Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder, characterized by a persistent pattern of inattention and/or hyperactivity/impulsivity that interferes with functioning or development (American Psychiatric Association, 2013). Research shows that ADHD could affect various aspects of an individual’s life, such as school performance (Faraone et al., 2001), social functioning (Bagwell et al., 2001), and quality of life (Lee et al., 2016) among other aspects. ADHD does not impact only diagnosed children but also their parents, and has been associated with poor marital functioning (Mohammadi et al., 2012) and a high level of parenting stress (Leitch et al., 2019). Although adolescents with ADHD and their parents face the same disorder, they may develop distinct attitudes and thoughts about it. However, little is known about the alignment of parent-adolescent perceptions regarding ADHD. The potential importance of divergent perceptions has been highlighted by a growing body of research indicating that divergent illness perceptions between parents/caregivers and their dependents are associated with a range of negative health-related outcomes in those dependents (e.g., Gaston et al., 2012; Juth et al., 2015). Understanding the implications of divergent parent-child perceptions of ADHD can potentially yield important insights for improving the management of the disorder.
Adolescence is a critical period of identity development (Erikson, 1986), in which adolescents strive for individuation. It is also recognized as a critical period for mental health challenges (Lee et al., 2014). The new challenges and stressors faced by adolescents in this period place unique demands on themselves and their families. The diagnosis of ADHD may pose additional challenges for adolescents and their families when they need to cope with this disorder in addition to the typical developmental changes at the same time. Although parents’ coping with offspring’s ADHD has been widely examined (see Craig et al., 2020 for a review), less is known about how adolescents cope with the disorder. Much of the existing research has investigated coping in terms of adolescents’ treatment adherence and specific ways of dealing with the challenges brought by ADHD (e.g., Eccleston et al., 2019; Ringer, 2021), rather than their overarching coping style. Understanding the broad categories of the ways that adolescents cope with the disorder, such as active (i.e., accommodative attempts to adjust to constraints) versus passive (i.e., attempts to disengage from the stressor) coping, may enable evaluations of their coping (Skinner et al., 2003). Given the shared ADHD experience, adolescents and parents are continually exposed to each other’s subjective perceptions of the disorder, which may contribute to their well-being and coping approaches. Understanding how adolescents’ coping styles may be affected by their parents is vital as it may provide better management of the disorder specifically and well-being broadly. A meta-analysis has found that ADHD has a negative impact on adolescents’ quality of life, especially in the psychosocial domain (Lee et al., 2016). However, it is unclear how parents’ perceptions of ADHD are related to adolescents’ well-being. As such, the present study addressed these gaps by investigating the correlates of parents’ perceptions of ADHD as well as divergent parent-child perceptions.
Studies of parents’ perceptions of ADHD have begun to emerge in recent years (e.g., Coletti et al., 2012; Johnston et al., 2005), but have largely focused on only one or two dimensions of ADHD perception. According to the Common-Sense Model of Illness Representations (CSM: also known as the Self-Regulation Model), illness perceptions comprise multiple dimensions. Individuals actively form seven cognitive representations of the illness when they encounter a health threat (e.g., symptoms and diagnosis), in order to understand and cope with the threat (Leventhal et al. (1980); Leventhal et al. (1984)). These dimensions are: (1) identity – how the illness and its symptoms are identified and labeled; (2) cause – the perceived reasons why an illness develops; (3) timeline – the ideas about how long it will last; (4) consequences – the emotional and functional effects on life; (5) control/cure, the extent to which a patient believes how controllable an illness is by the treatment and by themselves; (6) emotional representations – emotional responses towards the illness; and (7) coherence – how much individuals believe they understand their illness (Leventhal et al. (1980); Leventhal et al. (1984); Moss-Morris et al., 2002).
Using the CSM framework, a systematic review of literature on perceptions of ADHD among diagnosed adolescents and their parents (Wong et al., 2018) reported that a disproportionally large amount of attention has been paid to only one of these beliefs – perceived effectiveness of medication (corresponding to the control/cure dimension of CSM). In other words, most previous studies examined adolescents’ and parents’ beliefs about ADHD treatment, while paying little attention to other beliefs. We posit that such unbalanced attention should be rectified as all illness beliefs have been found to be related to important outcomes, such as coping behavior and treatment adherence (Hagger & Orbell, 2003; Richardson et al., 2017; Witteman et al., 2011). For instance, studies among parents/caregivers of patients with physical and mental illnesses have found that some under-explored illness beliefs, such as timeline and coherence, are related to patients’ treatment adherence and wellbeing (Salewski, 2003; Shanley & Reid, 2014). The lack of a theoretical foundation in previous studies thus implies that the potential impact of different facets of ADHD-related beliefs may have been overlooked.
To our knowledge, no studies have applied Leventhal’s CSM to examine parents’ perceptions of their offspring’s ADHD and their correlates. Existing studies on parents’ perceptions are narrowly-focused, not only because they have examined only one or two ADHD beliefs, but they have often assessed only treatment-related outcomes. For instance, quantitative and qualitative studies have found parents’ confidence in medication to be related to the uptake of pharmacological treatments (Coletti et al., 2012; Corkum et al., 1999; Johnston et al., 2005; Toomey et al., 2012); and their endorsement of biological causes of ADHD to be associated with their acceptance of medications (Lin & Chung, 2002). However, parents’ beliefs about ADHD may also be associated with other outcomes. Leventhal’s CSM proposes that a family’s illness beliefs may affect patients’ coping and well-being, as family members are sources of information that may influence patient’s own illness representations (Leventhal et al. (1980)). In support of this notion, research based on this framework with parents/caregivers of adolescents with physical and mental illnesses has found that parental illness beliefs are related to adolescents’ coping and psychological well-being. For instance, parents’ causal attributions concerning externalizing and internalizing problems have been found to associate with greater emotional distress in their offspring (Shanley & Reid, 2014). Additionally, parents’ perception of graver consequences of their offspring’s diabetes and chronic skin disease is related to adolescents’ poorer management of the illnesses (Gaston et al., 2012; Salewski, 2003). As such, the present study aimed to extend the scope in ADHD literature by applying the CSM to examine parental ADHD beliefs and their relationship with their children’s coping and quality of life (QoL), in addition to treatment adherence.
Research examining the alignment of parents’ and adolescents’ perceptions of ADHD has been particularly limited. To our knowledge, no studies have applied Leventhal’s CSM to investigate such alignment. Only three of the CSM’s illness beliefs – identity, cause, and treatment control – have been previously examined. These limited relevant findings suggest that parents’ and adolescents’ beliefs often diverge from each other. For example, structured diagnostic interviews with 168 adolescents (aged 12–18) with suspected behavioral problems and their caregivers found that only about 10% of the dyads agreed on the ADHD subtype diagnosis (Hogue et al., 2014). Likewise, among 86 children and adolescents (aged 9–14) diagnosed with ADHD, a comparison between their self- versus parent-report of symptoms showed that the youngsters perceived having fewer symptoms than their parents perceived them to have (Wiener et al., 2012). Adolescents may also hold stronger beliefs in psychosocial causes of ADHD than their parents. Surveys completed by 45 children and adolescents (aged 8–18) and their parents revealed that the offspring endorsed less physiological factors (e.g., “something I was born with”, 73% vs 91%) and more psychosocial factors (e.g., “my fault because I’m lazy”, 23% vs 12%) than their parents (Bowen et al., 1991).
Adolescents may perceive treatment to be less beneficial than their parents as well. Data from 40 pairs of adolescents and parents demonstrated that adolescents reported fewer positive changes related to medication usage (McElearney et al., 2005). In fact, a considerable amount of previous research has shown that youngsters with ADHD tend to overestimate their own competencies (see Owens et al., 2007 for a review). The term positive illusory bias (PIB) was used to describe this phenomenon (Hoza et al., 2002). Findings suggest that children/adolescents with ADHD report higher ratings of competence than their parents compared to typically developing counterparts (Fefer et al., 2018; Hoza et al., 2004; Hoza et al., 2002; Owens & Hoza, 2003). As such, adolescents with ADHD may also hold more positive views of the disorder than their parents. Consistent with this speculation, studies that have applied CSM to adolescents with physical illnesses (e.g., cancer and chronic diseases) have found that they hold less pessimistic views on such illnesses than do their caregivers/parents (Juth et al., 2015; Szentes et al., 2018).
To examine whether this is the case for adolescents with ADHD, here we compared diagnosed adolescents’ perceptions of their ADHD with those of their parents, using the CSM framework. As some previous research has identified potential gender differences in illness perceptions among adolescents and parents, we included gender in the analyses. For instance, female adolescents were found more likely to attribute their mental illness to internal causes than their male counterparts, and the two genders differed on the perceived consequences of their illnesses (Fox et al., 2008). Among parents, studies have found that mothers of children with ADHD took less responsibility for their children’s ADHD symptoms than fathers (Johnston & Freeman, 1997), and that they were more willing than the fathers to accept their children’s diagnosis of ADHD (Singh, 2003). As such, the present study included both adolescents’ and parents’ gender as covariates in the analyses.
Given the limited research on divergent parent-child perceptions of ADHD using the CSM framework, it is not surprising that no published study has examined such divergence in relation to coping and well-being. Thus, looking at research on other illnesses may be useful to draw predictions. A cross-sectional study that applied the CSM among 84 adolescents with diabetes and their mothers found that discrepant perceptions were associated with poorer coping with the illness (Olsen et al., 2008). Similarly, among 82 patients with psychosis and their carers, the application of the CSM showed that diverging views on illness consequences were related to greater anxiety, depression, and lower self-esteem (Kuipers et al., 2007). Likewise, Lobban et al. (2006) demonstrated that when relatives’ illness perceptions diverged from those of patients with schizophrenia, those relatives were more likely to be critical and hostile to the patients, which exacerbated negative patient outcomes. Since little is known about the related impact of divergent perceptions of ADHD among adolescents and their parents, the present study aimed to provide preliminary data to address this question.
To summarize, this study aimed to explore the following research questions: (1) what ADHD beliefs, as defined by the CSM framework, do parents hold about their child’s ADHD? (2) to what extent do parents’ and adolescents’ perceptions overlap? (3) which important adolescents’ outcomes are related to parental ADHD perceptions? and (4) are potential divergent perceptions relate to adolescents’ coping, QoL, and treatment adherence? The findings of the study could yield insights into ways to improve adolescents’ coping with disorder and their well-being. Namely, the findings on ADHD beliefs could help clinicians understand which beliefs may have the strongest relationship with adolescents’ coping and well-being. They could then consider addressing these beliefs held by adolescents and their parents using cognitive behavioral techniques.
Method
Participants
Ninety-nine parents of adolescents with ADHD were approached about the study in various settings; 77% (n = 76) of them initially provided consent to participate. An a priori power analysis was conducted using G*Power3 (Faul et al., 2009). Assuming a large effect size (Cohen’s f2 = 0.35), and an alpha of 0.05, the result showed that a total sample of 49 dyads was required to achieve a power of 0.80. Since this study is exploratory in nature, it is sufficiently powered to detect findings of a large effect size in this novel research area.
Parents were eligible to participate if their offspring: (1) were diagnosed with ADHD by a physician or a mental health professional, at least six months before; (2) were aged between 10 to 18 years-old; and (3) did not have a moderate-severe sensory/linguistic impairment that would interfere with their ability to complete a questionnaire. Three parents were not eligible to participate, four did not arrange a date and time for their adolescent’s participation, and one adolescent did not wish to participate. Two parents were excluded from the data analyses because of a large amount (over 50%) of missing data in one or more measures.
The final sample comprised N = 66 parents (52 mothers, mean age = 48.29 years) recruited from a private clinic (n = 4), ADHD support groups for parents (n = 6), and an educational consultancy (n = 56) that provides a coaching service to children and adolescents with ADHD in Sydney, Australia. One offspring of each parent also participated. Each dyad was given an $20 Australian dollars gift voucher upon completion of the study as compensation for their time. About half of the participants identified themselves as European (n = 35) and/or Oceanian (n = 34), about one-third of the parents had completed a certificate/diploma (n = 23) or a bachelor’s degree (n = 24), and about one-fifth of them have completed a postgraduate degree (n = 12). The sample consisted of a relatively affluent group, with more than half reporting a household income above $140,000 Australian dollars before tax. See supplementary materials (Appendix A) for participants’ characteristics. Among the parents, there were five pairs of mothers and fathers. To address analytic issues that arise from the lack of independence in those data, one parent of each dyad was randomly selected to be included in the analysis.
The adolescent participants have been previously described in detail (Blinded). In brief, 63 adolescents (50 males) aged between 10 and 18 (mean age = 14.28, SD = 2.07) were recruited with their parents. There were two pairs of siblings among the participants. One adolescent of each pair of siblings was randomly selected to address the aforementioned analytical issues. The final sample thus included 61 combinations of parents and adolescents with ADHD. The majority were diagnosed with a predominantly inattentive subtype (62%), followed by a combined subtype (21%), and a predominantly hyperactive-impulsive subtype (11%). Most adolescents (91%) were taking ADHD medications.
Compliance with Ethical Standards
The study was approved by an institutional Human Research Ethics Committee (Project no: 2016/173). Written informed consent was obtained from all parents and adolescents. All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Procedure
The researcher invited parents to participate in a study of parents’ thoughts and feelings about ADHD as well as those of their offspring. After obtaining consent and checking the adolescent’s eligibility and assent to participate in the study, parents and adolescents could choose to complete the questionnaire on site or online. Approximately one-third of them (34.4%) took part online. Chi-square and t-tests were used to examine whether the participants completed the questionnaire at the site or online differed on demographic characteristics, ADHD beliefs, and outcome variables in line with methodological suggestions offered by Ellis et al. (2021). We found that there were no significant differences between the two groups (p’s > 0.05), except parents who completed the survey online had a higher level of parenting stress than those who completed on-site (t(59) = 3.19, p = 0.002). The researcher explained to the parents that the adolescents had to fill in the questionnaire alone to ensure their responses were not affected by parents’ presence.
Measures
The questionnaires were clear and easy to follow, with a readability level of 4.3 grades for parents, and 2.6 grades for adolescents. The questionnaires were also reviewed and deemed appropriate by an experienced clinician specializing in adolescents’ health.
Demographic information
Parents provided information regarding adolescents’ age, gender, and ethnicity. Parents’ age, gender, ethnicity, marital status, educational level, occupation, and religiosity were also collected.
Treatment history
Parents provided information regarding adolescents’ age at ADHD diagnosis, who diagnosed the ADHD, the subtype of ADHD, comorbidity, past and current treatments received for ADHD, and the duration of current medications and/or behavioral treatments. Parents also answered questions regarding the history of their own ADHD and mental health diagnoses in their family.
Parents’ and adolescents’ perceptions of ADHD
The Brief ADHD Perception Questionnaire (BAPQ; Wong, 2018) was developed to assess parents’ and adolescents’ perceptions of ADHD. Sample items for parents included “How much does your child’s ADHD affect his/her life?” and “How much control do you feel your child has over his/her ADHD?”. Sample items for adolescents included “How much does your ADHD affect your life?” and “How much control do you feel you have over your ADHD?”. This measure is based on the Brief Illness Perception Questionnaire (Brief IPQ; Broadbent et al., 2006), which is a 9-item measure that assesses cognitive and emotional representations of illnesses. There were 21 items in the parents’ measure and 18 items in that of the adolescents’ one. These questionnaires are largely the same, except the parents’ one contained three additional items assessing their own experiences (e.g., “How much does your child’s ADHD affect your life?”) apart from their perception of their child’s ADHD. The rewording of items in the Brief IPQ to measure parents’/caregivers’ perceptions with respect to both the dependent and their own life have been done in previous studies as well (e.g., Broadbent et al., 2009; Matthews et al., 2018; Yu et al., 2017).
Substantial modifications were made to the original Brief IPQ in the dimensions of Cause and Treatment Control. On Cause, the measure was changed from open-ended questions to a set of questions gauging seven etiological beliefs of ADHD on a 5-point scale (1 = not an important cause, 5 = important cause). The reasons for this change were to enable easier completion for participants and to facilitate comparisons between adolescents’ and parents’ ratings. The causes were derived from previous studies that investigated the perceived causes in children and adolescents with ADHD (Bowen et al., 1991; Kendall et al., 2003; McMenamy et al., 2005). These causes were genes, the different way their brain works, parenting practices, adolescents’ learning from friends, difficulty of schoolwork, adolescents’ insufficient efforts, and God making them this way.
Since there is a variety of treatments available for ADHD, the measure of perceived treatment effectiveness was modified to gauge beliefs more precisely. The original single item that measured overall perceived treatment control was replaced with two items gauging the perceived effectiveness of medication and behavioral treatment separately.
Several linguistic simplifications were made to the original Brief IPQ questions to improve the readability for the participants. The word “symptoms” was replaced with “problems”; and “concerned” was replaced with “worried”. To adapt to the context of the current study, the word “illness” was replaced with “ADHD”. To ensure the questionnaire was age-appropriate for the adolescent participants, the rating scale was reduced from 10 points of the Brief IPQ, to five points, with a label attached to each rating option. The content and wording of items for both parents and adolescents were reviewed and approved by two experts with extensive experience in the clinical care of children and adolescents with ADHD. The internal consistencies of the scale for parents (Cronbach’s α = 0.69) and adolescents (α = 0.60) were somewhat low. However, this was expected due to the heterogeneity of the items and the breadth of the measure, as similar emphasis on the breadth over internal consistency has been previously suggested (e.g., Dar-Nimrod et al., 2018; Gosling et al., 2003; Rammstedt & John, 2007).
Adolescents’ coping
A revised version of the Coping with a Disease Questionnaire (CODI; Petersen et al., 2004) was used to measure adolescents’ coping with ADHD. The CODI was originally designed to assess the coping of children and adolescents with chronic physical health conditions. The original version included 28 items that measure six coping strategies. Following recommendations from clinical professionals on an advisory panel, who indicated that questionnaire length should be minimized to reduce burden on the adolescent participants, this instrument was shortened. The revised version contained 18 items; the three items with the highest factor loadings on each coping strategy in an international pilot study of this measure among children and adolescents with chronic physical health conditions (Petersen et al., 2004), were retained. To adapt to the context of the current study, the term “illness” was replaced with “ADHD”. The six coping strategies measured were “Avoidance” (e.g., “I try to ignore my ADHD”), “Cognitive-Palliative” (e.g., “I pray that my ADHD will go away”), “Emotional Reaction” (e.g., “I am angry about my ADHD”), “Acceptance” (e.g., “I have got used to my ADHD”), “Wishful Thinking” (e.g., “I want to stop having ADHD”), and “Distance” (e.g., “I think my ADHD is no big deal”). Adolescents indicated the frequency of their use of the strategy on 5-point scales, ranging from 1 (never) to 5 (always).
The internal consistency of the scales in this study ranged from unacceptable to good: Cognitive–Palliative α = 0.33, Avoidance α = 0.55, Distance α = 0.65, Acceptance α = 0.79, Emotional Reaction α = 0.79, Wishful thinking α = 0.80. Since an alpha of over 0.6 was considered as acceptable (Moss et al., 1998; Nunnally, 1978), only the four scales with α ≥ 0.60 were included in the data analysis. To enable a more concise interpretation of different coping strategies, we classified the strategies into two types based on the coping literature. Since accepting and minimizing the stressor constitute accommodative attempts to adjust to constraints (Connor-Smith et al., 2000; Skinner et al., 2003), “Acceptance” and “Distance” were combined to reflect an active coping strategy, which involved accepting oneself having the disorder and getting used to it, yet perceiving little problems about it. These strategies were strongly correlated (r = 0.55, p < 0.001) and had an acceptable, combined internal consistency (α = 0.71). Likewise, “Wishful Thinking” and “Emotional-Reaction” were combined to reflect a passive coping strategy, as wanting to stop having the disorder and reacting to having ADHD with strong emotions (i.e., feeling frustrated, angry, ashamed) reflect attempts to disengage from, and opposition to, the stressor, respectively (Connor-Smith et al., 2000; Skinner et al., 2003). These strategies were strongly correlated (r = 0.57, p < 0.001) and had an acceptable, combined internal consistency (α = 0.73) as well.
Adolescents’ Quality of Life (QoL)
The Pediatric Quality of Life Inventory – General Wellbeing Scale (PedsQL; Varni et al., 2003) was used to assess adolescents’ QoL. The instrument was designed to assess health-related QoL in healthy and ill children and adolescents. It includes six questions on perceived general well-being and one question on perceived general health. Participants indicated their ratings on a 5-point scale that ranged from 0 to 4, in which higher scores indicated better QoL. The internal consistency of this instrument in the current study was excellent (α = 0.91).
Treatment adherence
Two items were created to measure adherence to medications and behavioral treatments respectively. Parents indicated their rating on the questions “How much do you think your child has followed the (medication/behavioral) treatment?” on 7-point scales (1 = did not follow at all; 7 = followed completely).
Severity of ADHD
The Conners’s Global Index – Parent Version (CGI-P; Conners et al., 1998) was used to measure the severity of ADHD symptomatology. It is a widely used rating scale to assess symptoms of ADHD and psychopathology in children between three and 17 years of age. It includes 10 items to which parents responded on 4-point scales. The measure had good internal consistency (α = 0.86) in this study.
Statistical Analysis
The data were analyzed using SPSS version 26 (IBM Corporation, Somers, NY, USA), with significance levels set at 0.05. Since this study explores new questions, all analyses were conducted in an exploratory nature.
To examine the association between parents’ perceptions of ADHD and adolescents’ coping, QoL, and treatment adherence, a series of hierarchical regressions were conducted. In each regression model, covariates were entered in the first block and ADHD beliefs were entered in the second block; coping strategies, QoL, and treatment adherence were used as outcome variables. The covariates included in the analyses were parents’ gender, adolescents’ age and gender, and severity of adolescents’ ADHD, as previous findings suggested that these factors influence both youngsters’ and parents’ perceptions of ADHD (e.g., Bussing et al., 1998; Bussing et al., 2003; Chen et al., 2008; Fox et al., 2008; Harrison & Sofronoff, 2002; Johnston & Freeman, 1997; Maniadaki et al., 2005; Singh, 2003).
Analyses of ADHD beliefs were conducted in two stages. First, the associations between etiological beliefs and outcome variables were analyzed. Only the causes that were significantly associated with the outcome variables were included in the second stage. In the second stage, covariates were entered in the first block, ADHD beliefs were entered in the second block, followed by etiological beliefs (that were found to be significant predictors in the previous step) in the third block. The reason for separating the analyses into two stages is that the original Brief IPQ did not have a quantitative measure of the perception of causes (Broadbent et al., 2006). Including only the causes that are significant predictors in the analysis of all ADHD beliefs would thus allow a more refined understanding of the unique association of the ADHD beliefs.
To examine the alignment of parents’ and adolescents’ ADHD beliefs, difference scores of their perceptions were computed by subtracting parents’ scores from the adolescents’ scores. In such a manner, a continuous variable was created that indexes the direction and magnitude of the difference from the adolescents’ view (e.g., more pessimistic or optimistic relative to adolescents’ ratings). Subsequently, paired sample t-tests were conducted to examine these dissimilarities. To examine the association between discrepant perceptions and the outcomes, hierarchical regressions were performed. In the first stage, the outcome variables were regressed on discrepant etiological beliefs (that were found to be significantly different in the paired-sample t-tests). In the second stage, covariates were entered in the first block, followed by all the other discrepant ADHD beliefs (that were found to be significantly different in the paired-sample t-tests) in the second block, and discrepant etiological beliefs (that were significant predictors in the first stage) in the third block. To enhance the interpretation accuracy of the difference scores, we included the ADHD beliefs (total scores) of both adolescents and parents as predictors to address their contribution to the difference scores in both stages of the analysis (Hesketh, 2000).
Results
Parents’ Perceptions of ADHD
Descriptive statistics for parents’ ratings on the BAPQ are presented in Table 1. In general, parents perceived ADHD to have a large influence on adolescents’ lives and believed that both the adolescents and themselves had little personal control over the disorder. They anticipated that the ADHD would last for a long time and strongly believed in the effectiveness of medication treatment. Their ratings were largely normally distributed except for etiological beliefs. Inspection of histograms showed that beliefs regarding genes and brain abnormality were skewed to the left, implying that the majority perceived these were important causes of ADHD. Ratings on psychological and environmental causes were skewed to the right, suggesting that the majority believed these were not important causes. However, inspection of box-plots showed outliers in the ratings of these causes (i.e., parenting practice, learning from friends, schoolwork being too hard, and insufficient efforts), indicating that a few parents strongly believed in psychosocial causes of ADHD. Nevertheless, all outliers were retained in the data analysis because a diverse set of etiological beliefs is consistent with the findings from the ADHD literature (Wong et al., 2018).
Table 1
Parents’ (P) and Adolescents’ (A) Ratings on BAPQ, Paired-sample T-tests Comparing Their Perceptions of ADHD
Items in BAPQ | Adolescents | Parents | Difference (A-P) | 95% CI | t | p | d | |
|---|---|---|---|---|---|---|---|---|
M (SD) | M (SD) | M (SD) | Lower | Upper | ||||
Consequence (on P) | - | 3.77 (1.06) | - | - | - | - | - | - |
Consequence (on A) | 3.23 (0.97) | 4.23 (0.90) | −1.00 (1.21) | −1.31 | −0.69 | −6.45 | <0.001* | 0.83 |
Timeline | 3.51 (0.87) | 4.20 (0.83) | −0.69 (1.06) | −0.96 | −0.42 | −5.09 | <0.001* | 0.65 |
Personal control (of P) | - | 2.54 (0.87) | - | - | - | - | - | - |
Personal control (of A) | 2.82 (0.92) | 2.39 (1.0) | 0.43 (1.18) | 0.13 | 0.73 | 2.83 | 0.006* | 0.36 |
Medication control | 3.74 (1.14) | 4.21 (1.00) | −0.48 (1.21) | −0.78 | −0.17 | −3.08 | 0.003* | 0.40 |
Beha. ther. control | 3.08 (1.14) | 3.93 (1.05) | −0.85 (1.38) | −1.21 | −0.50 | −4.84 | <0.001* | 0.62 |
Identity | 3.30 (0.88) | 3.74 (0.81) | −0.44 (1.15) | −0.74 | −0.15 | −3.01 | 0.004* | 0.38 |
Concern | 2.34 (1.17) | 3.74 (1.09) | −1.39 (1.51) | −1.78 | −1.01 | −7.21 | <0.001* | 0.92 |
Coherence | 3.48 (1.03) | 3.80 (0.93) | −0.33 (1.22) | −0.64 | −0.02 | −2.10 | 0.040* | 0.27 |
Emotional Rep. (of P) | - | 3.93 (0.98) | - | - | - | - | - | - |
Emotional Rep. (of A) | 3.49 (1.14) | 3.97 (1.14) | −0.48 (1.25) | −0.80 | −0.16 | −2.98 | 0.004* | 0.38 |
Causes | ||||||||
Genes | 3.46 (1.30) | 4.31 (1.16) | −0.85 (1.53) | −1.24 | −0.46 | −4.36 | <0.001* | 0.56 |
Brain | 3.73 (1.33) | 4.63 (0.74) | −0.90 (1.46) | −1.28 | −0.52 | −4.78 | <0.001* | 0.62 |
God | 2.11 (1.39) | 1.77 (1.36) | 0.34 (1.58) | −0.06 | 0.75 | 1.70 | 0.094 | 0.22 |
Parenting | 1.28 (0.64) | 1.26 (0.71) | - | - | - | - | - | - |
Friends | 1.13 (0.50) | 1.02 (0.13) | - | - | - | - | - | - |
Schoolwork | 1.30 (0.64) | 1.03 (0.18) | - | - | - | - | - | - |
Insufficient efforts | 1.43 (0.85) | 1.11 (0.45) | - | - | - | - | - | - |
Correlates of Parents’ Perceptions of ADHD and Creation of Compound Variables
Pearson’s correlations showed significant associations between a number of different ADHD representations (see Appendix B). For instance, parents’ perceived consequences of ADHD for themselves were correlated (r’s > 0.40) with four ADHD beliefs (i.e., greater perceived consequences for adolescents, greater perceived symptoms, stronger emotional responses, and greater concern about the disorder). These beliefs were therefore combined to form a variable that reflects their subjective evaluation of the impact of ADHD. The internal consistency of this compound variable was very good (α = 0.91).
Adolescents’ Characteristics and Parents’ Perceptions of ADHD
Adolescents’ age, severity of ADHD, and duration of diagnosis were correlated with parents’ ADHD beliefs. Older adolescents’ age was associated with parents’ perceptions of less impact (r = −0.30, p = 0.020), reduced effectiveness of behavioral treatment (r = −0.32, p = 0.011), and reduced attribution to parenting practice (rs’s = −0.34, p = 0.007). Greater severity of the disorder was correlated with greater perceived impact of the disorder (r = 0.60, p < 0.001), greater confidence in behavioral treatment (r = 0.27, p = 0.035), and stronger attribution to parenting practice (rs = 0.26, p = 0.043). Longer duration of ADHD diagnosis was related to less confidence in behavioral treatments (r = −0.27, p = 0.033).
Independent samples t-test showed that adolescents’ gender and presence of comorbidity were related to parents’ ADHD beliefs. Parents of male adolescents perceived less effectiveness of medications (Mdiff = −0.60, t(59) = −2.07, p = 0.042, d = 0.65) than parents of female adolescents. Parents whose offspring had comorbid disorders perceived greater impact of ADHD (Mdiff = 2.34, t(59) = 2.34, p = 0.023, d = 0.60), and made stronger attribution to brain abnormality (mean rank = 36.34 vs 26.47) and parenting practice (mean rank = 34.70 vs 27.84) than parents of adolescents with no comorbidity (U = 312, z = −2.77, p = 0.006 and U = 358, z = −2.32, p = 0.020, respectively).
Parents’ Characteristics and Their Perceptions of ADHD
Parents’ gender, history of ADHD, and mental illnesses were related to their etiological beliefs. Fathers had stronger endorsement of schoolwork’s difficulty (mean rank = 35.08 vs 30.00) than mothers (U = 245, z = −2.88, p = 0.004). Parents who were diagnosed with ADHD (or their spouses were) held stronger belief in genes (mean rank = 42.00 vs 29.10, U = 135, z = −2.36, p = 0.019) and brain abnormality (mean rank = 39.50 vs 29.53, U = 157, z = −1.99, p = 0.046) than parents who were not diagnosed with ADHD. Moreover, parents who were diagnosed with mental illnesses had stronger attribution to parenting practice (mean rank = 35.71 vs 27.00, U = 330, z = −2.97, p = 0.003) than parents who were not diagnosed with mental illnesses.
Parents’ Perceptions of ADHD in Relation to Adolescents’ Coping
Table 2 shows the results of hierarchical regressions of parents’ ADHD beliefs in relation to adolescents’ outcome variables (with only significant models shown). Parents’ etiological beliefs were significantly associated with adolescents’ active coping (R2 = 0.422, F(9,51) = 4.14, p < 0.001). Stronger belief in the cause of parenting and two covariates (having less severe ADHD and being a male adolescent) were significantly related to this coping. In the second part of the analysis, parents’ ADHD beliefs were significantly associated with active coping, explaining 47.4% of variance. In the full model, parents’ stronger attribution to parenting in causing ADHD, and being a male adolescent were significantly related to greater use of active coping. The severity of ADHD was no longer significant.
Table 2
Hierarchical Regression of Parents’ ADHD Beliefs in Relation To Adolescents’ Coping
Predictor | Minimization | ||
|---|---|---|---|
Step 1 | Step 2 | Step 3 | |
β | β | β | |
Part 1 | |||
Age (A) | 0.01 | 0.09 | |
Gender (A) | −0.39** | −0.37** | |
Gender (P) | −0.05 | −0.04 | |
Severity of ADHD | −0.31* | −0.36** | |
Parenting | 0.38** | ||
Genes | 0.16 | ||
Brain abnormality | −0.04 | ||
Schoolwork | 0.18 | ||
Efforts | −0.11 | ||
Part 2 | |||
Age (A) | 0.01 | 0.05 | 0.18 |
Gender (A) | −0.39** | −0.45** | −0.39** |
Gender (P) | −0.05 | 0.00 | 0.00 |
Severity | −0.31* | −0.19 | −0.23 |
Timeline | −0.13 | −0.12 | |
Personal control (P) | −0.04 | 0.03 | |
Personal control (A) | 0.00 | −0.02 | |
Med. Control | 0.21 | 0.21 | |
Beha. Control | 0.09 | 0.09 | |
Coherence | −0.11 | −0.07 | |
Impact of ADHD | −0.21 | −0.24 | |
Parenting | 0.43*** | ||
Parents’ etiological beliefs were not significantly related to adolescents’ passive coping (R2 = 0.158, F(9,51) = 1.07, p = 0.403). Likewise, parents’ other ADHD beliefs were not significantly related to this coping either, R2 = 0.085, F(11,49) = 0.41, p = 0.944.
Parents’ Perceptions of ADHD in Relation to Adolescents’ QoL
Parents’ etiological beliefs were not significantly related to adolescents’ QoL, R2 = 0.175, F(9,49) = 1.16, p = 0.344. Their ADHD beliefs were not significantly related to this variable either, R2 = 0.231, F(11,47) = 1.28, p = 0.264.
Parents’ Perceptions of ADHD in Relation to Treatment Adherence
Parents’ etiological beliefs were not significantly related to adolescents’ adherence to medications (R2 = 0.230, F(9,45) = 1.49, p = 0.180). Their ADHD beliefs were not significantly related to adherence to medications either (R2 = 0.149, F(11,43) = 0.68, p = 0.748). The analysis of their perceptions of ADHD as predictors of their offspring’s adherence to behavioral treatments was not performed because less than half of the adolescents (46%) were receiving such treatments.
Comparison of Parents’ and Adolescents’ ADHD Beliefs
In most cases, paired-sample t-tests were performed to examine the differences between adolescents and parents’ perceptions of ADHD. For some etiological beliefs (i.e., parenting practice, learning from friends, difficulty of schoolwork, and insufficient efforts), Wilcoxon signed-rank tests were conducted because the difference scores on these causes were not normally distributed. Results showed that there were significant differences in parent-offspring perceptions of ADHD on all dimensions except three of the etiological beliefs (i.e., parenting practice, learning from friends, and God’s plan). Table 1 presents these results in detail.
Adolescents perceived significantly fewer symptoms, reduced consequences, greater personal control, and expected a shorter duration of ADHD than their parents. They also perceived both medications and behavioral treatments as less effective than did their parents. In addition, adolescents perceived that ADHD affected their feelings to a lesser degree than their parents thought. Adolescents also reported they had less understanding of ADHD than their parents. On etiological beliefs, adolescents made less attribution to genes and brain abnormality than their parents. However, adolescents believed that difficulty of schoolwork (mean rank = 8.31 vs 6.00, z = 2.86, p = 0.004) and insufficient efforts (mean rank = 10.72 vs 9.63, z = 2.553, p = 0.011) were more important causes of their ADHD than did their parents.
Discrepant Perceptions in Relation to Adolescents’ Coping
Table 3 shows the results of hierarchical regressions testing discrepancies in etiological beliefs and ADHD beliefs in relation to the outcome variables (with only the significant discrepant etiological beliefs from the first analyses included on the same outcomes). Only significant models are shown.
Table 3
Hierarchical Regression of Adolescents’ (A) and Parents’ (P) Discrepant ADHD Beliefs (A-P) in Relation to Adolescents’ Coping and QoL
Predictor | Minimization | QoL (with outlier) | QoL (without the outlier) | ||||||
|---|---|---|---|---|---|---|---|---|---|
Step 1 | Step 2 | Step 3 | Step 1 | Step 2 | Step 3 | Step 1 | Step 2 | Step 3 | |
β | β | β | β | β | β | β | β | β | |
Discrepant etiological beliefs | |||||||||
Age (A) | 0.01 | 0.01 | −0.13 | −0.10 | −0.14 | −0.08 | |||
Gender (A) | −0.38** | −0.23* | −0.32* | −0.13 | −0.34* | −0.14 | |||
Gender (P) | −0.05 | 0.09 | −0.15 | 0.01 | −0.14 | 0.05 | |||
Severity of ADHD | −0.32* | −0.23 | −0.16 | −0.08 | −0.24 | −0.18 | |||
Perception of ADHD (A) | −0.30* | −0.43* | −0.44*** | ||||||
Perception of ADHD (P) | −0.18 | −0.10 | −0.08 | ||||||
D - Genes | 0.02 | 0.12 | 0.14 | ||||||
D - Brain | −0.16 | 0.09 | 0.05 | ||||||
D - Schoolwork | −0.26* | −0.01 | 0.07 | ||||||
D - Efforts | −0.09 | −0.39** | −0.47*** | ||||||
Discrepant ADHD beliefs (all) | |||||||||
Age (A) | 0.01 | 0.15 | 0.06 | −0.14 | −0.00 | −0.08 | −0.15 | −0.04 | −0.12 |
Gender (A) | −0.39** | −0.26* | −0.24* | −0.35* | −0.18 | −0.14 | −0.37** | −0.20 | −0.16 |
Gender (P) | −0.05 | 0.07 | 0.03 | −0.17 | −0.06 | −0.04 | −0.16 | 0.01 | 0.04 |
Severity of ADHD | −0.31* | −0.08 | −0.13 | −0.17 | 0.06 | −0.05 | −0.24 | −0.04 | −0.15 |
Perception of ADHD (A) | −0.37 | −0.28 | −0.27 | −0.66 | 0.06 | −0.34 | |||
Perception of ADHD (P) | −0.15 | −0.23 | −0.31 | 0.15 | −0.58 | −0.11 | |||
D – Timeline | 0.32* | 0.28* | 0.02 | 0.09 | −0.05 | 0.03 | |||
D – Personal control | 0.14 | 0.14 | 0.14 | 0.06 | 0.26 | 0.17 | |||
D – Med. control | −0.02 | −0.04 | 0.05 | −0.19 | 0.27 | 0.03 | |||
D – Behav. control | −0.07 | −0.01 | 0.15 | 0.06 | 0.24 | 0.14 | |||
D – Impact | 0.14 | 0.07 | −0.08 | 0.32 | −0.29 | 0.11 | |||
D – Coherence | 0.28 | 0.27 | 0.11 | −0.04 | 0.14 | −0.00 | |||
D – Genes | - | - | - | ||||||
D – Brain | - | - | - | ||||||
D – Schoolwork | −0.20 | - | - | ||||||
D – Efforts | - | −0.40** | −0.41** | ||||||
Parents-adolescents discrepant etiological beliefs were significantly related to adolescents’ active coping (R2 = 0.490, F(10,49) = 4.70, p < 0.001). Discrepant beliefs in the difficulty of schoolwork and adolescent’s perception of ADHD were significantly related to this coping. Likewise, discrepant ADHD beliefs (including the discrepant beliefs in schoolwork’s difficulty) were significantly associated with active coping strategy, explaining 62.0% of the variance. In the full model, discrepant beliefs in timeline and gender were significantly associated with adolescents’ use of this coping. Adolescents expecting a longer duration of ADHD than parents and being a male adolescent were related to greater use of this coping. Attribution to schoolwork’s difficulty was no longer significantly related to this coping.
Discrepancies in etiological beliefs were not significantly associated with adolescents’ use of passive coping, R2 = 0.158, F(10,49) = 1.56, p = 0.146. Similarly, the other discrepant ADHD beliefs were not significantly associated with this coping either, R2 = 0.269, F(12,48) = 1.47, p = 0.168.
Discrepant Perceptions in Relation to Adolescents’ QoL
Discrepancies in etiological beliefs were significantly related to adolescents’ QoL, R2 = 0.479, F(10,47) = 4.32, p < 0.001. Different beliefs in insufficient efforts and adolescents’ perception of ADHD were significantly related to higher QoL. In the full model, discrepant endorsement of insufficient efforts (i.e., adolescents ascribing less importance to insufficient efforts than their parents) was the only significant correlate of better QoL. The removal of an outlier produced similar results (see Table 3 for a comparison).
Discrepant Perceptions in Relation to Treatment Adherence
The discrepant etiological beliefs were not significantly related to adolescents’ adherence to medication treatment, R2 = 0.176, F(10,43) = 0.92, p = 0.524. Likewise, other discrepancies in ADHD beliefs were not significantly related to adolescents’ adherence to medication, R2 = 0.316, F(13,41) = 1.46, p = 0.175.
Discussion
This exploratory study investigated parents’ perceptions of their adolescents’ ADHD and compared these perceptions with those of their diagnosed offspring, using the Common Sense Model (Leventhal et al. (1984)) as a theoretical framework. The correlates of perceptions of ADHD that diverge between parents and the offspring were also examined. To summarize, parents’ etiological beliefs in psychosocial causes of the disorder were significantly related to adolescents’ increased active coping. Additionally, parents viewed ADHD more pessimistically than adolescents, and divergent perceptions of two dimensions – timeline and causes were significantly linked to adolescent coping and well-being.
Parents’ Perceptions of their Child’s ADHD
Perceptions of ADHD were largely negative among the parents in our sample. They generally saw it as adversely impacting their children’s lives for the long term, and perceived little personal control over it. Most parents believed ADHD to be biologically based, while some held strong beliefs in psychosocial causes. More importantly, parents’ endorsement of psychosocial causes was related to their children’s coping style. Parents who strongly believed parenting practice was a cause of their children’s ADHD had adolescents who were more likely to deal with their ADHD using active coping strategies. It may be that these parents attribute ADHD to causes that are more amenable to change and therefore also encourage their children to exert more control over their ADHD. This finding would appear to support Leventhal et al. (1980); Leventhal et al. (1984) stance on the relationship between parent’s perceptions of their child’s disorder and the child’s coping. It is also noteworthy that parents’ etiological beliefs, especially those related to psychosocial causes, were the only significant correlate of adolescents’ coping among all the seven ADHD beliefs in the CSM framework. Given that parents seem to hold diverse and extreme beliefs about the causes of this disorder (as evident by the presence of outliers), more research is needed to examine the impact of different parental etiological beliefs on adolescents’ health-related outcomes. In particular, a greater focus on the impact of beliefs in non-biological causes is warranted.
Surprisingly, no strong evidence establishing a clear relationship between parents’ beliefs in biological causes and their children’s treatment adherence emerged, which is inconsistent with findings from the broader ADHD literature (e.g., Johnston et al., 2005; Toomey et al., 2012). Such discrepancies may be due to different aspects of treatment-related outcomes in the current and previous studies, in which treatment acceptability and uptake (Coletti et al., 2012; Johnston et al., 2005) were the focus instead of adherence to the treatment. Another possible explanation is the wording of the single-item measure of treatment adherence in this study. Acknowledging these inconsistencies, future research using a more sensitive measure of treatment adherence is required before drawing conclusions.
Comparison of Adolescents’ and Parents’ Perceptions of ADHD
Adolescents and parents seem to diverge markedly in their view of ADHD. In line with previous findings (e.g., McElearney et al., 2005; Wiener et al., 2012), adolescents perceive having fewer ADHD symptoms and have less confidence in medication than their parents. Similar to the findings in adolescent patients with physical illnesses (Juth et al., 2015; Szentes et al., 2018), adolescents with ADHD in our sample held a less pessimistic view than did their parents. They expected a shorter duration, perceived fewer consequences, and believed they have greater personal control over the symptoms than their parents. They also tended to see behavioral treatment as less effective than did their parents.
Parents and adolescents also held different etiological beliefs regarding ADHD. Compared to their parents, adolescents appear to endorse stronger attributions regarding psychological and environmental causes (e.g., insufficient effort and schoolwork being too hard) and weaker attributions regarding biological causes. These findings are consistent with the Bowen et al. (1991), which found that adolescents endorsed less physiological factors and more psychosocial factors as causes than their parents. Moreover, adolescents reported weaker emotional responses to the disorder than their parents, echoing another current finding - that they are less concerned about their ADHD than their parents are.
To summarize, adolescents seem to perceive ADHD as less threatening and less biologically based than do their parents. These findings also resonate with the positive illusory bias phenomenon observed among children and adolescents with ADHD (Fefer et al., 2018; Hoza et al., 2004; Hoza et al., 2002; Owens & Hoza, 2003), in which they self-reported higher competence than their actual competence. Reasons for the discrepant perceptions of ADHD might be explained by the inherent developmental differences between adolescents and adults, but potential explanations were not directly assessed in the present study. Regardless of the reasons, divergent perceptions seem to exist and may have important implications for adolescents’ health-related outcomes.
Divergent Perceptions of Timeline
Interestingly, adolescents who expected their ADHD to last longer than their parents did were more likely to cope with ADHD actively. However, on average, adolescents in the sample expected a shorter rather than longer duration than parents, suggesting that the existing divergent perceptions might reflect adolescents’ reduced use of active coping. This finding is consistent with Wong et al. (2019) who found that longer perceived duration was associated with active coping. It is also in line with the literature on the role of future orientation, which suggests that adolescents’ focus on the present, rather than the future, makes them more likely to make choices that have a negative impact on their long-term health and wellbeing (Steinberg, 2008). In contrast, greater future orientation was found to associate with improved health outcomes, such as reduced risk-taking behavior (Borowsky et al., 2009; Seginer, 2009; Steinberg, 2008). Since ADHD is a chronic disorder that continues to affect over half of diagnosed adolescents into adulthood (Barkley et al., 2000; Kessler et al., 2006; Wolraich et al., 2005), this finding suggests that clinicians should be cognizant of adolescents’ expectations for the future. It also suggests that cognitive-behavioral interventions that promote realistic beliefs regarding the duration of ADHD may benefit the coping of adolescents with the disorder. In addition, this result highlights the potential importance of perceptions of prognosis in the management of ADHD, further supporting the utility of Leventhal’s CSM in this population.
Divergent Etiological Beliefs
Contrary to previous findings that biomedical explanations of illnesses can reduce the blame ascribed to individuals (Cheung et al., 2014; Dar-Nimrod & Heine, 2011; Haslam, 2011), neither adolescents’ nor parents’ beliefs in biological causes of ADHD were related to adolescents’ coping and well-being. In contrast, their discrepant beliefs in psychosocial and environmental causes were related to these outcomes. Adolescents who have a weaker belief than their parents that difficulty of schoolwork causes ADHD appear to cope with ADHD more actively; those who have weaker belief than their parents in insufficient effort as a cause seem to enjoy better QoL. That said, adolescents in this sample held stronger beliefs in both causes than their parents, on average, implying that the current divergent etiological beliefs might undermine their coping and well-being. Interestingly, an analysis of adolescent data alone did not find a significant relationship between their etiological beliefs and coping (Wong et al., 2019), indicating that it is the divergence with their parents that may play a role in their coping. As such, these findings highlight the importance of considering adolescents’ and parents’ etiological beliefs in relation to one another.
For adolescents, having weaker beliefs in psychosocial causes than their parents seem to be associated with better coping and well-being in themselves. For parents, taken together with the aforementioned finding that stronger beliefs in psychosocial causes (i.e., parenting practice) are linked to adolescents’ active coping, stronger beliefs in non-biological causes seem to be associated with adolescents’ improved management of the disorder. This is at odds with current literature, in which ADHD has been conceptualized largely in biological terms (Konrad & Eickhoff, 2010; Liston et al., 2011; Nikolas & Burt, 2010). Future research into the impact of beliefs in psychosocial causes on coping and well-being is clearly warranted. Understanding this relationship seems particularly important. Even though the dyads largely believed in the biological causes of ADHD, it was their divergence in endorsing non-biological causes that accounted for adolescents’ coping and well-being. While research into ADHD continues to be dominated by studies of biological systems, the present study suggests that perceptions of non-biological factors are important to consider in relation to risk processes and important outcomes. If future research can establish a causal relationship that is in line with our findings, it may facilitate novel directions for interventions to modify such beliefs and improve health-related outcomes.
Conclusions
The present study suggests that parents who strongly endorse psychosocial causes of ADHD are more likely to have adolescents who cope with the disorder actively. Adolescents with ADHD seem to hold less pessimistic views of the disorder and believe it to be less biologically based than do their parents. Parent-child alignment on two ADHD-related belief dimensions, namely, timeline and causes, appears to be particularly relevant to adolescents’ coping and well-being. Divergence on these two dimensions may be related to detrimental outcomes. Adolescents’ current expectation of a shorter duration of ADHD than parents was linked to reduced use of active coping. Adolescents with stronger beliefs in psychosocial causes than parents used less active coping and experienced reduced well-being as well. The present findings indicate that despite a general belief in biomedical explanations for the disorder, psychosocial causal attributions may be a potent factor of adolescents’ outcomes. More future research into this overlooked area is warranted.
These findings should be interpreted in the context of the limitations of the study. The sample size was small, much like that of other studies on the topic (e.g., Chen et al., 2008; McElearney et al., 2005), which may potentially diminish the generalizability of the findings, especially the interpretation of the null findings, as many of the analyses were only powered to identify large effects. There was no independent sample validating the newly developed BAPQ or the adapted coping measure, thereby potentially limiting the interpretation of the current findings. That said, the items in the measures had clear face validity. The use of difference scores has been criticized as indicators of informant discrepancies. Polynomial regression has been suggested as an alternative analysis to address these concerns (e.g., Edwards, 2001; Laird & De Los Reyes, 2013). However, since polynomial regression is highly sensitive to outliers (Pant, 2019), it is not suitable for the current study due to the presence of a number of them. Thus, the use of hierarchical regression was deemed less biased for the current data. Moreover, the use of compound variables precluded us from delineating a clear relationship between the CSM’s seven illness beliefs and the specific coping strategies. Future longitudinal studies with a larger sample and without compound variables are likely to enable a more nuanced understanding of the causal relationships between the ADHD beliefs and outcome variables, as well as the changes of ADHD beliefs and coping strategies as the adolescents age. Involving more female participants in such research could shed light on gender difference in ADHD perceptions and management. Likewise, we also recommend that future research test for potential moderators of ADHD-related perceptions and outcomes, which may include age, gender, treatment history, and symptom severity and duration. Finally, comparing families’ perceptions of ADHD with those of clinicians and teachers may provide a more comprehensive understanding of how multiple divergent perceptions can affect coping and well-being. Nevertheless, in line with Leventhal’s conceptualization of illness perception, our findings highlight the potentially important role that ADHD perceptions play in the lives of adolescents with ADHD and their parents.
Supplementary information
The online version contains supplementary material available at https://doi.org/10.1007/s10826-024-02962-4.
Acknowledgements
We thank Mr Mark Brandtman, Prof Simon Clarke, and Prof Michael Kohn for their help with participant recruitment. We also thank the following parent support groups for the assistance with recruitment: Northern Beach Parent Support Group, ADDults with ADHD, ADHD Support Australia, Australian ADHD Support Group, and Citylife Community Initiatives ADHD Support Group - Illawarra. Lastly, we thank all the parents and adolescents who participated in this study.
Compliance with ethical standards
Conflict of interest
The authors declare no competing interests.
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