Disclosure of Attention–Deficit/Hyperactivity Disorder May Minimize Risk of Social Rejection

Abstract

The vast majority of young adults with Attention-Deficit/Hyperactivity Disorder (ADHD) report interpersonal difficulties, which are likely exacerbated by others' negative perceptions of ADHD. Therefore, researchers and clinicians have called for the development of attitude change strategies. One strategy is preventative disclosure, in which one selectively informs and educates others about their condition. No known research has explored preventative disclosure with ADHD. To examine the effects of disclosure, 306 young adults read vignettes that varied in a two (ADHD symptom presentation: hyperactive/impulsive vs. inattentive) by two (preventative disclosure vs. nondisclosure) design. A factor analysis of the questions following each vignette resulted in two factors: Socially Rejecting Attitudes (alpha = .82) and Potential Benefits with Treatment (alpha = .61). Results suggest that preventative disclosure may greatly reduce Socially Rejecting Attitudes (d = -.95). When ADHD was disclosed, respondents were more likely to report that the character would benefit from treatment (d = .39). A character presenting with hyperactive/ impulsive (compared to inattentive) symptoms was more likely to be viewed as potentially benefiting from treatment (d = .50). If the results of the present study replicate with clinical samples, preventative disclosure could have a significant impact on the psychosocial functioning of people with ADHD.

Full text

Disclosure of ADHDJastrowski et al.
Disclosure of Attention–Deficit/Hyperactivity
Disorder May Minimize Risk of Social Rejection
Kristen E. Jastrowski, Kristoffer S. Berlin, Amy F. Sato, and W. Hobart Davies
The vast majority of young adults with Attention–Deficit/Hyperactivity Disorder
(ADHD) report interpersonal difficulties, which are likely exacerbated by others’
negative perceptions of ADHD. Therefore, researchers and clinicians have called
for the development of attitude change strategies. One strategy is preventative dis
-
closure, in which one selectively informs and educates others about their condition.
No known research has explored preventative disclosure with ADHD. To examine
the effects of disclosure, 306 young adults read vignettes that varied in a two
(ADHD symptom presentation: hyperactive/impulsive vs. inattentive) by two (pre
-
ventative disclosure vs. nondisclosure) design. A factor analysis of the questions
following each vignette resulted in two factors: Socially Rejecting Attitudes (alpha
= .82) and Potential Benefits with Treatment (alpha = .61). Results suggest that pre-
ventative disclosure may greatly reduce Socially Rejecting Attitudes (d = –.95).
When ADHD was disclosed, respondents were more likely to report that the char-
acter would benefit from treatment (d = .39). A character presenting with hyperac-
tive/impulsive (compared to inattentive) symptoms was more likely to be viewed as
potentially benefiting from treatment (d = .50). If the results of the present study
replicate with clinical samples, preventative disclosure could have a significant im-
pact on the psychosocial functioning of people with ADHD.
Attention–Deficit/Hyperactivity Dis
-
order (ADHD) is one of the most common
psychiatric disorders in youth, with an esti
-
mated prevalence rate of approximately 3%
to 6% (Barkley, 1996). According to the
DSM–IV–TR (American Psychiatric Associa
-
tion, 2000), ADHD is a neurobehavioral con
-
stellation of inattention, hyperactivity,
and/or impulsivity symptoms. The current di
-
agnostic criteria include two 9–item symptom
categories, one pertaining to inattention (e.g.,
often does not seem to listen when directly
spoken to), and the other to symptoms of hy
-
peractivity (e.g., often talks excessively) and
impulsivity (e.g., often interrupts or intrudes
on others). The diagnosis of ADHD, Com
-
bined Type, is made when an individual ex
-
hibits six or more symptoms from both the in
-
attention and hyperactivity/impulsivity
categories, whereas the predominantly inat
-
Psychiatry 70(3) Fall 2007 274
Kristen E. Jastrowski, PhD, is a postdoctoral fellow in the Department of Anesthesiology at the
Medical College of Wisconsin. Kristoffer S. Berlin, PhD, is a postdoctoral fellow at the Brown Medical
School Clinical Psychology Training Consortium. Amy F. Sato, MS, is a graduate student in clinical psy
-
chology at the University of Wisconsin–Milwaukee. W. Hobart Davies, PhD, is a Associate Professor in
the Department of Psychology at the University of Wisconsin–Milwaukee and the Departments of Anes
-
thesiology Pediatrics and Psychiatry and Behavioral Medicine at the Medical College of Wisconsin.
Address correspondence Kristen E. Jastrowski, Ph.D., Jane B. Pettit Pain and Palliative Care Cen
-
ter, Children’s Hospital of Wisconsin, 9000 W. Wisconsin Avenue, MS 792, Milwaukee, WI 53226;
e–mail: KJastrowski@chw.org

tentive or predominantly hyperactive/impul
-
sive subtypes are deemed appropriate if six or
more symptoms from one category are
present but fewer than six symptoms from the
other category are evident.
While usually first diagnosed during
childhood, ADHD continues to impact many
adults. Estimates of the persistence of ADHD
into adulthood range from 30% to 80%
(Barkley, 1996; Barkley, Fischer, Edelbrock,
& Smallish, 1990; Klein & Manuzza, 1991).
Assessing the prevalence of ADHD in adult
-
hood is challenging because the manifestation
of symptoms changes across development
(e.g., less visible hyperactivity despite subjec
-
tive restlessness), the diagnostic criteria
changed somewhat during the course of most
longitudinal studies of ADHD, and the meth
-
odology used to assess ADHD in adulthood
can lead to prevalence underestimates
(Barkley, 1996; Goldstein, 1999; Hart, Lahey,
Loeber, Applegate, & Frick, 1995).
Longitudinal studies have reported
poor academic, behavioral, and emotional
outcomes among young adults with ADHD
(e.g., Biederman, et al., 1996; Hart, et al.,
1995). For instance, ADHD is associated with
disruptions in school and occupational func-
tioning. Teenagers with ADHD exhibit
greater utilization of special education ser-
vices (Barkley, Guevremont, Anastopoulos,
& Fletcher, 1992), poorer academic achieve
-
ment and higher rates of learning disorders
(Biederman, et al., 2004). They are also more
likely to be suspended, drop out of high
school, and/or seek employment rather than
attend college after graduating from high
school (Klein & Mannuzza, 1991). Individu
-
als with ADHD exhibit higher rates of behav
-
ioral disorders, such as Oppositional Defiant
Disorder and Conduct Disorder, and are at an
increased risk for developing Antisocial Per
-
sonality Disorder and/or a co–occurring
anxiety or mood disorder (Barkley, 1996).
In addition to the aforementioned aca
-
demic and psychiatric concerns, young adults
with ADHD often experience significant social
difficulties (Anastopoulos & Shaffer, 2001;
Barkley, 2004; Goldstein, 1999). As ADHD
progresses into young adulthood, the domains
of difficulty change and the social milieu be
-
comes more complex. Unfortunately, neither
the quality nor quantity of social difficulties en
-
during into adulthood has been thoroughly in
-
vestigated. It is important to note, however,
that those with behavioral disturbances (such
as ADHD) face stigmatization, which may play
a role in the social difficulties they experience
(Crisp, Gelder, Rix, Meltzer, & Rowlands,
2000). Research has demonstrated that the
general public endorses stigmatizing attitudes
towards individuals with psychological disor
-
ders and that this stigmatization often results in
negative outcomes such as rejection, social
withdrawal, and exacerbation of psychiatric
symptoms (e.g., Corrigan, Markowitz, Wat
-
son, Rowan, & Kubiak, 2003; Schumacher,
Corrigan, & Dejong, 2003).
Given that young adults with ADHD
experience social difficulties that may be
caused or compounded by others’ negative
perceptions, it seems necessary to address
these negative perceptions by developing atti-
tude change strategies. One attitude change
strategy that has been proposed is preventa-
tive disclosure—an attempt to counteract so-
cial stigma by selectively using both conceal-
ment and disclosure of one’s condition
(Joachim & Acorn, 2000; Tröster, 1997).
Those using this strategy believe that it is pos-
sible to change others’ beliefs through disclos
-
ing information about their condition. Indi
-
viduals opting to disclose preventatively may
inform only those who may witness
symptoms and not disclose when symptom
detection is unexpected.
The main proposed benefit of preventa
-
tive disclosure is that it may prevent the for
-
mation of negative impressions regarding an
individual’s condition. Schneider and Conrad
(1980) suggested that preventative disclosure
might reduce the extent to which symptoms or
complications of a condition are attributed to
other stigmatized conditions (e.g., interpret
-
ing fidgeting as a sign of a substance abuse
problem) or socially undesirable behavior
(e.g., inattention as a sign of rudeness). Disclo
-
sure has been found to prevent negative per
-
ceptions and/or misattributions of individuals
with chronic illnesses such as diabetes (Berlin,
Jastrowski et al. 275

Sass, Davies, & Hains, 2002; Berlin, Sass,
Davies, Reupert & Hains, 2005) and cystic fi
-
brosis (Berlin, Sass, Davies, Jandrisevits, &
Hains, 2005), as well as other psychiatric dis
-
orders such as Tourette’s Syndrome (Marcks,
Berlin, Woods, & Davies, 2007) and
trichotillomania (Marcks, Woods, &
Ridosko, 2005). However, no known
research has examined the impact of
disclosure on perceptions of ADHD.
Disclosing ADHD to others can be dif
-
ficult, and perhaps further complicated by the
social skills deficits common among individu
-
als with ADHD (Novotni & Petersen, 1999).
Making the decision to disclose involves col
-
laboration of the individual with ADHD,
his/her health care provider(s), and perhaps
family members or significant others. Health
care providers are often consulted about the
consequences of ADHD disclosure. Although
providers may have anecdotal evidence for the
benefits of disclosure, without empirical evi-
dence, the appropriateness of such recommen-
dations remains questionable. Therefore, the
present study aimed to investigate preventa-
tive disclosure in a way that may prove useful
to health care professionals.
The overall purpose of the present
study was to explore the effects of preventa-
tive disclosure of ADHD on young adults’ per-
ceptions of a hypothetical peer exhibiting
ADHD symptoms. Scant research exists per
-
taining to young adults with ADHD, as much
of what is known about ADHD is drawn from
work with children. An analogue design was
utilized to explore how a simplified preventa
-
tive disclosure of ADHD influenced attribu
-
tions about an individual with ADHD. Ana
-
logue designs are well–suited for this purpose
because they increase control by reducing the
number of confounding variables that exist in
naturalistic settings (Hintze, Stoner, & Bull,
2000). Although analogue designs have limi
-
tations, given the potential negative social
ramifications of disclosure, some preliminary
evidence for the positive effects of disclosure
seemed warranted before proceeding to
clinical samples and/or non–analogue designs.
The current investigation hypothesized
that a preventative disclosure of ADHD
would lead to: 1) fewer socially rejecting atti
-
tudes, and 2) positive attitudes about the
benefits of treatment. Due to limited research
in this area, no specific hypotheses were made
regarding ADHD symptom clusters; however,
this variable was included as it may moderate
disclosure status.
METHOD
Participants
There were a total of 306 participants,
67% of whom were currently undergraduate
students. Fifty–six percent were female, and
ages ranged from 18 to 26 years (M = 22.5
years, SD = 2.03 years). In terms of ethnicity,
the majority (85%) of the sample was Cauca
-
sian. The majority of participants were single
(92%), with the others married (7%) or di-
vorced/separated/widowed (4%).
Materials
The first page of the survey consisted of
questions pertaining to demographic infor-
mation. Each participant read one of four vi-
gnettes created specifically for this study. Vi-
gnettes were based on the social–skills deficits
most common among adults with ADHD
(Novotni & Petersen, 1999). The vignettes
differed according to a two (ADHD symptom
presentation: hyperactive vs. inattentive) by
two (preventative disclosure of disorder vs.
nondisclosure) design. The vignette is pre
-
sented in Table 1 with altered items stated par
-
enthetically. Respondents were presented 16
questions regarding the character described in
the vignette. The items and vignettes were de
-
veloped by one clinical psychologist and two
clinical psychology graduate students with
extensive professional experience related to
disclosure and/or ADHD.
Procedure
Participants were selected based on a
snowball sampling technique, in which stu
-
dents from a psychology course, blind to the
276 Disclosure of ADHD

study’s hypotheses, identified eight or more in
-
dividuals willing to participate in the study.
Once informed consent was obtained, partici
-
pants were directed to an on–line survey to fa
-
cilitate data collection. Completion of the
questionnaire took approximately 20 minutes.
A paper–and–pencil version was offered for
participants who preferred this method or who
were unable to access the Internet. The Institu
-
tional Review Board approved the study, and
informed consent was indicated by the comple-
tion of the survey. The only potential benefit of
participating was extra credit in a psychology
course, if so allowed. After reading the ran-
domly distributed vignette, participants were
asked to rate how much they agreed or dis-
agreed with the statement contained in each of
the 16 items. The statements ranged on a con-
tinuum from strongly disagree to strongly
agree.
RESULTS
In order to reduce the number of items
and increase the reliability of the dependent
variables, an exploratory factor analysis was
conducted on the 16 items developed for this
study. Items were developed to reflect compo
-
nents of Joachim and Acorn’s (2000) model
relevant to ADHD. In particular, items were
designed to reflect socially rejecting attitudes
toward the vignette character and to assess the
extent to which respondents would encourage
the vignette character to seek professional
help. This study’s sample size (N = 306) ex
-
ceeded standard recommendations of five to
ten cases per measure suggested for factor
analysis (Comrey & Lee, 1992; Gorsuch,
1983).
To determine the number of factors to
extract, a parallel analysis (Reise, Waller, &
Comrey, 2000) was conducted. In this pro
-
cess, two preliminary factor analyses were
conducted; one with the actual data from this
study, and the other using a dataset of ran
-
domly generated values that had the same
number of items and participants as the actual
data. The eigenvalues from these preliminary
factor analyses were then scree–plotted and
compared to determine the point at which the
eigenvalues for the actual data dropped below
the eigenvalues for the random data. This
comparison suggested that three factors
should be extracted.
Based on the suggestions of Russell
(2002), exploratory factor analysis was then
conducted using the correlation matrix, prin-
cipal axis factoring (to extract three factors),
and promax rotation. The three factor scores
were then computed by summing their respec
-
tive items or their reversed values if the item
had a negative loading. Items were excluded
from factors if they loaded on multiple scales
or had pattern matrix loadings below 0.35.
The third factor was not included in further
analyses given the unacceptable internal con
-
sistency (alpha = .42) and insufficient number
of items to form a factor (questions 12 and
15). Although the alpha coefficient for the sec
-
ond factor is low, it is still considered accept
-
able for the subsequent analyses (Bank,
Dishion, Skinner, & Patterson, 1990;
Patterson, 1986). The scores were then stan
-
dardized to correspond to a mean rating on
the five–point scale. Consequently, score in
-
terpretations were based on the actual rating
scale, so that a mean score of 3.0 would corre
-
spond to the average response of “somewhat
agree.” Table 2 shows the items, pattern fac
-
Jastrowski et al. 277
Table 1. Vignette with Altered Items Indicated in Brackets
Jamie has been a friend of yours for about a year. You enjoy spending time together, but you have noticed some things about
Jamie that have begun to annoy you. [Jamie is often quite fidgety and seldom sits still, even when talking one–on–one with
you. Jamie always talks more than any other friend you have, even when it seems inappropriate for what you are doing. Jamie
often interrupts when you or someone else in a group is talking. Several of your friends have commented that Jamie seems rude
and self–centered.] vs. [Often when you are talking, Jamie is busy doing multiple tasks and appears to not be paying full atten
-
tion to what you say. Jamie usually shows you later that most of what was said in the conversation was remembered, but there
are sometimes spots of the conversation that are not recalled. Jamie seems increasingly irresponsible: coming late for meeting
times, not following through on promises made to you, and losing important papers and other items.] [Recently, Jamie told
you about having a long–standing diagnosis of attention–deficit/hyperactivity disorder, and that these behaviors are common
for people with this neurobehavioral disorder.] vs. [None]

tor item loadings, and the internal consistency
alpha coefficients based on the unweighted
sum of factor items. The two factors to be used
as dependent variables were then operation-
ally defined as follows: “Socially Rejecting At-
titudes,” the extent to which respondents
would limit social contact with vignette char
-
acter and “Potential Benefits with Treat
-
ment,” the extent to which respondents
believe that the vignette character would
benefit from either medical or psychological
intervention to address problematic
behaviors.
To test the hypotheses of interest, a two
(preventative disclosure vs. non–disclosure)
by two (inattentive vs. hyperactive/impulsive
symptoms) Multivariate Analyses of Variance
(MANOVA) was conducted. A Bonferroni
adjustment was used to control for Type 1 er
-
rors resulting in an alpha level of .017 (.05/3)
for these analyses. A denominator of three
was used given the two main effects and one
two–way interaction. Multivariate omnibus
results failed to find a significant two–way in
-
teraction, Wilks’ Lambda =.99, F (2, 305) =
0.88, p = .42; however, results indicated sig
-
nificant effects of Disclosure, Wilks’ Lambda
= .74, F (2, 305) = 52.56, p < .0001 and Symp-
tom Presentation, Wilks’ Lambda =.91, F (2,
305) = 15.27, p < .0001. With regard to pre-
ventative disclosure, follow–up univariate
analyses revealed that disclosure of ADHD led
to less socially rejecting attitudes, F (1, 306) =
67.07, p < .0001, d = –0.95, and increased be
-
liefs that the character would benefit from
treatment, F (1, 306) = 10.68, p < .0001, d =
0.39. With regard to ADHD symptom presen
-
tation (inattentive versus hyperactive/impul
-
sive), univariate analyses revealed that char
-
acters who presented with hyperactive/
impulsive symptoms were viewed as more
likely to benefit from medical or psychological
treatment, F (1, 306) = 10.68, p < .0001, d =
0.50; however, no significant differences at p
< .017 were found between the ADHD symp
-
tom presentation groups (inattentive versus
hyperactive/impulsive) in terms of socially re
-
jecting attitudes, F (1, 306) = 3.97, p = 0.047,
d = 0.25. Table 3 provides the means,
standard deviations, and sample sizes for the
follow–up univariate analyses.
278 Disclosure of ADHD
Table 2. Items,* Item Factor Loadings (FL) from Factor Pattern Matrix and Factor Alpha Coefficients
123
Socially Rejecting Attitudes (alpha = .82)
4. It would be hard to spend time with Jamie. .786
8. My friendship with Jamie would be at risk. .738
5. I would try to limit the amount of time I spend with
Jamie. .737
1. I would be personally hurt by Jamie’s behaviors. .684
7. Jamie’s behaviors would drive me crazy. .675
2. I would probably continue the relationship with
Jamie. –.580
13. I would not take these behaviors personally. –.491
Potential Benefits with Treatment (alpha = .61)
9. Jamie would benefit from psychotherapy. .584
16. Jamie would probably benefit from medication. .530
10. I would feel sorry for Jamie. .522
3. Jamie has some significant problems. .403
6. Jamie probably has trouble keeping friends. .365
Excluded Items
11. My relationship with Jamie would probably improve
over time. –.398 .373
14. Trying to improve the relationship with Jamie would
be a waste of time. .395 –.511
12. I would talk to Jamie about these behaviors. .603
15. Sharing my concerns with Jamie would probably
improve these behaviors. .492
Note. *Items to be reversed scored have been indicated with the letter “r” after item number.

DISCUSSION
The primary purpose of this investiga
-
tion was to explore the impact of a preventa
-
tive ADHD disclosure on perceptions of
young adults with ADHD. Since persons with
ADHD are likely to experience social difficul
-
ties, which may in part be caused or com-
pounded by others’ negative perceptions, re-
searchers and clinicians have called for the
development of attitude change strategies,
such as preventative disclosure. Research has
shown that preventative disclosure may pre-
vent others from forming negative impres-
sions and may reduce the extent to which
symptoms of a disorder are attributed to other
stigmatized conditions (e.g., Berlin et al.,
2002, 2005; Marcks et al., 2007; Marcks et
al., 2005). As hypothesized, the current study
found that disclosure of ADHD led to less so
-
cially rejecting attitudes and more positive at
-
titudes about the benefits of professional help.
There was a large effect of preventative disclo
-
sure on socially rejecting attitudes and a
medium effect on beliefs that characters
would benefit from treatment.
Results provide support for Joachim
and Acorn’s (2000) theoretical framework re
-
garding preventative disclosure. The findings
suggest several benefits of disclosure. First, the
data indicate that individuals with ADHD
who disclose their diagnosis may prevent neg
-
ative social consequences, such as social rejec
-
tion. Given previous research findings sug
-
gesting that persons with ADHD are at risk
for social difficulties, this finding is of particu
-
lar importance. If preventative disclosure of
ADHD can indeed reduce socially rejecting at
-
titudes as the data suggest, it could be a
beneficial strategy to curtail negative social
outcomes. This effect does not appear to be
significantly influenced by symptom presenta
-
tion. Additionally, the findings from the cur
-
rent study indicate that by disclosing one’s di
-
agnosis of ADHD, peers may be more likely to
see the benefits of treatment—which may be
especially so in the case of individuals who
present with predominantly hyperactive/im-
pulsive symptoms. Although not assessed in
the present study, this may potentially facili-
tate the process of obtaining social support
from peers and possibly mitigate some of the
stigmatizing attitudes others hold toward
individuals with psychological disorders.
If replicated in clinical samples, these
findings would have important clinical impli-
cations. For instance, mounting evidence sug
-
gests that a variety of existing approaches (e.g.,
social skills training, behavioral and cogni
-
tive–behavioral treatments) may not be viable
or beneficial for young adults with ADHD
(Barkley, 2004). Should the results of the pres
-
ent study replicate with clinical samples of
young adults with ADHD, this basic interven
-
tion of preventative disclosure could have a sig
-
nificant impact on the quality of life and
psychosocial functioning of those with ADHD.
Furthermore, these results have significant im
-
plications for health care providers, as well as
for young adults and parents of adolescents
with ADHD. Although health care providers
may rely on anecdotal evidence or clinical judg
-
ment when espousing the benefits of preventa
-
tive disclosure of ADHD, prior to this study, no
empirical evidence existed for these benefits.
The results from the current study do indeed
Jastrowski et al. 279
Table 3. Descriptive Statistics Comparing the Effects of Disclosure Status and ADHD Type on Socially Rejecting
Attitudes and Potential Benefits with Treatment
Socially Rejecting Attitudes Potential Benefits with Treatment
Disclosure Status MSD n d MSD n d
Non–Disclosure 2.95
1
0.57 151 0.95 3.10
2
0.55 151 –0.39
Preventative Disclosure 2.37
1
0.64 159 3.31
2
0.55 159
Symptom Presentation
Hyperactive/Impulsive 2.56
ns
0.63 147 –0.25 3.35
3
0.53 147 0.50
Inattention 2.73
ns
0.70 163 3.08
3
0.56 163
Note. Similar superscripted numbers represent significant mean differences between the main effects[comma here] with “ns” rep
-
resenting non–significant differences at the .017 level.

suggest possible benefits for disclosure of
ADHD. This may provide the initial founda
-
tion for health care providers making recom
-
mendations concerning disclosure. Should
these results be replicated in clinical samples,
this line of research may ultimately aid individ
-
uals with the disorder and their families in the
decision-making process.
Several limitations of the current study
should be taken into consideration. First, the
presentation of ADHD—in terms of both the
nature and severity of symptoms—varies sig
-
nificantly across individuals with ADHD and
as a function of medication. The present study
investigated two (predominantly inattentive
and predominantly hyperactive/impulsive
symptoms) of the many possible presentations
of ADHD. Although both symptom clusters
typify young adults diagnosed with ADHD
(Novotni & Petersen, 1999), the validity of
the inattentive versus hyperactive distinction
employed in the present study will need to be
further evaluated in future research.
Research suggests that ADHD is often
comorbid with other psychiatric disorders
(Flannagan, Pillow, & Wise, 2002) and that in-
dividuals with ADHD are at increased risk for
personality disorders in adulthood (Hinshaw,
1987). However, it could be argued that the hy-
peractive/impulsive vignette depicted
maladaptive personality characteristics (e.g., the
description of Jamie as “rude and self–cen
-
tered”) in a way that may have confounded the
comparison between the inattentive and hyper
-
active/impulsive presentations. It may also be
the case that the inattentive vignette character
exhibited relatively adaptive social interaction
skills (e.g., “Jamie usually shows you later that
most of what was said in the conversation was
remembered”). Nevertheless, in the present
study, there was not a significant difference be
-
tween the hyperactive/impulsive and inattentive
characters in terms of socially rejecting atti
-
tudes. On the other hand, the inattentive char
-
acter was viewed as being less likely to benefit
from medical or psychological intervention,
which may indicate that the inattentive charac
-
ter was viewed as exhibiting less significant
problems and/or having less trouble keeping
friends.
Furthermore, it is possible that as the to
-
pography and severity of ADHD symptoms
vary, so may the effects of preventative disclo
-
sure, thus potentially limiting the
generalizability of the findings. Though it was
not the purpose of the present study, it will be
important for future studies to determine
whether preventative disclosure is differen
-
tially beneficial for individuals with predomi
-
nately inattentive versus hyperactive/impulsive
ADHD symptoms. In addition, although pre
-
ventative disclosure produced benefits in this
study, it is possible that certain participant
characteristics, such as ethnicity, socioeco
-
nomic status, or geographic region, may im
-
pact the effects of disclosure. Thus, these re
-
sults need to be replicated in other, more
diverse, samples. Additionally, information re
-
garding behaviors obtained in analogue studies
may fail to correlate with actual behaviors
(Hintze et al., 2000). Perhaps participants’ re-
sponses in the current study reflected socially
desirable attitudes; conversely, participants
might have strongly agreed with the item, “I
would try to limit the amount of time I spend
with Jamie,” and yet, they might not actually
do so when interacting with peers in their daily
lives. The degree to which participants’ self–re-
ports and actual “real–life” behaviors corre-
spond would likely depend on numerous fac-
tors, including the nature of their relationship
with the peer disclosing ADHD. Regardless, it
is reassuring that ascribing a diagnosis of
ADHD did not appear to confer a negative
stigma in the present study. Despite the limita
-
tions of analogue designs, preliminary evidence
for the positive effects of disclosure seemed
warranted before proceeding to clinical sam
-
ples. Thus, efforts should be made to determine
how the results obtained in the current study
generalize to a clinical population.
There are several avenues for future
research. Since disclosure is a complex and dy
-
namic process that is difficult to examine in an
experimental manner, future studies should
explore the effects of disclosure using a wide
array of methodologies and techniques that
more closely approximate this process as it oc
-
curs in the lives of individuals with ADHD.
With these new approaches, efforts should
280 Disclosure of ADHD

also be made to assess the validity of the mea
-
sures and improve the reliability coefficients.
Research should also assess variables that
may moderate the effects of disclosure. One
possible moderating variable that was not
measured or controlled for in this study was
prior knowledge about ADHD. It is likely that
if an individual is educated about ADHD,
his/her responses may be very different than
those with little knowledge about the disor
-
der. Also, given the high rates of psychiatric
comorbidity, the effects of disclosure may
vary as a function of the symptoms of ADHD
and/or other psychiatric disorders. Future in
-
vestigations should explore these issues. The
current study did not examine potential risks
for those who do not disclose, such as
misattribution of ADHD symptoms to an
-
other condition. Examining such risks is an
important area for future work, especially in
light of preventative disclosure research sug
-
gesting that failing to disclose Tourette’s Syn
-
drome and diabetes can lead to
misattributions of symptoms to substance
abuse problems (Berlin et al., 2005; Marcks,
Berlin, et al., 2007). The primary goal of the
current study was to begin investigating the
clinical utility of preventative disclosure in
ADHD, and in doing so, encourage additional
research on the viability and effectiveness of
preventative disclosure. Such work has the
potential to have significant clinical
implications for health care providers, young
adults with ADHD, and their families.
REFERENCES
American Psychiatric Association. (2000). Diag-
nostic and Statistical Manual of Mental Disor-
ders (4th ed. Text Revision). Washington, DC:
Author.
Anastopoulos, A.D., & Shaffer, S.D. (2001). At-
tention–deficit/hyperactivity disorder. In C.E.
Walker & M.C. Roberts (Eds.), Handbook of
Clinical Child Psychology (3rd ed.) (pp.
470–494). New York: Wiley.
Bank, L., Dishion, T., Skinner, M., & Patterson,
G. R. (1990). Method variance in structural
equation modeling: Living with “glop.” In G. R.
Patterson (Ed.), Depression and Aggression in
Family Interaction (pp. 247–279). Hillsdale, NJ:
Erlbaum.
Barkley, R.A. (1996). Attention–deficit/hyper
-
activity disorder. In E.J. Mash & R.A. Barkley
(Eds.), Child Psychopathology (pp. 63–112).
New York: Guilford.
Barkley, R.A. (2004). Adolescents with atten
-
tion–deficit/hyperactivity disorder: An overview
of empirically based treatments. Journal of Psy
-
chiatric Practice, 10, 39–56.
Barkley, R.A., Fischer, M., Edelbrock, C.S., &
Smallish, L. (1990). The adolescent outcome of
hyperactive children diagnosed by research cri
-
teria: I. An 8-year prospective follow–up study.
Journal of the American Academy of Child and
Adolescent Psychiatry, 29, 546–557.
Barkley, R.A., Guevremont, D.C.,
Anastopoulos,A.D., & Fletcher, K.E. (1992). A
comparison of three family therapy programs
for treating family conflicts in adolescents with
attention deficit hyperactivity disorder. Journal
of Consulting and Clinical Psychology, 60,
450–462.
Berlin, K. S., Sass, D. A., Davies, W. H., &
Hains, A. A. (2002). Impact of diabetes disclo
-
sure on perceptions of eating and self–care be
-
haviors. Diabetes Educator, 28, 809–816.
Berlin, K. S., Sass, D. A., Davies, W. H.,
Jandrisevits, M. D., & Hains, A. A. (2005). Cys
-
tic fibrosis disclosure may minimize risk of nega
-
tive peer evaluations. Journal of Cystic Fibrosis,
4, 169–174.
Berlin, K. S., Sass, D. A., Davies, W. H., Reupert,
S. R., & Hains, A. A. (2005). Parent perceptions
of hypoglycemic symptoms of youth with diabe
-
tes: Disease disclosure minimizes risk of negative
evaluations. Journal of Pediatric Psychology,
30, 207–212.
Biederman, J., Faraone, S., Milberger, S., Guite,
J., Mick, E., Chen, L., et al. (1996). A prospec
-
tive 4–year follow–up study of attention–deficit
Jastrowski et al.
281

hyperactivity and related disorders. Archives of
General Psychiatry, 53, 437–446.
Biederman, J., Monuteaux, M.C., Doyle, A.E.,
Seidman, L.J., Wilens, T.E., Ferrero, F., et al.
(2004). Impact of executive function deficits and
attention–deficit/hyperactivity disorder
(ADHD) on academic outcomes in children.
Journal of Consulting and Clinical Psychology,
72, 757–766.
Comrey A. L., & Lee, H. B. (1992). A
first course in factor analysis (2nd ed.).
Hillsdale, NJ: Erlbaum.
Corrigan, P., Markowitz, F. E., Watson, A., Ro
-
wan, D., & Kubiak, M. A. (2003). An attribu
-
tion model of public discrimination towards
persons with mental illness. Journal of Health
and Social Behavior, 44, 162–179.
Crisp, A. H., Gelder, M. G., Rix, S., Meltzer, H.
I., & Rowlands, O. J. (2000). Stigmatisation of
people with mental illnesses. British Journal of
Psychiatry, 177, 4–7.
Flannagan, D., Pillow, D.R., & Wise, J.C.
(2002). Perceptions and communications about
ADHD and ODD behaviors in children with
combined type attention deficit hyperactivity
disorder. Children’s Health Care, 31,223–236.
Goldstein, S. (1999). Attention–deficit/hyperac-
tivity disorder. In S. Goldstein & C.R. Reynolds
(Eds.), Handbook of Neurodevelopmental and
Genetic Disorders in Children (pp.154–184).
New York: Guilford.
Gorsuch, R. L. (1983). Factor Analysis. (2nd
ed.). Hillsdale, NJ: Erlbaum.
Hart, E., Lahey, B., Loeber, R., Applegate, B., &
Frick, P. (1995). Developmental change in atten
-
tion–deficit/hyperactivity disorder in boys: A
four–year longitudinal study. Journal of Abnor
-
mal Child Psychology, 23, 729–749.
Hinshaw, S.P. (1987). On the distinction be
-
tween attentional deficits/hyperactivity and con
-
duct problems/aggression in child
psychopathology. Psychological Bulletin, 101,
443–463.
Hintze, J. M., Stoner, G., & Bull, M. H. (2000).
Analogue assessment: Research and practice in
evaluating emotional and behavioral problems.
In E. S. Shapiro, & T. R. Kratochwil (Eds.), Be
-
havioral Assessment in the Schools: Theory, Re
-
search, and Clinical Foundations (2nd ed.) (pp.
104–138). New York: Guilford.
Joachim, G., & Acorn, S. (2000). Stigma of visi
-
ble and invisible chronic conditions. Journal of
Advanced Nursing, 32, 243–248.
Klein, R.G., & Mannuzza, S. (1991). Long–term
outcome of hyperactive children: A review. Jour
-
nal of the American Academy of Child and Ado
-
lescent Psychiatry, 30, 383–387.
Marcks, B. A, Berlin, K. S., Woods, D. W.,
Davies, W. H. (2007). A preliminary investiga
-
tion on the impact of tourette’s syndrome disclo
-
sure on peer perceptions and social functioning.
Psychiatry: Biological and Interpersonal Pro
-
cesses., 1, 59–67.
Marcks, B. A., Woods, D. W., & Ridosko, J. L.
(2005). The effects of trichotillomania disclo
-
sure on peer perceptions and social acceptabil
-
ity. Body Image: An International Journal of
Research, 2, 299–306.
Novotni, M., & Petersen, R. (1999). What Does
Everybody Else Know That I Don’t? Social
Skills Help for Adults with Attention Defi-
cit–Hyperactivity Disorder (AD/HD). Planta-
tion, FL: Specialty Press.
Pelham, W.E., & Milich, R. (1984). Peer rela-
tions of children with hyperactivity/attention
deficit disorder. Journal of Learning Disabili-
ties, 17, 560–568.
Reise, S. P., Waller, N. G., & Comrey, A. L.
(2000). Factor analysis and scale revision.
Psy
-
chological Assessment, 12, 287–297.
Russell, D. W. (2002). In search of underlying
dimensions: The use (and abuse) of factor analy
-
sis in personality and social psychology bulletin.
Personality and Social Psychology Bulletin, 28,
1629–1646.
Schneider, J. W., & Conrad, P. (1980). In the
closet with illness: Epilepsy, stigma potential
and information control. Social Problems, 28,
32–44.
Schumacher, M., Corrigan, P. W., & Dejong, T.
(2003). Examining cues that signal mental ill
-
ness stigma. Journal of Social and Clinical Psy
-
chology, 22, 467–476.
Tröster, H. (1997). Disclose or conceal? Strate
-
gies of information management in persons with
epilepsy. Epilepsia, 38, 1227–1237.
282 Disclosure of ADHD