Attention-deficit/hyperactivity disorder (ADHD) in cultural context: Do parents in Hong Kong and the United Kingdom adopt different thresholds when rating symptoms, and if so why?

TY - JOUR

T1 - Attention-deficit/hyperactivity disorder (ADHD) in cultural context

T2 - Do parents in Hong Kong and the United Kingdom adopt different thresholds when rating symptoms, and if so why?

AU - Chan, Wendy W.Y.

AU - Shum, Kathy Kar man

AU - Sonuga-Barke, Edmund J.S.

N1 - Funding Information: We express heartfelt gratitude to the children, parents and preschools for their participation and support, and to MSc students for their help in this project. This work was supported by the Centre for Doctoral Studies of King's College London (Wendy Wing‐ying Chan) and the National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London (Edmund J. S. Sonuga‐Barke). Publisher Copyright: © 2022 The Authors. International Journal of Methods in Psychiatric Research published by John Wiley & Sons Ltd.

PY - 2022/9

Y1 - 2022/9

N2 - Objectives: Attention-deficit/hyperactivity disorder (ADHD) prevalence is similar across world regions. However, because informants' decision thresholds may vary between regions, these similarities may mask regional variations in actual ADHD behaviours. We tested this by comparing the relationship between informant's ratings and children's measured activity in United Kingdom (UK) and Hong Kong (HK) and then explored whether any national differences in endorsement thresholds discovered are linked to cultural variations in parenting factors. Methods: Parents rated the 18 ADHD symptoms in 112 three-to-five-year-old children stratified for ADHD symptom levels (49 girls and 63 boys; 55 from the UK and 57 from HK) and completed some parenting questionnaires. Children's task-related activity was measured using actometers. Results: In both groups, measured activity was positively correlated with hyperactivity/impulsivity (r = 0.44HK; r = 0.41UK). While HK children were less active than UK children (p < 0.01), HK parents rated their children as more hyperactive/impulsive and inattentive (ps < 0.05). The lower rating threshold indicated by this pattern in HK parents were explained by their higher child-related stress levels. Conclusions: UK and HK parents operated different ADHD symptom endorsement thresholds. The link between these and child-related stress may mark a more general role of cultural pressure for child conformity and school achievement in HK.

AB - Objectives: Attention-deficit/hyperactivity disorder (ADHD) prevalence is similar across world regions. However, because informants' decision thresholds may vary between regions, these similarities may mask regional variations in actual ADHD behaviours. We tested this by comparing the relationship between informant's ratings and children's measured activity in United Kingdom (UK) and Hong Kong (HK) and then explored whether any national differences in endorsement thresholds discovered are linked to cultural variations in parenting factors. Methods: Parents rated the 18 ADHD symptoms in 112 three-to-five-year-old children stratified for ADHD symptom levels (49 girls and 63 boys; 55 from the UK and 57 from HK) and completed some parenting questionnaires. Children's task-related activity was measured using actometers. Results: In both groups, measured activity was positively correlated with hyperactivity/impulsivity (r = 0.44HK; r = 0.41UK). While HK children were less active than UK children (p < 0.01), HK parents rated their children as more hyperactive/impulsive and inattentive (ps < 0.05). The lower rating threshold indicated by this pattern in HK parents were explained by their higher child-related stress levels. Conclusions: UK and HK parents operated different ADHD symptom endorsement thresholds. The link between these and child-related stress may mark a more general role of cultural pressure for child conformity and school achievement in HK.

KW - attention-deficit hyperactivity disorder

KW - cross-cultural study

KW - parenting

KW - rating threshold

KW - social norms

UR - http://www.scopus.com/inward/record.url?scp=85131301105&partnerID=8YFLogxK

U2 - 10.1002/mpr.1923

DO - 10.1002/mpr.1923

M3 - Article

AN - SCOPUS:85131301105

SN - 1049-8931

VL - 31

JO - International Journal of Methods in Psychiatric Research

JF - International Journal of Methods in Psychiatric Research

IS - 3

M1 - e1923

ER -