Contributing factors in the manifestation of aggression in preschoolers with hyperactivity

Cross-Lagged Analysis of Interplay Between Differential Traits in Sibling Pairs: Validation and Application to Parenting Behavior and ADHD Symptomatology

Understanding the factors that contribute to behavioral traits is a complex task, and partitioning variance into latent genetic and environmental components is a useful beginning, but it should not also be the end. Many constructs are influenced by their contextual milieu, and accounting for background effects (such as gene-environment correlation) is necessary to avoid bias. This study introduces a method for examining the interplay between traits, in a longitudinal design using differential items in sibling pairs. The model is validated via simulation and power analysis, and we conclude with an application to paternal praise and ADHD symptoms in a twin sample. The model can help identify what type of genetic and environmental interplay may contribute to the dynamic relationship between traits using a cross-lagged panel framework. Overall, it presents a way to estimate and explicate the developmental interplay between a set of traits, free from many common sources of bias.

Child impact on family functioning: a multivariate analysis in multiplex families with children and mothers both affected by attention-deficit/hyperactivity disorder (ADHD)

ADHD seriously impacts family functioning, even the more in families with simultaneous parental and child ADHD. The aim of the study was to examine associations between family impact of child ADHD and child, mother and family characteristics in multiplex families with children and mothers both affected by ADHD. One hundred and forty-four mother-child pairs were assessed (children: mean age 9.4 ± 1.7 years, 73.6 % male). Family impact of child ADHD was rated by mothers using the Family Impact Questionnaire (FIQ). Multiple linear regression analyses were performed with child and maternal psychopathology and basic family characteristics such as employment, partnership status and number of children as predictors and FIQ subscores as criteria. Rates of variance explained by family variables were 49 % for negative feelings towards the child, 37 % for impact on partnership, 31 % for impact on social life and 27 % for impact on finances (p < .001, respectively). Pearson correlations with family impact were especially strong for child externalizing symptoms, maternal ADHD and co-morbid symptoms of the mother. The strongest independent predictor was oppositional defiant child behaviour. In ADHD multiplex families, mothers' perception of the impact of an ADHD child on its family can be explained to a substantial degree by child psychopathology, maternal psychopathology and basic family characteristics. Although a cross-sectional design does not allow for causal interpretations, the findings of this study offer important targets for the treatment of ADHD in a family context pointing to the need for assessing and treating parental mental health and co-morbid symptoms besides ADHD core symptoms.

Fathering and mothering of preschool boys with hyperactivity

This study examined links between paternal and maternal parenting factors and preschool hyperactivity in a community sample. Forty-one hyperactive and 38 comparison boys (aged 47—62 months) and their fathers and mothers were assessed on a range of interview, parent questionnaire, and observational measures of parenting and child behavior. Results showed that less observed maternal warmth, fathers’ self-reported overreactive and less authoritative parenting practices, and less satisfaction with parenting (fathers and mothers) were all significantly related to child hyperactivity, following statistical adjustment for the effects of child conduct problems and maternal age. Lower rates of observed paternal and maternal sensitivity were not significantly associated with preschool hyperactivity, after controlling for child conduct problems and maternal age. Findings highlight the importance of considering the role of both fathers’ and mothers’ parenting in the development of boys with early onset hyperactive and attentional behavior difficulties.

The joint development of physical and indirect aggression: Predictors of continuity and change during childhood

A person-oriented approach was adopted to examine joint developmental trajectories of physical and indirect aggression. Participants were 1183 children aged 2 years at the initial assessment and followed over 6 years. Most children followed either low or declining trajectories of physical aggression (PA), but 14.6% followed high stable trajectories. Approximately two-thirds of participants followed low indirect aggression (IA) trajectories (67.9%), and one-third (32.1%) followed high rising trajectories. The results combining both PA and IA group memberships indicate that most children (62.1%) exhibit desisting levels of PA and low levels of IA. A significant proportion followed a trajectory of moderately desisting PA and rising IA (14.2%), and 13.5% followed high level trajectories of both forms of aggression. Virtually no children were high on one type and low on the other. Multinomial regressions analyses were used to predict joint trajectory group membership from selected child and family variables measured at 2 years. Young motherhood and low income predicted membership in the high PA-high IA trajectory, but only hostile parenting remained significant after family processes variables were entered in the model. Being a boy, young motherhood, and hostile parenting were generally associated with higher levels of PA. Girls were more likely than boys to follow a trajectory of desisting PA and rising IA. The results suggest that some children, mostly girls, reduce their use of PA and tend to increase their use of IA, and that highly physically aggressive children also tend to be highly indirectly aggressive. Early family risk characteristics and hostile parenting interfere with the socialization of aggression.

Examining Subtypes of Behavior Problems among 3-Year-Old Children, Part II: Investigating Differences in Parent Psychopathology, Couple Conflict, and Other Family Stressors

This study examined family stressors among 3-year-old children who were classified as hyperactive (HYP), hyperactive and oppositional defiant (HYP/OD), and non-problem based on mothers' reports of behavior. Children with HYP/OD were found to experience higher levels of family stressors than non-problem children on almost every family stressor variable. Compared to children with HYP, families of children with HYP/OD also tended to report more Axis II maternal psychopathology, Axis I paternal psychopathology, and high intensity couple conflict tactics. However, the HYP and HYP/OD group did not significantly differ on maternal Axis I psychopathology, paternal Axis II psychopathology, parental marital status, negative life events, frequency of couple conflict, or use of lower intensity couple conflict tactics. Parents of children with HYP and HYP/OD reported more negative life events, more maternal adult ADHD symptoms, and more maternal avoidance and verbal aggression during marital conflict than parents of non-problem children. Implications for treatment and etiology are discussed.

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.

Examining Subtypes of Behavior Problems Among 3-Year-Old Children, Part I: Investigating Validity of Subtypes and Biological Risk-Factors

This study examined 3-year-old children who were classified as hyperactive (HYP), oppositional-defiant (OD), hyperactive and oppositional defiant (HYP/OD), and non-problem based on mothers' reports of behavior. Using fathers,' teachers,' and observers' ratings of children's behavior, concurrent validity was excellent for the HYP/OD group, moderate for the HYP group, and poor for the OD group. As predicted, both the HYP/OD and HYP groups reported more prenatal/perinatal birth complications and a greater family history of hyperactivity than did non-problem children. Furthermore, the HYP/OD group showed a greater family history of conduct disorder and oppositional defiant disorder (ODD) symptoms than did non-problem children; however, the HYP group also showed a greater family history of ODD than did non-problem children. Results suggest that as early as age 3, these behavior subtypes appear to be linked to biologically-based risk-factors in ways that are consistent with theories of the development of ADHD.

Examining Subtypes of Behavior Problems Among 3-Year-Old Children, Part III: Investigating Differences in Parenting Practices and Parenting Stress

This study examined parenting of mothers and fathers of 3-year-old children who were classified as hyperactive (HYP), hyperactive and oppositional defiant (HYP/OD), and non-problem based on mothers' reports of behavior. Parents of children with HYP/OD were less warm, showed more negative affect, and more laxness than parents of non-problem children; however, contrary to prediction, they did not differ significantly from parents of children in the HYP group. Compared to mothers of non-problem children, mothers of children in the HYP/OD group reported significantly more parenting stress across all domains, whereas mothers of children in the HYP group only reported elevated levels of stress associated with having a difficult child. Theoretical and treatment implications are discussed.

Psychosoziale Situation bei Familien von Kindern mit ADHS

Erste Studien belegen, dass die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) nicht nur mit einer ungünstigen Entwicklung des erkrankten Kindes oder Jugendlichen verbunden ist, sondern auch Auswirkungen auf die psychosoziale Situation aller Familienmitglieder hat. Die Pilotstudie ging der Frage nach, ob sich die Lebensqualität der Eltern von Kindern mit ADHS von der Lebensqualität der Eltern gesunder Kinder unterscheidet. Außerdem war von Interesse, inwieweit das Ausmaß des hyperkinetischen Verhaltens des erkrankten Kindes mit der psychosozialen Anpassung der gesunden Geschwister und der Lebensqualität der Eltern verbunden ist. Insgesamt 48 Elternteile beurteilten das Ausmaß hyperkinetischen Verhaltens der gesunden Geschwister sowie ihre eigene Lebensqualität. Die Eltern mit einem an ADHS erkrankten Kind schätzten zusätzlich das Ausmaß hyperkinetischen Verhaltens des erkrankten Kindes sowie die psychischen Auffälligkeiten der gesunden Geschwister ein. Die Ergebnisse legen nahe, dass das psychische Wohlbefinden der Eltern mit einem an ADHS erkrankten Kind gegenüber Eltern gesunder Kinder beeinträchtigt ist. Des Weiteren hing das Ausmaß des hyperkinetischen Verhaltens des erkrankten Kindes positiv mit den internalisierenden und Aufmerksamkeitsproblemen der gesunden Geschwister zusammen. Das Ausmaß des hyperkinetischen Verhaltens des erkrankten Kindes war außerdem mit einem beeinträchtigten psychischen Wohlbefinden des Elternteils assoziiert. Die Befunde unterstreichen die Forderung nach familienorientierten Interventionsmaßnahmen in der Behandlung von ADHS, die die psychosoziale Anpassung aller Familienmitglieder berücksichtigen.

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.

Preschoolers at risk for attention-deficit hyperactivity disorder and oppositional defiant disorder: family, parenting, and behavioral correlates

This community study assigned 129 4-year-olds to groups at risk for attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), both ADHD and ODD, or no problems. Mothers of children at risk for ODD reported more family dysfunction, felt less competent as parents, suggested fewer solutions to child behavior problems, demonstrated a less assertive approach to child management, and reported more child internalizing problems than did mothers of children not elevated on ODD symptoms. Mothers of children at risk for ADHD reported higher personal depression scores than did those of the non-ADHD subgroup. Children at risk for ADHD evidenced the most difficulties in school where teachers reported more social behavior, classroom management, and internalizing problems relative to other children not at risk for ADHD. When solving child management problems, mothers of children in all groups suggested twice as many controlling/negative management strategies as positive/preventive strategies. In addition, faced with oppositional and conduct problems, mothers of children in all groups increased controlling/negative suggestions and decreased positive/preventive suggestions. Mothers of girls at risk for ADHD, ODD, and ADHD/ODD gave more rewards per positive behavior than did mothers of boys.

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.

The association between psychopathology in fathers versus mothers and children's internalizing and externalizing behavior problems: a meta-analysis

In light of the selective focus on maternal (vs. paternal) psychopathology as a risk factor for child development, this meta-analysis examines the relative strength of the association between psychopathology in mothers versus fathers and the presence of internalizing and externalizing disorders in children. Associations were stronger between maternal than paternal psychopathology and the presence of internalizing (but not externalizing) problems in children, with all average effect sizes being small in magnitude. Relations were moderated by variables that highlight theoretically relevant differences between psychopathology in mothers versus fathers (e.g., age of children studied, type of parental psychopathology) and by variables related to methodological differences across studies (e.g., method of assessing psychopathology in parents and children, type of sample recruited, familial composition).

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.

Psychosocial adjustment and peer competence of siblings of children with Attention-Deficit/Hyperactivity Disorder

Preliminary data examined the relationships between mothers, their sons with Attention-Deficit/Hyperactivity Disorder (ADHD), and younger siblings. We hypothesized that the conflict between the mother and the son with ADHD would also occur in the relationship between the child with ADHD and the younger sibling. Significant associations were found among ADHD behaviors, family conflict variables, conflict in the relationship between mother and child with ADHD, conflict in the relationship between mother and younger sibling, and conflict in the relationship between the child with ADHD and the younger sibling. Further, significant associations were found between behavior symptoms associated with ADHD and more problematic family relationships. Of particular interest was the finding of an unexpected inverse association between siblings' peer competence and mother-ADHD conflict; specifically, that conflict occurring at home from ADHD accounted for a greater percentage of the variance in peer competence as rated by teachers. Recommendations are made for future research with larger samples, alternative designs, older siblings, and fathers.

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.

Validity of the parenting scale for parents of children with attention-deficit/hyperactivity disorder

The present study examined the validity of the parenting scale for parents of elementary school-aged children with attention-deficit/hyperactivity disorder (ADHD). Parents from 109 families with children who had been diagnosed with ADHD (106 mothers and 93 fathers) and from 70 families with non-problem children (69 mothers and 59 fathers) completed the parenting scale and reported on their children's behavior problems. Factor analyses revealed two interpretable factors for both mothers and fathers, corresponding to the overreactivity and laxness factors identified in previous studies of the parenting scale. Overreactivity and laxness scores were significantly higher for mothers and fathers of ADHD children than of non-ADHD children; this effect appeared to be accounted for by comorbid aggression and conduct problems among ADHD children. Results support the validity of the parenting scale for use with parents of ADHD children.

Assessing violence risk among youth

Despite recent declines in the reported rate of juvenile violence, there appears to be increasing public and professional concern about violent behavior among children and adolescents. Media accounts of school shootings and juvenile homicides have prompted a need to develop approaches for systematically assessing violence risk. This article describes the task of assessing general violence risk among youth, and argues that a somewhat different approach is required to assess cases where an identified or identifiable young person may pose a risk to a specifically identified or identifiable target (also referred to as "targeted violence"). Key risk factors for violent behavior among children and adolescents are identified, fundamental principles for conducting an assessment of violence potential in clinical and juvenile justice contexts are outlined, and an approach to assessment when an identified person engages in some communication or behavior of concern that brings him or her to official attention is briefly described.

Multimethod psychoeducational intervention for preschool children with disruptive behavior: two-year post-treatment follow-up

This paper describes the 2-year post-treatment follow-up of preschool children identified as having high levels of disruptive behavior at kindergarten entry. They were assigned to four treatment conditions: A no-treatment group, parent-training only, treatment classroom only, and the combination of parent training with the treatment classroom. Interventions lasted the entire kindergarten academic year. Initial post-treatment results reported previously indicated no effects for the parent-training program but some efficacy for the classroom intervention program. For this report, the disruptive behavior (DB) children were subdivided into those who did (n = 74) and did not (n = 77) receive the treatment classroom. Two-year post-treatment follow-up results indicated no differences between the classroom treated and untreated DB groups. These groups also failed to differ in the percentage of children using available treatments across the follow-up period. The DB children in both groups had significantly more symptoms of ADHD and ODD than a community control group (N = 47) at follow-up. They also received higher ratings of externalizing problems on the parent Child Behavior Checklist, more severe ratings of behavior problems at home, and ratings of more pervasive behavior problems at school, and had poorer academic skills. Results suggested that early intervention classrooms for DB children may not produce enduring effects once treatment is withdrawn, and that better approaches are needed for identifying those DB children at greatest risk for later maladjustment.

Attention-deficit/hyperactivity disorder in preschoolers. Does it exist and should we treat it?

The diagnosis of ADHD in preschool-aged children is difficult. High activity level, impulsivity, and short attention span--to a degree--are age-appropriate characteristics of normal preschool-aged children. However, excessive levels of these characteristics impede successful socialization, optimal learning, and positive parent-child interaction. Environmental stressors, inadequate parenting skills, and other diagnoses such as oppositional defiant, posttraumatic stress, or adjustment disorders can mimic ADHD. Although labeling may be necessary to obtain services, the emphasis should be placed on symptom resolution, given the uncertainties of diagnostic accuracy in this age group. Deferring a specific diagnosis of ADHD until confounding issues are clarified should be considered. The evaluation of serious behavior problems in young children must include a comprehensive consideration of environmental, health, cognitive, educational, and behavioral interactions. Both assessment and intervention should focus on the interactions between the child and his or her environment to determine how they facilitate or hinder adaptive integration as both the child and surroundings change and evolve. Treatment invariably necessitates involvement of a child and family psychotherapist or counselor to address behavior management strategies as well as family dynamics, parental psychopathology, or life stress. Parents must understand that counseling is an essential component of treatment and that they must be active participants. Psychopharmacologic intervention may be appropriate in some instances, although conventional wisdom suggests caution in young children, given the limited information about safety and efficacy of many agents, especially in children younger than 3 years old. Stimulants appear to be safe in older preschool-aged children. Children started on medication should be monitored closely for both positive and negative effects. A double-blinded, placebo-controlled trial of medication is warranted in equivocal situations.

Psychiatric and psychological morbidity as a function of adaptive disability in preschool children with aggressive and hyperactive-impulsive-inattentive behavior

Children with high levels of aggressive-hyperactive-impulsive-inattentive behavior (AHII; n = 154) were subdivided into those with (n = 38) and without (n = 116) adaptive disability (+AD/-AD) defined as a discrepancy between expected versus actual adaptive functioning. They were compared to each other and a control group of 47 normal children. Both AHII groups were more likely to have attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder than control children; more symptoms of general psychopathology; greater social skills deficits; more parental problems; and lower levels of academic achievement skills. Compared to AHII - AD children, AHII + AD children had (1) more conduct disorder; (2) greater inattention and aggression symptoms; (3) more social problems, less academic competence, and poorer self-control at school; (4) more severe and pervasive behavior problems across multiple home and school settings; and (5) parents with poorer child management practices. Thus, adaptive disability has utility as a marker for more severe and pervasive impairments in AHII children.

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.