The Lived Experience of Fostering a Child with ADHD Where the Placement Breaks Down

179 Pages·2017·0.88 MB·English

by  Andrew Field

We Love Them With All Our Heart:
The Lived Experience of Fostering a Child with ADHD
Where the Placement Breaks Down

A Thesis
Submitted to the Faculty of Graduate Studies and Research
In Partial Fulfillment of the Requirements
For the Degree of
Master of Social Work
University of Regina

By
Andrew Holman Field
Regina, Saskatchewan
January 3, 2017

Copyright 2016: A.H. Field
UNIVERSITY OF REGINA

FACULTY OF GRADUATE STUDIES AND RESEARCH

SUPERVISORY AND EXAMINING COMMITTEE

Andrew Holman Field, candidate for the degree of Master of Social Work, has presented a
thesis titled, We Love Them With All Our Heart: The Lived Experience of Fostering a
Child with ADHD Where the Placement Breaks Down, in an oral examination held on
December 19, 2016. The following committee members have found the thesis acceptable
in form and content, and that the candidate demonstrated satisfactory knowledge of the
subject material.

External Examiner: *Dr. Grant Charles, University of British Columbia

Supervisor: Dr. Ailsa M. Watkinson, Faculty of Social Work

Committee Member: Dr. Darlene Chalmers, Faculty of Social Work

Committee Member: Dr. Declan Martin Quinn, Adjunct

Chair of Defense: Dr. Vivian Puplampu, Faculty of Nursing

*Via videoconference
We Love Them With All Our Heart i
Abstract
This study used an interpretative phenomenological analysis methodology to
understand the lived experience of foster families providing care for children with a
diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) where the foster
placement broke down. The data was collected through a semi-standardized interview
process with foster parents representing five foster families. The essence was found to be
a deep and enduring love between the families and their foster children. Four key themes
emerged to express the foster families’ lived experience. Behaviours was the first theme
representing the ever-present, persistent, overwhelming, and ultimately defeating
behaviours participants experienced. The second theme was Anguish representing the
intensity of emotion experienced by all participants in the presence of the behaviours.
The third theme, Exhaustion and Failure, was a temporal theme representing the way all
placements seemed to “fade into breakdown.” The breakdowns did not occur in response
to culminating events but seemed to collapse with a final admission of failure. Finally,
the theme Connection represents an enduring bond that existed between the foster
children and parents in every family. An average of eight years after the breakdowns
occurred, the participants were all having regular, positive, supportive, and typically
parental contact with every child.
This thesis is informed by an understanding of children’s rights that includes the
right of and, it is contended, a legal obligation to ensure the successful care of all
children, including children in care, to adequate health care designed to address mental
health issues and, in particular, ADHD. The right of children to adequate health care
We Love Them With All Our Heart ii
includes the right to receive all necessary means to ensure their placement as “wards of
the state” enhances their overall well-being and protects their inherent dignity.
We Love Them With All Our Heart iii
Acknowledgements
I wish to acknowledge the foster families interviewed in this study and the many
foster families I have had the privilege to meet over the years. Your example keeps me
grounded in the ultimate goodness of people and inspires me to strive to make at least a
small contribution to your valuable work.
To Dr. Ailsa M. Watkinson, who stuck by me with encouragement and advice
throughout. To Dr. Darlene Chalmers, whose passion for research inspired much critical
analysis. To Dr. Declan Quinn, whom I have known for many years and who has
provided clinical insight and inspiration through his unerring commitment to children.
These are the members of my thesis committee and I thank you all.
We Love Them With All Our Heart iv
Dedication
I would first like to dedicate this work, with great respect, to all of the children
and youth in care in this province of Saskatchewan and in Canada. Your courage in the
face of so many obstacles has given me the inspiration to undertake this thesis.
To Dudley, Jean, and Jennifer who have been with me always.
Finally, my heartfelt thanks goes to my wife Rita and our children and their
families. I know you have all paid a price for my successful completion of this thesis.
For this I am deeply grateful. Know that although it may have felt you were least in my
attention you have always been the most.
We Love Them With All Our Heart v
Table of Contents
Supervisory and Examining Committee ............................. Error! Bookmark not defined.
Abstract ...................................................................................................................... i
Acknowledgements ................................................................................................... iii
Dedication .................................................................................................................. iv
Table of Contents ....................................................................................................... v
Introduction ............................................................................................................... 1
Literature Review ....................................................................................................... 6
Introduction ...................................................................................................................... 6
Child Welfare in Canada ..................................................................................................... 6
A brief history. ....................................................................................................................................... 6
Children in out-of-home care. ............................................................................................................... 9
Foster care outcomes. ......................................................................................................................... 10
Placement stability as a contributor to improved foster care outcomes. ........................................... 11
Placement breakdown. ........................................................................................................................ 11
ADHD ............................................................................................................................ 166
Introduction. ...................................................................................................................................... 166
History. ................................................................................................................................................. 16
Diagnosis. ........................................................................................................................................... 188
ADHD can lead to potentially serious consequences. ....................................................................... 199
Prevalence. ........................................................................................................................................ 222
Etiology. ............................................................................................................................................. 244
Treatment. ........................................................................................................................................... 33
Treatment barriers. ............................................................................................................................ 333
ADHD and risk for child maltreatment. ............................................................................................. 355
ADHD, maltreatment, and externalizing behaviours. ........................................................................ 377
Summary ....................................................................................................................... 388
Conceptual Framework ............................................................................................. 40
Research Question ........................................................................................................... 40
Conceptual Framework .................................................................................................... 40
International Human Rights Treaties ................................................................................ 41
The Universal Declaration of Human Rights. ....................................................................................... 41
We Love Them With All Our Heart vi
The Convention on the Rights of the Child. ......................................................................................... 42
The Convention on the Rights of Persons with Disabilities 2006. ..................................................... 433
United Nations Resolution on Guidelines for the Alternative Care of Children 2009. ...................... 455
The Canadian Human Rights Framework ......................................................................... 477
Canadian Charter of Rights and Freedoms. ....................................................................................... 477
Canadian common law. ..................................................................................................................... 477
Social Work Ethics .......................................................................................................... 499
Summary ......................................................................................................................... 50
Methodology ........................................................................................................... 51
Introduction .................................................................................................................... 51
Research Paradigm .......................................................................................................... 51
The research task: intention, meaning and understanding. ................................................................ 52
Research Question ........................................................................................................... 52
Interpretive Constructionist Theory .................................................................................. 52
Reflexivity and the Role of the Researcher ........................................................................ 53
Interpretative Phenomenological Analysis ........................................................................ 54
Participants ................................................................................................................... 566
Data Collection ................................................................................................................ 58
Data Analysis ................................................................................................................... 60
Ethical Considerations ...................................................................................................... 62
Credibility and Trustworthiness ..……………………………………………………………………………………..64
Findings .................................................................................................................. 666
The Essence: We Love Them With All Our Heart .............................................................. 666
Four Themes Emerging from the Lived Experiences ......................................................... 677
Figure 1: Four Themes Emerging from the Lived Experiences ........................................... 688
Figure 2: Lived Experiences / Love Them With All Our Heart Themes and Sub-themes ..... 699
Behaviours .................................................................................................................... 699
Figure 3: Theme 1: Behaviours ............................................................................................................ 70
Similar for all participants. ................................................................................................................... 70
Overwhelming...................................................................................................................................... 72
Intensified upon adolescence. ............................................................................................................. 73
Coping with stress. ............................................................................................................................... 74
We Love Them With All Our Heart vii
Defeat. ............................................................................................................................................... 755
Loss and relief. ................................................................................................................................... 788
Anguish ......................................................................................................................... 799
Figure 4: Theme 2: Anguish ............................................................................................................... 799
Powerlessness. ................................................................................................................................... 799
Frustration with child welfare agency support. ................................................................................... 81
Isolation. .............................................................................................................................................. 84
Family. ................................................................................................................................................ 877
Exhaustion and Failure ................................................................................................... 899
Figure 5: Theme 3: Exhaustion and Failure .......................................................................................... 90
Confusion. ............................................................................................................................................ 90
Lack of emotional intensity. ................................................................................................................. 90
Time. .................................................................................................................................................... 92
Grief. .................................................................................................................................................... 92
Connection ...................................................................................................................... 95
Figure 6: Theme 4: Connection ............................................................................................................ 95
Continue to have a relationship. .......................................................................................................... 95
My child. .............................................................................................................................................. 96
Summary ......................................................................................................................... 98
Discussion ................................................................................................................ 99
Discussion and Implications of the Findings .................................................................... 999
The behaviours. ................................................................................................................................. 999
Gradual and complex breakdown. ..................................................................................................... 102
Support needs. ................................................................................................................................... 103
The potential of enduring attachment. ........................................................................................... 1077
ADHD Literature and Parent Stress ............................................................................... 1099
ADHD and Placement Breakdown ................................................................................... 110
Social Work and the ADHD Evidence ........................................................................... 11111
Social Work and Neuroscience ................................................................................... 11616
The Human Rights Context ........................................................................................... 1188
Conclusion ........................................................................................................... 12121
Limitations................................................................................................................. 12222
Appendix A .................................................................... Error! Bookmark not defined.23
We Love Them With All Our Heart viii
Participant Consent Form ........................................................................................... 12323
Appendix B ............................................................................................................ 1288
Questions .................................................................................................................... 1288
References ............................................................................................................ 1299