Parenting stress among families of children with attention deficit hyperactivity disorder

Parent stress and social support in a randomized controlled trial of individual versus group parent training for children with HKD/ADHD

OBJECTIVES

Assess (a) the relative benefit of individual versus group parent training compared to treatment as usual (TAU) with an emphasis on parent outcomes. Investigate (b) if group parent training increases social support more than other modes of treatment and explore (c) how social support interacts with different modes of treatment.

METHOD

Compared individual with group parent training and treatment as usual (TAU) in a randomized controlled trial for N = 237 children with Hyperkinetic Disorder/Attention Deficit Hyperactivity Disorder (HKD/ADHD). Employed two formats of the same cognitive-behavioural parent training in the same settings to maximize comparability. Controlled for medication status and assessed changes from pre- to post-treatment and 6-month follow-up.

RESULTS

Parents reported more positive changes in the parent training groups than in TAU in relation to child behaviour problems and moodiness as well as more positive changes in parent stress and sense of competence. However, gains on parent stress were limited after group training as were gains on satisfaction. Social support improved similarly in all treatment groups. While results indicated clear main effects of social support on all child and parent measures, interactions of social support and treatment outcomes were found for child moodiness and parent stress.

CONCLUSIONS

Cognitive-behavioural parent training is beneficial beyond TAU, especially when it can be provided individually. Surprisingly, group training did not reduce parent stress more than TAU or individual training. Social support related to all measures and interacted with treatment on some outcomes. The findings have numerous implications for research and practice.

Does attention deficit hyperactivity disorder worsen family functioning and parenting styles? A case control study

OBJECTIVE

A bidirectional relationship between family functioning and parenting styles and Attention Deficit and Hyperactivity Disorder (ADHD) is proposed. The aim of this study is to examine the effect of ADHD symptoms on parenting styles and the general functionality of the family as well as symptoms of depression and anxiety.

METHODS

73 children with ADHD (56%) and 56 controls (43%) (a total of 129 participants, 31% female, 69% male) with a mean age of 11.3 (7-17, n: 129) were included in the study, which was conducted in Gaziantep University Hospital Child Psychiatry Department in 2022. The participants completed psychometric scales.

RESULTS

Parents of children with ADHD showed higher positive parenting scores than the control group (p < 0.05). Inconsistent discipline scores were substantially higher in the ADHD combined subtype (14.38 ± 5.2) than in the attention deficit dominant group (17.59 ± 3.96) In addition, a strong correlation was found between familial functionality scores and ADHD severity in the ADHD attention deficit dominant subtype (r:0.601; p:0.027) and as ADHD severity increased, family functionality decreased.

CONCLUSIONS

This study shows that parents of children with ADHD have different parenting styles and ADHD affects the overall functionality of the family in the Turkish sample.

Behavioral Parent Training for School-Aged Children With ADHD: A Systematic Review of Randomized Control Trials

BACKGROUND

All guidelines for the treatment of ADHD in children include behavioral parent training in combination with other strategies. In the past, several systematic reviews have been carried out that were either outdated or not sufficiently specific to ADHD. We wanted to conduct a new review focusing on a specific ADHD population of school age (4-12 years) and on behavioral and cognitive programs. We aimed to test our hypothesis that behavioral parent training would improve parents' difficulties, children's symptomatology, and the quality of life of families with ADHD.

METHODS

PUBMED, PsychInfo, Web of Science, ERIC, and Cochrane databases were searched for original articles on randomized control trials on behavioral parent training group for children with ADHD aged from 4 to 12 years until July 2023.

RESULTS

A total of 20 studies were included in the systematic review. The results were divided into four categories: parent data, child data collected by parents, teachers, or researchers. A qualitative analysis revealed for parents, effects on parental stress, feelings of parental efficacy, and negative parental educational behavior. As regard children, only effects are noted for parental assessment, on ADHD symptomatology, externalized disorders, and social skills.

CONCLUSION

Despite the heterogeneity or small number of studies in some categories, BPTs have positive effects on both parents and children. There are no convincing results to support the generalization of progress. This would seem to indicate that it remains essential to consider actions specific to each problematic environment for the child.

Familial Factors Associated With Symptom Severity in Children and Adolescents With ADHD: A Meta-Analysis and Supplemental Review

OBJECTIVE

Both genetic and environmental factors contribute to the development of ADHD, but associations between risk factors and ADHD symptom severity in affected children remain unclear. This systematic review and meta-analysis synthesizes evidence on the association between familial factors and symptom severity in children with ADHD (PROSPERO CRD42020076440).

METHOD

PubMed and PsycINFO were searched for eligible studies.

RESULTS

Forty-three studies (N = 11,123 participants) were meta-analyzed. Five additional studies (N = 2,643 participants) were considered in the supplemental review. Parenting stress (r = .25), negative parenting practices (r = .19), broken parental partnership (r = .19), critical life events (r = .17), parental psychopathologies (r = .14-.16), socioeconomic status (r = -.10), and single-parent family (r = .10) were significantly associated with ADHD symptom severity.

CONCLUSION

These results suggest that psychosocial familial factors show small but significant associations with symptom severity in children with ADHD. Implications are discussed.

The effect of physical activity on quality of life and parenting stress in children with attention-deficit/hyperactivity disorder: A randomized controlled trial

BACKGROUND

Poorer quality of life (QoL) is commonly observed in children with Attention-deficit/Hyperactivity Disorder (ADHD). Parents of children with ADHD also perceived elevated levels of parenting stress. Previous research has documented the positive effects of physical activity (PA) on managing ADHD symptoms. It is critical to implement ADHD management with broader functioning from both children's and parents' perspectives.

OBJECTIVE

This study aimed to examine whether PA would exert an influence on the QoL of children with ADHD and parenting stress of their parents.

METHODS

Forty-three children with ADHD (6-12 years) were randomly assigned to the PA intervention and waitlist control groups. Children in the intervention group participated in a 12-week PA program. Parent-reported QoL and parenting stress were assessed before and immediately after the intervention. Analysis of covariance with a mixed factorial design of 2 (time: before vs. after intervention) × 2 (group: PA intervention vs. waitlist control) was conducted to examine changes in QoL and parenting stress over the 12 weeks.

RESULTS

Compared to the control group, parents of children in the intervention group reported significant reduced overall parenting stress (p = .021, η² = 0.142) and child domain of parenting stress (p = .024, η² = 0.138) after the intervention. No significant improvement in QoL was documented in either group.

CONCLUSIONS

The participation of PA intervention positively impacts parenting stress perceived by parents of children with ADHD, which provides further evidence of the family-wide benefits of the PA intervention.

Cortisol Reactivity and Observed Parenting among Mothers of Children with and without ADHD

OBJECTIVE

Neurobiological models suggest links between maternal cortisol reactivity and parenting; however, no studies have examined cortisol reactivity and parenting in mothers of school-age children with ADHD.

METHOD

We examined the relationship between observed parenting and maternal cortisol reactivity in two laboratory contexts: the Trier Social Stress Task (TSST) and parenting-child interaction (PCI). Mothers of children with (N = 24) and without (N = 36) ADHD participated.

RESULTS

During the TSST, greater cortisol output and increase were associated with decreased positive and increased negative parenting. However, during the PCI, cortisol output was associated with increased self-reported and observed positive parenting, and decreased observed negative parenting. Cortisol change during the PCI was associated with decreased observed positive parenting and increased self-reported negative parenting. Among mothers of children with ADHD, cortisol output during the PCI was negatively associated with negative, inconsistent parenting. Change in cortisol predicted more inconsistent discipline and corporal punishment.

CONCLUSION

Findings contribute to an integrative biological, psychological, and cognitive process model of parenting in families of children with ADHD.

Maternal-fetal attachment, parenting stress during infancy, and child outcomes at age 3 years

Maternal-fetal attachment (MFA), a woman's relationship with and affiliative behaviors toward her unborn child, has been linked to near-term infant physical and developmental outcomes. However, further longitudinal research is needed to understand whether the impact of MFA extends past the earliest years of life. The current study explored relationships between MFA and child socioemotional competence and behavior problems at age 3 and whether parenting stress mediated the association between MFA and child outcomes. Data were collected from 221 primarily Black/African-American mothers who completed a scale of MFA during pregnancy. Mothers reported on parenting stress at infant age 7 months and reported on child socioemotional competence and problem behaviors at child age 3 years. In path analyses, MFA was directly associated with child socioemotional competence at age 3 years, but an indirect association between MFA and socioemotional competence via parenting stress was not significant. We also observed a significant indirect association between lower MFA and child internalizing behavior problems via parenting stress that was related to maternal dissatisfaction regarding interactions with her child. Findings suggest that assessing MFA may serve as a means to identify dyads who would benefit from support to promote individual health outcomes.

Étude de cohorte portant sur le lien entre les symptômes d’inattention et d’hyperactivité chez les enfants, les symptômes d’internalisation et la parentalité attentive durant la pandémie de COVID-19

Objectifs

Les rapports de difficultés de santé mentale chez les enfants canadiens se sont multipliés durant la pandémie de COVID-19, et les nouvelles recherches laissent croire que les enfants qui manifestent des symptômes marqués d’inattention et d’hyperactivité ont été disproportionnellement touchés. En conséquence, la pandémie a aussi eu un effet délétère sur les familles. Cette étude visait à : 1) examiner si les symptômes d’inattention et d’hyperactivité chez les enfants au début de l’année scolaire 2020-2021 étaient associés à la parentalité attentive (ou parentalité en pleine conscience) à la fin de l’année scolaire; et 2) examiner si les symptômes de dépression et d’anxiété chez les enfants à la fin de l’année ont tempéré cette association.

Méthodes

Les parents de 114 jeunes enfants d’une grande ville canadienne ont participé à cette étude durant l’hiver 2020 et le printemps 2021. Les parents ont répondu à plusieurs échelles d’évaluation dans le but de mesurer la symptomatologie de la santé mentale des enfants et l’attention dans les pratiques de parentalité.

Résultats

Les symptômes d’inattention et d’hyperactivité chez les enfants étaient significativement associés négativement à la parentalité attentive durant l’année scolaire, et les symptômes de dépression chez les enfants ont tempéré ce lien. En particulier, lorsque les symptômes de dépression étaient légers ou moyens chez les enfants, on a observé que des symptômes plus marqués d’inattention et d’hyperactivité étaient liés à un faible niveau de parentalité attentive. Par ailleurs, lorsque les symptômes dépressifs étaient marqués chez les enfants, les symptômes d’inattention et d’hyperactivité n’avaient aucune valeur prédictive sur la parentalité attentive.

Conclusions

La santé mentale des enfants, à savoir les symptômes d’inattention/hyperactivité et de dépression, est liée aux difficultés de parentalité attentive durant la pandémie de COVID-19. Ces résultats pourraient indiquer aux médecins quelles familles nécessitent plus de soutien durant la pandémie.

A cohort study examining the association between children's symptoms of inattention and hyperactivity, internalizing symptoms, and mindful parenting during the COVID-19 pandemic

Objectives

Increased mental health difficulties have been reported in Canadian children as a result of the COVID-19 pandemic, and emerging research suggests that children with high levels of symptoms of inattention and hyperactivity have been disproportionately impacted. Accordingly, the pandemic has impacted families as well. The purpose of this study was the following: (1) to examine whether children’s symptoms of inattention and hyperactivity at the beginning of the 2020 and 2021 academic year were associated with mindful parenting at the end of the academic year and (2) to examine whether children’s depressive and anxiety symptoms at the end of the year moderated this relationship.

Methods

Parents of 114 young children in a large Canadian city participated in this study in the Winter of 2020 and the Spring of 2021. Parents completed several self-report scales used to measure children’s mental health symptomatology and mindfulness in parenting.

Results

Children’s symptoms of inattention and hyperactivity were significantly, negatively associated with mindful parenting across the pandemic year, and children’s depressive symptoms moderated this relationship. Specifically, when children’s depressive symptoms were low or average it was found that higher symptoms of inattention and hyperactivity were associated with lower levels of mindful parenting. However, when children’s depressive symptoms were high their symptoms of inattention and hyperactivity were not predictive of mindful parenting.

Conclusions

Children’s mental health, namely symptoms of inattention/hyperactivity and depression, are related to challenges in mindful parenting during COVID-19. These results may inform practitioners about which families require additional support during the pandemic.

Machine Learning Prediction of ADHD Severity: Association and Linkage to ADGRL3, DRD4, and SNAP25

OBJECTIVE

To investigate whether single nucleotide polymorphisms (SNPs) in the ADGRL3, DRD4, and SNAP25 genes are associated with and predict ADHD severity in families from a Caribbean community.

METHOD

ADHD severity was derived using latent class cluster analysis of DSM-IV symptomatology. Family-based association tests were conducted to detect associations between SNPs and ADHD severity latent phenotypes. Machine learning algorithms were used to build predictive models of ADHD severity based on demographic and genetic data.

RESULTS

Individuals with ADHD exhibited two seemingly independent latent class severity configurations. SNPs harbored in DRD4, SNAP25, and ADGRL3 showed evidence of linkage and association to symptoms severity and a potential pleiotropic effect on distinct domains of ADHD severity. Predictive models discriminate severe from non-severe ADHD in specific symptom domains.

CONCLUSION

This study supports the role of DRD4, SNAP25, and ADGRL3 genes in outlining ADHD severity, and a new prediction framework with potential clinical use.

Child behavior problems during COVID-19: Associations with parent distress and child social-emotional skills

The COVID-19 pandemic and associated government-mandated shutdowns disrupted schooling, socialization, and family life for school-aged children during spring 2020. These disruptions may have contributed to increased child behavior problems. Thus, we examined behavior problems in 247 children aged 7 to 9 years during Ohio's shutdown period. We investigated whether differences in parent-reported child behavior problems were associated with concurrent parent distress during spring 2020 and/or children's social-emotional skills measured via teacher-reports from the previous year (spring 2019). Parent distress significantly predicted behavior problems, such that more distressed parents also reported more child behavior problems. Child pre-pandemic peer social skills also significantly predicted behavior problems, such that more skilled children exhibited fewer behavior problems. There were no interaction effects between parent distress and children's social-emotional skills on child behavior problems. Further research is needed to understand how children's social-emotional skills impact their ability to cope during times of epidemiological crisis.

Socio-demographic and clinical correlates of parenting style among parents having ADHD children: a cross-section study

Background

ADHD affects 7.8% of the school-aged population, making it one of the most common childhood brain illnesses. It is characterized by abnormally high levels of inattention, activity, and impulsivity at a young age. Being a parent of a child with ADHD is a real challenge, as the parents tend to be more disapproving, critical, and provide more impulse control directions; such parenting style can have an impact on the illnesses course, accentuate its signs and symptoms, and lead to secondary development of co-morbid psychiatric and behavioral problems. This makes the parent-child effect a matter of clinical importance that needs to be carefully assessed and managed. We aimed to estimate the sociodemographic and clinical correlates of parenting attitudes among parents having ADHD children. This cross-sectional study included 48 ADHD children from both sexes, aged from 6 to 12 years old, and their parents. In our study, we applied the Stanford-Binet Intelligence Scale 5th edition, the Conner’s Parent Rating Scale-revised, the parenting style as perceived by children questionnaire, and the Fahmy and El-Sherbini questionnaire for the measurement of socioeconomic status.

Results

Mothers of ADHD children had significantly lower scores of over-protections parenting style than the fathers; the current study showed a significant increase in total parenting scores and warmth/support in mild ADHD cases than in moderate and severe ones, and there is a significant increase in the mother’s positive parenting style toward ADHD children with lower levels of social problems, mild cases, and older age. There is a significant increase of positive parenting style toward ADHD children exerted by post graduated, professionally working, and high social class fathers and by working mothers among rural residents and high social class mothers. There is a positive correlation between IQ and a mother’s warmth/support.

Conclusion

ADHD children with mild symptoms, higher social functioning of the child, high socioeconomic level of the family, better education, and professional occupations of parents were associated with positive parenting style.

Parental Distress in the Time of COVID-19: A Cross-Sectional Study on Pediatric Patients with Neuropsychiatric Conditions during Lockdown

The lockdown due to the COVID-19 pandemic has had adverse psychological effects on children and parents. While parenting is essential for positive development, increased parental distress has interfered with children’s wellbeing. In our study, we aimed to identify the predictors of parental distress in families of children with neuropsychiatric disorders during lockdown. Seventy-seven parents of children with neuropsychiatric disorders were asked to fill three online questionnaires (a socio-demographic questionnaire, the Child Behavior Checklist (CBCL) and Parental-Stress-Index (PSI-4-SF) to explore the relationship between parental distress, emotional/behavioral problems in children and quarantine-related factors through univariate analyses and multiple mediation models. Significant positive associations between CBCL-internalizing-problems and all PSI-4-SF subscales, and between CBCL-externalizing-problems and “Difficult Child” subscales were found. “Parent–Child Dysfunctional Interaction” subscale and teachers–child relationship quality resulted negatively associated, as well as the “Difficult Child” subscale and peers–child relationship quality. The effect of teachers–child relationship quality on “Parent–Child Dysfunctional Interaction” was mediated by children internalizing problems, while the effect of peers–child relationship quality on “Difficult Child” by the child internalizing/externalizing problems. Internalizing problems in children with neuropsychiatric disorders were among the strongest predictors of parental stress during lockdown, mediating the indirect effects of quarantine-related factors, thus suggesting the importance of their detection during and after emergency situations to provide assistance and reduce parenting pressure.

Analysis of Psychosocial Adjustment in the Family During Confinement: Problems and Habits of Children and Youth and Parental Stress and Resilience

The COVID-19 health crisis has led to a dramatic change in dynamics and habits of families, which may be a factor involved in the development and maintenance of problems and difficulties in children. The present study is a cross-sectional study that aims to describe and analyze the relationship between the difficulties in psychological adjustment and the change of habits of the infant-juvenile population as perceived by their parents and their stress and resilience during the total confinement of the first wave of the COVID-19 pandemic in Spain, as well as analyzing the course of the changes and the relationships between weeks 3 to 6, that is, the score of different participants in each week of the confinement. The sample is comprised of 883 parents of children and adolescents between 3 and 18 years of age. Children’s psychological adjustment, children’s habits, parental stress, and parental resilience were assessed by parents. The results show that parents perceive a change in the habits and psychological difficulties in their children. At the same time, our results describe parents with a high level of stress and resilience, with differences depending on the children’s ages. The time of confinement accentuates the perception of parents about the psychological difficulties of their children and parental stress, as well as a decrease in resilience. These difficulties are reduced when the parent has resilience competencies. These results show that the resilience of parents mediate the relationship between parental stress and psychological problems of their children. These results shows that COVID-19 lockdown had a considerable effect on families, both on children and parents. Some practical implications based on results are provided.

The impact of preschool child and maternal attention-deficit/hyperactivity disorder (ADHD) symptoms on mothers' perceived chronic stress and hair cortisol

Providing care for a child with attention-deficit/hyperactivity disorder (ADHD) is associated with parenting stress. Moreover, adults with elevated ADHD symptoms report increased perceived stress. Despite this, it has rarely been examined whether and how child and maternal ADHD symptoms may affect maternal perceived stress and the stress-sensitive hypothalamic–pituitary–adrenal axis. This study therefore investigated the possible impact of child and maternal ADHD symptoms on mothers' perceived chronic stress and hair cortisol concentration (HCC), while simultaneously considering the effects of child oppositional defiant/conduct disorder (ODD/CD) and maternal depressive symptomatology. In total, 124 mothers (35.96 ± 5.21 years) of preschool children were included. Maternal perceived stress, ADHD and depressive symptoms were assessed using self-report measures. Child ADHD symptoms were assessed using an interview and questionnaires completed by mothers and teachers. Additionally, mothers provided information about their children’s ODD/CD symptoms. Hair samples were taken from mothers to assess HCC. Child and maternal ADHD, child ODD/CD, and maternal depressive symptoms accounted for 50% of the variance in perceived chronic stress (F(4, 119) = 30.24; p < 0.01), with only maternal ADHD (β = 0.52, p < 0.01) and depressive symptoms (β = 0.49, p < 0.01) being uniquely significant. Maternal ADHD symptoms did not moderate the relationship between child ADHD symptoms and maternal perceived chronic stress (b = − 0.01; SE b = 0.17; t(5, 118) = − 0.05; p = 0.96). Mother’s age became the only significant predictor of maternal HCC (β = 0.29; p < 0.01). Based on these findings, practitioners are advised to be aware of and take into account possible maternal ADHD and depressive symptomatology and perceived chronic stress when treating children diagnosed with ADHD.

Quality of Life Changes during the COVID-19 Pandemic for Caregivers of Children with ADHD and/or ASD

The COVID-19 pandemic has presented many challenges to caregivers of children. Families with children with attention-deficit/hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) are an understudied but potentially vulnerable population to changes during the outbreak. As such, the aim of this study was to contrast quality of life for caregivers of children with ADHD and/or ASD, before and during the pandemic, compared to caregivers of neurotypical (NT) children. Total, Parent Health-Related Quality of Life, and Family Functioning Summary Scores from the Family Impact Module of the Pediatric Quality of Life InventoryTM were contrasted among caregivers of children with ADHD, ASD, comorbid ADHD and ASD, and NT development. For all scores, caregivers of ADHD and/or ASD children reported lower quality of life, both before and during the pandemic, in comparison to caregivers of NT children. For all diagnoses, quality of life decreased during the pandemic, but caregivers of children with ADHD and/or ASD reported a greater decrease in quality of life than caregivers for NT children. There are limitations to this study in terms of the composition of the sample and the survey methodology, but we are able to conclude that caregivers of children with ADHD and/or ASD have been disproportionately affected by the pandemic, and it is imperative that these families receive additional resources and support to improve their quality of life.

Relationship Between Parental Attachment and Stress Elevation and Synchrony in Pediatric Occupational Therapy Patient-Parent Dyads

IMPORTANCE

Populations already experiencing chronic stress, such as families with children who are neurologically atypical, are at particular risk for developing stress-related disease.

OBJECTIVE

To establish feasibility of collecting salivary samples from pediatric occupational therapy patients and their parents in a clinical setting and at home and to examine associations among parental attachment style, parent self-reported stress, and physiological stress (i.e., cortisol) in pediatric occupational therapy patients who were neurologically atypical and their parents (N = 10 dyads).

DESIGN

Cross-sectional pilot study to test feasibility.

SETTING

Sliding-scale university clinic.

PARTICIPANTS

Participants were 10 children undergoing occupational therapy treatment and their parent. Families were approached and told the study was voluntary and would not affect their treatment. Families provided informed consent.

OUTCOMES AND MEASURES

Parents completed measures to assess their own attachment style, general and parenting stress, and stress in their child. Children and parents provided saliva samples during an occupational therapy clinic visit and collected samples at home to measure cortisol level.

RESULTS

Parent attachment avoidance was related to increased parent cortisol levels in the clinic and increased child cortisol levels at home. Parent and child cortisol levels had a strong, positive relationship in the clinic but not at home. We did not observe a difference between cortisol levels in children or parents in the clinic or at home.

CONCLUSIONS AND RELEVANCE

We concluded that this protocol is feasible and provide suggestions for future research.

WHAT THIS ARTICLE ADDS

Stress physiology in pediatric occupational therapy clients should be considered within the context of the family system. Family-based interventions may be particularly helpful for reducing client stress in this population.

Are Parent- and Teacher-Reported Executive Function Difficulties Associated With Parenting Stress for Children Diagnosed With ADHD?

Objective: To examine the relationship between parenting stress and parent- and teacher-reported executive function difficulties (EFDs) for childhood ADHD. Method: A secondary analysis using linear regression was conducted on parent- and teacher-completed Behavior Rating Inventory of Executive Function and Parenting Stress Indexes for 5- to 12-year-olds (n = 243) with ADHD. Results: The linear combination of teacher- and parent-reported EFDs accounted for 49% of the variance in child-related parenting stress. Teacher-reported school-based EFDs were relatively inconsequential, having accounted for only 3% of this variance. This stress is best explained by EFDs with emotional control in the school environment and parent-reported EFDs with emotional control, inhibit, monitor, and shift. Conclusion: Parent-reported EFDs, and less so school-based EFDs, are related to parenting stress, but only in regard to EFDs likely underpinning behavioral outbursts and those likely underpinning the daily hassles of providing specialized care to children with ADHD.

An Examination of Correlates of Quality of Life in Children and Youth With Mental Health Issues

Quality of life (QoL) is significantly lower in children with mental health issues compared to those who are typically developing or have physical health problems. However, little research has examined factors associated with QoL in this particularly vulnerable population. To address this limitation, 347 clinically referred children and adolescents were assessed using the interRAI Child and Youth Mental Health (ChYMH) Assessment and Self-reported Quality of Life- Child and Youth Mental Health (QoL-ChYMH). Hierarchical multiple linear regression analyses were conducted to examine QoL at the domain-specific level. Children and adolescents who experienced heightened anhedonia and depressive symptoms reported lower social QoL (e.g., family, friends and activities; p = 0.024, 0.046, respectively). Additionally, children and youth who experienced heightened depressive symptoms reported lower QoL at the individual level (e.g., autonomy, health; p = 0.000), and level of basic needs (e.g., food, safety; p = 0.013). In contrast, no mental state indicators were associated with QoL related to services (e.g., school, treatment). Due to the paucity of research examining predictors of QoL in children and youth with mental health challenges, this study contributes to the field in assisting service providers with care planning and further providing implications for practice.

Enhancement of Social Communication Behaviors in Young Children With Autism Affects Maternal Stress

Children with autism spectrum disorder (ASD) show difficulties in social communication behaviors, emotion regulation and daily living skills, and they frequently present with challenging behaviors. In parents of children with ASD, higher rates of stress and mental health problems have been reported than in parents of either typically developing children or children with other conditions. In this study, we tested whether maternal well-being changes with improved social communicative behaviors of children with ASD receiving early intervention. We examined developmental changes in 72 pre-schoolers and stress levels in their mothers (measured by the Parental Stress Inventory) before and after a 12-month community-based intervention program based on the Early Start Denver Model, a naturalistic developmental behavioral intervention targeting social communication. Multiple regression analyses showed that maternal child-related stress was predicted by changes in children's social communication behaviors (measured with the Pervasive Developmental Disorder Behavior Inventory). Gains in the early social communication behavior domain were the strongest predictor of post-intervention child-related maternal stress, surpassing adaptive behavior, language and non-verbal cognitive gains, and reduction in challenging behavior. These findings support the hypothesis that, in children with ASD, the acquisition of social communication behaviors contribute to improvements in maternal well-being.

Remote Learning During COVID-19: Examining School Practices, Service Continuation, and Difficulties for Adolescents With and Without Attention-Deficit/Hyperactivity Disorder

PURPOSE

This study examined remote learning practices and difficulties during initial stay-at-home orders during the COVID-19 pandemic in adolescents with and without attention-deficit/hyperactivity disorder (ADHD).

METHODS

Participants were 238 adolescents (132 males; 118 with ADHD) aged 15.64-17.99 years and their parents. Adolescents and parents completed questionnaires in May/June 2020 when in-person schools were closed in the U.S.

RESULTS

Twenty-two percent of families incurred financial costs to support remote learning, and only 59% of school-based services received before COVID-19 continued during COVID-19 remote learning. Adolescents with ADHD had fewer routines and more remote learning difficulties than adolescents without ADHD. Parents of adolescents with ADHD had less confidence in managing remote learning and more difficulties in supporting home learning and home-school communication. Thirty-one percent of parents of adolescents with ADHD with an Individualized Education Program (IEP) or receiving academic accommodations (504 Plan) reported remote learning to be very challenging, compared with 18% of parents of adolescents with ADHD without an IEP/504 Plan, and only 4% of parents of adolescents with neither ADHD nor an IEP/504 Plan. Fewer adolescent routines, higher negative affect, and more difficulty concentrating because of COVID-19 were each associated with greater adolescent remote learning difficulties only in adolescents with ADHD.

CONCLUSIONS

This study provides initial findings of the nature and impact of remote learning during the COVID-19 pandemic. It is imperative for schools and communities to provide the necessary supports to adolescents, particularly those with mental health and/or learning difficulties, and to their parents.

Health Behaviors, Physical Health, and Health Care Utilization in Children With ADHD

Objective: To compare health behaviors, physical health outcomes, and health care utilization between children with and without ADHD. Method: In this cross-sectional study, we obtained data for children with and without ADHD from the Korean National Health and Nutrition Examination Survey. To investigate the association between ADHD and health outcomes, we estimated the adjusted prevalence ratios (APRs) in these groups. Results: Among 10,838 children aged 7 to 18 years with and without ADHD, those with ADHD had significantly higher APRs for overall health problems, physical illness, and injuries than those without ADHD. Despite having health care needs, children with ADHD were less likely than those without ADHD to use health care services. However, there were no significant associations between most health behaviors and ADHD. Conclusion: Increased efforts are needed to provide quality health care services to address the medical conditions of children with ADHD and to enhance their health care utilization when needed.

Family Functioning in Latinx Families of Children with ADHD: The Role of Parental Gender and Acculturation

OBJECTIVES

It has been well-established that parents of children with ADHD report significantly higher levels of parenting stress and home chaos, and lower levels of parental efficacy than parents of children without ADHD. Unfortunately, most of the extant ADHD literature has focused on European American children and families, resulting in a paucity of research focusing on ethnic minority families of children with ADHD. The current study aimed to expand what is known about Latinx parents of children with ADHD by exploring contextual and cultural factors, such as parental gender and acculturation, which may account for variations in parenting experiences within this population.

METHODS

The present study utilized secondary data analysis to analyze ratings of parenting stress, home chaos, and parental efficacy among a sample of Latinx mothers and fathers of children with ADHD (n = 46 dyads).

RESULTS

Results indicated that Latinx mothers of children with ADHD reported higher levels of parenting stress than Latinx fathers of children with ADHD; however, no significant parental gender differences were found in ratings of parental efficacy or home chaos. Additionally, several significant relationships were found between parental acculturation and family functioning variables.

CONCLUSIONS

Latinx families of children with ADHD are an understudied and underserved population within the field of clinical psychology. The current study provides critical information on Latinx family functioning within the context of ADHD treatment, specifically pertaining to the complex interplay of parenting and acculturation variables.

Belastungserleben von Müttern mit Kindern mit ADHS

Zusammenfassung. Eltern von Kindern mit ADHS berichten von einer hohen psychischen Belastung, die durch die eigene und die kindliche Symptomatik bedingt scheint. Ziel der Studie ist es erstens zu prüfen, ob sich die mütterliche Belastung in Abhängigkeit davon unterscheidet, welche ADHS-Erscheinungsform bei den Kindern vorliegt und ob eine komorbide Symptomatik einer Störung mit oppositionellem Trotzverhalten (SOT) besteht. Zum zweiten soll untersucht werden, welche kindlichen und welche elterlichen Faktoren am besten die Gesamtbelastungen der Mütter aufklären können. An der Studie nahmen 207 Kinder ( M = 9.00 Jahre; SD = 1.52; 65.2 % männlich) teil. Von diesen wurden 138 Kinder nach dem ADHS-Erscheinungsbild (DSM-5) und nach der SOT in vier Untergruppen eingeteilt (unaufmerksames und gemischtes Erscheinungsbild mit/ohne SOT). Bei 157 Kindern wurden die mütterlichen (ADHS, Depression und Erziehungsstatus) und kindlichen Faktoren (ADHS, SOT und die Anzahl der im Haushalt lebenden Kinder) erhoben. Die Ergebnisse belegen, dass Mütter von Kindern, die neben einer ADHS eine zusätzliche SOT aufweisen, die größte Belastung berichten. Die mütterliche Depression und die gemischte ADHS-Erscheinungsform mit komorbider SOT des Kindes sagten die Belastung der Mütter am besten vorher. Im klinischen Kontext sollte bei Müttern von Kindern, die ein gemischtes ADHS-Erscheinungsbild mit SOT aufweisen, gezielt eine depressive Symptomatik abgeklärt werden.

Refining the Parenting Stress Index-Short Form (PSI-SF) in Chinese Parents

The Parenting Stress Index-Short Form (PSI-SF) is a popular brief assessment of parenting stress. However, its latent structure and psychometric properties have not been extensively addressed, in particular in non-Western cultures. The present study is the first to examine the factor structure and psychometric properties of the PSI-SF in parents from Mainland China (683 mother-father dyads; mean age of mothers = 37.10 years, SD = 3.68; mean age of fathers = 39.81 years, SD = 4.13). Initial analyses revealed that previously proposed factor structure of the PSI-SF did not fit the data well. Exploratory and confirmatory factor analyses were then conducted to develop a psychometrically sound and efficient abbreviated version of the PSI-SF. In this new version of 15 items (PSI-SF-15), there are three factors (i.e., parental distress, parent-child dysfunctional interaction, and difficult child). This abbreviated scale showed strict measurement invariance across sex of parent and satisfactory internal consistency. The convergent validity of the PSI-SF-15 were supported by its expected relations with the original PSF-SF measures, the multitrait-multimethod procedure, and its expected relations with scores on parenting behavior, parental depressiveness, and children's conduct problems. In conclusion, these results suggest that the PSI-SF-15 is a valid measure of parenting stress in Chinese parents, and that it holds promise as an informative and reliable alternative to the original PSI-SF when administration time is limited.

Longitudinal Trajectories of Parenting Stress Among Ethnic Minority Adolescent Mothers

OBJECTIVES

Parenting stress has been linked with negative outcomes for parents and their infants (e.g., parental depression, negative parenting behaviors, poor attachment). Racial/ethnic minority adolescent mothers have increased risk for experiencing parenting stress compared to their White counterparts. Little is known about the changes in parenting stress over time for this population.

METHODS

Growth mixture modeling (GMM) was conducted to determine the growth trajectory classes of 185 African American and Latina/Hispanic adolescent mothers over 2 years. Risk and protective factors (e.g., maternal depression, social support, self-esteem) were examined to determine their influence on parenting stress trajectories.

RESULTS

Three distinct trajectories of parenting stress were found: low stable stress (40.90%), decreasing stress (35.78%), and high stable stress (23.28%). Lower maternal depression (OR = 2.35), higher self-esteem (OR = 1.29), lower perceived social support from family (OR = 0.53) and higher perceived support from friends (OR = 1.65) predicted placement into the low stable parenting stress group over the high stable parenting stress group. Adolescents living with family (OR = 2.74) and Latina race/ethnicity (OR = 2.78) also served as predictors of placement into the low stable parenting stress group. Higher self-esteem (OR = 1.66) predicted placement into the decreasing parenting stress group over the high stable parenting stress group.

CONCLUSIONS

These findings highlight the importance of perceived peer support by adolescent mothers, regardless of their support family support (e.g., living at home and receiving child care). Considering developmental factors such as peer relationships may be important when working with adolescent mothers.

How Do Parents Influence Child Disruptive Behavior After Acquired Brain Injury? Evidence From a Mediation Model and Path Analysis

OBJECTIVES

Children with acquired brain injury (ABI) can present with disruptive behavior, which is often a consequence of injury and parent factors. Parent factors are associated with child disruptive behavior. Furthermore, disinhibition in the child also leads to disruptive behavior. However, it is unclear how these factors interact. We investigated whether parental factors influence child disruptive behavior following ABI and how these factors interact.

METHODS

Parents of 77 children with ABI participated in the study. Parent factors (executive dysfunction, trait-anxiety), potential intervention targets (dysfunctional parenting practices, parental stress, child disinhibition), and child disruptive behavior were assessed. A hypothetical model based on the literature was tested using mediation and path analysis.

RESULTS

Mediation analysis revealed that child disinhibition and dysfunctional parenting practices mediated the association of parent factors and child disruptive behavior. Parents' executive dysfunction mediated the association of dysfunctional parenting practices, parental stress and parent trait-anxiety. Parenting practices mediated the association of executive dysfunction and child disruptive behavior. Path analysis indices indicated good model adjustment. Comparative and Tucker-Lewis Index were &gt;0.95, and the root mean square error of approximation was 0.059, with a chi-square of 0.25.

CONCLUSIONS

A low level of parental trait-anxiety may be required to reduce dysfunctional parenting practices and child disinhibition. Impairments in child disinhibition can be exacerbated when parents present with high trait-anxiety. Child disinhibition is the major contributor of disruptive behavior reported by parents and teachers. The current study provides evidence of parent anxiety and child disinhibition as possible modifiable intervention targets for reducing child disruptive behavior. (JINS, 2019, 25, 237-248).

Predictors of Burden of Care Among Caregivers of Drug-Naive Children and Adolescents With ADHD: A Cross-Sectional Correlative Study From Muscat, Oman

OBJECTIVE

the study assessed the prevalence of burden of care among caregivers of children with ADHD in Oman. A related aim is to explore the predictors of the burden of care, subtypes of ADHD, and socio-demographic factors.

METHOD

Arabic version of the Zarit Burden Interview (ZBI) was administered to 117 caregivers of drug-naive children with ADHD. Sociodemographic background and clinical data were gathered from medical records and from the attending caregivers themselves. The ADHD symptoms were grouped under three categories : hyperactive, inattentive, or mixed.

RESULTS

the prevalence of the burden of care was estimated to be 34%. Income levels and the child's ADHD diagnosis being of "mixed" type have significant impact on the burden of care.

CONCLUSION

the results of this study indicate that the prevalence of the burden of care among the caregivers of ADHD children in Oman is comparable with that in the other regions of the world.

Analysis of the self-compassion and cognitive flexibility with marital compatibility in parents of children with autism spectrum disorder

Purpose: Parents of children with autism spectrum disorder (ASD) face many problems in their marital lives. Autism is a developmental disorder, emerging during childhood that affects development across various domains. Studies suggest that autism prevalence rates are increasing, and research shows that parents of children with ASD frequently experience high levels of parenting stress. Marital compatibility is fulfilled when couples have the sense of satisfaction and contentment from each other. This study was done to analyze self-compassion and cognitive flexibility in relation with marital compatibility in parents having children with ASD. Methods: A sample size with 100 married couples, who referred to autism centers, was selected after clinical interviews. The research tools included structural clinical interview (DSM SCID), self-compassion scales questionnaire, cognitive flexibility inventory questionnaire, and marital compatibility test questionnaire, which were completed by the participants. Results: The research is a correlational descriptive study. Data analysis was done by the path analysis method. The findings showed that there was a significant relation between self-compassion, cognitive flexibility, and marital compatibility. Conclusions: In this study, it could be concluded that compassion via flexibility can have indirect positive effects on marital compatibility as two features of self-compassion and cognitive flexibility can help parents of children with ASD to be more compatible and flexible in their marital lives.

Maternal ADHD Symptoms, Personality, and Parenting Stress: Differences Between Mothers of Children With ADHD and Mothers of Comparison Children

OBJECTIVE

Mothers raising a child with ADHD can experience high parenting stress. We evaluated if mothers' personality traits and own ADHD symptoms could also affect parenting stress.

METHOD

430 biological mothers from the Multimodal Treatment Study of Children with ADHD (MTA mothers) and 237 of a local normative comparison group (LNCG mothers) were evaluated at baseline. Interactions were tested between mothers' group and maternal personality/ADHD symptoms related to parenting stress.

RESULTS

Compared to LNCG, MTA mothers had higher parenting stress, self-reported ADHD, neuroticism, and lower conscientiousness and agreeableness. When personality and ADHD were evaluated together, ADHD symptoms interacted with mothers' group: high maternal ADHD was positively associated with parenting stress for LNCG but not MTA mothers.

CONCLUSION

Personality traits or ADHD characteristics do not appear operative for the high parenting stress of mothers of a child with ADHD. However, high maternal ADHD or low conscientiousness are associated with stress levels similar to raising a child with ADHD.

Child-based treatment of oppositional defiant disorder: mediating effects on parental depression, anxiety and stress

Previous research has shown that child-oppositional defiant disorder (ODD) and conduct disorders (CD) are associated with parental symptoms of depression, anxiety and/or stress, probably in a bidirectional relationship with mutual influences. It is, therefore, reasonable to assume that in child-centered treatment, a decrease in child-oppositional behavior problems constitutes (at least in part) a mechanism of change for a subsequent reduction in parental psychopathology. The aim of the present study (Clinical trials.gov Identifier: NCT01406067) was to examine whether the reduction in ODD symptoms due to child-based cognitive behavioral treatment (CBT) led to a reduction in parental depression, anxiety and stress. Eighty-one boys (age 6-12 years) with a diagnosis of ODD/CD were randomized either to a cognitive behavioral intervention group or an educational play group (acting as control group). Mediation analyses were conducted using path analysis. The stronger reduction in child ODD symptoms in the CBT group compared to the control group led to a decrease in parental depression and stress, as indicated by significant indirect effects (ab = 0.07 and ab = 0.08, p < 0.05). The proposed model for mechanisms of change was, therefore, confirmed for two of the three outcome parameters. Parental psychopathology and stress can be modified by child-centered CBT. The preceding reduction in ODD symptoms acts as a mediator for at least some of the changes in parental depression and stress. However, due to some limitations of the study, other possible explanations for the results found cannot be completely ruled out and are, therefore, discussed.

Comparison of Depression and Burnout Levels of Mothers of Children with Attention-Deficit Hyperactivity Disorder Before and After Treatment

OBJECTIVE

This study aimed to compare the depression and burnout levels of mothers of children having attention-deficit/hyperactivity disorder (ADHD) between the child's pre- and posttreatment periods.

METHOD

The study sample consisted of 40 children aged between 4 and 10 years and their mothers. Initially, 40 cases participated, but during the follow-up, 19 cases dropped out. The Beck Depression Inventory (BDI), the Maslach Burnout Inventory (MBI), and the Turgay DSM-IV Based Child and Adolescent Behaviour Disorders Screening and Rating Scale (T-DSM-IV-S) were used.

RESULTS

Among the mothers, posttreatment BDI scores, MBI-emotional exhaustion, and personal accomplishment were significantly lower than the pretreatment scores. In the treatment's second month, all T-DSM-IV-S subscale scores showed a statistically significant decrease.

CONCLUSIONS

It was concluded that treatment of children with ADHD would have a favorable impact on their mothers' depressive symptoms, which would consequently decrease negative parental attitudes, hence reducing the risk of behavioral disorder in children with ADHD and exerting a positive effect on their treatment.

Associations between Psychopathology in Mothers, Fathers and Their Children: A Structural Modeling Approach

This study investigated associations between parental and child psychopathology with parenting stress as a possible mediator, in order to get more insight in mothers' and fathers' roles in the development of psychopathology in children. Parents of 272 clinically referred (aged 6-20, 66% boys) reported about their own and their child's behavioral problems, and about parenting stress. Data were analyzed using Structural Equation Modeling. Outcomes of path models demonstrated that mothers' higher internalizing and externalizing problems were associated with respectively children's higher internalizing and externalizing problems. Fathers' higher externalizing problems were associated with both children's higher internalizing and externalizing problems, but fathers' internalizing problems were only associated with children's lower externalizing problems. Parenting stress fully mediated the relation between mothers' and children's externalizing problems, and partly mediated the relation between mothers' and children's internalizing problems. For fathers, parenting stress partly mediated the relation between fathers' internalizing problems and children's externalizing problems. Findings indicate that for mothers, the association between parental and child psychopathology is specific, whereas for fathers it is non-specific. Furthermore, results suggest that reducing parenting stress may decrease child problem behavior. Longitudinal studies are needed in order to gain more insight in the direction and underlying mechanisms of the relation between parental and child psychopathology, including parental stress.

Parenting practices of Singaporean mothers of children with ADHD

Objectives:

We wanted to determine: (1) whether ADHD symptoms were more common in mothers of children with ADHD; (2) whether mothers of children with ADHD differed in their parenting strategies; and (3) whether there was a difference in care-giving arrangements for children with ADHD and without ADHD. This was done by comparing mothers of children with ADHD with mothers of children without ADHD in Singapore.

Methods:

Mothers of children with ADHD ( n=46) and mothers of children without ADHD ( n=45) completed the Conners’ Parent Rating Scale-Revised, the Conners’ Adult ADHD Rating Scale-Self Report and the Alabama Parenting Questionnaire.

Results:

Mothers of children with ADHD did not report higher levels of current ADHD symptoms compared with the control group. However, they did use less adaptive parenting strategies. There were also no differences in the reported behaviours of children cared for by a paid worker and those cared for by mothers.

Conclusions:

Data support the Singapore Clinical Guidelines recommendations for the promotion of parenting skills, and referral to parenting programmes for parents of children with ADHD. The promotion of parenting skills and referral to parenting programmes for mothers of children with ADHD might include the option of electronic forms of programme delivery. The model of using paid help in the home, which is commonplace in Singapore, does not seem to disadvantage children with ADHD.

Child/Adolescent's ADHD and Parenting Stress: The Mediating Role of Family Impact and Conduct Problems

Objective: The demands of parenting are usually associated with some stress, and elevated levels of stress may affect the parent-child relationships and parenting practices. This is especially the case of families where children have special needs conditions or disorders, like Attention Deficit Hyperactivity Disorder (ADHD). Method: This study examined parenting stress among mothers of children and adolescents with ADHD. The sample comprised 126 mothers of girls (36; 29%) and boys (90; 71%) aged 6-17 years old. Results: Mothers reported their own stress levels as well as the children and adolescents' variables (severity of their ADHD symptoms, conduct, and emotional problems) and family-contextual variables (negative impact on family's social life, impact on couple relationship, and perceived social support). Hierarchical multiple regression showed that (a) negative impact on social life and conduct problems were the strongest predictors of mother's stress. Bootstrap mediation analyses revealed that (b) the association between child and adolescent's ADHD and parenting stress was mediated by children's conduct problems and by negative impact on family's social life, and not by children's emotional problems nor by mother's perceived social support. The mediation analysis also suggested (c) a pathway from child/adolescent's ADHD through children's conduct problems and then through their negative impact on family's social life to mother's parenting stress. Conclusion: These results suggest that both child/adolescent's and family factors should be considered in the designing of interventions for reducing parenting stress in families of children and adolescents with ADHD.

The Children's Attention-Deficit Hyperactivity Disorder Telemental Health Treatment Study: Caregiver Outcomes

The Children's Attention-deficit Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS) tested the hypotheses that children and caregivers who received guideline-based treatment delivered through a hybrid telehealth service delivery model would experience greater improvements in outcomes than children and caregivers receiving treatment via a comparison delivery model. Here, we present caregiver outcomes. 88 primary care providers (PCPs) in seven geographically underserved communities referred 223 children (ages 5.5 - 12.9 years) to the randomized controlled trial. Over 22 weeks, children randomized to the CATTS service delivery model received six sessions of telepsychiatry and six sessions of caregiver behavior management training provided in person by community therapists who were trained and supervised remotely. Children randomized to the comparison Augmented Primary Care (APC) service model received management in primary care augmented by a single telepsychiatry consultation. Caregiver outcomes included changes in distress, as measured by the Patient Health Questionnaire (PHQ-9), Parenting Stress Index (PSI), Caregiver Strain Questionnaire (CSQ) and Family Empowerment Scale (FES). Caregivers completed five assessments. Multilevel mixed effects regression modeling tested for differences between the two service delivery models in caregiver outcomes from baseline to 25 weeks. Compared to caregivers of children in the APC model, caregivers of children in the CATTS service model showed statistically significantly greater improvements on the PHQ-9 (β = -1.41, 95 % CI = [-2.74, -0.08], p < .05), PSI (β = -4.59, 95 % CI = [-7.87, - 1.31], p < .001), CSQ (β = -5.41, 95 % CI = [- 8.58, -2.24], p < .001) and FES (β = 6.69, 95 % CI = [2.32, 11.06], p < .01). Improvement in child ADHD symptoms mediated improved caregiver scores on the PSI and CSQ. Improvement in child ODD behaviors mediated caregiver CSQ scores. The CATTS trial supports the effectiveness of a hybrid telehealth service delivery model for reducing distress in caregivers of children with ADHD and suggests a mechanism through which the service model affected caregiver distress.

Correlates of Subjective Caregiver Strain in Caregivers of Youth Evaluated in a Pediatric Psychiatric Emergency Room

BACKGROUND

Although caregiver burden is relevant to the outcome for psychiatrically ill youth, most studies have focused on caregiver burden in the community or research settings. Therefore, we aimed at evaluating the subjective caregiver strain (SCS) at the time of presentation of youth to a pediatric psychiatric emergency room (PPER), assessing potential correlates to provide leads for improvements in formal support systems.

METHODS

In this retrospective cohort study, the internalized, externalized, and total SCS were assessed in caregivers of youth <18 years of age consecutively evaluated at a PPER during a 1 year period using the Caregiver Strain Questionnaire. Sociodemographic and a broad range of clinical data were collected during the PPER visit using a 12-page semistructured institutional evaluation form. The Appropriateness of Pediatric Psychiatric Emergency Room Contact scale, incorporating acuity, severity and harm potential, was used to rate appropriateness of the visit.

RESULTS

In caregivers of 444 youth, the internalized SCS was significantly higher than the externalized SCS (p < 0.001). Multivariable analyses indicated that higher total and externalized SCS were associated with disruptive behavior or substance abuse/dependent disorder diagnosis, presenting complaint of aggression, and discharge plan to the police. Higher total and internalized SCS were associated with lower child functioning, whereas total and internalized SCS were lower in adopted children. In addition, higher externalized SCS was associated with investigator-rated inappropriateness of the emergency visit, presenting complaint of defiance, and a lack of prior psychiatric ER visits.

CONCLUSIONS

High levels of CS in PPER highlight the necessity to adhere to existing guidelines regarding the inclusion of caregivers' perceptions into comprehensive psychiatric assessments. The particularly high strain in caregivers of children with externalizing disorders and in families with low-functioning youth may need to prompt PPER staff to provide efficient information on appropriate treatment options for these children and on support facilities for the parents.

Relations of mother's sense of coherence and childrearing style with child's social skills in preschoolers

BACKGROUND

We examined the relationships between mothers' sense of coherence (SOC) and their child's social skills development among preschool children, and how this relationship is mediated by mother's childrearing style.

METHODS

Mothers of 1341 Japanese children, aged 4-5 years, completed a self-report questionnaire on their SOC and childrearing style. The children's teachers evaluated their social skills using the social skills scale (SSS), which comprises three factors: cooperation, self-control, and assertion.

RESULTS

Path analyses revealed that the mother's childrearing mediated the positive relationship between mother's SOC and the cooperation, self-control, and assertiveness aspects of children's social skills. Additionally, there was a significant direct path from mother's SOC to the self-control component of social skills.

CONCLUSIONS

These findings suggest that mother's SOC may directly as well as indirectly influence children's social skills development through the mediating effect of childrearing. The results offer preliminary evidence that focusing on support to improve mothers' SOC may be an efficient and effective strategy for improving children's social skills development.

Prevalence of ADHD in Qatari School-Age Children

OBJECTIVE

The purpose of this quantitative survey study is to provide current accurate estimates of the number of students with ADHD in Qatar Independent and English Medium Private Schools, so that adequate support will be available to assist in the educational growth and development of these students.

METHOD

This cross-sectional descriptive study of teacher observational ratings used a standardized rating scale. Teachers completed the SNAP-IV. Rating Scales for more than 5,000 students from Qatar Independent Schools and private English Medium Schools between November 2011 and November 2012 in Qatar Grades 1 through 12.

RESULTS

Results align with and extend the previous study of ADHD in Qatar and the current worldwide prevalence.

CONCLUSION

Enhanced analyses were conducted to identify differences between age groups, genders, and between Private and Independent Schools. Implications for teachers, administrators, and medical personnel are discussed.

Attention-Deficit/Hyperactivity Disorder and Martial Satisfaction: The Preliminary Roles of Employment and Income

To explore the components of marital satisfaction in a group of 35 Iranian mothers of six to twelve years old children with attention-deficit/hyperactivity disorder (ADHD) in comparison with 35 mothers of normal children in Tehran, Iran, during year 2013, all mothers completed the demographic checklist and Golombok Rust inventory of marital satisfaction. Data were analyzed by performing descriptive statistics and independent t-test using the SPSS software version 21. There was no statistically significant difference between scores of marital satisfaction (P = 0.162) yet further data analysis revealed that martial satisfaction of employed mothers (22.27 ± 10.71 vs. 28.73 ± 12.3, P = 0.42) and those mothers who had a monthly income of more than 6,000,000 Rials (22.95 ± 12.31 vs. 22.21 ± 11.67, P = 0.04) was significantly better compared with the comparison group. It may be concluded that employment and reasonable income may contribute to a lower level of stress and improved relationship among mothers with ADHD children.

Quality of life, psychological characteristics, and adjustment in parents of children with Attention-Deficit/Hyperactivity Disorder

PURPOSE

This study investigated quality of life and adjustment mechanisms in parents of children with Attention-Deficit/Hyperactivity Disorder (ADHD).

METHOD

Ninety parents of children with ADHD completed a sociodemographic questionnaire and self-assessment scales to measure their perceived stress, social support, sense of control, coping strategies and quality of life.

RESULTS

ADHD in children negatively affected parents' quality of life, especially their psychological well-being and personal fulfillment. Family and couple relationships, as well as daily life activities, were also affected. The severity of the disorder, perceiving the situation as a threat or a loss, feeling guilty and holding on to irrational beliefs were related to emotion-focused coping strategies and to a poorer quality of life. Furthermore, hyperactivity index and stress ratings relative to perceiving the situation as a threat or a loss, and adopting emotion-focused coping strategies, predicted poorer quality of life. In contrast, perceiving the situation as challenging was related to a greater sense of control and personal fulfillment. Moreover, perceiving the situation as challenging and adopting problem-focused coping strategies predicted better quality of life.

CONCLUSION

The findings highlight the negative effects of ADHD on parent psychological adjustment and underline the need to recommend training programs that improve parenting skills, parents' perceptions concerning their child's behavior disorder and parental functioning.

Parenting stress among parents of children with Neurodevelopmental Disorders

In recent years, studies have shown that parents of children with Neurodevelopmental Disorders (NDDs) experience more parenting stress than parents of typically developing children, but the relation between the type of disorders and parenting stress is far from clear. The purpose of this study was to compare the parenting stress experienced by parents of 239 children with Specific Learning Disorders (SpLD), Language Disorders (LD), Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), and typical development (TD). Parents of children with NDDs experience more parenting stress than those of children who have TD. Although, parents of children with ASD or ADHD report the most high scores of parenting stress, also the parents of children with SpLD or LD report higher parental stress compared with parent of children without NDDs. Another interesting finding was that IQ level or emotional and behavioral problems are associated with the higher levels of parenting stress. This study suggest that parent, both mothers and fathers, of children with different type of NDDs should be provided with interventions and resources to empower them with the knowledge and skills to reduce their stress and to enhance their quality of life.

Child Developmentaleducational Status in Kindergarten and Family Coping as Predictors of Parenting Stress: Issues for Parent Consultation

This study examined the relationship among three constructs that frequently form the basis for parent consultation in early intervention, parenting stress, family coping, and developmental/educational status. Parents (N = 116) of kindergarten children completed the Parenting Stress Index (PSI) and the Family Crisis Oriented Personal Evaluation Scales (F-COPES), while their children were administered the Early Screening Profiles (ESP). Pearson correlations among the PSI, F-COPES, and the ESP revealed low positive to moderately negative correlations; most of the correlations were negative. These negative correlations were expected because coping and developmental/educational attainment may be related inversely to parenting stress. A stepwise multiple regression analysis revealed that the ESP Total Score and two coping strategies, Passive Appraisal and Reframing, accounted for 27.1%o of the variance on the PSI Total Scores. Implications for parent consultation are discussed.