The aim of this study was to compare the knowledge and beliefs about attention-deficit/hyperactivity disorder (ADHD) between first-generation Chinese Canadian and European Canadian parents, and to evaluate the efficacy of an existing translated ADHD information resource to improve their ADHD literacy. A community sample of 28 first-generation Chinese Canadian and 28 European Canadian parents of elementary school-aged children completed questionnaires measuring ADHD knowledge, treatment attitudes and perceived stigma, both before and after reading an informational pamphlet about ADHD. Compared with European Canadian parents, Chinese Canadian parents initially had less knowledge and more stigma about ADHD but had greater increases in knowledge and medication acceptability after passive psychoeducation. For both groups, passive psychoeducation increased ADHD stigma, but did not impact the already high acceptability for parent training intervention. Passive psychoeducation can improve mental health literacy among ethnic minority groups, but further work needs to tailor resources to address specific gaps in mental health literacy and recognize the need for concurrent stigma-reduction methods.
Alban-MetcalfeJ.Cheng-LaiA.MaT. (2002). Teacher and student ratings of attention-deficit/hyperactivity disorder in three cultural settings. International Journal of Disability, Development, and Education, 49(3), 281–299. https://doi.org/10.1080/1034912022000007298
2.
AngermeyerM. C.MatschingerH. (2005). Causal beliefs and attitudes to people with schizophrenia: Trend analysis based on data from two population surveys in Germany. The British Journal of Psychiatry, 186(4), 331–334. https://doi.org/10.1192/bjp.186.4.331
3.
ArciaE.FernándezM. C.JáquezM. (2004). Latina mothers’ stances on stimulant medication: Complexity, conflict, and compromise. Journal of Developmental & Behavioral Pediatrics, 25(5), 311–317. https://doi.org/10.1097/00004703-200410000-00002
4.
BaiG. N.WangY. F.YangL.NiuW. Y. (2015). Effectiveness of a focused, brief psychoeducation program for parents of ADHD children: Improvement of medication adherence and symptoms. Neuropsychiatric Disease and Treatment, 11, 2721. https://doi.org/10.2147/NDT.S88625
5.
BennettD. S.PowerT. J.RostainA. L.CarrD. E. (1996). Parent acceptability and feasibility of ADHD interventions: Assessment, correlates, and predictive validity. Journal of Pediatric Psychology, 21(5), 643–657. https://doi.org/10.1093/jpepsy/21.5.643
6.
BussingR.GaryF. A.MillsT. L.GarvanC. W. (2003). Parental explanatory models of ADHD. Social Psychiatry and Psychiatric Epidemiology, 38(10), 563–575. https://doi.org/10.1007/s00127-003-0674-8
7.
BussingR.GaryF. A.MillsT. L.GarvanC. W. (2007). Cultural variations in parental health beliefs, knowledge, and information sources related to attention-deficit/hyperactivity disorder. Journal of Family Issues, 28(3), 291–318. https://doi.org/10.1177/0192513X06296117
8.
BussingR.ZimaB. T.MasonD. M.MeyerJ. M.WhiteK.GarvanC. W. (2012). ADHD knowledge, perceptions, and information sources: Perspectives from a community sample of adolescents and their parents. Journal of Adolescent Health, 51(6), 593–600. https://doi.org/10.1016/j.jadohealth.2012.03.004
9.
ChanS. K.TseS.SitH. L.HuiC. L.LeeE. H.ChangW. C.ChenE. Y. (2016). Web-based psychoeducation program for caregivers of first-episode of psychosis: An experience of Chinese population in Hong Kong. Frontiers in Psychology, 7, 2006. https://doi.org/10.3389/fpsyg.2016.02006
10.
ChangC. C.ChenY. M.LiuT. L.HsiaoR. C.ChouW. J.YenC. F. (2020). Affiliate stigma and related factors in family caregivers of children with attention-deficit/hyperactivity disorder. International Journal of Environmental Research and Public Health, 17(2), 576. https://doi.org/10.3390/ijerph17020576
11.
ChenY.-L.ChangC.-C.ChenY.-M.LiuT.-L.HsiaoR. C.ChouW.-J.YenC.-F. (2021). Association between affiliate stigma and depression and its moderators in caregivers of children with attention-deficit/hyperactivity disorder. Journal of Affective Disorders, 279, 59–65. https://doi.org/10.1016/j.jad.2020.09.121
12.
ChenA. W.KazanjianA.WongH. (2009). Why do Chinese Canadians not consult mental health services: Health status, language or culture?Transcultural Psychiatry, 46(4), 623–641. https://doi.org/10.1177/1363461509351374
13.
ChienW.LeungS. (2013). A controlled trial of a needs-based, nurse-led psychoeducation programme for Chinese patients with first-onset mental disorders: 6 month follow up. International Journal of Nursing Practice, 19(Suppl 1), 3–13. https://doi.org/10.1111/ijn.12015
14.
ChiuM.AmarteyA.WangX.KurdyakP. (2018). Ethnic differences in mental health status and service utilization: A population-based study in Ontario, Canada. The Canadian Journal of Psychiatry, 63(7), 481–491. https://doi.org/10.1177/0706743717741061
15.
CorkumP.BesseyM.McGonnellM.DorbeckA. (2015). Barriers to evidence-based treatment for children with attention-deficit/hyperactivity disorder. ADHD Attention Deficit and Hyperactivity Disorders, 7(1), 49–74. https://doi.org/10.1007/s12402-014-0152-z
16.
CorkumP.RimerP.SchacharR. (1999). Parental knowledge of attention-deficit hyperactivity disorder and opinions of treatment options: Impact on enrolment and adherence to a 12-month treatment trial. The Canadian Journal of Psychiatry, 44(10), 1043–1048. https://doi.org/10.1177/070674379904401011
17.
DahlV.RamakrishnanA.SpearsA. P.JorgeA.LuJ.BigioN. A.ChackoA. (2020). Psychoeducation interventions for parents and teachers of children and adolescents with ADHD: A systematic review of the literature. Journal of Developmental and Physical Disabilities, 32(2), 257–292. https://doi.org/10.1007/s10882-019-09691-3
18.
DietrichS.BeckM.BujantugsB.KenzineD.MatschingerH.AngermeyerM. C. (2004). The relationship between public causal beliefs and social distance toward mentally ill people. Australian and New Zealand Journal of Psychiatry, 38(5), 348–354. https://doi.org/10.1111/j.1440-1614.2004.01363.x
19.
DonkerT.GriffithsK. M.CuijpersP.ChristensenH. (2009). Psychoeducation for depression, anxiety and psychological distress: A metaanalysis. BMC Medicine, 7, 79. https://doi.org/https://doi.org/ 10.1186/1741-7015-7-79
20.
DrechslerR.BremS.BrandeisD.GrünblattE.BergerG.WalitzaS. (2020). ADHD: Current concepts and treatments in children and adolescents. Neuropediatrics, 51(5), 315–335. https://doi.org/10.1055/s-0040-1701658
21.
DuPaulG. J.PowerT.AnastopoulosA.ReidR.McGoeyK. E.IkedaM. J. (1998). The ADHD-IV Rating Scale. Guilford.
22.
EiraldiR. B.MazzucaL. B.ClarkeA. T.PowerT. J. (2006). Service utilization among ethnic minority children with ADHD: A model of help-seeking behavior. Administration and Policy in Mental Health and Mental Health Services Research, 33(5), 607–622. https://doi.org/10.1007/s10488-006-0063-1
23.
FaraoneS. V.SergeantJ.GillbergC.BiedermanJ. (2003). The worldwide prevalence of ADHD: Is it an American condition?World Psychiatry, 2(2), 104.
24.
FungK.LiuJ. J. W.SinR.ShakyaY.GurugeS.BenderA.WongJ. P. (2020). Examining different strategies for stigma reduction and mental health promotion in Asian men in Toronto. Community Mental Health Journal, 57, 655–666. https://doi.org/10.1007/s10597-020-00723-3
25.
GongA. T.FurnhamA. (2014). Mental health literacy: Public knowledge and beliefs about mental disorders in mainland China. PsyCh Journal, 3(2), 144–158. https://doi.org/10.1002/pchj.55
26.
GuzzettiB. J. (2000). Learning counter-intuitive science concepts: What have we learned from over a decade of research?Reading & Writing Quarterly, 16(2), 89–98. https://doi.org/10.1080/105735600277971
27.
HamedA. M.KauerA. J.StevensH. E. (2015). Why the diagnosis of attention deficit hyperactivity disorder matters. Frontiers in Psychiatry, 6, 168. https://doi.org/10.3389/fpsyt.2015.00168
28.
HinshawS. P.SchefflerR. M.FultonB. D.AaseH.BanaschewskiT.ChengW.MattosP.HolteA.LevyF.SadehA.SergeantJ. A.TaylorE.WeissM. D. (2011). International variation in treatment procedures for ADHD: Social context and recent trends. Psychiatric Services, 62(5), 459–464. https://doi.org/10.1176/ps.62.5.pss6205_0459
29.
HoJ.YehM.McCabeK.LauA. (2012). Perceptions of the acceptability of parent training among Chinese immigrant parents: Contributions of cultural factors and clinical need. Behavior Therapy, 43(2), 436–449. https://doi.org/10.1016/j.beth.2011.10.004
30.
HuangC.-J.ZhangJ.QiW.-L.LiM.PanS.-Y.ZhuX.-H.ZhouY.-Y.TangG.-Z. (2012). A cross-sectional study of awareness of attention-deficit/hyperactivity disorder in parents. Chinese Mental Health Journal, 26(10), 766–770.
31.
JohnstonC.HommersenP.SeippC. (2008). Acceptability of behavioral and pharmacological treatments for attention-deficit/hyperactivity disorder: Relations to child and parent characteristics. Behavior Therapy, 39(1), 22–32. https://doi.org/10.1016/j.beth.2007.04.002
32.
KellisonI.BussingR.BellL.GarvanC. (2010). Assessment of stigma associated with attention-deficit hyperactivity disorder: Psychometric evaluation of the ADHD Stigma Questionnaire. Psychiatry Research, 178(2), 363–369. https://doi.org/10.1016/j.psychres.2009.04.022
33.
KilH.SinghA. D.BainsA.RodakT.AndradeB. F. (2021). Parental attributions in ethnocultural minority, immigrant, and country of origin parents: A scoping review and call for research. Clinical Child and Family Psychology Review, 24(4), 707–724. https://doi.org/10.1007/s10567-021-00361-5
34.
KrainA. L.KendallP. C.PowerT. J. (2005). The role of treatment acceptability in the initiation of treatment for ADHD. Journal of Attention Disorders, 9(2), 425–434. https://doi.org/10.1177/1087054705279996
35.
KubbC.ForanH. M. (2020). Online health information seeking by parents for their children: Systematic review and agenda for further research. Journal of Medical Internet Research, 22(8), e19985. https://doi.org/10.2196/19985
36.
LamC. S.TsangH. W.CorriganP. W.LeeY. T.AngellB.ShiK.LarsonJ. E. (2010). Chinese lay theory and mental illness stigma: Implications for research and practices. Journal of Rehabilitation, 76(1), 35–40.
37.
Lê CookB.TrinhN.-H.LiZ.HouS. S.-Y.ProgovacA. M. (2017). Trends in racial–ethnic disparities in access to mental health care, 2004-2012. Psychiatric Services, 68(1), 9–16. https://doi.org/10.1176/appi.ps.201500453
38.
LiuJ.YanF.MaX.GuoH. L.TangY. L.RakofskyJ. J.WuX. M.LiX. Q.ZhuH.GuoX. B.YangY.LiP.CaoX. D.LiH. Y.LiZ. B.WangP.XuQ. Y. (2016). Perceptions of public attitudes towards persons with mental illness in Beijing, China: Results from a representative survey. Social Psychiatry and Psychiatric Epidemiology, 51(3), 443–453. https://doi.org/10.1007/s00127-015-1125-z
39.
LooP. W.WongS.FurnhamA. (2012). Mental health literacy: A cross-cultural study from Britain, Hong Kong and Malaysia. Asia-Pacific Psychiatry, 4(2), 113–125. https://doi.org/10.1111/j.1758-5872.2012.00198.x
40.
MahJ. W. T.JohnstonC. (2007). Cultural variations in mothers’ attributions: Influence of child attention-deficit/hyperactivity disorder. Child Psychiatry and Human Development, 38(2), 135–153. https://doi.org/10.1007/s10578-007-0047-8
41.
MikamiA. Y.ChongG. K.SaporitoJ. M.NaJ. J. (2015). Implications of parental affiliate stigma in families of children with ADHD. Journal of Clinical Child & Adolescent Psychology, 44(4), 595–603. https://doi.org/10.1080/15374416.2014.888665
42.
MuellerA. K.FuermaierA. B.KoertsJ.TuchaL. (2012). Stigma in attention deficit hyperactivity disorder. ADHD Attention Deficit and Hyperactivity Disorders, 4(3), 101–114. https://doi.org/10.1007/s12402-012-0085-3
43.
NaS.RyderA. G.KirmayerL. J. (2016). Toward a culturally responsive model of mental health literacy: Facilitating help-seeking among East Asian immigrants to North America. American Journal of Community Psychology, 58(1-2), 211–225. https://doi.org/10.1002/ajcp.12085
44.
NorvilitisJ. M.FangP. (2005). Perceptions of ADHD in China and the United States: A preliminary study. Journal of Attention Disorders, 9(2), 413–424. https://doi.org/10.1177/1087054705281123
45.
NusseyC.PistrangN.MurphyT. (2013). How does psychoeducation help? A review of the effects of providing information about Tourette syndrome and attention-deficit/hyperactivity disorder. Child: Care, Health and Development, 39(5), 617–627. https://doi.org/10.1111/cch.12039
46.
PaulhusD. L.ReidD. B. (1991). Enhancement and denial in socially desirable responding. Journal of Personality and Social Psychology, 60(2), 307–317. https://doi.org/10.1037/0022-3514.60.2.307
47.
PedersonA. B.TsaiA. C.HawkinsD.MoskowitzJ. T.DixonL. (2023). Understanding the association between mental health knowledge and mental health service utilization among black adults. Community Mental Health Journal, 59(1), 57–67. https://doi.org/10.1007/s10597-022-00988-w
48.
PescosolidoB. A.MartinJ. K.LongJ. S.MedinaT. R.PhelanJ. C.LinkB. G. (2010). A disease like any other? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. American Journal of Psychiatry, 167(11), 1321–1330. https://doi.org/10.1176/appi.ajp.2010.09121743
49.
PhamA. V. (2013). Attention deficit hyperactivity disorder among Asian American families: Challenges in assessment and treatment. Communique (Milwaukee, Wis ), 41(6), 9–10.
50.
PhamA. V.CarlsonJ. S.KosciulekJ. F. (2010). Ethnic differences in parental beliefs of attention-deficit/hyperactivity disorder and treatment. Journal of Attention Disorders, 13(6), 584–591. https://doi.org/10.1177/1087054709332391
51.
RaoA.AroraP. G.MyszkowskiN. (2024). A pilot evaluation of a school-based psychoeducational program for Chinese and Latino/a parents: Perceived effectiveness and acceptability. Contemporary School Psychology, 28, 483–495. https://doi.org/10.1007/s40688-023-00453-9
52.
RenC.LeiM. (2020). Positive portrayals of ‘living with HIV’ to reduce HIV stigma: Do they work in reality?Journal of Applied Communication Research, 48(4), 496–514. https://doi.org/10.1080/00909882.2020.1789688
RyderA. G.AldenL. E.PaulhusD. L. (2000). Is acculturation unidimensional or bidimensional? A head-to-head comparison in the prediction of personality, self-identity, and adjustment. Journal of Personality and Social Psychology, 79(1), 49–65. https://doi.org/10.1037/0022-3514.79.1.49
55.
SageA.CarpenterD.SaynerR.ThomasK.MannL.SulzerS.SandlerA.SleathB. (2017). Online information-seeking behaviors of parents of children with ADHD. Clinical Pediatrics, 57(1), 52–56. https://doi.org/10.1177/0009922817691821
56.
SciuttoM. J. (2015). ADHD Knowledge, misconceptions, and treatment acceptability. Journal of Attention Disorders, 19(2), 91–98. https://doi.org/10.1177/1087054713493316
57.
SciuttoM.J.TerjesenM.D. (2004). Psychometric properties of the Knowledge of Attention Deficit Disorders Scale (KADDS). Unpublished test development data.
SibleyM. H.SwansonJ. M.ArnoldL. E.HechtmanL. T.OwensE. B.StehliA.AbikoffH.HinshawS. P.MolinaB. S. G.MitchellJ. T.JensenP. S.HowardA. L.LakesK. D.PelhamW. E.SternK. (2017). Defining ADHD symptom persistence in adulthood: Optimizing sensitivity and specificity. Journal of Child Psychology and Psychiatry, 58(6), 655–662. https://doi.org/10.1111/jcpp.12620
60.
SlobodinO.MasalhaR. (2020). Challenges in ADHD care for ethnic minority children: A review of the current literature. Transcultural Psychiatry, 57(3), 468–483. https://doi.org/10.1177/1363461520902885
61.
SmithT. B.TrimbleJ. E. (2016). Foundations of multicultural psychology: Research to inform effective practice. American Psychological Association. https://doi.org/10.1037/14733-000
SwansonJ. M.ArnoldL. E.MolinaB. S.SibleyM. H.HechtmanL. T.HinshawS. P.AbikoffH. B.StehliA.OwensE. B.MitchellJ. T.NicholsQ.HowardA.GreenhillL. L.HozaB.NewcornJ. H.JensenP. S.VitielloB.WigalT.EpsteinJ. N. … SternK. (2017). Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: Symptom persistence, source discrepancy, and height suppression. Journal of Child Psychology and Psychiatry, 58(6), 663–678. https://doi.org/10.1111/jcpp.12684
64.
van LangenM. J. M.SzőkeR.RijkelijkhuizenD. N. J.DurstonS.van HulstB. M. (2022). Lost in explanation: Internal conflicts in the discourse of ADHD psychoeducation. BMC Psychiatry, 22(1), 690. https://doi.org/10.1186/s12888-022-04327-x
65.
Van WidenfeltB. M.TreffersP. D.De BeursE.SiebelinkB. M.KoudijsE. (2005). Translation and cross-cultural adaptation of assessment instruments used in psychological research with children and families. Clinical Child and Family Psychology Review, 8(2), 135–147. https://doi.org/10.1007/s10567-005-4752-1
66.
WangT.LiuK.LiZ.XuY.LiuY.ShiW.ChenL. (2017). Prevalence of attention deficit/hyperactivity disorder among children and adolescents in China: A systematic review and meta-analysis. BMC Psychiatry, 17(1), 1–11. https://doi.org/10.1186/s12888-016-1187-9
67.
WongD. F. K.ChengC. W.ZhuangX. Y.NgT. K.PanS. M.HeX.PoonA. (2017). Comparing the mental health literacy of Chinese people in Australia, China, Hong Kong and Taiwan: Implications for mental health promotion. Psychiatry Research, 256, 258–266. https://doi.org/10.1016/j.psychres.2017.06.032
68.
XuZ.HuangF.KoestersM.StaigerT.BeckerT.ThornicroftG.RueschN. (2018). Effectiveness of interventions to promote help-seeking for mental health problems: Systematic review and meta-analysis. Psychological Medicine, 48(16), 2658–2667. https://doi.org/10.1017/S0033291718001265
69.
YangK. G.RodgersC. R. R.LeeE.Le CookB. (2019). Disparities in mental health care utilization and perceived need among Asian Americans: 2012–2016. Psychiatric Services, 71(1), 21–27. https://doi.org/10.1176/appi.ps.201900126
70.
YinH.WardenaarK. J.XuG.TianH.SchoeversR. A. (2020). Mental health stigma and mental health knowledge in Chinese population: A cross-sectional study. BMC Psychiatry, 20(1), 1–10. https://doi.org/10.1186/s12888-020-02705-x
71.
YuJ.RobertsM.WongM.ShenY. (2011). Acceptability of behavioral family therapy among caregivers in China. Journal of Child and Family Studies, 20(3), 272–278. https://doi.org/10.1007/s10826-010-9388-1
72.
YuX. H.ZhongL.HuangJ. (2019). How online ADHD-related information affects Chinese parents’ decisions?World Journal of Pediatrics, 15(1), 57–65. https://doi.org/10.1007/s12519-018-0207-x
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