Implications of Parental Affiliate Stigma in Families of Children with ADHD

Abstract

This study examined parents' perceptions/awareness and internalization of public courtesy stigma (affiliate stigma) about their children's inattentive and hyperactive/impulsive symptoms, and associations between parental affiliate stigma, parental negativity expressed toward the child, and child social functioning. Participants were families of 63 children (ages 6–10; 42 boys) with attention-deficit/hyperactivity disorder, assessed in a cross-sectional design. After statistical control of children's severity of inattentive and hyperactive/impulsive symptoms (as reported by parents and teachers), parents' self-reports of greater affiliate stigma were associated with more observed negative parenting. The associations between high parental affiliate stigma and children's poorer adult informant-rated social skills and greater observed aggression were partially mediated by increased parental negativity. As well, the positive association between children's adult informant-rated aggressive behavior and parental negativity was partially mediated by parents' increased affiliate stigma. Parental affiliate stigma about their children's inattentive and hyperactive/impulsive symptoms may have negative ramifications for parent–child interactions and children's social functioning. Clinical implications for parent training interventions are discussed.

Notes

¹The five items contained in our affiliate stigma questionnaire are as follows: (a) Are you ever embarrassed by your child's inattentive or hyperactive/impulsive behaviors; (b) Do you worry that others view you as a “bad parent” because of your child's inattentive or hyperactive/impulsive behaviors; (c) Do you ever worry that, as a parent, you should have prevented your child's inattentive or hyperactive/impulsive behaviors; (d) Does embarrassment about your child's inattentive or hyperactive/impulsive behaviors ever decrease your likelihood of pursuing social relationships with other adults; (e) Does embarrassment about your child's inattentive or hyperactive/impulsive behaviors ever decrease your likelihood of pursuing social interactions for your child with other children? In line with the conceptualization of Mak and Cheung (2008), this scale assesses the affective (Item a), cognitive (Items b and c), and behavioral (Items d and e) components of affiliate stigma.

²Because children were nested in playgroups for the criterion measure of observed aggressive behavior, we considered whether analyses for this dependent variable should be conducted using multilevel modeling. However, the ICC (estimate of the proportion of variance at the playgroup level) in an unconditional model was .10, which is moderately low. As well, we achieve the same results (in terms of direction of effects and whether or not the finding is statistically significant) regardless of whether or not multilevel modeling is used. Therefore, for the sake of simplicity we have chosen to omit the use of multilevel modeling.

³Because we recognized that parents' negative attitudes about ADHD in general may also account for the findings obtained herein, we considered parents' reports on the Community Attitudes toward the Mentally Ill inventory (CAMI; Taylor & Dear, 1981), modified to be specific to cognitive attitudes about ADHD. The CAMI assesses the extent to which individuals self-report negative beliefs about the nature of ADHD and endorse beliefs that individuals with ADHD should be treated differently from everyone else. This scale has 12 items (sample item: One of the main causes of ADHD is a lack of self-discipline and will power), answered on a 5-point metric from 1 (strongly agree) to 5 (strongly disagree). Alpha in our sample was .68. Although parents' negative attitudes toward ADHD on the CAMI were positively correlated with their affiliate stigma (r = .27, p = .033), when we reconducted all analyses with statistical control of CAMI scores, all previous results remained the same in direction and significance and no new results emerged.