Patterns of Parental Adherence and the Association to Child and Parenting Outcomes Following a Multicomponent School-Home Intervention for Youth With ADHD

The goal of the present study was to evaluate the role of parent adherence in the Collaborative Life Skills (CLS) program, a multicomponent school-home intervention, for predicting child and parenting outcomes. A sample of 129 children (63% male; M age = 8.22, SD = 1.10; grades 2–5) with attention-deficit/hyperactivity disorder (ADHD) and their parents participated in CLS, which included 10 weekly behavioral parent training group sessions. Each week, parents provided information on their CLS skill use between sessions (at home) as part of the intervention. Outcome measures included parent and teacher ratings of child behavior and parenting at post-intervention and 6 months follow-up. Growth mixture models examining weekly parent skill use trajectories throughout the intervention significantly predicted parent- and teacher-reported outcomes including parent-rated child behavior, teacher-rated academic competence, and positive parenting behaviors. Fifty-two percent of parents displayed moderate skill use throughout the intervention, whereas the remaining parents had either low (20%) or high (28%) initial levels of use but demonstrated high skill utilization by the middle of the intervention. Results highlight the importance of examining individual differences in parents between session strategy use for behavioral parent training interventions targeting child and parenting outcomes.     

Improving Outcomes for Youth with ADHD: A Conceptual Framework for Combined Neurocognitive and Skill-Based Treatment Approaches

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent and chronic mental health condition that often results in substantial impairments throughout life. Although evidence-based pharmacological and psychosocial treatments exist for ADHD, effects of these treatments are acute, do not typically generalize into non-treated settings, rarely sustain over time, and insufficiently affect key areas of functional impairment (i.e., family, social, and academic functioning) and executive functioning. The limitations of current evidence-based treatments may be due to the inability of these treatments to address underlying neurocognitive deficits that are related to the symptoms of ADHD and associated areas of functional impairment. Although efforts have been made to directly target the underlying neurocognitive deficits of ADHD, extant neurocognitive interventions have shown limited efficacy, possibly due to misspecification of training targets and inadequate potency. We argue herein that despite these limitations, next-generation neurocognitive training programs that more precisely and potently target neurocognitive deficits may lead to optimal outcomes when used in combination with specific skill-based psychosocial treatments for ADHD. We discuss the rationale for such a combined treatment approach, prominent examples of this combined treatment approach for other mental health disorders, and potential combined treatment approaches for pediatric ADHD. Finally, we conclude with directions for future research necessary to develop a combined neurocognitive + skill-based treatment for youth with ADHD.     

Program for the Education and Enrichment of Relational Skills: Parental Outcomes With an ADHD Sample

The goal of the current study was to examine the effect of the Program for the Education and Enrichment of Relational Skills (PEERS®), a 14-week parent-assisted friendship-building program for adolescents with ADHD, on parental functioning, quality of the parent-adolescent relationship, and family functioning. Participants included 25 parents of adolescents with ADHD. Families completed PEERS®. Measures of parenting stress, parental efficacy, parent-adolescent communication, parent-adolescent involvement, causal attributions for negative social interactions, and family chaos were completed by parents at pre- and post-treatment. Parents demonstrated statistically significant improvements in parenting stress and parent-adolescent communication and marginally statistically significant improvement in parental efficacy. Parents also demonstrated reliable change in parenting stress, parent-adolescent communication, parent-adolescent involvement, and family chaos. Overall, these findings demonstrate the benefit of PEERS® at improving parental functioning, quality of the parent-adolescent relationship, and family functioning for families of adolescents with ADHD.     

Review of the Evidence for Motivation Deficits in Youth with ADHD and Their Association with Functional Outcomes

Preeminent theories of attention-deficit/hyperactivity disorder (ADHD) suggest that motivation deficits are core underlying features of the disorder. However, it is currently unclear whether empirical evidence supports the assertion that significant group (ADHD v. comparison) differences in motivation exist or that problems with motivation contribute to the functional impairments that youth with ADHD experience. Accordingly, this review focused on evaluating and summarizing the empirical literature on the presence of motivation deficits and their association with functional outcomes in samples of youth with ADHD. Twenty studies met the review inclusion criteria. Results support the assertion that youth with ADHD have lower academic-related motivation in comparison to their peers and that motivation plays an important role in academic outcomes, with the strongest evidence to date for reading achievement. However, the available evidence is limited, and few existing studies are aligned with the much larger theoretical and empirical motivation literature in typically developing youth. Given preliminary evidence that motivation plays a role in the academic impairments of youth with ADHD, the review concludes with a discussion of whether current ADHD interventions adequately target motivation and highlights important future directions.     

Parental involvement in children's learning: Comparing parents of children with and without Attention-Deficit/Hyperactivity Disorder (ADHD)

The present study examined involvement in children's learning among parents of 101 children between 8 and 12 years of age (53 parents of children with ADHD, 48 parents of children without ADHD). Compared to parents of children without ADHD, parents of children with ADHD reported lower self-efficacy in their ability to help their children, felt less welcome and supported by their children's schools and teachers, and perceived less time and energy for involvement in their children's academic lives. Mothers of children with and without ADHD reported similar types and levels of involvement behaviors in the home. Fathers of children with ADHD reported being more disengaged from their children's learning and using more coercive and punitive interactions regarding their children's achievement compared to fathers of children without ADHD. These findings underscore the difficulties in parent-supported learning practices and home-school collaboration initiatives faced by parents of children with ADHD and educators alike. Implications for school psychology practice are discussed.     

Externalizing Symptomatology Among Adoptive Youth: Prevalence and Preadoption Risk Factors

The extent of symptomatology related to attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) was examined in a statewide sample of adopted youth, aged 4–18 years (n = 808). The use of normed questionnaires in a nonclinical sample decreased biases associated with past research on adopted children. According to parental report, a striking number of the youth qualified as manifesting significant symptom levels of externalizing behavior problems: 21% met symptom cutoffs for ADHD (with or without ODD) and 20% met criteria for ODD (with or without ADHD), for a combined total of 29% of the sample. A number of parent-reported, preadoptive risk factors distinguished these groups from one another and from the nonexternalizing youth. The clearest associated factors included histories of preadoption abuse/neglect, later age of adoption, prenatal drug exposure, and placement in multiple foster homes prior to adoption. We discuss implications regarding both etiology and current controversies surrounding the disproportionate levels of behavioral difficulties in adopted youth.     

A Review of Factors that Promote Resilience in Youth with ADHD and ADHD Symptoms

The vast majority of research on youth with ADHD has focused on risk factors and describing the types of impairment individuals with ADHD experience. However, functional outcomes associated with ADHD are heterogeneous, and although many youth with ADHD experience significant negative outcomes (e.g., school dropout), some are successful in multiple domains of functioning (e.g., pursue and graduate college). There is a growing body of literature supporting the existence of factors that protect youth with ADHD from experiencing negative outcomes, but there is no published synthesis of this literature. Accordingly, the goals of this review are to conceptualize risk–resilience in the context of ADHD using a developmental psychopathology framework and to systematically review and critique evidence for promotive and protective factors in the context of ADHD. The literature search focused specifically on resilience in the context of ADHD symptoms or an ADHD diagnosis and identified 21 studies, including clinic, school, and community samples. Findings of promotive and/or protective factors are summarized across individual, family, and social–community systems. Overall, we know very little of the buffering processes for these youth, given that the study of promotive and protective factors in ADHD is in its infancy. The strongest evidence to date was found for social- and family-level systems. Specifically, multiple longitudinal studies support social acceptance as a protective factor, buffering against negative outcomes such as poor academic performance and comorbid depressive symptoms for youth with ADHD. There was also compelling evidence supporting positive parenting as a promotive factor. In terms of individual-level factors, positive or modest self-perceptions of competence were identified as a promotive factor in multiple studies. Future directions for research that will catalyze the study of resilience with ADHD are provided, and the potential for targeting protective mechanisms with intervention and prevention is discussed.     

Psychological Empowerment Among Urban Youth: Measurement Model and Associations with Youth Outcomes

Empowerment‐based strategies have become widely used method to address health inequities and promote social change. Few researchers, however, have tested theoretical models of empowerment, including multidimensional, higher‐order models. We test empirically a multidimensional, higher‐order model of psychological empowerment (PE), guided by Zimmerman's conceptual framework including three components of PE: intrapersonal, interactional, and behavioral. We also investigate if PE is associated with positive and negative outcomes among youth. The sample included 367 middle school youth aged 11–16 (M = 12.71; SD = 0.91); 60% female, 32% (n = 117) white youth, 46% (n = 170) African‐American youth, and 22% (n = 80) identifying as mixed race, Asian‐American, Latino, Native American, or other ethnic/racial group; schools reported 61–75% free/reduced lunch students. Our results indicated that each of the latent factors for the three PE components demonstrate a good fit with the data. Our results also indicated that these components loaded on to a higher‐order PE factor (X² = 32.68; df: 22; p = .07; RMSEA: 0.04; 95% CI: .00, .06; CFI: 0.99). We found that the second‐order PE factor was negatively associated with aggressive behavior and positively associated with prosocial engagement. Our results suggest that empowerment‐focused programs would benefit from incorporating components addressing how youth think about themselves in relation to their social contexts (intrapersonal), understanding social and material resources needed to achieve specific goals (interactional), and actions taken to influence outcomes (behavioral). Our results also suggest that integrating the three components and promoting PE may help increase likelihood of positive behaviors (e.g., prosocial involvement); we did not find an association between PE and aggressive behavior. Implications and future directions for empowerment research are discussed.     

Neighborhood Types and Externalizing Behavior in Urban School-Age Children: Tests of Direct, Mediated, and Moderated Effects

We evaluated the association of neighborhood types and externalizing behavior problems in 99 predominately African-American urban children (M = 10.7 years), and the extent to which qualities of the family environment mediated or moderated these associations. Three distinct neighborhood types were identified using cluster analysis of census and crime data. Results showed that children living in very poor neighborhoods with moderate crime levels had more behavior problems than children living in relatively low crime, low poverty areas. Family stress mediated the association between neighborhood type and behavior problems. Family cohesion moderated the association of neighborhood type and adjustment: children living in the most impoverished neighborhoods with high levels of family cohesion demonstrated fewer behavior problems relative to their peers in low-cohesive households in the same area, and similar levels of behavior problems relative to children in highly cohesive homes in low crime, low poverty areas.     

Internalizing and Externalizing Behaviors Share a Common Predictor: the Effects of Early Maladaptive Schemas Are Mediated by Coping Responses and Schema Modes

We investigated the relationships of adolescents’ internalizing and externalizing behaviors with their early maladaptive schemas (EMS), coping responses, and schema modes. We focused on EMS related to experiences of disconnection and rejection that comprise vulnerable emotions, such as shame, mistrust, deprivation, abandonment, and isolation/alienation. This cross-sectional study included a total of 699 adolescents (combined clinical and non-referred sample) who were 11 to 18 years old (M?=?14.6; SD?=?1.6), and of which 45% was male. All participants completed self-report questionnaires on EMS, coping responses, schema modes, and behavior problems. We aimed to clarify the relationships between these variables by testing mediation, moderation, and moderated mediation models. In general, coping responses functioned as mediators rather than moderators in the relationships between EMS and schema modes. Furthermore, EMS regarding experiences of disconnection and rejection were related to both internalizing and externalizing behavior problems, and coping responses and schema modes mediated these effects. In conclusion, although adolescent internalizing and externalizing behavior problems manifest quite differently, they seem related to the same EMS.     

Prediction of Preschool Aggression from DRD4 Risk,Parental ADHD Symptoms,and Home Chaos

This study investigated the influence of a child’s DRD4 risk, parental levels of ADHD symptoms, and the interactive influence of these factors on the development of preschool aggression. Additionally, the study investigated the role of home chaos as a mediator between parental ADHD symptoms and child aggression. The sample consisted of 84 4.5-year-old children and their parents. Children were genotyped for the DRD4 polymorphism. ADHD symptoms were self-reported by parents when the child was 2 to 6 months old. Parental reports of home chaos and the child’s aggression were collected 4 years later. Child’s DRD4 risk and parental ADHD symptoms significantly contributed to the prediction of preschool aggression. However, contrary to our hypotheses, no interactions were found between the child’s DRD4 risk and the levels of parental ADHD symptoms. Home chaos played a mediating role in the relation between paternal ADHD symptoms and the child’s aggression. The relation between maternal ADHD symptoms and the child’s aggression was not significantly mediated through the level of home chaos. The current study emphasizes the importance of longitudinally investigating the contribution of parental ADHD symptoms to child aggression, while also exploring the differential contribution of maternal/paternal inattention and hyperactivity-impulsivity symptoms. Moreover, home chaos was found to be a significant environmental mechanism through which paternal ADHD symptoms affect children’s aggression in the preschool years.     

Pathways from Birth Weight to ADHD Symptoms through Fluid Reasoning in Youth with or without Intellectual Disability

Although individual differences in fluid reasoning reliably mediate predictions of attention-deficit/hyperactivity disorder (ADHD) symptoms from birth weight in youth with typical cognitive development (TD), it is unknown if this indirect effect operates similarly in the development of ADHD symptoms secondary to intellectual disability (ID). Thus, we evaluated mediation by fluid reasoning in a longitudinal sample of 163 youth (45% female) with (n = 52) or without (n = 111) ID who were followed prospectively from age 5 to age 13. At age 9, youth completed the Arithmetic subtest of the Wechsler Intelligence Scale for Children, a measure of fluid reasoning. At ages 9 and 13, mothers and teachers separately rated youth ADHD symptoms and mothers completed a diagnostic interview. Mediation was tested via path analysis with bootstrapped confidence intervals, and moderated mediation estimated whether indirect effects differed between ID and TD youth or based on youth IQ. Controlling for demographic factors and age 9 ADHD symptoms, age 9 Arithmetic mediated birth weight and multi-method/informant age 13 ADHD symptoms, such that birth weight positively predicted Arithmetic, which negatively predicted ADHD symptoms. Neither ID status nor IQ moderated the observed indirect effect through Arithmetic, suggesting that it was similar for ID and TD youth as well as across the range of youth IQs. These findings support previous evidence that fluid reasoning, as measured by Arithmetic, may causally mediate birth weight and ADHD symptoms, and suggest that this pathway operates similarly with respect to the development of ADHD symptoms in youth with ID.     

Parental Attachment and Externalizing Behaviors among Chinese Adolescents: The Mediating Role of Self-Control

Journal of Child and Family Studies - Self-control theory proposes that weak emotional bonds with caregivers are key in the lack of self-control development, that in turn increases the likelihood...     

Parental Physical Illnesses and Their Association with Subsequent Externalizing and Internalizing Symptoms in Children

Journal of Child and Family Studies - Parental physical illnesses can be stressful for children. We estimated the prevalence of children who experience parental physical illnesses, and whether...     

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.