Parent-child relationships and ADHD symptoms: a longitudinal analysis

Bidirectional effects of parenting and ADHD symptoms in young children: Effects of comorbid oppositional symptoms

Psychosocial factors play an important role in the manifestation of attention-deficit/hyperactivity disorder (ADHD) symptoms and accompanying impairment levels in children. In a community sample of 796 children evaluated at 4, 5, and 6 years of age, bidirectional effects were examined for each of three components of parenting (parental support, hostility, scaffolding skills) and ADHD-specific symptoms that are not associated with symptoms of oppositional defiant disorder. Results indicated that (a) age 4 parenting factors were not associated with changes in ADHD-I (inattention) or ADHD-H (hyperactive-impulsive) symptoms in the subsequent year, (b) ADHD-I and ADHD-H symptoms at age 4 were not associated with changes in parenting factors at age 5, (c) age 5 ADHD-I and ADHD-H symptoms were associated with decreases in parental scaffolding skills and increases in parental hostility from ages 5 to 6 years, and (d) parental support at age 5 was associated with a decrease in ADHD-H symptoms at age 6. Findings suggest that ADHD symptoms can lead to poorer parenting attitudes and behavior, while parental support during kindergarten has a small effect on decreasing ADHD-H symptoms over time.

The Comparison of Psychological Factors and Executive Functions of Children with Attention Deficit Hyperactivity Disorder and Cognitive Disengagement Syndrome to ADHD and ADHD Comorbid with Oppositional Defiant Disorder

OBJECTIVE

The study aims to examine family functionality, emotion regulation difficulties, preference for loneliness, social exclusion, internalizing and externalizing disorders, and executive functions in children with Attention Deficit Hyperactivity Disorder (ADHD) and Cognitive Disengagement Syndrome (CDS) and compare with ADHD, and ADHD+ Oppositional Defiant Disorder (ODD).

METHOD

This study included 842 children aged 8-12 years. The subjects were categorized according to DSM-V as ADHD (n = 246), ADHD + ODD (n = 212), ADHD + CDS (n = 176), and Control group (n = 207). The solitude and social exclusion, difficulties in emotion dysregulation and Barkley SCT scales, Child Behavior Checklist, family assessment device, and Central Vital Signs (CNSVS) test were used.

RESULTS

According to the study, children with ADHD + CDS had higher rates of internalizing disorders. They also preferred being alone and experienced more difficulty communicating with their parents and solving problems within the family. Additionally, these children had difficulty recognizing and understanding the emotional reactions of others. The ADHD + ODD group presented a poorer performance on CNSVS domain tests except for the psychomotor speed test than other groups. Also, ADHD + CDS children had the lowest psychomotor speed scores and lower scores on reaction time and cognitive flexibility than pure ADHD children.

CONCLUSION

This study will contribute to the etiology, treatment, and clinical discrimination of ADHD + CDS.

ADHD Symptoms in Middle Childhood: The Role of Child Attachment and Maternal Emotional Availability in an Inpatient Clinical Sample

BACKGROUND

Child ADHD symptoms are highly prevalent in middle childhood, alongside impairment in social functioning. The parent-child relationship has been shown to play an important role; however, studies investigating specific facets of the parent-child relationship in ADHD symptomatology in middle childhood have been neglected. We assumed that higher ADHD symptoms were associated with both (1) lower maternal emotional availability (EA) and (2) lower child attachment security. Moreover, (3) we aimed to explore which specific EA dimensions were associated with ADHD symptoms.

METHODS

In a socio-pediatric clinic in Germany, 71 inpatient mother-child dyads (child age: M = 7.70, SD = 1.06; n = 54 boys) were assessed. Clinical data about child ADHD symptoms (Child Behavior Checklist 6-18 subscale "attention deficit/hyperactivity problems"), maternal EA (free play), and child attachment representation (Attachment Story Completion Task, GEV-B) were analyzed cross-sectionally.

RESULTS

Controlling for child oppositional behavior and sex, child ADHD symptoms were associated with overall maternal EA, and more specifically non-hostility, but not with child attachment representation.

CONCLUSIONS

Our results imply that the role of parent-child interaction quality should be considered in the treatment of ADHD. Bidirectional effects cannot be ruled out.

All in the Family? A Systematic Review and Meta-analysis of Parenting and Family Environment as Risk Factors for Attention-Deficit/Hyperactivity Disorder (ADHD) in Children

Parenting and family environment have significant impact on child development, including development of executive function, attention, and self-regulation, and may affect the risk of developmental disorders including attention-deficit/hyperactivity disorder (ADHD). This paper examines the relationship of parenting and family environment factors with ADHD. A systematic review of the literature was conducted in 2014 and identified 52 longitudinal studies. A follow-up search in 2021 identified 7 additional articles, for a total of 59 studies that examined the association of parenting factors with ADHD outcomes: ADHD overall (diagnosis or symptoms), ADHD diagnosis specifically, or presence of the specific ADHD symptoms of inattention and hyperactivity/impulsivity. For parenting factors that were present in three or more studies, pooled effect sizes were calculated separately for dichotomous or continuous ADHD outcomes, accounting for each study's conditional variance. Factors with sufficient information for analysis were parenting interaction quality (sensitivity/warmth, intrusiveness/reactivity, and negativity/harsh discipline), maltreatment (general maltreatment and physical abuse), parental relationship status (divorce, single parenting), parental incarceration, and child media exposure. All factors showed a significant direct association with ADHD outcomes, except sensitivity/warmth which had an inverse association. Parenting factors predicted diagnosis and overall symptoms as well as inattentive and hyperactive symptoms when measured, but multiple factors showed significant heterogeneity across studies. These findings support the possibility that parenting and family environment influences ADHD symptoms and may affect a child's likelihood of being diagnosed with ADHD. Prevention strategies that support parents, such as decreasing parenting challenges and increasing access to parent training in behavior management, may improve children's long-term developmental health.

Mother and child mental health over time in children with Autism and/or ADHD in the Longitudinal Study of Australian Children

This study utilised a longitudinal population-based study to explore mother and child mental health trajectories over time from child age 0 to 14 years, between children with ASD, ADHD, or ASD + ADHD. It explored whether a bidirectional relationship between mother psychological distress and child emotional and behavioural problems (EBPs) existed. The birth cohort from the Longitudinal Study of Australian Children was used. Child EBPs were assessed using the Strengths and Difficulties Questionnaire; and mother emotional distress using the Kessler K6. Generalised estimating equations and structured equation modelling was used to understand changes over time, differences between groups and bidirectional relationships. As expected, children with ASD, ADHD or ASD + ADHD had higher EBPs than children without, and their mothers had higher levels of psychological distress across most time points, but with differing trajectories. Mothers of children with ASD (with or without ADHD) showed increasing psychological distress over time, while mothers of children with ADHD had reducing distress. The bidirectional relationship between mother and child mental health found in children without diagnoses was only partially present in children with ASD/ADHD. Findings highlight support needs and discuss implications for transactional models of parent/child emotional problems in children with neurodevelopmental disorders.

Effectiveness of ENGAGE in reducing difficulties in everyday executive functions among Finnish preschoolers: a randomized controlled trial

Effective interventions applicable for young preschool-age children are needed to reduce the risk of widespread and sustained adversities that are linked to early executive function (EF) difficulties. This randomized controlled trial (RCT) examined the effectiveness of the play-based ENGAGE intervention in improving behavioral outcomes related to EFs among Finnish preschool-age children with hyperactivity and/or inattention problems. 95 children between 4 and 5 years of age and their parents were randomly assigned to the ENGAGE intervention or a waitlist control group. Parents and early childhood education (ECE) teachers rated the children's EF difficulties and problem behaviors at pre-intervention, post-intervention, and 5-month follow-up. Repeated measures linear mixed modeling was used to examine the effect of ENGAGE on child outcomes. Those receiving ENGAGE exhibited significantly greater decreases in parent-rated attentional problems, hyperactivity/impulsivity, and acting out behaviors than the control group did, with mostly moderate effect sizes. No consistent improvements in the teacher ratings of children's EF related difficulties were found in either group. Low dropout (8%) from the intervention and high acceptability ratings indicated that ENGAGE is a palatable intervention for parents. The present study showed that findings from an earlier RCT on ENGAGE conducted in New Zealand could be generalized to a different cultural setting, as the intervention effectively reduced young Finnish children's EF difficulties in the home context. Extending ENGAGE and other play-based interventions into different everyday contexts of children, such as ECE, could further enhance the beneficial effects on children's EFs and behavior.

Exploring Co-Regulation-Related Factors in the Mothers of ADHD Children-Proof of Concept Study

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a complex neurological condition interfering with family relationships and co-regulation capabilities. Therefore, exploring factors underpinning parental co-regulation ability is crucial for future fostering relationships in families of children with ADHD.

OBJECTIVE

This preliminary study aims to characterize and compare the executive-functions, anxiety, self-efficacy, and sensory modulation in mothers of children with and without ADHD.

METHOD

Mothers of children with (study group) and without (control-comparison, group) ADHD completed online self-reports, measuring executive-functions; parental self-efficacy; anxiety; and sensory modulation.

RESULTS

The study group (N = 40) had lower self-efficacy compared to the control group (N = 27; p = 0.018), and the control group had lower sensory responsiveness (p = 0.025). Within both groups the Behavior Rating Inventory of Executive Function-Adult (BRIEF-A) Global Executive Function Composite score (GEC) and the Beck Anxiety Inventory (BAI) were moderately correlated. Further, within the study group correlations were found between the BRIEF-A-GEC and the Sensory Responsiveness Questionnaire (SRQ)-Aversive scores (r = 0.37, p ≤ 0.01), and between the BRIEF-A Behavioral-Rating-Index and the parental self-efficacy scores (r = 0.31, p ≤ 0.05). Within the control group, negative correlations were found between the BRIEF-A-GEC and SRQ-Hedonic scores (r= -0.44, p < 0.05).

CONCLUSION

Self-efficacy, executive-functions, high sensory responsiveness and anxiety traits are interwoven and may impact parental co-regulation ability.

Secure Attachment Relationships With Mothers, But Not Fathers, Moderate the Relation Between Attention-Deficit Hyperactivity Symptoms and Delinquency in Adolescents

OBJECTIVE

The primary aim of this study was to investigate whether secure parent-adolescent attachment relationships moderate the longitudinal relation between 9th grade (G9) ADHD symptoms and 12th grade (G12) delinquency within a community sample of adolescents.

METHOD

Participants included 335 9th graders, of whom 203 students completed measures again in 12th grade. Mothers reported on their adolescents' ADHD symptoms and aggressive behaviors, and adolescents completed measures of their own delinquency and their perceptions of their parent-child attachment relationships.

RESULTS

G9 ADHD symptoms predicted increases in G12 delinquent behaviors. Moderation effects were also found such that G9 ADHD symptoms predicted G12 delinquency for only those youth who had moderate or low levels of secure maternal attachment. Paternal secure attachment did not moderate the effects of G9 ADHD symptoms on G12 delinquency.

CONCLUSION

Findings underscore the importance of secure maternal attachment relationships in the development of delinquency among adolescents with ADHD symptoms.

Parental rejection in early adolescence predicts a persistent ADHD symptom trajectory across adolescence

Despite a general decrease of attention-deficit/hyperactivity disorder (ADHD) symptoms during adolescence, these may persist in some individuals but not in others. Prior cross-sectional studies have shown that parenting style and their interaction with candidate genes are associated with ADHD symptoms. However, there is a lack of longitudinal research examining the independent and interactive effects of parenting and plasticity genes in predicting the course of attention-deficit/hyperactivity disorder (ADHD) symptoms across adolescence. Here, we investigated how children perceived their parents' parenting style (i.e., rejection, overprotection, and emotional warmth) at the age of 11, and their interaction with DRD4, MAOA, and 5-HTTLPR genotypes on parent-reported ADHD symptoms at three time points (mean ages 11.1, 13.4, and 16.2 years) in 1730 adolescents from the TRacking Adolescents' Individual Lives Survey (TRAILS). Growth Mixture Modeling in Mplus identified four ADHD symptom trajectories: low, moderate stable, high decreasing, and high persistent. Perceived parental rejection predicted class membership in the high persistent trajectory compared to the other classes (p < 0.001, odds ratios between 2.14 and 3.74). Gene-environment interactions were not significantly related to class membership. Our results indicate a role of perceived parental rejection in the persistence of ADHD symptoms. Perceived parental rejection should, therefore, be taken into consideration during prevention and treatment of ADHD in young adolescents.

Parenting roles for young people with attention-deficit/hyperactivity disorder transitioning to adult services

AIM

To inform transitions from child to adult health services, we explored the work and roles parents take in the care of young people with attention-deficit/hyperactivity disorder (ADHD) aged 14 to 25 years old.

METHOD

Using framework thematic analysis, we analysed data collected from 28 semi-structured interviews with parents of young people with ADHD to generate a typology and triangulated it against findings from 64 interviews with young people with ADHD. The interviews were carried out as part of a three-strand, interactive mixed-method study.

RESULTS

An entourage typology of three parent roles was identified. Parents moved between 'manager' and 'roadie' roles as their child gradually matured. A 'superfan' role was identified which supported young people's positive self-image but may impede withdrawal from the 'manager' role. Continued parental involvement into adulthood reflected a need to maintain the balance of resources required to maintain quality of life for the whole family.

INTERPRETATION

This is the first study to explore parental roles in the health care of young people with ADHD. Parents will vary in their capacity to fulfil the identified roles and step back their care as their children reach adulthood. The findings can inform intervention development to support families and transition between services.

WHAT THIS PAPER ADDS

Parents move from a 'manager' to 'roadie' role as young people mature. A 'superfan' role supports positive self-image and directed health care work. Continued involvement reflects parental responsibility to juggle wider family needs and resources. Parents differ in capacity to fulfil and move between these roles.

Prospective prediction of developing internalizing disorders in ADHD

BACKGROUND

Clinical course in attention-deficit/hyperactivity disorder (ADHD) is highly heterogeneous with respect to both core symptoms and associated features and impairment. Onset of comorbid anxiety and mood disorders during later childhood and adolescence is one critical aspect of divergent outcomes in ADHD. Characterizing heterogeneity in onset of anxiety and depression and identifying prospective predictors of these divergent courses may facilitate early identification of the children most at risk.

METHODS

A total of 849 children recruited for a case-control study of ADHD development, aged 7-12 years at baseline, completed up to six annual waves of comprehensive clinical and cognitive assessment, including multi-informant behavior ratings, parent semi-structured clinical diagnostic interviews, and measures of executive function (EF). Latent class growth curve analyses (LCGAs) characterized patterns of anxiety and depression over time. Trajectories were predicted from baseline parent-rated child temperament, lab-measured child EF, coded parental criticism, and child-reported self-blame for inter-parental conflict.

RESULTS

Latent class growth curve analyses separately identified three trajectories for anxiety and three for depression: persistently high, persistently low, and increasing. Temperamental fear/sadness and irritability were independent predictors that interacted with family characteristics. Baseline parental criticism and self-blame for inter-parental conflict exerted influence but only in the context of low temperamental risk. Better baseline child working memory was associated with delayed onset of depression.

CONCLUSIONS

The interaction of baseline child emotional features with EF or family environment predicted divergent courses of both anxiety and depression from middle-childhood to mid-adolescence. Results suggest modifiable risk factors associated with prospective differences in long-term outcomes.

The association between nonpharmacological interventions and quality of life in children with attention deficit hyperactivity disorder: A systematic review

BACKGROUND

Attention deficit hyperactivity disorder is a common psychiatric disorder with a worldwide prevalence of about five percent among children and adolescents. This disorder affects most aspects of their lives e.g., academic performance and social relations, and their overall quality of life is reduced compared to healthy peers. The majority of children with ADHD are treated with medication that potentially has an insufficient effect and/or frequently occurring side effects.

OBJECTIVES

To enable nurses and other health care professionals to guide children with ADHD and their families in their choices of treatment, based on the best available literature on the association between nonpharmacological interventions and quality of life.

DATA SOURCES

A literature search was performed in the databases CENTRAL, Embase, PubMed, CINAHL, and PsycINFO. Seven randomized controlled trials were included in this systematic review. They examined the use of polyunsaturated fatty acids, physical activity, psychoeducation, cognitive therapy, cognitive training, hippotherapy, and behavioral therapy.

CONCLUSIONS

The study of behavioral therapy in the form of a sleep intervention detected an improvement in quality of life which was statistically significant compared to the control group.

IMPLICATIONS FOR PRACTICE

Children with ADHD and a sleep disorder may gain improvement in their quality of life from a sleep intervention.

Explaining the Prospective Association of Positive and Negative Parenting Behaviors and Child ADHD Symptoms: Pathways Through Child Executive Function and Reward Responsivity

Objective: Parenting behavior is a well-established correlate of offspring ADHD. However, little is known about how parenting exerts its effects on offspring ADHD symptomatology. We examined whether prospective associations between positive and negative parenting behaviors and child ADHD symptoms are mediated by deficits in child executive function (EF) and reward responsivity (RR). Method: One hundred and thirty-five children with and without ADHD were assessed across two Waves, when children were mean ages 6 and 8 respectively. Children completed tasks on EF, and parents completed questionnaires about their parenting behaviors and their children's RR and ADHD symptoms. Results: Negative parenting behavior at Wave 1 was indirectly associated with offspring ADHD symptoms at Wave 2 via offspring EF. Conclusion: Individual differences in EF, but not RR, during early childhood may constitute a potential pathway by which negative parenting behaviors exerts its effects on subsequent offspring ADHD symptomatology. Treatment implications are discussed.

Genetics of Attention-Deficit Hyperactivity Disorder

Attention-Deficit Hyperactivity Disorder (ADHD) has long been recognized as being a highly heritable condition and our understanding of the genetic contributions to ADHD has grown over the past few decades. This chapter will discuss the studies that have examined its heritability and the efforts to identify specific genetic risk-variants at the molecular genetic level. We outline the various techniques that have been used to characterize genetic contributions to ADHD, describing what we have learnt so far, what there is still to learn and the methodologies that can be used to further our knowledge. In doing so we will discuss research into rare and common genetic variants, polygenic risk scores, and gene-environment interplay, while also describing what genetic studies have revealed about the biological processes involved in ADHD and what they have taught us about the overlap between ADHD and other psychiatric and somatic disorders. Finally, we will discuss the strengths and limitations of the current methodologies and clinical implications of genetic research to date.

Characterizing Parent–Child Interactions in Families of Autistic Children in Late Childhood

Parent–child interactions are influential to a wide range of positive developmental processes in neurotypical children, yet contributions to our understanding of these interactions using observational methods in families of children on the autism spectrum are lacking. The aim of the current study is to investigate how autism symptoms might impact these interactions. We use a family discussion task to: (1) compare families of autistic children aged 8–12 years (n = 21) to families of typically developing children (n = 21, matched on age and cognitive abilities) on the observed levels of supportive and directive behaviors in the parent–child relationship, and (2) examine the associations between parent–child interaction characteristics and child functioning. Results showed no differences in the observed levels of supportive behavior exhibited by parents, but significantly less supportive behavior in autistic children compared to neurotypical children. In addition, parents of autistic children had higher levels of observed directive behavior compared to parents of neurotypical children. Levels of supportive behavior in parents and autistic children were negatively associated with child ADHD symptoms. Findings reinforce literature on younger children describing positive parenting characteristics and further rebuke historical accounts of negative parenting qualities of parents of autistic children.

Primary School Children’s Self-Reports of Attention Deficit Hyperactivity Disorder-Related Symptoms and Their Associations With Subjective and Objective Measures of Attention Deficit Hyperactivity Disorder

Background

The diagnosis of Attention deficit hyperactivity disorder (ADHD) is primarily dependent on parents’ and teachers’ reports, while children’s own perspectives on their difficulties and strengths are often overlooked.

Goal

To further increase our insight into children’s ability to reliably report about their ADHD-related symptoms, the current study examined the associations between children’s self-reports, parents’ and teachers’ reports, and standardized continuous performance test (CPT) data. We also examined whether the addition of children’s perceptions of ADHD-symptoms to parents’ and teachers’ reports would be reflected by objective and standardized data.

Methods

The study included 190 children with ADHD, aged 7–10 years, who were referred to a pediatric neurologic clinic. A retrospective analysis was conducted using records of a clinical database. Obtained data included children’s self-reports of their attention level and ADHD-related symptoms, parent, and teacher forms of the Conners ADHD rating scales, Child Behavior Checklist (CBCL), Teacher’s Report Form (TRF), and CPT scores.

Results

Children’s self-evaluations of their functioning were globally associated with their teachers’ and parents’ evaluations, but not uniquely. Children’s self-reports of ADHD symptoms were not uniquely linked to a specific CPT impairment index, but to a general likelihood of having an impaired CPT. The CPT performance successfully distinguished between the group of children who defined themselves as inattentive and those who did not.

Conclusion

Primary school children with ADHD are able to identify their limitations and needs difficulties and that their perspectives should inform clinical practice and research. The clinical and ethical imperative of taking children’s perspectives into account during ADHD diagnosis and treatment is highlighted.

Attachment Representations in Children with and without Attention-Deficit/Hyperactivity Disorder (ADHD)

Attention-Deficit/Hyperactivity Disorder (ADHD) in children is associated with several adverse family characteristics, such as higher parenting stress, more conflicted parent–child relationships, lower parental competence, and higher levels of parental psychopathology. Hence, children with ADHD more often grow up under suboptimal circumstances, which may impact the development of their attachment representations. Here, we investigated whether children with ADHD have more insecure and disorganized attachment representations than their typically developing peers, and which factors could explain this association. We included 104 children between 4 and 11 years old, 74 with ADHD (without Conduct Disorder) and 30 typically developing control children. Children completed a state-of-the-art story stem task to assess their attachment representation, and we measured parents’ expressed emotion (as an index of parent–child relationship quality), parents’ perceived sense of competence, parental education levels, and parent-rated ODD symptoms of the child. We found that, after controlling for multiple comparisons, children with ADHD had less secure and more ambivalent and disorganized attachment representations relative to their typically developing peers. These group differences were independent of comorbid ODD and parental education levels. There were no group differences on avoidant attachment representations. Explorative analyses within the ADHD group showed that attachment representations were not related to parent–child relationship quality, perceived parenting competence, parental education levels, and comorbid ODD symptoms. We conclude that children with ADHD disproportionately often have attachment problems. Although this conclusion is important, treatment implications of this co-occurrence are yet unclear as research on ADHD and attachment is still in its infancy.

Daily Behaviors, Worries and Emotions in Children and Adolescents with ADHD and Learning Difficulties during the COVID-19 Pandemic

The aim of the present study was to investigate the effects of the coronavirus crisis on behavioral and emotional parameters in children and adolescents with ADHD and Learning Difficulties. A total of 101 children, 5–18 years old, were included in the study, 63 (44 boys) of which were diagnosed with ADHD and learning difficulties (ADHD/LD) and 38 were healthy children (19 boys). The CRISIS questionnaire for parents/caregivers was used. The questionnaire was completed during the first national lockdown in Greece and the data referred to two time-points: 3 months before, and the past 2 weeks. A significant deterioration in the “Emotion/Worries (EW)” symptoms was observed during the pandemic in the control group (2.62 ± 0.16 vs. 2.83 ± 0.18, p < 0.001). No such differences were noted in the ADHD group: 3.08 ± 0.25 vs. 3.12 ± 0.29, p = 0.12. Provision of educational and activities support was related to increased EW before the crisis. In ADHD/LD children, higher parental education and child’s younger age were related to increased symptoms of EW. In the entire group, previous mental health conditions, increasing stress due to restrictions, and increased COVID-related worries were positively associated with the EW symptoms during the crisis. Less affected relations with friends and less reduction in contact with people outside the home were negatively related with EW during the crisis. The study revealed specific parameters that negatively affected the emotional and behavioral variables of children with ADHD and learning difficulties.

Do ADHD Symptoms and Relationship Quality With Mothers and Best Friends Across High School Predict Depressive Symptoms for Adolescents?

Objective: Symptoms of ADHD place adolescents at increased risk for depression. The transition from middle to high school may magnify depression risk. This study examined whether changes in adolescents' negative relationship quality with their mothers and best friends from eighth to 12th grades mediated the longitudinal relations between ADHD and depressive symptoms. Method: 368 adolescents (48.5% male) were initially recruited. Results: Boys with elevated ADHD symptoms in the eighth grade reported steeper increases in negative relationship quality with their mothers relative to girls, and that this trajectory mediated the relation between ADHD and depressive symptoms. ADHD symptoms were also associated with increases in negative friendship quality across high school for boys; however, this did not mediate the relation between ADHD and depressive symptoms for either sex. Conclusion: Growth in mother-adolescent negative relationship quality may be one mechanism that explains the development of depressive symptoms in adolescent boys with elevated ADHD symptoms.

Association between emotional and behavioral problems and perceived parenting in attention deficit hyperactivity disorder: An exploratory study

BACKGROUND

Parent-child relationship difficulties are seen in families of children and adolescents diagnosed with attention deficit hyperactivity disorder (ADHD), and they may contribute to long-term negative outcomes.

AIM

Our aim was to examine perceived parenting and its correlation with emotional and behavioral problems in children and adolescents with a diagnosis of ADHD.

MATERIALS AND METHODS

This was a cross-sectional study involving 38 children and adolescents, between 8 and 16 years of age, diagnosed to have ADHD. Parents rated the children and adolescents on the Strengths and Difficulties Questionnaire (SDQ), whereas children/adolescents rated parents on the Alabama Parenting Questionnaire (APQ).

RESULTS

The study population primarily consisted of males (86.8%), between 8 and 12 years (68%), and belonged to urban families (82%). Warm, attentive, and engaged parenting behaviors which were subsumed under the domain of parental involvement in the APQ were associated with fewer total problem behaviors as well as specifically lower conduct and peer problems on the SDQ. Similarly, parents who used positive disciplining strategies as per the APQ had fewer total behavioral problems as well as specifically lower emotional problems on the SDQ. Children with comorbid oppositional defiant disorder reported lesser mean scores in all domains of parenting and significantly in the domains of parental involvement and positive parenting as per the APQ.

CONCLUSIONS

Parental involvement and positive parenting were significantly associated with fewer emotional and behavioral problems in children and adolescents diagnosed with ADHD. This has direct implications for clinical practice. Further studies are needed to adapt parenting strategies to the Indian context.

Trajectories of Depressive Symptoms in Adolescence: The Interplay of Maternal Emotion Regulation Difficulties and Youth ADHD Symptomatology

Objective: ADHD and depression co-occur at higher than chance levels in adolescence, but moderators of this association are not well understood. Consistent with a developmental-transactional framework, one such moderator may be maternal emotion regulation (ER) difficulties. Using latent growth curve modeling, the current study examined the independent and interactive effects of adolescent ADHD symptoms and maternal ER difficulties on the trajectory of depressive symptoms across adolescence. Method: This study included a community sample of 247 adolescents (M_age = 13.06 years) assessed annually over a 6-year period. Results: Findings suggested that youth with greater ADHD symptoms whose mothers evidenced more ER difficulties demonstrated steeper increases in depressive symptoms over time relative to their peers with lower ADHD symptoms or whose mothers reported fewer ER difficulties. Conclusion: This work highlights the importance of maternal ER difficulties in predicting the trajectory of depressive symptoms among adolescents with ADHD symptomatology.

The Association between Prosocial Behaviour and Peer Relationships with Comorbid Externalizing Disorders and Quality of Life in Treatment-Naïve Children and Adolescents with Attention Deficit Hyperactivity Disorder

Several recent studies confirmed that Attention Deficit Hyperactivity Disorder (ADHD) has a negative influence on peer relationship and quality of life in children. The aim of the current study is to investigate the association between prosocial behaviour, peer relationships and quality of life in treatment naïve ADHD samples. The samples included 79 children with ADHD (64 boys and 15 girls, mean age = 10.24 years, SD = 2.51) and 54 healthy control children (30 boys and 23 girls, mean age = 9.66 years, SD = 1.73). Measurements included: The "Mini International Neuropsychiatric Interview Kid; Strengths and Difficulties Questionnaire" and the "Inventar zur Erfassung der Lebensqualität bei Kindern und Jugendlichen". The ADHD group showed significantly lower levels of prosocial behaviour and more problems with peer relationships than the control group. Prosocial behaviour has a weak positive correlation with the rating of the child's quality of life by the parents, both in the ADHD group and in the control group. The rating of quality of life and peer relationship problems by the parents also showed a significant negative moderate association in both groups. The rating of quality of life by the child showed a significant negative weak relationship with peer relationships in the ADHD group, but no significant relationship was found in the control group. Children with ADHD and comorbid externalizing disorders showed more problems in peer relationships than ADHD without comorbid externalizing disorders. Based on these results, we conclude that therapy for ADHD focused on improvement of prosocial behaviour and peer relationships as well as comorbid externalizing disorders could have a favourable effect on the quality of life of these children.

Aiding diagnosis of childhood attention-deficit/hyperactivity disorder of the inattentive presentation: Discriminant function analysis of multi-domain measures including EEG

INTRODUCTION

We developed a neurocognitive assessment tool (NCAT) in consultation with mental health professionals working with children with AD/HD as a diagnostic aid and screening tool. This study examines the predictive utility of NCAT in the classification of children with AD/HD Inattentive presentation.

METHOD

Fifty three children with AD/HD Inattentive presentation and 161 typically-developing children completed an NCAT assessment. Discriminant function analyses examined group membership prediction for separate components of NCAT and for the components combined.

RESULTS

The combined model correctly classified 93.4 % of participants, with 91.4 % sensitivity and 93.9 % specificity. Contributions to classification were from SNAP-IV, psychological needs satisfaction, self-regulation, executive function performance, and EEG. The combined model resulted in a 9.3 % increase in specificity and 5.9 % increase in sensitivity compared to SNAP-IV alone.

CONCLUSIONS

NCAT provides good discrimination between children with and without AD/HD of the Inattentive presentation, and further investigation including other subtypes and comorbidities is warranted.

Disentangling nature from nurture in examining the interplay between parent-child relationships, ADHD, and early academic attainment

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is highly heritable and is associated with lower educational attainment. ADHD is linked to family adversity, including hostile parenting. Questions remain regarding the role of genetic and environmental factors underlying processes through which ADHD symptoms develop and influence academic attainment.

METHOD

This study employed a parent-offspring adoption design (N = 345) to examine the interplay between genetic susceptibility to child attention problems (birth mother ADHD symptoms) and adoptive parent (mother and father) hostility on child lower academic outcomes, via child ADHD symptoms. Questionnaires assessed birth mother ADHD symptoms, adoptive parent (mother and father) hostility to child, early child impulsivity/activation, and child ADHD symptoms. The Woodcock-Johnson test was used to examine child reading and math aptitude.

RESULTS

Building on a previous study (Harold et al., 2013, Journal of Child Psychology and Psychiatry, 54(10), 1038-1046), heritable influences were found: birth mother ADHD symptoms predicted child impulsivity/activation. In turn, child impulsivity/activation (4.5 years) evoked maternal and paternal hostility, which was associated with children's ADHD continuity (6 years). Both maternal and paternal hostility (4.5 years) contributed to impairments in math but not reading (7 years), via impacts on ADHD symptoms (6 years).

CONCLUSION

Findings highlight the importance of early child behavior dysregulation evoking parent hostility in both mothers and fathers, with maternal and paternal hostility contributing to the continuation of ADHD symptoms and lower levels of later math ability. Early interventions may be important for the promotion of child math skills in those with ADHD symptoms, especially where children have high levels of early behavior dysregulation.

Prenatal and perinatal factors associated with ADHD risk in schoolchildren: EPINED epidemiological study

The aim of this study is to assess the relationship between pre- and perinatal factors and ADHD in a sample of scholars exploring differences between ADHD presentations and spectrum of severity. A total of 6720 scholars (aged 3-4 and 10-11) participated in a double-phase epidemiologic cross-sectional study (Epidemiological Study of Neurodevelopmental Disorders, EPINED), and a sample of 646 scholars (ADHD risk, ASD risk and controls without risk) were individually assessed in the second phase of the study. The ADHD diagnosis, based on DSM-5 criteria, was performed with the Kiddie-Schedule for Affective Disorders & Schizophrenia, Present & Lifetime Version. Associations for the different ADHD presentations between prenatal, perinatal and postnatal factors and ADHD (n = 168), subclinical ADHD (n = 88) and non-ADHD (n = 310) were analysed. Logistic regression models showed that gestational diabetes (p = 0.012), instrumental delivery (p = 0.011), family history of psychopathology (p = 0.033) and maternal ADHD phenotype (p = 0.023) were associated with ADHD. These factors were related to the hyperactive-impulsive and combined presentations, but they were not related to the inattentive presentation. Maternal weight gain was associated with subclinical ADHD. In conclusion, metabolic disorder in the pregnancy, difficulties in childbirth and specific family phenotype were related to ADHD, specifically with hyperactive-impulsive presentation, but not in subclinical ADHD.

Prenatal and Postnatal Predictive Factors for Children's Inattentive and Hyperactive Symptoms at 5 Years of Age: The Role of Early Family-related Factors

We examined several parent-reported prenatal and postnatal factors as potential risk factors for attention-deficit and hyperactivity disorder (ADHD) symptomatology in 5-year-old children. Our study is based on the CHILD-SLEEP birth cohort. Several parental questionnaires were collected prenatally (32nd pregnancy week) and postnatally (i.e. child aged 3, 8, and 24 months and at 5 years). At 5 years of age, ADHD symptoms were assessed using questionnaires. Our main results showed that being a boy, parental depressive symptoms, more negative family atmosphere or a child's shorter sleep duration, and maternal authoritarian parenting style predicted inattentive/hyperactive symptoms. Maternal and paternal authoritative parenting style predicted less inattentive/hyperactive symptoms. Children with several risk factors together had the highest risk for inattentive/hyperactive symptoms. Our findings emphasise the need for early screening and treatment of parental mental health, and early evidence-based targeted parental support, to enable early intervention in those children at a risk of developing ADHD.

Rolling out a mindfulness-based stress reduction intervention for parents of children with ADHD: a feasibility study

BACKGROUND

Attention-deficit/Hyperactivity Disorder (ADHD) is the single most frequent reason for attendance at Child and Adolescent Mental Health Services (CAMHS) in Ireland. Research has suggested that parents of children with ADHD experience more parenting stress than parents of non-clinical controls, yet routine treatment for ADHD rarely addresses parental well-being. Mindfulness-based interventions (MBIs) have been found to result in a reduction in parental stress.

METHOD

An adapted Mindfulness-Based Stress Reduction (MBSR) intervention was delivered to parents (n = 23) of children with ADHD recruited from CAMHS and ADHD Ireland.

RESULTS

Following the intervention a significant improvement was documented within the social relationships domain of quality of life (WHOQOL-BREF) and a significant reduction on the child hyperactivity scale of the Strengths and Difficulties (SDQ) questionnaire.

CONCLUSION

This pilot study suggests that an MBSR intervention is both feasible and effective for parents whose children have ADHD. Larger scale studies need to be conducted before inclusion in routine CAMHS.

Parental Emotion Regulation and Mentalization in Families of Children With ADHD

Objective: The aim of this study is to examine the role of parental emotion regulation (ER) and parental mentalization as possible contributors to hostile and coercive parenting in families of children with ADHD. Method: Seventy-four Israeli families (64 mothers and 48 fathers) seeking parent training for child ADHD completed measures during the intake session. Measures included parental ER; parental mentalization; hostile, coercive, and submissive parenting; and child symptoms. Results: Findings suggested a relationship between parental ER and coercive parenting independent of child age, symptom level, and parental mentalization. Parental mentalization appeared to buffer against hostility specifically among parents with low ER capacities. Patterns were parallel for mothers and fathers. Conclusion: Study findings highlight the importance of evaluating and addressing parental ER in interventions attempting to reduce coercive parenting. The findings also highlight the potential role of parental mentalization as a protective mechanism against hostile parenting in families of children with ADHD.

Family and developmental history of ADHD patients: a structured clinical routine interview identifies a significant profile

Similar to other neurodevelopmental disorders, the diagnosis of attention-deficit hyperactivity disorder (ADHD) is based on clinical and psychosocial assessment. This assessment is performed in clinical practice using the clinical routine interview technique. Domains of the clinical routine interview are, among others, present symptoms, history of present illness and family and developmental history. Family and developmental history are important parts in the diagnostic process of ADHD. In contrast to the domains of present symptoms and history of present illness, there are currently no structured interviews or rating scales available to thoroughly assess family and developmental history in ADHD. The aim of the study was to assess the profile of operationalized data from a structured clinical routine interview addressing family and developmental history from ADHD patients and control participants. A structured interview to assess family and developmental history was derived from the guidelines used at different university hospitals for Child and Adolescent Psychiatry as well as from the descriptions in leading textbooks. Based on these guidelines and descriptions, the interview was an optimization of possible questions. Clinical data were obtained from parents of male patients who had the diagnosis of ADHD between the ages of 12-17 years (n = 44), and of healthy controls (n = 41). Non-metric data were operationalized into three categories, 0-normal behavior, 1-minor pathological behavior, 2-major pathological behavior. ADHD patients express a profile that significantly differs from control participants. Comparison of significant items with the empirical ADHD literature indicates strong agreement. Our findings support the importance and feasibility of the clinical routine interview in family and developmental history in the context of diagnosing ADHD.

Measurement-based Data to Monitor Quality: Why Specification at the Population Level Matter?

Measurement-based care is conceptualized as a driver for quality improvement. The triple aim in the National Quality Strategy purposively muddles the population levels to provide a health policy goal that is encompassing, transactional, and will stimulate change. Specification of the population level has implications for the purpose, proposed target mechanisms that drive quality improvement, methodologic challenges, and implications for program evaluation and data interpretation. To demonstrate, population levels are conceptualized at the individual (tier 1), clinical aggregate (tier 2), and national level (tier 3).

The Longitudinal Relation between Observed Maternal Parenting in the Preschool Period and the Occurrence of Child ADHD Symptoms in Middle Childhood

In this longitudinal population-based cohort (N = 547) we examined the relation between maternal discipline and sensitivity in the preschool period and the occurrence of attention-deficit hyperactivity disorder (ADHD) symptoms in middle childhood, taking into account pre-existing child attention and executive function (EF) problems, and oppositional defiant disorder (ODD) symptom comorbidity. Maternal parenting was observed during a ‘do not touch task’ (positive and negative discipline) and a teaching task (sensitivity) at age 3. Parents reported on the occurrence of ADHD and ODD symptoms at age 8 using the Conners’ Parent Rating Scale. Attention and executive function problems were assessed using parent questionnaires at age 4. Important covariates such as harsh discipline and maternal depression were also taken into account. Maternal sensitivity significantly predicted later ADHD symptoms beyond pre-existing child attention and EF problems, and comorbid ODD symptoms. However, maternal negative and positive discipline did not significantly predict later ADHD symptoms over and above these covariates. This study demonstrates the importance of maternal sensitivity in the etiology of core ADHD symptoms above and beyond pre-existing child attention and EF problems, and comorbid ODD symptoms.

ADHD symptoms across adolescence: the role of the family and school climate and the DRD4 and 5-HTTLPR genotype

We examined bidirectional relations between attention-deficit/hyperactivity disorder (ADHD) symptoms and family and school climate, and the possible role of DRD4 and/or 5-HTTLPR genotypes herein. Three-wave longitudinal data of 1860 adolescents (mean ages 11, 13.5, and 16 years) from the general population and clinic-referred cohort of TRacking Adolescents' Individual Lives Survey were used. Using a multigroup Random Intercept Cross-Lagged Panel Model, we tested between-person (i.e., stable trait levels) and within-person (i.e., causal processes) associations across ADHD symptoms, family and school climate, and the extent to which these depended on genotype. Findings indicated no influence of genotype. Results did show significant between-person differences (ADHD symptoms with family climate r = .38; and school climate r = .23, p values < .001), indicating that higher stable levels of ADHD symptoms were associated with a less favorable family and school climate. Regarding within-person causal processes, ADHD symptoms predicted a less favorable family climate in early adolescence (β = .16, p < .01), while ADHD symptoms predicted a more favorable family climate in the later phase of adolescence (β = - .11, p < .01), a finding which we explain by normative developmental changes during adolescence. Overall, this study showed that negative associations between ADHD symptoms and both family and school climate are largely explained by stable between-person differences. We recommend applying the Random Intercept Cross-Lagged Path Model to developmental data to tease stable associations and change processes apart.

Examining the Role of Genetic Risk and Longitudinal Transmission Processes Underlying Maternal Parenting and Psychopathology and Children's ADHD Symptoms and Aggression: Utilizing the Advantages of a Prospective Adoption Design

Although genetic factors may contribute to initial liability for ADHD onset, there is growing evidence of the potential importance of the rearing environment on the developmental course of ADHD symptomatology. However, associations between family-level variables (maternal hostility, maternal depressive symptoms) and child behaviors (developmental course of ADHD and aggression) may be explained by genes that are shared by biologically related parents and children. Furthermore, ADHD symptoms and aggression commonly co-occur: it is important to consider both simultaneously to have a better understanding of processes underlying the developmental course of ADHD and aggression. To addresses these issues, we employed a longitudinal genetically sensitive parent-offspring adoption design. Analyses were conducted using Cohort I (n = 340) of the Early Growth and Development Study with cross-validation analyses conducted with Cohort II (n = 178). Adoptive mother hostility, but not depression, was associated with later child ADHD symptoms and aggression. Mothers and their adopted children were genetically unrelated, removing passive rGE as a possible explanation. Early child impulsivity/activation was associated with later ADHD symptoms and aggression. Child impulsivity/activation was also associated with maternal hostility, with some evidence for evocative gene-environment correlation processes on adoptive mother depressive symptoms. This study provides novel insights into family-based environmental influences on child ADHD and aggression symptoms, independent of shared parental genetic factors, implications of which are further explicated in the discussion.

The Role of Parental Monitoring in Mediating the Link Between Adolescent ADHD Symptoms and Risk-Taking Behavior

Objective: ADHD in adolescents and low level of parental monitoring have been associated with increased risk-taking behavior. The present study examined whether parental knowledge of the child's whereabouts mediates the correlations between adolescent ADHD symptoms and risk-taking behavior. Method: Ninety-two adolescents and their parents completed questionnaires assessing perceptions of parents' monitoring, engagement in risk-taking behaviors, and ADHD symptoms. Results: Greater engagement in risk-taking behavior correlated with higher levels of ADHD symptoms and decreased parental monitoring. Mediation analysis revealed both direct effect of ADHD symptoms on risk-taking behavior and an indirect effect mediated by level of parental knowledge. Conclusion: These findings suggest that parental knowledge is negatively affected by the presence of ADHD symptoms, and may in turn lead to risk-taking behavior. The findings emphasize the need to target parenting and in particular parental knowledge of the child's whereabouts to reduce risk-taking behaviors among youth with ADHD.

Promising effect of a family rugby programme for children with ADHD: Promoting parent-child relationship and perceptual change on child's behaviors

BACKGROUND AND PURPOSE

This study explored the effectiveness of a family-based rugby programme to improve the parent-child relationship for children with ADHD and their parents.

MATERIALS AND METHODS

A total of 17 Chinese families (12 fathers and 13 mothers) of children (in early primary grades) with ADHD participated in this study. Mixed methods, including questionnaires, parent focus groups, parental reflective journals, and interviews with children, were adopted.

RESULTS

Quantitative data suggested a trend of parental perceptual change on their children's ADHD behaviors. Thematic analysis on the qualitative data further suggested the family rugby programme served as "a family play context" that helped promote parent-child relationship for the Chinese children with ADHD and their parents. Participating children experienced "a different self" and better self-control when playing rugby.

CONCLUSION

There is a promising effect of the use of rugby as an alternative family-based approach for children with ADHD and their parents.

Longitudinal Relationships Between Parent Involvement, Parental Warmth, ADHD Symptoms, and Reading Achievement

Objective: This study examined potential bidirectional relationships between parental warmth, parent involvement in education, child symptoms of ADHD, and achievement between ages five and nine. Method: Using data from the Fragile Families and Child Wellbeing Study, a nationally representative, longitudinal study, associations between ADHD symptoms, parental warmth, parental involvement, and reading achievement in a cross-lagged panel model were analyzed with a sample of 3,386 children. Results: Parental warmth at the age of 5 years was a negative predictor of ADHD symptoms at the age of 9 years; ADHD symptoms at the age of 5 years negatively predicted parental warmth at the age of 9 years. ADHD symptoms at the age of 5 years negatively predicted later parental involvement, but involvement did not predict later ADHD symptoms. Conclusion: Findings provide support for bidirectional associations between parental warmth and ADHD symptoms across time but unidirectional effects from ADHD to parental involvement. These findings have implications for informing intervention efforts to consider both parenting and child-evocative effects.

Discrepancies in Mother-Adolescent Reports of Parenting Practices in a Psychiatric Sample: Associations with Age, Psychopathology, and Attachment

Discrepancies in parent-adolescent reports of parenting practices may reveal important information about parent-adolescent relationship quality. Youth attachment security has been identified as a factor that may explain discrepancies between parents and adolescents in reporting on parenting. However, previous research has not examined this question among clinical samples, and has generally utilized non-optimal analytic strategies in modeling discrepancies. The current study aimed to extend previous work by using latent profile analysis (LPA) to identify patterns of mother-adolescent divergence in reports of parenting in a large clinical sample, examining the characteristics of discrepancy groups in terms of age, gender, and psychopathology, and examining associations between attachment and discrepancies. A sample of adolescents with psychiatric disorders (N = 416; ages 12-17) and their mothers completed reports of parenting practices. Adolescents also completed the Child Attachment Interview and a measure of psychopathology. LPA was used to identify groups of mother-adolescent dyads with similar patterns of divergence across domains of parenting. Chi-square, ANOVA, and logistic regression analyses were used to test associations between youth age, gender, psychopathology, and attachment and mother-adolescent discrepancy profile membership. Three discrepancy profiles emerged: Strong Divergence, Moderate Divergence, and Low Divergence. Youth in the Moderate Divergence profile were oldest and had highest levels of externalizing pathology. Youth with insecure (dismissing and preoccupied) attachment, relative to securely attached youth, were more likely to be in the Strong Divergence profile. Securely attached adolescents were more likely to be in Low or Moderate Divergence profiles. Clinical implications are discussed.

Parental Reflective Functioning in Mothers and Fathers of Children With ADHD: Issues Regarding Assessment and Implications for Intervention

Parental factors contribute to ADHD, partly in an etiological way and partly as moderators and mediators of child outcomes and treatment effects. An important aspect of parenting seems to be parental reflective functioning (PRF), defined as the parent's capacity to reflect upon his own and his child's internal mental experience. The studies on parenting factors linked to ADHD have not extensively investigated the role of PRF. Recent findings on interventions have begun to consider mentalization to promote empathy and emotion regulation in parents, but empirical studies assessing PRF are still scarce. The aim of this cross-sectional study was to compare specific familial and parental functioning characteristic between parents of children with attention deficit/hyperactivity disorder (ADHD) and parents of controls without ADHD. A clinical sample of 41 children with ADHD aged 8–11 years and their parents was compared with a matched, non-clinical sample of 40 children. Three aspects of parental functioning were investigated: parental symptomatology, parental alliances and PRF; children's differences in strength and difficulty profiles were also assessed. The results showed that families of children with ADHD had lower socioeconomic status, and both mothers and fathers of the same families reported higher scores for depression and lower PRF than did the control group; only mothers showed lower parental alliance. Logistic regression highlighted the fact that several of these familial and parental factors contributed to the increased risk of belonging to the clinical group, specifically both mothers' and fathers' depressive symptoms and lower PRF. These data represent new findings with potentially meaningful clinical implications for both assessment and intervention.

Children's Inattention and Hyperactivity, Mother's Parenting, and Risk Behaviors in Adolescence: A 10-Year Longitudinal Study of Chilean Children

OBJECTIVE

To examine how mothers' nurturant and, separately, hostile parenting mediate the effects of young children's inattentiveness and hyperactivity on risk behaviors in adolescence.

METHOD

Data were analyzed from 920 healthy Chilean children, studied at 5.5, 10 years, and adolescence. Children's hyperactivity and inattentiveness at 5.5 years were assessed by mother ratings on the Children's Adaptive Behavior Inventory. Mothers' nurturance and hostility toward the child at 10 years were assessed by maternal interview on the Home Observation for Measurement of the Environment. Youth's delinquent and aggressive behaviors in adolescence were compiled from the Youth Self-Report questionnaire, and youth's substance use in adolescence was assessed by an extensive self-report substance use inventory. Structural equation modeling was used to identify direct and indirect effects.

RESULTS

Findings supported a mediating effect, with more severe child hyperactivity at 5.5 years leading to mothers' greater hostility toward her child at age 10, which, in turn, led to greater delinquency and aggression in adolescence. Marginal mediating effects were also found from child hyperactivity and inattention at 5.5 years to mothers' lower nurturance at 10 years to youth substance use in adolescence.

CONCLUSION

Mothers' hostile treatment of children with hyperactive or inattentive behaviors contributed to adolescent risk behaviors and is an area of intervention.

Association Between Parenting Style and Socio-Emotional and Academic Functioning in Children With and Without ADHD: A Community-Based Study

OBJECTIVE

In a community-based study, we examined parenting style and its relationship to functioning in 6- to 8-year-old children ( n = 391; 66.2% male) with ADHD ( n = 179), compared with non-ADHD controls ( n = 212).

METHOD

Parenting style was assessed using parent-reported (93.5% female) measures of warmth, consistency, and anger. Child socio-emotional and academic functioning was measured via parent- and teacher-reported scales, and direct academic assessment.

RESULTS

Parents reported less consistency and more anger in the ADHD group compared with non-ADHD controls, with no differences in warmth. Parenting warmth, consistency, and anger were associated with parent-reported aspects of socio-emotional functioning for children with ADHD and non-ADHD controls, after adjusting for socio-demographic variables, externalizing comorbidities, and ADHD symptom severity. Parenting style was no longer related to academic functioning and most teacher-reported outcomes after adjustment.

CONCLUSION

Generic parenting interventions that promote warm, consistent, and calm parenting may help alleviate socio-emotional impairments in children with ADHD.

The effectiveness of PMT program on parent-child relationship in parents with ADHD children: A randomized trial

Background: Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder in children that creates problems in parents-children relationships. Improving familial and social interactions of these children needs mental and social interventions, and parents' management training (PMT) program is one of these interventions. The present study aimed at determining the effectiveness of PMT program on parent-child relationship of parents with ADHD children. Methods: Through an experimental research, 40 parents with ADHD children were selected based on purposeful sampling. A total of 20 parents were randomly placed in intervention group and received 8 sessions of intervention course (60 minutes per session) and the other 20 parents were grouped in the control group and received no training intervention. Research tools included a researcher-designed demographics questionnaire and Parker's Bonding Instrument (PBI). Data were collected at pretest, posttest, and follow- up stages and analyzed using descriptive and covariance analysis. Results: The results revealed that PMT program was significantly effective in reducing excessive support and increasing parent care index in parents with ADHD children (p<0.05). Conclusion: The results of the present study supported the effectiveness of PMT program on parent-child relationship of the parents with ADHD children.

Parent Emotion Expression and Autonomic-Linked Emotion Dysregulation in Childhood ADHD

Despite evidence that ADHD is associated with disruptions in emotion regulation, few studies have examined the biological correlates of emotion dysregulation among children with this disorder. Prior work has pointed to roles of the parasympathetic and sympathetic nervous system, as indexed via respiratory sinus arrhythmia (RSA) and cardiac pre-ejection period (PEP), respectively. Work in typically developing populations suggests that parenting behavior and parental emotion expression may shape the development of these systems. To date, a single study has examined the independent and interactive roles of autonomic nervous system functioning and parent emotion expression in youth with ADHD. This study seeks to extend that work. 86 children (42 with ADHD), aged 8-12 years, and a parent completed a parent-child interaction task, while electrocardiography and impedance cardiography data were recorded to derive RSA and PEP. Parent and child emotion word use (positive and negative valence) were coded from recordings of the task. Parents of youth with ADHD used fewer positive emotion words throughout the task. Additionally, throughout the task, children with ADHD engaged in excessive RSA withdrawal from baseline. Further, the association between RSA reactivity and ADHD diagnosis was moderated by parent positive emotion word use. Specifically, those with RSA augmentation and parents displaying high positive affect across the task conditions were least likely to have an ADHD diagnosis. If replicated and extended, these results support the use of interventions specifically designed to increase parental modeling of positive emotions, while simultaneously focusing on building emotion regulation skills in youth with ADHD.

A longitudinal, within-person investigation of the association between the P3 ERP component and externalizing behavior problems in young children

BACKGROUND

Externalizing problems, including aggression and conduct problems, are thought to involve impaired attentional capacities. Previous research suggests that the P3 event-related potential (ERP) component is an index of attentional processing, and diminished P3 amplitudes to infrequent stimuli have been shown to be associated with externalizing problems and attention-deficit/hyperactivity disorder (ADHD). However, the vast majority of this prior work has been cross-sectional and has not examined young children. The present study is the first investigation of whether within-individual changes in P3 amplitude predict changes in externalizing problems, providing a stronger test of developmental process.

METHOD

Participants included a community sample of children (N = 153) followed longitudinally at 30, 36, and 42 months of age. Children completed an oddball task while ERP data were recorded. Parents rated their children's aggression and ADHD symptoms.

RESULTS

Children's within-individual changes in the P3 amplitude predicted concomitant within-child changes in their aggression such that smaller P3 amplitudes (relative to a child's own mean) were associated with more aggression symptoms. However, changes in P3 amplitudes were not significantly associated with ADHD symptoms.

CONCLUSIONS

Findings suggest that the P3 may play a role in development of aggression, but do not support the notion that the P3 plays a role in development of early ADHD symptoms.