Parental ADHD status and its association with proband ADHD subtype and severity

Working and short-term memory in children with ADHD: an examination of prefrontal cortical functioning using functional Near-Infrared Spectroscopy (fNIRS)

Working memory impairments are an oft-reported deficit among children with ADHD, and complementary neuroimaging studies implicate reductions in prefrontal cortex (PFC) structure and function as a neurobiological explanation. Most imaging studies, however, rely on costly, movement-intolerant, and/or invasive methods to examine cortical differences. This is the first study to use a newer neuroimaging tool that overcomes these limitations, functional Near Infrared Spectroscopy (fNIRS), to investigate hypothesized prefrontal differences. Children (aged 8-12) with ADHD (N = 22) and typically developing (N = 18) children completed phonological working memory (PHWM) and short-term memory (PHSTM) tasks. Children with ADHD evinced poorer performance on both tasks, with greater differences observed in PHWM (Hedges' g = 0.67) relative to PHSTM (g = 0.39). fNIRS revealed reduced hemodynamic response among children with ADHD in the dorsolateral PFC while completing the PHWM task, but not within the anterior or posterior PFC. No between-group fNIRS differences were observed during the PHSTM task. Findings suggest that children with ADHD exhibit an inadequate hemodynamic response in a region of the brain that underlies PHWM abilities. The study also highlights the use of fNIRS as a cost-effective, noninvasive neuroimaging technique to localize/quantify neural activation patterns associated with executive functions.

Psychometric Properties of the Parental Stress Scale in Swedish Parents of Children with and without Neurodevelopmental Conditions

Background

Parents of children with neurodevelopmental conditions (NDC) are at risk of experiencing elevated levels of parental stress. Access to robust instruments to assess parental stress is important in both clinical and research contexts. Objective: We aimed to evaluate the psychometric properties of a Swedish version of the Parental Stress Scale (PSS), completed by parents of 3- to 17-year-old children, with and without NDCs.

Method

Main analyses were conducted on data from three independent samples: a community sample (n=1018), a treatment-seeking sample of parents of children with various disabilities (n=653), and a sample of parents of children with Attention-Deficit/Hyperactivity Disorder (ADHD) who themselves reported varying ADHD symptom severities (n=562). Additional analyses were enabled by the use of data from a complementary test-retest sample (n=337).

Results

The internal consistency of the PSS was good (Cronbach's alpha, α=.87) and its test-retest reliability moderate (ICC=.66). The scale correlated in the expected direction with related constructs (r=.50-.56 in the community sample). An exploratory factor analysis found its internal structure to reflect two aspects of parental stress: Lack of Parental Rewards and Role Satisfaction (factor 1, α=.90) and Parental Stressors and Distress (factor 2, α=.85). The treatment-seeking parents of children with disabilities reported higher parental stress than community reference parents (p<.001; Cohen's d=1.17). Moreover, we found that parents with high ADHD symptom severity reported higher parental stress than parents with low ADHD symptom severity (p<.001; d=0.39).

Conclusion

In summary, we found evidence in support of the reliability and validity of the PSS, which overall was judged to be useful as a measure of parental stress in a Swedish context. In addition, our results underline the importance of considering parental stress and related needs in assessments and intervention planning involving families of children with NDCs.

Psychological Treatments for Hyperactivity and Impulsivity in Children with ADHD: A Narrative Review

Treatment of the ADHD types (hyperactive-impulsive, inattentive, and combined) in children has rarely been studied separately, although their prognostic courses differ widely. In addition, data show that improvements in hyperactivity/impulsivity are hard to achieve. Thus, we focused on treatments tailored to hyperactivity/impulsivity. We examined meta-analyses and systematic reviews within the inter- and intra-individual treatments and found that psychoeducation and training for parents, school-based interventions, reinforcement strategies, and neurofeedback consistently showed small to moderate effect sizes in reducing hyperactivity/impulsivity in children. Conversely, emotional self-regulation, social skills, and cognitive trainings showed unsatisfactory results. In summary, we found that the quality of usual care can be surpassed when the designated interventions are purposefully combined into a multimodal treatment program.

Estimating the Risk of Attention Deficit Hyperactivity Disorder (ADHD) in Parents of Children with ADHD and the Association with Their Children's Disease Severity and Adherence to Medication

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is characterised by inattentiveness, hyperactivity, and impulsivity. Up to half of the affected children have a parent with ADHD. In this study, the risk of ADHD among parents of ADHD children was estimated. The associations between parental ADHD and child ADHD severity and medication adherence were determined.

METHODOLOGY

Parents of children and adolescents diagnosed with ADHD attending the University Kebangsaan Malaysia Medical Centre (UKMMC) were recruited between June to August 2022 and the administered Conners' Adult ADHD Rating Scale (CAARS) self-report short form, Vanderbilt ADHD Parent Rating Scale (performance section), and Medication Adherence Report Scale (MARS).

RESULTS

Forty-five children with ADHD were recruited and 15 out of 45 (33%) parents were detected to have ADHD. ADHD severity was worse in children with ADHD parents for total severity (mean of 34.67 vs. 29.13, p = 0.047) and difficult behaviours at home (mean of 7.87 vs. 6.27, p = 0.036). The children's academic performance and behavioural challenges at home and school were positively correlated with the parental ADHD scores for 'inattention' and 'problems with self-care' subscales.

CONCLUSIONS

A total of 33% of ADHD children had parents with ADHD. ADHD children with ADHD parents were more likely to have behavioural problems at home and more severe ADHD. However, no statistical significance was noted with medication adherence.

censusADHD Study: An Australian-wide medication-based recruitment study for Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

Attention-deficit/hyperactivity disorder affects over 5% of children and is characterised by a persistent pattern of problems with focussing or maintaining attention and/or hyperactivity-impulsivity. The censusADHD Study is a richly phenotyped nationwide cohort of Australian children with attention-deficit/hyperactivity disorder. The overarching aims of the study are to examine attention-deficit/hyperactivity disorder medication utilisation patterns and treatment response, the impact of children's attention and behavioural problems on caregivers, and costs related to attention-deficit/hyperactivity disorder.

METHODS

Families of potential attention-deficit/hyperactivity disorder cases aged between 6 and 11 years were identified using Pharmaceutical Benefits Scheme prescription records for attention-deficit/hyperactivity disorder medications held by Services Australia and sent a study information letter. Data were collected from 1574 primary caregivers via online survey in 2015, including the behavioural profile of the child, the child's medication use and experiences with side effects and the impact of the child's behaviour on the caregiver. Approximately 81% of caregivers also consented to record linkage of the child's Pharmaceutical Benefits Scheme and Medicare Benefits Schedule claims to directly assess prescription dispensing history and health service usage to estimate costs to the family and Medicare health system.

RESULTS

Boys were diagnosed with attention-deficit/hyperactivity disorder earlier (p = 0.021), more likely to present as the combined and predominantly hyperactive subtypes (p = 0.001) and at higher risk of experiencing a school suspension (p < 0.001) or expulsion (p = 0.043). Overall, children presenting as the combined subtype had higher rates of psychiatric comorbidities (p < 0.001). Finally, prescription costs for each family and the Pharmaceutical Benefits Scheme significantly increased in the year following attention-deficit/hyperactivity disorder diagnosis (p < 0.001).

CONCLUSION

Research examining the psychosocial and financial impact of attention-deficit/hyperactivity disorder on Australian children and their families is needed. Our findings demonstrate the importance of examining both gender and attention-deficit/hyperactivity disorder subtype presentation in future studies.

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.

Child attachment and ADHD: a systematic review

Attention Deficit/Hyperactivity Disorder (ADHD) is a frequent neurodevelopmental disorder in children. ADHD has a multifactorial origin, combining genetic and environmental factors. Several studies suggested an influence of early parent-child relationships on the symptomatic expression of ADHD. In this review, we examine the studies that have investigated the links between attachment and ADHD in children. We searched for studies published between January 2000 and November 2019 on PsychInfo, PubMed, and Scopus. Selected studies included a theoretically based measure of attachment and an explicit measure of ADHD symptoms or an ADHD diagnosis. Studies that included children from adoption, institutionalization, or mistreatment were not included. We found only 26 studies meeting the inclusion criteria. Almost all these studies indicated a link between the attachment type and the presence of attentional difficulties and hyperactivity. However, associations were better explained, in several studies, by confounding factors such as comorbidities, cognitive difficulties, or contextual factors. The method used to assess attachment and parental mental health also had an impact. An increasing number of studies show a link between the type of attachment and the presence of attentional difficulties and hyperactivity in children. However, the nature of this link remains unclear. Implications for future research are discussed.

Is Parents' ADHD Symptomatology Associated With the Clinical Feasibility or Effectiveness of a Psychoeducational Program Targeting Their Children's ADHD?

OBJECTIVE

To examine if the clinical feasibility and effectiveness of a psychoeducational program targeting children's ADHD differ between parents with varying ADHD symptom severities.

METHOD

An open trial analyzed data from 549 parents of children with ADHD aged 3 to 17 years, who participated in psychoeducation at an outpatient habilitation/disability clinic. In all analyses, parents were stratified into three symptom severity groups (low/middle/high) based on scores on an ADHD screening scale.

RESULTS

Parental ADHD symptom severity was not associated with results on any outcome, although the odds of having incomplete data were higher in parents reporting higher symptom severity. Across the entire sample, we observed high program completion rates, positive acceptability ratings and large increases in parental knowledge.

CONCLUSIONS

Psychoeducation may be beneficial regardless of the participating parent's ADHD symptomatology. Further research is needed to examine whether these results are generalizable to parents diagnosed with ADHD, an underrepresented group in our study.

Prenatal risk factors and genetic causes of ADHD in children

BACKGROUND

Attention deficit/hyperactivity disorder (ADHD) is a common disease among children; it affected 5-7% of the population in 2015. ADHD is a multifactorial disease, and its etiology is still not clearly understood.

DATA SOURCES

This narrative review has been done by searching the PubMed and Embase databases using attention deficit/hyperactivity disorder, ADHD, risk factors; genetics; pediatrics; psychiatrics as keywords.

RESULTS

ADHD is considered to be a hereditary disorder in which genes play the fundamental role in the pathogenesis; however, findings from genetic-environmental studies support the hypothesis that genetic factors can exert effects on an individual's condition by determining his/her responses to environmental exposures, especially those during the prenatal stage.

CONCLUSION

ADHD is considered as a hereditary disorder in which genes and prenatal risk factors play fundamental roles in the pathogenesis.

Impact of Parental Impulsivity on Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder: Do Mothers' Attitudes Predict Symptom Severity in Children?

ABSTRACT

Attention deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder that occurs early in school-aged children, and it is highly comorbid with oppositional defiant disorder (ODD). Parents of children with ADHD frequently show mental problems related to impulsivity. The aim of this study was to examine the relationship between impulsivity of the mothers and the symptom patterns and severity of children. A total of 85 children between the ages of 6 and 12 and their mothers participated. Conners' Parent and Teacher Scales, Structured Clinical Interview for DSM-IV Personality Disorders, and ıowa gambling task were applied. We found a positive correlation between the impulsivity of the mothers and the total symptom severity of ADHD and ODD in children. During the treatment process of ADHD, the evaluation of impulsivity in mothers of children with ODD comorbidity and treatment of impulsivity in the mother would be beneficial. In future studies, examining the effects after treatment of impulsivity may contribute to the literature.

Sex differences in parent-offspring recurrence of attention-deficit/hyperactivity disorder

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a highly heritable neurodevelopmental disorder sharing genetic risk factors with other common psychiatric disorders. However, intergenerational recurrence patterns of ADHD from parents to sons and daughters are not known. We aimed to examine the risk of ADHD in offspring of parents with ADHD and parents with other psychiatric disorders by parental and offspring sex, using parents without the specific disorders as comparison.

METHODS

In a generation study linking data from several population-based registries, all Norwegians born 1967-2011 (n = 2,486,088; Medical Birth Registry of Norway) and their parents were followed to 2015. To estimate intergenerational recurrence risk, we calculated prevalence differences (PD) and the relative risk (RR) of ADHD in offspring by parental ADHD, bipolar disorder (BD), schizophrenia spectrum disorder (SCZ), major depression (MDD), all by parental and offspring sex.

RESULTS

The absolute prevalence of ADHD in offspring of parents with ADHD was very high, especially in sons of two affected parents (41.5% and 25.1% in sons and daughters, respectively), and far higher than in offspring of parents with BD, SCZ or MDD. Intergenerational recurrence risks were higher for maternal than paternal ADHD (RR_maternal 8.4, 95% confidence interval (CI) 8.2-8.6 vs. RR_paternal 6.2, 6.0-6.4) and this was also true on the absolute scale (PD_maternal 21.1% (20.5-21.7) vs. PD_paternal 14.8% (14.3-15.4)). RRs were higher in daughters, while PDs higher in sons. Parental SCZ, BD and MDD were associated with an approximately doubled risk of offspring ADHD compared to parents without the respective disorders, and estimates did not differ significantly between daughters and sons.

CONCLUSIONS

The intergenerational recurrence risks of ADHD were high and higher from mothers with ADHD than fathers with ADHD. Other parental psychiatric disorders also conferred increased risk of offspring ADHD, but far lower, indicating a sex- and diagnosis-specific intergenerational recurrence risk in parents with ADHD.

Prevalence of mental illness among parents of children receiving treatment within child and adolescent mental health services (CAMHS): a scoping review

People affected by mental illness often come from families with patterns of mental illness that span across generations. Hence, child and adolescent mental health services (CAMHS) likely provide treatment to many children with parents who also experience mental illness. The aim of this scoping review was to: (1) identify the prevalence of mental illness among parents of children in CAMHS; (2) identify and appraise the methodologies that have been implemented to assess the prevalence of parental mental illness in CAMHS; (3) identify additional circumstances associated with families where both parent and child experience mental illness; and (4) present recommendations that have been made for CAMHS practice based on these findings. English language, peer-reviewed studies (2010-2018) that had investigated the mental health of parents in CAMHS were included in the review. Literature searching yielded 18 studies which were found to have utilised diverse methodologies to assess parental mental health. Overall, reported prevalence of parental mental illness ranged from 16 to 79%; however, a single study that was deemed to be comprehensive reported prevalence rates of 36% for mothers and 33% for fathers. Across studies, parent and child mental illness was found to be associated with additional adversities impacting family functioning and wellbeing. For children who receive treatment for mental illness, having a parent who also experiences mental illness is a frequent family circumstance that has implications for their prospects for recovery. Accordingly, the mental health of parents should be an important consideration within the mental health care CAMHS provide to children.

Sexual dysfunction in patients with adult attention deficit hyperactivity disorder: A pilot study

Attention deficit hyperactivity disorder (ADHD) symptomatology, comorbid diseases, and pharmacological treatment with antidepressants can have a negative impact on sexual function, which in turn increases the likelihood of sexual dysfunction in people with ADHD. The objective of this pilot study was to differentiate and delineate possible sexual dysfunction in adults with ADHD. Adult ADHD patients (n = 32, cisgender / heterosexual) and healthy controls (n = 32, cisgender / heterosexual) filled out the DÄS-Zuf questionnaire with 59 items (Krieger, 2013). This questionnaire is divided into the scales “general contentment with life,” “anxiety/depression,” “sexual dysfunction” and “sexual satisfaction.” Patients with ADHD had significantly higher scores on single items measuring various aspects of sexual dysfunction as well as higher scores on the “anxiety/depression” scale and lower scores on the “general contentment with life” scale. Following repeated measures analyses of covariance in which the scale “anxiety/depression” was controlled as covariate, none of the previously differences for single items between ADHD patients and controls remained significant. ADHD patients with methylphenidate showed stronger physical sexual arousal compared to those without methylphenidate. The results of this pilot study suggest several explanations for sexual dysfunction among adults with ADHD and offer tentative routes for practical treatment approaches.

Difference in Psychic Distress Lived by Parents With ADHD Children and Parents With Healthy Children: Focus on Gender Differences

Objective: ADHD has a complex and negative influence on the family system. The aim of this study was to analyze the perception of emotional distress in a group of parents of children with ADHD. Method: A sample was recruited from the public health system ADHD Unit at Sant Joan de Déu Hospital (Barcelona). The parents of 60 children with newly diagnosed ADHD and the parents of 60 healthy children were included. Results: Higher levels of distress in families with children with ADHD were seen. The distress is present in both parents, with a higher prevalence in the mothers group. A positive correlation was found between ADHD symptoms in the children and the distress reported by parents. A three times higher rate of separations and divorce among parents of children with ADHD was seen. Conclusion: ADHD in children and adolescents increases the emotional distress reported by parents, mainly related to the severity of symptoms present in the children.

Parental ADHD Symptoms and Inhibitory Control in Relation to Parenting Among Mothers of Children With and Without ADHD

Objective: The study examined how the interplay between maternal ADHD symptoms and maternal inhibitory control and child ADHD is related to parenting behaviors. Method: The sample included 141 mothers and their 8- to 12-year-old children, 61 children with ADHD and 80 without. Parenting was measured using self-reports (i.e., overreactive and lax parenting) and observation (i.e., negative and supportive parenting). Maternal inhibitory control was measured using a neurocognitive task. Hierarchical multiple regressions were conducted to predict parenting, controlling for child sex, conduct behaviors, and parenting distress. Results: Interactions between maternal ADHD symptoms and maternal inhibitory control suggested that hyperactive-impulsive symptoms were linked to parenting negativity only when inhibitory control was low, and maternal inattention symptoms were related to lax parenting only when maternal inhibitory control was high or when children did not have ADHD. Conclusion: Results indicate the importance of maternal regulation processes in the mechanisms linking maternal ADHD with parenting.

ADHD Symptoms, Academic and Social Difficulties in Parents of Children with ADHD

Objective: To evaluate the prevalence of ADHD in a group of parents of children with ADHD compared with the general population. To compare academic level, unemployment aid rate and marital separations/divorce of this parents sample. Methodology: The experimental group was formed by the parents of 60 children with ADHD. The control group was formed by the parents of 60 healthy children. To assess the retrospective and current ADHD symptomatology among the parents of the sample the Wender Utah Rating Scale (WURS) and the Attention Deficit Hyperactivity Disorder-rating scale (ADHD.rs) were used. Also, the Hollingshead Four-Factor Index of Socioeconomic status (SES-Child) was used. Results: 20.33% of the mothers in the case group met criteria for a retrospective diagnosis of ADHD, while none of the control group mothers met criteria (p < .01). Regarding fathers, there was a retrospective ADHD diagnosis in 25% of the case group compared to 10% in the control group (p < .01). In terms of the current symptoms, 25.42% of the mothers and 21.43% of fathers in the case group met diagnostic criteria for probable ADHD compared to 1.67% in the control group (p < .01 in both genders). Parents in the case group had a lower academic level (p < .01), received more unemployment aid (p = .02) and reported a higher rate of marital separation or divorce (p = .02). Conclusions: Parents of children with ADHD have a higher incidence of retrospective and current ADHD diagnosis and they also present worse socioeconomic factors.

Parental Stress and Parental Self-Efficacy as Mediators of the Association Between Children's ADHD and Marital Satisfaction

Parents of children with ADHD often experience low marital satisfaction, since the child's increased susceptibility to maladjustment can affect family dynamics as a whole.

OBJECTIVES

To explore this association by examining parental stress and parental self-efficacy as two possible mediators.

METHOD

Totally, 182 Israeli parents of children in the first to ninth grades (63 parents of children with ADHD and 119 without) completed parental self-efficacy, marital satisfaction, and parental stress questionnaires.

RESULTS

As expected, parents of children with ADHD reported higher parental stress, and lower self-efficacy and marital satisfaction than non-ADHD parents. The association between ADHD parents and marital satisfaction was fully explained by parental stress and self-efficacy, suggesting that personal characteristics and situation appraisal are tapped when facing strain and hardship.

CONCLUSION

These findings provide a window of hope for an otherwise deterministic view of the ADHD-marital dissolution relationship and propose individual and familial interventions that may minimize these damaging effects.

Maternal ADHD symptoms, child ADHD symptoms and broader child outcomes

OBJECTIVE

This study investigated the associations between maternal symptoms of attention deficit hyperactivity disorder (ADHD) and child functional outcomes in a community-based sample of children with and without ADHD.

DESIGN AND SETTING

In this cohort study, children with ADHD and healthy controls were recruited through schools in Melbourne, Australia, using a combined screening (Conners 3 ADHD Index) and case confirmation (Diagnostic Interview Schedule for Children Version IV) procedure.

PATIENTS

117 children with ADHD and 149 control children were included in the analyses.

MAIN OUTCOME MEASURES

Maternal ADHD symptoms (Conners Adult ADHD Rating Scale) and child outcomes (ADHD severity, quality of life (QoL), academic competence, social-emotional functioning) were measured at a mean child age of 8.9 years.

RESULTS

Mothers of children with ADHD had clinically elevated ADHD symptoms compared with mothers of control children (adjusted analysis: 18.0% vs 2.0%, P<0.001). Elevated maternal ADHD symptoms were associated with greater child ADHD symptom severity and lower QoL by maternal report for children with (severity P=0.01; QoL P=0.003) and without (severity P=0.003; QoL P=0.003) ADHD. Elevated maternal ADHD symptoms were additionally associated with increased parent-rated emotional problems, peer problems and total impairment scores in children without ADHD (all P<0.01).

CONCLUSIONS

Maternal ADHD symptoms are associated with increased ADHD symptom severity and reduced QoL by maternal report in offspring with or without ADHD, and have broader negative associations with emotional and social functioning in children without ADHD. In the evaluation of the referred children, maternal ADHD symptoms should be considered and referral made to adult services where indicated.

Children's Early Disruptive Behavior Predicts Later Coercive Behavior and Binge Drinking by Mothers

PURPOSE

We examined the prospective influence of early child problematic behavior on later coercive interactions and binge drinking by mothers.

DESIGN AND METHODS

Canadian participants are from the Quebec Longitudinal Study of Child Development, born between spring 1997 and 1998, which allowed a longitudinal birth cohort design. At the 41months, 628 parents reported on children's oppositional, aggressive, turbulent, and inattentive/hyperactive behavior. Mothers then reported on their own coercive and binge drinking behavior at the 60month follow-up.

RESULTS

We estimated a series of ordinary least-squares regressions to examine the relationship between early child behavior problems and later parental coercion and binge drinking, above and beyond many key pre-existing/concurrent confounding factors including prior parenting stress and binge alcohol use. Oppositional, aggressive, and turbulent child behaviors at 41months predicted harsh, negative parenting at 60months. Early inattentive/hyperactive child behavior also forecasted later binge alcohol use by mothers within the same time frame.

CONCLUSION

Negative preschool behavior predicted harsh, negative maternal behavior kindergarten entry. Early inattentive/hyperactive behavior also forecasted later binge alcohol use by mothers. Coercive parenting and alcohol use are clinically signs of adult distress. Such parents might use alcohol excessively because of its perceived stress-dampening effects and mental evasion from their life difficulties and frustration experiences.

PRACTICE IMPLICATIONS

Problematic preschool behavior can lead to less effective child-rearing and unhealthy parental behavior. Such at-risk mothers would benefit from professional caring practices. Practitioners can inspire change, especially using interaction interventions which encourage positive parent-child relations that, in turn, diminish parental distress.

ADHD and Depression Symptoms in Parent Couples Predict Response to Child ADHD and ODD Behavior

Parents of children with attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) often have elevated ADHD and depressive symptoms, both of which increase the risk of ineffective parenting and interparental discord. However, little is known about whether child ADHD/ODD behavior and parent ADHD or depressive symptoms uniquely or synergistically predict the quality of parenting and interparental communication during triadic (mother-father-child) interactions. Ninety parent couples, including 51 who have children diagnosed with ADHD, were randomly assigned to interact with a 9-12 year-old confederate child (84 % male) exhibiting either ADHD/ODD-like behavior or typical behavior. Parents reported their own ADHD and depressive symptoms, and parents and observers rated the quality of parenting and interparental communication during the interaction. Actor-partner interdependence modeling indicated that child ADHD/ODD behavior predicted less positive and more negative parenting and communication, independent of adult ADHD and depressive symptoms. Parent couples including two parents with elevated ADHD communicated more positively while managing children exhibiting ADHD/ODD behavior than couples managing children behaving typically or couples with only one parent with elevated ADHD symptoms. Couples including one parent with, and one parent without, elevated ADHD or depressive symptoms parented less positively and more negatively, and communicated more negatively, when managing children exhibiting ADHD/ODD behavior than when managing children behaving typically. Taken together, depending on the similarity of ADHD and depressive symptom levels in parent couples, adults managing children exhibiting ADHD/ODD behavior may parent or communicate positively or negatively. Findings highlight the need to consider the psychopathology of both parents when treating children with ADHD in two-parent homes.

Mediators and Moderators of the Relation between Parental ADHD Symptomatology and the Early Development of Child ADHD and ODD Symptoms

The present study examined mediators and moderators of the relation between parental ADHD symptomatology and the development of child attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms across the preschool years. Participants included 258 (138 boys) 3-year-old children (M = 44.13 months, SD = 3.39) with and without behavior problems and their parents who took part in a 3-year longitudinal study. Maternal ADHD symptoms predicted later ADHD symptoms in children, controlling for early child symptomatology. Both family history of ADHD and paternal comorbid psychopathology predicted later child ADHD and ODD symptoms, but they did not account for the association between maternal and child ADHD symptoms. Although paternal ADHD symptoms were associated with age 3 child ADHD symptoms, they did not significantly predict later child ADHD symptoms controlling for early symptomatology. Family adversity moderated the relation between maternal ADHD and child ADHD symptoms, such that the relation between maternal and child ADHD symptoms was stronger for families with less adversity. Maternal overreactive parenting mediated the relation between maternal ADHD symptoms and later child ADHD and ODD symptoms. Our findings suggest that targeting paternal comorbid psychopathology and maternal parenting holds promise for attenuating the effects of parental ADHD on children's ADHD.

The Role of Parent Psychopathology in Emotion Socialization

This study examined the relation between parent psychopathology symptoms and emotion socialization practices in a sample of mothers and fathers of preschool-aged children with behavior problems (N = 109, M age = 44.60 months, 50 % male). Each parent completed a self-report rating scale of their psychopathology symptoms and audio-recorded naturalistic interactions with their children, which were coded for reactions to child negative affect. Results supported a spillover hypothesis for mothers. Specifically, mothers who reported greater overall psychopathology symptoms, anxiety symptoms, substance use, and borderline and Cluster A personality symptoms were more likely to exhibit non-supportive reactions. Additionally, mothers who reported greater anxiety and Cluster A personality symptoms were more likely to not respond to child negative affect. Compensatory and crossover hypotheses were also supported. Partners of mothers who reported high levels of anxiety were more likely to use supportive reactions to child negative affect. In contrast, partners of mothers who reported high levels of borderline and Cluster A personality symptoms and overall psychopathology symptoms were more likely to show non-supportive reactions. With the exception of borderline personality symptoms, fathers' psychopathology was unrelated to parental responses to child negative affect. Results highlight the importance of maternal psychopathology in parental emotion socialization practices.

Self-Rated ADHD Symptoms Among Biological Mothers or Fathers of Children with Confirmed ADHD in a French Population

Parents of children with ADHD are more likely to present the disorder, which can affect quality of life and parenting strategies. Few studies have examined parental ADHD to date, none in France. Prevalence of self-rated ADHD symptoms in adulthood and childhood was estimated among 60 biological mothers or fathers of children with confirmed ADHD in France. Cutoffs were total score ≥46 on the Wender Utah Rating Scale and ≥4 on the Adult ADHD Self-Report Scale Screener. Results indicated possible child and adult ADHD in 12.5% of mothers and 10.0% of fathers. As these percentages exceed reported prevalence rates for the French population, a greater effort must be made to diagnose the disorder in parents.

Occurrence of ADHD in parents of ADHD children in a clinical sample

BACKGROUND

Despite the fact that there is a large amount of research on childhood attention deficit hyperactivity disorder (ADHD) treatment and an increasing amount of research on adult ADHD, little is known about the prevalence and influence of parental ADHD. Therefore, this study examined the frequency of parental ADHD in a clinical sample of German children suffering from ADHD. We also tried to find different levels of symptom severity for prognostic relevance. Furthermore, the association between subtypes of ADHD in children and their parents was investigated.

METHOD

In this study, parents of 79 ADHD children were screened for ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition and International Classification of Diseases, 10th edition. The Wender Utah Rating Scale and the ADHS-Self-Report were given to 75 mothers and 49 fathers for retrospective and current symptoms. Frequency of ADHD symptoms and severity groups was calculated and relationship between parental and children's ADHD was tested.

RESULTS

ADHD occurrence for mothers of children with ADHD was 41.3%, for fathers 51.0%. About 16.0% of the mothers had a mixed type, 9.3% had a hyperactive-impulsive subtype, and 16.0% had an inattentive subtype. Of the fathers, 18.4% had a mixed type, 10.2% had a hyperactive-impulsive subtype, and 22.4% had an inattentive subtype; 61% of the mothers and 46.9% of the fathers had low symptom severity. Medium symptom severity was reported by 37.7% mothers and 46.9% fathers, while 1.3% of the mothers and 6.2% of the fathers showed severe symptoms. No significant correlation between parental and child diagnoses was observed.

CONCLUSION

As nearly half of the parents suffered from ADHD, these results are a matter of concern in families with ADHD children. Besides parent-child interactions, parental ADHD symptoms might influence parental education style and also effects parent training as well as the child's therapy outcome. In the future, parents should be screened for ADHD symptoms if they or their child receive treatment and to adjust processes and design of treatment to the symptoms.

Neurological soft signs in children with attention deficit hyperactivity disorder: Their relationship to executive function and parental neurological soft signs

The correlations between neurological soft signs (NSS) in children with attention deficit hyperactivity disorder (ADHD) and their executive function, symptoms of inattention, and hyperactivity-impulsivity and the NSS of their parents remain unclear. This study aimed to examine: (1) the prevalence of NSS in children with ADHD and their parents; (2) the correlation between the NSS of children with ADHD and the NSS of their parents; and (3) the correlation between the NSS of children with ADHD and their executive function and symptoms. NSS were assessed with the Cambridge Neurological Inventory (CNI) in 57 children with ADHD (and 80 parents) and 60 healthy children (and 75 parents). Executive function was measured with the Behavioral Rating Inventory of Executive Function (BRIEF). Children with ADHD and their parents had significantly higher NSS than normal children and their parents, respectively, and the NSS of children with ADHD were correlated more strongly with the NSS of their fathers than their mothers. No correlation was found between NSS and BRIEF executive function, but Disinhibition in children with ADHD was significantly correlated with hyperactivity-impulsivity symptoms. Paternal and maternal NSS provided different predictions for child NSS. It may be that NSS are more likely to be genetically transmitted by fathers.

Child ADHD and ODD behavior interacts with parent ADHD symptoms to worsen parenting and interparental communication

Attention-deficit hyperactivity disorder (ADHD) in children and adults increases risk of parenting difficulties and interparental discord. However, little is known about whether disruptive child behavior and adult ADHD operate additively or synergistically to predict parenting and interparental relationship quality. As part of a larger study, 90 parent couples were randomly assigned to interact with a 9-12 year-old confederate child exhibiting either ADHD/ODD-like behavior or typical behavior. Before these interactions, parents reported their own ADHD symptoms. Afterwards, parents reported on their partner's parenting and interparental communication behavior. Observers coded the parenting and communication behavior of both partners during the tasks. Child ADHD/ODD-like behavior was found to predict less positive and more negative parenting and communication reported by partners and observers beyond adult ADHD symptoms and other covariates. Elevated adult ADHD symptoms only uniquely increased risk of observer-coded negative parenting. Child and adult ADHD behavior interacted synergistically to predict partner-reported negative parenting and interparental communication, such that parents reporting greater ADHD symptoms-especially inattentiveness-were rated by their partners as parenting and communicating more negatively when managing child ADHD/ODD-like behavior than parents with fewer ADHD symptoms or those managing typical child behavior. Child and adult ADHD behavior did not interact to predict observer-coded parenting or interparental communication, and patterns did not differ for mothers or fathers. Our results underscore the potential risk of parents with elevated ADHD symptoms parenting and communicating negatively, at least as perceived by their partners, during interactions with children exhibiting ADHD/ODD behavior.

The Role of Parental ADHD in Sustaining the Effects of a Family-School Intervention for ADHD

This study investigated the extent to which parental Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms impact child and parent outcomes following a multimodal family-school intervention, the Family School Success (FSS) program, when compared to an active-control condition (CARE). Participants were 139 children with ADHD (67% male; 91% non-Hispanic; 77% Caucasian; Grades 2-6) and their primary caretaker (91% female; ages 26-59) who participated in a randomized clinical trial evaluating the efficacy of FSS. Associations were examined between parent-reported ADHD symptoms at baseline and intervention outcomes reported by parents and teachers after treatment and at a 3-month follow-up, including child homework and classroom impairments, child ADHD and oppositional defiant disorder symptoms, parenting behaviors, and parent-teacher relationship quality. Across both treatment conditions, parental ADHD was not associated with parent or child outcomes at postassessment. However, differences emerged between the two treatment groups at follow-up for parents with ADHD, particularly when an empirically supported symptom cutoff was used to identify parents at risk for having ADHD. In FSS, but not in CARE, parental ADHD was associated with declines in treatment gains in the quality of the parent-teacher relationship and the child's homework performance. Parents at risk for ADHD had difficulty maintaining treatment effects for themselves and their child in the FSS intervention but not in CARE. The supportive and educational components central to the CARE intervention may be helpful in promoting the sustainability of psychosocial interventions for children with ADHD who have parents with elevated ADHD symptoms.

Parent-of-origin effects in ADHD: distinct influences of paternal and maternal ADHD on neuropsychological functioning in offspring

OBJECTIVE

The authors examined parent-of-origin effects in transmission of ADHD and neuropsychological functioning. Proof of these effects can identify more etiologically homogeneous ADHD subgroups and facilitate genetic studies.

METHOD

The authors included 238 ADHD and 147 control families. ADHD in children was assessed using parent and teacher ratings, while parents completed self-reports. Children were assessed with neuropsychological paradigms measuring IQ, motor, timing, and executive functions.

RESULTS

Paternal and maternal ADHD were equally positively related to ADHD in offspring. Paternal ADHD was related to poorer time reproduction in offspring and to lower verbal and total IQ in daughters. Maternal ADHD was related to poorer inhibition and motor control in offspring. No mediating effects of neuropsychological functions were found between parent and offspring ADHD symptoms.

CONCLUSION

Neuropsychological functions may be more sensitive to parent-of-origin effects than ADHD symptoms and possibly useful in detecting the transmission of different gene-brain network pathways depending on parental sex.

Early fathering as a predictor of later psychosocial functioning among preschool children with behavior problems

The present study examined the role of early fathering in subsequent trajectories of social emotional and academic functioning of preschool children with behavior problems. Participants were 128 preschool-aged children (73 boys, 55 girls) with behavior problems whose biological fathers took part in a longitudinal study. Children were 3 years of age at the beginning of the study and were assessed annually for 3 years. Early paternal depressive symptoms predicted many aspects of children's outcome 3 years later, including externalizing and internalizing problems, social skills deficits, and lower cognitive and academic functioning, and predicted changes in children's externalizing, internalizing, and social problems across the preschool years. Paternal socioeconomic status (SES) also consistently predicted children's later functioning across these domains. Furthermore, self-reported paternal attention-deficit hyperactivity disorder (ADHD) symptoms and laxness, as well as observed frequent commands were associated with later externalizing problems in children. Paternal depressive symptoms and laxness mediated the relation between paternal ADHD symptoms and child functioning. Results suggest that aspects of early father functioning play an important role in the psychosocial, cognitive, and academic development of preschool-aged children with behavior problems.

Parent attendance and homework adherence predict response to a family-school intervention for children with ADHD

This study examined the relative contribution of two dimensions of parent engagement, attendance and homework adherence, to parent and child treatment response and explored whether early engagement was a stronger predictor of outcomes than later engagement. The sample consisted of parents of participants (n = 92; M age = 9.4 years, SD = 1.27; 67% male, 69% White) in a 12-session evidence-based family-school intervention for children with attention-deficit/hyperactivity disorder. Attendance was assessed using clinician records, and homework adherence was measured by rating permanent products. Outcomes included parent and teacher ratings of family involvement in education, parenting practices, and child functioning. Accounting for the contributions of baseline scores and attendance, homework adherence was a significant predictor of parental self-efficacy, the parent-teacher relationship, parenting through positive involvement, and the child's inattention to homework and homework productivity. Accounting for the contribution of baseline scores and homework adherence, attendance was a significant predictor of one outcome, the child's academic productivity. Early homework adherence appeared to be more predictive of outcomes than later adherence, whereas attendance did not predict outcomes during either half of treatment. These results indicate that, even in the context of evidence-based practice, it is the extent to which parents actively engage with treatment, rather than the number of sessions they attend, that is most important in predicting intervention response. Because attendance is limited as an index of engagement and a predictor of outcomes, increased efforts to develop interventions to promote parent adherence to behavioral interventions for children are warranted.

Are parental ADHD problems associated with a more severe clinical presentation and greater family adversity in children with ADHD?

Although Attention Deficit Hyperactivity Disorder (ADHD) is recognised to be a familial and heritable disorder, little is known about the broader family characteristics of having a parent with ADHD problems. The main aim of this study was to investigate the relationship between parent ADHD problems, child clinical presentation and family functioning in a sample of children with ADHD. The sample consisted of 570 children with ADHD. Child psychopathology was assessed using a semi-structured diagnostic interview. Questionnaires were used to assess ADHD in the parents (childhood and current symptoms), family environment and mother/father-child relationship. Parental ADHD problems were associated with a range of adverse clinical outcomes in children with no difference in effects for mothers with ADHD problems compared to fathers with ADHD problems. Levels of maternal hostility were higher in families where mothers had ADHD problems, but reduced where fathers had ADHD problems. Parental ADHD problems index higher risk for more severe clinical presentation of ADHD in children and higher levels of family conflict (where there are maternal but not paternal ADHD problems). This study highlights that children with more severe behavioural symptoms are more likely to have a parent with persistent ADHD which has important implications when considering treatment and intervention strategies.

What can ADHD without comorbidity teach us about comorbidity?

Neuropsychiatric comorbidity in ADHD is frequent, impairing and poorly understood. In this report, characteristics of comorbid and comorbid-free ADHD subjects are investigated in an attempt to identify differences that could potentially advance our understanding of risk factors. In a clinically-referred ADHD cohort of 449 youths (ages 6-18), age, gender, IQ, SES and ADHD symptoms were compared among ADHD comorbid free subjects and ADHD with internalizing and externalizing disorders. Logistic regression analyses were also carried out to investigate the relationship between comorbidity and parental psychiatric status. Age range was younger in the ADHD without comorbidity and older in ADHD+internalizing disorders. No significant difference in IQ or SES was found among ADHD comorbid and comorbid-free groups. ADHD with internalizing disorder has a significantly greater association with paternal psychiatric conditions. After matching by age, gender, IQ and SES, ADHD with externalizing disorders had significantly higher total ADHD, hyperactivity/impulsivity score and single item score of difficulty awaiting turn than ADHD without comorbidity and ADHD with internalizing disorders. Older age ranges, ADHD symptom severity and parental psychopathology may be risk factors for comorbidity.