Parental Challenges in Raising Preschoolers With Attention-Deficit/Hyperactivity Disorder in Mainland China’s First-Tier Cities: Qualitative Study Using Framework Analysis (Preprint)

BACKGROUND First-tier cities in mainland China present unique challenges for raising children with attention-deficit/hyperactivity disorder (ADHD) due to rapid urbanization, intense academic pressure, and distinct sociocultural dynamics. While existing research has documented ADHD parenting challenges across various contexts, limited attention has been paid to the preschool period in Chinese metropolitan settings, where early intervention is crucial yet complicated by traditional values and evolving health care systems. OBJECTIVE This study aimed to explore the comprehensive challenges faced by parents raising preschoolers with ADHD in these metropolitan contexts. METHODS We conducted web-based semistructured focus group interviews with 13 parents (n=12, 92% mothers and n=1, 8% fathers; aged between 32 and 44 years) of preschool children with ADHD (n=10, 77% boys and n=3, 23% girls; aged between 5 and 7 years) in first-tier cities in mainland China between March and July 2024. Participants were purposively recruited through the ADHD Mutual Support Alliance’s platform if they had a preschool child with a formal ADHD diagnosis and lived in first-tier cities. Four interviews were conducted (3 focus groups with 4 participants each and 1 pilot individual interview). All interviews were moderated by a practitioner working with populations with ADHD following a semistructured interview guide developed through expert panel consultation. Interviews were audio-recorded and transcribed verbatim. Qualitative data were analyzed using framework analysis, using a theoretical framework approach, with dual-researcher coding and participant verification to ensure methodological rigor. Data were coded and organized manually using Microsoft Word, supported by NVivo software. RESULTS Challenges emerged across six major themes: (1) individual psychological and behavioral challenges, including parental emotional burden, self-blame, and difficulties managing ADHD symptoms; (2) microsystem challenges in family and school environment challenges, particularly regarding behavioral management and teacher understanding; (3) mesosystem difficulties in family-school-hospital coordination, highlighted by recurring teacher complaints and inconsistent diagnostic standards; (4) exosystem barriers in work-family balance and health care access, including limited availability of specialized services and financial burdens; (5) macrosystem challenges from societal stigma and traditional educational values, manifesting as discrimination fears and academic pressure; and (6) chronosystem impacts from historical and social changes, notably the COVID-19 pandemic’s influence and gaps in support systems compared to countries with comprehensive health care infrastructure. CONCLUSIONS Parents face multilayered challenges in raising preschoolers with ADHD, particularly regarding access to specialized health care services, navigation of educational systems, and use of culturally adapted interventions. These challenges are intensified by the unique urban context of intense academic pressure and rapid modernization. Future initiatives should focus on enhancing health care resource accessibility, developing culturally sensitive support programs, implementing systematic educational accommodations, and promoting broader societal awareness of ADHD in mainland China. These findings underscore the necessity for comprehensive ecological interventions that address challenges across all systemic levels while considering the unique characteristics of Chinese metropolitan environments.