1
Adolescents' beliefs about sources of help for ADHD
and depression
Dr Lorraine Swordsa, Dr Eilis Hennessyb, Dr Caroline Hearyc
a
Trinity College Dublin, Children’s Research Centre, Dublin 2, Ireland
(swordsl@tcd.ie)
b
University College Dublin, School of Psychology, Belfield, Dublin 4, Ireland
(eilis.hennessy@ucd.ie)
c
National University of Ireland Galway, School of Psychology, Galway, Ireland
(caroline.heary@nuigalway.ie)
2
Adolescents' beliefs about sources of help for ADHD and depression
The peer group begins to become a source of support during late childhood and
adolescence making it important to understand what type of help young people might
suggest to a friend with an emotional or behavioral problem. Three groups of young
people participated in the study with average ages of 12 (N=107), 14 (N=153) and 16
years (N=133). All participants were presented with vignettes describing fictional
peers, two of whom had symptoms of clinical problems (ADHD and depression) and
a third comparison peer without symptoms. Results indicate that all participants
distinguished between clinical and comparison vignette characters and they believed
that the characters with clinical symptoms needed help. The 16-year-olds were more
likely to differentiate between the two clinical vignettes in terms of the type of help
suggested. The results are discussed in light of previous research on adolescents'
understanding of sources of help for mental health problems.
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Mental health and behavioural problems are relatively common during the teenage
years (Ford, Goodman, & Meltzer, 2003; Lynch, Mills, Daly, & Fitzpatrick, 2006).
Although most adolescents will not be diagnosed with a clinical condition, many will
have contact with someone with a mental health problem over the course of their
childhood and/or adolescent years. This might include having a sibling, classmate or
friend with ADHD or depression. Understanding what young people know about such
problems has, therefore, been of growing interest to researchers over the last decade.
Indeed, the term ‘mental health literacy’ (Jorm, Korten, Jacomb, Christensen, Rodgers
& Pollitt, 1997) has been used to refer to knowledge of mental health problems as
well as the sources of help available and a number of studies on mental health literacy
have been carried out with young people (e.g. Burns, & Rapee, 2006; Cotton, Wright,
Harris, Jorm, & McGorry, 2006).
What exactly do children and adolescents know about mental health and
psychological problems? The picture that emerges from a review of studies published
over the last twenty years is that children can identify peers who have behavioural
problems from the pre-school years onwards but that the range of problems that
children can identify increases as they get older (Hennessy, Swords & Heary, 2008).
For example children who are different from their peers by virtue of higher levels of
aggression are recognised before children who are different by virtue of being more
withdrawn than their peers (Younger, Schwartzman, & Ledingham, 1985). The
research also suggests that from middle childhood onwards, children can suggest a
range of possible causes for mental health and behavioural problems (Chassin &
Coughlin, 1983; Kalter & Marsden, 1977; Maas, Marecek, & Travers, 1978). These
include explanations that are internal to the individual (such as being ‘born that way’)
as well as external (such as inappropriate parenting) (Maas et al., 1978). Two studies
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(Boxer & Tisak, 2003; Dollinger, Thelen & Walsh,1980) suggest that internal
explanations for problems may become increasingly common in later adolescence,
thus implying that understanding of mental health continues to change throughout the
adolescent years.
One aspect of adolescents’ understanding of mental health that has been of
particular interest in recent years is the extent to which they are aware sources of help
for mental health problems (Burns & Rapee, 2006; Hill, 1999). Adolescence has been
the particular focus of this research for two reasons. The first is that adolescents are
at greater risk of certain mental health problems (e.g. depressive disorders) than are
younger children (Costello, Mustillo, Erkanli, Keeler & Angold, 2003; Ford et al.,
2003). The second reason for the focus on adolescents is because of their increasing
autonomy and greater emphasis on broadening social support to include extended
family and peers (Levitt et al., 2005). For adolescents, therefore, the peer group may
be an important source of information and support at a time when they are trying to
cope with mental health problems. What these young people know about possible
sources of help is thus extremely important as it may determine whether or not help is
sought from qualified mental health professionals.
Research from Australia and the United States of America highlights the fact
that young people are likely to turn to their peer group for help if they experience a
mental health problem. In their research with 15 to 17 year olds in Australia,
Sheffield, Fiorenza and Sofronoff (2004) found that friends were the second largest
source of help for participants who had experienced a mental illness or a personal
emotional/behavioural problem. The results also demonstrated that the participants
were significantly more willing to seek help for problems from informal sources
(family and friends) than from formal sources (such as doctors, psychologists or
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psychiatrists) and perceived fewer barriers to help seeking in the case of the informal
support. Research by Wisdom and Agnor (2007) in the United States also found that
adolescents who had a clinical diagnosis of depression reported that their peers had an
important influence on how they coped with their illness. Their small qualitative
study with 14 to 19 year olds emphasised that adolescents can have a beneficial role
by becoming what they term ‘depression guides’ to depressed peers. A ‘depression
guide’ was an adolescent who had experienced depression him/herself and who
offered advice to others on such things as recognising the problem and seeking
treatment. The authors also reported that peers could have an adverse influence
through expressing negative attitudes about depression or its treatment. The
importance of peers as a source of help is also emphasised by Offer, Howard,
Schonert & Ostrov (1991) who reported that parents and friends were the most
frequently used as sources of help across their sample of 17 year olds, however
among those who were disturbed, friends were chosen as a source of help over
parents. These findings emphasise the important role that peers play for teenagers
who have a diagnosed mental health problem.
The three studies just mentioned explored individuals’ personal experiences of
help seeking for a range of personal and mental health problems. The literature also
contains a number of studies that have focused on adolescents’ perceptions of
appropriate sources of help for a peer who experiences a mental health problem. In a
review of these studies Hill (1999) concluded that young people generally emphasise
the central role of family and friends in providing help and support. This is confirmed
by a number of more recent studies around the world. For example, Raviv, Sills,
Raviv and Wilansky (2000) reported that adolescents in Israel would be more likely to
recommend that a peer with depression seek help from a friend or parent than from a
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formal source such as a psychologist or counsellor. Two studies in Australia also
report high levels of belief in the value of informal sources of support that include
family and friends (Cotton, et al., 2006; Wright et al., 2005). The study by Wright et
al. (2005) had a very wide age range of participants (12 to 25 years) and found that
the younger age group (12 to 17 years) were significantly more likely to believe that
family and friends were the best form of help for peers with depression and psychosis
than were the older group (18 to 25 years). The one exception to the finding that
adolescents are more likely to refer peers to informal than to formal sources of help is
reported in a study by Burns and Rapee (2006). Their study with adolescents in
Australian schools found that young people placed school counsellors ahead of
friends as the recommended source of support for a depressed peer. The authors note
that schools in Australia typically have counsellors attached and that pupils are very
familiar with their work.
The findings of research so far indicate that from mid adolescence (about
14/15 years upwards) peers are an important source of help to young people who have
themselves reported a mental health problem (Sheffield et al., 2004; Wisdom &
Agnor, 2007). The research also suggests that young people are likely to recommend
an informal source of help to a peer who is experiencing a problem (Hill, 1999; Raviv
et al., 2000). The aim of the present study is to extend our understanding of the
development of beliefs about appropriate sources of help for peers with mental health
problems by including a wider age range of participants than has typically been
included in such studies. There are several reasons for believing that this might prove
useful. First, the peer group is believed to become increasingly important as a source
of support for emotional and behaviour problems during late childhood and
adolescence, however this age range has never been sampled in a single study to
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determine age related differences in beliefs about sources of help. Second, little is
known about the extent to which adolescents believe that different sources of help are
appropriate for different types of mental health problem. ADHD and depression were
chosen as the focus of the study because they are among the top three most commonly
diagnosed clinical conditions during adolescence in Ireland (Lynch et al., 2006) and
allow a comparison between an externalising and an internalising problem. Our
specific questions were: i) Do adolescents distinguish between peers with ADHD and
depression in judging their need for help? ii) Do adolescents differ in the total number
of sources of help they suggest for peers with ADHD and depression? iii) Are there
differences in the suggested sources of help for the peers with ADHD and depression?
In answering each of these questions, the analysis also focused on differences across
the three age groups of participants.
Method
Sampling
Participants were recruited from randomly selected primary and second level
schools from the Irish Department of Education and Science (DES) published lists of
schools in the Leinster (Eastern) region of Ireland. In Ireland, children attend primary
school for eight years, up to the age of 12/13 years and then transition to second level
school. The sample was stratified using published data on receipt of additional
assistance from the DES. Approximately 61.4% of primary schools and 31% of
second level schools receive additional funds because the pupils are regarded as being
at an economic disadvantage. Unfortunately the designation system has many flaws,
not least the fact that many more primary schools are designated disadvantaged within
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the system. In the final sample, 7 (63%) of the primary schools and 2 (22%) of the
second level schools were designated disadvantaged. The proportions of sampled
primary and second level schools were compared to the national proportions using
goodness of fit tests. Neither the proportion of primary (2 (1, N=11) =0.024, p > .05)
or second level schools (2 (1, N = 9) = 0.330, p > .05) that were designated as
disadvantaged differed significantly from the proportions expected.
The principals of 41 randomly selected schools were sent information
packages, 20 (11 primary and 9 second level) agreed to participate (48.78%).
Information sheets and forms requesting active consent were sent to the parents of
752 pupils. Student delivery of the consent forms was used as recommended by
McMorris et al. (2004). In total 53% agreed to participate (n=398), 2.93% declined
(n= 22), the remainder did not return the consent forms. Three pupils were absent on
the day of data collection and two pupils in the oldest age group were excluded
because they were so much older than the other participants in that group. The final
participant count was 393. Participants were sampled from the final class of primary
school (age 12/13) and from two second level school classes (age 14/15 and 16/17).
All participants verbally assented to participation prior to data collection.
The final study sample included 393 participants, 206 male and 187 female,
aged from 12 years 5 months to 19 years. See Table 1 for a detailed breakdown of
participants’ numbers, gender and ages by school year.
Insert Table 1 about here
Instruments
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All instruments were presented to participants in a single booklet structured
around three short descriptions (vignettes) of peers (see Appendix). Four forms of the
booklet were produced in order to counter-balance the gender of the target peers
described in the vignettes and to provide all participants with age appropriate
information. Thus half of the booklets described a boy with ADHD and a girl with
depression and half of the booklets described a girl with ADHD and a boy with
depression. The order of presentation of vignettes was the same in all booklets: the
character with ADHD appeared first, followed by a ‘comparison’ vignette depicting a
character with good academic ability, the character with depression appeared in the
final vignette. The age appropriate adjustments included, for example, information
for younger participants that they would read about other ‘children’ of their age, for
older participants this was adjusted to ‘young people’ or ‘teenagers’ of their age.
The clinical vignettes used in the study were based on DSM criteria adapted
from case studies presented in Carr (1999) and validated with 14 clinical
psychologists practicing in Ireland. The clinical psychologists were sent six vignettes
describing ADHD, conduct disorder, separation anxiety disorder, dog phobia,
Asperger’s syndrome and depression. Clinicians were requested to rate each vignette
on a 6-point scale for its accuracy as a description of the named disorder and its
frequency as a problem presenting in their practice. ADHD, conduct disorder and
depression were selected for inclusion in the study as they were given the highest
accuracy ratings and were rated as common problems. The vignettes were used in a
previous qualitative study by Hennessy and Heary (2009).
Participants were asked two questions to ascertain their understanding of the
vignette characters’ need for help and the possible sources of help available. The
need for help was determined with a single item: ‘Do you think that X needs help?’ A
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four point rating scale was used to capture their response: ‘Definitely Yes’; ‘Maybe
yes’; ‘Maybe no’; ‘Definitely no’. This was followed by a single open-ended
question: ‘If yes, who do you think could help X?’ Participants’ responses to these
items are the primary focus of the present paper.
Socio-demographic information on the participants’ families was gathered in a
short questionnaire that was given to parents with the research information leaflet and
consent form. The questionnaire asked parents to provide information on their age,
employment status and highest level of education attained. For each of these
questions a set of ‘tick box’ response categories was provided with, for example, age
was grouped into ten year blocks and education grouped into six categories from
‘Intermediate/Group Certificate’ (the examination taken at the end of compulsory
schooling in Ireland) to ‘Higher degree’. In addition there were two open-ended
questions. One asked for the parent’s current job title (if they were employed) and a
second asked for the number of children in the family.
Procedure
Participants filled in the questionnaires in their class group and completion took an
average of 40 minutes.
Ethics
All parts of the research complied with the University College Dublin (UCD)
Ethics Code of Good Practice and Research and the Code of Professional Ethics of
the Psychological Society of Ireland. The research proposal was approved by the
Human Research Ethics Sub-Committee of the UCD Ethics Committee.
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Results
Data analysis focused on three main questions: i) Do participants distinguish
between peers with ADHD and depression in judging their need for help? ii) Do
participants differ in the total number of sources of help they suggest for peers with
ADHD and depression? iii) Are there differences in the suggested sources of help for
the vignette characters with ADHD and depression? In all three questions there was
also a focus on age related differences in participants’ responses. In the case of the
first question, data was in the form of a four point rating scale for each character and
was analysed using a two way (age X vignette) mixed measure ANOVA. Age was a
between subjects variable and vignette was a repeated measure. In the case of the
second question the data were the total number of different sources of help suggested
by each participant and a two way mixed measure ANOVA was again used (age X
vignette). In the case of the final question the data were categorical as they were
derived from participant responses to an open-ended question on who could help the
target characters. Therefore, these data were analysed using a series of chi-square
statistics.
Evaluation of the need for help
Participants rated the target characters’ need for help on a 4-point rating scale
with lower scores indicating a greater perceived need for help. Although the range of
scores on this item was small this has been reported as having only minimal effects on
level of significance when using analysis of variance (Glass, Peckham, & Sanders,
1972). Mean scores and standard deviations for each age group of participants are
presented in Table 2. The figures show that in the case of the clinical vignettes all the
means are ≤ 2.00 suggesting that participants of all ages generally believed that they
were in need of help. The data presented in Table 2 also demonstrates that
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participants generally did not believe that the character in the comparison vignette
needed help. To examine age related differences in beliefs about the extent to which
the vignette characters (ADHD, depression, comparison) needed help a two way
mixed measure ANOVA was conducted. The ANOVA indicated a significant
interaction between age and the vignette characters’ condition F (4, 774) = 3.09, p <
.05, 2 = .016. Inspection of the graph of means indicated that the interaction was
disordinal so tests for simple effects were conducted.
The tests for simple effects indicated that there were no significant differences
in the responses of the different age groups to the character with ADHD F (2, 774) =
0.26; p > 0.05 or the comparison character F (2, 774) = 0.06; p > 0.05. There were,
however, significant differences in their responses to the character with depression F
(2, 774) = 11.63; p < 0.05. Post hoc (Tukey/Kramer) analysis indicated that the 16year-olds were significantly different from both the 14-year-olds Q = 5.90, p < .01
and the 12 year olds Q = 6.06, p < .01. The 14-year-olds and the 12-year-olds did not
differ significantly from one another Q = 0.16, p > .05. This indicates that the 16year-olds believed that the character with depression was significantly more in need
of help than did the 14-year-olds or the 12-year olds.
Tests for simple effects were also used to explore differences in responses to
the three vignettes within each of the age groups of participants. In the sample of 12year-olds there were significant differences in responses to the vignette characters: F
(2, 774) = 225.35, p < .05. Post hoc (Tukey/Kramer) analysis indicated that there
were significant differences between responses to the comparison character and each
of the clinical characters: ADHD: Q = 30.98, p < .01 and depression: Q = 26.88, p <
.01. This indicates that the 12-year-olds believed that the characters with clinical
problems were significantly more in need of help than the comparison character. The
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two clinical vignettes were also significantly different from one another Q = 4.10, p <
.01 such that the character with ADHD was judged as more in need of help than the
character with depression.
In the sample of 14-year olds there were significant differences in responses to
the vignette characters F (2, 774) = 330.04. Post hoc (Tukey/Kramer) analysis
indicated that there were significant differences between responses to the comparison
character and each of the clinical characters: ADHD Q = 30.98, p < .01; depression Q
= 27.54, p < .01. Again, the two clinical characters were judged as significantly more
in need of help than the comparison character. The two clinical vignettes were also
significantly different from one another Q = 3.44, p < .05 and again it was the
character with ADHD who as judged as being more in need of help.
In the sample of 16 year olds there were also significant differences in
responses to the vignette characters F (2,774) = 351.55 p < 0.05. Post hoc
(Tukey/Kramer) analysis indicated that there were significant differences between
responses to the comparison character and each of the clinical characters: ADHD Q =
31.97, p < 0.01; depression Q = 33.28, p < .01. The two clinical characters were
judged as significantly more in need of help than the comparison character. In this
age group, however, estimates of the two clinical characters’ need for help were not
significantly different from one another Q = 1.31 , p > .05.
Table 2 about here
Number of sources of help
Participants who indicated that they believed the target character in each
vignette needed help were asked an open-ended question about who could provide the
help. They were free to make as many or as few suggestions as they wished. The
initial analysis focused on the absolute number of different types of help made by the
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participants. Participants suggested up to 5 sources of help and the means for each
age group are presented in Table 3. Very few participants suggested help for the
character in the comparison vignette and this is reflected in very small mean scores.
Inspection of the means for the clinical vignettes indicates that older participants, in
general, suggested more sources of help than younger participants and that all groups
suggested more sources of help for ADHD than for depression. A two-way mixed
measure ANOVA was conducted in order to explore age related differences. The
ANOVA indicated that there was a significant interaction between vignette (ADHD,
depression, comparison) and age (12, 14, 16 years) F (4, 780) = 4.43, p < .05, 2 =
.02. Inspection of a graph of the means indicated that the interaction was ordinal so
the main effects could be interpreted. There were significant main effects for vignette
F (2, 780) = 347.78, p < .001, 2 = .47 and for age F (2, 390) = 5.81, p < .003, 2 =
.03. Post hoc analyses (Dunnett C, equal variances not assumed) indicated that,
regardless of vignette type, the oldest group (16-year-olds) gave significantly more
help suggestions than the other groups (who were not significantly different from one
another). Bonferroni pairwise comparison on the repeated measure (vignette)
indicates significantly more sources of help were suggested for both clinical vignette
characters than for the comparison character and that significantly more sources of
help were suggested for the character with ADHD than the character with depression.
Table 3 about here
Sources of help suggested
Participants’ responses to the open ended questions on who could help the
vignette characters were coded by the second author into seven different categories.
Definitions of each category with examples are presented in Table 4 (the 7th category
‘don’t know’ is omitted from the table). A second coder was then used to calculate
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inter-rater reliability on 100% of the responses. This produced Cohen’s Kappa
coefficients of .989 for ADHD and .984 for depression. In the very small number of
cases where the first and second coder disagreed the initial code was used in the
analysis. Only 30 (7.6%) participants mentioned any source of help for the character
in the comparison vignette so this data has been omitted.
Table 4 about here
The frequency data for participants’ suggested sources of help for the vignette
characters with ADHD and depression are presented in Table 5. As expected, in all
three age groups family are perceived to be an important source of help for ADHD
and depression, with teachers also being mentioned very regularly. Friends were not
mentioned as frequently as had been expected, even in the group of 16-year-olds. Chi
square analysis suggests that the 16-year-old participants made a greater distinction
between the needs of the two vignette characters than either of the two younger age
groups. Thus, there are no significant differences between sources of help suggested
for ADHD and depression by the 12-year-old participants and just one difference for
the 14-year-olds (who were more likely to recommend a mental health professional
for ADHD than depression). In contrast, 16-year-olds distinguished between the
vignette characters in their recommendations of friends, teachers and doctors.
Table 5 about here
Discussion
The data analysis focused on three questions relating to participants’ beliefs
about sources of help for fictional characters two of whom had clinical problems
(ADHD and depression) and one who did not. Initial analysis of the responses
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suggested that participants in all age groups believed that the characters in the clinical
vignettes were in need of help. In contrast, their responses to the comparison vignette
clearly showed that they did not believe that this character needed help. This finding
is consistent with Peterson, Mullins and Ridley-Johnson (1985) who found that
vignette characters who were portrayed as being depressed were given high ratings on
a scale that measured their need for therapy. Similarly, Burns and Rapee (2006)
found that teenagers distinguished between depressed and non-depressed vignette
characters in terms of how much they would ‘worry’ about them.
While the majority of participants in each age group rated the clinical vignette
characters as needing help, there was also evidence of differences between younger
and older participants. In particular, the findings suggest that the 12- and 14-yearolds were less convinced of the depressed character’s need for help than the 16-yearolds. Evidence for this comes from the fact that the 16-year-olds rated the depressed
character as significantly more in need of help than either of the other two age groups
and also that the 12- and 14-year-olds rated the character with ADHD as significantly
more in need of help than the character with depression. The different responses of
these age groups may be due to differences in their perceptions of when help is
appropriate or in differing interpretations of the behaviour described. The findings
are, however, consistent with the findings of a series of studies conducted by
Younger in the 1980s. In these studies Younger demonstrated that children identified
and distinguished aggressive behaviour at a younger age than withdrawn behaviour.
For example, he found that there were developmental changes in children’s ability to
recall withdrawn but not aggressive behaviour (Younger & Piccinin, 1989), that social
withdrawal becomes increasingly important as a social schema as children got older
(Younger & Boyko, 1987) and that aggressive behaviours formed a cohesive category
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before withdrawn behaviours (Younger et al., 1985). While aggressive and
withdrawn behaviours are clearly distinct from ADHD and depression, nonetheless
they share certain similarities in that aggression and ADHD are both externalizing
behaviours whereas depression and withdrawal are both internalising.
The present study also found that there were age related differences in the
participants’ ability to suggest sources of help for the two vignette characters with
younger participants suggesting fewer sources of help for the character with
depression. Looking at the absolute number of sources of help suggested by
participants of different ages is a novel feature of this study. While other studies have
asked participants open ended questions about sources of help (Burns & Rapee, 2006)
they have typically focused only on the type of help suggested. In the case of Burns
and Rapee, for example, they asked respondents to list sources of help and had 677
suggestions from 202 participants. It is not clear, however, whether these suggestions
were evenly spread across all participants. The oldest participants in the present study
are similar in age to the participants in Burns and Rapee’s (2006) study and like them
were able to suggest multiple sources of help for the vignette characters. While Burns
and Rapee (2006) focused on vignette characters with symptoms of depression, the
present study also included a vignette describing symptoms of ADHD and found that
significantly more sources of help were suggested for the latter than for the former.
The findings of the present study support many previous studies that have
found that children and adolescents believe that family members are important
sources of help for mental health problems. Previous studies similarly reported that
adolescents recommended family as a primary source of help for externalizing
(Roberts, Johnson, & Beidleman, 1984), internalizing (Burns & Rapee, 2006) and
‘personal’ problems (Reetz & Shemberg, 1985). Similarly, parents were one of the
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most commonly cited sources of help for affective problems in Raviv et al.’s (2000)
research with adolescents in Israel. Finally, the combined group of ‘family and
friends’ was the most commonly cited source of help for depression and psychosis by
participants in the 12 - 17 year age group in research in Australia by Wright et al.
(2005).
In addition to family, participants in the present study believed that school
teachers were an important sources of help for both clinical vignette characters. This
stands in contrast to the findings of many other studies. Studies by Burns and Rappee
(2006), Cotton et al., (2006) and Raviv et al. (2000) all found that a very low
percentage of participants referred to teachers as a possible source of support for a
peer with a mental health problem. Only one other study with young adolescents
(Reetz & Shemberg, 1985) found that a substantial proportion of participants
suggested teachers as a source of support. There are many possible reasons why
participants in the present study should have been more likely to recommend teachers
than in other studies, including the fact that all of the vignettes clearly placed the
target characters in a school context as this was seen as one that would be familiar to
all participants.
While family and teachers represented important informal sources of support
for young people in the present study, peers were typically seen as less important.
Although this finding may seem surprising, in fact it is broadly consistent with the
findings of Cotton et al. (2006) and Wright et al. (2005) because they combined
family and friends into a single source of support. Raviv et al. (2004) looked
separately at parents and friends as sources of support and found that friends came
second to parents for a story depicting a young person with depression. It is
important to note that the 16-year-olds in the present study were clearly distinguishing
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between the value friends’ support for peers with ADHD and depression. They were
more than twice as likely to suggest peer support for depression than for ADHD.
Comparison of the sources of help suggested for the characters with ADHD
and depression yielded some interesting differences between younger and older
participants. In particular, the analysis demonstrated that the 16-year-olds were
distinguishing between the help suggested for the two characters, whereas the
younger participants were not. While the authors are not aware of other studies with
adolescents that have compared suggested sources of help for different mental health
problems, there is research evidence that young people distinguish between mental
health problems in terms of likely causes (Maas et al., 1978, Roberts, et al., 1981).
The fact that the present study included three age groups of adolescents suggests that
understanding of mental health problems, and specifically how people with such
problems can be helped, may continue to develop throughout adolescence.
Some important limitations of the present study also need to be acknowledged.
The first relates to the use of vignettes to elicit responses from participants. Vignettes
are a very common way of presenting information on peers with mental health
problems and have been widely used in other studies to avoid the use of labels (e.g.
Francis, Boyd, Aisbett, Newnham, & Newnham, 2006, Raviv et al., 2000, Roberts et
al., 1984, Wright et al, 2005). Nonetheless, questions remain about the extent to
which children’s responses to characters described in vignettes are comparable to
their responses to real peers. The only study to have done this comparison (Juvonen,
1991) looked at attitudes rather than knowledge about sources of help, however, the
findings made it clear that there were significant differences in responses to
hypothetical and real peers. Thus, any implication that young people might use their
knowledge of sources of help, as demonstrated in the findings of this study, to advise
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their friends or to seek advice themselves need to be treated with caution. It is also
important to note that the order of the vignettes was not counter-balanced. The
decision to present the vignettes in the same order to all participants was taken
because the questionnaires already existed in multiple forms to allow for age
differences in participants and to counter-balance the gender of the characters
described in the vignettes. This is, however, a limitation of the study as the order of
presentation may have influenced the participants’ responses.
A further limitation is the low response rate from parents, only 55.93% of
whom returned consent forms. In this our findings are not consistent with those of
McMorris et al. (2004) who reported high response rates with student delivered
forms. Our response rate is, however not too far below the consent rate reported in
another large scale Irish study of adolescents (Lynch et al., 2006) who reported that
60% of forms were returned with a 2.8% refusal rate as compared with 2.93% in the
present study.
The findings of the present study indicate a growing awareness of professional
sources of help for mental health problems with increasing age, but say nothing about
the source of this knowledge. Hinshaw (2005) has pointed to the role that the media
plays in conveying negative messages about mental health problems and these may
serve as a primary source of information on this topic for young people. It is also the
case that some schools are implementing short courses specifically designed to
provide information on mental health and dealing with common problems and that
exposure to these courses (in Ireland this is typically during the 12th year of school e.g
Byrne, Barry & Sheridan, 2004) might increase awareness of sources of help.
Understanding the sources of mental health knowledge is an important goal for future
research on this topic given the fact that less than half of the oldest group of
21
participants suggested that either of the vignette characters could seek help from a
mental health professional.
22
Acknowledgements
This research was funded with a grant from the Irish Research Council for the
Humanities and Social Sciences. The authors grateful acknowledge the assistance of
all the school, parents and pupils who took part in the research.
23
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27
Table 1
Participant Numbers, Gender and Age by School Year
Age
Total
Male
Female
Mean Age
SD months
12
107
66
41
12yrs 5mths
5.52
14
153
73
80
14yrs 5mths
5.13
16
133
67
66
16yrs 8mths
7.96
28
Table 2
Participants’ mean ratings of the target characters’ need for help - lower scores
indicate greater need for help
Age
Vignette character
ADHD
Mean
Standard deviation
Depression
Mean
Standard deviation
Comparison Mean
Standard deviation
12
14
16
Overall
N = 107
N = 153
N =133
N=393
1.75
1.78
1.71
1.75
.78
.82
.74
.78
2.00
1.99
1.63
1.87
.87
.80
.69
.80
3.64
3.67
3.66
3.67
.72
.68
.74
.71
29
Table 3
Mean number of sources of help for vignette characters suggested by participants in
each year group
Age
Vignette character
ADHD
Mean
Standard deviation
Depression
Mean
Standard deviation
Comparison Mean
Standard deviation
12
14
16
Overall
N = 107
N = 153
N =133
N=393
1.19
1.35
1.47
1.34
.86
.95
1.02
.96
1.05
1.03
1.44
1.17
.90
.90
.96
.94
.08
.12
.09
.10
.37
.41
.38
.39
30
Table 4
Categories of sources of help suggested by participants
Code
Family
Definition and examples
All named relatives including extended family e.g. mother, father, sister,
cousin, grandparent etc.
Friend
All references to a friend or peers
Teacher
All references to classroom teachers/teaching assistants of any type e.g.
special teacher, special needs teacher.
Doctor
All general references to doctors that don’t included a named mental health
specialization e.g. doctor, special doctor.
Mental health
All named mental health professionals and references to teachers with
professional
special training in counseling: psychiatrist, psychologist, shrink, therapist,
counselor.
Other
Any individual that did not fall into one of the above categories e.g. social
worker, nurse, God
31
Table 5
Types of help for vignette characters suggested by participants in each group1
Vignette type
ADHD

Age (N)
Source of help
Depression
12 year olds
Family
43 (40.2%)
41 (38.3%)
0.06
(n= 107)
Friend
10 (9.3%)
15 (14.0%)
1.14
Teacher
32 (30.0%)
25 (23.4%)
1.18
Doctor
7 (6.5%)
2 (1.9%)
2.90
professional
29 (27.2%)
19 (17.7%)
2.68
14 year olds
Family
55 (35.9%)
41 (26.8%)
2.98
(n= 153)
Friend
21 (13.7%)
24 (15.7%)
0.24
Teacher
41 (26.8%)
28 (18.3%)
3.16
Doctor
15 (9.8%)
11 (7.2%)
0.68
professional
60 (39.2%)
34 (22.2%)
10.36 **
16-year-olds
Family
34 (25.6%)
48 (36.1%)
3.13
(n= 133)
Friend
19 (14.3%)
41 (30.8%)
9.07**
Teacher
45 (33.8%)
27 (20.3%)
6.16**
Doctor
26 (19.5%)
6 (4.5%)
14.20**
46 (34.6%)
57 (42.8%)
1.92
Mental health
Mental health
Mental health
professional
*p < .05 ** p < .01
32
1
Participants were free to suggest more than one source of help so cell totals do not
correspond with numbers of participants
33
Appendix1
Vignettes
ADHD
Jake finds it very difficult to pay attention to what the teacher says and finds it
difficult to concentrate on doing sums or reading or other work that the teacher gives
him. Jake also finds it hard to stay sitting down when he is supposed to and often gets
up or fidgets a lot. Often he has trouble waiting his turn in games and often interrupts
when other people are doing things.
Depression
Lauren is an attractive girl who usually does okay in school. However, recently
Lauren began to think that she is ugly, and not good at anything. She spends a lot of
time thinking about all the things that she is not able to do and other sad thoughts.
Sometimes she finds it hard to sleep at night so she is very often tired and upset
during the day and cries a lot.
1
There were four versions of each vignette: male and female, younger and older. The
younger version of the two vignettes are presented here.