P a r e n t a n d C h ild K n o w le d g e a n d A t t i t u d e s

T o w a r d M e n t a l I lln e s s : A P i l o t S t u d y
Rosemond T. Lorona and Cindy Miller-Perrin*
Pepperdine University

The present study examined the relationship between children

and their parents with regard to their knowledge and attitudes toward
mental illness. Previous literature suggested that children may have an
incomplete knowledge of mental illness and may perceive it negatively, but
was inconclusive as to where children are learning about mental illness.
We hypothesized that parents and children would have similar perceptions
of mental illness, indicating parental influence on the socialization of their
childrens views about mental illness. Data were gathered from 24 pairs of
students and parents from a middle school and high school. All parent and
child participants completed both a knowledge and attitude assessment,
and responses of parents were compared to responses of children. The
results showed that children tended to have incomplete knowledge of
mental illness and that parents and children had significantly different
knowledge and attitudes toward mental illness, t( 23) = 3.57, p = .002 and
<(23) = -2.96, p = .007, respectively. Correlational analyses indicated that
parental attitudes in particular may be related to their childrens knowledge
and attitudes (rs ranging from .02-69). Future research should include a
larger, more diverse sample to examine additional age and sex differences.
A B STR A C T.

ental illness is a serious issue that affects

many individuals including both adults
and children. According to the National
Institute of Mental Health and the Substance Abuse
and Mental H ealth A dm inistration (SAMHA), the
12-m onth prevalence rate fo r all psychological
disorders, excluding developm ental, childhood,
and substance-related disorders, in U.S. adults is
18.6% (SAMHA, 2013). The lifetime prevalence rate
for any psychological disorder including substancerelated disorders, bu t excluding developm ental
disorders, in U.S. adolescents is 46.3% (Merikangas
et al., 2010). Although the high prevalence might
suggest that people are m ore aware and accepting
of mental illness, research has suggested that people
tend to stigmatize m ental illness (Corrigan, 2000).
U nfortunately, m any negative attitu d es tow ard
m ental illness have been expressed even at young
ages (see Wahl, 2002, for a review). U nderstanding
the way that children see the world and its people is
im portant because their perceptions develop into

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their adult attitudes, which can then be perpetuated

to future generations.
Current literature has suggested that, although
som e c h ild re n have a good u n d e rs ta n d in g o f
m ental illness and its correlates and causes, o ther
c h ild re n may n o t fully u n d e rsta n d th e causes,
symptoms, treatments, and long-term prognoses of
mental illness. For example, after hearing a speaker
talk about m ental illness, adolescents and children
ap p eared to grasp the causes and treatm en ts of
m ental illness (Bailey, 1999; DeSocio, Stember, &
Schrinsky, 2006). However, children who were not
formally spoken to about m ental illness showed
some coherent knowledge of the causes of m ental
illness, but they did not fully understand the symptom ology (Wahl, Susin, Lax, Kaplan, & Zatina,
2012) o r how to tre a t m en tal illness (R oberts,
Beidleman, & W urtele, 1981; Wahl et al., 2012).
Knowledge of m ental illness and its treatm ent
may vary by demographic factors such as age, educa
tion, and socioeconom ic status. W hen com pared

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Lorona and Miller-Perrin | Parent and Child Knowledge and Attitudes

to younger children, for example, older children

had m ore knowledge about the causes and treat
m ents of m ental illness because younger children
te n d e d to over m edicalize m ental illness (Fox,
Buchanan-Barrow, & Barrett, 2010; Roberts et al.,
1981; Spitzer & Cameron, 1995). Younger children
tended to believe that m ental illness was similar to
a physical problem , and this u n d erstanding was
expressed by their ideas that people with m ental
illness could spread th eir illness and should be
treated in hospitals or with surgery (Fox et al., 2010;
Roberts et ah, 1981; Spitzer & C am eron, 1995).
C hildren with a lower socioeconom ic status also
tended to over medicalize m ental illness and had
po o rer knowledge about psychological disorders
than their peers of a higher socioeconomic status
(Roberts,Johnson, & Beidleman, 1984). This could
have been because of less medical care and medical
knowledge am ong this low socioeconomic popula
tion (Roberts et ah, 1984). C hildren from nonWestern cultures may also differ in their am ount of
knowledge of mental illness. For example, children
in N igeria showed a general lack o f knowledge
about psychological disorders, which could have
been due to th eir societys non-W esternized view
o f m edicine and greater beliefs in supernatural
powers (Dogra etah, 2012; Ronzoni, Dogra, Omigbodun, Bella, & Atitola, 2010).
Som e ch ildren have d em onstrated a rough
u n d ersta n d in g o r know ledge o f m ental illness;
consequently, research has suggested that many
ch ild ren have negative attitudes toward people
with mental illness (Watson, Miller, & Lyons, 2005).
A lthough knowledge o f m ental illness addresses
cognitions th at capture how m uch people know
ab out m ental illness, attitudes are separate from
knowledge and include biases, stereotypes, and
emotional reactions to mental illness. For example,
33% o f o ne sam ple of N igerian school children
described people with mental illness in derogatory
terms (Ronzoni et al., 2010), which indicated nega
tive beliefs. Similarly, Wahl and colleagues (2012)
assessed the attitudes o f m iddle school students
in the U nited States and noticed mixed findings;
a majority of students had positive attitudes, but a
considerable m inority had negative perceptions
o f m ental illness. Interestingly, the participants
from Wahl et al. (2012) showed positive attitudes
toward m ental illness such as believing that those
with m ental illness were good friends, respectable,
and approachable people. However, these beliefs
did n o t translate to behavior because m any stu
dents showed a desire for social distance by being

less willing to work on school projects or go on a

date with som eone with a m ental illness. Although
the students explicit attitudes suggested positive
views of mental illness, persisting negative beliefs
translated into a desire for social distance. O ther
research has suggested th a t ch ild ren may view
m ental illness as the responsibility o f the affected
individual or perceive people with mental illness as
dangerous (Corrigan et al., 2007). N either is opti
mal because the form er can lead to less sympathy
and more anger, and the latter can lead to fear and
avoidance (Corrigan etal., 2007).
Indeed, research has supported the notion that
many children want greater social distance from
those who have m ental illness than those who do
not, w hether that m eans being physically set apart
(Spitzer & Cam eron, 1995; Weiss, 1986) or being
socially distant in relationships and not wanting to
be friends (Dogra et al, 2012; Roberts et al., 1981;
Wahl et al., 2012). W hen asked to draw themselves
at any distance from a drawn figure o f som eone
with either no m ental health problem or someone
with m ental illness, children in kindergarten and
grades 2, 4, 6, and 8 chose to be significantly farther
away from the character with m ental illness than
the character without m ental illness (Weiss, 1986).
W hen given different vignettes about characters
with either mild or severe physical or mental illness,
fifth and sixth grade children were m ore likely to
have greater knowledge about the characters with
the physical illness, and also expressed the least
interest in being friends with som eone with a mild
psychological disorder (Roberts et al., 1981).
Although past research is im portant in under
standing the way that children perceive the world,
very few studies have investigated why children have
the knowledge and attitudes that they do. Research
has suggested that m edia may influence children
to believe that people with m ental illness should
be feared or sent away because many movies have a
crazy character who is negatively porU ayed (Wahl,
2003). However, conflicting research has suggested
that media is a less significant source of knowledge
fo r c h ild re n than everyday social interactions,
which may shape knowledge and attitudes (Baker,
Bedell, & Prinsky, 1982). In a study by Baker and
colleagues (1982), for example, 75 children were
asked about the m eanings o f certain words such
as crazy, nuts, mentally ill, and emotionally disturbed
and the origin o f their learning. In term s o f the
origin o f such words, c h ild re n s m ost freq u en t
response was I d o n t know /rem em ber, bu t the
second most frequent response for every word was

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adult, followed by peers and mass media. This

suggested that, in addition to the influence of the
media, children may be socialized by other sources.
Although these findings have suggested that
the stigma that children hold toward mental ill
ness is influenced by socialization, no research
has yet explored the impact of specific people on
childrens attitudes toward mental illness. Such
influences could include parents, caregivers, and
peers, in addition to educational program s. A
popular approach has been to shape the attitudes
of children by educating them in school about
mental illness. Some of these educational programs
have demonstrated the ability to increase childrens
understanding and positive attitudes toward mental
illness, especially in short-term assessments (Economou et al., 2014; Pinto-Foltz, Logsdon, & Myers,
2011; Spagnolo, Murphy, & Librera, 2008; Ventieri,
Clarke, & Hay, 2011). However, the positive effects
of the education tended to diminish over time,
meaning that education may need to be ongoing
(Pinfold et ah, 2003; Pinto-Foltz et ah, 2011; Ven
tieri et ah, 2011). These school interventions may
not have long-term significance in impacting the
way that children perceive mental illness.
This lack of success for some intervention
program s may occur because children gained
their perspectives from places other than school,
and these perspectives were already ingrained
and difficult to change. It may be that parents or
friends contributed more to childrens knowledge
and attitudes about mental illness. With regard to
attitudes toward stuttering, for example, children
had similar attitudes as their parents and neigh
bors, who are often a childs first social contacts
(Ozdemir, St. Louis, & Topbas, 2011). A similar
mechanism could be operating with regard to other
psychological disorders. In other words, the lack of
understanding and the presence of negative atti
tudes toward mental illness displayed by children
may be the result of parental socialization. Chandra
and Minkovitz (2007) indicated that only one fifth
of the sampled eighth grade students had talked
with their parents about m ental illness. Those
who had not seemed to infer or assume what their
parents thought about mental illness, and many
of these students had more negative views toward
mental illness than peers who had talked about it
with parents (Chandra & Minkovitz, 2007). This
qualitative research indicated the possibility that,
even if students had not formally spoken with par
ents about mental illness, they might have learned
at home that mental illness was negative and a topic

to be avoided. Similarly, Mueller, Callanan, and

Greenwood (2014) suggested that parents com
municated very little with their children concerning
mental illness, but when they did, they tended to
use stigmatizing language. How parents act toward
others with m ental illness, expose children to
mental illness, and talk about mental illness may
be factors that contribute to how children perceive
psychological disorders. Unfortunately, previous
research has not explored the specific influence
that parents have on their childrens knowledge
and attitudes of mental illness. If parents influence
children, professionals could intervene in order
to achieve lasting positive changes in childrens
perceptions of mental illness.
The purpose of the current pilot study was to
examine the relationship between parents and
childrens knowledge and attitudes toward mental
illness. Middle school students were assessed because
these childrens views have shown stability and simi
larities to the beliefs of adults (Weiss, 1985). More
over, previous research that involved middle school
children suggested that a large portion of this age
group holds negative attitudes and beliefs toward
individuals with mental illness (Corrigan etal., 2007;
Roberts etal., 1981; Wahl etal., 2012; Weiss, 1986),
which is concerning given that these attitudes could
persist into childrens future attitudes toward mental
illness (Weiss, 1985). The current study also exam
ined a sample of high school students to understand
how knowledge and attitudes may or may not be
affected by parent influence when a child is older
and seeking more independence.
We hypothesized that (a) parents and children
would have equal levels of knowledge and the same
attitudes toward mental illness. We also expected
that (b) the knowledge and attitudes of children
of both age groups would be positively correlated
with the knowledge and attitudes of their parents
and (c) these relationships would remain when
the students were separated by age and (d) sex.
Because parents were likely the first significant
socializing influence on the children, we expected
that the impressions they left on their children
would be stable across developm ent and across
sex. The knowledge and attitudes of middle school
students were expected to be stable and similar to
adults responses, and the correlation was expected
to persist with age, even when children were in high
school and had experienced more social influence.
We also descriptively explored the knowledge and
attitudes toward mental illness that children and
parents endorsed.

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M e th o d

Participants

A total of 24 parent and student pairs participated

in the study. Eighteen (75%) of the pairs included
a seventh grade child (aged 12-13 years), and six
(25%) of the pairs included an eleventh grade
child (aged 16-17 years). Participants included 16
(67%) girls, and eight (33%) boys. Mothers (n= 22;
92%) and fathers (n= 2, 8%) filled out the surveys.
Other demographic information was not collected.
However, the overall school district demographics
reflected a primarily Hispanic student population,
and most students qualified for free and reduced
lunch programs. Students came from a middle
school and high school in a suburb of Los Angeles,
California.
Measures

An assessment of knowledge and an assessment of

attitudes related to mental illness were given to all
student and adult participants. All parents and chil
dren received identical forms of the assessments.
Reliability calculations for the present study are
omitted due to the small sample size, which could
lead to inaccurate estimates
Knowledge assessment. The knowledge assess
ment included items developed by Wahl and col
leagues (2012) to measure knowledge of mental
illness. It consisted of 17 items (e.g., Mental illness
and mental retardation are the same thing.) rated
on a 5-point Likert scale ranging from 1 (strongly dis
agree) to 5 (strongly agree) . Scores on the assessment
ranged from 17 to 85. High scores indicated greater
knowledge of mental illness. The scale was found
to have a test-retest reliability of .49 and an internal
consistency coefficient of .63 (Wahl etal., 2012).
Attitude assessment. The attitude assessment
included items developed by Wahl and colleagues
(2012) to measure attitudes toward mental illness.
It consisted of 17 items (e.g., It is a good idea
to avoid people with mental illness.) rated on a
5-point scale ranging from 1 (strongly disagree) to 5
(strongly agree). Scores on the assessment ranged
from 17 to 85. High scores indicated more negative
attitudes toward mental illness. The scale was found
to have a test-retest reliability of .74 and an internal
consistency coefficient of .83 (Wahl etal., 2012).
Procedure

Once the institutional review board of Pepperdine

University approved the protocol (041205), middle
school and high school students and their parents
were recruited for the present study. Participants

were recruited with the approval of the principals

of the middle school and high school. Parents of
200 seventh grade students who attended a registra
tion fair were given envelopes with an information
letter, consent form for one parent, parental con
sent form for the student, the parent assessment of
knowledge, and the parent assessment of attitudes.
Envelopes containing the same materials were
also mailed to the homes of 200 eleventh grade
students. All inform ation that went to parents,
including the surveys, was translated into Spanish
to cater to the needs of the sample and obtain a
larger sample size. Parents completed the assess
ments and the consent forms, and then sent these
documents to the researchers in a self-addressed,
stam ped envelope via first-class mail. Consent
forms and assessments received from the parents
were coded in order to match parent responses to
child responses. Parents who returned the surveys
and consent forms participated in the study, as did
their children.
The ch ild ren were then assessed at each
school. Only the students whose parents com
pleted knowledge and attitude assessments and
consent forms participated. Two middle school
student-parent pairs were dropped from the sample
because the students were absent on assessment
days. Before completing the assessments, students
completed a child assent form. If they agreed to
participate, they were asked to complete die knowl
edge assessment and attitude assessment. Students
were told to complete the assessments to the best
of their abilities. They were assured that there were
no right or wrong answers to the assessment items
and that their responses would be kept anonymous.
R e s u lts

Descriptive analyses were used to examine general

patterns in knowledge and attitudes toward mental
illness. A paired-samples t test was used to find the
difference in the means between parent and child
responses. A Pearson product-moment correlation
was used to find the association between parent
and child responses. The scores of the assessment
of knowledge were analyzed separately from the
scores on the assessment of attitudes, and age and
sex differences were also analyzed.
Descriptive Findings of Knowledge
and Attitudes

General patterns of response were analyzed by

examining the proportion of children and parents
who agreed or disagreed with each assessment item,

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as well as how many were unsure about each item.

Table 1 indicates the percentage of children and
parents who endorsed each item on the knowledge
assessment, and Table 2 indicates the proportions
of children and parents who endorsed each item
on the attitude assessment.
Certain items were answered similarly by a
strong majority of participants. More than 70%
of parents agreed with many items that indicated
positive attitudes toward m ental illness such as
(a) Psychological treatm ent (such as talking to
a psychologist or counselor) is useful and (b)
People with mental illness deserve respect. At
least 70% of parents disagreed with many items that
also indicated positive attitudes such as (a) Psycho
and maniac are okay terms for mental illness and
(b) It is a good idea to avoid people with mental
illness.
Children tended to respond similarly to the
parents on each item, but in smaller proportions.
Exceptions to this pattern were that a majority of
children, but not parents, agreed or were unsure
that (a) Psycho and maniac are okay terms for

mental illness and (b) Mental illness and men

tal retardation are the same thing. In addition,
children, but not parents, did not agree that (a)
Mental illness is often shown in negative ways on
TV and movies and (b) People with mental illness
are able to help others. However, for these items,
many children reported being unsure in their
responses. In general, children answered fewer
items in high majority agreement or disagreement
because, on almost every item, more children than
parents indicated that they were unsure. The only
exceptions were Most people with severe forms
of mental illness do not get better, even with treat
ment, on which parents and children were equally
unsure, and I have little in common with people
who have mental illness, on which slightly more
parents than children were unsure.
Differences Betw een Children and Parents

Paired-samples t tests between child and parent

total scores were conducted to examine if children
and parents differed in general knowledge and
attitudes toward mental illness. Note that higher

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Lorona and Miller-Perrin | Parent and Child Knowledge and Attitudes

knowledge scores indicated more knowledge about

mental illness, and higher attitude scores indicated
more negative views of mental illness. The pairedsamples t test on the knowledge assessment indi
cated that the scores significantly differed, t( 23) =
3.57, p= .002, because children demonstrated less
knowledge (M= 56.25, SD= 5.38) than parents (M
= 61.27, SI) = 4.86). A paired-samples t test between
child and parent total scores on the attitude assess
m ent also indicated that the scores significantly
differed, t( 23) = -2.96, p= .007, because children
demonstrated more negative attitudes (M= 40.96,
SD= 7.87) than parents (M= 34.32, SD= 6.93).
C o rre la tio n s B e tw e e n P a re n t a n d C hild

small sample size. Eleventh grade childrens attitude

scores had a strong, but nonsignificant, association
with parent knowledge (r=-.41, p= .415). The older
students also had a weak relationship between their
knowledge and attitude scores, but the relationship
between parent knowledge and attitude was statisti
cally significant (r= -.81, p= .049).
C o rre la tio n s B e tw e e n Parents
a n d C h ild re n b y Sex

W hen grouped by sex, boys and girls scores

differed in association with parent scores, as dis
played in Table 3. Girls knowledge scores were
significantly related to parent attitude scores (r =
.69, p = .003). Girls attitude scores were negatively

K n o w le d g e a n d A ttitu d e s

Pearson product-moment correlations were used

to examine the associations between parent and
child knowledge and attitudes. Relationships
were examined between the total scores for child
knowledge, child attitudes, parent knowledge, and
parent attitudes, and are shown in Table 3. Child
knowledge and attitude scores had a significant
association (r = -.46, p = .022), suggesting that
more knowledge was associated with more positive
attitudes toward mental illness. Parent knowledge
and attitude scores also had a moderate negative
association (r= -.29, p= .176), although it was not
statistically significant. Childrens total scores on
the knowledge assessment did not show a strong
relationship with parent knowledge, nor did child
attitudes significantiy correlate with parental atti
tudes (see Table 3). Although statistically nonsig
nificant, there was a moderate correlation between
child knowledge and parent attitude (r = .25, p =
.243), which indicated that child knowledge slightly
increased with more negative parental attitudes.
C o rre la tio n s B e tw e e n P aren ts an d

TABLE 3

Correlations Between Child and Parent Knowledge

and Attitudes in Total and Subgroup Samples

Table 3 also shows correlations among the two

distinct age groups. Seventh grade c h ild ren s
knowledge scores had a significant positive associa
tion with parent attitude scores (r= .56, p = .015),
which indicated that more knowledge in children
was related to more negative parental attitudes.
All other correlations were small to moderate, but
nonsignificant.
Eleventh grade childrens knowledge scores
had a moderate correlation to parent knowledge
(r= .25, p = .631), and a strong association with parent
attitude scores (r=-.65,p= . 160), although neither
correlation reached statistical significance due to

Child

Parent

Parent

A ttitu d e

K now ledge

A ttitud e

Total S am ple (n = 2 4 )
Child K now ledge

1.00

Child A ttitud e

-.4 6 '

1.00

Parent K now ledge

.09

-.1 2

1.00

P arent A ttitu d e

.25

-.1 0

-.2 9

1.00

Seventh Graders (n = 18)

Child K now ledge

1.00

Child A ttitud e

-.6 3 "

1.00

Parent K now ledge

-.1 7

-.0 2

1.00

-.13

-.21

Parent A ttitu d e

.5 6 '

1.00

Eleventh Graders (n = 6)
Child K now ledge

1.00

Child A ttitud e

.16

1.00

Parent K now ledge

.25

-.41

1.00

-.6 5

.15

-.8 1 '

Parent A ttitud e

C h ild re n b y A g e

Child
K now ledge

1.00

Fem ales (n = 16)

Child K now ledge

1.00

Child A ttitud e

-.4 8 '

1.00

Parent K now ledge

-.0 5

-.4 9 *

1.00

-.21

-.2 9

Parent A ttitud e

.6 9 "

1.00

M ales (n = 8)
Child K now ledge

1.00

Child A ttitud e

-.4 6

1.00

.23

.22

1.00

-.0 2

-.0 8

-.11

Parent K now ledge

Parent A ttitud e

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|l fp < .10. 'p < .0 5 . " p < .01.

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co rrelated with p a re n t attitu d e scores (r= -.21,

p = .439) and had a strong negative correlation

with parent knowledge scores (r= -.49, p = .055),
although n eith er correlation reached statistical
significance.
Boys represented a small portion of the sample,
and no statistically significant correlations were
observed between knowledge and attitude scores.
Some correlations were small to m oderate in size,
although nonsignificant (see Table 3).
D is c u s s io n

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The results of the current pilot study indicated that

many children were unsure of many of the specifics
of psychological problems and still needed to learn
m ore about m ental illness. For example, children
tended to be unsure of whether people with mental
illness were m ore likely to lie, if m ental illness was
caused by som ething biological, or if schizophrenia
involved multiple personalities. These results were
similar to those of past research, which suggested
that children needed more education about mental
illness (Roberts et al., 1981; Wahl et al., 2012).
The results of the current study also suggested
th at many children had not m ade definite deci
sions with regard to their attitudes and opinions
o f m ental illness. C hildren were unsure o f their
o p in io n s o n m any item s such as I w ould be
frightened if approached by a person with m ental
illness, If I had a m ental illness, I would not tell
any of my friends, and Only people who are weak
and overly sensitive let m ental illness affect them .
Because children were unsure of how to feel toward
m ental illness, it is possible that parents and other
socializing influences could still make an impact on
children and adolescents if they explicitly inform
children about m ental illness and help influence
positive attitudes.
The results of the present study showed that
parents had m ore knowledge and definite attitudes
toward m ental illness than their children, but that
this information was not necessarily communicated
to their children. The results suggested that parents
with positive attitudes did not necessarily educate
their children about m ental illness and that their
perceptions m ight n o t have been explored with
their children. This interpretation is supported by
M ueller et al. (2014), who found that p arent com
m unication was limited with children concerning
m ental illness. Similarly, Yap, W right, and Jorm
(2011) found that parent stigma level did not have
m uch o f an influence on c h ild re n s likelihood
to seek psychological help, which indicated that

p aren ts attitudes m ight no t have been explored

with their children. Children of the present sample
tended to have less knowledge and m ore negative
attitudes toward m ental illness than their parents,
which suggested that there was still opportunity
for parents and sources outside of the hom e to
in flu en ce c h ild re n s p ercep tio n s o f m en tal ill
ness. Perhaps it may be productive to give future
educational interventions to parents to make them
m ore aware that children have room to grow in
knowledge an d attitudes toward m ental illness,
and that the parents can help in the education of
their children. Future research may also need to
explore at what age children are most formidable
in their knowledge and attitudes of m ental illness
so that educational interventions can be targeted
toward specific developm ental needs.
Because the difference in the m eans between
c h ild re n s and p a re n ts knowledge and attitude
scores was significant, the results indicated that
p aren ts had d iffe ren t know ledge an d attitu d es
o f m en tal illness th an th e ir c h ild re n ; p a re n ts
potentially had a less direct influence on childrens
know ledge an d attitudes o f m ental illness than
originally hypothesized. It may be that other social
izing agents such as media, peers, or school staff
have a greater im pact on inform ing children on
m ental illness and m ental illness stigma.
Although the /-test results suggested that the
scores of parents and children significandy differed
for the knowledge and attitude assessments, the
correlational results suggested that th ere m ight
be m ore subtle relationships between parents and
childrens knowledge and attitudes toward m ental
illness. A pardcularly interesting, m oderate correla
tion was observed between child knowledge and
parent attitude, indicating that m ore negative par
ent attitudes toward m ental illness were associated
with increased knowledge in their children. This
could be because children learned about m ental
illness from a p aren ts negative attitude. Negative
inform ation and experiences tend to be m ore eas
ily rem em bered and reinforced (see Baumeister,
Bratslavsky, Finkenauer, & Vohs, 2001, for a review),
so negative parental ideas ab o u t m ental illness,
even subtle ones, could make the overall topic of
m ental illness m ore accessible for a child to think
about. The same principle could have been at work
in the slight negative association found between
p a re n t and child attitudes. A lthough a positive
relationship between parents and childrens atti
tudes was expected, the results supported the idea
that children may ultimately learn attitudes from

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Lorona and Miller-Perrin | P a re n t an d Child K n o w le d g e an d A ttitu d e s

sources outside o f the hom e (Baker et al., 1982;

C handra & Minkovitz, 2007; Wahl, 2003).
A lthough the age groups were n o t equal in
nu m b er, these prelim inary findings suggested
that age differences are worth further exploration.
Seventh grade ch ildren were significantly m ore
likely to know more about mental illness when their
parents had a more negative attitude toward mental
illness, whereas the older students were m ore likely
to know m ore about m ental illness if their parents
had m ore knowledge or a m ore positive attitude
toward mental illness. With attitudes, seventh grade
students ten d ed to have m ore positive attitudes
if th eir paren ts had negative attitudes, whereas
eleventh grade students were m ore likely to have
positive attitudes if their parents had m ore posi
tive attitudes o r m ore knowledge toward m ental
illness. A possible explanation is that, if a topic was
especially unfavorable within the hom e, younger
c h ild re n p o ten tially so u g h t m ore in fo rm atio n
about it outside of the home. However, older chil
d ren m ight have behaved differently to becom e
m ore sim ilar to th eir parents in com parison to
younger children. These changes in age should
be explored longitudinally to see whether children
become m ore impressed by their parents attitudes
over time.
The sex groups were also small and unequal in
num ber, but these prelim inary findings suggested
that child knowledge and attitude form ation dif
fered based on sex. For example, girls knowledge
was significantly related to parental attitudes such
that m ore knowledge was related to a m ore nega
tive attitude toward m ental illness. Girls attitudes
were marginally related to parental knowledge such
th at m ore positive attitudes increased with m ore
p aren tal know ledge. However, boys were m ore
likely to have m ore knowledge if their parents had
m ore knowledge about m ental illness. This indi
cated the possibility that parents might have explic
itly shared m ore of their knowledge about m ental
illness with their male children. Girls m ight have
learned about m ental illness from o th er sources
such as through talking about m ental health with
peers, which may occur m ore with girls than with
boys (C handra & Minkovitz, 2007).
Although parents did not have many similari
ties with childrens knowledge and attitudes toward
m ental illness, th ere may be value in educating
parents in the future about communicating to their
children about m ental illness. Lack of communica
tion or subtle com m unication betw een parents
a n d c h ild re n m ay be a factor in how c h ild re n

gain knowledge and attitudes toward m ental ill

ness (C handra & Minkovitz, 2007; M ueller et al.,
2014). Alternatively, if children are mainly being
socialized by other factors such as teachers, peers,
and media, educational program s may be the best
option to give students m ore understanding and
positive attitudes toward m ental illness (Spagnolo
et al., 2008; Ventieri et al., 2001). However, better
program s should be researched in order to make
m ore significant, longer lasting im pressions on
students.
Limitations

The main limitation o f the present study was the

sm all sam ple size o b tain ed , w hich lim ited the
generalizability o f the findings. In addition, the
small sam ple and unequal n u m b er o f boys and
girls, an d seventh and eleventh grade students,
m ade it difficult to com pare groups. With a larger
sample, stable correlations, sex differences, and
age differences could have been better observed.
The small sample and low parent response rate was
somewhat baffling because various measures were
taken to encourage response. We included return
envelope and postage, personally signed the cover
letters, an d provided both English and Spanish
translations. Parents m ight no t have participated
in the study for a variety o f reasons such as they
were busy with work or childcare responsibilities,
forgot to com plete and re tu rn the m aterials, or
h ad a lack o f in terest in the research m aterial.
Perhaps a b etter recru itm en t strategy for future
studies would be to go into schools on a registration
day or open house evening and personally invite
parents to participate, possibly even giving them
the option of com pleting the surveys at that time.
Such approaches m ight better ensure that parents
received and understood all of the materials and
had an opportunity to com plete them.
A nother lim itation to the cu rren t study was
the lack o f dem ographic inform ation collected
from the sam ple. W ithout ethnic dem ographic
inform ation, for example, we could not examine
the role of cultural differences in how parents and
children related in perceptions of m ental illness.
T here is research that has suggested cultural dif
ferences in how m ental illness is viewed (Abdullah
& Brown, 2011; Yeh, H o u g h , M cCabe, Lau, &
Garland, 2004), but we cannot be certain if these
cultural differences played a role in the results of
the c u rre n t study. It is also unknow n if the cur
ren t results generalized to parents and children
of all ethnicities or if the resul ts were unique to a

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Parent and Child Knowledge and Attitudes | Lorona and Miller-Perrin

particular ethnic group.

A nother lim itation was the inclusion of an
unsure response option. Because unsure was between
agree and disagree, it might have influenced the
total assessment scores, especially for the children,
who often indicated that they were unsure about
the assessment items. Children responding with
unsure on many items affected the total scores,
which could have contributed to the differences
seen in the means between parents and children.
It was also a limitation that the knowledge assess
m ent had low reliability for parent participants.
This could be due to the assessment being too
heterogeneous in scope; the assessment covers
multiple aspects of knowledge about mental ill
ness (e.g., causes, symptoms, treatm ent), and it
may not be reasonable to assume that participants
were equally knowledgeable in all of these areas.
Although the reliability may not impact the inter
pretation of the descriptive results or differences in
knowledge observed between parents and children,
the low internal consistency reliability could have
impacted the correlational analyses, which should
be interpreted with caution. Future research may
need to reevaluate the scoring of these assessments
or explore alternative measurements of knowledge
that may be less heterogeneous and more reliable.

where interventions should take place to educate

children and prom ote better attitudes toward
mental illness. Changing negative beliefs concern
ing mental illness is imperative for creating a more
integrated, understanding, and accepting society.

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Author Note. Rosemond T. Lorona, Social Science Division,

Pepperdine University; Cindy Miler-Perrin, Social Science
Division, Pepperdine University.
Rosemond T. Lorona is now at the Department of
Psychology and Neuroscience at Baylor University, Waco, TX.
This research was supported by the Academic Year
Undergraduate Research Initiative from Pepperdine
University.
Correspondence concerning this article should be
addressed to Rosemond T. Lorona, Department of Psychology
and Neuroscience, Baylor University, Waco, TX 76798. E-mail:
Rosemond_Lorona@baylor.edu

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