Attitude Change and ADHD

Attitude Change and ADHD

Author: Powlin V. Manuel MD, MBA

Attitude is people’s evaluation the various aspects of the social world formed from social learning, classical conditioning, instrumental conditioning, and observational learning. Making an assessment of the existing attitude will provide us information to take appropriate measures to change attitude. The existing attitude of the parents, teachers, peers, and healthcare providers affect the outcome of patients suffering from ADHD. Before we can make an effective social change in any specific area we wish to improve, we need to know the existing attitude by different techniques of measuring attitude.  We must have an effective communicator to deliver the appeal for change; we need to have an effective and appealing content for receptive audience for attitude change and effective social change.

Attitude Change and ADHD

Attitude Change

Attitude is people’s evaluation the various aspects of the social world (Baron, Branscombe, & Byrne, D., 2009).  The authors ascribe the following characteristics to attitude.  Attitude formation occurs as a result of social learning, classical conditioning, instrumental conditioning, and observational learning. Attitudes are acquired from other people from social learning process. Such learning can involve social learning, classical conditioning, and instrumental conditioning.  Attitudes that are acquired through instrumental conditioning arise from possible rewards and punishments for adopting the particular attitudes; this aspect originally was promoted by Skinner. Attitude formation is affected by agenda setting, framing, persuasion, appeals, and sources of social influence.

Attitude Formation

We often adopt attitudes that others hold, because we compare ourselves with others even if we hold different views than others. The process of social comparison lead us to adopt attitude positions of those we see ourselves similar to others but not of those who are dissimilar (Baron, Branscombe, & Byrne, D., 2009). The authors ascribe the following features of attitude formation: if we identify ourselves with q group we are influenced by messages that are aimed at our group; we do not expect to be influenced when we do not identify with a group that the message is aimed at; attitudes however, do not always predict behavior; sometimes we are not willing to express our true attitude as we are influenced by the context and. the concerns about how others around us feel about us; and they will make us not act according our attitude. If we ignorantly believe that others have different attitude than us we hesitate to express our attitude in public. The strength of attitude is influenced by attitude extremity or the magnitude of vested interest. Attitude certainty and personal experience also add strength to espresso attitude.

Attitude Measurement

Historically to effect any social change the researchers needed to assess the current attitude towards any social situation and have effectively employed different techniques.Attitude measurement techniques included protocol analysis and cognitive response analysis (Ostrom, 1986). The author explains the issues related to attitude measurement as follows:  individuals develop attitudes through sensory inputs of the past, perception, memory formation, and retrieval process. In cognitive psychology the structure of attitude relevant information is being explored using measures of recall, recognition, and reaction time. Attitude assessment can be accomplished through survey design on different issues. The Likert scale is commonly used in survey research. It is often used to measure respondents’ attitudes by asking the extent to which they agree or disagree with a particular question or statement. Thurstone scale was the first formal technique for measuring an attitude developed by Louise Leon Thurstone as a means of measuring attitudes towards religion. It is made up of statements about a particular issue, and each statement has a numerical value indicating how favorable or unfavorable it is judged to be and a mean score is computed. Guttmann’s scalogram analysis is to establish a one-dimensional continuum for a concept you to measure. Osgood’s Semantic differential was designed to measure the meaning of concepts in which the respondent is asked to choose where his or her position lies, on a scale between two extreme adjectives.

Attitude Change

Katz (1960) argued that at the psychological level reason for holding or changing attitudes are based on the function they perform for the individual such as the function of adjustment, ego defense, value expression, and knowledge. The conditions needed to modify an attitude vary according to the motivational basis of the attitude. Change in areas of belief and feeling are needed to achieve a change in attitude. Several factors affect the strength of relationship between attitudes and behavior. Baron, Branscombe, & Byrne, D., 2009 explain the following factors: attitude influences behavior through two different mechanisms: intentions derived from our attitudes, norms, and perceived control over the behavior;  attitudes are changed through the use of messages focused on the characteristics of the individual delivering the message, the content of the message, and audience. Characteristic of the individual can easily influence the audience. Elaboration-persuasion model (ELM), and the heuristic systematic model are the two modern theories of persuasion. These theories explain the cognitive processes involved in persuasion. Persuasive messages are processed through systematic processing which involve attention to message content, or through heuristic processing, which involves use of mental shortcuts. The strength of argument affects the systematic processing while the characteristics of the actor work through heuristic processing.

Measures at changing attitude may not always be successful. Baron, Branscombe, & Byrne, D., (2009) makes the following assessment: there are certain factors which contribute to resist to persuasion; any message that may limit personal freedom may produce an opposition to message content; forewarning concerning the negative effects and exposure to contents or information that contradicts our views may lead to avoidance of exposure to message and the audience will stay away from listening to the message. Persuasive messages that are contrary to our views may lead to resistance to persuasion. Cognitive dissonance exerts a negative effect on attitude change, this occurs when we are induced to say or do things that are inconsistent with our true attitudes.

Attitude Change and ADHD

The outcome of individuals suffering from Attention Deficit Hyperactivity Disorder (ADHD) is influenced by the culturally induced attitudes of society, parents, teachers, social workers, peers, and providers of healthcare.

Teachers’ Attitude toward adhd

Teachers’ knowledge and attitude of the difficulties inherent in ADHD is important for the social outcome of ADHD. Brook, Watenberg, & Geva (2000) found that the general knowledge of teachers about both conditions were low. Thirteen percent of all teachers believed that learning disability was the result of parental attitude, and 40% believed that ADHD children should be punished in a manner similar to non-suffers. 45.7% of teachers expected the children with ADHD to experience multiple difficulties as adults. Berkle (2004) found that attitudes and knowledge significantly correlated among teachers and undergraduate education students and that ADHD is a valid diagnosis with implications for school setting, and expressed a desire for comprehensive training.

Practitioners’ Attitude

Pediatricians vary in their behavior towards ADHD patients and that can have impact on the way the children with ADHD are managed (Kwasman, Tinsley, & Lepper, 1995). Attitudes and understanding of ADHD by general practitioners is important in the outcome of patients as many of these parents need to be managed by general practitioners (Shaw, Wagner, Fastwood & Mitchell, 2003).  In Australia the authors found that the general practitioners showed a resistance to manage these children, and they wanted to work in close liaisons with specialists. Cooperation between schools, parents, and therapeutic institutions is important for an effective multimodal treatment program. Ghanizadeh, Bahredart & Moeini (2005) found that there was significant correlation between teachers’ knowledge of ADHD and their attitude and that knowledge about ADHD was very low, and that 53.1% of elementary school teachers considered ADHD to be the result of parents spoiling the children.

Parent’s Attitude toward adhd

Parent’s attitude towards dealing with ADHD can be impacted by cultural model, and parents play an important role in diagnosis and management of ADHD. Arcia, & Fernindez (1998) in a qualitative study of Cuban-American mothers of 7-10 year old children with ADHD, found that mothers lacked a cultural model of normal child development and that hampered their development of schema of ADHD which could interfere with seeking treatment for the condition. Parent’s knowledge and attitude about ADHD are barriers to evaluation treatment, source of information and early treatment. Ghanizadeh (2007) found that half of the parents studied did not agree that ADHD was due to biological and genetic variability leading to delay in referral.

Peer’s Attitude

Attitudes and behavior interactions of other children in school to labeling of children with ADHD can have an impact on the outcome of ADHD.  Law, Sinclair, & Fraser (2007) hypothesized that Children’s negative attitude towards peers with diagnosis ADHD need to be targeted for changed behavior. In a study in Israel however no correlation was found between pupil’s knowledge, and attitude; pulps knowledge on learning disability was higher than that of ADHD (Brook & Geva, 1999). In Israel most of the information about ADHD was received from television and news papers while physicians and nurses were the least source of information. Stigmatization attitudes can have a negative impact on the development of behavior of those stigmatized. In a study of national sample of children ages 8-18 concerning the magnitude of stigmatization and to examine the variation in the level of stigma by school location, regions of the United States, grade level ethnicity and race, towards peers with depression and ADHD, Walker, Coleman, Lee, Squire, & Friesen (2008), found that across most items, both depression and ADHD were more stigmatized than asthma. The authors reported that the perception among peers of likelihood of violence and antisocial behavior from ADHD were exceedingly high.

Attitudes are structures that reside in long-term memory, and are activated when the object of attitude is encountered (Tourangeau, & Rasinski, 1988). The authors argue that it is useful to represent attitudes as network of interrelated beliefs in order to make any effective change in attitude. The attitudes are organized into schema or stereotypes, or some combination of the two. There are cultural differences in knowledge among African-American and white parents, and interferes with the attitude towards utilizing available health services, suggesting that minority children may be less likely to receive services of ADHD (Bussing, Schoenberg, & Perwien, 1998). Authors found that minorities receive educational information at much lower rate from physicians compared to whites, fewer African-American parents heard of add (69% compared to 95%). Attitude change can occur only if the disparity in knowledge is reduced. Inadequate and delayed treatment of add in African-American children leading to higher rates of delinquency, incarceration, teen pregnancy in the population with ADHD (Hervey-Jumper, Douyon, & Franco, 2006).

Reference

Arcia, E. & Fernindez, M.C. (1998). Cuban mothers’ schema of add: development,          characteristics, and help-seeking behavior. Journal of Child and Family Studies,     7(3), 333-352 [abstract].

Baron, R. A., Branscombe, N. R., & Byrne, D. (2009). Social psychology (12th ed.).

Boston: Pearson Education, Inc.

Beckle, B. (2004). Knowledge and attitude about attention deficit hyperactivity disorder (ADHD): a comparison between practicing teachers and undergraduate            education students. Journal of Attention Disorders 7 (3), 151-161     doi: 10.1177/108705470400700303

Brook, U., & Geva, D (1999). Knowledge and attitude of high school pupils towards        peers’ attention deficit and learning disabilities. Patient Education and            Counseling, 43(1), 31-36.

Brook, U., Watenberg, N., & Geva, D. (2000). Attitude and knowledge of attention deficit             hyperactivity disorder and learning disability among high school teachers.            Patient Education and Counseling, 40(3), 247-252.

Bussing, R., Schoenberg, N.E., & Perwien, A.R. (1998). Knowledge and information       about ADHD: evidence of cultural differences among African-American and white parents. Social Science & Medicine, 46(7), 919-928.

Ghanizadeh, A. (2007). Education  and counseling of parents of children with attention/-          deficit hyperactivity disorder. Patient Education and Counseling, 68(1), 23-28.

Ghanizadeh, A., Bahredart, M.J., & Moeini, S.R.(2006). Knowledge and attitude towards            attention deficit hyperactivity disorder among elementary school teachers. Patient   Education and Counseling, 61(1), 84-88.

Hervey-Jumper, H., Douyon, K., & Franco, K.N. (2006). Deficit in diagnosis, treatment   and continuity of care in African-American children and adolescents with add.           Journal of The National Medical Association, 98(2), 233-238.

Katz, D. (1960). The functional approach to the study of attitudes. Public Opinion             Quarterly, 24(2), 163-204.

Kwasman, A., Tinsley, B.J., & Lepper, H.S. (1995). Pediatricians’ knowledge and             attitude concerning diagnosis and treatment of attention deficit and hyperactivity   disorders. Archives of Pediatrics & Adolescent Medicine, 149(11), 1211-1216.

Law, G. Urquhart., Sinclair, S. & Fraser, N. (2007). Children’s attitudes and behavioral    intentions towards a peer with symptoms of ADHD: Does the addition of a       diagnostic label make a difference? Journal of Child Health Care, 11 (2), 98-111.      http://dx.doi.org/10.1177/1367493507076061.

Ostrom, T.M.(1987). Measuring social attitudes: a handbook for researchers and practitioners. Applied Psychology Measurement, 11(1), 107-108.

Reid, N. (2006). Thoughts on attitude measurement. Research in Science &         Technological Education, 24, 3–27. Retrieved July 9, 2007, from the Academic       Search Premier database. (AN 19978034)

Shaw, Wagner, Fastwood & Mitchell (2003). A qualitative study of ADHD in Australia

Family Practice 20 (2):129-134.doi:10.1093/fampra/20.2.129

Tourangeau, R., & Rasinski, K.A. (1988). Cognitive processes underlying context           effects in attitude measurement. Psychological Bullettin, 103(3), 299-314.

Walker, J.S., Coleman,D., Lee, J., Squire, P., N., & Friesen, B.J.(2008). Children’s           stigmatization of childhood depression and add: Magnitude and demographic           variation in a national sample. Child and Adolescent psychiatry, 47(8), 912-920

Powlin V. Manuel MD, MBA is a board certified pediatrician, and allergist and Immunologist practicing pediatrics for the last 35 years.

Dr. Manuel served as a clinical faculty at LSU Medical Center in Lafayette, Louisiana for many years.

Dr. Powlin Manuel has served in the Board of Lafayette Parish Medical Society, United Way of Acadiana, and other organizations. Dr. Manuel has served as the Chair of Public Relations Committee of Louisiana State Medical Society, President of Louisiana State Allergy Society, President of Louisiana Initiative for Teen Pregnancy Prevention.

Dr. Powlin Manuel has won the following awards: Louisiana Citizen of the Year, Humanitarian of the Year and Lifetime Achievement Award from Louisiana Allergy Society.
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