EEoL- ADHD and Convenience

Running head: ADHD and Convenience 1
The Effect of Experience on Labeling: ADHD and Convenience
Maxwell Birdnow
University of Central Missouri
Author Note
Thisresearchwas conductedbyMaxwell Birdnow underthe directionof Dr.StevenSchuetz
withthe Departmentof Psychological Science atthe Universityof Central Missouri.

ADHD and Convenience 2
Abstract
Attention-deficit/hyperactivitydisorderaffects 3-5% of all Americanchildren.Due tothe
massive increase inADHDdiagnosesinthe pastfew decades,manypubliccirclesare concernedthat
ADHD may be frequentlymisdiagnosed.If thisisaccurate,there mustbe a cause of thismisdiagnosis. In
thisexperiment,we explore one possiblecause of thisphenomenon:convenience. Convenience refers
to anythingthatfacilitatesease inlife. Convenience asaconstruct ishighlyvaluedinWestern cultures
due to itspotential tosave time andmake life easier. A diagnosisof ADHDisconvenientforall of the
partiesinvolved:it grantschildrenaccesstoreimbursabletherapies(butespeciallystimulants),it
relievesparentsandteachersfromthe presence of arambunctiouschild,anditprovidesaneasy
explanationfordifficultbehavior. Therefore,conveniencemaycause practitionerstomore readily
diagnose ADHD. 150 college studentswereprimedforone of fourlevelsof convenience andaskedto
respondtothree vignettesdescribingdifferentlevelsof ADHD. Several chi-square testsof independence
were usedtodetermine the relationshipbetweenprimingandthe likelihoodof adiagnosis. There was
not a statisticallysignificantrelationshipbetweenthe type of primingandthe likelihoodof adiagnosis.

Introduction
Attention-deficit/hyperactivitydisorder(ADHD) hascausedcontroversyinpublicand
professionaldomains. Asdiagnosisratescontinue toclimb,manyare worriedthatmisdiagnosisand
overdiagnosismaybe a widespreadproblem.Withthe problemof overdiagnosiscomesthe problemof
excessivemedicalizationof ADHD. Inthe UnitedStates,3-5% of all school-agedchildrenare currently
diagnosedwithADHD(Kristjansson,2009). Thisis a massive increase in the rate of diagnosissince the
1970’s, whendiagnosiswas“virtuallynonexistent”(Connor,2011). Before one can considerwhathas
causedthisgradual rise indiagnosis,one mustunderstandthe criteriaforandhistoryof ADHD.
The firstempirically-testedsetof diagnosticcriteriaforwhatwouldbecome ADHDwas
includedinthe DSM-III.Itwascalledattention-deficitdisorder,andthe diagnosiscouldbe further
qualifiedas“withhyperactivity”or“withouthyperactivity”.The 1987 revision,DSM-III-Rshiftedthe
focusmore toward inattentivenessandthe disorderwasrenamedattention-deficit/hyperactivity
disorder(Goldman,Genel,Bezman,&Slanetz,1998). The DSM-IV dividedthe disorderintothree
subtypes:predominantlyinattentive type,predominantlyhyperactive-impulsive type,andcombined
type (Diagnosticandstatistical manual of mental disorders:DSM-IV,1994).The DSM-V (2013) keptthese
subtypes.
Those diagnosedwithpredominantlyinattentive type mustexhibitsix of nine inattentive
symptoms,suchas “difficultyorganizingtasksandactivities”orfrequentforgetfulness(Diagnosticand
statistical manual of mental disorders:DSM-IV,1994).Those withpredominantlyhyperactive-impulsive
type mustexhibitsix of nine hyperactive-impulsive symptoms,suchasexcessive fidgetingorclimbingon
thingswhenitisnot appropriate todo so.Those withcombinedtype meetcriteriaforboth othertypes.
For a diagnosisof anytype,all symptomsmusthave persistedfor atleastsix monthsandmanifestedin
a maladaptive way.Clinicallysignificantimpairmentmustbe evident inmultiple settings.Finally,the

symptomsmustnotbe the resultof one of several otherdisorders(Diagnosticandstatistical manual of
mental disorders:DSM-IV,1994).
The criteriafor a diagnosisof ADHDremainedlargelyunchangedbetweenthe DSM-IV and
the DSM-V.The maindifference betweenthemisthatthe DSM-V increasedthe maximum age of onset
for a diagnosisfromage seventoage twelve (Batstra etal.,2012). Those waryof misdiagnosisfearthat
increasingthe maximumage of onsetmayleadpeople the confuse ADHDsymptomswith signsof
natural development,suchas“pubertal restlessnessanddistractibility”(Ward,2013).
Tenpercentof all childreninthe UnitedStatesare labeledbyatleastone source as
“hyperactive”(Kristjansson,2009). About75% of all ADHD diagnosesare applied tomales(Singh,2008).
Seventypercentof all childrendiagnosedwithADHDcontinue havingsymptomsintoadulthood
(Kristjansson,2009). The US hasthe highestratesof diagnosisandmedicatedtreatmentof ADHDof any
Western,developednation(Morrow etal.,2012). About10-12% of boysinthe US are currently
prescribedRitalin (Kristjansson,2009). Childreninthe UnitedKingdomare twentytimeslesslikelyto
receive adiagnosisof ADHDthan childreninthe US (Kristjansson,2009). The prevalence rate of ADHDis
highestinSouthAmericannations,where 11.8 percentof school childrenare diagnosedwiththe
disorder(Singh,2008). The disparity of diagnosis ratesbetweenregions ispartiallydue tothe use of the
DSM insome regionsand the use of the WorldHealthOrganization’s ICDinothers. The ICDcriteriafor a
diagnosisof hyperkineticdisorder(the ICDequivalentof ADHD) are more stringentthanthe DSM
criteriaforADHD. While the DSMliststhree subtypesof ADHDandrequirescriteriapercentagesfora
diagnosisof eachof them,the ICD requiresindividualstoshow “hyperactivity,inattentionand
impulsivity”inordertobe consideredforadiagnosis(Singh,2008). Studieshave shownthatdoctors
usingthe DSM-IV to diagnose ADHDratherthan the ICD-10 are three to fourtimesmore likelyto

diagnose ADHD(Singh,2008). Regardless,thesedisparitiesinratesof diagnosisbetweendifferent
regionsdemonstrate possible overdiagnosis,andinotherpopulations underdiagnosis,of ADHD.
The questionedethicsof diagnosis of ADHDandtreatmentwithstimulantdrugsisreflected
withinthree mainpublicopinionsregardingthe underlyingcause of ADHD. People of the biological
standpointbelievethe disorderisentirelygenetic,whichjustifies diagnosisandtreatmentwithdrugs
(Singh,2008). Those of the bio-social standpointbelievethatADHDis causedbya myriadof geneticand
environmental factors,andtherefore “diagnosisdoesnotyetadequatelycapture the heterogeneityand
complexityof the disorder”(Singh,2008). Theybelievethatstimulantinterventionisjustified afterother
interventionsand/ortherapieshave beenutilized. Kristjansson(2009) notesthatovermedicalizationof
social problemstakesawayfromindividual accountability,“improperlydecontextualisesand
depoliticisessocial issues”,andgetspeople’shopesupforanidealisticworldwithoutsuffering. Finally,
those whobelieveinanenvironmental cause of ADHDbelieve thatthe disorderisdevelopedsolelyfrom
one’senvironment. Thisincludessocial interaction,media,andcertainfoodsandsubstances.People of
thisstandpointtypicallyavoidstimulantmedicationstotreatADHD (Singh,2008).
A fourthstandpoint,whichissometimesassociatedwiththe Churchof Scientology,is that
ADHD isa fictitiousdisorder(Singh,2008).Some psychiatrists,psychologists, andotherintellectualsalso
holdthisview,probablyformore empirical reasons. Inhiscontroversial book ADHDDoesNotExist, Dr.
RichardSaul,behavioral neurologist, explicatesthatADHD,ratherthan beinga unitarydisorder,ismore
accuratelydescribedasa culminationof overtwentyotherconditionsanddisorders(Saul,2014). These
include mooddisorders,visionproblems,hyperthyroidism, sleepproblems,learning disabilities,and
OCD (Saul,2014). Accordingto Dr. Saul,providingarushed,carelessdiagnosisof ADHDpreventsor
delayspatientsfromgettingmore appropriate treatment(Saul,2014).He alsopositsthattreatment

withunnecessarystimulantsmayleadtofurthercomplications,suchassleepdisruption,decreased
appetite,andsubstance abuse (Saul,2014).
While notall skepticsof ADHDare as extreme intheirviews asRichardSaul,hisconcerns
aboutthe dangersof overdiagnosis andstimulantmedicationare fairlycommon amongothergroups.
Accordingto the AmericanAcademyof Pediatrics,childrencanbe diagnosed withADHDandtreated
withmethylphenidate (Ritalin)atas youngas age four (“ADHD:Clinical Practice Guideline”,2011).
Childrenthisyoung are especiallysusceptible tothe side effectsof stimulantmedications.Inadditionto
the complicationslistedabove,stimulantuse mayalsoleadtoheadaches,agitation,abdominalpain,
and,particularlyinpreschoolers,failure togainweightappropriately(Frances,2011). Criticsof stimulant
treatmentinchildpopulations oftennote thatthe safetyof suchdrugshas not beenadequatelytested
ina sample thatgeneralizesto targetpopulations(Frances,2011). Afterall,testingstimulantdrugson
childrenwouldbe unethical,sotheyare onlytestedonadults (Singh,2008).
In additiontothe biological risksassociatedwithtreatment,thereare alsopsychological and
social implicationsthatcome witha diagnosis. Some sourcesargue thatadiagnosis mayignore the
social dimensionscausingdifficulties(Batstra etal.,2012).The stigmathat surroundsa childwithADHD
affectshisrelationshipwithhispeers,histeachers,andhimself (Batstra etal.,2012). Inadditionto
potential prejudice anddiscriminationfrompeers, self-stigmacanleadtodecreasedself-efficacy,low
self-esteem, andreducedconfidence inthe future (Batstraetal.,2012). Once a childisdiagnosed,his
teachersandparentsmay begintoexpectnegative behavior fromhimandnegative interactionswith
him.The child,inresponse,performspoorly,leadingadultstofurtherlowertheirexpectations. Thisis
calledthe PygmalionEffect (Batstraetal.,2012). If overdiagnosis of ADHDisan existingproblem, then
those whoare diagnosedhaphazardlyare stigmatizedfornoreason(Ward,2013). Finally,overdiagnosis

may leadparentsandteachersto be skeptical of all ADHDdiagnoses.Thisbecomestroublesomewhen a
professionalprovidesadiagnosisto achildwhogenuinelyhasthe disorder(Ward,2013).
AnotherproblemassociatedwithrisingratesinADHD diagnosesisthatof diversion.
Accordingto Gallucci,Martin,and Usdan (2014), “diversionisdefinedasthe unlawful channelingof
regulatedpharmaceuticalsfromlegal sourcestothe illicitmarketplace.” Goldman etal. (1998) found
that diversionof stimulantmedicationsintendedtotreatADHD was nota majorproblematthe time,
but that itmightsoonbecome one giventhe contemporarytrendsof diagnosisandtreatment.
Seventeenyearsworthof time mayhave allowedstimulantdiversiontoprogresstoa problematiclevel.
McCabe, Teter,andBoyd (2004) interviewed1,536 middle andhighschool studentsabouttheir licitand
illicituse of stimulants.Of those interviewed, 4.5% of studentsreported illicituse of stimulant
medications (McCabe,Teter,&Boyd,2004). Of the studentsprescribedstimulantmedications,23.3%
had beenapproachedbyotherstudentswith the intentionof buyingortradingfordrugs. A more recent
college-level studyfoundthat58.9%of stimulantprescription-holdershave soldtheirmedicationat
leastonce (Gallucci,Martin,& Usdan,2014). The motive fordiversionwastypicallyeither“tomake
money”or to “helpsomeone out”duringastressful academicperiod (Gallucci etal.,2014). People who
diverttheirmedication were found more likelytobelongtoafraternityoran at-riskpeergroup
(DeSantis,Anthony,&Cohen,2013). Theywere more likelytomisuse ornotuse theirmedicationaswell
as overestimatehowmanypeople abusestimulants(DeSantisetal.,2013).
There are,of course,prosto accurate and appropriate diagnosis.These includeaccessto
treatment,reimbursementfortreatment,andaccesstospecial education.Diagnosisalsoprovides
statisticsforresearch.Indeed,if ADHDistobe studiedmore closely,“careful,safe follow-upof children
takingpsychotropicdrugsisessential”(Singh,2008). Finally,adiagnosisvalidatesandprovidesmeaning
to the impairmentthatpeople experience (Batstraetal.,2012).

The current literature regardingthe overdiagnosisof ADHDpositsthatthe problemmustbe
amelioratedwhileavoidingthe riskof underdiagnosis. The AAPsuggestsbehaviortherapyasa firststep
to treatmentof childrenagedfourandfive (“ADHD:Clinical Practice Guideline”,2011). However,
behavioral approaches are generally ignoredbecausethey are often unavailable andbecause drugsare
ubiquitousandexpertlymarketed(Frances,2011). The AAPnotesthatif behaviortherapiesare not
available,the caretakermustweighthe risksof providingstimulantmedication tohisorher childversus
the risksof delayingdiagnosisandtreatment(“ADHD:Clinical Practice Guideline”,2011).Furthermore,
86% of childrenwhoare diagnosedhave mildormoderate cases(Jackson,2013).Thissuggeststhat
perhapsmore patientscanbenefitfrominterventions besidesstimulants.
Batstra et al. (2012) suggesta “steppeddiagnosis”forchildhoodpsychiatricdisorders,much
like the systeminthe Netherlands.Firstandforemost,theybelieve that “accesstohelpshouldbegin
witha pre-diagnosticstage”(Batstraetal.,2012). This meanswatchful observationandbrief
interventionshouldbe available andreimbursabletopeople withoutadiagnosis.Thisprevents
misdiagnosiswhile encouragingmore people toseekhelpwithoutthe fearof a diagnosis(Batstra etal.,
2012). Onlyafterthe otheroptions have beenexhausted should achildbe diagnosed andprescribed
stimulants.Thissystem wouldsave moneynotonlyforthe patients andtheirparents,butalsoforthe
insurance companiesthat maytypically provide paymentforerroneouslyprescribedmedications.
So isoverdiagnosisof attention-deficit/hyperactivitydisorderanexistingproblem?The
literature showsconflictingreports. Inthe late nineties,Goldman etal. (1998) foundthat overdiagnosis
of ADHD wasnot a widespreadproblem.JensenandKettle (1999) notedthat only12.5% of the
participantswithADHDintheirstudyhad accessto medicationfortheirdisorder.However,theyalso
notedthat some of the participantswhowere prescribedmedicationdidnotmeetthe criteriafor
ADHD, butinstead “manifestedhighlevelsof ADHDsymptoms,suggestingthatthe medicationhadbeen

appropriatelyprescribed”(Jensen&Kettle,1999). Thisstatementbringsintoquestionthe ethicsof
subjectivityinthe diagnosticprocess. Furthermore,the JensenandKettle articleisbasedon the DSM-III-
R criteria,andcriteriafor ADHD have become more inclusive witheachnew iterationof the DSM
(Jackson,2013).
A more recentarticle by Bruchmüller,Margraf,andSchneider(2012) observedthe diagnosis
habitsof one thousandpsychologists,psychiatrists,andother trainedprofessionals.Eachparticipant
was givenone of fourseparate vignettesandaskedtogive a diagnosisof the subject.Onlyone of the
vignette subjectsactuallymetthe criteriaforADHD,andthere was a male anda female versionof each
vignette.The non-ADHDvignettesexhibitedsome ADHDsymptoms,butitwasstatedthat othercriteria
were absent.Inthe end,”16.7% of patientsinnon-ADHDvignetteswere diagnosed“(Bruchmüller,
Margraf, & Schneider,2012). Thisdemonstratesthatprofessionalsoftenoverlook certain”exclusion
criteria“whenprovidingadiagnosis(Bruchmülleretal.,2012). Jackson(2013) citesfurthersystematic
diagnosisof patientswhodonotfulfill the criteriaof ADHD.
Morrow et al.(2012) researchedhow relativeage mighthave aneffectonwhetherornota
professionalprovidesachildwithanADHD diagnosis.Theyconductedacohortstudyof nearlya million
childrenaged6-12 in BritishColumbiafrom1997-2008. The cutoff date for childrentobeginschoolingin
BritishColumbiais December1st,meaningchildrenborninDecemberare alwaysthe youngestintheir
grade while childrenborninJanuaryare alwaysthe oldest.The resultsshowedthat boysbornin
Decemberwere 30%more likely toreceive adiagnosisof ADHD and41% more likelytoreceive
medicationforthe disorder(Morrowetal.,2012). Girlsbornin Decemberwere 70% more likely to
receive adiagnosisof ADHDand 77% more likelyto receivemedication (Morrow etal.,2012).
Furthermore,the relative age effectwasstable overthe decade-longstudy.Thisindicatesthatthe
youngeststudentsinanygiven grade atany school maybe more likelytoreceiveadiagnosisof ADHD

due to comparativelylowmaturity (Morrow etal.,2012). More generally,itindicatesthatcertain
populationsof studentsare atriskfor overdiagnosiswhileothers(perhapsthe oldestchildrenineach
grade) are at riskfor underdiagnosis(Morrow etal.,2012).
Some sourcesbelieve thatthe increase inADHDdiagnosesisdue toincreasedADHD
awareness(Koplewicz,2012).While awarenesshasalmostcertainlyplayedarole inthe increase of
diagnoses,otherfactorswere atplayas well.Tobeginwith, the chairsof the DSM-IV and DSM-V admit
that loweringthe thresholdfordiagnosishascreated“unreal”epidemicsof childhoodADHDandautism
(Batstraet al.,2012). Furthermore,itissuggestedthat“78% of those advisingDSM-5forADHD and
disruptive behaviourdisordersdisclosedlinkstopharmaasa potential financial conflictof interest”
(Jackson,2013). The role of drug companieshasalsoraisedsome concernsaboutoverdiagnosis. Drug
companiespromote diagnosistocontinue sellingpsychotropicdrugs(Batstraetal.,2012). Theyoftendo
thisunderthe guise of awareness,forwhichtheyoftenhire celebritiesasspokespeople(Jackson,2013).
Teachers,parents,andcurrentADHD patientsmaysee suchadvertisementsandpressure doctorsto
diagnose (Batstraetal.,2012). In additiontoadvertisements,othersocietalfactors,suchasthe
increasingrate of bothparentsworkingfull-time,maycause stressforparents,whichlowerstheir
tolerance for“individual variation”(Batstra,2012). Thisloweredtolerancemayexplainthe readinessto
attribute complex problemstoaunitarydisorder. Additionally,epidemiological studies“systematically
overstate ratesof disorder”,meaningthatundertreatmentof ADHDis overestimated(Batstra,2012).
Thiscausesalarm for more awareness,whichinturnleadstoevenmore diagnosis. Finally,teachersare
increasinglymore involvedinthe diagnosisof childreninthe UnitedStatesandCanada,withthe UK
beginningtofollowthe trend (Kristjansson,2009).
In an attemptto furtherinvestigate the source of overmedicalizationof ADHD, Kristjansson
(2009) offers anddissects fourcommonexplanations. The conservative view isthatpatientsorwould-be

patientsof ADHD supportmedicalizationtoobtainbenefits,andparentsuse the diagnosisto“passthe
buck” of beingresponsible fortheirchildren(Kristjansson,2009). While parentsactivelysearchfora
diagnosis,itisoftenmerelytoensure treatmentfortheirchildren(Kristjansson,2009). The existentialist
viewmaintainsthatpeoplehave atendencytoself-deceive,creatingaview of themselvesasunfree,
medicalizedpeople whodonothave responsibilityovertheiractions(Kristjansson,2009).By self-
deceivingpeoplewouldkeepthemselvesinthe darkabouthow to deal withtheirsymptoms.However,
mostADHD patientsandparentskeepupto date on the latestliterature aboutthe disorder
(Kristjansson,2009). The liberalistview positsthatsocial agentsplugmedicalizationtogainmoneyand
power(Kristjansson,2009). However,portraitsof crookedpoliticians,drugcompanies,andpractitioners
are merely stereotypes(Kristjansson,2009).The poststructuralistview issimilar tothe liberalistview,as
are the “culprits”of overmedicalization.However,nospecificagendaisassumedtobe inplayby any
one agentor group inthe poststructuralistview (Kristjansson,2009). Social agentsalwaysstrive for
more power,creatinganinherentlyoppressive system“withamonopolyontruth”(Kristjansson,2009).
However,doctors,teachers,andpoliticianshave been reportedasdisliking the pressure tofulfill new
rolesas ADHD diagnosticians(Kristjansson,2009).Kristjanssonnotesthatnone of these explanations
adequatelydescribe the cause of overmedicalizationandoverdiagnosis(2009).Instead,he statesthat
the “westernliberal conceptionof the self”hasconditionedpeople totreatthe natural sufferinginlife
as a disease thatneedstobe cured (Kristjansson,2009).
The purpose of thisresearchis to determineif convenience isafactor contributingto
misdiagnosis of ADHD.Afterall,workingwithadifficultstudentasaparentor teachertakesa lotof time
and effort.Diagnosingthe studentismuchmore convenientbecause itattributesbehaviorproblemsto
somethingoutof control of anyone.A haphazarddiagnosisisconvenientforthe teacherswhocansend
studentstoa resource room or dismisstheirhyperactivebehaviorwithouttryingtofix it. However,such
actionsincrease the riskof stigmafor the child. Furthermore,sincebehavioral interventionsare often

time-consumingandare,inmanyplaces,unavailable,stimulanttreatmentisamore convenient
approach.Stimulanttreatmentisconvenientforparents andteachers whochoose tohelptheirchildren
alleviate theirsymptomsratherthanface the cause of the disorder.Thishintsat convenience playinga
role intreatmentas well asdiagnosis. However,givingchildren andadolescents whoare misdiagnosed
powerful stimulantssuchas RitalinandAdderall isunethical due tothe side effectsof suchdrugs.Thisis
whystrict adherence tocriteriaforan ADHD diagnosisiscrucial.Itisalsowhy the role of convenience in
diagnosisisimportanttoobserve.
Convenience canbe operationally definedasanythingthatfacilitatesease in life. The
opposite of convenience ismeaningful work,whichcanbe definedasworkthatone valuesasgrowthful
or providespersonal meaning. Convenience asaconstruct hasnot been studiedheavilybythe
psychological community,asidefrominthe contextof convenience foods.However, asinterestin
conveniencegrowsitisbecomingclear thatit isa construct whichcan have a profoundimpacton the
waypeople interactwiththeirenvironment.Mostcurrentliterature aboutconvenience exploresthe
role itplaysin consumerbehavior,suchasthe role itplaysinconsumeruse of self-servetechnologies
(Collier&Kimes,2013). Much lessliterature isavailable onhow convenience affectsdiagnosis. Swartz
(2013) positsthatdiagnosesare notalwaysusedproperlyandinthe intendedmanner.Thisleadsto
overcategorizationand“treatmentbyconventionorconvenience”(Swartz,2013). The presentstudy
inquiresintoone specificcase of potential correlation:convenience anddiagnosisof ADHD.
The null hypothesisinthisresearchisthatthere isnota relationshipbetweenthe type of
prime usedandthe likelihoodof anADHD diagnosis.The alternativehypothesisisthatthere is a
relationshipbetweenthe type of prime usedandthe likelihoodof anADHD diagnosis.
Method

Participants
Participantsconsistedof currentUCMstudentswho were recruitedviathe school’s online SONA
system. The sample consistedof 150 participantsaged18 to 56, withan average age of 20.47 and a
standarddeviationof 4.867. The sample consistedof 74% femalesand 26% males.Participantswere
72% Caucasian/white,16.7%African American/black,4% Middle Eastern,3.3% Hispanic,2.7%
multiracial,and1.3%Asian. Some data were discardeddue toa language barrierpreventingcertain
participantsfromfinishingthe tasksinthe allottedtime. Participantswere randomlyassignedtoeach
level of priming.
Materials
Four scrambledsentencetasks (A,B,C,and D) were usedasprimingtools forlevelsof convenience.
Primingcanbe definedas the use of one stimulustoaffectaparticipant’sreactiontoanotherstimulus
by usingimplicitmemory(Priming- ImplicitMemory, 2011). Here,the firststimulusisthe primingtool
while the second setof stimuli is the vignettes. The tasks promptedparticipantsto unscramble aseries
of sentences,omittingone word persentence.These scrambledsentence taskswere developedfor
anotherstudyon convenience.
Three vignetteswere usedtopromptparticipants’responses.These vignetteswere adapted
froma DSM-IV Casebook (Spitzer,1994). The case studieshave beenalteredsothattheyare fromthe
pointof viewof eachchild,meaningtheyare infirstpersonand some of the language hasbeenreduced
to wordsa childcouldunderstand. These childrenare namedAlan,Eddie,andMark. The vignette about
Alandescribeshimashaving little tonosymptomsof ADHD.The vignette aboutEddie showsaclear-cut
case of ADHD, predominantlyhyperactive-impulsive type.The vignetteabout Markdescribeshimas
exhibitingsome symptomsof ADHD,predominantlyinattentive type.However,he doesnotmeet the
criteriafora diagnosis.Usingthe DSM-IV,hisage of onsetdisqualifiesadiagnosis.The DSM-IV isusedin

thisstudy;regardless,Markdoesnotmeetenoughcriteriafora DSM-V diagnosiseither. The vignettes
do notcontainany keywordsthat relate directlytodiagnosis.Thisambiguityisinplace toprevent
loadedquestioning.Afterreadingeachvignette,participantsare promptedwiththe question“Basedon
the above description,what youwould sayabout[Alan,Mark,or Eddie,respectively]?”All male names
were chosenbecause malesmake up75% of the diagnosedpopulation.
Finally,ademographicform inquiringage,sex,andracial identity wasused.
Design
The independentvariable isthe primingprovidedviathe scrambledsentence tasks. The fourlevelsare
describedas“convenience”,“meaningful work”,“specificconvenience”,and“control”. The dependent
variable iswhetherornotparticipants diagnose ADHDinresponse toeachvignette.The vignetteswere
randomizedwithineachlevelof the independentvariable toavoidordereffects.Thisisabetween-
groupsdesign. A participantismarkedas havingdiagnosed ADHDinanygivenvignetteif he/shestates
that the childmay or doeshave ADHD,ADD, or an “attentiondisorder”.The phrase “attentionproblem”
istoo general of a termto qualifyfordiagnosis. Afterprimaryanalysisof the data,a secondary null
hypothesiswasdeveloped:there isnorelationshipbetweenthe race/ethnicityof aparticipantandthe
likelihoodof anADHDdiagnosis.
Procedure
Participantswhowere recruitedviaSONA wereprovidedwithpacketscontaining,inorder:one of four
scrambledsentence tasks;all three vignette/prompts,randomized;anda demographicform. After
makingsure informedconsentwasreceived,participantswere askedtocompletethe tasksinthe order
theywere provided,handingthe materialsintothe proctoronce finished.Packetswerekepttogether
withpaperclips.
Results

A chi-square testof independence wasperformedwithineachvignettetodetermine
whetherornot the variablesof primingand likelihoodof an ADHDdiagnosis were independentfrom
one another. A confidence interval of 95% was assumed(α=.05). The resultswithinEddie’svignette(the
“ADHD” case study) are reportedinTable 1. They can be summarizedbythe expression χ²(3,N = 150) =
2.239, p = .524. Thisdemonstratesthatthere isno statisticallysignificantrelationshipbetweenthe type
of prime usedandthe likelihoodof anADHD diagnosisrelative toEddie’svignette. Therefore,we fail to
rejectthe null hypothesisinthiscase. The resultsforMark’svignette (the “NotADHD,butmeetingsome
criteria”case study) are reportedinTable 2. Theycan be summarizedbythe expression χ²(3,N = 150) =
3.517, p = .319. Thisdemonstratesthatthere isno statisticallysignificant relationshipbetweenthe type
of prime usedandthe likelihoodof anADHD diagnosisrelative toMark’svignette.Therefore,we fail to
rejectthe null hypothesisinthiscase.Finally,the resultsforAlan’svignette (the “NotADHD”case study)
are reportedinTable 3. Theycan be summarizedbythe expressionχ²(3,N = 150) = 2.967, p = .397. Once
more,thisdemonstratesthatthere isno statisticallysignificant relationshipbetweenthe type of prime
usedand the likelihoodof an ADHD diagnosisrelative toAlan’svignette.Therefore,we failtorejectthe
null hypothesis relative toall three case studies. We mustinall casesaccept the null hypothesis: the
type of prime usedisindependentfromthe likelihoodof anADHD diagnosis. Figure 1isan error bar
graph demonstratingthisindependence.
A chi-square testof independence wasperformedtodetermineif the variables of race and
the likelihoodof adiagnosiswere independentfromone another.The secondarynull hypothesiscan
onlybe rejectedinrelationtothe “Eddie”vignette. The dataforthe relationshipare presentedinTable
4. The resultsare reportedasχ²(5, N = 150) = 11.877, p = .037. Assumingα=.05,we can rejectthe
secondarynull hypothesisandacceptthe secondaryalternative hypothesis:The variablesof race and
the likelihood of diagnosisare notindependentfromone anotherwithinthe Eddie vignette.Table 4
relatesrace and the likelihoodof adiagnosiswithinthe Eddie vignette.

Discussion
The resultsindicate that there isnosignificantrelationshipbetweenthe levelof the prime
and the likelihoodof adiagnosis.Thismeansthatprimingfordifferentlevelsof conveniencedoesnot
affectthe likelihoodof acollege student’sdiagnosisof ADHD. Convenience,therefore,maynotplaya
handin diagnosis. However,itisimportanttonote thatit isnot oftenthatcollege studentsare askedto
diagnose achild.Itis not theirresponsibilitytolabel suchchildrenorprovide stimulants;thatisthe job
of practitioners.A similarexperimentcouldbe conductedwithsuchpractitionersinorderto get a data
setthat bettergeneralizestoanappliedfield.Afterall,practitionersare more familiarwiththe criteria
for a diagnosisof ADHDthan are mostotherindividuals.
While the sample usedforthisresearchwasnotexplicitly diverse,itisimportanttonote
that the secondaryalternative hypothesiswassupportedwithinthe Eddie vignette. Mostnotably,
AfricanAmericanparticipantswere farlesslikely thanCaucasianparticipants todiagnose Eddie, achild
whomet all of the criteriafor a diagnosis. Middle Easternparticipantsacrossthe boarddidnot diagnose
any of the children. Thismaypointto differinglevelsof ADHDawarenessbetweendifferentraces,
ethnicities,and/ornationalities. Furtherresearchonhow these factorsaffectattitudestowardADHD
couldbe studiedwithaquasi-experimental design,whereinpeopleof differentraces,ethnicities,and
nationalitiesare promptedwithopen-endedquestions aboutADHD. The social factorsat playthat affect
the likelihoodof adiagnosiscould alsobe studiedwithsuchadesign.
Many participantswhodidnotdiagnose Eddie withADHDnotedthathe mayhave some
otherdisorder.Those listedincludedautismspectrumdisorder,sleepdisorder,Downsyndrome,and
learningdisabilities. Thismayindicate confusionaboutADHDinrelationtootherdisorders.However,
some of the participantswho did diagnose Eddie withADHDindicatedthathe might have one ormore
of these otherdisorders aswellas ADHD. Thisindicates awarenessof comorbidity.ItalsoindicatesDr.

RichardSaul’sbelief thatADHDisoftencausedbyotherdisorders(Saul,2014). Participants also
described Eddie ashavingtoomuchenergy,lackingrespect,beingadventurous,andlikingtoexplore
newthings. A fewparticipantsnotedthatdoctorsmaydiagnose Eddie withADHDwheninreality he is
justa normal,playful kid.Thisrecapitulates the recurringthemeof thisresearch:ADHDisroutinely
misdiagnosedin“normal”children.
Participantswhodidnotdiagnose Mark withADHDdescribedhimaslonely,depressed,self-
doubting,awkward,insecure,andintrovertedaswell ashavinglow self-esteemandself-efficacyand
beingan“outcast”. While Eddie wasmore frequentlydiagnosed,the participantsseemedtoattacha
greaterstigmato Mark eventhoughhe fell shortof the criteriaforADHD- predominantly inattentive
type. Thisraisesa question:Are the symptomsof ADHD- predominantly inattentive type more highly
stigmatizedthanthe symptomsof ADHD- predominantlyhyperactive-impulsivetype?If so,isita matter
of more easily understandingandrecognizingthe symptomsof the latter? Answerstothese questions
can be pursuedinfurtherresearch. Inresponse tobothMark and Eddie’svignettes,manyparticipants
showedsympathy ratherthanovertlyexpressingstigma. Thismayindicate how the stigmasurrounding
ADHD mightdecrease asyoungergenerationsbecome increasinglyaware of the disorder.
Thisresearchcouldbe improvedinthe future ina numberof ways. First,inthe present
experimentMark’sfatherwascast ina badlight.It wasnotedthat Mark feelslike hisfathermakesfun
of himforthe difficultieshe hasinschool,socially,andonthe basketball court.Manyparticipantsnoted
that hisfatherwas eitherabusive ora jerk,andthat perhapsMark’s problemsstemfromhisrelationship
withhisfather.The wordingmayhave beenmisleadingtosome participants,throwingthemoff the trail
of a clinical diagnosis.Anotherimprovementwouldbe toincrease the time thatparticipantsare allotted
to fill outthe packet.Non-Englishspeakersoftentook more time unscrambling the scrambledsentences
inthe primes.Some of themlefttheirdatapacketsunfinisheddue totime constraints,meaningtheir

data had to be discarded. Furthermore,eventhoughall male nameswere usedforthe vignettes,some
participantsmistook“Eddie”and“Alan”forfemale names.Thismayhave hadan effectonwhetheror
not those participants were willingtodiagnose ADHD. Finally,75% of the sample inthisstudyconsisted
of femalesand 72% of the participantsidentifiedasCaucasianorwhite.Inthe future,amore diverse
sample shouldbe used.
Conclusion
Whetheror notconvenience playsarole inthe diagnosisof attention-deficit/hyperactivity
disorderremainsunclear. The resultsof thisstudy are inconclusiveand leadtomore questions.Further
researchexaminingthe role of convenience inADHDdiagnosisshoulduse asample of psychiatrists,
psychologists,pediatricians,teachers, andotherpractitionerswhooftenplaythe biggestrolesinan
ADHD diagnosis. Convenience,asanemergingconstruct,needstobe more thoroughlyexploredin
termsof howitaffectsthe way that people interactwiththeirenvironment.Convenience needsto be
studiedinrelationtoenvironmental phenomenaaswell asinthe contextof marketresearch. Most of
the literature agreesthatdiagnosisof ADHDneedstobe a steppeddiagnosis,andthisisreflectedinthe
data. Many participantswhodidnotdiagnose Eddie orMark notedthat theythinkthe kidscoulduse
some extrahelp.This demonstratesthatthere isa growinginterestinpre-diagnosticassistance,whichis
importantto a steppeddiagnosissystem.

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Appendix A
Table 1
The relationship between thetype of prime and likelihood of
diagnosiswithin the Eddie(ADHD) vignette.
Value df Asymp. Sig. (2-
sided)
Pearson Chi-Square 2.239a
3 .524
Likelihood Ratio 2.247 3 .523
Linear-by-Linear Association 1.314 1 .252
N of Valid Cases 150
Table 2
diagnosiswithin the Mark(non-ADHDwith symptoms) vignette.
Value Df Asymp. Sig. (2-
sided)
3 .319
Linear-by-Linear Association .333 1 .564
Table 3
diagnosiswithin the Alan (non-ADHDwithoutsymptoms) vignette.
Value Df Asymp. Sig. (2-
sided)
3 .397
Linear-by-Linear Association .163 1 .686

Table 4
The relationship between racial identity and the likelihood of a
diagnosiswithin the Eddievignette.
Value df Asymp. Sig.
(2-sided)
5 .037
Linear-by-Linear Association 3.010 1 .083

Table 2
diagnosiswithin the Eddievignette.
Appendix B

Figure 1. An errorbar graph representingthe likelihoodof adiagnosisforADHDinrelationtoeach
prime andwithineachvignette.

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