Mother-child interactions and noncompliance in hyperactive boys with and without conduct problems

Overview of Attention Deficit Hyperactivity Disorder in Young Children

Attention deficit hyperactivity disorder (ADHD) is a complex disorder, which can be seen as a disorder of life time, developing in preschool years and manifesting symptoms (full and/or partial) throughout the adulthood; therefore, it is not surprising that there are no simple solutions. The aim of this paper is to provide a short and concise review which can be used to inform affected children and adults; family members of affected children and adults, and other medical, paramedical, non-medical, and educational professionals about the disorder. This paper has also tried to look into the process of how ADHD develops; what are the associated problems; and how many other children and adults are affected by such problems all over the world basically to understand ADHD more precisely in order to develop a better medical and or non-medical multimodal intervention plan. If preschool teachers and clinicians are aware of what the research tells us about ADHD, the varying theories of its cause, and which areas need further research, the knowledge will assist them in supporting the families of children with ADHD. By including information in this review about the connection between biological behavior, it is hoped that preschool teachers and clinicians at all levels will feel more confident about explaining to parents of ADHD children, and older ADHD children themselves about the probable causes of ADHD.

Altering the function of commands presented to boys with oppositional and hyperactive behavior

Mentalistic and behavioral analyses of noncompliance among children with hyperactive behavior are contrasted. Then, a behavioral training program for 3 boys with behavior characteristic of attention deficit hyperactivity disorder and oppositional defiant disorder is described. The child-focused training was conducted in conjunction with parent training. In an effort to increase the rate of compliance, the child-training program was designed to alter the function of parent commands by teaching the boys to verbalize rules about parent commands and consequences in the context of observing parent-child role-plays. Training was conducted within a multiple baseline design across children. Direct observation of mother-child interactions, telephone interviews, and standardized rating scales showed that training resulted in clinically significant reductions in noncompliance and improved parenting behavior. A 6-month follow-up revealed stable outcomes.

Reciprocal relationships between parenting behavior and disruptive psychopathology from childhood through adolescence

Theoretical models suggest that child behaviors influence parenting behaviors, and specifically that unpleasant child behaviors coerce parents to discontinue engaging in appropriate discipline. This study examined reciprocal relationships between parenting behaviors (supervision, communication, involvement, timid discipline and harsh punishment) and child disruptive disorder symptoms (ADHD, ODD and CD) in a clinic-referred sample of 177 boys. Annual measures, including structured clinical interviews, were obtained from the beginning of the study (when boys were between the ages of 7 to 12) to age 17. Specific reciprocal influence was observed; only timid discipline predicted worsening behavior, namely ODD symptoms, and ODD symptoms predicted increases in timid discipline. Greater influence from child behaviors to parenting practices was found: ODD also predicted poorer communication and decreased involvement, and CD predicted poorer supervision. ADHD was neither predictive of, nor predicted by, parenting behaviors. The results are specifically supportive of a coercive process between child behaviors and parenting behaviors, and generally suggestive of greater influence of child behaviors on parenting behaviors than of parenting behaviors on child behaviors.

On-line social decision making and antisocial behavior: some essential but neglected issues

The last quarter century has witnessed considerable progress in the scientific study of social information processing (SIP) and aggressive behavior in children. SIP research has shown that social decision making in youth is particularly predictive of antisocial behavior, especially as children enter and progress through adolescence. In furtherance of this research, more sophisticated, elaborate models of on-line social decision making have been developed, by which various domains of evaluative judgment are hypothesized to account for both responsive decision making and behavior, as well as self-initiated, instrumental functioning. However, discussions of these models have neglected a number of key issues. In particular, the roles of nonconscious cognitive factors, learning and development, impulsivity and behavioral disinhibition, emotion, and other internal and external factors (e.g., pharmacological influences and audience effects) have been largely absent from scholarly writings. In response, this article introduces discussion of these factors and reviews their possible roles in on-line social decision making and antisocial behavior in youth.

Association between activity level and situational factors in children with attention deficit/hyperactivity disorder in elementary school

The aim of this study was to determine whether the objective activity level of children with attention deficit/hyperactivity disorder (AD/HD) is associated with situational factors in elementary school. A total of 16 children with combined-type AD/HD (13 boys, 3 girls) and 20 controls matched for age and gender participated in the study. All the participants wore the objective measurement of activity level for 1 week while attending elementary school. The average activity levels were calculated for the morning and afternoon classes. The classes were categorized into four types: (i) in-seat classes, in which the participants were expected to learn quietly while sitting in their own seats; (ii) not-in-seat classes, in which the participants were not expected to sit in their seats; (iii) physical education classes; and (iv) lunch/recess periods. During the afternoon in-seat classes, the children with AD/HD were significantly more active than the controls. However, no significant differences based on the group (children with AD/HD or controls) were observed during the other morning or afternoon classes. These findings indicate that in naturalistic settings where the effects of situational demands involving inhibition and the effect of fatigue overlapped, the children with AD/HD exhibited an activity level that was different from that exhibited by the controls. Differences in the activity levels of children with AD/HD and normal controls were identified using an objective measurement of activity level when two situational factors overlapped.

Psychometric properties of the Alabama parenting questionnaire-preschool revision

The psychometric properties of the Alabama Parenting Questionnaire-Preschool Revision (APQ-PR) were explored in a sample of hyperactive-inattentive preschool children (N = 47) and nonimpaired controls (N = 113). A subset of parents completed the questionnaire on 2 occasions, approximately 1 year apart. Factor analysis revealed a 3-factor solution, accounting for 32.28% of the variance. The resultant Positive Parenting, Negative/Inconsistent Parenting, and Punitive Parenting factors demonstrated good internal consistency and temporal stability. At baseline, parents of hyperactive-inattentive and control children did not differ on any APQ-PR subscale. However, over time parents of controls increased their use of positive parenting techniques, whereas the use of positive parenting practices decreased over time in the hyperactive-inattentive group.

A Family-Centered Approach to Planning and Measuring the Outcome of Interventions for Children with Attention-Deficit/Hyperactivity Disorder

This paper discusses a set of closely related parenting and family factors that should be considered when planning and measuring the outcome of interventions for children with attention-deficit/hyperactivity disorder (ADHD). These include parenting and parent-child relationships, parental cognitions, parental adjustment, marital interactions, general family relationships, and adaptive child functioning within the family. The measurement of each construct is discussed, and comparative, longitudinal, and treatment outcome studies using these measures are reviewed. It is concluded that measures of treatment outcome for children with ADHD could be improved by utilizing multiple informants, developing tools with greater content and contextual validity, relying more on observational methods, and identifying those measures which are of greatest importance to families. Given the multiple pathways via which both psychosocial and pharmacological interventions exert their influence, composite measures combining multi-informant, multimethod constructs may represent more useful measures of treatment outcome than measures of primary ADHD symptoms.

Mother?Son Interactions in Families of Boys With Attention-Deficit/Hyperactivity Disorder With and Without Oppositional Behavior

Parenting responsiveness and over-reactivity were assessed among 25 mothers of 7-9-year-old sons with Attention-Deficit/Hyperactivity Disorder (ADHD) and oppositional behavior (Oppositional Defiant, OD), 24 mothers of sons with ADHD only, and 38 mothers of nonproblem sons. Responsiveness was observed during mother-son play and clean-up interactions and over-reactivity was assessed using self-reports of parenting in discipline situations. Mothers of sons with ADHD/OD were less responsive and more over-reactive than mothers of nonproblem sons, and mothers of sons with ADHD only did not differ from the other groups. Mothers of sons with ADHD/OD reported more hostility than mothers of nonproblem sons, and controlling for maternal hostility eliminated the significant group differences in responsiveness during clean-up and in over-reactivity. Controlling for the child's ADHD subtype did not alter the pattern of results. The implications for addressing responsiveness and over-reactivity as components of parent-mediated behavioral treatments for ADHD are considered.

The link between health-related quality of life and clinical symptoms among children with attention-deficit hyperactivity disorder

Clinical research on attention-deficit hyperactivity disorder (ADHD) has begun to integrate measures of health-related quality of life (HRQL) as part of the overall assessment of treatment outcomes. This study examines the association between HRQL and measures of clinical symptoms of ADHD. Data were gathered from 297 children and adolescents in an 8-week, randomized, double-blind, placebo-controlled, clinical trial of atomoxetine treatment for ADHD. HRQL was assessed with the Child Health Questionnaire 50-item Parent Form. ADHD symptoms were assessed with the ADHD Rating Scale-IV; Parent Version and Clinical Global Impressions-ADHD-Severity. Associations between HRQL and clinical symptoms were assessed with correlations, analyses of variance with post hoc comparisons, and t tests. The Child Health Questionnaire 50-item Parent Form scales assessing psychosocial domains of HRQL were significantly negatively correlated with clinical measures. Improvement in clinical symptoms was associated with corresponding improvement in psychosocial aspects of HRQL. The findings suggest that HRQL instruments can add important information to efficacy measures in clinical trials of ADHD treatment.

The family psychosocial characteristics of children with attention-deficit hyperactivity disorder with or without oppositional or conduct problems in Japan

We investigated whether the correlates of family psychosocial characteristics among Japanese children with attention-deficit hyperactivity disorder (ADHD) differ according to the comorbid condition of oppositional defiant disorder (ODD) or conduct disorder (CD). Three groups of children (12 ADHD, 15 ADHD + ODD/ CD, and 14 control) were compared on family psychosocial variables. Findings indicated that the interpersonal relationships in ADHD + ODD/ CD children's family were more conflictive and less organized than those of the control. Mental health among mothers of ADHD + ODD/CD children was worse than those of ADHD and control children. Childhood ADHD symptoms of parents were the most severe among parents of ADHD + ODD/CD children. These results support the nosological distinction between ADHD comorbid with ODD and CD. The need for specific clinical intervention according to the comorbid condition is stressed.

Issues in the diagnosis of attention-deficit/hyperactivity disorder in children

This paper provides a brief overview of the nature of attention-deficit/hyperactivity disorder (ADHD) in children and the current criteria used in its clinical diagnosis. While the disorder continues to be viewed as one of inattention and/or hyperactive-impulsive behavior, theories of ADHD are beginning to focus more on poor inhibition and deficient executive functioning (self-regulation) as being central to the disorder. Problems have been identified by research pertaining to the clinical diagnostic criteria outlined in the DSM-IV that, at present, remain unresolved. Clinicians should be aware of these problems and the adjustments that need to be made to them when dealing with special populations that were not represented in the field trials used to develop these criteria.

Child disobedience and noncompliance: a review

Child disobedience and noncompliance is a recurring problem frequently brought to the attention of pediatricians and others working with children and their parents. This article reviews empirical studies concerning childhood noncompliance. Definitions of noncompliance (also called disobedience) are presented, and observational studies that have measured noncompliance in the laboratory and at home are reviewed. Studies show considerable variability in the prevalence of noncompliance, but demonstrate that it is a frequent problem for parents. Longitudinal data from the Pittsburgh Youth Study are presented to more closely examine the onset and stability of noncompliance in childhood and adolescence. Evidence suggests that extreme childhood noncompliance is relatively stable over time, peaking slightly during early adolescence and decreasing during late adolescence. Studies indicate that for some children noncompliance predicts aggression and externalizing problems. Antecedents of noncompliance including parental discipline techniques and child characteristics are reviewed. Parent training programs designed to reduce noncompliance are described, and the effectiveness of such programs is examined.

Early parent-child relations and family functioning of preschool boys with pervasive hyperactivity

This study examined the quality of parent-child relationships and family functioning of preschool children with early onset hyperactivity by comparing a community sample of 33 pervasively hyperactive preschool boys with a comparison sample of 34 boys. Mothers and children were assessed at home on a range of interview, parent questionnaire, and observational measures of parenting and family functioning. Results of the study showed that higher rates of reported lax disciplinary practices, less efficient parental coping, lower rates of father-child communication, and less synchronous mother-child interactions were significantly associated with hyperactivity following statistical adjustment for the effects of conduct problems and other confounding factors. The best parenting predictor of hyperactivity was maternal coping. The present findings suggest that the way in which parents interact with their preschool children may make a unique contribution to the development and ongoing behavioral difficulties experienced by children with pervasive hyperactivity. Findings also highlight the importance of considering the role of fathers in the behavioral development of boys with early tendencies to hyperactive and distractible behavior problems.

What did mummy say? Dyadic interactions between young "hard to manage" children and their mothers

Thirty preschoolers rated as "hard to manage" on Goodman's (R. Goodman, 1997) Strengths and Difficulties Questionnaire (SDQ), and a group of matched control children were observed and recorded on audiotape at home, interacting with their mothers (Time 1). At the 18-month follow-up home visits (Time 2), the children and mothers were filmed across 4 observation settings. Mother-child interactions were rated on affect, control, responsiveness and "connectedness" of communication. At Time 1, mothers of the "hard to manage" group used more negative control and engaged in fewer connected conversations than did mothers in the control group. At Time 2, mothers of the "hard to manage" group displayed higher levels of negative control and lower levels of positive control. These results are discussed in terms of the importance of examining connected communication and different observation contexts when examining dyadic mother-child interactions.

Responsiveness in interactions of mothers and sons with ADHD: relations to maternal and child characteristics

We observed mother-child interactions, at baseline, in 136 families of 7-10-year-old boys with attention-deficit/hyperactivity disorder (ADHD) who were part of a large clinical trial, the Multimodal Treatment Study of Children with ADHD. Independent coders rated stylistic aspects of maternal behavior and factor analyses revealed a responsiveness factor that included overall responsiveness and sensitivity to the child, warmth and acceptance, and appropriate control. We examined relations between maternal responsiveness and (a) maternal depressive symptoms and maternal childhood ADHD symptoms, and (b) boys' ADHD and conduct problem symptoms. Controlling for all other variables, maternal responsiveness displayed a unique negative association with mother-reported child conduct problems, but not with child ADHD symptoms, and also was negatively related to maternal depressive symptoms. We discuss the unique association between mother-reported child conduct problems and parenting, and note the utility of studying parenting style in families of children with ADHD. We describe the results within the framework of a transactional model.

A meta-analytic examination of comorbid hyperactive-impulsive-attention problems and conduct problems

The author quantitatively reviewed prevalence rates, defining features, associated features, developmental trajectory, and etiology to examine 3 taxonomic questions about comorbid hyperactive-impulsive-attention problems (HIA) and conduct problems (CP): Do HIA and CP co-occur randomly? Does comorbid HIA-CP differ from HIA-only and CP-only? Do HIA and CP combine synergistically? Results showed that HIA and CP co-occur at a greater than random rate, that comorbid HIA-CP differs from HIA-only and CP-only in multiple ways, and that there is little evidence that HIA and CP combine synergistically. However, sample type, grouping definition, age, gender, and subtype of disruptive behavior often moderated these findings. Overall, the review suggests that HIA-CP is best conceptualized as an additive combination of HIA and CP rather than as a distinct category.

Parent-adolescent conflict in teenagers with ADHD and ODD

Eighty-seven male teens (ages 12-18 years) with ADHD/ODD and their parents were compared to 32 male teens and their parents in a community control (CC) group on mother, father, and teen ratings of parent-teen conflict and communication quality, parental self-reports of psychological adjustment, and direct observations of parent-teen problem-solving interactions during a neutral and conflict discussion. Parents and teens in the ADHD/ODD group rated themselves as having significantly more issues involving parent-teen conflict, more anger during these conflict discussions, and more negative communication generally, and used more aggressive conflict tactics with each other than did parents and teens in the CC group. During a neutral discussion, only the ADHD/ODD teens demonstrated more negative behavior. During the conflict discussion, however, the mothers, fathers, and teens in the ADHD/ODD group displayed more negative behavior, and the mothers and teens showed less positive behavior than did participants in the CC group. Differences in conflicts related to sex of parent were evident on only a few measures. Both mother and father self-rated hostility contributed to the level of mother-teen conflict whereas father self-rated hostility and anxiety contributed to father-teen conflict beyond the contribution made by level of teen ODD and ADHD symptoms. Results replicated past studies of mother-child interactions in ADHD/ODD children, extended these results to teens with these disorders, showed that greater conflict also occurs in father-teen interactions, and found that degree of parental hostility, but not ADHD symptoms, further contributed to levels of parent-teen conflict beyond the contribution made by severity of teen ADHD and ODD symptoms.

Families of children with attention-deficit/hyperactivity disorder: review and recommendations for future research

This review integrates and critically evaluates what is known about family characteristics associated with childhood Attention-Deficit/Hyperactivity Disorder (ADHD). Evidence suggests that the presence of ADHD in children is associated to varying degrees with disturbances in family and marital functioning, disrupted parent-child relationships, specific patterns of parental cognitions about child behavior and reduced parenting self-efficacy, and increased levels of parenting stress and parental psychopathology, particularly when ADHD is comorbid with conduct problems. However, the review reveals that little is known about the developmental mechanisms that underlie these associations, or the pathways through which child and family characteristics transact to exert their influences over time. In addition, the influence of factors such as gender, culture, and ADHD subtype on the association between ADHD and family factors remains largely unknown. We conclude with recommendations regarding the necessity for research that will inform a developmental psychopathology perspective of ADHD.

Externalisierende und internalisierende Störungen in der Kindheit: Untersuchungen zur Entwicklungspsychopathologie

Zusammenfassung. Theoretischer Hintergrund: In taxonomischen Systemen psychischer Auffälligkeiten des Kindesalters werden externalisierende von internalisierenden Störungen abgegrenzt. Fragestellung: Es wurde der Frage nachgegangen, ob diesen Störungsmustern eine spezifische Pathogenese und eine differentielle Ätiologie zugrunde liegen. Methode: Im Rahmen einer prospektiven Längsschnittstudie an 362 Kindern mit unterschiedlichen organischen und psychosozialen Risikobelastungen wurden emotionale und Verhaltensauffälligkeiten vom Säuglings- bis zum Grundschulalter mittels eines standardisierten klinischen Interview diagnostiziert. Merkmale der frühen Mutter-Kind-Interaktion wurden mit Hilfe einer standardisierten Verhaltensbeobachtung im Alter von 3 Monaten erfaßt. Ergebnisse: Externalisierende Störungen manifestierten sich früher, kamen auf jeder Altersstufe häufiger vor, und zeigten eine größere Stabilität als internalisierende Störungen. Frühindikatoren späterer Störungen ließen sich bereits ab dem Kleinkindalter nachweisen. Vor allem externalisierende Störungen standen im Zusammenhang mit frühen psychosozialen Risiken. Vorläufer späterer Störungen fanden sich in spezifischen dysfunktionalen Interaktionsmustern der Mutter-Kind-Interaktion im frühen Säuglingsalter. Schlussfolgerungen: Die Ergebnisse stehen im Einklang mit der Vorstellung entwicklungspsychopathologisch distinkter Störungskategorien.

Central auditory processing ability in children with ADHD with and without learning disabilities

A few studies have shown more central auditory processing deficits in children with attention-deficit/hyperactivity disorder (ADHD) than in nondisabled children. Because these studies failed to screen participants with ADHD for learning disabilities (LD), it is not clear whether these deficits are correlates of ADHD or LD or both. In the present study, the central auditory processing ability of children with ADHD, ADHD with LD, and no disabilities was examined. Results indicated lower central auditory processing ability, and significant correlations between reading and ADHD symptoms and reading and central auditory processing ability in the ADHD with LD group compared with the other two groups. These findings suggest that central auditory processing deficits are more likely to be associated with LD than ADHD.

Outlasting disruption: the process of reinvestment in families with ADHD children

The goal of the research described in this article was to generate a grounded theory of how parents of children with attention deficit hyperactivity disorder (ADHD) coped with this chronic behavioral disorder. Interview data from 15 families with ADHD children (N = 59) were analyzed using the grounded theory method. Data analysis revealed that parents outlasted the disruption of ADHD through three subprocesses of "reinvesting": making sense, recasting biography, and relinquishing the "good ending." Findings suggest that there is a developmental trajectory of how parents adjust to the disorder over time and that there is a need for increased social and mental health services for all members of the family over the course of the disorder.

The overlap of attention deficit hyperactivity disorder with other common mental disorders

OBJECTIVE

The literature on the overlap (co-morbidity) of attention deficit hyperactivity disorder (ADHD) with conduct disorder, specific learning disability, and anxiety disorders was reviewed to examine: (i) the evidence for ADHD being a syndrome distinct from the other conditions; and (ii) the evidence for co-morbid patterns representing meaningful subtypes of ADHD.

METHODOLOGY

Narrative review of the literature.

CONCLUSIONS

Conduct disorder is distinguished from ADHD by prognosis, patterns of association and familial aggregation. Pure' disorders are uncommon, however, and there is little evidence to support a distinct co-morbid subtype. There are few data that reliably distinguish ADHD from specific learning disabilities, but there are weaknesses in research to date. A specific ADHD+learning disabled subtype may exist, but as yet the implications for treatment are not known. Attention deficit hyperactivity disorder is distinguished from anxiety by symptom discrimination, factor analysis, patterns of association, familial aggregation and treatment response. There is evidence for a distinct ADHD+anxiety subtype.

Effects of an educational intervention on mothers of male children with attention deficit hyperactivity disorder

An experimental research study was done to determine whether an educational intervention about attention deficit hyperactivity disorder (ADHD) would improve a mother's knowledge about ADHD and her feelings of competence as a parent. 20 low socioeconomic status mothers who had a male child between the ages of 5 and 11 diagnosed with ADHD and placed on methylphenidate were randomly selected for the study. An experimental group of 10 mothers was given a 5-week educational intervention on ADHD; the remaining 10 mothers served as a control group. Differences between the experimental and non-experimental mothers in knowledge and opinions about ADHD and parental sense of competency were measured. Scores improved in parental satisfaction and parental sense of competency in mothers who participated in the educational intervention. The research findings support the idea that nurses can assist a family in learning and dealing with their child's ADHD, a chronic condition.

Social information processing in mild mentally retarded children

This study examined the social information processing (SIP) skills of mild mentally retarded (MR) children using Dodge's model. Six sets of pictures depicting provocation situations were used to elicit measures of accuracy of interpretation to accidental and hostile cues, attribution of ambiguous cues, and hostile and nonhostile behavior responses to all three types of cues. MR children were compared to nonretarded groups matched for chronological age (CA-matched) and mental age (MA-matched) on these variables. Compared to both nonretarded groups, the MR group was less accurate in interpretation of accidental cues and more hostile in their responses to the ambiguous cues. The latter finding remained even after partialing out externalizing behavior problems. The results are discussed in terms of factors associated with SIP skills, and the assessment and treatment of MR children.

Effects of experimenter and mother presence on the attentional performance and activity of hyperactive boys

The attentional performance, activity, and off-task behavior of hyperactive boys with and without conduct problems and normal boys were compared on a cancellation task under three conditions: when performing the task alone, with mother present, and with experimenter present. Results indicated that both the hyperactive groups achieved poorer attentional scores than normal subjects in the alone and mother present conditions, but improved in the experimenter present condition. The performance of the hyperactive boys with conduct problems was particularly affected by this condition. The activity and off-task behavior scores of both the hyperactive groups were higher than controls in all conditions, although the hyperactive boys with conduct problems decreased in off-task behavior when the experimenter was present. Attention and behavior scores were not significantly correlated. The implications of these findings for assessment of hyperactivity, and the role of noncompliance in the attentional behavior of hyperactive children, are discussed.