{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T13:33:23Z","timestamp":1776519203318,"version":"3.51.2"},"reference-count":47,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,9,2]],"date-time":"2021-09-02T00:00:00Z","timestamp":1630540800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011645","name":"Kaohsiung Medical University Hospital","doi-asserted-by":"publisher","award":["KMUH109-M911"],"award-info":[{"award-number":["KMUH109-M911"]}],"id":[{"id":"10.13039\/501100011645","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>The aims of this study were to examine the proportion of caregivers who were hesitant to vaccinate their children with attention-deficit\/hyperactivity disorder (ADHD) against coronavirus disease 2019 (COVID-19) and the factors related to caregiver intentions to vaccinate their children against COVID-19. In total, 161 caregivers of children with ADHD were recruited in this study. The caregivers completed an online questionnaire to provide data regarding their intention to vaccinate their children against COVID-19, concerns about the effectiveness and safety of vaccines, unfavorable family attitudes toward vaccines, and children\u2019s medication use for ADHD and comorbid psychopathology. The factors related to caregiver intentions to vaccinate their child were examined using linear regression analysis. The results indicated that 25.5% of caregivers were hesitant to vaccinate their children with ADHD, and 11.8% refused to vaccinate their children against COVID-19. The caregivers\u2019 concerns about the safety of vaccines and children\u2019s regular use of medication for ADHD were negatively associated with caregiver intentions to vaccinate, whereas the children\u2019s comorbid conduct or oppositional defiant problems were positively associated with the caregiver intentions to vaccinate. An intervention that enhances caregiver intentions to vaccinate their children with ADHD against COVID-19 by addressing the related factors found in this study is warranted.<\/jats:p>","DOI":"10.3390\/vaccines9090983","type":"journal-article","created":{"date-parts":[[2021,9,6]],"date-time":"2021-09-06T23:55:22Z","timestamp":1630972522000},"page":"983","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Factors Related to Caregiver Intentions to Vaccinate Their Children with Attention-Deficit\/Hyperactivity Disorder against COVID-19 in Taiwan"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7371-1757","authenticated-orcid":false,"given":"Ching-Shu","family":"Tsai","sequence":"first","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2351-2335","authenticated-orcid":false,"given":"Ray C.","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA"},{"name":"Department of Psychiatry, Children\u2019s Hospital and Regional Medical Center, Seattle, WA 98105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Min","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1156-4939","authenticated-orcid":false,"given":"Cheng-Fang","family":"Yen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan"},{"name":"Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan"},{"name":"College of Professional Studies, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,2]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2021, July 19). WHO Coronavirus (COVID-19) Dashboard. Available online: https:\/\/covid19.who.int\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1860","DOI":"10.15585\/mmwr.mm6949e2","article-title":"Summary of guidance for public health strategies to address high levels of community transmission of SARS-CoV-2 and related deaths, December 2020","volume":"69","author":"Honein","year":"2020","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_3","unstructured":"World Health Organization (2021, July 19). WHO Sage Roadmap for Prioritizing Uses of COVID-19 Vaccines in the Context of Limited Supply. Available online: https:\/\/cdn.who.int\/media\/docs\/default-source\/immunization\/sage\/covid\/sage-prioritization-roadmap-covid19-vaccines_31a59ccd-1fbf-4a36-a12f-73344134e49d.pdf?sfvrsn=bf227443_36&download=true."},{"key":"ref_4","unstructured":"World Health Organization (2021, July 19). Coronavirus disease (COVID-19): Vaccines. Available online: https:\/\/www.who.int\/news-room\/q-a-detail\/coronavirus-disease-(covid-19)-vaccines."},{"key":"ref_5","unstructured":"World Health Organization (2021, July 19). WHO Lists Additional COVID-19 Vaccine for Emergency Use and Issues Interim Policy Recommendations. Available online: https:\/\/www.who.int\/news\/item\/07-05-2021-who-lists-additional-covid-19-vaccine-for-emergency-use-and-issues-interim-policy-recommendations."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2469","DOI":"10.1093\/cid\/ciaa556","article-title":"SARS-CoV-2 (COVID-19): What do we know about children? A systematic review","volume":"71","author":"Mehta","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/j.vaccine.2020.11.078","article-title":"Epidemiology of COVID-19 infection in young children under five years: A systematic review and meta-analysis","volume":"39","author":"Bhuiyan","year":"2021","journal-title":"Vaccine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.ijid.2020.11.163","article-title":"Severe COVID-19 infection and pediatric comorbidities: A systematic review and meta-analysis","volume":"103","author":"Tsankov","year":"2021","journal-title":"Int. J. Infect. Dis."},{"key":"ref_9","unstructured":"Centers for Disease Control and Prevention (2021, July 19). COVID-19 Vaccines for Children and Teens, Available online: https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/vaccines\/recommendations\/adolescents.html."},{"key":"ref_10","unstructured":"European Medicines Agency (2021, July 19). First COVID-19 Vaccine Approved for Children Aged 12 to 15 in EU. Available online: https:\/\/www.ema.europa.eu\/en\/news\/first-covid-19-vaccine-approved-children-aged-12-15-eu."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1002\/wps.20806","article-title":"Increased risk of COVID-19 infection and mortality in people with mental disorders: Analysis from electronic health records in the United States","volume":"20","author":"Wang","year":"2021","journal-title":"World Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Merzon, E., Manor, I., Rotem, A., Schneider, T., Vinker, S., Golan Cohen, A., Lauden, A., Weizman, A., and Green, I. (2020). ADHD as a risk factor for infection with COVID-19. J. Atten. Disord.","DOI":"10.1177\/1087054720943271"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Merzon, E., Weiss, M.D., Cortese, S., Rotem, A., Schneider, T., Craig, S.G., Vinker, S., Golan Cohen, A., Green, I., and Ashkenazi, S. (2021). The association between ADHD and the severity of COVID-19 infection. J. Atten. Disord.","DOI":"10.1177\/10870547211003659"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Pollak, Y., Shoham, R., Dayan, H., Gabrieli-Seri, O., and Berger, I. (2021). Symptoms of ADHD predict lower adaptation to the COVID-19 outbreak: Financial decline, low adherence to preventive measures, psychological distress, and illness-related negative perceptions. J. Atten. Disord.","DOI":"10.31234\/osf.io\/nqt6v"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"7789","DOI":"10.1016\/j.vaccine.2020.10.027","article-title":"Parents\u2019 and guardians\u2019 views on the acceptability of a future COVID-19 vaccine: A multi-methods study in England","volume":"38","author":"Bell","year":"2020","journal-title":"Vaccine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"7668","DOI":"10.1016\/j.vaccine.2020.09.084","article-title":"Caregiver willingness to vaccinate their children against COVID-19: Cross sectional survey","volume":"38","author":"Goldman","year":"2020","journal-title":"Vaccine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e548","DOI":"10.9778\/cmajo.20200302","article-title":"SARS-figureoV-2 vaccination intentions among mothers of children aged 9 to 12 years: A survey of the All Our Families cohort","volume":"9","author":"Hetherington","year":"2021","journal-title":"CMAJ Open"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Montalti, M., Rallo, F., Guaraldi, F., Bartoli, L., Po, G., Stillo, M., Perrone, P., Squillace, L., Dallolio, L., and Pandolfi, P. (2021). Would parents get their children vaccinated against SARS-CoV-2? Rate and predictors of vaccine hesitancy according to a survey over 5000 families from Bologna, Italy. Vaccines, 9.","DOI":"10.3390\/vaccines9040366"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1080\/10810730.2021.1871986","article-title":"Preparing for a COVID-19 vaccine: A mixed methods study of vaccine hesitant parents","volume":"25","author":"Rhodes","year":"2020","journal-title":"J. Health Commun."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s10654-021-00728-6","article-title":"COVID-19 vaccine acceptance among pregnant women and mothers of young children: Results of a survey in 16 countries","volume":"36","author":"Skjefte","year":"2021","journal-title":"Eur. J. Epidemiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e134","DOI":"10.1097\/INF.0000000000003042","article-title":"Evaluation of COVID-19 vaccine refusal in parents","volume":"40","author":"Yigit","year":"2021","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e24827","DOI":"10.2196\/24827","article-title":"Parental acceptability of COVID-19 vaccination for children under the age of 18 years: Cross-sectional online survey","volume":"3","author":"Zhang","year":"2020","journal-title":"JMIR Pediatr. Parent."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Kuhl, J., and Beckmann, J. (1985). From intentions to actions: A theory of planned behavior. Action Control, Springer.","DOI":"10.1007\/978-3-642-69746-3"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1080\/00223980.1975.9915803","article-title":"A protection motivation theory of fear appeals and attitude change1","volume":"91","author":"Rogers","year":"1975","journal-title":"J. Psychol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"6472","DOI":"10.1016\/j.vaccine.2011.06.107","article-title":"Factors associated with uptake of vaccination against pandemic influenza: A systematic review","volume":"29","author":"Bish","year":"2011","journal-title":"Vaccine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"100321","DOI":"10.1016\/j.ssmph.2018.11.005","article-title":"Using protection motivation theory to predict intention to adhere to official MMR vaccination recommendations in Switzerland","volume":"7","author":"Camerini","year":"2019","journal-title":"SSM Popul. Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1177\/0890117120985833","article-title":"Influenza vaccination among U.S. college or university students: A systematic review","volume":"35","author":"Shon","year":"2021","journal-title":"Am. J. Health Promot."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Chang, C.-C., Chen, Y.-M., Hsiao, R.C., Chou, W.-J., and Yen, C.-F. (2021). Did affiliate stigma predict affective and behavioral outcomes in caregivers and their children with attention-deficit\/hyperactivity disorder?. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18147532"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Chang, C.C., Chen, Y.M., Liu, T.L., Hsiao, R.C., Chou, W.J., and Yen, C.F. (2020). Affiliate stigma and related factors in family caregivers of children with attention-deficit\/hyperactivity disorder. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17020576"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.jad.2020.09.121","article-title":"Association between affiliate stigma and depression and its moderators in caregivers of children with attention-deficit\/hyperactivity disorder","volume":"279","author":"Chen","year":"2021","journal-title":"J. Affect. Disord."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"113692","DOI":"10.1016\/j.psychres.2020.113692","article-title":"Identifying the impact of the confinement of Covid-19 on emotional-mood and behavioural dimensions in children and adolescents with attention deficit hyperactivity disorder (ADHD)","volume":"296","author":"Melegari","year":"2021","journal-title":"Psychiatry Res."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Nonweiler, J., Rattray, F., Baulcomb, J., Happ\u00e9, F., and Absoud, M. (2020). Prevalence and associated factors of emotional and behavioural difficulties during COVID-19 pandemic in children with neurodevelopmental disorders. Children, 7.","DOI":"10.20944\/preprints202007.0636.v1"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"102077","DOI":"10.1016\/j.ajp.2020.102077","article-title":"Acute stress, behavioural symptoms and mood states among school-age children with attention-deficit\/hyperactive disorder during the COVID-19 outbreak","volume":"51","author":"Zhang","year":"2020","journal-title":"Asian J. Psychiatry"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1207\/s15327906mbr2603_7","article-title":"How many subjects does it take to do a regression analysis?","volume":"26","author":"Green","year":"1991","journal-title":"Multivar. Behav. Res."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Wang, P.W., Ahorsu, D.K., Lin, C.Y., Chen, I.H., Yen, C.F., Kuo, Y.J., Griffiths, M.D., and Pakpour, A.H. (2021). Motivation to have COVID-19 vaccination explained using an extended Protection Motivation Theory among university students in China: The role of information sources. Vaccines, 9.","DOI":"10.3390\/vaccines9040380"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Fan, C.W., Chen, I.H., Ko, N.Y., Yen, C.F., Lin, C.Y., Griffiths, M.D., and Pakpour, A.H. (2021). Extended theory of planned behavior in explaining the intention to COVID-19 vaccination uptake among mainland Chinese university students: An online survey study. Hum. Vaccines Immunother., 1\u20138.","DOI":"10.1080\/21645515.2021.1933687"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"4510","DOI":"10.1016\/j.vaccine.2021.06.044","article-title":"Adapting the Motors of Influenza Vaccination Acceptance Scale into the Motors of COVID-19 Vaccination Acceptance Scale: Psychometric evaluation among mainland Chinese university students","volume":"39","author":"Chen","year":"2021","journal-title":"Vaccine"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Yeh, Y.-C., Chen, I.-H., Ahorsu, D.K., Ko, N.-Y., Chen, K.-L., Li, P.-C., Yen, C.-F., Lin, C.-Y., Griffiths, M.D., and Pakpour, A.H. (2021). Measurement Invariance of the Drivers of COVID-19 Vaccination Acceptance Scale: Comparison between Taiwanese and Mainland Chinese-Speaking Populations. Vaccines, 9.","DOI":"10.3390\/vaccines9030297"},{"key":"ref_39","unstructured":"Taiwan Centers for Disease Control (2021, July 22). First Batch of AstraZeneca\u2019s COVID-19 Vaccine Arrives in Taiwan, Available online: https:\/\/www.cdc.gov.tw\/En\/Bulletin\/Detail\/GpdnyWUqMG2cWTJxFsBGjQ?typeid=158\/."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Bronfenbrenner, U. (1979). The Ecology of Human Development, Harvard University Press.","DOI":"10.4159\/9780674028845"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1690091","DOI":"10.1080\/17482631.2019.1690091","article-title":"Experience of stress in parents of children with ADHD: A qualitative study","volume":"14","author":"Leitch","year":"2019","journal-title":"Int. J. Qual. Stud. Health Well-Being"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/1063426610387433","article-title":"Parenting stress in families of children with ADHD: A meta-analysis","volume":"21","author":"Theule","year":"2013","journal-title":"J. Emot. Behav. Disord."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Deater-Deckard, K. (2004). Parenting Stress, Yale University Press.","DOI":"10.12987\/yale\/9780300103939.001.0001"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1097\/JCP.0000000000000747","article-title":"A naturalistic comparison of methylphenidate and risperidone monotherapy in drug-naive youth with attention-deficit\/hyperactivity disorder comorbid with oppositional defiant disorder and aggression","volume":"37","author":"Masi","year":"2017","journal-title":"J. Clin. Psychopharmacol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.psychres.2016.02.010","article-title":"Combined pharmacotherapy-multimodal psychotherapy in children with disruptive behavior disorders","volume":"238","author":"Masi","year":"2016","journal-title":"Psychiatry Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1111\/j.1469-7610.2004.00250.x","article-title":"Conduct disorder and oppositional defiant disorder in a national sample: Developmental epidemiology","volume":"45","author":"Maughan","year":"2004","journal-title":"J. Child Psychol. Psychiatry"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Chen, Y.-L., Lin, Y.-J., Chang, Y.-P., Chou, W.-J., and Yen, C.-F. (2021). Differences in the protection motivation theory constructs between people with various latent classes of motivation for vaccination and preventive behaviors against COVID-19 in Taiwan. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18137042"}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/9\/9\/983\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:55:16Z","timestamp":1760165716000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/9\/9\/983"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,2]]},"references-count":47,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["vaccines9090983"],"URL":"https:\/\/doi.org\/10.3390\/vaccines9090983","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,2]]}}}