Children's Beliefs About Causes of Childhood Depression and ADHD: A Study of Stigmatization

Objective: Children's causal attributions about childhood mental health problems were examined in a national sample for prevalence; relative stigmatization; variation by age, race and ethnicity, and gender; and self-report of a diagnosis of depression or attention-deficit hyperactivity disorder (ADHD). Methods: A national sample of 1,091 children were randomly assigned to read vignettes about a peer with depression, ADHD, or asthma and respond to an online survey. Causal attributions and social distance were assessed, and correlations were examined. Logistic regression models for each causal item tested main effects and interaction terms for conditions, demographic characteristics, and self-reported diagnosis. Results: The beliefs that parenting, substance abuse, and low effort caused the condition were all strongly intercorrelated and were moderately correlated with social distance. The depression condition was the strongest predictor of endorsement of the most stigmatizing causal beliefs. Stigmatizing causal beliefs were evident for ADHD, but with more modest effects. Children who reported a diagnosis were more likely to endorse parenting and substance abuse as causes (attenuated for ADHD). Modest to moderate effects were found for variation in causal beliefs across ethnic groups. Conclusions: This study demonstrated a consistent presence of stigmatization in children's beliefs about the causes of childhood mental health problems. Low effort, parenting, and substance abuse together tapped a moralistic and blaming view of mental health problems. The results reinforce the need to address stigmatization of mental disorders and the relative stigmatization of different causal beliefs. The findings of variation by ethnicity and diagnosis can inform and target antistigmatization efforts. (Psychiatric Services 60:950-957, 2009)