Parental beliefs about the nature of ADHD behaviours and their relationship to referral intentions in preschool children K. Maniadaki,* E. Sonuga-Barke,* E. Kakouros† and R. Karaba‡ *University of Southampton, Developmental Brain & Behaviour Unit, School of Psychology, Southampton †Technological Educational Institution of Athens, Department of Early Childhood Education, and ‡Psychological Center of Developmental and Learning Disabilities ‘ARSI’, Athens, Greece Accepted for publication 21 February 2006 Keywords ADHD, parental beliefs, preschool children, referral intentions, self-efficacy Correspondence: Dr Katerina Maniadaki, 52 Karatasou Str., 136 76 Thrakomakedones, Athens, Greece E-mail: katerina@arsi.gr Abstract Background Parental beliefs about child problem behaviour have emerged as closely related to referral intentions to mental health services. Methods This study compared beliefs of severity, impact and advice seeking for attention deficit/ hyperactivity disorder (ADHD) behaviours of parents whose preschool children present ADHD behaviours with those of parents whose children do not display such behaviours. Both parents of 295 preschoolers, aged 4–6 years, enrolled in kindergartens in Athens, filled in: (i) a questionnaire composed by a vignette describing a hypothetical 5-year-old child presenting ADHD symptoms followed by rating scales assessing dimensions of severity, impact and referral intention, and (ii) the ‘Strengths and Difficulties Questionnaire’ for screening ADHD behaviours in their own child. Results Results showed that almost half of the parents who reported ADHD behaviours in their own child replied that they had never met a child exhibiting such behaviours. These parents also perceived such behaviours as being less severe and with less negative family impact than parents who did not report such behaviours in their own child. Conclusions Parents whose preschool child displays ADHD behaviours tend to perceive them as normal developmental patterns and may suspend the referral of the child. Implications of these findings for early identification of ADHD are discussed. Introduction Attention deficit/hyperactivity disorder (ADHD) is well estab- lished as a developmental disorder with neurobiological under- pinnings, and manifests as a spectrum of primary symptoms of inattention and hyperactivity-impulsivity with an onset in early childhood (Faraone & Biederman 1994; Barkley 1998). Accord- ing to the American Psychiatric Association (APA 1994), the disorder affects 3–5% of school-aged children, whereas community-based studies constantly reveal higher prevalence rates of ADHD (Lesesne et al. 2003; Canino et al. 2004). Prospective studies also indicate that up to half of children with ADHD will continue to display symptoms into adulthood (Weiss et al. 1985; Mannuzza et al. 1991). Moreover, children affected by ADHD are at a high risk of developing comorbid disorders, such as oppositional defiant disorder or conduct dis- order, and impaired social adjustment as well (Taylor et al. 1996; Seija 2002). Irrespective of ADHD high prevalence rates, chronicity, comorbidity and availability of evidence-based treatments, a great number of affected children do not receive treatment either from school-based or from specialist mental health Original Article doi:10.1111/j.1365-2214.2006.00642.x © 2006 The Authors Journal compilation © 2006 Blackwell Publishing Ltd 188