CHAPTER ONE PRESENTATION OF THE PROBLEM Introduction Attention Deficit Hyperactivity Disorder, also known as ADHD, is one of the most common childhood psychiatric disorders with a prevalence rate of 3 to 5 percent of school-aged children (Worley & Wolraich 2005, p. 1571). The ADHD society of the Philippines, a young and dynamic organization committed to create a loving, understanding and supportive environment for children, adolescents and adults with this disorder has been vigorously pursuing a nationwide awareness campaign on the disorder since its formal organization in 2001.
According to their 2006 study, ADHD is said to have 4 percent incidence (more than 3 million) in the total Philippine population (ADHD Society of the Philippines, 2006). Children with ADHD have boundless energy; they exhibit excessive levels of activity such as restlessness, and fidgeting. They have been described as “perpetual motion machines”- continuously running, jumping, wiggling, or squirming.
They experience a greater than average number of accidents, from minor mishaps to more serious incidents that may lead to physical injury or destruction of property. The etiology of ADHD is unknown, but studies have suggested an interaction among psychosocial and biologic factors. The Diagnostic Statistical Manual of Mental Disorders- IV Text Revision (DSM-IV TR) is a common language and standard criteria for the classification of mental disorders published by the American Psychiatric Association.
ADHD refers its diagnosis to this tool having met at least six of the criteria under inattention (poorly sustained attention or persistence of effort or task), impulsivity (the inability to stop and think before acting), or hyperactivity (the display of excessive movement not required to complete a task (Townsend, 2008). Handling ADHD children requires a great amount of patience and dedication considering the characteristics of the disorder. Parents would often label the child to be “out of control” and have difficulties in dealing with these behaviors. Parents may report largely unsuccessful ttempts to discipline and/or control their child (Videbeck, 2008). Having a child with ADHD affects the functioning of the family, contributing increasing stress levels to its primary caregivers. Researches support the idea that the behavior of the child with ADHD can result to increasing parenting stress (Baker, 1994; Harpin, 2004; Strahm, 2008). Research with families with children who have this disorder indicates that these parents report high levels of stress and are more commanding and negative in their parenting style than parents of children without ADHD.
Parents of these children tend to report more marital problems, higher rates of psychiatric illness, and lower self-esteem than parents of children without ADHD (Ryan & McDougall, 2009). Some researches focus on maternal parenting since mothers are primarily the ones giving direct care to these children and, thus, are also the ones who get more affected by the parenting stress. A research on mothers having children with the disorder revealed parenting to be stressful and demanding (Peters & Jackson, 2008).
Wallace (2005) study on the perception of mothers having sons with ADHD resulted to extreme difficulties, as well as, their untiring efforts to help their child be accepted in their social and educational community. In view of the difficulties experienced by mothers involved with these children, it is clear that there is a need for more researches to be conducted. This study on the phenomenological approach had enable the researchers to explore the total feelings and experiences of mothers with ADHD children and retrieve significant information on pressing concerns inherent to the individuals.
The results of the study will help increase the awareness of the society and the government on the situation’s need for support, not just to the child itself but also to the mothers caring for them as well. Background of the Study Before the conceptualization of this study, the researchers – who are primarily student nurses – were exposed to Psychiatric Health Nursing Rotation. Through this experience, the researchers were provided a learning opportunity of the different psychiatric conditions, among which are childhood disorders.
The researchers have particularly given special attention to one type of childhood disorder – the Attention Deficit Hyperactivity Disorder, more commonly known as ADHD. Having enough knowledge on these disorders stimulated the curiosity of the researchers on how parents rear children with ADHD. According to Peters & Jackson (2008), mothers are primarily the ones giving direct care to their children and, thus, are also the ones who get more affected by the parenting stress. This study is then based predominantly on the lived experience of mothers as caregivers of children exhibiting ADHD manifestations.
Furthermore, considering the physical, mental and emotional stresses brought of having a child manifesting these disruptive and intrusive behaviours, concerns on the totality of experiences and feelings of mothers taking care of children with ADHD had come up to setting the study –what is it like to be a mother with a child/children having ADHD? What do they think or how do they feel when they take care of children with this disorder? These are some of the questions that this research study is intended to answer.
At the same time, this study will help the researchers understand and appreciate the experiences of the mothers as they raise their children with ADHD manifestations. Through this descriptive phenomenological study careful descriptions of the total experiences of the said mothers are emphasized, thus, allowing nurses to care for the totality of the human person when they take into consideration aspects of being, such as lived experiences offered by qualitative approach which quantitative methods cannot fully describe.
Definition of Terms • Attention Deficit-Hyperactivity Disorder (ADHD) – a disorder most common in children characterized by developmentally inappropriate degrees of inattention, impulsiveness and hyperactivity displayed across situations and cause impairment in social, academic, and/or family functioning. • Pre-diagnosed/ children with ADHD-like manifestations – children with ADHD manifestations critically determined by psychologists using the DSM-IV Criteria. Note: In this study, “child/children with ADHD” (which is mostly sed in succeeding pages) will have similar meaning with “child/children with ADHD-like manifestations” as defined. Such phrase is utilized in the course of this study to clearly emphasize that the children involved are only critically determined by psychologists due to problems of availability and accessibility of psychiatrist specializing in ADHD in the Negros Oriental Province where the subjects are to be taken and also, considering that most of the participants cannot afford to seek a psychiatrist’s consultation for final diagnosis. Mother – single or with a partner, of a child/children with ADHD-like manifestations • Lived experience – the totality of all events that happened or occurred in someone’s life in specific situations. Statement of the Problem Children with ADHD are usually characterized as having excessive activity and difficulty in paying attention (Stuart & Laraia, 2005, p. 739). These children are highly distractible and unable to contain stimuli. Motor activity is excessive and movements are random and impulsive. These children have difficulty forming satisfactory interpersonal relationships (Townsend, 2008).
Parenting a child, any child, is a difficult task to begin with. When you have a child with ADHD, you are parenting a child who has greater demands, needs more attention and requires greater patience and understanding. Parents, caregivers or sibling of children with ADHD are not exempted from feelings of frustrations, guilt, and perhaps, anger (Videbeck, 2004). This research aims to identify phenomenological themes of the experiences of mothers whose children have ADHD and specifically answer the following questions: ) What is the lived experience of mothers raising children with ADHD in terms of phenomenological themes? 2) What are the essential meanings that could be drawn from the lived experiences of these mothers? 3) What are the implications of the lived experience of these mothers to the nursing profession? 4) What recommendations may be proposed to assist mothers in caring for ADHD children? 5) What are the contextual factors that influence the mothers’ lived experiences of having a child with ADHD? 6) What are strategies that mothers utilize to deal with their ADHD children?
Purpose of the Study This study seeks to qualitatively investigate lived experiences of mothers taking care of a child with ADHD or Attention Deficit Hyperactivity Disorder, a childhood disorder wherein parents find themselves chronically exhausted mentally and physically (Videbeck, 2004). This research aims to discover the totality of feelings from the experiences of the mothers taking care of a child with ADHD. Moreover, this study is intended to explain and apply Husserl’s contemporary descriptive phenomenology as the tradition used in this phenomenological inquiry.
The study aims to: (1) elucidate the nature of the lived experiences of mothers of children with ADHD, (2) explore the essential meaning of their lived experiences, and (3) generate phenomenological themes combined from the essential meanings. Significance of the Study To Nursing Clientele. When nurses work with children, it is necessary to work with their families and understand their needs also (Peate & Whiting, 2006). It is not only the individual child or young person who suffers from the negative impact of ADHD. Parents and caregivers, brothers and sisters, friends and teachers are also affected.
Gaining subjective experiences of living with ADHD may lead to improved assessments and better treatment outcomes for all family members affected by this disorder (Ryan & McDougall, 2009). The study puts emphasis on the importance of expressing the totality of feelings of these persons to gain understanding on their situation. The family, most especially the primary caregiver – who is usually the mother – should be taken into account. Knowing what it is like to rear a child with ADHD and identifying phenomenological themes give nurses the understanding and a clearer view of the needs of the mother in order to give uality, holistic care to the mother herself, her child and her family as a whole. To Nursing Practice. Nurses should consider the wider family impacts as part of their assessment and management strategies. This may sometimes require a formal assessment of family needs focusing on personal, social, mental health needs and liaison with other professionals will help ensure that families receive the support they require. (Ryan & McDougall, 2009, p100). The results of this study would help us understand mothers’ experiences, on what they feel and how they deal with the situation of having children with ADHD.
Awareness of the results would increase the nurses’ sensitivity and empathy as they therapeutically communicate with mothers having ADHD children. To Nursing Education. Qualitative research has direct relevance to nursing practice in that they move to uncover life processes. (Polit & Beck, 2008). Knowledge of the process increases understanding of the totality of experiences of mothers having ADHD children. This would provide us information and understanding, in which, would help enhance the quality of nursing care.
The result of this study would create a much wider range of knowledge base to augment adaptation of mothers in the care of their child with ADHD. To the Nursing Research. Nurses in practice cannot be effective if they do not understand the patient’s viewpoint. It is evident that some aspects of knowledge of care have been significantly advanced by qualitative research, especially suited to beliefs about health and illness, attitudes and behaviours. It is also relevant that qualitative research is especially suited to when little is known about a subject.
As nursing is a constantly changing profession, there are certainly many aspects that affect care about which relatively little is known (Hall, 2006). Research findings from studies provide strong evidences as to which nurses could base their decisions and actions when it comes to giving of quality care for their patients and the significant others (Polit & Beck, 2008). This will serve as supplementary knowledge, along with other related studies, to guide future researches that would want to replicate this study to attain generalizability.
Together, the results of this study would increase the awareness of nurses and other health care givers to formulate actions to provide support to these mothers having children with ADHD. To the Community in General. A community is a collection of people who interact with one another and whose common interests or characteristics form the basis for a sense of unity or belonging (Allander & Spradley, 1996). People try to live as one to thrive and survive with its diversity and complexity. Each member is vital to the well-being of the whole.
With the information garnered from this study, the community shall be able to witness the lived experience of the mothers having children with attention-deficit hyperactivity disorder. Through this study, it will raise awareness regarding the needs of these mothers. This would improve the community’s understanding and acceptance regarding their situation, and would encourage the community’s private or public sectors to implement programs which aim to build support for these mothers to at least lessen their burden in taking care of a child with ADHD.
Scope and Delimitation This is a qualitative study that targets on one of the receptive and susceptible sectors of our society – the mothers. This narrowly comprises on mothers who have particular experience raising and living with children with attention-deficit hyperactivity disorder or ADHD. This study aims to identify phenomenological themes of the experiences of mothers whose children have ADHD particularly to explore and understand the mothers’ feelings, experiences, and ways of coping with the behavioral manifestations of children with ADHD.
The descriptive phenomenological theory of Edmund Husserl served as the study’s main tool in the investigation of this research study. Data gathering was conducted in Negros Oriental within four months, from October 2010 to January 2011 at any equally convenient time for the researchers and the participants. This study considered certain parameters yet still taking utmost consideration on the richness of the data being collected. The researchers have set the following inclusion criteria for limiting the participants: 1. Must be residents of Negros Oriental. 2. Must be willing to participate in the study. 3.
Must be of sound-mind. 4. Must be able to articulate and express their feelings and experiences. 5. Must be able to understand and speak Cebuano or English language. CHAPTER TWO REVIEW OF RELATED LITERATURE Attention Deficit/Hyperactivity Disorder (ADHD) Attention Deficit/Hyperactivity Disorder (ADHD), as characterized by the American Psychiatric Association (2000), is a constant and unrelenting behavior of inattention and/or hyperactivity-impulsivity that is more than expected of individuals at the same developmental level. Not all individuals present the same symptoms of ADHD; some display one predominant pattern over the other.
As stated in the Diagnostic Statistical Manual of Mental Disorders IV (2000), there are three subtypes of ADHD which are the following: “Attention-Deficit/ Hyperactivity Disorder (ADHD), Combined Type: this is used when, during at least six months’ time, six (or more) symptoms of inattention and six (or more) symptoms hyperactivity-impulsivity are observed. ” “Attention-Deficit/ Hyperactivity Disorder (ADHD), Predominantly Inattentive Type: this is used when, during at least six months’ time, six (or more) symptoms of inattention are present but show fewer than six symptoms of hyperactivity-impulsivity. “Attention-Deficit/ Hyperactivity Disorder (ADHD), Predominantly Hyperactive-Impulsive Type: this is used when, during at least six months’ time, six (or more) symptoms of hyperactivity-impulsivity are present but show fewer than six symptoms of inattention. ” DSM-IV Diagnostic Criteria for ADHD (APA, 2000) A. Either (1) or (2): (1) six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level. Inattention a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities (b) often has difficulty sustaining attention in tasks or play activities (c) often does not seem to listen when spoken to directly (d) often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) (e) often has difficulty organizing tasks and activities (f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) (g) often loses things necessary for tasks or activities (e. g . , toys, school assignments, pencils, books, or tools) (h) is often easily distracted by extraneous stimuli (i) is often forgetful in daily activities 2) six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level. Hyperactivity (a) often fidgets with hands or feet or squirms in seat (b) often leaves seat in classroom or in other situations in which remaining seated is expected (c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) (d) often has difficulty playing or engaging in leisure activities quietly (e) is often “on the go or often acts as if driven by a motor” (f) often talks excessively Impulsivity g) often blurts out answers before questions have been completed (h) often has difficulty awaiting turn (i) often interrupts or intrudes on others (e. g. , butts into conversations or games) B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before seven years old. C. Some impairment from the symptoms is present in two or more settings (e. g. , school ,work, home). D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning. E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder. Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e. g. Mood Disorder, Anxiety Disorder, Dissociative Disorder or a Personality Disorder). Code based on type: Attention-Deficit/Hyperactivity Disorder, Combined Type: if both Criteria A1 and A2 are met for the past 6 months. Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type: if Criterion A1 is met but Criterion A2 is not met for the past 6 months. Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type: if Criterion A2 is met but Criterion A1 is not met for the past 6 months. Incidence and Prevalence Estimates in the world population reveal that ADHD is prevalent in three to seven percent of school age children with results differing on the sample population and method used.
ADHD is more common in males compared to females. Depending on the setting and type of ADHD, the male-to-female ratio ranges from 2:1 to 9:1. According to the data found in the website of the ADHD Society of the Philippines (http://www. adhdsociety. org), a 2006 study indicated a four-percent incidence of ADHD (more than 3 million) in the total Philippine population. According to Videbeck (2008), ADHD was believed to be outgrown, but recently, studies show that it can be carried on into adulthood. It is estimated that two-thirds of children diagnosed with ADHD experience symptoms until they reach adolescence. Etiologic factors Furman (2005, p. 94) states, “the lack of evidence of an underlying unique genetic, neurologic, psychologic, or biologic pathology and the lack of an identified etiology in ADHD” are one of the many mysteries that researchers are trying to solve. Although the exact cause has not been identified, studies show that ADHD is more common in the first-degree biological relatives of diagnosed individuals compared to the general population (APA, 2000). Besides genetics, other factors are associated with ADHD. These factors include abnormal brain structures and level of neurotransmitters, prenatal, prenatal, and postnatal factors including maternal smoking during pregnancy and exposure to toxic substances in utero, environmental factors like elevated degrees of lead in the body, intake of foods high in artificial flavorings, preservatives, and sugar.
And lastly, psychosocial factors such as family conflicts, parental discord, high psychosocial stress, and low socioeconomic status all attempt to explain the cause of ADHD (Townsend, 2008). Related Research Studies Mothers’ experiences of parenting a child with attention deficit/hyperactivity disorder. Peters and Jackson (2008) explored the perceptions and experiences of mothers parenting a child with ADHD. Dominant issues were identified such as the caring responsibility being overwhelming, stigma, scrutiny, criticism, guilt, self-blame, and advocacy role of the mother. The study concluded that mothering a child with attention deficit hyperactivity disorder is stressful and demanding, and mothers felt marginalized.
The media portraying this disorder contributed to the confusion of the mothers towards this disorder with regard to its causes, diagnosis and treatment. More education is needed in order for them to give appropriate guidance and support to their children with ADHD. The experiences of primary caregivers raising school-aged children with attention-deficit hyperactivity disorder. This study by Lin, et al. (2009) aimed to understand the experiences of primary caregivers who are bringing up school-aged children with attention-deficit hyperactivity disorder in order help address the problems related to caring for school-aged children with attention-deficit hyperactivity disorder.
Three themes and seven sub-themes emerged from this study and are the following: the burdens of caring (parenting burdens, emotional burdens and family conflicts), the lack of adequate support systems (lack of support from professionals, spouses and other family members) and the mechanisms of coping (cognitive coping strategies and social coping strategies). The Perceptions of Mothers of Sons with ADHD. Last 2005, a study was conducted by Nancy Wallace that contains the mothers’ own reports of bringing up a son diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and also describes the effects of the behavioural symptoms and how it influences thinking of observers to the cause of the disorder. The results yielded 5 thematic areas namely nuclear families, siblings, extended families, social network, and education system with various experiences by the mothers. Parents’ experience raising a child with Attention Deficit Hyperactivity Disorder (ADHD).
Strahm (2008) conducted a study in order to measure family functioning and parenting stress with parents raising a child with and without ADHD. Results showed that parents in the ADHD group had significantly lower family functioning in marital and sibling relationships and higher parenting stress compared to the typical group. The findings suggest that although ADHD has a significant impact on family relationships and stress, parents work hard to maintain a positive environment for their children with ADHD. Children’s accounts of attention-deficit/hyperactivity disorder. This is a qualitative study done by Kendall, et al. (2003) to find out what were the experiences of children and adolescents living with attention deficit hyperactivity disorder (ADHD).
The sample consisted of 39 children and adolescents with ADHD who participated in indepth, semistructured interviews. Their experiences were reflected in 6 themes: problems in thinking, behaving, and feeling; meaning and identity; taking pills; the importance of Mom; causes of ADHD; and differences associated with ethnicity or race. “I Have Always Felt Different”: The Experience of Attention-Deficit/Hyperactivity Disorder in Childhood. This study by Shatell, et al. (2008) examined the experience of childhood ADHD within the contexts of home, school, and friendships. The sample included 16 college-enrolled young adults (ages 18–25) with a self-reported history of ADHD.
Participants revealed feelings of difference, misunderstanding, and struggle in all areas of their lives (home, school, and friendships). Outlasting disruption: the process of reinvestment in families with ADHD children. Kendall (1998) studied about how families with children who have ADHD manage the ongoing and persistent difficulties caused by their children’s ADHD symptoms. At first, it describes the family life as chaotic, conflictual, and exhausting. As parents undergo through several processes in caring for their child, it arrives at its final stage that involves coming to terms with the child’s disability and reinvesting in the “real” children, family, other children, marriage, and themselves.
The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Harpin (2005) discussed different effects of ADHD in a child’s life. The impacts mentioned are not only on the child but also on parents and siblings. It provides information on the adverse effects of ADHD upon children and their families as it changes from the preschool years to primary school and adolescence. It also states disruptions to both professional and personal life since ADHD may persist into adulthood. In addition, ADHD has been associated with increased healthcare costs for patients and their family members. With these results, healthcare implications are discussed.
Parental beliefs about the nature of ADHD behaviours and their relationship to referral intentions in preschool children. This study by Maniadaki, et al. (2006) compared beliefs of severity, impact and advice seeking of parents whose preschool children present ADHD behaviors with those parents whose children do not display such behaviors. Results showed that almost half of the parents who reported ADHD behaviors in their own child replied that they had never met a child exhibiting such behaviours.. The researchers concluded that parents whose preschool child displays ADHD behaviours tend to perceive them as normal developmental patterns and may suspend the referral of the child.
Parenting Stress and ADHD: A Comparison of Mothers and Fathers. Baker (1994) examined the differences between maternal and paternal reports of parenting stress associated with having a child with ADHD. Results showed little difference between maternal and paternal reports of parenting stress in such families. Child behavior, socioeconomic status, and years married contributed more to parenting stress than parent gender. Healthcare Use, Social Burden and Costs of Children With and Without ADHD. In this study conducted by De Ridder and De Graeve (2006), the researchers provided quantitative information on the economic, social and emotional burden borne by families of children with ADHD.
Results yielded that the disorder, ADHD, affects schooling, productivity of the parents, and places a psychological and emotional burden on the family. Childhood ADHD also results in a significantly higher use of healthcare with an estimated annual cost that is six times higher compared to the siblings without ADHD. This study concluded that childhood ADHD results in significantly higher use of healthcare and adversely affects academic achievements and parents’ productivity. CHAPTER THREE METHODOLOGY Research Design Polit and Beck (2008) believe that qualitative studies uses an emergent design — A design that emerges as researchers make ongoing decisions reflecting what has already been learned.
Thus, the design that has been used here is flexible and resilient enough for researchers to be capable of amending what will be learned and will be stopped when data saturation arises during the track of data collection. This study used Husserl’s Descriptive phenomenology which was first developed by Edmund Husserl. This emphasizes descriptions of human experience. This insists on the careful description of ordinary conscious experience of everyday life (Polit and Beck, 2008, . 228). According to Lauer (1965), it is the goal of phenomenology to unravel the secrets they contain — the essence of things. Thus, the phenomenological approach is useful if little is understood about a phenomenon.
The researchers used Husserlian phenomenology as a method in gathering data and Colaizzi’s framework was utilized in analyzing the data collected. Numerous steps has been pursued which include techniques of data collection to clarification from the study participants and comparison from the researchers’ descriptive results with their lived experiences to validate results, and significant steps in between. Kozier, et al. (2004, p. 28) stated that the goal of qualitative research is to thoroughly explain and describe a phenomenon. The researchers collected data through in-depth interviews with the participants. The researchers strived to have full access to the participants’ world and had full detail in their lived experience.
Inductive method was used to analyze data by identifying themes and patterns to develop a theory or framework that helped explain a phenomenon. Setting of the Study Taking into consideration the location where the researchers are pursuing their chosen academic degree, the area of coverage for the research study is within the area of Negros Oriental. Another rationale for the chosen area of coverage is to make the most of time and efficiency in gathering data making sure the representative group reflects the population. The setting of the study is in Negros Oriental, the Philippines. Negros Oriental is located on the eastern side of the Negros Island in the Central Visayas Region, occupying the southern lobe of the island of Negros.
Negros Oriental is in Region VII (Central Visayas Region) grouped together with other Cebuano-Speaking provinces of Cebu, Bohol and Siquijor. It measures 103 miles from the north to south and from the east to west it is 49 miles at its widest, and 8 miles at its narrowest. It is bounded by a chain of rugged mountains from its sister province of Negros Occidental and separated from Cebu by the Tanon Strait. Negros Oriental consists of twenty (20) municipalities, five (5) cities and five hundred fifty-seven (557) barangays. It is also further divided into three (3) legislative districts. The collection of data took place according to the informants’ preference and convenience.
In such a way, the informants were able to express their experiences freely and without hesitations. Informants of the Study Inclusion Criteria The participants of the study are mothers taking care of a child with ADHD. The following criteria are taken into consideration when choosing the participants: – Mother of a child with/pre-diagnosed with ADHD – Must be residents of Negros Oriental. – Must be willing to participate in the study. – Must be of sound-mind and able to articulate and express their feelings and experiences. – Must be able to understand and speak Cebuano or English language. Qualitative Sampling A representative sample is needed for qualitative studies to ensure hat measurements accurately reflect to the population (Polit & Beck, 2008). With this in mind, a random sample was not the best method of selecting informants who are knowledgeable, reflective, and keen to talk at length with the researchers. As defined by Polit & Beck (2008, p. 343), “Purposive sampling is a non-probability sampling method in which the researcher selects the participants based on personal judgment about which ones will be the most informative. ” With the use of purposive sampling – that is, selecting cases that would benefit the study most – the researchers would probably acquire the most significant data from the target population. Thus, purposive sampling was used by the researchers.
The researchers estimated a total of ten (10) prospect participants of this study but only got to interview eight (8) of them since data saturation was then achieved. Research Tool In the research study, data were collected from the study participant using a semi-structured interview. The semi-structured interview was the primary method of collecting data for the lived experience of mothers directly rearing of a school-age child with ADHD. A semi structured interview is an excellent method of collecting data since it gave the researchers an opportunity to endeavor into the deeper real meaning of lived experience of the mothers of an ADHD child.
The researchers used the primary question, “Pwede nimo masulti kanamo unsa imong kinatibuk-ang experiensya sa pag-akatar sa imong anak nga adunay ADHD? ” (Translation: Can you describe to us as fully as you can your experience of taking care of a child with ADHD? ) Method of Data Collection The phenomena in which researchers are interested must ultimately be captured and translated into data that can be analyzed. Without high-quality data collection methods, the accuracy and robustness of the conclusions are subject to challenge. (Polit and Beck, 2008, p. 367) In this chapter, the intricate method of data collection, though loosely structured, is discussed as a salient part of this study.
Prior to actual data collection, the researchers foremost obtained a clearance from the Silliman University College of Nursing Human Research Ethics Committee having considered that the study includes human participants. The implementation of the prearranged data collection plan was carried out right after which included pre, actual and post-data collection. Pre-data Collection. With the aim of finding the eligible respondents for the study, the researchers tapped a number of institutions within Negros Oriental which can provide permission and data that would be utilized to approach these possible infomants. In particular, identified institutions include the Great Physician (GP) Rehabilation Foundation and Philippine Mental Health Association (PMHA).
After permission from the authority was sought, possible key informants were recognized. Researchers have been guided that they must maintain a high level of trust with participants. With this, the researchers initially built rapport to the informants by introducing themselves and briefly stating the purpose of the study. The issue on confidentially was given emphasis as well. After discussion of significant details of the study, the informants were open to voice out clarifications and questions for them to be addressed properly. Granted that the prospect informants agreed to participate in the study, they were then formally asked to sign the Consent Form.
Written in English with corresponding Cebuano vernacular, the consent form precisely discussed the study title, purpose, confidentiality, condition of no-risk involved, and contact information of the primary interviewer. Likewise, the information of the use of audio recorder that would ensure verbatim documentation of client responses was mentioned. The informants were given the opportunity in choosing the location, date, time of interview and type of recording device in their most convenient preference. Ultimately, the researchers and the informants had then mutually agreed on specified meeting details for the interview proper. Data Collection.
Interview was the most important tool for gathering data in this research study. With the appropriate materials such as the tape recorder, interview guide and previously signed informed consent form, the researchers went to the location of the interview where the participant was most comfortable to stay since the place where the communication occurs, influences the outcome of the interaction (Townsend, 2008). Getting acquainted and establishing rapport was important before the researchers started the interview with the participant. A short introductory conversation was done to allay the anxiety of the mother and build trust between the researcher and the participant.
In addition, proxemics – the way people perceive and use environmental, social and personal space in interactions (Keltner, et al. , 2007, p. 90) – was also taken into consideration. According to Videbeck (2004, p. 113), people feel less comfortable with smaller distances when communicating with strangers. The most appropriate distance which is acceptable for communication in social work and business settings is the social zone, which utilizes a distance of 4-12 feet. Also, the researchers and the participant were positioned in a manner where no barrier, such as a table, is located between the two of them. Through this, the researchers showed sincerity in listening to the interviewee.
The researcher then started the interview proper when the primary question was asked. The primary question was: • “Pwede nimo masulti kanamo unsa imong kinatibuk-ang experiensya sa pag-akatar sa imong anak nga adunay ADHD? ” (Can you describe to us as fully as you can your experience of taking care of a child with ADHD? ) Rephrasing of the question was done by the researcher when the participant had difficulty in answering the question. Another questions related to the primary question were asked: • “Unsa man ang imo mga nahuna-hunaan sa pagpadako nimo sa imong anak nga naay ADHD? ” (Can you describe to us your thoughts in taking care of a child with ADHD? • “Unsa man ang imo mga nabati sa pagpadako nimo sa imong anak nga naay ADHD? ” (Can you describe to us your feelings in taking care of a child with ADHD? ) • “Unsa kaha ang laing mga butang nga naka-apekto o naka-impluwensya sa katibuk-an nimong kaagi sa pagpadako sa imong anak nga adunay ADHD? ” (Can you identify factors that could have affected you in taking care of a child with ADHD? ) Before the termination of the interview, the researchers then asked: • “Sa dili pa nako palungon ning recorder para mahuman ning atong pag-istortyahanay, naa pa ba kay laing ganahang isulti? ” (Before I turn off the recorder and terminate this conversation, is there anything else you want to share? This was done so as not to compromise the collection of data considering there are participants that would not want to fully share their experience until the end of the interview. The participant was given as much time to answer the questions to allow her to gather her thoughts and express her feelings fully and honestly. Also, if by chance the mother refused to answer the question(s) asked, the researcher would not insist on it and would respect the participant’s decision. The participant was also assured of her right not to respond. During the whole course of the interview, the researcher ensured the working condition of the recorder and that the entire conversation was recorded. In addition, the interviewer took note of both verbal and nonverbal cues that transpired during the conversation.
The same method of interviewing was done to the other participants, using the same question, until data saturation was achieved by the researchers. Post-data collection. This part of data collection incorporated transcription and confirmation of data with the mother and also included debriefing sessions. Interview was done with the mother and the conversation was transcribed per verbatim including verbal and nonverbal cues that the researchers observed. Important points were emphasized, clarified, and referred back to the mother/interviewee. Afterwards, the researcher-interviewer set another session with the mothers for data to be confirmed and another debriefing session.
Debriefing session after data collection was completed in order to permit participants to ask questions or air complaints (Polit & Beck, 2008, p. 182). After the whole process of data collection had been completed, the respondents were given incentives. The informants were also properly informed that the interview had ended and that they would be given freedom to communicate with the researchers with significance to the study conducted. Analysis of Data Colaizzi’s framework was utilized in the management and organization of the data gathered in this study. Descriptive phenomenology requires a lengthy and rich description of everyday experiences. This is exactly what Colaizzi’s framework allowed – a wealthy influx of valuable data from in-depth interviews with the study participants.
The process of gathering, organizing, and analyzing data is outlined by this framework into several steps that also include returning to the study participants, as a final step of validation (Polit & Beck, 2008, p. 520). As already mentioned, Colaizzi’s method comprises seven steps: 1. Each research informant’s verbatim transcript is read to acquire a sense of the whole; 2. Significant statements and phrases pertaining to the phenomenon being studied are extracted from each transcript; 3. Meanings are formulated from the significant statements; 4. Meanings are organized into themes, and these themes evolve into theme clusters, and eventually into theme categories; 5.
These results are integrated into a rich and exhaustive description of the lived experience; 6. The essential structure of the phenomenon is formulated; and 7. Validation is sought from the research informants to compare the researcher’s descriptive results with their lived experiences. If necessary, the researcher’s description is modified to achieve congruence with the lived experience of the research informants. The researchers gathered data with the use of audio recording as a means of accurate and convenient way of documentation. Documentation included verbatim responses or verbal cues which the respondents articulated during interview.
As soon as the interview was over, the researchers listened to the tape-recorded interviews/conversation and checked for its audibility and completeness as suggested by Polit and Beck (2008, p. 386). Thereafter such, the data were then transcribed for analysis. Interviews were transcribed verbatim from the audiotape by the researchers. The data were then copied directly to a word processing package that is compliant with the researchers’ computers and/or laptops. (Drury, 2001) Each transcription, called a “protocol” (Colaizzi, 1978), was read several times, as the audiotape of the interview was replayed, to gain a sense of total content. This was particularly emphasized in the first step of Colaizzi’s method, to acquire a sense of the whole. Extracting significant statements from the protocols:
Significant statements and phrases pertaining to the phenomenon being studied, the lived experience of mothers rearing a child with ADHD, were extracted from each protocol and coded. Formulating meanings from the significant statements: Next, the underlying meaning of each statement was written. This step “moves from what the participants said to what they meant” (Forrest, 1989). Transcendence or going beyond to what one experiences is important to form formalized meanings. It involves the researchers being cognizant of contextual factors that modify the meanings of verbatim transcription of the interview. The research informants’ use of sarcasm, jargon, economy of phrase and the expression of strong emotion can alter the meaning of the verbatim transcriptions. (Drury, 2001)
This step is a “precarious leap” (Colaizzi, 1978), and the researchers had undertaken the following check to ensure that they remained true to the data: The underlining meaning of each significant statement, called a formulated meaning, was coded with the same symbol as the significant statement from which it was derived. Another research member then independently read each significant statement while listening to a copy of the audiotape and, referring to a hard copy of the transcribed interview protocol, wrote the formulated meaning for each significant statement. The researchers then compared their notes, discussed any discrepancies, and made adjustments when necessary. Next, the coded formulated meanings from all of the interviews were combined. (Drury, 2001)
Organizing formulated meanings into themes: “The next step in the data analysis is to form clusters of themes that are common to the protocols. The formulated meanings will be sorted into groups that represent specific themes” (Coward, 1989). Each theme was coded and each formulated meaning that was formed part of a particular theme was listed beneath it. (Drury, 2001) Organizing coded themes into theme clusters: The next step in the analysis of data was to organize similar coded themes into theme clusters. At some point, the researchers decided that no further collapsing of the data was appropriate, as to do so would lose richness that was contained in the data. Drury, 2001) Writing an exhaustive description of the phenomenon being studied: The next step in the analysis of data was to produce an exhaustive description of the phenomenon being studied from the theme categories. According to Patton (1990), an exhaustive description goes beyond mere fact or surface appearance, but stops short of becoming “trivial and mundane. ” An exhaustive description should communicate the “voices, feelings, actions, and meanings” of the interacting individuals. A final validation was undertaken by returning to the research informants and asking them if the researchers’ description validated their own experiences.
If the results were not congruent to what the participants wanted to imply, the participants have the freedom to modify the rich description and the researchers were responsible to gather and analyze the data rigorously until the resulting essences would be amenable to the informants’ experiences. This was an important undertaking as related to the last step of Colaizzi’s method. Analysis Matrix In order to show how data were analyzed, an analysis matrix is presented which include: significant statements pertaining to the phenomenon extracted from the transcriptions. The second column portrays the formulated meaning which eventually emerged from similar patterns that were identified and sewn together during the course of the study. The last column is the pure essence or the themes, which were derived from the meanings through understanding and analyzing the significant statements that were verbalized by the participants. Respondent |Significant Statements |Formulated |Themes | | | |Meanings | | |A | | | | |B | | | | |C | | | | |D | | | | |E | | | | |F | | | | |G | | | | |H | | | | Rigour
Prior to data collection, bracketing and intuiting are two vital principles in Husserlian phenomenology. Bracketing is the first process in phenomenological reduction. It is withholding and suspension of beliefs, judgments, assumptions as well as biases about the lived experience of mothers rearing children with ADHD. On the other hand, intuiting refers to being open to the meanings attributed to the phenomenon to fully grasp the experience as described by the participants (Speigelberg, 1978). The researchers then maintained these two principles from the start of data collection through in-depth conversation with the informants and observation of non-verbal cues until theme clusters were formulated.
Other than the use of bracketing and intuiting prior to data collection, supplementary care was also taken to ensure that the analysis would not be biased by the researchers’ acknowledged preconceptions. The most common technique used by Husserlian researchers to ensure that rigour is not compromised due to researcher bias is to “identify and articulate assumptions prior to data collection and analysis,” (Morse, 1994). The steps of extracting significant statements and creating formulated meanings from the interview protocols were done independently by the researchers. The formulated meanings were modified to accurately reflect the informants’ lived experience.
Another research member then scrutinized and validated the researchers’ organization of formulated meanings into themes and their evolution to theme clusters. (Drury, 2001) Data collection and analysis were documented to provide an audit trail. Field notes were kept that summarized the date, time, location, and the subject matter of all meetings between the researchers and their advisers, the research informants, and the colleague who validated the analysis. (Drury, 2001) Conceptual Framework In this qualitative study, the following section (Figure 1) illustrates a diagram that utilized the Husserlian phenomenology and Colaizzi’s method as a way of relating the succeeding methodological interpretation. Ethical Considerations
In any discipline that involves research with human beings or animals, researchers must address a range of ethical issues (Polit and Beck, 2008, p. 167). Since this study involved humans as study participants, care was exercised in ensuring that their rights were protected. One of the most fundamental ethical principles in research is that of beneficence, which imposes a duty on researchers to minimize harm and to maximize benefits (Polit and Beck, 2008, p. 170). Since this study concerns human research, it is intended to produce benefits for the participants themselves or a situation that is more common, for other individuals or society as a whole.
In this study, researchers had an obligation to avoid, prevent, or minimize harm (nonmaleficence). Participants weren’t subjected to unnecessary risks for harm or discomfort may it be physical, emotional, social, or financial and researchers will use strategies to minimize such. Researchers were also prepared to terminate the research if there was a reason to suspect that continuation would result in undue distress to the study participants. Informed Consent. The principle of self-determination means that prospective participants have the right to decide voluntarily whether to participate in a study, without risking any penalty or prejudicial treatment (Polit and Beck, 2008, pp. 171-172).
One particularly important procedure done be the researchers for safeguarding participants and protecting their right to self-determination involved obtaining their informed consent. Informed consent means that participants have adequate information regarding the research, are capable of comprehending the information, and have the power of free choice, enabling them to consent to or decline participation voluntarily (p. 176). This right to self-determination included freedom from coercion of any type and required careful thought since the researchers had the position of authority, control, or influence over potential participants (purposive sampling). Confidentiality. Appropriate confidentiality procedures were implemented in this study.
A promise of confidentiality is a pledge that any information participants provide will not be publicly reported in a manner that identifies them and will not be made accessible to others (Polit and Beck, 2008, p. 180). Any research information gathered from the participants would not be shared with strangers, nor with people known to the participants, unless the participant gives the researcher explicit permission to do so. In research reports, researchers would take considerable precautions to safeguard identities especially because the study comprised less than ten participants. Other than using a fictitious name, researchers would have to slightly distort identifying information or present only general descriptions. Right to Withdraw Without Penalty.
Justice connotes fairness and equity, and so one aspect of the justice principle concerns the equitable distribution of benefits and burdens of research (Polit and Beck, 2008, p. 173). The right to fair treatment was exercised through ensuring that researchers treated people who declined to participate in this study or who withdrew from this study after agreeing to participate in a non-prejudicial manner. CHAPTER FOUR DATA PRESENTATION, ANALYSIS AND DISCUSSION In this chapter, the results of the data collection and analysis are presented in order for the researchers to gain understanding on the phenomenon of the lived experience of mothers of children who have ADHD- like manifestations. Colaizzi’s framework was utilized in the management and organization of the data gathered in this study.
An extensive and meticulous process was accomplished to be able to grasp as accurate as possible the account of the existing phenomenon. The process is carried out in the following outline: Interviews (n=8) v Significant Statements (n= 93) v Formulated Meanings (n=164) v Themes (n=43) v Theme Clusters (n=8) v Exhaustive description of the phenomenon v Member Check Colaizzi’s Methodological Interpretation: 1. Each research informant’s verbatim transcript is read to acquire a sense of the whole; The researchers gathered data with the use of audio recording as a means of accurate and convenient way of documentation. Documentation included verbatim responses or verbal cues which the respondents articulated during interview.
The interview contained the primary question, “Pwede nimo masulti kanamo unsa imong kinatibuk-ang experiensya sa pag-akatar sa imong anak nga adunay ADHD? ” (Can you describe to us as fully as you can your experience of taking care of a child with ADHD? ) As soon as the interview was over, the researchers listened to the tape-recorded interviews/conversation and checked for its audibility and completeness. Thereafter such, the data were then transcribed verbatim by pairs for analysis. The data were then copied directly to a word processing package that is compliant with the researchers’ computers and/or laptops. Each protocol was read several times, as the audiotape of the interview was replayed, to gain a sense of total content. 2.
Significant statements and phrases pertaining to the phenomenon being studied are extracted from each protocol; Significant statements and phrases (n= 94) pertaining to the phenomenon being studied, the lived experience of mothers rearing a child with ADHD, were extracted from each protocol and coded. 3. Meanings are formulated from the significant statements. Identifying the underlying meaning of each significant statements, the researchers were able to come up with the formulated meanings (n=164) coded with the same symbol as the significant statement. The researchers then compared their notes, discussed any discrepancies, and made adjustments. 4. Meanings are organized into themes, and these themes evolve into theme clusters, and eventually into theme categories; The formulated meanings were then sorted into themes (n=43 ). Similar coded themes were then organized into theme clusters (n=8).
No further collapsing of data was appropriate and thus richness was contained in the data. 5. These results are integrated into a rich and exhaustive description of the lived experience; From the theme categories, the researchers produced an exhaustive description of the lived experience of these mothers with children who have ADHD manifestations. 6. The essential structure of the phenomenon is formulated; With the exhaustive description derived from this data analysis, the researchers were able to grasp an understanding of this phenomenon. 7. Validation is sought from the research informants to compare the researcher’s descriptive results with their lived experiences.
A final validation was undertaken by returning to the research informants and asking them if the researchers’ description validated their own experiences. The results were congruent with what the participants wanted to imply and were all amenable to the participant’s experiences. Theme Clusters DENIAL Denial is an ego defense mechanism wherein an individual refuses to acknowledge the existence of a real situation or the feelings associated with it (Townsend, 2005). Reality here is either completely disregarded or transformed so that it is no longer threatening. It is primarily used to protect the person from immediate impact of a situation that might otherwise cause intolerable pain if consciously acknowledged.
In this case, denial was used by the mothers to temporarily isolate themselves from the reality that their child has a disorder especially in the early phase of awareness. This is exhibited in the example statements of Mothers A & C: Mother A, Significant Statement 3: I still couldn’t accept at first that my son had some kind of disability. (Dili pa ko kadawat atong una na akong anak naay deprensya. ) Mother C, Significant Statement 26: I said to myself, “he’s okay. ” (Ana ko sa akong kaugalingon, “okay rana siya. ”) In these sample statements, the mothers were able to avoid emotional conflicts by refusing to acknowledge the condition of their child. INEXPERIENCE Inexperience is defined as the lack of experience that would lead to an increase in knowledge or skill (Encarta, 2007).
It is also stated in Webster Comprehensive Dictionary (1992) as the lack of knowledge gained from experience. In the context of this study, the mother is forced into new waters. She is faced with the challenge of raising an ADHD child without prior exposure or experience. Rearing an ADHD child is not an easy task as Mother B and H said respectively: Mother B, Significant Statement 1: At first, I totally don’t understand him. He is so restless and I do not know what to do to make him stay put. I don’t understand why he was acting unlike the others. (Wala gyud ko kasabot niya sauna ug ngano ing-ana iya nilihokan na lahi sa uban. Sige ug lihok, kiat kaayo. Makaguol, dili ko kahibalo unsaon siya nga mapuyo. )
Mother H, Significant Statement 89: It’s tiring. I want to cry at first because I didn’t know, I had no experience raising a child with that condition. (Kapoy. Kahilakon ko anang una kay di man ko hibalo wa man koy experience anang galam ug bata nga naa anang kondisyona. ) The mothers’ lack of experience in dealing with the demands of the situation puts them at a disadvantage but was able to overcome such as are now dealing comfortably their children with such disorder. The researcher further supports the development of this theme cluster in relation to the article in the journal Child: Health, Care and Development. The results of the article by Maniadaki, et al. 2006) entitled “Parental beliefs about the nature of ADHD behaviours and their relationship to referral intentions in preschool children” showed that almost half of the parents who reported ADHD behaviors in their own child replied that they had never met a child exhibiting such behaviours. The researchers concluded that parents whose preschool child displays ADHD behaviours tend to perceive them as normal developmental patterns and may suspend the referral of the child. BURDEN/HARDSHIP Encarta (2009) defines burden as an experience that is painful or distressing. To be burdened is to be in a place or in a situation which is hard to deal with, a load of hardships entailed with suffering, difficulty, and loss. The situation became burdensome for the mother who has to exert an extra effort to care for her child who has ADHD.
Strahm (2008) in his study entitled “Parents’ experience raising a child with Attention Deficit Hyperactivity Disorder (ADHD)” aimed to measure family functioning and parenting stress with parents raising a child with and without ADHD. Results showed that parents in the ADHD group had significantly higher parenting stress compared to the typical group. The findings suggest that although ADHD has a significant impact on family relationships and stress, parents work hard to maintain a positive environment for their children with ADHD. In addition, the article “The experiences of primary caregivers raising school-aged children with attention-deficit hyperactivity disorder” by Lin, et al. (2009) showed that there are different types of burdens of caring.
These are parenting burdens, emotional burdens and family conflicts. During the course the researchers’ in depth interview, it was found out that taking care of children with ADHD entails the mother to face burdens and difficulties in development, education, and discipline. Lack of resources exacerbated the situation posing a hindrance in finding ways to transcend the difficulties in rearing a child wit