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Gao T, Yang L, Zhou J, Zhang Y, Wang L, Wang Y, Wang T. Development and validation of a nomogram prediction model for ADHD in children based on individual, family, and social factors. J Affect Disord 2024; 356:483-491. [PMID: 38640979 DOI: 10.1016/j.jad.2024.04.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVES A reliable, user-friendly, and multidimensional prediction tool can help to identify children at high risk for ADHD and facilitate early recognition and family management of ADHD. We aimed to develop and validate a risk nomogram for ADHD in children aged 3-17 years in the United States based on clinical manifestations and complex environments. METHODS A total of 141,356 cases were collected for the prediction model. Another 54,444 cases from a new data set were utilized for performing independent external validation. The LASSO regression was used to control possible variables. A final risk nomogram for ADHD was established based on logistic regression, and the discrimination and calibration of the established nomogram were evaluated by bootstrapping with 1000 resamples. RESULTS A final risk nomogram for ADHD was established based on 13 independent predictors, including behavioral problems, learning disabilities, age, intellectual disabilities, anxiety symptoms, gender, premature birth, maternal age at childbirth, parent-child interaction patterns, etc. The C-index of this model was 0.887 in the training set, and 0.862 in the validation set. Internal and external validation proved that the model was reliable. CONCLUSIONS A nomogram, a statistical prediction tool that assesses individualized ADHD risk for children is helpful for the early identification of children at high risk for ADHD and the construction of a conceptual model of society-family-school collaborative diagnosis, treatment, and management of ADHD.
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Affiliation(s)
- Ting Gao
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou 510623, China
| | - Lan Yang
- Nanfang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Jiayu Zhou
- Department of Neonatology, National Children's Medical Center / Children's Hospital of Fudan University, Shanghai 201102, China
| | - Yu Zhang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou 510623, China; School of Physical Education and Health, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
| | - Laishuan Wang
- Department of Neonatology, National Children's Medical Center / Children's Hospital of Fudan University, Shanghai 201102, China
| | - Yan Wang
- Department of Neurology, Xi 'an Children's Hospital, Shaanxi 710021, China.
| | - Tianwei Wang
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
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Patkar P, Shah H, Sahu S. A mixed-methods study of Indian mothers assessing the effect of the lockdown on the understanding of ADHD in their child and the burden experienced. Ind Psychiatry J 2023; 32:S243-S249. [PMID: 38370930 PMCID: PMC10871433 DOI: 10.4103/ipj.ipj_216_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 07/11/2023] [Accepted: 08/28/2023] [Indexed: 02/20/2024] Open
Abstract
Background Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed developmental disorders and is common among referrals to child guidance clinics. Aim This study aimed to study the impact of the lockdown during the coronavirus disease 2019 (COVID-19) pandemic on the mother's understanding of ADHD and the burden faced by her. Materials and Methods A mixed-methods design with a combination of a qualitative and quantitative approach was adopted. An in-depth in-person semi-structured interview with the participant's mother was conducted. The qualitative and quantitative part of the study consisted of burden assessment by the Zarit Caregiver Burden Scale. The responses were transcribed, and themes were identified. Results As far as understanding the disorder was concerned, the major themes identified were "Knew about the child's problems from teachers but online schooling made me see the child's issues in person" and "Knew about the illness but more time led to bonding and understanding the child." When questioned about the burden faced, the major themes that evolved were "Increased exhaustion taking care of a child 24/7" and "Increased burden as one felt angry and irritated with the child, the school, and the family." The Zarit caregiver questionnaire revealed a statistically significant difference in the burden of care before and after the pandemic, with a greater number of mothers falling in the mild to moderate and severe categories of burden. Conclusion The COVID-19 pandemic increased the caregiver burden for mothers of children with ADHD. Their understanding of their child's disorder increased significantly as they could spend more time and devise different ways and means of helping their child in academics and other areas.
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Affiliation(s)
- Prajakta Patkar
- Department of Psychiatry, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Henal Shah
- Department of Psychiatry, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Samiksha Sahu
- Department of Psychiatry, Gandhi Medical College, Bhopal, Madhya Pradesh, India
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Weyers L, Zemp M, Alpers GW. Impaired Interparental Relationships in Families of Children With Attention-Deficit/Hyperactivity Disorder (ADHD). ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2019. [DOI: 10.1027/2151-2604/a000354] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Abstract. Research on attention-deficit/hyperactivity disorder (ADHD) in children and adolescents has traditionally focused on the genetic and neurobiological aspects of the disorder, but the role of family relationships has been much less systematically examined. There is growing evidence that the quality of interparental relationships and a child’s ADHD symptoms are reciprocally related. Because the literature appears to be inconsistent, this meta-analysis aims to summarize previous research and assess whether there are robust differences in the quality of interparental relationships between parents of children with ADHD and parents of healthy children. This meta-analysis of 15 studies with 43 effect sizes revealed a small but significant difference ( d = .24), which indicates that parents of a child with ADHD report poorer relationship quality than parents of healthy children. This effect was moderated by the child’s age and did not depend on whether the child had a comorbid oppositional defiant disorder (ODD) or conduct disorder (CD). The causality of this relationship has yet to be determined.
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Affiliation(s)
- Lena Weyers
- Department of Psychology, University of Mannheim, Germany
| | - Martina Zemp
- Department of Psychology, University of Mannheim, Germany
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Avrech Bar M, Jlole Majadla S, Bart O. Managing Everyday Occupations as a Predictor of Health and Life Satisfaction Among Mothers of Children With ADHD. J Atten Disord 2018; 22:1008-1016. [PMID: 26341279 DOI: 10.1177/1087054715601211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Raising a child with special needs disturbs the balance of family life and affects mothers' everyday life. The purpose of this study was to assess the contribution of occupational competence, occupational settings, and role load to the health and life satisfaction of Arab mothers of children with and without ADHD. METHOD Participants included 40 Israeli Arab women aged 25 to 40 years. Half were mothers of children with ADHD and half were mothers of children without ADHD. Data were collected by using four self-report questionnaires. RESULTS Occupational competence and occupational settings predicted mothers' mental health and life satisfaction. Having or not having a child with ADHD only reflects a minor contribution. CONCLUSION Enhancing mothers' occupational competence and settings may increase their health and life satisfaction. This study highlights the need to focus on maternal occupational competence and settings as they affect mothers' health and well-being when providing intervention to children with ADHD.
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Zemp M. [The interparental relationship in families with children with ADHD: Interactions between couple distress and child's symptoms]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2017; 46:285-297. [PMID: 29116874 DOI: 10.1024/1422-4917/a000558] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The interparental relationship in families with children with ADHD: Interactions between couple distress and child's symptoms Abstract. The impact of the family in the development and maintenance of childhood ADHD is well established. However, previous research in this field focused largely on parenting and the quality of the parent-child relationship, whereas the role of the interparental relationship has been neglected. This review summarizes the current state of research on the interactions between a couple distress and their child's ADHD and discusses interparental conflict as a risk factor for the development of ADHS-related symptoms. Based on the present knowledge, an integrative model is postulated that assumes an interaction of genetic vulnerability for childhood ADHD and a couple distress. It depicts how distress in the interparental relationship may both directly and indirectly affect the etiology, maintenance, and/or amplification of childhood ADHD-related symptoms, which in turn affect the interparental relationship. The review highlights the significance of relationship distress prevention programs for couples to prevent adjustment problems in children, and the adequate consideration of couple conflict in diagnostics and therapy among families with children with ADHD.
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Affiliation(s)
- Martina Zemp
- 1 Lehrstuhl für Klinische und Biologische Psychologie und Psychotherapie, Juniorprofessur für Kinder- und Jugendlichenpsychotherapie, Universität Mannheim, Mannheim
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6
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Jarnecke AM, South SC, Elkins IJ, Krueger RF, Tully EC, Iacono WG. The role of parental marital discord in the etiology of externalizing problems during childhood and adolescence. Dev Psychopathol 2017; 29:1177-1188. [PMID: 27995815 PMCID: PMC5478482 DOI: 10.1017/s095457941600122x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Previous research has established that parental marital discord is associated with higher levels of offspring externalizing behaviors, but it is unclear how parental relationship functioning is associated with the genetic and environmental variance on a factor of externalizing problems. Thus, the current study assessed how parental marital discord moderates genetic and environmental variance on offspring externalizing problems at two different ages: childhood and late adolescence. That is, the magnitude of genetic and environmental influences on offspring externalizing at ages 11 and 17 was examined as a function of parental marital discord. Consistent with a diathesis-stress model of psychopathology, it was hypothesized that with increasing marital discord, genetic influences on externalizing would be more pronounced. Rather, results indicated that for the 11-year-old sample, nonshared environmental influences were greater when parental marital discord was low, and comparatively, shared environmental influences contributed more to the variance in externalizing problems when parental marital discord was high. No moderation was found for the 17-year-old cohort. In contrast to studies that do not find an effect of the shared environment, these results provide evidence that the common rearing environment has an impact on externalizing problems in preadolescent children.
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Brown NM, Brown SN, Briggs RD, Germán M, Belamarich PF, Oyeku SO. Associations Between Adverse Childhood Experiences and ADHD Diagnosis and Severity. Acad Pediatr 2017; 17:349-355. [PMID: 28477799 DOI: 10.1016/j.acap.2016.08.013] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 08/24/2016] [Accepted: 08/29/2016] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Although identifying adverse childhood experiences (ACEs) among children with behavioral disorders is an important step in providing targeted therapy and support, little is known about the burden of ACEs among children with attention deficit-hyperactivity disorder (ADHD). We described the prevalence of ACEs in children with and without ADHD, and examined associations between ACE type, ACE score, and ADHD diagnosis and severity. METHODS Using the 2011 to 2012 National Survey of Children's Health, we identified children aged 4 to 17 years whose parents indicated presence and severity of ADHD, and their child's exposure to 9 ACEs. Multivariate logistic regression was used to estimate associations between ACEs, ACE score, and parent-reported ADHD and ADHD severity, adjusted for sociodemographic characteristics. RESULTS In our sample (N = 76,227, representing 58,029,495 children), children with ADHD had a higher prevalence of each ACE compared with children without ADHD. Children who experienced socioeconomic hardship (adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.21-1.59), divorce (aOR, 1.34; 95% CI, 1.16-1.55), familial mental illness (aOR, 1.55; 95% CI, 1.26-1.90), neighborhood violence (aOR, 1.47; 95% CI, 1.23-1.75), and incarceration (aOR, 1.39; 95% CI, 1.12-1.72) were more likely to have ADHD. A graded relationship was observed between ACE score and ADHD. Children with ACE scores of 2, 3, and ≥4 were significantly more likely to have moderate to severe ADHD. CONCLUSIONS Children with ADHD have higher ACE exposure compared with children without ADHD. There was a significant association between ACE score, ADHD, and moderate to severe ADHD. Efforts to improve ADHD assessment and management should consider routinely evaluating for ACEs.
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Affiliation(s)
- Nicole M Brown
- Department of Pediatrics, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, NY.
| | - Suzette N Brown
- Department of Pediatrics, Maimonides Infants and Children's Hospital of Brooklyn, NY
| | - Rahil D Briggs
- Department of Pediatrics, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, NY
| | - Miguelina Germán
- Department of Pediatrics, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, NY
| | - Peter F Belamarich
- Department of Pediatrics, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, NY
| | - Suzette O Oyeku
- Department of Pediatrics, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, NY
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8
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Green JL, Rinehart N, Anderson V, Efron D, Nicholson JM, Jongeling B, Hazell P, Sciberras E. Association between autism symptoms and family functioning in children with attention-deficit/hyperactivity disorder: a community-based study. Eur Child Adolesc Psychiatry 2016; 25:1307-1318. [PMID: 27154048 DOI: 10.1007/s00787-016-0861-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 04/25/2016] [Indexed: 12/11/2022]
Abstract
Autism spectrum disorder (ASD) symptoms are elevated in populations of children with attention-deficit/hyperactivity disorder (ADHD). This study examined cross-sectional associations between ASD symptoms and family functioning in children with and without ADHD. Participants were recruited to a longitudinal cohort study, aged 6-10 years (164 ADHD; 198 controls). ADHD cases were ascertained using community-based screening and diagnostic confirmation from a diagnostic interview. ASD symptoms were measured using the Social Communication Questionnaire. Outcome variables were parent mental health, family quality of life (FQoL), couple conflict and support, and parenting behaviours. After adjustment for a range of child and family factors (including other mental health comorbidities), higher ASD symptoms were associated with poorer FQoL across all three domains; emotional impact (p = 0.008), family impact (p = 0.001) and time impact (p = 0.003). In adjusted analyses by subgroup, parents of children with ADHD+ASD had poorer parent self-efficacy (p = 0.01), poorer FQoL (p ≤ 0.05), with weak evidence of an association for less couple support (p = 0.06), compared to parents of children with ADHD only. Inspection of covariates in the adjusted analyses indicated that the association between ASD symptoms and most family functioning measures was accounted forby child internalising and externalising disorders, ADHD severity, and socioeconomic status; however, ASD symptoms appear to be independently associated with poorer FQoL in children with ADHD. The presence of ASD symptoms in children with ADHD may signal the need for enhanced family support.
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Affiliation(s)
- Jessica L Green
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia.
- Murdoch Childrens Research Institute, Parkville, VIC, 3125, Australia.
- Deakin Child Study Centre, School of Psychology, Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia.
| | - Nicole Rinehart
- Murdoch Childrens Research Institute, Parkville, VIC, 3125, Australia
- Deakin Child Study Centre, School of Psychology, Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia
| | - Vicki Anderson
- Murdoch Childrens Research Institute, Parkville, VIC, 3125, Australia
- The Royal Children's Hospital, Parkville, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
| | - Daryl Efron
- Murdoch Childrens Research Institute, Parkville, VIC, 3125, Australia
- The Royal Children's Hospital, Parkville, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
| | - Jan M Nicholson
- Murdoch Childrens Research Institute, Parkville, VIC, 3125, Australia
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
| | - Brad Jongeling
- Child Development Service, Joondalup, WA, Australia
- The University of Western Australia, Perth, WA, Australia
| | - Philip Hazell
- Discipline of Psychiatry, The University of Sydney, Sydney, NSW, Australia
| | - Emma Sciberras
- Murdoch Childrens Research Institute, Parkville, VIC, 3125, Australia
- Deakin Child Study Centre, School of Psychology, Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia
- The Royal Children's Hospital, Parkville, VIC, Australia
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9
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Predictors of Informant Discrepancies Between Mother and Middle School Teacher ADHD Ratings. SCHOOL MENTAL HEALTH 2016; 8:452-460. [PMID: 27980693 DOI: 10.1007/s12310-016-9192-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A diagnosis of attention-deficit/hyperactivity disorder (ADHD) according to the Diagnostic and Statistical Manual, 5th Eldition (DSM-5) is assessed in youth using ratings from both a parent and a teacher. However, individual and contextual differences between informants may lead to discrepancies in these ratings. The purpose of this study was to examine predictors of discrepancies between mother and middle school teacher reports of ADHD symptoms and related impairment. In an ethnically diverse sample of middle school students with well-diagnosed DSM-IV-TR ADHD (N = 112), we examined a range of mother and school setting characteristics that may contribute to informant discrepancies in this population. Hierarchical multiple regression analyses suggested that mothers with higher levels of education and psychopathology (i.e., ADHD symptom severity, parenting stress) may be most likely to report adolescent ADHD symptom severity that is higher than reported by teachers. Reports from general education teachers (vs. special education) were associated with lower symptom severity compared to mothers. Finally, a documented diagnosis of ADHD in the school was predictive of more severe reports from mothers. We discuss explanations for these findings and implications for assessment of middle school students with ADHD.
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10
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Babinski DE, Pelham WE, Molina BSG, Gnagy EM, Waschbusch DA, Wymbs BT, Sibley MH, Derefinko KJ, Kuriyan AB. Maternal ADHD, Parenting, and Psychopathology Among Mothers of Adolescents With ADHD. J Atten Disord 2016; 20:458-68. [PMID: 23160485 PMCID: PMC3582708 DOI: 10.1177/1087054712461688] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study describes the parenting and psychopathology of mothers with ADHD of adolescents with ADHD (MCA), non-ADHD mothers of adolescents with ADHD (CA), and non-ADHD mothers of adolescents without ADHD (COMP). METHOD Two sets of pairwise comparisons: (a) COMP versus CA and (b) CA versus MCA were conducted. We hypothesized that CA would experience greater distress in parenting and psychopathology compared with COMP and that MCA would experience even more impairment compared with CA. RESULTS Few differences emerged in comparisons of CA and COMP, with the exception of CA reporting greater parent-adolescent conflict and internalizing problems. In contrast, differences consistently emerged in comparisons of MCA and CA showing more difficulty for MCA in parenting and psychopathology. CONCLUSION These findings underscore the need for treatments that address parental ADHD when adolescent ADHD is the intended target.
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Affiliation(s)
- Dara E Babinski
- Florida International University, Miami, FL, USA University of Pittsburgh Medical Center, PA, USA
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Wymbs BT, Wymbs FA, Dawson AE. Child ADHD and ODD behavior interacts with parent ADHD symptoms to worsen parenting and interparental communication. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2015; 43:107-19. [PMID: 24882503 DOI: 10.1007/s10802-014-9887-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) in children and adults increases risk of parenting difficulties and interparental discord. However, little is known about whether disruptive child behavior and adult ADHD operate additively or synergistically to predict parenting and interparental relationship quality. As part of a larger study, 90 parent couples were randomly assigned to interact with a 9-12 year-old confederate child exhibiting either ADHD/ODD-like behavior or typical behavior. Before these interactions, parents reported their own ADHD symptoms. Afterwards, parents reported on their partner's parenting and interparental communication behavior. Observers coded the parenting and communication behavior of both partners during the tasks. Child ADHD/ODD-like behavior was found to predict less positive and more negative parenting and communication reported by partners and observers beyond adult ADHD symptoms and other covariates. Elevated adult ADHD symptoms only uniquely increased risk of observer-coded negative parenting. Child and adult ADHD behavior interacted synergistically to predict partner-reported negative parenting and interparental communication, such that parents reporting greater ADHD symptoms-especially inattentiveness-were rated by their partners as parenting and communicating more negatively when managing child ADHD/ODD-like behavior than parents with fewer ADHD symptoms or those managing typical child behavior. Child and adult ADHD behavior did not interact to predict observer-coded parenting or interparental communication, and patterns did not differ for mothers or fathers. Our results underscore the potential risk of parents with elevated ADHD symptoms parenting and communicating negatively, at least as perceived by their partners, during interactions with children exhibiting ADHD/ODD behavior.
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Affiliation(s)
- Brian T Wymbs
- Department of Psychology, Ohio University, Porter Hall, Athens, OH, 45701, USA,
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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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Nikolas MA, Klump KL, Burt SA. Parental involvement moderates etiological influences on attention deficit hyperactivity disorder behaviors in child twins. Child Dev 2014; 86:224-40. [PMID: 25263271 DOI: 10.1111/cdev.12296] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although few would now contest the presence of Gene × Environment (G × E) effects in the development of child psychopathology, it remains unclear how these effects manifest themselves. Alternative G × E models have been proposed (i.e., diathesis-stress, differential susceptibility, bioecological), each of which has notably different implications for etiology. Child twin studies present a powerful tool for discriminating between these models. The current study examined whether and how parental involvement moderated etiological influences on attention deficit hyperactivity disorder (ADHD) within 500 twin pairs aged 6-11 years. Results indicated moderation of genetic and nonshared environmental contributions to ADHD by parental involvement, and moreover, suggested both differential susceptibility and bioecological models of G × E. Results highlight the utility of child twin samples in testing different manifestations of G × E effects.
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McConnell D, Savage A, Breitkreuz R. Resilience in families raising children with disabilities and behavior problems. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:833-848. [PMID: 24491480 DOI: 10.1016/j.ridd.2014.01.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/06/2014] [Accepted: 01/09/2014] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to investigate the resilience displayed by families raising children with disabilities and behavior problems. The question is why do some families do well when others, exposed to similar stressors, struggle to keep their family life running? A stratified (by child age group) random sample of 538 families raising children with disabilities in Alberta, Canada took part. Participants completed the Family Life Survey, which incorporated measures of child behavior problems, social-ecological resources and family-level 'outcomes'. Families raising children with disabilities and behavior problems 'do well' under conditions of high social support and low financial hardship. In contrast, families with low levels of social support and high levels of financial hardship typically struggle, even when the number or intensity of child behavior problems is low. The study findings are consistent with the view that 'resilience' has more to do with the availability and accessibility of culturally relevant resources than with intrinsic, individual or family factors. With respect to family-level outcomes, strengthening social relationships and ameliorating financial hardship may be more important than behavior modification.
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Affiliation(s)
- David McConnell
- Family and Disability Studies Initiative, Occupational Therapy, Rehabilitation Medicine, University of Alberta, 3-66 Corbett Hall, Edmonton, AB, Canada T6G 2G4.
| | - Amber Savage
- Family and Disability Studies Initiative, Occupational Therapy, Rehabilitation Medicine, University of Alberta, 3-66 Corbett Hall, Edmonton, AB, Canada T6G 2G4.
| | - Rhonda Breitkreuz
- Gender, Family, & Policy Studies, Human Ecology, University of Alberta, 330 Human Ecology, Edmonton, AB, Canada T6G 2N1.
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Abstract
The current study explored longitudinal associations between interparental aggression, the development of child attention skills, and early childhood behavior problems in a diverse sample of 636 families living in predominately low-income, nonmetropolitan communities. The results of latent-variable, cross-lagged longitudinal models revealed that maternal-reported interparental aggression in infancy predicted reduced observed attention skills in toddlerhood; no association was observed, however, between attention in infancy and interparental aggression during the toddler years. Further, reduced toddler attention and high interparental aggression were both associated with increased risk for attention-deficit/hyperactivity disorder symptoms and conduct problems at 3 years of age. Processes largely operated in similar ways regardless of child gender or low-income status, although a few differences were observed. Overall, the results suggest that interparental aggression undermines attention development, putting children's early behavioral adjustment at risk.
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Evans SW, Owens JS, Bunford N. Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2013; 43:527-51. [PMID: 24245813 PMCID: PMC4025987 DOI: 10.1080/15374416.2013.850700] [Citation(s) in RCA: 274] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this research was to update the Pelham and Fabiano ( 2008 ) review of evidence-based practices for children and adolescents with attention-deficit/hyperactivity disorder. We completed a systematic review of the literature published between 2007 and 2013 to establish levels of evidence for psychosocial treatments for these youth. Our review included the identification of relevant articles using criteria established by the Society of Clinical Child and Adolescent Psychology (see Southam-Gerow & Prinstein, in press ) using keyword searches and a review of tables of contents. We extend the conceptualization of treatment research by differentiating training interventions from behavior management and by reviewing the growing literature on training interventions. Consistent with the results of the previous review we conclude that behavioral parent training, behavioral classroom management, and behavioral peer interventions are well-established treatments. In addition, organization training met the criteria for a well-established treatment. Combined training programs met criteria for Level 2 (Probably Efficacious), neurofeedback training met criteria for Level 3 (Possibly Efficacious), and cognitive training met criteria for Level 4 (Experimental Treatments). The distinction between behavior management and training interventions provides a method for considering meaningful differences in the methods and possible mechanisms of action for treatments for these youth. Characteristics of treatments, participants, and measures, as well as the variability in methods for classifying levels of evidence for treatments, are reviewed in relation to their potential effect on outcomes and conclusions about treatments. Implications of these findings for future science and practice are discussed.
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Hagan MJ, Roubinov DS, Purdom Marreiro CL, Luecken LJ. Childhood interparental conflict and HPA axis activity in young adulthood: Examining nonlinear relations. Dev Psychobiol 2013; 56:871-80. [DOI: 10.1002/dev.21157] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 07/18/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Melissa J. Hagan
- Department of Psychology; Arizona State University; Tempe Arizona 85287
| | | | | | - Linda J. Luecken
- Department of Psychology; Arizona State University; Tempe Arizona 85287
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Wymbs B, Molina B, Pelham W, Cheong J, Gnagy E, Belendiuk K, Walther C, Babinski D, Waschbusch D. Risk of intimate partner violence among young adult males with childhood ADHD. J Atten Disord 2012; 16:373-83. [PMID: 22044962 PMCID: PMC3272093 DOI: 10.1177/1087054710389987] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Research has clearly documented the social dysfunction of youth with ADHD. However, little is known about the interpersonal relationships of adults diagnosed with ADHD in childhood, including rates of intimate partner violence (IPV). METHOD Using data from the Pittsburgh ADHD Longitudinal Study, analyses compared the level of IPV (verbal aggression, violence) reported by young adult (18- to 25-year-old) males with childhood ADHD (n = 125) with reports by demographically similar males without ADHD histories (n = 88). RESULTS Males with childhood ADHD, especially those with conduct problems persisting from childhood, were more likely to be verbally aggressive and violent with romantic partners than males without histories of ADHD or conduct problems. CONCLUSIONS Research is needed to replicate these findings, to explore potential mechanisms, and to develop effective interventions for romantic relationship discord among young adults with ADHD histories, especially those with persistent conduct problems.
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Affiliation(s)
- Brian Wymbs
- Seattle Children's Research Institute, Seattle, WA 98101, USA.
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Nikolas M, Klump KL, Burt SA. Youth appraisals of inter-parental conflict and genetic and environmental contributions to attention-deficit hyperactivity disorder: examination of GxE effects in a twin sample. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2012; 40:543-54. [PMID: 22006350 DOI: 10.1007/s10802-011-9583-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Identification of gene x environment interactions (GxE) for attention-deficit hyperactivity disorder (ADHD) is a crucial component to understanding the mechanisms underpinning the disorder, as prior work indicates large genetic influences and numerous environmental risk factors. Building on prior research, children's appraisals of self-blame were examined as a psychosocial moderator of latent etiological influences on ADHD via biometric twin models, which provide an omnibus test of GxE while managing the potential confound of gene-environment correlation. Participants were 246 twin pairs (total n = 492) ages 6-16 years. ADHD behaviors were assessed via mother report on the Child Behavior Checklist. To assess level of self-blame, each twin completed the Children's Perception of Inter-parental Conflict scale. Two biometric GxE models were fit to the data. The first model revealed a significant decrease in genetic effects and a significant increase in unique environmental influences on ADHD with increasing levels of self-blame. These results generally persisted even after controlling for confounding effects due to gene-environment correlation in the second model. Results suggest that appraisals of self-blame in relation to inter-parental conflict may act as a key moderator of etiological contributions to ADHD.
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Affiliation(s)
- Molly Nikolas
- Department of Psychology, University of Iowa, Iowa City, IA 52242, USA.
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Walther CAP, Cheong J, Molina BSG, Pelham WE, Wymbs BT, Belendiuk KA, Pedersen SL. Substance use and delinquency among adolescents with childhood ADHD: the protective role of parenting. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2012; 26:585-98. [PMID: 22329747 DOI: 10.1037/a0026818] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Several domains of parenting have been identified as important for adolescent well-being. Whether these same domains are equally beneficial for adolescents with ADHD histories remains an empirical and clinically important question. This study examined whether parental knowledge of their teen's activities and whereabouts, consistency, support, and parent-adolescent conflict are associated with substance use and delinquency similarly for adolescents with and without a diagnosis of ADHD in childhood. A sample of 242 adolescents, 142 diagnosed with ADHD in childhood and prospectively followed into adolescence, and 100 without ADHD in childhood, were the focus of study. The relations between adolescent-reported outcomes (i.e., substance use and delinquency) and parenting behaviors were tested using latent variable modeling to determine both the effects of general (common) and specific (unique) parenting behaviors for participants with and without a history of ADHD. Adolescents' report of parental knowledge was a significant correlate of delinquency and substance use above and beyond other parenting variables and the variance in common across the parenting variables. More knowledge was associated with less delinquency and substance use for all participants, but parental knowledge was more strongly associated with alcohol use for adolescents with versus without childhood ADHD. These correlational findings suggest that, despite the increased difficulty of parenting youths with ADHD histories, actions taken by parents and youth to increase parental awareness may provide some protection against behavioral transgressions known to be elevated in this population.
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Cussen A, Sciberras E, Ukoumunne OC, Efron D. Relationship between symptoms of attention-deficit/hyperactivity disorder and family functioning: a community-based study. Eur J Pediatr 2012; 171:271-80. [PMID: 21743986 DOI: 10.1007/s00431-011-1524-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 06/22/2011] [Indexed: 02/04/2023]
Abstract
UNLABELLED This study examined the relationship between family functioning and attention-deficit/hyperactivity disorder (ADHD) symptoms in an Australian community-based sample. Children were screened for ADHD in their second year of formal schooling. Two hundred and two (202) primary caregivers completed validated measures of family quality of life (QoL), parent mental health, parenting styles and parental relationship quality. Compared with controls, parents of children screening positive for ADHD reported poorer family QoL in the domains of emotional impact (mean difference [MD] -20.1; 95% CI -38.2 to -1.9, p = 0.03) and impact on family activities (MD -17.2; 95% CI -27.9 to -6.5, p = 0.002), less parental warmth (MD -3.4; 95% CI -6.0 to -0.9, p = 0.01) and higher parental depression (MD 6.8; 95% CI 1.8 to 11.7, p = 0.009) and anxiety (MD 6.2; 95% CI 1.7 to 10.6, p = 0.008) after adjusting for socio-demographic characteristics and child conduct symptoms. Parents of children screening positive for ADHD reported higher stress (MD 4.5; 95% CI 1.2 to 7.1, p = 0.007) and more inconsistent (MD 3.0; 95% CI 1.2 to 4.8, p = 0.002) and hostile (MD = 2.2; 95% CI 1.0 to 3.4, p = 0.001) parenting after adjusting for socio-demographic factors only. No difference in parental relationship quality and parental inductive reasoning was identified. CONCLUSION These findings suggest a strong association between poor family functioning and ADHD symptoms and carry implications for comprehensive ADHD management and the importance of seeing the child within the family context.
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Affiliation(s)
- Alexandra Cussen
- Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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Martel MM, Nikolas M, Jernigan K, Friderici K, Waldman I, Nigg JT. The dopamine receptor D4 gene (DRD4) moderates family environmental effects on ADHD. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2011; 39:1-10. [PMID: 20644990 PMCID: PMC4306231 DOI: 10.1007/s10802-010-9439-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is a prime candidate for exploration of gene-by-environment interaction (i.e., G x E), particularly in relation to dopamine system genes, due to strong evidence that dopamine systems are dysregulated in the disorder. Using a G x E design, we examined whether the DRD4 promoter 120-bp tandem repeat polymorphism, previously associated with ADHD, moderated the effects of inconsistent parenting and marital conflict on ADHD or Oppositional-Defiant Disorder (ODD). Participants were 548 children with ADHD and non-ADHD comparison children and their parents. Homozygosity for the DRD4 promoter 120-bp tandem repeat insertion allele increased vulnerability for ADHD and ODD only in the presence of inconsistent parenting and appeared to increase susceptibility to the influence of increased child self-blame for marital conflict on ADHD inattention. DRD4 genotypes may interact with these proximal family environmental risk factors by increasing the individual's responsivity to environmental contingencies.
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Affiliation(s)
- Michelle M Martel
- Psychology Department, University of New Orleans, 2000 Lakeshore Drive; 2005 Geology & Psychology Building, New Orleans, LA 70148, USA.
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Heinrichs N, Cronrath AL, Degen M, Snyder DK. The link between child emotional and behavioral problems and couple functioning. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/19424620.2010.569366] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wymbs BT, Pelham WE. Child effects on communication between parents of youth with and without attention-deficit/hyperactivity disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2010; 119:366-375. [PMID: 20455609 PMCID: PMC2976593 DOI: 10.1037/a0019034] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Numerous studies indicate interparental conflict causes child externalizing behavior. However, far less is known about the inverse relationship. Exploring this gap in the literature has clear implications for parents of children with externalizing disorders (e.g., attention-deficit/hyperactivity disorder [ADHD]). Adapting an experimental child behavior manipulation paradigm (Lang, Pelham, Atkeson, & Murphy, 1999; Pelham et al., 1997, 1998), parent couples of 9- to 12-year-old boys and girls with ADHD (n = 51) and without ADHD (n = 39) were randomly assigned to interact with a "disruptive" or "typical" confederate child. According to parent and observer ratings, parents interacting with disruptive confederates communicated less positively and more negatively with each other during and after the interactions than did parents who interacted with typical confederates. Observational coding also indicated that child effects on negative interparental communication were more noticeable among parents of youth with ADHD, particularly those with comorbid oppositional defiant disorder or conduct disorder, compared with parents of youth without ADHD. These findings extend results of prospective studies highlighting child effects on marital quality.
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Affiliation(s)
- Brian T Wymbs
- Department of Psychology, University at Buffalo, State University of New York
| | - William E Pelham
- Department of Psychology, University at Buffalo, State University of New York
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Nikolas M, Friderici K, Waldman I, Jernigan K, Nigg JT. Gene x environment interactions for ADHD: synergistic effect of 5HTTLPR genotype and youth appraisals of inter-parental conflict. Behav Brain Funct 2010; 6:23. [PMID: 20398347 PMCID: PMC2865439 DOI: 10.1186/1744-9081-6-23] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 04/16/2010] [Indexed: 12/31/2022] Open
Abstract
Background Serotonin genes have been hypothesized to play a role in the etiology of attention-deficit hyperactivity disorder (ADHD); prior work suggests that serotonin may interact with psychosocial stressors in ADHD, perhaps via mechanisms involved in emotional dysregulation. Because the development of behavioral and emotional regulation depends heavily both on the child's experience within the family context and the child's construals of that experience, children's appraisals of inter-parental conflict are a compelling candidate potentiator of the effects of variation within the serotonin transporter gene promoter polymorphism (5HTTLPR) on liability for ADHD. Method 304 youth from the local community underwent a multi-informant diagnostic assessment procedure to identify ADHD cases and non-ADHD controls. Youth also completed the Children's Perception of Inter-Parental Conflict (CPIC) scale to assess appraisals of self-blame in relation to their parents' marital disputes. The trialleic configuration of 5HTTLPR (long/short polymorphism with A> G substitution) was genotyped and participants were assigned as having high (La/La N = 78), intermediate (La/Lg, La/short, N = 137), or low (Lg/Lg, Lg/short, short/short, N = 89) serotonin transporter activity genotypes. Teacher reported behavior problems were examined as the target outcome to avoid informant overlap for moderator and outcome measures. Results Hierarchical linear regression analyses indicated significant 5HTTLPR × self-blame interactions for ADHD symptoms. Examination of the interactions indicated positive relations between reports of self-blame and ADHD symptoms for those with the high and low serotonin activity genotypes. There was no relation between self-blame and ADHD for those with intermediate activity 5HTTLPR genotypes. Conclusion Both high and low serotonergic activity may exert risk for ADHD when coupled with psychosocial distress such as children's self-blame in relation to inter-parental conflict. Results are discussed in relation to the role of serotonin in the etiology of the ADHD and related externalizing behaviors.
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Affiliation(s)
- Molly Nikolas
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA.
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A systematic review of parenting in relation to the development of comorbidities and functional impairments in children with attention-deficit/hyperactivity disorder (ADHD). Child Psychiatry Hum Dev 2010; 41:168-92. [PMID: 19768532 DOI: 10.1007/s10578-009-0159-4] [Citation(s) in RCA: 239] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Accepted: 08/31/2009] [Indexed: 10/20/2022]
Abstract
This review synthesizes recent research evidence regarding the parenting characteristics associated with families with children with Attention-Deficit/Hyperactivity Disorder (ADHD). ADHD is a complex, heterogeneous disorder with a range of genetic and environmental factors that contribute to its behavioral expression and different developmental trajectories. The current review adopts a developmental psychopathology perspective to conceptualize the risk and protective factors that might shape the developmental pathways of the disorder across different domains. Following from Johnston and Mash's review (Johnston and Mash, Clin Child Fam Psychol Rev 4:183-207, 2001), the present review systematically examines empirical studies from 2000-2008 that investigate parenting variables in relation to the development of children with ADHD, with a particular focus on the development of externalizing and internalizing comorbidities, as well as functional impairments in academic and social contexts. The most recent research evidence uses correlational designs to show that ADHD is associated with problematic family functioning, including greater stress within the family, higher rates of parental psychopathology and conflicted parent-child relationships, which appears to be exacerbated in children with comorbid oppositional and conduct problems. However, there is an absence of literature that considers the role that parents play in contributing to children's development in areas such as academic achievement and peer competence, as well as the development of internalizing difficulties. Future research should examine family factors that are associated with resilience in children with ADHD, using longitudinal designs that reflect the dynamic changes associated with a developmental psychopathology framework.
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Nigg JT, Nikolas M, Miller T, Burt SA, Klump KL, von Eye A. Factor structure of the Children's Perception of Interparental Conflict Scale for studies of youths with externalizing behavior problems. Psychol Assess 2009; 21:450-6. [PMID: 19719356 DOI: 10.1037/a0016564] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The assessment of children's perception of marital conflict is an important area of research related to family relations, children's cognitions about self, and the development of psychopathology. The leading instrument in this domain is the Children's Perception of Interparental Conflict Scale (CPIC; J. H. Grych, M. Seid, & F. D. Fincham, 1992). It has 48 items organized into 9 conceptual designed subscales, with reports of 3-factor higher order structure to the 9 subscales. However, the 3-factor solution does not capture all 9 subscales well. Further, items have never been subjected to factor analysis to evaluate the best fitting factor structure at the item level. Doing so is particularly important when bringing the scale into new populations such as children with attention-deficit/hyperactivity disorder (ADHD) or disruptive behavior disorders. In the present study, 2 samples of children (total N = 1,190; ages 6-18 years) completed the CPIC. An exploratory factor analysis in Sample 1 (from a clinical study of ADHD and non-ADHD youths) yielded 4 interpretable factors. A confirmatory factor analysis in Sample 2 (a population sample of twins) confirmed the generalizability of the solution with an acceptable fit, although 1 item was dropped. The final solution used 38 of the 48 items. The 4-factor solution captured a Conflict Properties factor, two appraisal factors labeled Threat to Self and Self-Blame, and a Triangulation/Stability factor that included elements of appraisal and content. The authors concluded that the item-based 4-factor solution to the CPIC is preferable to the 9-factor or 3-factor formulation.
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Affiliation(s)
- Joel T Nigg
- Department of Psychology, Michigan State University, USA.
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Wymbs BT, Pelham WE, Molina BSG, Gnagy EM, Wilson TK, Greenhouse JB. Rate and predictors of divorce among parents of youths with ADHD. J Consult Clin Psychol 2008; 76:735-44. [PMID: 18837591 PMCID: PMC2631569 DOI: 10.1037/a0012719] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Numerous studies have asserted the prevalence of marital conflict among families of children with attention-deficit/hyperactivity disorder (ADHD), but evidence is surprisingly less convincing regarding whether parents of youths with ADHD are more at risk for divorce than are parents of children without ADHD. Using survival analyses, the authors compared the rate of marital dissolution between parents of adolescents and young adults with and without ADHD. Results indicated that parents of youths diagnosed with ADHD in childhood (n = 282) were more likely to divorce and had a shorter latency to divorce compared with parents of children without ADHD (n = 206). Among a subset of those families of youths with ADHD, prospective analyses indicated that maternal and paternal education level; paternal antisocial behavior; and child age, race/ethnicity, and oppositional-defiant/conduct problems each uniquely predicted the timing of divorce between parents of youths with ADHD. These data underscore how parent and child variables likely interact to exacerbate marital discord and, ultimately, dissolution among families of children diagnosed with ADHD.
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Affiliation(s)
- Brian T Wymbs
- Center for Children and Families, University at Buffalo, State University of New York, NY, USA.
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