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.

References Chacko, A., Pelham, W. E., Gnagy, E. M., Greiner, A., Vallano, G.,

Bukstein, O., et al. (2005). Stimulant medication effects in a

sum-mer treatment program among young children with

attention-deficit/hyperactivity disorder. Journal of the American

Academy of Child and Adolescent Psychiatry, 44(3), 249-257. Danckaerts, M., Heptinstall, E., Chadwick, O., & Taylor, E. (1999).

Self-report of attention deficit and hyperactivity disorder in

adolescents. Psychopathology, 32, 81-92. de Boo, G. M., & Prins, P. J. (2007). Social incompetence in

children with ADHD: Possible moderators and mediators in

social-skills training. Clinical Psychology Review, 27(1), 78-97. Hoza, B., Gerdes,A. C., Mrug, S., Hinshaw, S. P., Bukowski, W. M.,

Gold, J. A., et al. (2005). Peer-assessed outcomes in the multimodal

treatment study of children with attention deficit hyperactivity

disorder. Journal of Clinical Child and Adolescent Psychology, 34(1), 74-86.

Minde, K., Eaking, L., Hechtman, L., Ochs, E., Bouffard, R.,

Greenfield, B., et al. (2003). The psychosocial functioning of

children and spouses of adults with ADHD. Journal of Child

Psychology and Psychiatry, 44(4), 637-646. Smith, B. H., Pelham, W. W. E., Gnagy, E., Molina, B., & Evans, S.

(2000). The reliability, validity, and unique contributions of self-

report by adolescents receiving treatment for attention-

deficit/hyperactivity disorder. Journal of Consulting and Clinical

Psychology, 68, 489-499. Smith, J. A. (1995). Semi-structured interviewing and qualitative

analysis. In J. A. Smith, R. Harre, & L. Van Langehove (Eds.), Rethinking methods in psychology (pp. 143-159). London: Sage.

Smith, J. A. (1996). Beyond the divide between cognition and

discourse. Using interpretative phenomenological analysis in health psychology. Psychology and Health, 11, 261-271.

Smith, J. A., Flowers, P., & Osborn, M. (1997). Interpretative

phenomenological analysis and the psychology of health and

illness. In L. Yardley (Ed.), Material discourses of health and

illness (pp. 68-91). London: Routledge.

Smith, J. A., Jarman, M., & Osborn, M. (1999). Doing interpretative

phenomenological analysis. In M. Murray & K. Chamberlain

(Eds.), Qualitative health psychology (pp. 218-240). London:

Sage. Wender, P. H., Reimherr, F. W., & Wood, D. R. (1980). Attention

deficit disorder (“minimal brain dysfunction”) in adults: A

replication study of diagnosis and drug treatment. Archives of

General Psychiatry, 38, 449-456. Willig, C. (2001). Introducing qualitative research in psychology:

Adventures in theory and method. Buckingham, UK: Open

University Press. Young, S., & Bramham, J. (2007). ADHD in adults: A psychological

guide to practice. Chichester, UK: Wiley. Young, S., Bramham, J., Gray, K., & Rose, E. (in press). The experience

of receiving a diagnosis and treatment of ADHD in adulthood. A

qualitative study of clinically referred patients using interpretive

phenomenological analysis. Journal of Attention Disorders.

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.