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As many parents of a child with ADHD know, social relationships are often an area of particular difficulty, despite concerted efforts they make to help their child establish and maintain friendships.

A recent study appearing in the Journal of Health and Social Behavior on the attitudes of adults towards children with mental health problems highlights one factor that may be contributing to these difficulties [Martin, J.K., et al (2007). The consequences of fear: Americans preferences for social distance from children and adolescents with mental health problems. Journal of Health and Social Behavior, 48, 50-67.]

The focus of this study was to learn whether US adults prefer that they and their children maintain social distance from children/adolescents with mental health problems, as well as the factors that may contribute to this. Participants were a nationally representative sample of 1393 adults living in the US. 

Each participant was read a randomly selected vignette that provided a brief behavioral description of 1 of 4 different children. The vignettes were constructed to describe behaviors characteristic of a child with ADHD, a child with depression, a child with "normal troubles" and a child with a medical condition (asthma). No mention of any diagnosis was provided.

Below are shortened and slightly paraphrased versions of the descriptions provided for each "child".

ADHD - John has always had trouble in school, especially in completing assignments on time, even though he/she has average intelligence.  His teachers note that he is very distractible, and that they often have to remind him to get back to the task at hand.  John is often up and down, out of his seat, looking out the window, or talking to classmates.  He does similar things at home.  He also has difficulty making and keeping friends.

Depression - In the last few months John has been increasingly moody, staying in his room after school, and seems to have lost interest in his favorite hobbies and in friends.  He always feels tired and doesn't feel like eating.  He has been having trouble concentrating on what he is doing at home and at school, and has told his parents "I wish I hadn't been born".  One of his friends has also heard him talk about committing suicide.

Normal troubles - John has several friends in his neighborhood that he gets together with one or two times per week, and is involved in several hobbies including sports and music.  He usually gets along fairly well with other kids, but occasionally has some problems with needing to have his own way or go first in games.  His parents note that he is sometimes moody, but that this comes and goes.

Asthma - John has a history of breathing problems.  He often has coughing bouts at night and doesn't sleep very well.  His parents and teachers have noted that these problems tend to be particularly bad during challenging situations and during strenuous sports activities.  He feels badly about his breathing problems, which seem to be getting worse and wishes he could "be just like the other kids."  He is involved in several hobbies and shares these activities with several friends.

After hearing the vignette, participants were asked a series of questions to learn their thoughts and feelings about the child depicted.  Across participants, the age (8 vs. 14), gender, and race of the child portrayed hwas varied; this enabled the researchers to learn whether these factors contributed to adults' feelings about the child.

The first questions focused on adults' preference for social distance.  Specifically, participants were asked how willing they would be to:

- move next door to a family with a child like the one just described;

- have their child make friends with that child;

- spend an evening socializing with that child's family; and,

- have that child in their child's classroom".

Responses were made on a 1 to 4 scale with 1 indicating that they would be "definitely willing" and 4 indicating they would be "definitely unwilling".

In addition to the questions, the researchers were also interested in examining factors that might alter or modify adults' preference for social distance. Of particular interest were participants' beliefs about the "causes" of the child's problems, e.g., "bad character", "chemical imbalance in the brain", whether they believed the child depicted had a mental illness, and whether they believed the child depicted was a danger to self or others.


- Results -

The table below presents results for the 4 questions assessing the desire to maintain social distance.  The entry in each column represents the percentage of adults who indicated they would be definitely unwilling or probably unwilling to: have the child move next door, spend an evening with the child's family, have their child make friends with the child, or to have the child in their child's class.


                                            "Normal troubles"       ADHD        Depression        Asthma

Have child move next door             10%                      22%             18%             9%

Spend evening w/ family               10%                      17%             17%             6%

Have child make friends                10%                      23%             30%             5%

Have child as classmate                 6%                       19%             11%            3%


As can be seen, when the child depicted was described as having symptoms characteristic of ADHD or depression, the percentage of adults who were unwilling for themselves or their child to engage with the child or the child's family was 2-3 times higher than when a child with "normal troubles" or asthma was depicted. 

For example, 23% of adults reported that they were either definitely unwiling or probably unwilling to have their child make friends with a child who displayed behaviors indicative of ADHD compared to only 6% of adults who were read the vignette describing a child with normal troubles.  The differences in response to each question are all statistically significant.


- What factors modified adults' preference for social distance? -

Given this clear preference to maintain distance from children described as having mental health problems, the researchers were also interested in factors that either increased or decreased this preference.  Here is a summary of their findings:

* The desire for social distance was greater for older children than for younger children (14 vs 8).

* Overall, female participants were less likely to desire distance than male participants.

* When participants believed the child's problems were caused by a lack of parental discipline, their preference for distance increased.

* When participants believed the child's problems were related to food or chemical allergies, their preference for distance decreased.

* Attributing the child's problems to the "normal ups and downs" of childhood  decreased the preference for distance.

* Attributing the child's problems to a mental illness increased the preference for distance.

* Believing that the child posed a danger to themselves or to others increased the preference for distance.


Interestingly, the degree to which participants believed the child's problems resulted from a chemical imbalance or from a genetic predisposition - two factors that have been found to reduce the preference for social distance from adults with mental health problems - were not significantly related to adults' preferences for social distance from children.


- Summary and Implications -

Results from this study indicate that "... a substantial minority of American adults are reluctant to interact, or to have their children interact, with children described in ways consistent with ADHD and depression.  Specifically, about 1 in 5 adults was unwilling to have these children living next door, in his or her child's class, or as his or her child's friend. 

These findings point to the continuing barriers to public acceptance of children with mental health problems and the need for ongoing efforts to address these barriers.  Although not directly examined in this study, one can imagine how adults' preference to maintain distance could be communicated - both directly and indirectly - to their own children, and contribute to the development of stigmatizing attitudes and beliefs in children towards their peers who struggle with mental health issues.  This process could play a role in the social difficulties that many children with ADHD and depression experience.

Several other findings from this report are interesting to consider.  It was noteworthy that adults' preference for distance was not reduced when they made medical attributions, e.g., chemical imbalance, genetic predisposition, for children's problems.  Given the considerable efforts made by advocacy organizations such as CHADD towards educating the public about biological factors contributing to ADHD, it is disconcerting that this does not seem likely to reduce stigma for children displaying ADHD behaviors.

On the other hand, attributing a child's problems to "poor parenting" significantly increased adults' preference for social distance.  This highlights the importance of continued efforts to educate the public that ADHD is not caused by "poor parenting."

Findings pertaining to the "mental illness" label, which increased the preference for distance, present a bit of a conundrum.  On the one hand, recognizing that the behaviors/symptoms associated with ADHD and depression reflect an "illness" can be important in reducing a tendency to blame parents and/or children themselves for the child's difficulties.  It may also be important when in efforts to attain better insurance coverage for these conditions.  On the other hand, the "mental illness" label does seem to be associated with greater stigmatization of children.

Finally, it was evident that adults who believed the child described presented a danger to themselves or to others had a significantly greater desire to maintain distance.  In fact, when this was taken into account, the preference for distance from a child with depressive symptoms was no longer significant and preference for distance from a child with ADHD symptoms was substantially diminished. 

These findings suggest that a belief on the public's part that children with these conditions present a danger to their own child is an important contributor to their desire for distance.  The authors suggest that "...public service campaigns about "underlying causes" need to be replaced with or accompanied by attempts to uncouple the conflation of dangerousness and mental illness."  This is an important point, although it must be noted that while the authors' findings imply that adults viewed children with ADHD or depressive symptoms as more dangerous than other children, they did not specifically test whether this was the case.

In summary, results from this study indicate that a substantial minority of the American public continue to hold stigmatizing views towards children and adolescents with mental health problems, and suggests that perceptions of dangerousness may underlie this stigma.  While these findings highlight the need for continued efforts on the part of parents, professionals, and educators to address this issue, it is important to recognize that about 4 of 5 adults did not report these attitudes.  Thus, in addition to the concern raised by these findings, there also appears to be reasons for hope.