An estimated two-thirds of children with attention-deficit/hyperactivity disorder (ADHD) remain symptomatic in adolescence and young adulthood [1
], placing them at increased risk for adverse outcomes, such as lowered academic and vocational achievements, substance abuse, and involvement with the justice system [2
]. In addition, their risk may be accentuated by poor adherence to recommended care because older youth are more likely to discontinue ADHD treatment than their school-age counterparts [3
]. Earlier studies suggest that discontinuation of treatment may be related to adolescents' increasing self-determination of health behavior as well as their negative attitudes towards mental health treatment and stigma [4
Increased adolescent-focused ADHD psychoeducation in the context of a collaborative care paradigm might have the potential to prevent premature treatment discontinuation for this chronic disorder. However, little is known about adolescent knowledge of ADHD, or about culturally sensitive psychoeducation or self-management education [6
] for ADHD, despite the fact that such education is considered essential in a chronic illness model [7
]. Educational interventions for ADHD are best framed in the context of existing health education models. According to the health belief model (HBM) [8
] whether or not treatment is sought depends on knowledge and awareness of a health condition and its treatments, as well as receiving cues to action. The HBM assesses patient perceptions that can be targets of psychoeducational interventions, including perceptions of disorder seriousness, susceptibility, and benefits of interventions [9
]. Most studies of ADHD health beliefs indicate significant needs for remedial educational interventions. For example, less than one-half of respondents in a nationally representative adult study could correctly identify ADHD symptoms from a vignette and ADHD symptoms were rated as less serious than depression symptoms [10
]. Adult studies also identified misperceptions about etiology [11
]), revealed beliefs about overtreatment [12
], and documented stigma perceptions surrounding the disorder [10
]. In addition, there appears to be significant racial/ethnic variation in adults' ADHD knowledge and explanatory models [13
], such that Caucasian parents express greater familiarity with ADHD than parents from minority backgrounds [10
]. The first large-scale study of youth beliefs about ADHD causes [15
] found that stigmatizing attributional beliefs, such as low effort, inadequate parenting or substance abuse causing ADHD were common. However, this study did not assess general youth ADHD knowledge or perceptions or examine how attitudes about ADHD vary by well established factors that influence seeking care, such as clinical severity and prior mental health service use.
Further, although existing research suggests significant unmet need for ADHD health information among parents and youth [10
], little is known about their usual information sources and their information gathering preferences. Previous studies reported that parents rate pediatrician-provided information as useful and trustworthy than Internet sources [16
]. Internet-based health information merits specific consideration due to general trends towards the Internet as a health information source [17
] and increasing Internet use by youth.
Thus, more data on the extent of adolescents' and their parents' ADHD knowledge and perceptions is required to identify target areas for educational and self-management interventions for this group at heightened risk of treatment discontinuation. Guided by the HBM, the objectives of this study are to: 1) describe adolescent and parent ADHD knowledge, perceptions and cues to action and test whether they vary by sociodemographic characteristics, ADHD risk status and lifetime mental health service use; 2) determine adolescent- and parent-reported use of and preference for ADHD information sources and examine variation by ADHD risk status; and 3) among youth at high risk for ADHD, compare utilized and preferred health information sources by adolescents and parents to identify potential gaps that may be addressed by psychoeducation interventions. .