Measurement of stigmatization towards adults with attention deficit hyperactivity disorder (ADHD)

If a group of people is associated with unfavorable, negative characteristics, resulting in discrediting stereotypes, it can be described as stigmatization. Stigmatization can have adverse consequences for individuals, either affecting individuals directly resulting in diminished self-esteem, a lack of self-satisfaction and a reduced quality of life, or affecting individuals via the general public leading to social exclusion, rejection and a lack of public support.

“Compared to classic physical conditions (i.e. conditions which are typically associated with physical dysfunction such as asthma), individuals with behavioral deviances such as ADHD were shown to be at higher risk to be stigmatized.”

In trying to explain this elevated risk of being stigmatized, it can be referred to the general public’s assumption that individuals with mental disorders might not be able to control their own behavior as well as to adapt to social norms. With regard to ADHD, in particular externalizing behavior (e.g. obvious fidgeting with hands and feet), norm-violating behavior (e.g. interrupting others, blurting out answers) and rule-breaking behavior (e.g. not adapting to school or work environment) were demonstrated to lead to discrimination, isolation and social rejection. Furthermore, an unclear cause of ADHD and sometimes incomplete and ambiguous media reports can trigger stigmatizing beliefs towards individuals with ADHD.

Considering the risk of individuals with ADHD to be stigmatized, there is surprisingly little knowledge about stigmatizing beliefs of the general public, which can be partly explained by a shortage of disease specific assessment tools allowing the specific measurement of stigma towards adults with ADHD. Assessment tools applied in previous research comprise several approaches for the quantification of stigmatizing beliefs. Most commonly used methods are either surveys or the presentation of vignettes which depict individuals with certain ADHD like characteristics and ask respondents for the agreeableness to certain statements regarding these characteristics.

Unfortunately, the available measures primarily focus on children or do not distinguish between children, adolescents and adults with ADHD. Moreover, most of the measures have not been specifically developed to measure stigmatization towards ADHD but are mostly assessment tools to measure stigmatization towards mental disorders in general.

“Since there is a need for disease specific measures, we developed a questionnaire which allows the measurement of stigmatization towards adults with ADHD.”

By the development of this assessment tool, we proposed that stigmatization towards adults with ADHD is not a unified construct but consists of six dimensions of stigmatization. These six dimensions of stigmatization include (1) social functioning of adults with ADHD (e.g. ‘Adults with ADHD care less about others’), (2) thoughts about misuse of medication (e.g. ‘Adults with ADHD simulate symptoms’), (3) the ability to take responsibility (e.g. ‘I would mind if my investment advisor had ADHD’), (4) attitudes about norm-violating behavior (e.g. ‘Adults with ADHD act without thinking’), (5) assumed consequences of diagnostic disclosure (e.g. ‘Adults with ADHD feel excluded from the society’) and (6) stigmatizing beliefs on the etiology of ADHD (e.g. ‘ADHD is caused by bad parenthood’). The assumption that stigmatization towards adults with ADHD has multiple facets (i.e. several dimensions) is confirmed by the finding that the level of stigmatization differs (a) between various stigma dimensions and (b) between people of different educational and occupational background. In this respect, for example, we revealed that teachers and physicians showed both an overall low level of stigmatization but showed also differences in their pattern of stigmatizing beliefs when compared to each other.

“The newly developed assessment tool can be helpful in determining the effectiveness of approaches to prevent and intervene stigmatization towards adults with ADHD.”

However, going beyond attitudes and beliefs towards individuals with ADHD, the consequences of the public’s stigmatizing beliefs on actual behavior towards individuals with ADHD is still largely unknown. It therefore remains a crucial challenge for future research to explore to what respect negative beliefs affect actual behavior and how negative consequences can be prevented for the stigmatized person.

Relevant Publications and Links

Fuermaier, A.B.M., Tucha, L., Koerts, J., Mueller, A.K., Lange, K.W., & Tucha, O. (2012). Measurement of stigmatization towards adults with attention deficit hyperactivity disorder. PLoS ONE, 7(12), e51755.

Fuermaier, A.B.M., Tucha, L., Mueller, A.K., Koerts, J., Hauser, J., Lange, K.W. & Tucha, O. (2014). Stigmatization in teachers towards adults with attention deficit hyperactivity disorder, SpringerPlus, 3, 26.

Mueller, A.K., Fuermaier, A.B.M., Koerts, J., & Tucha, L. (2012). Stigma in attention deficit hyperactivity disorder. ADHD Attention Deficit and Hyperactivity Disorders, 4, 101-114.


NOTE: Image by Peter Heilmann, licenced under CC BY 2.0

Associate Professor

Anselm Fürmaier is associate professor at the Department of Clinical and Developmental Neuropsychology. He studied psychology at the Universities of Regensburg, Germany, and Keele, UK, with an emphasis on biological psychology and clinical neuropsychology (MSc in 2010). After graduation, he came to Groningen to work on his PhD project on cognitive functioning of adults with attention deficit hyperactivity disorder (ADHD). In 2014, he obtained his PhD and became assistant professor in the field of clinical neuropsychology. In 2020 he was promoted to associate professor. His research interests comprise the neuropsychological assessment of attention disorders in patients with psychiatric and neurological conditions, with an emphasis on everyday functioning. Large parts of his research are dedicated on the development and evaluation of tools for the assessment of symptom and performance validity.

Selected publications

Becke, M., Fuermaier, A.B.M., Buehren, J., Weisbrod, M., Aschenbrenner, S., Tucha, O., & Tucha, L. (2019). Utility of the Structured Interview of Reported Symptoms (SIRS-2) in detecting feigned adult attention-deficit/hyperactivity disorder. Journal of Clinical and Experimental Neuropsychology, 41(8), 786-802.

Fuermaier, A.B.M., Fricke, J.A., de Vries, S.M., Tucha, L., & Tucha, O. (2019). Neuropsychological assessment of adults with ADHD: A Delphi consensus study. Applied Neuropsychology: Adult, 26(4), 340-354.

Fuermaier, A.B.M., Tucha, O., Russ, D., Ehrenstein, J.K., Stanke, M., Heindorf, R., Buggenthin, R., Aschenbrenner, S., Koerts, J., & Tucha, L. (2020). Utility of an attention-based performance validity test for the detection of feigned cognitive dysfunction after acquired brain injury. Journal of Clinical and Experimental Neuropsychology, 42(3), 285-297.

Groen, Y., Fuermaier, A.B.M., Tucha, L., Weisbrod, M., Aschenbrenner, S., & Tucha, O. (2018). A situation-specific approach to measure attention in adults with ADHD: The everyday life attention scale (ELAS). Applied Neuropsychology: Adult. 26(5):411-440.

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