Attention-deficit hyperactivity disorder (ADHD) and its treatment have sparked public and intellectual controversy for more than 40 years. Critics charge that ADHD is not a “real” disease but rather a constellation of behaviors that parents and schools have become unwilling or unable to tolerate. According to critics, parents and teachers accept diagnostic labels and psychostimulant prescriptions because they offer relatively straightforward, inexpensive, and fast-acting solutions to complex problems (1
). By implication, critics claim that ADHD is overdiagnosed and that children are receiving unnecessary and inappropriate treatment.
Contrary to this claim, research on treatment utilization suggests that only half of children with ADHD receive treatment, and less than half of them receive specialty care (5
). Fewer children receive psychostimulant medications than would be expected with estimated population prevalence rates (6
), which supports the claim that ADHD is underdiagnosed and undertreated. The “International Consensus Statement on ADHD” (10
) faults the media for publishing irresponsible stories that imply that ADHD is not a valid or real disorder. According to the statement, such stories diminish public recognition of the often devastating consequences of the disorder and the potential for medical treatments to alleviate them.
Given these competing discourses, it is important to understand the level of public awareness of ADHD and public preferences regarding its treatment. Such an understanding can offer insight into the degree to which the public accepts critical versus biomedical conceptualizations of the disorder. It also has the potential to explain observed differences in treatment utilization over time and across subgroups of the population (11
). Growing public awareness of ADHD has been offered as one explanation for the expansion of treatment during the 1990s (11
). Differences in knowledge about ADHD and in beliefs about the causes of the disorder also have been invoked to explain socioeconomic and racial and ethnic differences in treatment utilization (14
What little we know about knowledge of and attitudes toward ADHD is based primarily on studies of school personnel and parents of children who are in treatment or are at risk of the disorder. Studies of school personnel suggest that teachers and school social workers are generally well informed about ADHD but that important knowledge gaps remain, particularly in regard to the role of diet as a cause of ADHD and the efficacy of behavioral interventions as stand-alone treatments (19
). Studies of parents emphasize variations in beliefs about ADHD that are rooted in race and ethnicity. African-American parents are less likely than white parents to have heard of ADHD and to consider ADHD a medical problem, and they are more likely to attribute ADHD to excessive sugar in the child's diet (16
In contrast, prior research provides little information about general public attitudes toward ADHD and its treatment. To our knowledge, the only study of general public attitudes compared responses to two vignettes: one in which a school-age boy's behavior problems were attributed to ADHD and a second in which the same set of behavior problems was attributed to epilepsy (25
). Respondents were more accepting of medication therapies for the epileptic child than they were for the child with ADHD, indicating public resistance to medication use (and, perhaps, a biomedical conceptualization) for mental health problems.
In this article we present the results of a recent national survey concerned with public knowledge of and attitudes toward children's mental health problems. Our analysis extends prior research by investigating general knowledge and attitudes about ADHD, rather than relying on responses to vignettes, and by inquiring specifically about whether respondents believe that ADHD is “real” and about medication and counseling treatment options. The study considered general levels of public awareness and beliefs as well as variations by sociodemographic characteristics of the respondent: gender, race and ethnicity, education, income, and age.
We expected women's knowledge of and attitudes toward ADHD, in comparison with men's, to be more consistent with dominant psychiatric conceptualizations. Women generally are more predisposed than men to seek treatment for health problems (26
) and are more likely to recognize and acknowledge psychiatric problems (27
). Consistent with that expectation, fathers of sons with ADHD reported strong resistance to biomedical explanations and to medication strategies for treatment (28
). We also expected to observe less knowledge about ADHD and less acceptance of biomedical understandings of the disorder among African Americans than among white respondents. We based this expectation on findings from research with parents of children at risk of ADHD (16
) and studies that have found African Americans to be more skeptical about psychiatric medications and biomedical orientations to mental illness (29
). Higher socioeconomic status, as indicated by years of education and income, was expected to predict greater awareness of ADHD and an endorsement of biomedically oriented treatments (31
). We expected younger respondents to have more knowledge of ADHD than older respondents, because younger respondents grew up in a time when the disorder was more widely recognized.
Our models of treatment preferences also included as a predictor the belief that ADHD is real. Prior research suggests that beliefs about the nature of children's problems affect treatment decisions (7
). We expected respondents who reported believing that ADHD is real to be more supportive of the use of medication for ADHD.