The Role of Counterfactual Thinking on Attitudes Toward ADHD Medication Use

ABSTRACT

Objective: Despite serious health risks, attitudes toward Attention-Deficit Hyperactivity Disorder (ADHD) medication use in college students remain favorable. Given the robust link between attitudes and behavior (e.g., the Theory of Planned Behavior), it is important to understand how these attitudes are developed and maintained. The current study examined the role of counterfactual, or “what if’” thinking as a mechanism for the development of attitudes toward ADHD medications. Method: All participants (n = 190) were asked to read either a positive or negative scenario regarding ADHD medication misuse and rate their attitudes toward the behavior; half of the participants were also asked to generate counterfactuals prior to rating their attitudes. Results: Results suggest that scenario valence influenced the direction of counterfactual statements. Further, through the generation of upward counterfactuals, the negative scenario elicited more positive attitudes toward ADHD medication misuse. Conclusions: Based on limited prior research, it is suggested that upward counterfactuals may allow individuals to explain away the misuse of ADHD medication and avoid negative emotions such as guilt and shame related to current or prior ADHD medication misuse. In sum, additional research is needed to confirm preliminary findings that suggest counterfactual thinking could be a precursor to ADHD medication misuse.

KEYWORDS:

• Counterfactual thinking
• attitudes
• ADHD medication
• nonprescription use

Glossary

• Attention-Deficit-Hyperactivity Disorder (ADHD): A clinical diagnosis that consists of a pattern of inattention, hyperactivity, or a combination of the two resulting in a loss of focus, follow-through, and/or fidgety movements, excessive talking, or limitless energy.

• Attitude: An individual's evaluation of a particular event or behavior that typically includes a component of positive or negative affect and an intention to change future behaviors.

• Counterfactual thinking: The use of “what-if” or “if only” thoughts that posit alternative actions that could have occurred in past factual events.

• Functional counterfactual theory: The idea that certain kinds of counterfactual thoughts (typically upward counterfactuals focusing on how a negative outcome could have been avoided) can have a preparative or adaptive function, in that they can identify corrective behaviors, increase motivation and intentions, and improve future outcomes.

• Nonprescription stimulant use: The use of stimulant medications for purposes outside of the physicians' recommendations, such as recreational use, or without a physician prescription.

• Stimulant medications: Psychoactive drugs prescribed by physicians to improve a number of physical and psychological symptoms. For the purposes of this paper, stimulant medications will be referred to within the context of treating ADHD to alleviate symptoms of inattention and hyperactivity.

• Theory of Planned Behavior: The Theory of Planned Behavior (TPB) started as the Theory of Reasoned Action in 1980 to predict an individual's intention to engage in a behavior at a specific time and place. The theory includes attitudes, subjective norms, perceived behavioral control, and intentions to explain all behaviors over which people have the ability to exert self-control.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Notes on contributors

Ashley M. Ramos

Ashley M. Ramos, MS, is a fifth-year doctoral student in the Clinical Psychology program at Texas A&M University. Her research interests include the role of psychosocial factors in relation to the development of child and adolescent health-risk behaviors with a particular emphasis on the role of family functioning in pediatric chronic health conditions. Ashley has focused her clinical work on pediatric populations and is pursuing a career in an academic pediatric hospital.

Brittney Becker

Brittney Becker is a doctoral student at Texas A&M University in the area of Social and Personality Psychology. Her primary research interests include counterfactual thinking, preference categorization, evaluative categorization, and how these processes affect judgment and decision making.

Julie A. Biemer

Julie A. Biemer, BA, is a doctoral student in the School of Behavioral and Brain Sciences at the University of Texas at Dallas. Although counterfactual thinking still holds an interest for her, she has now shifted her primary focus to romantic relationships. Specifically, she studies how partners behave toward each other, such as how they communicate, resolve conflict, and give/receive affection. Additionally, she seeks to investigate how these behaviors help or hinder couples in maintaining their intimate bond.

Lindsay Clark

Lindsay Clark, BS, is a master's student in the Clinical Psychology program at the University of Houston at Clear Lake. While counterfactual thinking and decision-making are still an interest for her, she now primarily studies disruptive behavior and impulsivity in adolescents and emerging adults. Her current research seeks to understand links between childhood trauma and antisocial traits and behaviors in adolescence and adulthood.

Sherecce Fields

Sherecce Fields is an assistant professor in Clinical Psychology at Texas A&M University. Dr. Fields' primary degree is in Clinical Psychology with areas of specialization in Child Clinical and Pediatric Psychology. Dr. Fields' research incorporates behavioral and clinical intervention methods and most recently has included the use of physiological measures to examine research questions related to adolescent health risk behaviors including tobacco use, obesity, and risky sexual behavior.

Rachel Smallman

Rachel Smallman is an assistant professor of Social Psychology at Texas A&M University. Her research focuses on social cognition, with a specific interest in counterfactual thinking. In particular, she is interested in how these thoughts of “what might have been” can both help and hinder future decisions, behavioral intentions, and future behavior. Additionally, she studies the relationship between counterfactual thinking and health-related outcomes.