British parents' beliefs about the causes of three forms of childhood psychological disturbance

Mothers' and Fathers' Perspectives on the Causes of Their Child's Disorder

BACKGROUND

Parental beliefs about the cause of their child's illness are thought to affect parents' help-seeking behaviors, treatment decisions, and the child's health outcomes. Yet, research on parental beliefs about disease causation is still scarce. While a small number of studies assesses parental cause attributions for singular disorders (e.g., neurodevelopmental disorders), no study has compared disorders with differing physical versus mental conditions or with mixed comorbidities in children and adolescents or their caregivers. Furthermore, most pediatric research suffers from a lack of data on fathers.

OBJECTIVE

Hence, the objective of the current study was to test for possible differences in mothers' and fathers' perceptions about the etiology of their child's illness.

METHODS

Forty-two parent couples (overall N = 84) whose child had been diagnosed either with Attention Deficit Hyperactivity-Disorder (ADHD) or Autism Spectrum Disorder (ASD) (category "neurodevelopmental disorder") or with a primary physical illness and a comorbid mental disorder, e.g. depression (category "psychosomatic disorder") were asked to rate possible causes of their child's illness using a modified version of the revised Illness Perception Questionnaire (IPQ) Cause scale.

RESULTS

A two-way ANOVA showed that psychosomatic disorders were significantly more strongly attributed to be caused by medical and environmental stressors than neurodevelopmental disorders. A significant parent × illness category interaction revealed that this effect was more pronounced in fathers.

CONCLUSIONS

By providing first insights into parental beliefs about the etiology of their children's neurodevelopmental versus psychosomatic disorders, this study paves ground for future research and tailored counseling of affected families.

Understanding parental causal explanations and help seeking in attention-deficit/ hyperactivity disorder: perspectives from a developing Asian nation

INTRODUCTION

Research on parental understanding of causation and help-seeking for ADHD comes from ethnic minorities in developed nations; research from Asia is scarce. Our purpose was to explore perceptions of Indian parents regarding causation and diagnosis of problematic childhood behaviors diagnosed as ADHD or hyperkinetic disorder, and to understand the process of decision making and help seeking using a qualitative study design.

METHOD

In-depth, semi-structured interviews were conducted with 52 parents (33 mothers and 19 fathers), focusing on initial emotional reactions and cognitive appraisals, decision making, parental causal explanations and perceptions regarding diagnosis and symptom labeling.

RESULTS

Mothers were decision makers for seeking professional help either singly or jointly in 76.1% of cases. Initial reactions ranged from those with negative valence (negative emotional reactions and cognitive appraisals) to ambi-valence (recognition of problems, but at the same time not accepting completely) and positive valence (sense of relief and hopefulness). Psycho-social explanations (63.46%) were more common than biological explanations (51.82%), with 19.23% reporting both explanations. Biological explanations included illness model (e.g. brain problem, obstetric complications), hereditary and intellectual disability. Psycho-social explanations included psychological (e.g. lack of motivation) and social (e.g. problems with disciplining at home) causations. Irrespective of initial reactions and causal explanations, a significant majority of parents were aware of the diagnosis and labeled problems as symptoms attributable to ADHD.

CONCLUSION

Our findings provide insights for development of culturally sensitive psycho-social interventions; from understanding of causal attributions, process of decision making and help seeking.

Conceptualizing Culturally Infused Engagement and Its Measurement for Ethnic Minority and Immigrant Children and Families

Despite the central role culture plays in racial and ethnic disparities in mental health among ethnic minority and immigrant children and families, existing measures of engagement in mental health services have failed to integrate culturally specific factors that shape these families' engagement with mental health services. To illustrate this gap, the authors systematically review 119 existing instruments that measure the multi-dimensional and developmental process of engagement for ethnic minority and immigrant children and families. The review is anchored in a new integrated conceptualization of engagement, the culturally infused engagement model. The review assesses culturally relevant cognitive, attitudinal, and behavioral mechanisms of engagement from the stages of problem recognition and help seeking to treatment participation that can help illuminate the gaps. Existing measures examined four central domains pertinent to the process of engagement for ethnic minority and immigrant children and families: (a) expressions of mental distress and illness, (b) causal explanations of mental distress and illness, (c) beliefs about mental distress and illness, and (d) beliefs and experiences of seeking help. The findings highlight the variety of tools that are used to measure behavioral and attitudinal dimensions of engagement, showing the limitations of their application for ethnic minority and immigrant children and families. The review proposes directions for promising research methodologies to help intervention scientists and clinicians improve engagement and service delivery and reduce disparities among ethnic minority and immigrant children and families at large, and recommends practical applications for training, program planning, and policymaking.

Adult Perspectives on Behavior and Emotional Problems in African American Children

Using vignettes describing African American children with internalizing (e.g., withdrawal) versus externalizing (e.g., quarrels) problems, parents, teachers, and clinicians made judgments regarding problem seriousness, prognosis, etiology, referral, and intervention needs. Opinions of parents, teachers, and clinicians differed markedly, especially with regard to judgments about children with externalizing problems. Black raters’ ratings significantly differed from those of Whites, especially for seriousness and prognostic judgments with regard to the problems. The findings suggest that interventionists who address problems that African American youth present should attend to the attitudes and judgments of adults who report on such problems. Clinicians can simultaneously harness appropriate judgments and attitudes and decrease counterproductive beliefs and behavior in their interventions with Black children.

Providing information to parents of children with mental health problems: a discrete choice conjoint analysis of professional preferences

We used discrete choice conjoint analysis to model the ways 645 children's mental health (CMH) professionals preferred to provide information to parents seeking CMH services. Participants completed 20 choice tasks presenting experimentally varied combinations of the study's 14 4-level CMH information transfer attributes. Latent class analysis revealed three segments. Open Access professionals (32.2%) preferred that intake workers automatically provide all parents with CMH information. They preferred information prepared by professional organizations and located at accessible settings such as public schools. They responded favorably to the internet as a source of information for parents. Controlled Access professionals (22.2%) preferred information that was approved and recommended by a child's therapist, prepared by an experienced clinician, and located at hospitals and CMH clinics. Process Sensitive professionals (45.6%) showed a stronger preference for active learning materials with parenting groups and therapist "coaching" calls supporting the knowledge transfer process. Simulations suggested that realizing the benefits of CMH information requires the development of knowledge transfer strategies that align the preferences of professionals with those of the families they serve.

Seeking help for attention deficit hyperactivity disorder in developing countries: A study of parental explanatory models in Goa, India

This qualitative study analyzes the explanatory models employed by parents whose children have been diagnosed with attention deficit hyperactivity disorder (ADHD) and the ways in which these explanatory models change as they seek help for their child's problem. In-depth interviews were conducted with 24 parents recruited from a list of children who had been diagnosed with ADHD at a community-based child development center (CDC) in Goa, India. The most frequent reasons for consulting the CDC were educational difficulties. Despite having received an ADHD diagnosis and reporting significant adverse impact of the child's behavior, most parents were reluctant to accept the biomedical explanatory model or even consider their child's difficulties as an illness. Instead, parents most commonly attributed causality to psychological models, learning and memory difficulties, and to models which emphasized either the volitional or non-volitional nature of the problem, or to attribute blame of self or spouse. Interventions most commonly used were educational and religious; consultation with the CDC was the last resort for many parents. We conclude that cultural attitudes towards mental illness significantly affect parental perception and behavior in response to interventions by biomedical practitioners for child mental health problems in developing countries.

Parental beliefs about the nature of ADHD behaviours and their relationship to referral intentions in preschool children

BACKGROUND

Parental beliefs about child problem behaviour have emerged as closely related to referral intentions to mental health services.

METHODS

This study compared beliefs of severity, impact and advice seeking for attention deficit/hyperactivity disorder (ADHD) behaviours of parents whose preschool children present ADHD behaviours with those of parents whose children do not display such behaviours. Both parents of 295 preschoolers, aged 4-6 years, enrolled in kindergartens in Athens, filled in: (i) a questionnaire composed by a vignette describing a hypothetical 5-year-old child presenting ADHD symptoms followed by rating scales assessing dimensions of severity, impact and referral intention, and (ii) the 'Strengths and Difficulties Questionnaire' for screening ADHD behaviours in their own child.

RESULTS

Results showed that almost half of the parents who reported ADHD behaviours in their own child replied that they had never met a child exhibiting such behaviours. These parents also perceived such behaviours as being less severe and with less negative family impact than parents who did not report such behaviours in their own child.

CONCLUSIONS

Parents whose preschool child displays ADHD behaviours tend to perceive them as normal developmental patterns and may suspend the referral of the child. Implications of these findings for early identification of ADHD are discussed.

Comorbidity and WISC-III profiles of Greek children with attention deficit hyperactivity disorder, learning disabilities, and language disorders

The aim of the present study was to (a) examine the prevalence of ADHD and the comorbid difficulties in a sample of 114 children, 3.6 to 17.6 yr. of age (89 boys, 25 girls) referred to our Unit and (b) evaluate the discriminative ability of the WISC-III scores for children with Attention Deficit Hyperactivity Disorder (n = 22), Learning Disability (n = 50), and Language Disorder (n = 42). Analysis showed only 18% of 114 children had an Attention Deficit Hyperactivity Disorder diagnosis. Multivariate analysis of variance and stepwise discriminant function analysis were applied. Vocabulary and similarities were the best predictors for distinguishing between language disorders and the other two groups. Moreover, the Language Disorder group scored significantly lower on all the subtests while the Attention Deficit Hyperactivity Disorder and Learning Disability groups scored lower on coding and information, respectively. Children with Attention Deficit Hyperactivity Disorder and Learning Disability could not be accurately identified from the WISC-III test or their ACID profile.

The Importance of Parental Attributions in Families of Children with Attention-Deficit/Hyperactivity and Disruptive Behavior Disorders

Presents a social-cognitive model outlining the role of parental attributions for child behavior in parent-child interactions. Examples of studies providing evidence for the basic model are presented, with particular reference to applications of the model in families of children with Attention-Deficit/Hyperactivity Disorder (ADHD) and/or oppositional defiant/conduct disordered behavior. Parent or child factors that may moderate the operation of links within the model are suggested, and evidence of such moderator effects is presented. The conceptualization and measurement of parental attributions also are discussed. The limitations of the model and existing evidence, as well as recommendations for future research in this area are presented throughout the paper. The paper concludes with a summary of the clinical implications of the model and research on parental attributions with regards to improving interventions for families of children with attentional and disruptive behavior problems.

Parents' causal attributions about attention deficit/hyperactivity disorder: the effect of child and parent sex

BACKGROUND

Boys with attention deficit/hyperactivity disorder (AD/HD) demonstrate disruptive behaviour at significantly higher rates compared to girls. Disruptive behaviour often develops as a result of negative interaction patterns within the caregiving relationship. Given the importance of parental cognitions as mediators of parental behaviour, the consideration of parent and child sex in the investigation of causal attributions regarding AD/HD may, at least partially, explain sex differences in the prevalence of disruptive behaviour among children with AD/HD.

AIM

To examine the effect of parent and child sex on parental causal attributions and reactions about AD/HD and to investigate the interrelationships between these variables.

SAMPLE

Three hundred and seventeen mothers and 317 fathers of boys and girls aged 4-6 years and enrolled in kindergartens in Athens.

METHOD

A Greek version of the Parental Account of the Causes of Childhood Problems Questionnaire was used, which followed a vignette about a hypothetical child displaying symptoms of AD/HD. Half of the participants received a male and another half received a female version of the vignette.

RESULTS

The child's sex greatly influenced parents' causal attributions about AD/HD. Higher ratings of intentionality were conferred to boys with AD/HD than girls and these attributions were related to stricter responses towards boys. In contrast, parents who considered biological dysfunction as underlying AD/HD, they mostly did so in the case of girls. Minimal effect of parent sex on causal attributions was found.

CONCLUSIONS

Because causal attributions of intentionality relate to the response of more strictness and such attributions are more prevalent for boys than girls, then these perceptions about the aetiology of AD/HD in boys may be at the basis of negative interaction patterns. The increase of such interaction patterns may place boys at a more vulnerable position towards the development of secondary behaviour problems.

Exploring help-seeking for ADHD symptoms: a mixed-methods approach

OBJECTIVE

Gender and race differences in treatment rates for attention-deficit/hyperactivity disorder (ADHD) are well documented but poorly understood. Using a mixed-methods approach, this study examines parental help-seeking steps for elementary school students at high risk for ADHD.

METHODS

Parents of 259 students (male/female, African American/Caucasian) identified as being at high risk for ADHD completed diagnostic interviews and provided detailed accounts of help-seeking activities since they first became concerned about their child. Help-seeking steps (n=1,590) were analyzed using two methods: inductive analysis based on grounded theory, and deductive quantitative analysis of coded data derived from application of the network-episode model, merged subsequently with demographic and other characteristics.

RESULTS

The inductive analysis revealed unique parental perceptions of their children's sick role and of the agents of identification and intervention for each of the four groups. Deductive analysis showed significant variations by race and gender in consultation experiences, in the person or entity being consulted and in the transactions occurring in the consultation, and in illness careers.

CONCLUSION

ADHD symptoms are interpreted as having different implications for the sick role and the intervention, dependent on a child's gender and race. Educational interventions need to address cultural stereotypes contributing to inequitable access to treatment.

Trainee nursery teachers' perceptions of disruptive behaviour disorders; the effect of sex of child on judgements of typicality and severity

BACKGROUND

Adults' perceptions of children with disruptive behaviour disorders (DBDs), which usually interfere with socialization and referral of children to mental health services, might differ according to the child's sex. Given the importance of (a) the interactions between these children and their educators, and (b) early identification and referral, the impact of the child's sex on adults' perceptions is an important factor to consider.

AIM

To examine the role of gender-related expectations in the identification and referral of childhood DBDs by trainee nursery teachers.

SAMPLE

One hundred and fifty-eight female trainee nursery teachers (mean age = 20 years) at the Department of Early Childhood Education in Athens.

METHOD

Trainee nursery teachers' perceptions of male and female children with DBDs were explored using a Greek version of the Parental Account of the Causes of Childhood Problems Questionnaire. Eighty-one participants answered questions about a set of disruptive behaviours ascribed to a boy and 77 about the same behaviour ascribed to a girl.

RESULTS

DBDs ascribed to girls were considered to be no more severe or of greater concern than those ascribed to boys. Judgements of severity were related to concern in the same way for boys and girls. However, DBDs were regarded as less typical for girls than boys.

CONCLUSIONS

The child's sex affected trainee teachers' judgements of typicality, but not severity, of children's behaviour problems. The implications of this finding for socialization practices and referral attitudes are discussed.

Not afraid to blame: the neglected role of blame attribution in medical consumerism and some implications for health policy

A crucial aspect of medical consumerism has been overlooked in past research and policymaking: how consumers decide whom to "blame" for bad outcomes. This study explores how, in a system increasingly dominated by managed care, these attributions affect consumers' attitudes and behavior. Using data from the experiences of people with serious mental illness, hypotheses are tested regarding the origins and consequences of blaming for medical consumerism. Blame was allocated to health plans in a manner similar, but not identical, to the way in which blame was allocated to health care professionals. Both allocations are shaped by enrollment in managed care, with blame allocation affecting consumers' subsequent willingness to talk about adverse events. Policy implications include the need for more finely tuned grievance procedures and better consumer education about managed care practices.

Attributions of responsibility for children's mental health problems: parents and professionals at odds

Surveys of 102 mothers of inner-city youths with mental health problems and their clinicians examined discrepancies in mothers' and professionals' causal and solution attributions for the children's problems. Greater causal responsibility was attributed to mothers by professionals than by mothers, while they agreed on the children's responsibility. They disagreed about their respective solution responsibilities, though agreeing that causally responsible children should help with solutions. Mothers considered many more community resources for solutions than did professionals. Implications for improvement of services to urban children are discussed.