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Augustin M, Mall V, Licata-Dandel M. ADHD Symptoms in Middle Childhood: The Role of Child Attachment and Maternal Emotional Availability in an Inpatient Clinical Sample. Eur J Investig Health Psychol Educ 2024; 14:1572-1584. [PMID: 38921070 PMCID: PMC11202776 DOI: 10.3390/ejihpe14060104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/27/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Child ADHD symptoms are highly prevalent in middle childhood, alongside impairment in social functioning. The parent-child relationship has been shown to play an important role; however, studies investigating specific facets of the parent-child relationship in ADHD symptomatology in middle childhood have been neglected. We assumed that higher ADHD symptoms were associated with both (1) lower maternal emotional availability (EA) and (2) lower child attachment security. Moreover, (3) we aimed to explore which specific EA dimensions were associated with ADHD symptoms. METHODS In a socio-pediatric clinic in Germany, 71 inpatient mother-child dyads (child age: M = 7.70, SD = 1.06; n = 54 boys) were assessed. Clinical data about child ADHD symptoms (Child Behavior Checklist 6-18 subscale "attention deficit/hyperactivity problems"), maternal EA (free play), and child attachment representation (Attachment Story Completion Task, GEV-B) were analyzed cross-sectionally. RESULTS Controlling for child oppositional behavior and sex, child ADHD symptoms were associated with overall maternal EA, and more specifically non-hostility, but not with child attachment representation. CONCLUSIONS Our results imply that the role of parent-child interaction quality should be considered in the treatment of ADHD. Bidirectional effects cannot be ruled out.
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Affiliation(s)
- Michaela Augustin
- Social Pediatrics, TUM School of Medicine and Health, Technical University of Munich, Heiglhofstr. 69, 81377 Munich, Germany; (V.M.); (M.L.-D.)
| | - Volker Mall
- Social Pediatrics, TUM School of Medicine and Health, Technical University of Munich, Heiglhofstr. 69, 81377 Munich, Germany; (V.M.); (M.L.-D.)
- German Center for Child and Adolescent Health (DZKJ), Partner Site Munich, Heiglhofstr. 69, 81377 Munich, Germany
- kbo-Kinderzentrum Munich, Heiglhofstr. 65, 81377 Munich, Germany
| | - Maria Licata-Dandel
- Social Pediatrics, TUM School of Medicine and Health, Technical University of Munich, Heiglhofstr. 69, 81377 Munich, Germany; (V.M.); (M.L.-D.)
- kbo-Kinderzentrum Munich, Heiglhofstr. 65, 81377 Munich, Germany
- Department of Psychology, Charlotte Fresenius University, Infanteriestr. 11a, 80797 Munich, Germany
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2
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Claussen AH, Holbrook JR, Hutchins HJ, Robinson LR, Bloomfield J, Meng L, Bitsko RH, O'Masta B, Cerles A, Maher B, Rush M, Kaminski JW. All in the Family? A Systematic Review and Meta-analysis of Parenting and Family Environment as Risk Factors for Attention-Deficit/Hyperactivity Disorder (ADHD) in Children. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:249-271. [PMID: 35438451 PMCID: PMC9017071 DOI: 10.1007/s11121-022-01358-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/15/2022]
Abstract
Parenting and family environment have significant impact on child development, including development of executive function, attention, and self-regulation, and may affect the risk of developmental disorders including attention-deficit/hyperactivity disorder (ADHD). This paper examines the relationship of parenting and family environment factors with ADHD. A systematic review of the literature was conducted in 2014 and identified 52 longitudinal studies. A follow-up search in 2021 identified 7 additional articles, for a total of 59 studies that examined the association of parenting factors with ADHD outcomes: ADHD overall (diagnosis or symptoms), ADHD diagnosis specifically, or presence of the specific ADHD symptoms of inattention and hyperactivity/impulsivity. For parenting factors that were present in three or more studies, pooled effect sizes were calculated separately for dichotomous or continuous ADHD outcomes, accounting for each study's conditional variance. Factors with sufficient information for analysis were parenting interaction quality (sensitivity/warmth, intrusiveness/reactivity, and negativity/harsh discipline), maltreatment (general maltreatment and physical abuse), parental relationship status (divorce, single parenting), parental incarceration, and child media exposure. All factors showed a significant direct association with ADHD outcomes, except sensitivity/warmth which had an inverse association. Parenting factors predicted diagnosis and overall symptoms as well as inattentive and hyperactive symptoms when measured, but multiple factors showed significant heterogeneity across studies. These findings support the possibility that parenting and family environment influences ADHD symptoms and may affect a child's likelihood of being diagnosed with ADHD. Prevention strategies that support parents, such as decreasing parenting challenges and increasing access to parent training in behavior management, may improve children's long-term developmental health.
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Affiliation(s)
- Angelika H Claussen
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Joseph R Holbrook
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Helena J Hutchins
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention Research Participation Programs, Atlanta, GA, USA
| | - Lara R Robinson
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeanette Bloomfield
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lu Meng
- Covid-19 Response Health System and Worker Safety Task Force, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca H Bitsko
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Brion Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Jennifer W Kaminski
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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May T, Williams K. Mother and child mental health over time in children with Autism and/or ADHD in the Longitudinal Study of Australian Children. Dev Psychopathol 2024; 36:170-180. [PMID: 36345845 DOI: 10.1017/s0954579422001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study utilised a longitudinal population-based study to explore mother and child mental health trajectories over time from child age 0 to 14 years, between children with ASD, ADHD, or ASD + ADHD. It explored whether a bidirectional relationship between mother psychological distress and child emotional and behavioural problems (EBPs) existed. The birth cohort from the Longitudinal Study of Australian Children was used. Child EBPs were assessed using the Strengths and Difficulties Questionnaire; and mother emotional distress using the Kessler K6. Generalised estimating equations and structured equation modelling was used to understand changes over time, differences between groups and bidirectional relationships. As expected, children with ASD, ADHD or ASD + ADHD had higher EBPs than children without, and their mothers had higher levels of psychological distress across most time points, but with differing trajectories. Mothers of children with ASD (with or without ADHD) showed increasing psychological distress over time, while mothers of children with ADHD had reducing distress. The bidirectional relationship between mother and child mental health found in children without diagnoses was only partially present in children with ASD/ADHD. Findings highlight support needs and discuss implications for transactional models of parent/child emotional problems in children with neurodevelopmental disorders.
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Affiliation(s)
- Tamara May
- School of Psychology, Charles Sturt University, Bathurst, NSW, Australia
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
- Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Katrina Williams
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
- Murdoch Childrens Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Melbourne University, Parkville, VIC, Australia
- Developmental Paediatrics, Monash Children's Hospital, Clayton, VIC, Australia
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4
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Schwartz A, Galera C, Kerbage H, Montagni I, Tzourio C. Adverse Childhood Experiences and ADHD Symptoms Among French College Students. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:1109-1117. [PMID: 38045835 PMCID: PMC10689313 DOI: 10.1007/s40653-023-00543-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 12/05/2023]
Abstract
To examine the relationship between adverse childhood experiences (ACEs) and Attention-deficit Hyperactivity Disorder (ADHD) among college students. We investigated the association between ACEs and ADHD symptoms among French college students enrolled in the i-Share cohort using multivariate logistic regression models. The sample comprised of 1062 participants with a mean age of 20.3 (SD = 2.3) of which 30.6% had no ACEs exposure, 29.6% had 1 ACE, 19.2% had 2 ACEs, and 20.6% had ≥ 3 ACEs. After controlling for potential confounders, every increase in ACE exposure heightened the risk of ADHD symptoms with the respective adjusted Odds Ratios and 95% confidence intervals: 1 ACE: 2.1 (0.7-6.3) / 2 ACEs: 4.5 (2.6-12.8)/ ≥ 3 ACEs: 5.2 (1.8-14.8). Estimates for ADHD symptoms were higher with sexual abuse, emotional and physical neglect, and bullying. Findings suggest that ACEs heighten the risk for developing ADHD symptoms among college students and bear important implications for prevention and clinical practice.
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Affiliation(s)
- Ashlyn Schwartz
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, CHU Bordeaux, 146 Rue Léo Saignat, F-33000 Bordeaux, France
- Department of Public Health, University of Tennessee-Knoxville, Knoxville, USA
| | - Cédric Galera
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, CHU Bordeaux, 146 Rue Léo Saignat, F-33000 Bordeaux, France
- Charles Perrens Hospital, Bordeaux, France
| | - Hala Kerbage
- Department of Child and Adolescent Psychiatry, Saint Eloi University Hospital, 34090 Montpellier, France
- Center for Epidemiology and Population Health (CESP) INSERM U1018, Developmental Psychiatry Team, Paris-Saclay University, Villejuif Cedex 94807, Paris, France
| | - Ilaria Montagni
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, CHU Bordeaux, 146 Rue Léo Saignat, F-33000 Bordeaux, France
| | - Christophe Tzourio
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, CHU Bordeaux, 146 Rue Léo Saignat, F-33000 Bordeaux, France
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Aquino GA, Perry NB, Aviles AI, Hazen N, Jacobvitz D. Developmental antecedents of attention-deficit/hyperactivity disorder symptoms in middle childhood: The role of father-child interactions and children's emotional underregulation. Dev Psychopathol 2023:1-9. [PMID: 37092656 DOI: 10.1017/s0954579423000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
The present study examined the influence of fathers' parenting quality during infancy on children's emotion regulation during toddlerhood and, subsequently, attention-deficit/hyperactivity disorder (ADHD) symptoms in middle childhood. Fathers and their 8-month-old infants (N = 124) were followed over time to obtain home observations of parenting quality at 8 and 24 months, laboratory observations of children's emotion regulation at 24 months, and teacher reports of children's ADHD symptoms at 7 years. A path analysis revealed that fathers' emotional disengagement in infancy and minimizing responses to children's distress in toddlerhood forecast children's development of ADHD symptoms in middle childhood. Further, a significant indirect effect was found such that fathers' parenting at 8 and 24 months predicted subsequent development of ADHD symptoms at age 7 through toddlers' difficulty regulating emotion. Implications of this study for early intervention and directions for future research are discussed.
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Affiliation(s)
- Gabriela A Aquino
- Department of Human Development & Family Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Nicole B Perry
- Department of Human Development & Family Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Ashleigh I Aviles
- Department of Human Development & Family Sciences, The University of Texas at Austin, Austin, TX, USA
- Institute of Human Development and Social Change, NYU Steinhardt School of Culture, Education, and Human Development, New York, NY, USA
| | - Nancy Hazen
- Department of Human Development & Family Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Deborah Jacobvitz
- Department of Human Development & Family Sciences, The University of Texas at Austin, Austin, TX, USA
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Karalunas SL, Antovich D, Miller N, Nigg JT. Prospective prediction of developing internalizing disorders in ADHD. J Child Psychol Psychiatry 2022; 64:768-778. [PMID: 36464786 DOI: 10.1111/jcpp.13731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clinical course in attention-deficit/hyperactivity disorder (ADHD) is highly heterogeneous with respect to both core symptoms and associated features and impairment. Onset of comorbid anxiety and mood disorders during later childhood and adolescence is one critical aspect of divergent outcomes in ADHD. Characterizing heterogeneity in onset of anxiety and depression and identifying prospective predictors of these divergent courses may facilitate early identification of the children most at risk. METHODS A total of 849 children recruited for a case-control study of ADHD development, aged 7-12 years at baseline, completed up to six annual waves of comprehensive clinical and cognitive assessment, including multi-informant behavior ratings, parent semi-structured clinical diagnostic interviews, and measures of executive function (EF). Latent class growth curve analyses (LCGAs) characterized patterns of anxiety and depression over time. Trajectories were predicted from baseline parent-rated child temperament, lab-measured child EF, coded parental criticism, and child-reported self-blame for inter-parental conflict. RESULTS Latent class growth curve analyses separately identified three trajectories for anxiety and three for depression: persistently high, persistently low, and increasing. Temperamental fear/sadness and irritability were independent predictors that interacted with family characteristics. Baseline parental criticism and self-blame for inter-parental conflict exerted influence but only in the context of low temperamental risk. Better baseline child working memory was associated with delayed onset of depression. CONCLUSIONS The interaction of baseline child emotional features with EF or family environment predicted divergent courses of both anxiety and depression from middle-childhood to mid-adolescence. Results suggest modifiable risk factors associated with prospective differences in long-term outcomes.
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Affiliation(s)
| | - Dylan Antovich
- Psychiatry and Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, USA
| | - Natalie Miller
- Psychiatry and Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, USA
| | - Joel T Nigg
- Psychiatry and Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, USA
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7
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Darling Rasmussen P, Elmose M, Lien G, Musaeus A, Kirubakaran R, Ribeiro JP, Storebø OJ. Remarkable high frequency of insecure attachment in children with ADHD persists in a three-year follow-up. Nord J Psychiatry 2022; 76:323-329. [PMID: 34632915 DOI: 10.1080/08039488.2021.1969428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Studies have pointed to a complicated and mutual relationship between attention deficit hyperactivity disorder (ADHD) and attachment. In an observational follow-up study conducted in 2015 60 children from 7 years to 12 years recently diagnosed with ADHD were included and assessed according to attachment representation showing 85% of the children to be insecurely attached. AIM The aim of this study was to investigate the stability of this remarkably high frequency of insecure attachment in the same cohort of children. METHODS Children previously assessed using the child attachment interview (CAI) when diagnosed with ADHD were contacted three years later for a follow-up CAI assessment. RESULTS At follow-up, 31 children participated in the CAI-interviews. Since their diagnosis with ADHD, the children had received treatment as usual. The CAI-interviews showed a continued high rate of insecure attachment with 90% of the children classifying as insecurely attached compared to expected 38% in the normal population. Of these, the majority of children (77%) were classified as dismissing. CONCLUSION Our findings suggest that targeting ADHD-symptoms with our current treatment strategies does not in itself improve attachment security. Attachment security may in turn be a factor of importance when evaluating general functioning and prognosis.
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Affiliation(s)
| | - Mette Elmose
- Department of Psychology, University of Southern Denmark, Odense M, Denmark
| | - Gunnhild Lien
- Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Amalie Musaeus
- Department of Child and Adolescent Psychiatry, Holbaek, Denmark
| | | | | | - Ole Jakob Storebø
- Psychiatric Research Unit, Slagelse, Denmark.,Department of Psychology, University of Southern Denmark, Odense M, Denmark.,Child and Adolescent Psychiatric Department, Roskilde, Denmark
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Condo JS, Chan ESM, Kofler MJ. Examining the effects of ADHD symptoms and parental involvement on children's academic achievement. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 122:104156. [PMID: 35007980 PMCID: PMC8944944 DOI: 10.1016/j.ridd.2021.104156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/23/2021] [Accepted: 12/20/2021] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Our understanding of the role of parental involvement in academic outcomes for children with ADHD is limited, with mixed evidence suggesting a positive association between parental involvement and academic achievement for pediatric ADHD but limited evidence regarding how this varies based on ADHD symptom severity, ADHD symptom domains, or co-occurring ODD symptoms. In this context, the present study aimed to examine the effects of parental involvement, ADHD symptoms, and comorbid ODD on children's overall, reading, and math achievement. METHOD A well-characterized clinically-evaluated sample of 162 children recruited through a university-based children's learning/behavioral health clinic and community resources (ages 8-13; 50 girls; 69% Caucasian/Non-Hispanic) were administered standardized academic achievement tests, with parents and teachers completing measures of parental involvement and ADHD symptoms, respectively. RESULTS Inattention, but not hyperactivity-impulsivity, was associated with lower academic achievement in all tested models (β= -.16 to -.22, all p < .03). Surprisingly, parental involvement had significant negative associations with math and overall academic achievement (β= -.13 to -.26, both p< .05) and did not moderate the relations between ADHD symptoms and academic achievement in any tested model. Comorbid ODD symptoms did not significantly predict academic achievement or interact with parental involvement in any tested model. These findings were robust to control for child IQ, age, sex, SES, anxiety, and depression. CONCLUSION Parental involvement may not serve as a protective factor against academic underachievement for children with clinically elevated ADHD symptoms, and may predict lower rather than higher academic achievement for clinically evaluated children in general.
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Affiliation(s)
- Jaida S Condo
- Florida State University, Department of Psychology, United States
| | | | - Michael J Kofler
- Florida State University, Department of Psychology, United States.
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Meinzer MC, Felton JW, Oddo LE, Rubin KH, Chronis-Tuscano A. Do ADHD Symptoms and Relationship Quality With Mothers and Best Friends Across High School Predict Depressive Symptoms for Adolescents? J Atten Disord 2021; 25:1699-1711. [PMID: 32506994 DOI: 10.1177/1087054720923088] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Symptoms of ADHD place adolescents at increased risk for depression. The transition from middle to high school may magnify depression risk. This study examined whether changes in adolescents' negative relationship quality with their mothers and best friends from eighth to 12th grades mediated the longitudinal relations between ADHD and depressive symptoms. Method: 368 adolescents (48.5% male) were initially recruited. Results: Boys with elevated ADHD symptoms in the eighth grade reported steeper increases in negative relationship quality with their mothers relative to girls, and that this trajectory mediated the relation between ADHD and depressive symptoms. ADHD symptoms were also associated with increases in negative friendship quality across high school for boys; however, this did not mediate the relation between ADHD and depressive symptoms for either sex. Conclusion: Growth in mother-adolescent negative relationship quality may be one mechanism that explains the development of depressive symptoms in adolescent boys with elevated ADHD symptoms.
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Structural Equation Modeling (SEM): Childhood Aggression and Irritable ADHD Associated with Parental Psychiatric Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910068. [PMID: 34639370 PMCID: PMC8507797 DOI: 10.3390/ijerph181910068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022]
Abstract
Background: Children with attention deficit hyperactivity disorder (ADHD) co-occurring with Oppositional Defiant Disorder (ODD) further present aggressive behavior and may have a depressive parent. A child with co-occurring ADHD and ODD has differentially higher levels of behavioral and emotional difficulties. Little is known about how the irritable subtype of ADHD in children mediates the development of parental symptomatology. This study aims to elucidate the direct or indirect influence of childhood disruptive ADHD with aggressive behavior on their parental symptom using Structural Equation Modeling (SEM). Methods: A total of 231 ADHD children and their parents completed the Swanson, Nolan, and Pelham Version IV questionnaire for symptoms of ADHD, Oppositional Defiant Disorder (ODD) scale for irritable symptoms, Child Behavior Check List (CBCL) for aggression, and Symptom Checklist (SCL) for parental symptom. Results: The three-factor confirmatory factor analysis (CFA) model found symptoms of inattention, hyperactivity/impulsivity, irritable ODD, and aggression were inter-related. Mediational analyses demonstrated ODD mediates symptoms directly predicting the risk of increasing ADHD severity. Disruptive child symptoms (ADHD + ODD + aggression) may increase the risk of depression-related symptoms in the parent. When the child’s aggression increases by one standard deviation (SD), parental psychiatric symptoms increase by 0.235 SD (p < 0.001). Conclusions: By this SEM pathway analysis, there is the correlation between the disruptive, more aggressive subtype of ADHD in children/adolescents and the existence of psychopathological symptomatology of their parents. ADHD + ODD + aggression in children should be classified as an irritable subtype of ADHD, warranting early diagnosis and intensive treatment.
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Riglin L, Leppert B, Dardani C, Thapar AK, Rice F, O'Donovan MC, Davey Smith G, Stergiakouli E, Tilling K, Thapar A. ADHD and depression: investigating a causal explanation. Psychol Med 2021; 51:1890-1897. [PMID: 32249726 PMCID: PMC8381237 DOI: 10.1017/s0033291720000665] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/10/2020] [Accepted: 03/04/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is associated with later depression and there is considerable genetic overlap between them. This study investigated if ADHD and ADHD genetic liability are causally related to depression using two different methods. METHODS First, a longitudinal population cohort design was used to assess the association between childhood ADHD (age 7 years) and recurrent depression in young-adulthood (age 18-25 years) in N = 8310 individuals in the Avon Longitudinal Study of Parents and Children (ALSPAC). Second, two-sample Mendelian randomization (MR) analyses examined relationships between genetic liability for ADHD and depression utilising published Genome-Wide Association Study (GWAS) data. RESULTS Childhood ADHD was associated with an increased risk of recurrent depression in young-adulthood (OR 1.35, 95% CI 1.05-1.73). MR analyses suggested a causal effect of ADHD genetic liability on major depression (OR 1.21, 95% CI 1.12-1.31). MR findings using a broader definition of depression differed, showing a weak influence on depression (OR 1.07, 95% CI 1.02-1.13). CONCLUSIONS Our findings suggest that ADHD increases the risk of depression later in life and are consistent with a causal effect of ADHD genetic liability on subsequent major depression. However, findings were different for more broadly defined depression.
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Affiliation(s)
- Lucy Riglin
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Beate Leppert
- Population Health Sciences, Bristol Medical School and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Christina Dardani
- Population Health Sciences, Bristol Medical School and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Centre of Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ajay K. Thapar
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Frances Rice
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Michael C. O'Donovan
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - George Davey Smith
- Population Health Sciences, Bristol Medical School and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Evie Stergiakouli
- Population Health Sciences, Bristol Medical School and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Kate Tilling
- Population Health Sciences, Bristol Medical School and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
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Lantz S, Fornwall C, Lööf M, Isaksson J. SKILLS - A psychoeducational group programme for children with ADHD. Scand J Psychol 2021; 62:460-467. [PMID: 33982811 DOI: 10.1111/sjop.12727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/18/2021] [Accepted: 02/16/2021] [Indexed: 11/26/2022]
Abstract
Psychoeducation is regarded as a first line of intervention for attention-deficit/hyperactivity disorder (ADHD). Previous studies have been limited to psychoeducation for adult patients or parents of children with ADHD. Therefore, the aim of the present study was to investigate the acceptability and effectiveness of a psychoeducational group intervention for children with ADHD. The two-session psychoeducational intervention, SKILLS, was completed by 125 children (6-12 years) with ADHD and their parents. Self-ratings and parental ratings of ADHD symptoms, functional impairment and attitudes to diagnosis and treatment were collected before and after treatment. Post-treatment client satisfaction and parental responses to an open question about SKILLS were assessed. The data were analyzed using a combination of quantitative and qualitative (content analysis) methods. A majority of the participants expressed satisfaction with the group intervention. The intervention had no effect on symptoms and level of function, although the parents were more positive to their child's diagnosis after the intervention. The parents were positive to the group format and to the opportunity for their children to meet other children with similar symptoms. Parents wished for more interactive elements and more opportunities for children to share experiences. We concluded that the group intervention was accepted by most participants, although more activating exercises and opportunities for interaction between participants should be included. Since the intervention group was not compared with a control group, the results should be interpreted with caution. Future studies should use a randomized control treatment design and investigate the effect on adherence to later treatment.
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Affiliation(s)
- Sofia Lantz
- Department of Neuroscience, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
| | - Charlotta Fornwall
- Department of Neuroscience, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
| | - Måns Lööf
- Child & Adolescent Psychiatric Clinic, Gävle, Sweden
| | - Johan Isaksson
- Department of Neuroscience, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden.,Department of Women's and Children's Health, Centre for Psychiatry Research, Karolinska Institute Centre of Neurodevelopmental Disorders (KIND), Karolinska Institute, Stockholm, Sweden
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Sellers R, Harold GT, Smith AF, Neiderhiser JM, Reiss D, Shaw D, Natsuaki MN, Thapar A, Leve LD. Disentangling nature from nurture in examining the interplay between parent-child relationships, ADHD, and early academic attainment. Psychol Med 2021; 51:645-652. [PMID: 31839017 PMCID: PMC7295681 DOI: 10.1017/s0033291719003593] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is highly heritable and is associated with lower educational attainment. ADHD is linked to family adversity, including hostile parenting. Questions remain regarding the role of genetic and environmental factors underlying processes through which ADHD symptoms develop and influence academic attainment. METHOD This study employed a parent-offspring adoption design (N = 345) to examine the interplay between genetic susceptibility to child attention problems (birth mother ADHD symptoms) and adoptive parent (mother and father) hostility on child lower academic outcomes, via child ADHD symptoms. Questionnaires assessed birth mother ADHD symptoms, adoptive parent (mother and father) hostility to child, early child impulsivity/activation, and child ADHD symptoms. The Woodcock-Johnson test was used to examine child reading and math aptitude. RESULTS Building on a previous study (Harold et al., 2013, Journal of Child Psychology and Psychiatry, 54(10), 1038-1046), heritable influences were found: birth mother ADHD symptoms predicted child impulsivity/activation. In turn, child impulsivity/activation (4.5 years) evoked maternal and paternal hostility, which was associated with children's ADHD continuity (6 years). Both maternal and paternal hostility (4.5 years) contributed to impairments in math but not reading (7 years), via impacts on ADHD symptoms (6 years). CONCLUSION Findings highlight the importance of early child behavior dysregulation evoking parent hostility in both mothers and fathers, with maternal and paternal hostility contributing to the continuation of ADHD symptoms and lower levels of later math ability. Early interventions may be important for the promotion of child math skills in those with ADHD symptoms, especially where children have high levels of early behavior dysregulation.
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Affiliation(s)
- R Sellers
- School of Psychology, Andrew and Virginia Rudd Centre for Adoption Research and Practice, University of Sussex, Brighton, UK
- Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - G T Harold
- School of Psychology, Andrew and Virginia Rudd Centre for Adoption Research and Practice, University of Sussex, Brighton, UK
- Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- School of Psychology, Trinity College Dublin, The University of Dublin, Ireland
| | - A F Smith
- School of Psychology, Andrew and Virginia Rudd Centre for Adoption Research and Practice, University of Sussex, Brighton, UK
| | - J M Neiderhiser
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - D Reiss
- Yale Child Study Center, New Haven, CT, USA
| | - D Shaw
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | - A Thapar
- Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - L D Leve
- Prevention Science Institute, University of Oregon, Eugene, ORUSA
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Prenatal and Postnatal Predictive Factors for Children's Inattentive and Hyperactive Symptoms at 5 Years of Age: The Role of Early Family-related Factors. Child Psychiatry Hum Dev 2021; 52:783-799. [PMID: 32951139 PMCID: PMC8405488 DOI: 10.1007/s10578-020-01057-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 11/06/2022]
Abstract
We examined several parent-reported prenatal and postnatal factors as potential risk factors for attention-deficit and hyperactivity disorder (ADHD) symptomatology in 5-year-old children. Our study is based on the CHILD-SLEEP birth cohort. Several parental questionnaires were collected prenatally (32nd pregnancy week) and postnatally (i.e. child aged 3, 8, and 24 months and at 5 years). At 5 years of age, ADHD symptoms were assessed using questionnaires. Our main results showed that being a boy, parental depressive symptoms, more negative family atmosphere or a child's shorter sleep duration, and maternal authoritarian parenting style predicted inattentive/hyperactive symptoms. Maternal and paternal authoritative parenting style predicted less inattentive/hyperactive symptoms. Children with several risk factors together had the highest risk for inattentive/hyperactive symptoms. Our findings emphasise the need for early screening and treatment of parental mental health, and early evidence-based targeted parental support, to enable early intervention in those children at a risk of developing ADHD.
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15
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The Longitudinal Relation between Observed Maternal Parenting in the Preschool Period and the Occurrence of Child ADHD Symptoms in Middle Childhood. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:755-764. [PMID: 30417251 PMCID: PMC6469827 DOI: 10.1007/s10802-018-0492-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In this longitudinal population-based cohort (N = 547) we examined the relation between maternal discipline and sensitivity in the preschool period and the occurrence of attention-deficit hyperactivity disorder (ADHD) symptoms in middle childhood, taking into account pre-existing child attention and executive function (EF) problems, and oppositional defiant disorder (ODD) symptom comorbidity. Maternal parenting was observed during a ‘do not touch task’ (positive and negative discipline) and a teaching task (sensitivity) at age 3. Parents reported on the occurrence of ADHD and ODD symptoms at age 8 using the Conners’ Parent Rating Scale. Attention and executive function problems were assessed using parent questionnaires at age 4. Important covariates such as harsh discipline and maternal depression were also taken into account. Maternal sensitivity significantly predicted later ADHD symptoms beyond pre-existing child attention and EF problems, and comorbid ODD symptoms. However, maternal negative and positive discipline did not significantly predict later ADHD symptoms over and above these covariates. This study demonstrates the importance of maternal sensitivity in the etiology of core ADHD symptoms above and beyond pre-existing child attention and EF problems, and comorbid ODD symptoms.
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16
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Sellers R, Harold GT, Thapar A, Neiderhiser JM, Ganiban JM, Reiss D, Shaw DS, Natsuaki MN, Leve LD. Examining the Role of Genetic Risk and Longitudinal Transmission Processes Underlying Maternal Parenting and Psychopathology and Children's ADHD Symptoms and Aggression: Utilizing the Advantages of a Prospective Adoption Design. Behav Genet 2020; 50:247-262. [PMID: 32623545 DOI: 10.1007/s10519-020-10006-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/26/2020] [Indexed: 01/27/2023]
Abstract
Although genetic factors may contribute to initial liability for ADHD onset, there is growing evidence of the potential importance of the rearing environment on the developmental course of ADHD symptomatology. However, associations between family-level variables (maternal hostility, maternal depressive symptoms) and child behaviors (developmental course of ADHD and aggression) may be explained by genes that are shared by biologically related parents and children. Furthermore, ADHD symptoms and aggression commonly co-occur: it is important to consider both simultaneously to have a better understanding of processes underlying the developmental course of ADHD and aggression. To addresses these issues, we employed a longitudinal genetically sensitive parent-offspring adoption design. Analyses were conducted using Cohort I (n = 340) of the Early Growth and Development Study with cross-validation analyses conducted with Cohort II (n = 178). Adoptive mother hostility, but not depression, was associated with later child ADHD symptoms and aggression. Mothers and their adopted children were genetically unrelated, removing passive rGE as a possible explanation. Early child impulsivity/activation was associated with later ADHD symptoms and aggression. Child impulsivity/activation was also associated with maternal hostility, with some evidence for evocative gene-environment correlation processes on adoptive mother depressive symptoms. This study provides novel insights into family-based environmental influences on child ADHD and aggression symptoms, independent of shared parental genetic factors, implications of which are further explicated in the discussion.
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Affiliation(s)
- Ruth Sellers
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Brighton, UK.,Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Gordon T Harold
- Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK. .,Faculty of Education, University of Cambridge, 184 Hills Road, Cambridge, CB2 8PQ, UK.
| | - Anita Thapar
- Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Jenae M Neiderhiser
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Jody M Ganiban
- Department of Psychology, George Washington University, Washington, DC, USA
| | - David Reiss
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Daniel S Shaw
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Misaki N Natsuaki
- Department of Psychology, University of California, Riverside, CA, USA
| | - Leslie D Leve
- Prevention Science Institute, University of Oregon, Eugene, OR, USA
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17
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Leppert B, Millard LAC, Riglin L, Davey Smith G, Thapar A, Tilling K, Walton E, Stergiakouli E. A cross-disorder PRS-pheWAS of 5 major psychiatric disorders in UK Biobank. PLoS Genet 2020; 16:e1008185. [PMID: 32392212 PMCID: PMC7274459 DOI: 10.1371/journal.pgen.1008185] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/05/2020] [Accepted: 02/11/2020] [Indexed: 12/14/2022] Open
Abstract
Psychiatric disorders are highly heritable and associated with a wide variety of social adversity and physical health problems. Using genetic liability (rather than phenotypic measures of disease) as a proxy for psychiatric disease risk can be a useful alternative for research questions that would traditionally require large cohort studies with long-term follow up. Here we conducted a hypothesis-free phenome-wide association study in about 330,000 participants from the UK Biobank to examine associations of polygenic risk scores (PRS) for five psychiatric disorders (major depression (MDD), bipolar disorder (BP), schizophrenia (SCZ), attention-deficit/ hyperactivity disorder (ADHD) and autism spectrum disorder (ASD)) with 23,004 outcomes in UK Biobank, using the open-source PHESANT software package. There was evidence after multiple testing (p<2.55x10-06) for associations of PRSs with 294 outcomes, most of them attributed to associations of PRSMDD (n = 167) and PRSSCZ (n = 157) with mental health factors. Among others, we found strong evidence of association of higher PRSADHD with 1.1 months younger age at first sexual intercourse [95% confidence interval [CI]: -1.25,-0.92] and a history of physical maltreatment; PRSASD with 0.01% lower erythrocyte distribution width [95%CI: -0.013,-0.007]; PRSSCZ with 0.95 lower odds of playing computer games [95%CI:0.95,0.96]; PRSMDD with a 0.12 points higher neuroticism score [95%CI:0.111,0.135] and PRSBP with 1.03 higher odds of having a university degree [95%CI:1.02,1.03]. We were able to show that genetic liabilities for five major psychiatric disorders associate with long-term aspects of adult life, including socio-demographic factors, mental and physical health. This is evident even in individuals from the general population who do not necessarily present with a psychiatric disorder diagnosis. Psychiatric disorders are associated with a wide range of adverse health, social and economic problems. Our study investigated the association of genetic risk for five common psychiatric disorders with socio- demographics, lifestyle and health of about 330,000 participants in the UK Biobank using a systematic, hypothesis-free approach. We found that genetic risk for attention deficit/hyperactivity disorder (ADHD) and bipolar disorder were most strongly associated with lifestyle factors, such as time of first sexual intercourse and educational attainment. Genetic risks for autism spectrum disorder and schizophrenia were associated with altered blood cell counts and decreased risk of playing computer games, respectively. Increased genetic risk for depression was associated with other mental health outcomes such as neuroticism and irritability. In general, our results suggest that genetic risk for psychiatric disorders associates with a range of health and lifestyle traits that were measured in adulthood, in individuals from the general population who do not necessarily present with a psychiatric disorder diagnosis. However, it is important to note that these associations are not necessary causal but can also represent genetic correlation or be influenced by other factors, such as socio-economic factors and selection into the cohort. The findings should inform future research using causally informative designs.
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Affiliation(s)
- Beate Leppert
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- * E-mail: (BL); (ES)
| | - Louise A. C. Millard
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Intelligent Systems Laboratory, University of Bristol, Bristol, United Kingdom
| | - Lucy Riglin
- Division of Psychological Medicine and Clinical Neurosciences; MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, United Kingdom
| | - George Davey Smith
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences; MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, United Kingdom
| | - Kate Tilling
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Esther Walton
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, United Kingdom
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Evie Stergiakouli
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- * E-mail: (BL); (ES)
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18
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Tistarelli N, Fagnani C, Troianiello M, Stazi MA, Adriani W. The nature and nurture of ADHD and its comorbidities: A narrative review on twin studies. Neurosci Biobehav Rev 2019; 109:63-77. [PMID: 31838192 DOI: 10.1016/j.neubiorev.2019.12.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/06/2019] [Accepted: 12/11/2019] [Indexed: 12/26/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children worldwide, and also the recognition of its persistence into adulthood is increasing. While ADHD in childhood is highly heritable and mostly driven by familial factors, during adulthood it appears to show a lower heritability, even if there is not total agreement on this yet. This disorder often co-occurs with many other conditions, which also vary across the different stages of development, and several studies have used the twin design to investigate these comorbidities, giving valuable insights into the origins of the observed co-occurrence. This review aims to summarize the main results of twin research, according to the following domains: individual traits, cognitive impairment, behavioral manifestations, clinical conditions and psychosocial risk factors. Individual features seem to play a role in this symptomatology and include personality traits such as negative emotionality, personality disorders and temperamental dimensions with a predominance of novelty seeking. At a lower level, ADHD is associated with both functional and anatomic brain characteristics. ADHD is also associated with some forms of cognitive impairment, such as sluggish cognitive tempo, and learning disabilities, with a specific predisposition to reading disability. In addition, ADHD is strongly associated with externalizing disorders such as conduct disorder and oppositional defiant disorder, and some behavioral outcomes, particularly substance use and abuse both in adolescence and adulthood. Moreover, ADHD symptoms often overlap with other psychological disorders, namely affective and internalizing disorders, as well as autism spectrum disorder and autistic-like traits in a wider sense. Notably, a genetic overlap has been found between asthma and ADHD, particularly with respect to hyperactivity/impulsivity dimensions. ADHD also appears to represent a risk factor for disordered eating, and, more specifically, for binge eating and bulimia nervosa. Finally, among psychosocial factors, an association has been proposed between childhood maltreatment and ADHD symptoms.
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Affiliation(s)
- Naomi Tistarelli
- Department of Brain & Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Corrado Fagnani
- Center "Behavioral Sciences and Mental Health", Istituto Superiore di Sanità, Rome, Italy
| | | | - Maria Antonietta Stazi
- Center "Behavioral Sciences and Mental Health", Istituto Superiore di Sanità, Rome, Italy
| | - Walter Adriani
- Center "Behavioral Sciences and Mental Health", Istituto Superiore di Sanità, Rome, Italy.
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19
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Penner F, Vanwoerden S, Borelli JL, Sharp C. Discrepancies in Mother-Adolescent Reports of Parenting Practices in a Psychiatric Sample: Associations with Age, Psychopathology, and Attachment. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 48:343-360. [PMID: 31758368 DOI: 10.1007/s10802-019-00589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Discrepancies in parent-adolescent reports of parenting practices may reveal important information about parent-adolescent relationship quality. Youth attachment security has been identified as a factor that may explain discrepancies between parents and adolescents in reporting on parenting. However, previous research has not examined this question among clinical samples, and has generally utilized non-optimal analytic strategies in modeling discrepancies. The current study aimed to extend previous work by using latent profile analysis (LPA) to identify patterns of mother-adolescent divergence in reports of parenting in a large clinical sample, examining the characteristics of discrepancy groups in terms of age, gender, and psychopathology, and examining associations between attachment and discrepancies. A sample of adolescents with psychiatric disorders (N = 416; ages 12-17) and their mothers completed reports of parenting practices. Adolescents also completed the Child Attachment Interview and a measure of psychopathology. LPA was used to identify groups of mother-adolescent dyads with similar patterns of divergence across domains of parenting. Chi-square, ANOVA, and logistic regression analyses were used to test associations between youth age, gender, psychopathology, and attachment and mother-adolescent discrepancy profile membership. Three discrepancy profiles emerged: Strong Divergence, Moderate Divergence, and Low Divergence. Youth in the Moderate Divergence profile were oldest and had highest levels of externalizing pathology. Youth with insecure (dismissing and preoccupied) attachment, relative to securely attached youth, were more likely to be in the Strong Divergence profile. Securely attached adolescents were more likely to be in Low or Moderate Divergence profiles. Clinical implications are discussed.
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Affiliation(s)
- Francesca Penner
- Department of Psychology, University of Houston, 3695 Cullen Blvd, Room 126, Houston, TX, 77204, USA
| | - Salome Vanwoerden
- Department of Psychology, University of Houston, 3695 Cullen Blvd, Room 126, Houston, TX, 77204, USA
| | - Jessica L Borelli
- Department of Psychological Science, University of California - Irvine, 4201 Social & Behavioral Sciences, Irvine, CA, 92697, USA
| | - Carla Sharp
- Department of Psychology, University of Houston, 3695 Cullen Blvd, Room 126, Houston, TX, 77204, USA.
- Centre for Development Support, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa.
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20
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González RA, Vélez-Pastrana MC, McCrory E, Kallis C, Aguila J, Canino G, Bird H. Evidence of concurrent and prospective associations between early maltreatment and ADHD through childhood and adolescence. Soc Psychiatry Psychiatr Epidemiol 2019; 54:671-682. [PMID: 30903235 DOI: 10.1007/s00127-019-01659-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 01/17/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE An emerging body of work suggests a link between childhood maltreatment and attention-deficit hyperactivity disorder (ADHD). However, research examining the role of maltreatment in the early course of the disorder lacks robust evidence from longitudinal studies. Our aim was to examine concurrent and prospective associations between maltreatment experiences and ADHD diagnosis and sex differences, and to estimate the association between repetitive maltreatment exposure and ADHD through childhood and adolescence. METHODS Data were obtained from the Boricua Youth Study, a longitudinal study of 2480 children and adolescents of Puerto Rican background. Neglect, physical, emotional and sexual abuse, and foster placement were regressed on ADHD diagnosis measured at each of three waves using the Diagnostic Interview Schedule for Children-IV. Multilevel regressions estimated the effects of exposure on ADHD, adjusted by age, sex, income, household education, parental psychopathology, comorbidity and ADHD medication status. RESULTS Emotional abuse and foster placement had robust associations with ADHD diagnosis. For girls, physical abuse had a threefold increase in the odds of having ADHD diagnosis; for boys, associations were observed only for emotional abuse. Prospective models examining the risk of ADHD following maltreatment provided initial evidence for the effects of physical abuse on ADHD, and a linear trend for repetitive exposure suggested increased probability for disorder persistence. CONCLUSIONS Associations between early maltreatment and ADHD were robust. Different categories of maltreatment increase the likelihood of ADHD for girls and boys. Increased exposure to maltreatment may predict symptom persistence. Interventions addressing ADHD must consider the effects of both sex and family environment.
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Affiliation(s)
- Rafael A González
- Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College London, 7th floor Commonwealth Building, Du Cane Road, London, W12 0NN, UK. .,Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan, PR, USA.
| | - María C Vélez-Pastrana
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan, PR, USA.,Ph.D. Program in Clinical Psychology, Carlos Albizu University, San Juan, PR, USA
| | - Eamon McCrory
- Division of Psychology and Language Sciences, University College London, London, UK
| | | | - Jivelisse Aguila
- Ph.D. Program in Clinical Psychology, Carlos Albizu University, San Juan, PR, USA
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico School of Medicine, San Juan, PR, USA
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21
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Hope S, Deighton J, Micali N, Law C. Maternal mental health and childhood injury: evidence from the UK Millennium Cohort Study. Arch Dis Child 2019; 104:268-274. [PMID: 30104390 DOI: 10.1136/archdischild-2017-313809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 06/27/2018] [Accepted: 07/07/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We assessed whether maternal mental health problems increased rates for child injury during the preschool years and mid-childhood, and the extent to which associations could be accounted for by a range of potential explanatory factors. DESIGN We analysed the UK Millennium Cohort Study, a nationally representative sample with data collected throughout childhood. Multinomial regression was used to investigate whether two measures of maternal mental health (diagnosed depression/anxiety and psychological distress) were associated with subsequent childhood injury. Models adjusted for sociodemographics, parenting and child externalising behaviours. MAIN OUTCOME MEASURE Maternal report of unintentional injuries (none, 1, 2+) recorded at three data collection periods (3-5 years; 5-7 years; 7-11 years). RESULTS The analytic sample comprised n=9240 families who participated 3-11 years with complete data on exposures and outcomes (multiply imputing missing covariates). Exposure to maternal mental health problems was associated with increased rates of subsequent childhood injuries. Associations attenuated after adjustment for potential explanatory factors, although they remained elevated. For example, high maternal distress was associated with injuries 3-5 years (adjusted relative risk ratio (aRRR): 1 injury=1.18, 95% CI 0.86 to 1.61; 2+ injuries=2.22, 95% CI 1.22 to 4.02); injuries 5-7 years (aRRR: 1 injury=1.31, 95% CI 0.97 to 1.76; 2+ injuries=1.84, 95% CI 1.09 to 3.09); and injuries 7-11 years (aRRR: 1 injury=1.03, 95% CI 0.81 to 1.31; 2+ injuries=1.33, 95% CI 0.97 to 1.81). CONCLUSIONS Children exposed to mothers with mental health problems had higher rates of childhood injury than those not exposed. If further investigation of this association suggests causality then it will be important to test measures that address mothers' mental health issues with a view to reducing injuries among their children.
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Affiliation(s)
- Steven Hope
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jessica Deighton
- UCL and Anna Freud National Centre for Children and Families, London, UK
| | - Nadia Micali
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Catherine Law
- UCL Great Ormond Street Institute of Child Health, London, UK
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22
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Luo Y, Weibman D, Halperin JM, Li X. A Review of Heterogeneity in Attention Deficit/Hyperactivity Disorder (ADHD). Front Hum Neurosci 2019; 13:42. [PMID: 30804772 PMCID: PMC6378275 DOI: 10.3389/fnhum.2019.00042] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 01/25/2019] [Indexed: 12/24/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects approximately 8%–12% of children worldwide. Throughout an individual’s lifetime, ADHD can significantly increase risk for other psychiatric disorders, educational and occupational failure, accidents, criminality, social disability and addictions. No single risk factor is necessary or sufficient to cause ADHD. The multifactorial causation of ADHD is reflected in the heterogeneity of this disorder, as indicated by its diversity of psychiatric comorbidities, varied clinical profiles, patterns of neurocognitive impairment and developmental trajectories, and the wide range of structural and functional brain anomalies. Although evidence-based treatments can reduce ADHD symptoms in a substantial portion of affected individuals, there is yet no curative treatment for ADHD. A number of theoretical models of the emergence and developmental trajectories of ADHD have been proposed, aimed at providing systematic guides for clinical research and practice. We conducted a comprehensive review of the current status of research in understanding the heterogeneity of ADHD in terms of etiology, clinical profiles and trajectories, and neurobiological mechanisms. We suggest that further research focus on investigating the impact of the etiological risk factors and their interactions with developmental neural mechanisms and clinical profiles in ADHD. Such research would have heuristic value for identifying biologically homogeneous subgroups and could facilitate the development of novel and more tailored interventions that target underlying neural anomalies characteristic of more homogeneous subgroups.
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Affiliation(s)
- Yuyang Luo
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Dana Weibman
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Jeffrey M Halperin
- Department of Psychology, Queens College of the City University of New York, Flushing, NY, United States
| | - Xiaobo Li
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States.,Department of Electric and Computer Engineering, New Jersey Institute of Technology, Newark, NJ, United States
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23
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Breaux RP, Harvey EA. A Longitudinal Study of the Relation Between Family Functioning and Preschool ADHD Symptoms. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2018; 48:749-764. [DOI: 10.1080/15374416.2018.1437737] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Rosanna P. Breaux
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst
| | - Elizabeth A. Harvey
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst
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Anaya B, Pérez-Edgar K. Personality development in the context of individual traits and parenting dynamics. NEW IDEAS IN PSYCHOLOGY 2018; 53:37-46. [PMID: 30872892 DOI: 10.1016/j.newideapsych.2018.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Our conceptualization of adult personality and childhood temperament can be closely aligned in that they both reflect endogenous, likely constitutional dispositions. Empirical studies of temperament have focused on measuring systematic differences in emotional reactions, motor responses, and physiological states that we believe may contribute to the underlying biological components of personality. Although this work has provided some insight into the early origins of personality, we still lack a cohesive developmental account of how personality profiles emerge from infancy into adulthood. We believe the moderating impact of context could shed some light on this complex trajectory. We begin this article reviewing how researchers conceptualize personality today, particularly traits that emerge from the Five Factor Theory (FFT) of personality. From the temperament literature, we review variation in temperamental reactivity and regulation as potential underlying forces of personality development. Finally, we integrate parenting as a developmental context, reviewing empirical findings that highlight its important role in moderating continuity and change from temperament to personality traits.
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ADHD Symptoms in Middle Adolescence Predict Exposure to Person-Related Life Stressors in Late Adolescence in 5-HTTLPR S-allele Homozygotes. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 46:1427-1437. [DOI: 10.1007/s10802-017-0377-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Dinkler L, Lundström S, Gajwani R, Lichtenstein P, Gillberg C, Minnis H. Maltreatment-associated neurodevelopmental disorders: a co-twin control analysis. J Child Psychol Psychiatry 2017; 58:691-701. [PMID: 28094432 DOI: 10.1111/jcpp.12682] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Childhood maltreatment (CM) is strongly associated with psychiatric disorders in childhood and adulthood. Previous findings suggest that the association between CM and psychiatric disorders is partly causal and partly due to familial confounding, but few studies have investigated the mechanisms behind the association between CM and neurodevelopmental disorders (NDDs). Our objective was to determine whether maltreated children have an elevated number of NDDs and whether CM is a risk factor for an increased NDD 'load' and increased NDD symptoms when controlling for familial effects. METHODS We used a cross-sectional sample from a population-representative Swedish twin study, comprising 8,192 nine-year-old twins born in Sweden between 1997 and 2005. CM was defined as parent-reported exposure to emotional abuse/neglect, physical neglect, physical abuse, and/or sexual abuse. Four NDDs were measured with the Autism-Tics, AD/HD, and other comorbidities inventory. RESULTS Maltreated children had a greater mean number of NDDs than nonmaltreated children. In a co-twin control design, CM-discordant monozygotic twins did not differ significantly for their number of NDDs, suggesting that CM is not associated with an increased load of NDDs when genetic and shared environmental factors are taken into account. However, CM was associated with a small increase in symptoms of attention-deficit/hyperactivity disorder and autism spectrum disorder in CM-discordant MZ twins, although most of the covariance of CM with NDD symptoms was explained by common genetic effects. CONCLUSIONS Maltreated children are at higher risk of having multiple NDDs. Our findings are, however, not consistent with the notion that CM causes the increased NDD load in maltreated children. Maltreated children should receive a full neurodevelopmental assessment, and clinicians should be aware that children with multiple NDDs are at higher risk of maltreatment.
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Affiliation(s)
- Lisa Dinkler
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden.,Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden
| | - Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden.,Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Helen Minnis
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden.,Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Lambek R, Sonuga-Barke E, Psychogiou L, Thompson M, Tannock R, Daley D, Damm D, Thomsen PH. The Parental Emotional Response to Children Index. J Atten Disord 2017; 21:494-507. [PMID: 24994878 DOI: 10.1177/1087054714539996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The current study introduces the Parental Emotional Response to Children Index (PERCI), a new questionnaire specifically designed to measure parents' emotional response to ADHD and related behaviors (delay discounting and delay aversion). METHOD The PERCI was completed by parents of 6- to 14-year-old children with ( n = 126) and without ( n = 160) ADHD. RESULTS Factor analysis confirmed five separate subscales with acceptable psychometric properties. Parents of children with ADHD reported a stronger emotional response to ADHD behaviors than parents of typically developing children and inattention symptoms evoked the strongest emotional response in parents regardless of child diagnostic status. CONCLUSION Parents' emotional responses appear to be differentiated in terms of specific ADHD-related triggers mapping onto the different domains of ADHD and delay-related responses. Further research is required to understand changes in parental emotional responses over time and their impact on children's developmental trajectories.
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Affiliation(s)
| | - Edmund Sonuga-Barke
- 1 Aarhus University, Denmark.,2 Ghent University, Belgium.,3 University of Southampton, UK
| | | | | | | | | | - Dorte Damm
- 7 Aarhus University Hospital, Risskov, Denmark
| | - Per Hove Thomsen
- 1 Aarhus University, Denmark.,7 Aarhus University Hospital, Risskov, Denmark
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Chang JPC, Gau SSF. Mother-Child Relationship in Youths with Attention-Deficit Hyperactivity Disorder and their Siblings. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 45:871-882. [DOI: 10.1007/s10802-016-0218-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Siblings' Perceptions of Their ADHD-Diagnosed Sibling's Impact on the Family System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13090910. [PMID: 27649212 PMCID: PMC5036743 DOI: 10.3390/ijerph13090910] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/05/2016] [Accepted: 09/06/2016] [Indexed: 12/24/2022]
Abstract
This qualitative study explored siblings’ perceptions of the impact a sibling diagnosed with ADHD has within the family system. Specific focus was placed on the different ways these different sibling cohorts were parented. Participants constituted eight adult females with a mean age of 20 years from different cultural and socio-economic backgrounds in the province of Gauteng, South Africa. Data was collected using semi-structured interviews and was analysed thematically. The four themes that emerged from the interviews include differential parental treatment, rejection, discrepancy with discipline, and the parentified child. Specifically, the results of this study revealed feelings of differential parental treatment and discipline that took place in the home and rejection experienced by the non-ADHD sibling. There was also a common theme of a parentified child, who had to carry a burden of caring for their sibling with ADHD. The non-diagnosed siblings perceive themselves to be particularly negatively impacted. The results are discussed in light of the previous empirical studies, and recommendations are made.
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The Safety of Atomoxetine for the Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: A Comprehensive Review of Over a Decade of Research. CNS Drugs 2016; 30:603-28. [PMID: 27290715 DOI: 10.1007/s40263-016-0349-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Atomoxetine is a noradrenergic reuptake inhibitor prescribed for attention-deficit/hyperactivity disorder (ADHD) that first gained approval in the USA in 2002 and has been authorized in 97 countries worldwide. The aim of this paper is to comprehensively review publications that addressed one or more of seven major safety topics relevant to atomoxetine treatment of children and adolescents (aged ≥6 years) diagnosed with ADHD. While the review focuses on children and adolescents, publications in which data from patients aged >18 years and from 6 to 18 years were analyzed in the same dataset were included. Using a predefined search strategy, including agreement of two reviewers when selecting papers, reduced the potential for bias. Using this process, we identified 70 eligible papers (clinical trials, epidemiological studies, and case reports) across the seven topics. We also referred to the European Summary of Product Characteristics (SPC) and US label. We found 15 papers about suicidality, three about aggression/hostility, seven about psychosis/mania, six about seizures, seven about hepatic effects, 29 about cardiovascular effects, and 28 about growth and development. The main findings (i.e., those from the largest and most well-conducted studies/analyses) are as follows. A large register-based study of pediatric and adult patients (6818 received atomoxetine) calculated a hazard ratio of 0.96 for suicide-related events during treatment with atomoxetine, and a meta-analysis of 23 placebo-controlled studies (N = 3883), published in 2014, found no completed suicides and no statistically significant association between atomoxetine and suicidality. The frequency of aggression/hostility was not statistically significantly higher with atomoxetine, e.g., experienced by 1.6 % (N = 21/1308) of atomoxetine-treated patients versus 1.1 % (N = 9/806) of placebo-treated patients in one meta-analysis. Symptoms of psychosis and mania were mainly observed in patients with comorbid bipolar disorder/depression. Based on spontaneous reports, during a 2-year period when 2.233 million adult and pediatric patients were exposed to atomoxetine, the reporting rate for seizures was 8 per 100,000 patients. In the manufacturer's database, atomoxetine was a "probable cause" of three hepatic adverse events (AEs) (all reversible hepatitis), and 133 hepatic AEs had possible confounding factors and were "possibly related" to atomoxetine, during 4 years when atomoxetine exposure had reached about 4.3 million patients. Rare cases of severe liver injury are described in the US label and European SPC; a case requiring liver transplantation is described in the US label. In a comprehensive review of a clinical trials database (N = 8417 received atomoxetine), most pediatric patients experienced modest increases in heart rate and blood pressure, and 8-12 % experienced more pronounced changes (≥20 bpm, ≥15 to 20 mmHg). However, in three long-term analyses (≥2 years), blood pressure was within age norms, and few patients discontinued due to cardiovascular AEs. As described in the European SPC, QT interval prolongation is uncommon, e.g., in an open-label study, 1.4 % of 711 children and adolescents had prolonged QTc intervals (≥450 ms in males, ≥470 ms in females) that were not clinically significant at ≥3 years of treatment with atomoxetine. The European SPC warns about potential QT interval prolongation in patients with a personal or family history, or if atomoxetine is administered with other drugs that potentially affect the QT interval. Decreases in growth (weight and height gain) occurred and were greatest in patients of above average weight and height, but appeared to recover over 2-5 years of atomoxetine treatment. In conclusion, suicidality, aggression/hostility, psychosis, seizures, liver injuries, and prolonged QT interval are uncommon or rare in children and adolescents treated with atomoxetine, based on data from the predefined search and from the European SPC. Overall, the data that we assessed from our search do not suggest that associations exist between atomoxetine and suicidality or seizures. The data also suggest that an association may not exist between atomoxetine and aggression/hostility. While atomoxetine may affect the cardiovascular system, the data suggest these effects are not clinically significant in most patients. Reductions in growth appear to be reversible in the long term.
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Abstract
Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental disorder with a prevalence of 1·4-3·0%. It is more common in boys than girls. Comorbidity with childhood-onset neurodevelopmental disorders and psychiatric disorders is substantial. ADHD is highly heritable and multifactorial; multiple genes and non-inherited factors contribute to the disorder. Prenatal and perinatal factors have been implicated as risks, but definite causes remain unknown. Most guidelines recommend a stepwise approach to treatment, beginning with non-drug interventions and then moving to pharmacological treatment in those most severely affected. Randomised controlled trials show short-term benefits of stimulant medication and atomoxetine. Meta-analyses of blinded trials of non-drug treatments have not yet proven the efficacy of such interventions. Longitudinal studies of ADHD show heightened risk of multiple mental health and social difficulties as well as premature mortality in adult life.
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Affiliation(s)
- Anita Thapar
- Child & Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK.
| | - Miriam Cooper
- Child & Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK
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Steinberg EA, Drabick DAG. A Developmental Psychopathology Perspective on ADHD and Comorbid Conditions: The Role of Emotion Regulation. Child Psychiatry Hum Dev 2015; 46:951-66. [PMID: 25662998 DOI: 10.1007/s10578-015-0534-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Research investigating attention-deficit/hyperactivity disorder (ADHD) and co-occurring disorders such as oppositional defiant disorder, conduct disorder, anxiety, and depression has surged in popularity; however, the developmental relations between ADHD and these comorbid conditions remain poorly understood. The current paper uses a developmental psychopathology perspective to examine conditions commonly comorbid with ADHD during late childhood through adolescence. First, we present evidence for ADHD and comorbid disorders. Next, we discuss emotion regulation and its associations with ADHD. The role of parenting behaviors in the development and maintenance of emotion regulation difficulties and comorbid disorders among children with ADHD is explored. An illustrative example of emotion regulation and parenting over the course of development is provided to demonstrate bidirectional relations among these constructs. We then present an integrated conceptual model of emotion regulation as a shared risk process that may lead to different comorbid conditions among children with ADHD. Implications and directions for future research are presented.
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Affiliation(s)
- Elizabeth A Steinberg
- Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA.
| | - Deborah A G Drabick
- Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA
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Asbrand J, Lerach T, Tuschen-Caffier B. Störungstypische Erziehungsfaktoren bei Aufmerksamkeits- und Angststörungen im Kindes- und Jugendalter. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2015. [DOI: 10.1026/1616-3443/a000329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Die Erziehungsfaktoren Negativität und Kontrolle werden sowohl im Zusammenhang mit der Aufmerksamkeits-Defizit-Hyperaktivitäts-Störung (ADHS) als auch mit Angststörungen (AS) diskutiert. Fragestellung: Unklar ist bislang, ob ADHS und AS gleichermaßen mit negativer Erziehung zusammenhängen oder ob verschiedene Erziehungsfaktoren bei den jeweiligen Störungsbildern eine störungstypische Rolle spielen. Methode: Einschlägige Studien aus dem Zeitraum von 1994 bis 2014 wurden systematisch analysiert. Neben generellen Zusammenhängen wurden moderierende Faktoren ermittelt. Ergebnisse: Während kindliche ADHS verstärkt mit elterlicher Negativität, zum Teil aber auch mit Kontrolle, assoziiert ist, zeigt sich bei kindlichen AS insbesondere ein Zusammenhang mit elterlicher Kontrolle. Die Ergebnisse werden von verschiedenen Faktoren wie Erhebungsmethode (Fragebogen vs. Beobachtung) und Medikation moderiert. Schlussfolgerungen: Störungstypische Zusammenhänge zwischen kindlicher Psychopathologie und Erziehungsfaktoren betonen die Relevanz gegenüberstellender Forschung von ADHS und AS und können Implikationen für eine störungsorientierte Psychotherapie haben.
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Affiliation(s)
- Julia Asbrand
- Abteilung für Klinische Psychologie und Psychotherapie, Institut für Psychologie, Albert-Ludwigs-Universität Freiburg
| | - Teresa Lerach
- Abteilung für Klinische Psychologie und Psychotherapie, Institut für Psychologie, Albert-Ludwigs-Universität Freiburg
| | - Brunna Tuschen-Caffier
- Abteilung für Klinische Psychologie und Psychotherapie, Institut für Psychologie, Albert-Ludwigs-Universität Freiburg
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Elmore AL, Nigg JT, Friderici KH, Jernigan K, Nikolas MA. Does 5HTTLPR Genotype Moderate the Association of Family Environment With Child Attention-Deficit Hyperactivity Disorder Symptomatology? JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2015; 45:348-60. [PMID: 25602736 DOI: 10.1080/15374416.2014.979935] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Problematic family dynamics are common among youth with attention-deficit hyperactivity disorder (ADHD). Multiple mechanisms, including diathesis-stress (vulnerability) and differential susceptibility Gene × Environment interaction effects (G × E), have been proposed to account for this association. G × E effects for ADHD were examined via interactions between a genetic marker hypothesized to influence sensitivity to the environment (the promoter polymorphism of the serotonin transporter gene -5HTTLPR) and family conflict and cohesion in predicting ADHD symptoms. There were 498 youth ages 6-17 years (251 ADHD, 213 non-ADHD) and their parents who completed a multistage, multi-informant assessment (including parent and youth reports on the Family Environment Scale), and saliva sample collection for genotyping. Linear regression analyses examined interactions between 5HTTLPR genotype and the Family Environment Scale scales of conflict and cohesion reported by parent and child. Criteria laid out by Roisman et al. ( 2012 ) were applied to evaluate diathesis stress versus differential susceptibility G × E mechanisms. Results demonstrated interactions between 5HTTLPR genotype and both conflict and cohesion in predicting inattention but not hyperactivity-impulsivity. Both interactions were highly consistent with differential susceptibility models of G × E effects. 5HTTLPR genotype appeared to moderate the relationship between family conflict/cohesion and inattentive symptoms. Interactions highlight the role of 5HTTLPR genotype as a potential marker of environmental sensitivity and provide support for differential susceptibility models of G × E effects for ADHD.
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Affiliation(s)
| | - Joel T Nigg
- b Department of Psychiatry , Oregon Health and Science University
| | - Karen H Friderici
- c Department of Microbiology and Molecular Genetics , Michigan State University
| | - Katherine Jernigan
- c Department of Microbiology and Molecular Genetics , Michigan State University
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Daviss WB, Diler RS. Suicidal behaviors in adolescents with ADHD: associations with depressive and other comorbidity, parent-child conflict, trauma exposure, and impairment. J Atten Disord 2014; 18:680-90. [PMID: 22820277 DOI: 10.1177/1087054712451127] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine potential predictors of lifetime suicidal behaviors (SBs) in adolescents with ADHD. METHOD Participants were 101 adolescents with ADHD aged 11 to 18 years, evaluated for lifetime SB and psychopathology with semistructured interviews, and for lifetime trauma exposure, parent-child conflict, ADHD symptoms, and functional impairment with child, parent, and teacher ratings. RESULTS Controlling for the effects of age, female sex, and comorbid depressive and other disorders, lifetime SB (n = 28) remained significantly associated (p = .001) with parent-child conflict, and to a lesser extent (p < .05) with impairment in nonacademic domains of function and breadth of exposure to victimization events. Measures related to past and current ADHD symptoms and signs were not associated with lifetime SB. CONCLUSION Apart from depression, clinicians should pay particular attention to parent-child conflict, victimization trauma, and social impairment rather than levels of ADHD symptoms when weighing the likelihood of SB in youth with ADHD.
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Affiliation(s)
- W Burleson Daviss
- University of Pittsburgh, Pittsburgh, PA Geisel School of Medicine at Dartmouth, Hanover, NH
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Abstract
OBJECTIVE The present study uses structural equation modeling of latent traits to examine the extent to which family factors, cognitive factors and perceptions of rejection in mother-child relations differentially correlate with aggression at home and at school. METHODS Data were collected from 476 school-age (7-15 years old) children with a diagnosis of ADHD who had previously shown different types of aggressive behavior, as well as from their parents and teachers. Structural equation modeling was used to examine the differential relationships between maternal rejection, family, cognitive factors and aggression in home and school settings. RESULTS Family factors influenced aggression reported at home (.68) and at school (.44); maternal rejection seems to be related to aggression at home (.21). Cognitive factors influenced aggression reported at school (.-05) and at home (-.12). CONCLUSIONS Both genetic and environmental factors contribute to the development of aggressive behavior in ADHD. Identifying key risk factors will advance the development of appropriate clinical interventions and prevention strategies and will provide information to guide the targeting of resources to those children at highest risk.
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Genetic origin of the relationship between parental negativity and behavior problems from early childhood to adolescence: a longitudinal genetically sensitive study. Dev Psychopathol 2013; 25:487-500. [PMID: 23627958 DOI: 10.1017/s0954579412001198] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Little is known about how genetic and environmental factors contribute to the association between parental negativity and behavior problems from early childhood to adolescence. The current study fitted a cross-lagged model in a sample consisting of 4,075 twin pairs to explore (a) the role of genetic and environmental factors in the relationship between parental negativity and behavior problems from age 4 to age 12, (b) whether parent-driven and child-driven processes independently explain the association, and (c) whether there are sex differences in this relationship. Both phenotypes showed substantial genetic influence at both ages. The concurrent overlap between them was mainly accounted for by genetic factors. Causal pathways representing stability of the phenotypes and parent-driven and child-driven effects significantly and independently account for the association. Significant but slight differences were found between males and females for parent-driven effects. These results were highly similar when general cognitive ability was added as a covariate. In summary, the longitudinal association between parental negativity and behavior problems seems to be bidirectional and mainly accounted for by genetic factors. Furthermore, child-driven effects were mainly genetically mediated, and parent-driven effects were a function of both genetic and shared-environmental factors.
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Harold GT, Leve LD, Barrett D, Elam K, Neiderhiser JM, Natsuaki MN, Shaw DS, Reiss D, Thapar A. Biological and rearing mother influences on child ADHD symptoms: revisiting the developmental interface between nature and nurture. J Child Psychol Psychiatry 2013; 54:1038-46. [PMID: 24007415 PMCID: PMC3767192 DOI: 10.1111/jcpp.12100] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Families of children with attention deficit hyperactivity disorder (ADHD) report more negative family relationships than families of children without ADHD. Questions remain as to the role of genetic factors underlying associations between family relationships and children's ADHD symptoms, and the role of children's ADHD symptoms as an evocative influence on the quality of relationships experienced within such families. Utilizing the attributes of two genetically sensitive research designs, the present study examined associations between biologically related and nonbiologically related maternal ADHD symptoms, parenting practices, child impulsivity/activation, and child ADHD symptoms. The combined attributes of the study designs permit assessment of associations while controlling for passive genotype-environment correlation and directly examining evocative genotype-environment correlation (rGE); two relatively under examined confounds of past research in this area. METHODS A cross-sectional adoption-at-conception design (Cardiff IVF Study; C-IVF) and a longitudinal adoption-at-birth design (Early Growth and Development Study; EGDS) were used. The C-IVF sample included 160 mothers and children (age 5-8 years). The EGDS sample included 320 linked sets of adopted children (age 6 years), adoptive-, and biologically related mothers. Questionnaires were used to assess maternal ADHD symptoms, parenting practices, child impulsivity/activation, and child ADHD symptoms. A cross-rater approach was used across measures of maternal behavior (mother reports) and child ADHD symptoms (father reports). RESULTS Significant associations were revealed between rearing mother ADHD symptoms, hostile parenting behavior, and child ADHD symptoms in both samples. Because both samples consisted of genetically unrelated mothers and children, passive rGE was removed as a possible explanatory factor underlying these associations. Further, path analysis revealed evidence for evocative rGE processes in the longitudinal adoption-at-birth study (EGDS) from biologically related maternal ADHD symptoms to biologically unrelated maternal hostile parenting through early disrupted child behavior (impulsivity/activation), with maternal hostile parenting and disrupted child behavior associated with later child ADHD symptoms, controlling for concurrent adoptive mother ADHD symptoms. CONCLUSIONS Results highlight the importance of genetically influenced child ADHD-related temperamental attributes on genetically unrelated maternal hostility that in turn links to later child ADHD symptoms. Implications for intervention programs focusing on early family processes and the precursors of child ADHD symptoms are discussed.
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Humphreys KL, Katz SJ, Lee SS, Hammen C, Brennan PA, Najman JM. The association of ADHD and depression: mediation by peer problems and parent-child difficulties in two complementary samples. JOURNAL OF ABNORMAL PSYCHOLOGY 2013; 122:854-867. [PMID: 24016021 PMCID: PMC3806877 DOI: 10.1037/a0033895] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for the development of depression, with evidence that peer and academic difficulties mediate predictions of later depression from ADHD. In the present study, we hypothesized that parent-child relationship difficulties may be an additional potential mediator of this association. Academic, peer, and parent-child functioning were tested as mediators of the association of attention problems and depression in two distinctly different yet complementary samples. Study 1 was a cross-sectional sample of 5- to 10-year-old children (N = 230) with and without ADHD. Study 2 was a prospective longitudinal sample of 472 youth, followed prospectively from birth to age 20 years, at risk for depression. Despite differences in age, measures, and designs, both studies implicated peer and parent-child problems as unique mediators of depressive symptoms, whereas academic difficulties did not uniquely mediate the ADHD-depression association. Furthermore, inattention symptoms, but not hyperactivity, predicted depressive symptoms via the disruption of interpersonal functioning. The inclusion of oppositional defiant disorder into models impacted results and supported its independent role in parent-child problems. Implications include support for interventions that target interpersonal competence, which may effectively reduce the risk of depression among children with ADHD.
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Affiliation(s)
| | | | | | | | | | - Jake M Najman
- School of Population Health, University of Queensland
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40
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Sonuga-Barke EJS, Cartwright KL, Thompson MJ, Brown J, Bitsakou P, Daley D, Gramzow RH, Psychogiou L, Simonoff E. Family characteristics, expressed emotion, and attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2013; 52:547-548.e2. [PMID: 23622856 DOI: 10.1016/j.jaac.2013.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 02/21/2013] [Accepted: 03/05/2013] [Indexed: 10/26/2022]
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Parenting Practices and Prospective Levels of Hyperactivity/Inattention Across Early- and Middle-Childhood. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2013. [DOI: 10.1007/s10862-013-9341-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) and its possible causes still attract controversy. Genes, pre and perinatal risks, psychosocial factors and environmental toxins have all been considered as potential risk factors. METHOD This review (focussing on literature published since 1997, selected from a search of PubMed) critically considers putative risk factors with a focus on genetics and selected environmental risks, examines their relationships with ADHD and discusses the likelihood that these risks are causal as well as some of the main implications. RESULTS No single risk factor explains ADHD. Both inherited and noninherited factors contribute and their effects are interdependent. ADHD is familial and heritable. Research into the inherited and molecular genetic contributions to ADHD suggest an important overlap with other neurodevelopmental problems, notably, autism spectrum disorders. Having a biological relative with ADHD, large, rare copy number variants, some small effect size candidate gene variants, extreme early adversity, pre and postnatal exposure to lead and low birth weight/prematurity have been most consistently found as risk factors, but none are yet known to be definitely causal. There is a large literature documenting associations between ADHD and a wide variety of putative environmental risks that can, at present, only be regarded as correlates. Findings from research designs that go beyond simply testing for association are beginning to contest the robustness of some environmental exposures previously thought to be ADHD risk factors. CONCLUSIONS The genetic risks implicated in ADHD generally tend to have small effect sizes or be rare and often increase risk of many other types of psychopathology. Thus, they cannot be used for prediction, genetic testing or diagnostic purposes beyond what is predicted by a family history. There is a need to consider the possibility of parents and siblings being similarly affected and how this might impact on engagement with families, influence interventions and require integration with adult services. Genetic contributions to disorder do not necessarily mean that medications are the treatment of choice. We also consider how findings might influence the conceptualisation of ADHD, public health policy implications and why it is unhelpful and incorrect to dichotomise genetic/biological and environmental explanations. It is essential that practitioners can interpret genetic and aetiological research findings and impart informed explanations to families.
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Affiliation(s)
- Anita Thapar
- Child & Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK.
| | - Miriam Cooper
- Child & Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of MedicineCardiff,MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of MedicineCardiff, UK
| | - Olga Eyre
- Child & Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of MedicineCardiff,MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of MedicineCardiff, UK
| | - Kate Langley
- Child & Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of MedicineCardiff,MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of MedicineCardiff, UK
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Glatz T, Stattin H, Kerr M. Parents' reactions to youths' hyperactivity, impulsivity, and attention problems. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2012; 39:1125-35. [PMID: 21748550 DOI: 10.1007/s10802-011-9541-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hyperactivity, impulsivity, and attention problems (HIA) in children and adolescents are stressful for parents. In this study, we used theories of parents' perceived power and attributions for youths' behaviors to develop a model to understand parents' reactions to their youths' HIA. We followed 706 youths (376 boys and 330 girls, aged 10-12 years at T1) and their parents in a community-based project over 5 years. Measures of youths' HIA, youths' unresponsiveness to correction, parents' feelings of powerlessness, parental monitoring, and parents' negative behaviors toward their youths, were used. HIA in youths predicted increases in parents' perceptions that their youths were unresponsive to correction, which in turn prompted parents to feel more powerless over time. Further, parents' feelings of powerlessness were associated with increases in negative parenting behaviors over time. These results indicate a movement to more negative parenting practices over time as a result of youths' HIA.
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Affiliation(s)
- Terese Glatz
- Center for Developmental Research at JPS, Örebro University, SE-701 82 Örebro, Sweden.
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Cartwright KL, Bitsakou P, Daley D, Gramzow RH, Psychogiou L, Simonoff E, Thompson MJ, Sonuga-Barke EJS. Disentangling child and family influences on maternal expressed emotion toward children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2011; 50:1042-53. [PMID: 21961778 DOI: 10.1016/j.jaac.2011.07.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 06/30/2011] [Accepted: 07/06/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We used multi-level modelling of sibling-pair data to disentangle the influence of proband-specific and more general family influences on maternal expressed emotion (MEE) toward children and adolescents with attention-deficit/hyperactivity disorder (ADHD). METHOD MEE was measured using the Five Minute Speech Sample (FMSS) for 60 sibling pairs (aged 5 through 17 years) each comprising one proband with ADHD and one child without ADHD. Questionnaire measures were used to assess child and adolescent conduct and emotional problems and maternal depression and ADHD. Multi-level models partitioned the effects of five MEE components (initial statement [IS], relationship [REL], warmth [WAR], critical comments [CC], and positive comments [PC]) into proband-specific and general family effects. RESULTS Significant proband-specific effects were confirmed for all MEE components, with higher levels of MEE expressed toward probands with ADHD than siblings without ADHD. For REL, PC, and CC, this effect was explained by comorbid child conduct problems rather than ADHD. Only low WAR was associated with child ADHD itself. Furthermore, only low WAR was related to variations in more general family characteristics, especially levels of maternal depression. CONCLUSIONS MEE toward children with ADHD was influenced by proband-specific factors. For most components, these were driven by comorbid symptoms of conduct problems rather than ADHD itself. WAR was different; it was influenced by both child-specific and more general characteristics of the family. Further studies utilising a longitudinal design are required to establish the direction of causation and extend our understanding of the relationship between EE components and ADHD.
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Affiliation(s)
- Kim L Cartwright
- Institute for Disorders of Impulse and Attention, School of Psychology, University of Southampton, UK
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Lahey BB. Out of the funhouse mirrors: steps toward understanding the role of parenting in maladaptive child development. J Am Acad Child Adolesc Psychiatry 2011; 50:975-7. [PMID: 21961772 DOI: 10.1016/j.jaac.2011.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 06/29/2011] [Indexed: 11/17/2022]
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Screening parents during child evaluations: exploring parent and child psychopathology in the same clinic. J Am Acad Child Adolesc Psychiatry 2011; 50:441-50. [PMID: 21515193 PMCID: PMC3083121 DOI: 10.1016/j.jaac.2011.02.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 01/27/2011] [Accepted: 01/31/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Children of depressed and/or anxious parents are at increased risk for developing psychiatric disorders. Little research has focused on screening parents bringing their children for psychiatric evaluation, and few studies have included fathers or Hispanic children. This study had the following aims: 1) to identify current symptom rates in parents bringing their children for evaluation; and 2) to determine whether parental symptoms were associated with children's symptoms, diagnoses, and functioning. METHOD The sample included 801 mothers, 182 fathers, and 848 children (aged 6 through 17 years). The majority (55.66%) were Hispanic, who attended a child and adolescent psychiatric evaluation service. Parent and child symptoms were assessed via parental reports. Children's diagnoses and functioning were determined by clinicians. Multiple regression analyses were used to determine whether severity of parental symptoms was associated with clinical child variables adjusting for child and parent demographic variables. RESULTS In all, 18.80% of mothers and 18.42% of fathers reported elevated internalizing symptoms. Maternal symptoms were significantly associated with problems in children's functioning and children's anxiety, depression, and oppositional/conduct diagnoses; but not attention-deficit/hyperactivity disorder. Adjusting for parental and child demographics had a reduction on the effect of maternal symptoms on child depression. Paternal symptoms and functioning were positively associated with children's diagnoses, but the associations were smaller and not significant. Both parents' symptoms were significantly associated with children's internalizing and externalizing symptoms. However, these significant effects were not moderated by marital status or child ethnicity. CONCLUSIONS This study highlights the importance of screening parents when their children receive a psychiatric evaluation. The findings support the development of mental health services that address psychiatric needs of the entire family within one clinical setting.
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Healey DM, Flory JD, Miller CJ, Halperin JM. Maternal positive parenting style is associated with better functioning in hyperactive/inattentive preschool children. INFANT AND CHILD DEVELOPMENT 2011. [DOI: 10.1002/icd.682] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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