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9 Mar 2019

Meza JI et al. Atten Defic Hyperact Disord 2019; Epub ahead of print

Despite the increase in knowledge regarding psychiatric disorders, attitudes towards individuals with these disorders have not significantly improved (Schomerus et al. 2012). The symptoms of ADHD affect an individual’s functioning, including peer relationships, academic achievement and family relationships, and children with ADHD may be vulnerable to stigma (Lebowitz 2016). The aim of this study was to assess whether children with ADHD are stigmatised because of their expressed behaviour (active symptoms) or because of the diagnostic label of ADHD.

Using Amazon’s Mechanical Turk (MTurk) online platform, participants recruited from the USA were assigned to read a vignette about (a) a typically developing child, (b) a child with active ADHD symptoms and (c) a child with active ADHD symptoms plus a diagnostic label. Participants were then asked to report on their emotional reactions,* attitudes and perceptions towards the child they had read about in the vignette. Covariates such as participant age, ethnicity, gender, level of education (self, father and mother), liberal versus conservative, religion and objective status were also included in the study.

A total of 305 participants aged between 18 and 67 years (mean age = 36.22 years, standard deviation [SD] = 10.87) were included in the study; 51% were male and 74.1% were European/European American. Most participants (52.1%) reported knowing someone with ADHD, and 7.2% of participants indicated that they had a diagnosis of ADHD. For each of the experimental groups of the study, 102 participants were assigned to vignette (a) a typically developing child, 101 to vignette (b) a child with active ADHD symptoms, and 102 to vignette (c) a child with active ADHD symptoms plus a diagnostic label. There were no statistically significant differences related to participants’ sociodemographic variables.

The main results from the study are presented below:

  • The vignette about a child with active ADHD symptoms had significantly higher mean scores for negative attitudes (mean = 4.14, SD = 0.99, p < 0.001), animalistic adjectives (mean = 2.69, SD = 1.05, p < 0.001), social distance scores (mean = 2.80, SD = 1.06, p = 0.046) and reports of anger (mean = 2.29, SD = 1.60, p = 0.031) compared with the vignette of a typically developing child or a child with active ADHD symptoms and a diagnostic label.
  • Across the three vignettes, there was a significant correlation between negative adjectives and higher social distance scores: r = –0.301 (p < 0.05) for a typically developing child; r = 0.466 (p < 0.001) for a child with active ADHD symptoms; and r = 0.491 (p < 0.001) for a child with active ADHD symptoms and a diagnostic label.
    • Animalistic adjectives were also significantly associated with a child with active ADHD symptoms (r = 0.432, p < 0.001) and a child with active ADHD symptoms plus a diagnostic label (r = 0.286, p < 0.05), but not with a typically developing child (r = 0.183, p > 0.05).
    • Emotion reports of anger and social distance were also not significantly associated in a typically developing child (r = 0.146, p > 0.05). However, there was a significant correlation between emotion reports of anger and social distance for a child with active ADHD symptoms (r = 0.578, p < 0.001), and for a child with active ADHD symptoms and a diagnostic label (r = 0.234, p < 0.05).

These data suggest that negative attitudes may be related to the stigma associated with children who display active symptoms of ADHD. Moreover, participants who only received a behavioural description, but not the diagnostic label of ADHD, showed significantly more stigmatising attitudes against the child with active ADHD symptoms, which may reflect their desire to keep a greater social distance from the child, associating them with more animalistic and other negative adjectives. This indicates that having a label of ADHD may actually be a protective factor that helped participants overcome biases related to childhood ADHD.

There were some limitations to this study that should be considered when interpreting the results. The child described in each vignette did not vary in age, gender or ethnicity, and the gender of the child may have impacted the results, as although ADHD is more common in boys, girls and adults are also affected by ADHD. In addition, the study only used subjective self-report to measure the participants’ attitudes towards the children in the vignettes. The authors stated that with the increasing publicity of psychiatric disorders, reporting positive attitudes towards mental illnesses could be a result of participants’ social desirability. Finally, the source of the study sample relied solely upon MTurk so future studies could replicate these findings in other samples to ensure generalisability of the results to the US population.

In conclusion, the authors highlighted that these findings suggest that more research should be aimed at developing a better understanding of what strategies could be developed to change attitudes and perceptions towards children with ADHD. They also stated that the public should be informed that diagnostic labels may not be as stigmatising, and the benefits of seeking professional help may outweigh the feared social consequences.

Read more about stigma and ADHD here

 

*To assess positive and negative attitudes, participants indicated how far they considered both positive and negative adjectives described the person in the vignette, on a 7-point scale from 1 (not at all) to 7 (extremely). Participants were also asked to rate how far human- and non-human–related words described the person in the vignette, on a 7-point scale from 1 (not at all) to 7 (extremely)
Participants’ anger was assessed after reading the vignette about each person using a single item consisting of a synonym cluster (angry, irritable, mad) on a 7-point scale from 1 (not at all) to 7 (extremely)
Social distance was measured by a modified version of the Social Distance Scale, which was developed using the World Psychiatric Association (2001) Programme to Reduce Stigma and Discrimination of Schizophrenia. Participants were asked how willing they would be to: (1) move next door to the person depicted in the vignette; (2) spend an evening socialising with the person; (3) make friends with the person; (4) start working closely with the person; and (5) have the person become part of the family, on a scale of 1 (definitely yes) to 5 (definitely no)

Lebowitz MS. Stigmatization of ADHD: a developmental review. J Atten Disord 2016; 20: 199-205.

Meza JI, Monroy M, Ma R, et al. Stigma and attention-deficit/hyperactivity disorder: negative perceptions and anger emotional reactions mediate the link between active symptoms and social distance. Atten Defic Hyperact Disord 2019; Epub ahead of print.

Schomerus G, Schwahn C, Holzinger A, et al. Evolution of public attitudes about mental illness: a systematic review and meta-analysis. Acta Psychiatr Scand 2012; 125: 440-452.

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