Attention-deficit/hyperactivity disorder (ADHD) in cultural context: Do parents in Hong Kong and the United Kingdom adopt different thresholds when rating symptoms, and if so why?

Objectives Attention-deficit/hyperactivity disorder (ADHD) prevalence is similar across world regions. However, because informants' decision thresholds may vary between regions, these similarities may mask regional variations in actual ADHD behaviours. We tested this by comparing the relationship between informant's ratings and children's measured activity in United Kingdom (UK) and Hong Kong (HK) and then explored whether any national differences in endorsement thresholds discovered are linked to cultural variations in parenting factors. Methods Parents rated the 18 ADHD symptoms in 112 three-to-five-year-old children stratified for ADHD symptom levels (49 girls and 63 boys; 55 from the UK and 57 from HK) and completed some parenting questionnaires. Children's task-related activity was measured using actometers. Results In both groups, measured activity was positively correlated with hyperactivity/impulsivity (r = 0.44(HK); r = 0.41(UK)). While HK children were less active than UK children (p < 0.01), HK parents rated their children as more hyperactive/impulsive and inattentive (ps < 0.05). The lower rating threshold indicated by this pattern in HK parents were explained by their higher child-related stress levels. Conclusions UK and HK parents operated different ADHD symptom endorsement thresholds. The link between these and child-related stress may mark a more general role of cultural pressure for child conformity and school achievement in HK.