Mothers' Attributions for Behavior in Nonproblem Boys, Boys With Attention Deficit Hyperactivity Disorder, and Boys With Attention Deficit Hyperactivity Disorder and Oppositional Defiant Behavior

Non-pharmacological treatment of Attention Deficit Disorder with or without Hyperactivity (ADHD). Overview and report of the first international symposium on the non-pharmacological management of ADHD

Attention Deficit Disorder with or without Hyperactivity (ADHD is a neurodevelopmental disorder which affects the day-to-day functioning of children and adults with this condition. Pharmacological treatment can reduce the symptoms associated with ADHD, but it has some limitations. The objective of this symposium is to determine the effects of non-pharmacological approaches on ADHD symptoms. Results indicate that the following intervention are promising approaches: cognitive behavioral therapy (CBT), mindfulness-based interventions (MBI), yoga, cognitive and metacognitive intervention, neurofeedback and parental training programs. Current research advocates multimodal approaches in conjunction with school or work accommodations integrating innovative technologies.

Predictors and Moderators Two Treatments of Oppositional Defiant Disorder in Children

OBJECTIVE

The aim of this study was to examine predictors and moderators of behavioral improvement in children with Oppositional Defiant Disorder (ODD) following treatment with Parent Management Training (PMT) and Collaborative and Proactive Solutions (CPS). Initial problem severity, inconsistent discipline, parental attributions of child misbehavior, and child lagging cognitive skills were examined.

METHOD

One hundred and forty-five children aged between 7 and 14 (103 males, M = 8.88 years, ethnicity representative of the wider Australian population) were randomly assigned to PMT and CPS. Assessment was conducted at baseline, post-intervention, and at 6-month follow-up, using independently rated semi-structured diagnostic interviews and parent-ratings of ODD symptoms. Using an intent-to-treat sample in this secondary analysis (Murrihy et al., 2022), linear regressions and PROCESS (Hayes, 2017) were used to examine these predictors and possible moderators of treatment.

RESULTS

Higher pre-treatment levels of conduct problems, lagging skills, and inconsistent discipline predicted poorer behavioral outcomes following both treatments. The only characteristic that moderated treatment outcome was child-responsible attributions - mothers who were more likely to attribute their child's problematic behaviors to factors in the child had significantly poorer outcomes in PMT than CPS at 6-month follow-up.

CONCLUSIONS

CPS may be a more beneficial treatment than PMT for families who have been identified as having higher levels of child-responsible attributions before commencing treatment for ODD. While tentative, this provides promising insights as to how treatment outcomes for children with ODD may be improved.

Parental Attributions in Ethnocultural Minority, Immigrant, and Country of Origin Parents: A Scoping Review and Call for Research

OBJECTIVE

Maladaptive parental attributions for their children's behavior have been linked to poorer parenting skills, heightened child internalizing and externalizing difficulties, and parents' less willingness to engage in treatment. Although most parental attributions research has been focused on White or European-origin parents, attention has recently turned to ethnic and cultural groups that are underrepresented literature. The present scoping review synthesized existing work on parental attributions among ethnocultural minority and immigrant parents in an adopted country and parents residing in their native non-Western country of origin.

METHOD

A systematic search of five databases was conducted for literature published up to and including the last week of December 2020. Title and abstract screening, then full-text screening, identified 18 records for inclusion in the review.

RESULTS

Although descriptive, single-culture studies showed that maladaptive parental attributions were associated with poorer parenting and child outcomes across cultures, studies comparing ethnocultural groups demonstrated differences in parental attributions across groups.

CONCLUSIONS

Despite the rise in and importance of literature on parental attributions, these results point to a limited scope in understanding parental attributions of ethnocultural minority, immigrant, and country of origin parents. Gaps identified in the literature point to promising future research directions, and a call is made for culturally sensitive parental attribution measures.

Transdiagnostic Associations Among Parental Causal Locus Attributions, Child Behavior and Psychosocial Treatment Outcomes: A Systematic Review

Parents' interpretations of the cause of their children's behavior, i.e., parental attributions, are linked to parenting behavior and child development. However, it is not yet known whether parental attributions are systematically associated with children's internalizing and externalizing symptoms and behavior or psychosocial treatment engagement and outcomes across diagnostic categories. This systematic review aimed to fill this knowledge gap using a transdiagnostic perspective to synthesize the literature on the associations between parent-causal and child-responsible attributions and children's internalizing and externalizing behavior, treatment engagement, and treatment outcomes for parents and children. A total of 67 studies were identified. Overall, biased child-responsible attributions were associated with elevated child internalizing and externalizing symptoms and behavior across diagnoses, while findings on the association between parent-causal attributions and child behavior were inconsistent. The link between parental attributions and treatment engagement was also mixed, varying across treatment type, child diagnosis, and focus of attributions. Regarding treatment outcomes, less biased parent-causal and child-responsible attributions were linked to post-treatment improvements in children's behaviors, while mixed findings were reported on post-treatment improvements in parental attributions. Findings are discussed with a focus on approaches to enhance the effectiveness of assessment and psychosocial treatment approaches across diagnostic categories with consideration of parental attributions.

How Do Mothers' Parental Attributions Affect Child Outcomes from a Positive Parenting Intervention? A Mediation Study

Problematic parental attributions refer to negative causal explanations for child problem behaviour and are known to predict parenting intervention outcomes. This study examines alternative accounts of how mothers' problematic parental attributions, operationalised as negative pre-treatment and change resistant parental attributions during treatment, may affect child behaviour outcomes from a parenting intervention program. Putative mediators included parental feelings about the child and use of harsh discipline. Participants were 163 families with children aged from 3 to 16 referred to specialist clinics for the treatment of conduct problems. Measures were collected as part of pre-treatment, post-treatment, and 3-month follow-up assessments. Mothers' pre-treatment and change resistant parental attributions were associated with smaller improvements in parental feelings at the end of treatment which in turn were associated with greater use of harsh discipline. Greater use of harsh discipline was associated with greater conduct problems overall. Smaller improvements in parental feelings mediated the effects of pre-treatment and change resistant parental attributions on outcomes in mothers' use of harsh discipline and mediated the effects of change resistant parental attributions on outcomes in child conduct problems. Smaller improvements in parental feelings about the child may act as a mechanism that explains the impact of problematic parental attributions on treatment outcomes.

Improved Parent Cognitions Relate to Immediate and Follow-Up Treatment Outcomes for Children With ADHD-Predominantly Inattentive Presentation

We investigated treatment effects on parenting self-efficacy and parent cognitive errors, and whether these parent cognitions are related to short- and long-term outcomes in parenting behaviors in psychosocial treatment for youth with attention-deficit/hyperactivity disorder, predominantly inattentive presentation (ADHD-I). In a randomized controlled trial across two sites (University of California, San Francisco, and University of California, Berkeley), 199 children between the ages of 7 and 11 were randomized to the Child Life and Attention Skills (CLAS; n = 74) program, parent-focused treatment (PFT; n = 74), or treatment as usual (TAU; n = 51). Parents reported on self-efficacy, cognitive errors, positive parenting, and negative parenting prior to treatment, immediately after treatment, and in the next school year at follow-up. Compared to TAU, CLAS and PFT had higher posttreatment parenting self-efficacy, and CLAS alone had lower posttreatment parent cognitive errors. At follow-up, only CLAS had improved parent cognitive errors compared to TAU. No other between-group differences were found in parenting self-efficacy or cognitive errors. Improved parenting self-efficacy was associated with improved posttreatment negative parenting outcomes for PFT and CLAS, and improved parent cognitive errors were also related to improvements in positive and negative posttreatment parenting outcomes for CLAS. Posttreatment parenting self-efficacy mediated follow-up negative parenting outcomes for CLAS and posttreatment parent cognitive errors mediated improved follow-up positive and negative parenting outcomes for CLAS. PFT and CLAS led to enhanced parenting self-efficacy, and CLAS appears especially robust in improving parent cognitive errors both in the short and long term. Pathways provide support for the possibility of parent cognitions as mediators of treatment effects on parenting; clinical focus on such cognitions may be useful.

Knowledge and Attitude of Parents of Children With Attention Deficit Hyperactivity Disorder Towards the Illness

Background

The knowledge and attitude of parents about attention deficit hyperactivity disorder (ADHD) is a public health issue in which management and rehabilitation approaches may be influenced.

Objectives

The current study aimed to evaluate the knowledge and attitude of the parents of children with ADHD towards this disorder in Tabriz, Iran.

Materials and Methods

The current cross-sectional study evaluated 295 parents of children and adolescents with ADHD referred to psychiatric clinics of Tabriz University of Medical Sciences. The subjects were diagnosed based on Kiddie schedule for affective disorders and schizophrenia for school-aged children (K-SADS) and recruited according to a convenience sampling method in the first five months of 2014. The parents’ knowledge and attitude towards ADHD was studied by a researcher-made questionnaire.

Results

The overall knowledge of parents was 66% in which 76.72% were aware of related signs and symptoms and 43.38% were able to identify the aberrations. Meanwhile, 44.62% of the parents knew the etiology and 54.75% had information about treatment strategies. In addition, 33.55%, 37.91%, 25.52% were aware of ADHD consequences, diagnosis and prevalence dimensions, respectively. Moreover, 82.72% of the parents had a positive attitude towards ADHD. A positive correlation was found between parents’ attitude towards ADHD and their overall knowledge (identification, etiology, treatment, consequences and prevalence dimensions), ranging from 0.12 to 0.36 (P < 0.50). Age, gender, and place of residence did not have a correlation with parents’ knowledge and attitude towards ADHD. Parent’s education level only had a positive correlation with the knowledge of symptoms, with a value of 0.19 (P < 0.01). Parents with a higher overall knowledge, knowledge of ADHD symptoms, and prevalence rates accepted combination therapy (P < 0.05).

Conclusions

While the overall knowledge of parents regarding ADHD was favorable, they were mostly unable to identify the aberrations in children with ADHD. These results may help practitioners address pitfalls in parent management training programs.

The Development of Comorbid Conduct Problems in Children With ADHD: An Example of an Integrative Developmental Psychopathology Perspective

OBJECTIVE

We describe interactions among factors that contribute to the development of conduct problems among children with ADHD.

METHOD

An integrative developmental psychopathology analysis combines various approaches and posits one model of how diverse risk factors operate together to contribute to the development of conduct problems among children with ADHD.

RESULTS

Substantial genetic risk increases covariation between ADHD and conduct problems. Candidate genes are associated with CNS monoaminergic neurotransmission. Subsequent neurodevelopmental impairment interferes with executive function, with impaired verbal working memory playing an important role. Parent/child bi-directional influences exacerbate the risk for conduct problems when ADHD symptoms increase the likelihood of a coercive parenting style. Parent stress in reaction to child comorbid ADHD and conduct problems, and parent attribution for the child's conduct problem behavior, add to the potential for coercion and reduce constructive parent-child interaction that might otherwise enhance the development of verbal working memory.

CONCLUSION

In an integrated manner, these variables increase the risk that a child with ADHD will subsequently develop conduct problems.

The negative attribution processes of mothers of children with attention deficit/hyperactivity disorder

The objective of this study was to investigate the attribution processes of mothers regarding children's prosocial behaviors, inattention, and hyperactivity/impulsivity (symptoms of attention deficit/hyperactivity disorder, ADHD) using two paradigms. The first paradigm involved multidimensional attributions. The second paradigm concerned making attributions of children's identical behaviors based on information such as consensus, distinctiveness, and consistency. The participants were 64 mothers of children with ADHD (7-13 years old) and 64 mothers with typical/normal children (7-12 years old). The results showed that mothers of typical children exhibited positive attribution styles or person attributions whereas mothers of children with ADHD exhibited negative attribution styles. Mothers of children with ADHD tended to make personal attributions of children's negative behaviors (e.g., inattention and hyperactivity/impulsivity; HI) but made situational attributions of prosocial behaviors. The results of this study can be used in future studies of the effects of intervention on children with ADHD or in studies related to neurophysiology.

The effects of parental depressive symptoms, appraisals, and physical punishment on later child externalizing behavior

Examined a cognitive-behavioral pathway by which depressive symptoms in mothers and fathers increase risk for later child externalizing problem behavior via parents' appraisals of child behavior and physical discipline. Participants were 245 children (118 girls) at risk for school-age conduct problems, and their parents and teachers. Children were approximately 3 years old at Time 1 (T1) and 5 ½ years old at Time 2 (T2). At T1, mothers and fathers reported their depressive symptoms, perceptions of their child's reciprocal affection and responsiveness, frequency of physical punishment, and child externalizing problems. Mothers, fathers, and teachers provided ratings of externalizing behavior at T2. Structural equation modeling revealed that parents' negative attributions mediated positive relations between their depressive symptoms and frequency of physical punishment for both fathers and mothers. More frequent physical punishment, in turn, predicted increased child externalizing behavior at T2. In future research, transactional mechanisms underlying effects of clinical depression on child conduct problems should be explored at multiple stages of development. For parents showing depressive symptoms, restructuring distorted perceptions about their children's behavior may be an important component of intervention programs.

Parents' reactions to youths' hyperactivity, impulsivity, and attention problems

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.

Parenting cognitions and treatment beliefs as predictors of experience using behavioral parenting strategies in families of children with attention-deficit/hyperactivity disorder

We tested a model of mothers' parenting efficacy and attributions for child ADHD behaviors as predictors of experiences with behavioral treatment. The model proposed that mothers' beliefs regarding the acceptability and effectiveness of behavioral strategies would intervene between mothers' cognitions about parenting and child behavior and their treatment experiences. Participants were 101 mothers of 5- to 10-year-old children (82% male) with ADHD. Mothers reported their parenting efficacy and attributions for child behavior, and then received a single session of treatment teaching 2 behavior management strategies. Then, mothers reported their beliefs regarding the acceptability and effectiveness of these strategies. A follow-up phone interview 1 week later assessed mothers' experiences in using the behavioral strategies. The overall model fit the data. Attributions of child ADHD behavior as more pervasive, enduring, and within the child's control were related to seeing behavioral treatment as more acceptable, but neither attributions nor treatment acceptability predicted treatment experience. However, mothers with higher parenting efficacy viewed the behavioral strategies as more likely to be effective, and this pathway significantly predicted positive treatment experience. Implications for understanding the variables that contribute to parental decision-making and treatment participation for childhood ADHD are considered.

Teachers' and education students' perceptions of and reactions to children with and without the diagnostic label "ADHD"

Thirty-four elementary school teachers and 32 education students from Canada rated their reactions towards vignettes describing children who met attention-deficit/hyperactivity disorder (ADHD) symptom criteria that included or did not include the label "ADHD." "ADHD"-labeled vignettes elicited greater perceptions of the child's impairment as well as more negative emotions and less confidence in the participants, although it also increased participants' willingness to implement treatment interventions. Ratings were similar to vignettes of boys versus girls; however, important differences in ratings between teachers and education students emerged and are discussed. Finally, we investigated the degree to which teachers' professional backgrounds influenced bias based on the label "ADHD." Training specific to ADHD consistently predicted label bias, whereas teachers' experience working with children with ADHD did not.

Parental attributions for success in managing the behavior of children with ADHD

OBJECTIVE

The current study evaluated the effects of differing intensities of behavior modification and medication on parents' self-reported success in managing their child's misbehavior and the attributions parents gave for success or failure.

METHOD

Children were randomized to receive in counterbalanced orders different levels of behavior modification, each for 3-week cycles. In addition, medication was manipulated using a medication assessment procedure. Parents reported daily how successful they were in managing their child's misbehavior and the attributions for either their success or failure.

RESULTS

Parents of children with ADHD generally felt successful in managing their child's behavior, regardless of treatment condition. In the high behavior modification condition, they were more likely to endorse items that attributed their success to their own effort.

CONCLUSION

In conditions in which parents were given more intensive tools to manage misbehavior they were more likely to attribute their success to their own effort.

A systematic review of parenting in relation to the development of comorbidities and functional impairments in children with attention-deficit/hyperactivity disorder (ADHD)

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.

Parent and adolescent depressive symptoms: the role of parental attributions

This study examined whether negative parental attributions for adolescent behaviour mediate the association between parental and adolescent depressive symptoms, and whether this relationship is moderated by adolescent gender. Mothers and fathers and 124 adolescents (76 girls and 48 boys; ages 14 to 18) participated. Adolescents were primarily Caucasian, and varied in the level of depressive symptoms (with 27% of the sample meeting diagnostic criteria for a current unipolar depressive disorder). Parents and adolescents completed measures of depressive symptoms, and participated in a videotaped problem-solving discussion. After the discussion, each parent watched the videotape and, at 20 s intervals, offered attributions for their adolescent's behaviour. Adolescent gender moderated the relation between parental attributions and adolescent depressive symptoms, with stronger associations for female adolescents. For both mothers and fathers, both parental depressive symptoms and negative attributions about the adolescent's behaviour made unique contributions to the prediction of depressive symptoms in adolescent females. There also was evidence that negative attributions partially mediated the link between depressive symptoms in mothers and adolescent daughters. The results are interpreted as consistent with parenting as a partial mediator between parental and adolescent depressive symptoms, and suggest that adolescent girls may be particularly sensitive to parents' negative interpretations of their behaviour.

Acceptability of behavioral and pharmacological treatments for attention-deficit/hyperactivity disorder: relations to child and parent characteristics

One-hundred nine mothers of 5- to 12-year-old boys with attention-deficit/hyperactivity disorder (ADHD) participated. Mothers read case descriptions of boys with ADHD and of boys with both ADHD and oppositional defiant disorder (ODD). Half of the mothers were randomly assigned to read descriptions of behavioral parent training and half to read descriptions of stimulant medication as treatments for the children in the case descriptions. Mothers rated the acceptability and effectiveness of the treatments and provided information on their experiences with both types of treatment. Mothers rated behavioral parent training as more acceptable than medication. There was no difference in ratings of the effectiveness of the two treatments in the scenarios, and mothers rated medication as more effective than behavioral strategies with their own children. Comorbidity of ADHD and ODD did not influence ratings of acceptability or effectiveness. Mothers' ratings of the acceptability of behavioral parent training were related to how much they believed in these strategies and how effective the strategies were with their own children. Although mothers' ratings of the acceptability of medication were related to their beliefs in this form of treatment, they were not related to perceptions of effectiveness of medication for their own child. Implications for understanding the difficulties faced by parents of children with ADHD in treatment decision-making are presented.

Mothers' and fathers' attributions and beliefs in families of girls and boys with attention-deficit/hyperactivity disorder

This study examined parent and child gender effects on parents' attributions and beliefs in regards to child symptoms of attention-deficit/hyperactivity disorder (ADHD). Participants included mothers and fathers of 19 girls and 17 boys with ADHD. Groups of boys and girls, aged 5-13 years, were equated on age and medication status, as well as ADHD symptom severity. These groups also were similar in the severity of comorbid oppositional behaviors and internalizing problems, as well as a variety of demographic characteristics. Parents' attributions for child behavior were assessed in response to written scenarios describing either hyperactive/impulsive or inattentive symptoms of ADHD. Parents also completed a questionnaire assessing beliefs and knowledge about ADHD. There were no child gender effects for parents' attributions or beliefs. All parents attributed inattentive symptoms to more internal, global and stable causes than impulsive symptoms. Mothers attributed both inattentive and impulsive child symptoms to more global and stable causes than did fathers. Fathers, but not mothers, reported more negative reactions to ADHD symptoms that were perceived as having an internal cause. Finally, mothers scored higher on beliefs in behavior management than did fathers, and fathers believed more in psychological causes and treatments for ADHD. Possible explanations for and implications of these results are explored.