view of the world by interpreting their
account of their experiences of the phenomena under
investigation by “allowing participants to tell their own
story, in their own words” (Smith, Flowers, & Osborn,
1997, p. 68). Thus, IPA is a qualitative research method
for gaining insight into how an individual perceives certain
aspects of his or her world. This involves the collection of
detailed and rich qualitative data on small samples using a
semistructured interview. It is important that the researcher
does not gather the data with preconceived hypotheses
already derived or assumptions about the data likely
generated. Therefore, it is not possible, nor necessary, for
this approach to establish reliability or validity of the
interview. The data determine how the research question is
answered. The aim is not to make objective descriptions
but to make sense of individuals‟ experiences in a way that
addresses a research question using an inductive approach.
It is inherent in this method that the researcher‟s biases
and
experiences will affect the interpretation of the data
(Smith, 1996). This study had the following aims: (a) to explore the
experience of living with a person who has undergone a
process of diagnosis in his or her adult years and (b) to
examine, from a partner‟s perspective, how diagnosis
and treatment with medication affects the ADHD
partners‟ own understanding of himself or herself, his or
her behavior, and his or her relationships with others.
Method Participants
The partners of eight clients who had previously been
diagnosed at the Maudsley Hospital, Adult ADHD
Service, London, were invited to participate on a voluntary
basis in the study by letter, which was followed up by a
phone call. Participants (“the partners”) were contacted
with the consent of the patients (“the ADHD patients”),
who had all previously agreed to participate in a study
investigating their own experience of receiving a diagnosis
of ADHD in adulthood (Young et al., in press). All of the partners agreed to participate (n 8). Of the
partners, 5 were women and 3 were men, aged between 21
years and 55 years (M 39). All partners had been in a
relationship with the ADHD patient for at least 3 years,
and all had been in the relationship prior to the ADHD
patient receiving the diagnosis. The length of time since
the ADHD patient had been diagnosed with ADHD ranged
from 1 month to 6 years (M 19 months). Of the dyads,
three were married and four were cohabiting; one partner
was not living with the ADHD patient. Also, four of the
dyads had children (ranging from one to three children),
and all four had at least one child diagnosed with ADHD.
Of the 8 partners, 5 were employed in full-time work and 3
were unemployed. At the time of the interviews with the
partners, seven of the ADHD patients were taking
stimulant medication for their ADHD. One had taken
medication in the past but had elected to stop.
Interview Schedule
A semistructured interview was developed to gain a
detailed account of the impact of diagnosis of ADHD in
adulthood from a partner‟s perspective (see appendix).
This method of interviewing did not dictate the exact
course of the interview, allowing the participant maxi-
mum opportunity to tell his or her own story and to guide
the interviewer toward a more specific understanding of
the topic (Smith, 1995). In addition to the main scheduled
questions, there were various prompts that enabled
the interviewer to encourage participants to give more
specific examples of experiences relating to the
discussion, particularly if the participant was not
sufficiently forthcoming. The interview was split into two main sections. The first
half retrospectively considered the time prior to the ADHD
patients‟ diagnosis of ADHD and asked partners how they
perceived the ADHD patients to feel about them-selves
prior to diagnosis and what coping strategies they used to
cope with their difficulties. The second half focused on the
partners‟ perspectives of the ADHD patient receiving the
diagnosis and using stimulant medication.
Procedure
Once the consent forms and proposed partners‟
details had been received from the ADHD patient, the
researcher contacted the partners to ascertain whether
they were willing to participate in the research and to
arrange a date for an interview. All interviews were
con-ducted by a female assistant psychologist, working
under the supervision of a clinical psychologist. The
interviewer had been trained in qualitative methodology
and was adept in the application of interpretative
phenomenological analysis (IPA). The interviewer was
employed independently from the Adult ADHD Service
and had no prior involvement in the ADHD patients‟
clinical assessments and/or treatment. The length of the
interviews ranged from 60 minutes to 90 minutes. Each
interview was audiotaped and subsequently fully
transcribed by the researcher. Data Analysis
IPA was the method of choice as it involves the
emergence of qualitative phenomenon based on
individuals‟ experiential reports. IPA is grounded in
exploring the salience of these experiences for the
participants rather than attempting to impose an
objective account. This method acknowledges the
reflexive nature of the interview and involves both the
participants‟ and the researchers‟ interpretations of
phenomenon. As data statements are gathered through
the course of the inter-view, there is flexibility to further
enquire into particular areas as they emerge while
acknowledging that the researchers‟ own interpretations
are needed to make sense of the participants‟ personal
worlds. IPA was considered to be the most appropriate
qualitative method for the current study as the aim was
to acquire insight into participants‟ psychological
worlds rather than to examine basic social processes,
which are best investigated using grounded theory.
The analysis commenced with an “idiographic
approach,” which involved a detailed initial examination
of a single interview transcript prior to analyzing the
others. During this initial stage, any principal issues and
ideas emerging from the transcript were recorded in the
left-hand margin. The transcript was reread a number of
times, and existing ideas and concepts were given more
abstract keywords that were recorded in the right-hand
column and provided a synopsis of the text. Examination
of this one interview provided a list of preliminary themes.
With these themes in mind, the remaining seven transcripts
were examined using the same procedure in which the
researcher continued to search for instances of existing
themes but also identified novel emergent themes.
Thereafter, a list of themes for each interview was
produced, together with transcript extracts that sup-ported
and illustrated them. The list of themes (and corresponding
transcript extracts) for each interview were read together to
identify connecting themes and parallels between the
interviews. Once the preliminary themes that pervaded
across the interviews had been established, several were
grouped together based on their conceptual similarity,
allowing master and subordinate themes to be identified.
The transcript extracts that had been paired with the
preliminary themes were reread, and instances that
supported the master and subordinate themes were
assigned accordingly. Each transcript was then reread to
ensure that the final master and subordinate themes were
characteristic of the original material.
Results and Discussion
From the interviews, three master themes emerged
from the analysis: (a) perceptions of inadequacy, (b) the
emotional impact of the diagnosis, and (c) medication
not a panacea.
Perceptions of Inadequacy
Partners described how they perceived the ADHD
patients to have specific difficulties and inadequacies in
three key areas: (a) attentional problems, (b) interpersonal
relationship problems, and (c) dysfunctional and/or
compensatory coping strategies. In particular, partners
recalled how the ADHD patients‟ attentional problems had
affected their ability to start and complete tasks:
She would try to start a project, but sometimes she
wouldn‟t even be able to get it off the ground.
Other times she‟d get it off the ground but
wouldn‟t finish it.
Partners also identified that completing tasks often
took longer than expected:
He took really long to do things. And they were “slow” at completing tasks:
It was just the slowness of him and how he was taking his time with everything.
Partners also identified emotional lability to be a
problem and described how this affected their relationship:
Unstable personality, up and down. . . . When you
don‟t know what sort of mood he‟s going to be in.
It made things quite tense at times ‟cause it was
unpredictable.
I‟d say [the symptoms] caused her to be quick
tempered . . . and quite volatile.
Some patients were described as having a low thresh-
old for frustration, which led to anger:
He was kinda frustrated with himself at times . . . . It wasn‟t like he was angry with anybody, I think he was angry with himself.
She would start something and not finish it, and that
would get at her, very moody and aggressive as well.
Interpersonal relationship problems appeared to be
longstanding, with the patients feeling they were not
understood by family members:
When I first met him he said, “Oh you‟re probably
never going to meet my mom and dad, I‟m never
gonna see them again and . . . y‟know I hate them.”
From what I understand, his mom just couldn‟t
understand what was going on with him.
Disruption to relationships may be in part because of
a lack of social communication skills:
When we were talking he would carry on talking
to people, . . . even if their eyes glaze over he still
talks to them ‟cause he‟s more interested in what
he has to say.
He tended not to be able to sit down for a long
time. So when we had people over or when we
were visiting people he would, you would see he
was very impatient and just wanted to walk off.
Interpersonal relationship problems were perceived to
stem from the patients‟ feelings of low self-esteem and
worthlessness:
She hated herself. Her self-confidence was on the floor.
Very low self-esteem . . . thinks that no one likes her.
Partners understood how feelings of emotional
instability caused the patients to feel inadequate and
distressed:
Always blamed himself. On one or two occasions he would get really distressed and upset about it.
Partners stated that the ADHD patients compensated for
their low self-esteem and related difficulties (e.g.,
depressive thoughts) with dysfunctional coping
strategies, most commonly alcohol misuse:
She got very, very depressed very quickly. . . . She
latched onto drinking quite heavily.
Patients used alcohol to avoid facing up to their difficulties:
He spent most of the time in the pub. Getting wasted
probably, yeah, just y‟know escaping from every-
thing and going and finding a group of friends and
just avoiding the whole, whatever the matter was.
Other strategies involved acting out in an attempt to mask underlying feelings of inadequacy:
I think he felt quite important, and that he was
number one and he knew all the answers but I think
he knew that it was just covering up some-thing. . . .
If he‟s in a new situation he would some-times
overcompensate by being more extravert.
I mean outwardly to most people they‟d think he
was full of confidence, and that‟s the way he
always came across. But when you sort of sit him
down and there wasn‟t lots of people around, he‟d
sort of come out, sort of the real feelings.
The Emotional Impact of Diagnosis
Following receipt of an ADHD diagnosis by the patient,
the partners described how they themselves had
experienced a distinct emotional reaction and engaged in
their own process of psychological adjustment. Soon after
the diagnosis had been made, the partners described
feeling confused about what support they should be
providing for the patient and how this conflicted with
them coming to terms themselves with the newly
diagnosed status of the patient:
It was a bit of a strain on me . . . big, big strain
because while she was going through the diagnosis
stage I was very quiet; I didn‟t know whether I
wanted to be with her anymore.
Not only did partners express confusion over how to
support the patient, but they also felt as if they were not
adequately equipped emotionally to deal with the
situation:
We went through this patch where I don‟t think he
thought I was supporting him. . . . He needed help
with something and I didn‟t wanna give him that
help and I didn‟t think I could deal with it.
After their initial confusion partners described a
sense of relief that they now had an explanation for the
patients‟ difficulties:
I was actually quite relieved and she was very
relieved as well ‟cause she had an answer why she
was being that way.
Partners described how the diagnosis gave them a
framework for better understanding the patients.
Disharmony in their relationship reduced as their
attention shifted from the patient “being” the problem to
a person “having” a problem:
I don‟t get so annoyed because I understand why;
you know why he is behaving in a particular way.
And you can talk to him more, instead of saying,
“What the hell are you doing?” you can say well
this is a symptom. . . . It‟s easier for me to see it as
a symptom . . . whereas before it was like, “Why
are you treating me like this?” . . . It gets sort of
less personal in a way.
Acceptance also involved partners becoming more
tolerant of the patients‟ problems now that they could
attribute them to a specific cause:
I suppose in a way I‟m a lot more tolerant of her as well, even though sometimes I‟ve had enough.
I find that I‟ve had to change the way I speak to
him and work with him and stuff like that „cause I
still find he gets frustrated with things.
Partners also noted that receiving the diagnosis
initially appeared to boost patients‟ self-esteem as this
enabled patients to relocate blame for their previous
difficulties and failures away from themselves to an
external attribution, whereby ADHD could account for
their problems:
It means now she knows it is something that can be
controlled and its not something she‟s doing wrong . . . well since the medication she‟s a different
person. More positive, easy going, smiley. . . . She
looks a lot happier in herself.
The partners, like the patients, appeared to have
engaged in a process toward acceptance of the diagnosis
and ADHD status:
I don‟t find it any more pressure to be honest; on a
day-to-day basis it‟s just something I have in the
background, in my head y‟know.
Medication is Not a Panacea
Initially, the partners described a sense of relief that
the ADHD patient was undergoing treatment. They
noted general improvements in the patients‟ functioning
at a personal level (e.g., improved cognitive abilities,
inter-personal style, and self-esteem) and interpersonal
level (e.g., improved relationships among themselves,
the family, and a wider social network). More
specifically, partners reported that the ADHD patients
were able to stay on task and recognized how this
positively affected their sense of achievement:
She can start a job and finish it. Now that she‟s on Ritalin she accomplishes things more often.
Partners observed that patients‟ interpersonal styles
improved as a result of medication, in particular
because they were noted to react less impulsively and to
be less temperamental:
Instead of coming out with very snap answers . . . she‟d actually sit there and ponder about it for a bit.
The partners also noted a great improvement in the
patients‟ relationships with their families. They appeared
to feel supported and understood by their parents:
She‟s [his mother] definitely trying to make
allowances and work round things rather than her
first reaction may have shouted or had a go at him.
. . . His mom is a bit more supportive now.
Perhaps of most significance to partners themselves
was that their relationship seemed more positive:
I said to him he seemed more normal, he just, he was
warm, he was relaxed. . . . It just made him how he
ought to be we felt . . . and he always ought to have
been. I think we both feel more hopeful, a lot more
hopeful and confident about the future.
Nevertheless, despite the clear perceived advantages
of stimulant medication, partners also talked about the
limitations of medication and were disappointed that
this was not a “cure-all” or panacea. In particular,
partners commented that symptoms rapidly returned
once the effects of medication had worn off:
[When the tablets wear off] he‟s more quick tempered, perhaps a bit bolshy and snappy.
Even when taking medication, residual problems were
noted to be present, in particular poor time management,
procrastination, and motivational problems:
He still has behaviors which I would classify as
ADD. Things as regard to underestimating his time
and procrastinating, and gets distracted sometimes.
He still intends to do things and not do them.
Low self-esteem and poor self-efficacy remained
present and persisted following medication, probably as
a result of experiencing a lifetime of repeated failures
and underachievement:
She still questions herself a lot. . . . Trouble is, the
future doesn‟t hold a lot for her because at the end
of the day when you look back at her childhood
and the schooling—that holds her back. And now
she feels it‟s too late.
It still seems that she still needs positive
reinforcement from others . . . so her self-esteem
probably isn‟t as good as it should be.
Partners speculated that the patients could be better
supported by mental health professionals and believed
they would benefit from nonpharmacological therapy
for these problems:
More of a supporting role, more a phone call, a
phone call to say, “Look, I need to speak to some-
one about something. Can I come and see you?”
Ideally, but I know there‟s time and money involved,
there‟d be more of a one-to-one thing, and so
people‟s specific problems could be dealt with.
It seems like the meetings they have are very long
apart. . . . I think there should be more with the
doctors or someone else like that . . . sometimes I
think you can get lost in what‟s happening with
you. I think it would be good to have a one-to-one.
Conclusion
This study aimed to explore the experience of living
with a person who has undergone a process of diagnosis in
their adult years. The perspective of partners represents an
important step toward understanding the multi-faceted
psychological experiences that follow diagnosis and
treatment. Three master themes emerged from the analysis,
identifying that prior to diagnosis, partners perceived the
ADHD patient to have global inadequacies that were not
entirely addressed by treatment with medication. It seemed
that, as a result of their ADHD symptoms, the ADHD
patients endured interpersonal problems over the course of
their lifespan. These difficulties were associated with low
self-esteem, low self-efficacy, and emotional lability.
Partners, in parallel with the previously reported
psychological process by the ADHD patients (Young et
al., in press), underwent a psychological process of
emotional adjustment in response to the patient receiving
diagnosis and treatment. For partners, this process
involved initial confusion about being in a relationship
with someone who has a “disorder.” During this period,
the partners felt uncertain about their future relationship
and how to provide support. Partners experienced relief in
the expectation that pharmacological treatment would
provide an “answer” for the patients‟ problems and
recognized some improvements in functioning. However,
this perception was short lived, as they quickly realized
that medication was not a “magic cure.” Many problems
still remained (e.g., low self-esteem), and partners
speculated on how nonpharmacological treatment may
provide additional help. Although the current study is consistent with previous
research in which the ADHD patients reported the benefits
of medication (Young et al., in press), partners identified a
wider range of improvements than those self-reported. It is
possible that the partners had a better appreciation of
functional improvements following diagnosis and
treatment with medication than did the patients,
particularly with respect to those affecting interpersonal
relationships. Epidemiological and clinical
studies have suggested that informants may be more
reliable sources of reporting symptoms in children
(Danckaerts, Heptinstall, Chadwick, & Taylor, 1999;
Smith, Pelham, Gnagy, Molina, & Evans, 2000) and adults
(Wender, Reimherr, & Wood, 1980), and this may also be
the case for identifying functional improvement. The first study (Young et al., in press) found that prior
to diagnosis and medication, ADHD patients felt that there
was little hope for the future because of their history of
underattainment. Following treatment with medication,
they reported an increase in self-efficacy, as they believed
that achieving goals had become a genuine possibility.
Partners seemed to corroborate that the ADHD patients
experienced an increase in self-efficacy, but this was
clearly a first step, as they were noted to continue to have
problems organizing their time and carrying out tasks,
which hampered them from successful achievement.
Perhaps the ADHD patients need help to develop realistic
expectations for the future and to overcome learned
helplessness by developing skills and/or improving the
specific skills required to achieve new goals. IPA has certain limitations, as this method is designed
to investigate phenomena from the point of view of the
participants, with the aim of capturing and characterizing
their specific experiences into master and subordinate
themes. It depends a great deal on the participants‟ use of
language in describing their experiences, and, therefore, as
perceptions are shaped by the accessibility and familiarity
of certain constructs, these may significantly differ from
those of the researcher. In addition, the perceptions of
some partners may have been influenced by recall bias, as
the period between diagnosis and interview varied, ranging
between 1 month to 6 years (M 19 months).
Nevertheless, it was useful to include participants at
different stages of the experience of the patient receiving a
diagnosis as this allowed the exploration of change over
time from a partner‟s perspective. A further limitation is that the researcher‟s use of
questions and exposure to previous theory and concepts
likely influenced the analytic process and interpretation
of results. This allows the researcher to understand and
describe how individuals experience a phenomenon, but
it does not provide an explanation regarding why they
have these experiences (Willig, 2001). Thus, causal
inferences cannot be made, and it is difficult to
generalize the findings to a wider population. Despite these limitations, the study highlights an
important role for psychological treatment. Partners
believed that the provision of psychologically based
interventions would be helpful for the ADHD patients, in
particular with anticipating future challenges and hurdles,
applying appropriate coping strategies, and managing
ongoing difficulties with low self-esteem. Such tech-
niques have been described in the Young-Bramham
Cognitive Behavioural Treatment Programme for
ADHD adults (Young & Bramham, 2007). It is notable
that partners themselves felt somewhat at a loss as to
how to sup-port their newly diagnosed partner, and
information leaflets for partners and/or directing them
toward local support groups would do much to support
partners in dealing with this process and would help to
reduce feelings of anxiety (of both partners and
patients), uncertainty, marital dissatisfaction, and
separation and (for some) divorce.
Appendix
Interview Guide Introduction
Introduce self and aims of the research project. It is
important to gain an understanding of people‟s views and
ideas. Explain confidentiality procedures. Need to obtain the
consent form for recording the interview.
Interview Outline
This interview will cover the following areas: How you would describe your relationship with your
partner prior to diagnosis. How you would describe your partner‟s personality,
behavior, and problems prior to diagnosis. If you think your partner has changed in any way
following the diagnosis. If you think your partner has changed in any way
following medication. How you think your partner can be best supported in the
future.
Problem Perceptions
1. Prior to the diagnosis, how would you describe the
difficulties your partner was experiencing? 2. What specific problems did you notice?
Prompt:
Why did you think that was?
3. Did you feel that your partner had any control over
the difficulties? Prompt:
Seek specific examples to illustrate this if necessary.
4. How did these difficulties affect your relationship? Perceptions of Self
5. Prior to the diagnosis, how do you think your partner
felt about himself or herself?
Prompts:
As an individual? As
a male or female? Other self-related factors, e.g., what liked/did not like
about self, self-esteem, confidence, self-efficacy, control,
self-image, abilities, skills. How do you think others would have described him or her
prior to diagnosis? Prompt:
Thoughts and feelings on personality, character. How did other people behave toward your partner before
the diagnosis?
Explanation for Cause of Difficulties
8. How did your partner tend to explain the difficulties
he or she experienced prior to diagnosis? 9. Did your partner feel that he or she had any control
over their difficulties? 10. If something went well, how did your partner tend to
explain it?
Coping or Support Prior to Diagnosis and Medication
11. What sort of things helped your partner deal with the
difficulties prior to diagnosis? Prompts:
1. Coping with the symptoms themselves. 2. Coping with the impact of the symptoms on life.
Constructive and nonconstructive methods of coping
(talking to others, thinking about things, writing things down,
alcohol, withdrawing, fights, etc.). What has been helpful/unhelpful?
12. How much support did your partner receive from
friends and family prior to diagnosis?
I’d like to move on to discuss the diagnosis of ADHD and its impact.
Seeking the Diagnosis
13. What finally made your partner seek help? Prompts:
Reasons why sought help. When sought help. The process.
14. How did your partner feel when ADHD was first diag-
nosed in adulthood?
Prompts:
Thoughts and expectations. Meaning of the diagnosis.
15. What does it feel like for your partner now?
Prompts:
Have their feelings toward the diagnosis changed in any way?
16. How do you think life for your partner would have
been different if he or she had received a diagnosis in
childhood?
Explanation for Difficulties or Attitudes and Beliefs About
Having ADHD
17. Since the diagnosis, if something goes wrong, how
does your partner explain it now? Prompt:
Changes since the diagnosis.
18. Since the diagnosis and medication, how much control do
you think your partner has over his or her difficulties? Prompt:
Changes since diagnosis.
19. What changes do other people notice when your
partner takes his or her medication for ADHD?
Attitudes Toward Medication
20. How does your partner feel about taking medication
for ADHD? 21. What would you say has been the biggest difference
for your partner since taking medication? 22. Does your partner think the medication works all the
time? 23. Have you noticed any difference between when your
partner does and does not take the medication? 24. What would you say has made the most difference to
your partner—the diagnosis or the medication?
Perceptions of Self After the Diagnosis
25. Since the diagnosis and medication have you noticed any
changes in the way your partner views himself or herself?
Prompts:
As an individual? As
a male or female? Other self-related factors, e.g., what liked/did not like
about self, self-esteem, confidence, self-efficacy, control,
self-image, abilities, skills.
26. How do you think other people would describe him
or her now?
Prompts:
Thoughts and feelings on personality and character and
note any changes. Friends, family, work colleagues.
27. Has the diagnosis changed your partner‟s thoughts or
beliefs about the future and what it holds for him or her?
Prompt:
Implications for the future with ADHD.
Coping or Social Support Since Diagnosis and Medication
28. You said that before the diagnosis your partner some-
times coped by X. . . . Since the diagnosis has this
changed?
Prompts:
Managing/coping with the symptoms themselves (e.g.,
poor concentration) Coping with the impact of the symptoms on life.
Constructive and nonconstructive methods of coping
(talking to others, taking time out, thinking about things,
writing things down, alcohol, drugs, fights, etc). What has been helpful/unhelpful? Has the diagnosis/medication made a difference to coping
and if so how?
29. What sort of things does your partner still find
difficult?
Future Contact With Services
30. Since the diagnosis, what help does your partner cur-
rently receive from services?
Prompt:
Perceptions of adequacy and appropriateness for needs.
31. What help would your partner like for the future?
Conclusions and Reflections on the Interview
Can we just take a few moments to ask you how you felt
about doing this interview? Is there anything else you would like to add? Thank you for your help and for taking the time to speak to me.
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Susan Young is a senior lecturer in forensic clinical
psychology at the Institute of Psychiatry. She is a chartered
clinical and forensic psychologist and a clinical
neuropsychologist. Her research interests include
neurodevelopmental disorders, social cognition, and forensic
risk assessment. Katie Gray is an assistant psychologist at Broadmoor
Hospital, Berkshire, United Kingdom. Her research has
focused on the psychological impact of receiving a diagnosis
of ADHD in adulthood, with a view to developing services
for this client group in the community. Jessica Bramham is a lecturer in clinical neuropsychology at
the Institute of Psychiatry and the lead clinical psychologist
at the Adult ADHD Service at the Maudsley Hospital
London. Her research interests include neurodevelopmental
disorders in adulthood and social cognition.