ADHD and Depression Symptoms in Parent Couples Predict Response to Child ADHD and ODD Behavior

Parents of children with attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) often have elevated ADHD and depressive symptoms, both of which increase the risk of ineffective parenting and interparental discord. However, little is known about whether child ADHD/ODD behavior and parent ADHD or depressive symptoms uniquely or synergistically predict the quality of parenting and interparental communication during triadic (mother-father-child) interactions. Ninety parent couples, including 51 who have children diagnosed with ADHD, were randomly assigned to interact with a 9–12 year-old confederate child (84 % male) exhibiting either ADHD/ODD-like behavior or typical behavior. Parents reported their own ADHD and depressive symptoms, and parents and observers rated the quality of parenting and interparental communication during the interaction. Actor-partner interdependence modeling indicated that child ADHD/ODD behavior predicted less positive and more negative parenting and communication, independent of adult ADHD and depressive symptoms. Parent couples including two parents with elevated ADHD communicated more positively while managing children exhibiting ADHD/ODD behavior than couples managing children behaving typically or couples with only one parent with elevated ADHD symptoms. Couples including one parent with, and one parent without, elevated ADHD or depressive symptoms parented less positively and more negatively, and communicated more negatively, when managing children exhibiting ADHD/ODD behavior than when managing children behaving typically. Taken together, depending on the similarity of ADHD and depressive symptom levels in parent couples, adults managing children exhibiting ADHD/ODD behavior may parent or communicate positively or negatively. Findings highlight the need to consider the psychopathology of both parents when treating children with ADHD in two-parent homes.     

A sequential analysis of the mother-adolescent interactions of ADHD,ADHD/ODD,and normal teenagers during neutral and conflict discussions

The sequential interactions of three groups of teenagers conversing with their mothers during both neutral and conflict discussion situations were evaluated. Groups consisted of (1) attention deficit hyperactivity disorder (ADHD) alone (n =21), (2) ADHD with comorbid oppositional defiant disorder (ADHD/ODD; n =40), and (3) a community control group of adolescents (n =49). All groups had been followed concurrently for the past 8 to 10 years before being reevaluated in this study. Results indicated that (1) teens and parents in all groups interacted in a tightly linked manner, with the behavior of each member being significantly related only to the immediate antecedent behavior of the other; (2) mothers in all groups were more likely than teens to initiate positive behaviors; (3) teen interactions could be characterized as tit-for-tat while mothers could be typified as be-nice-and-forgive; (4) mother-teen dyads in the ADHD/ODD group displayed significantly higher rates of conflict behaviors than dyads in the other two groups, who did not differ significantly from each other on most measures; and (5) mothers in the ADHD/ODD group responded in a manner similar to their teens (greater negativity) and less like that of mothers in the other groups. The majority of conflict between ADHD children and their parents seemed due to comorbid ODD and such ODD is a family, not just a teen, characteristic.     

Mother–Child Agreement on Reports of Internalizing Symptoms Among Children Referred for Evaluation of ADHD

The effects of maternal (bias), child (age, severity of behavior problems), and measurement characteristics (similarity of parent and child measures; types of internalizing symptoms) on mother–child agreement on reports of children's internalizing symptoms were examined for 65 children referred for evaluation of ADHD. Agreement was low and did not improve when parents and children completed parallel measures. Mothers and children were more likely to agree on severity of internalizing symptoms rated as behavioral than those rated as ideational. The majority of discordant reports were of the type that mothers, but not children, reported clinically elevated symptoms. This type of discordance appeared to be a function of maternal negative bias rather than underreporting of symptoms by children.     

Effects of Alcohol Intoxication on Parenting Behavior in Interactions With Child Confederates Exhibiting Normal or Deviant Behaviors

Experimental analogue methods were used to study how acute alcohol intoxication in parents influences their perceptions of and reactions to child behaviors, as well as their strategies for management of those behaviors. All participating parents had a grade school-aged son, but in half the cases this target child had a diagnosed externalizing disorder, whereas for the remaining half neither the target son nor any other offspring of the parents evidenced any psychopathology. Equal numbers of married fathers, married mothers, and single mothers from each of these groups received either alcoholic or nonalcoholic beverages prior to videotaped interactions with male child confederates who, depending on condition, enacted behaviors characteristic of either normal boys or boys with attention deficit hyperactivity/conduct/oppositional defiant disorders (ADHD/CD/ODD). Results indicated that intoxicated parents rated their ADHD/CD/ODD child partners as less deviant than did sober parents. Alcohol intoxication caused all participant groups to exhibit less attention and productive work and more commands, indulgences, and off-task talk in the interactions. Implications for better understanding of the role of psychosocial factors in the correlation between adult drinking problems and childhood behavior disorders are discussed.     

Making faces: testing the relation between child behavior problems and mothers' interpretations of child emotion expressions

We examined the relations between preschool boys' behavior problems and mothers' interpretations of children's emotion expressions. A sample of 31 mothers of oppositional boys and 28 control mothers responded to standard stimuli depicting child emotional reactions to maternal control attempts; mothers were instructed to think of the stimuli as either (a) their own child or (b) an unfamiliar child. Mothers of oppositional boys were more likely to generate negative interpretations than were control mothers when thinking of their own children; however, this difference did not generalize to the explicitly unfamiliar child condition. Mothers of oppositional boys demonstrated negative and comparison mothers demonstrated positive interpretive tendencies toward their own children. Findings suggest that child emotion cues may trigger biased maternal cognitions even in the absence of child misbehavior.     

Adolescents with attention deficit hyperactivity disorder: Mother-adolescent interactions,family beliefs and conflicts,and maternal psychopathology

A group of 83 adolescents with attention deficit hyperactivity disorder (ADHD) were subdivided into those with ADHD alone (n = 27) and those with ADHD and oppositional defiant disorder (ADHD/ODD, n = 56). They were compared to each other and a community control group (n = 77) on measures of family conflicts, family beliefs, maternal adjustment, and observations of mother-adolescent interactions during both a neutral and conflict discussion. Both ADHD groups had more topics on which there was conflict and more angry conflicts at home than control adolescents on parent reports. Only the ADHD/ODD adolescents reported more such conflicts, endorsed more extreme and unreasonable beliefs about their parent-teen relations, and demonstrated greater negative interactions during a neutral discussion than the control teenagers. Similarly, only mothers of the ADHD/ODD teens displayed greater negative interactions during a neutral discussion, more extreme and unreasonable beliefs about their parent-teen relations, greater personal distress, and less satisfaction in their marriages than the mothers in the control group. Most findings for the ADHD only group were between the control group and the group with mixed ADHD/ODD but did not differ from either group. Results imply that it is the combination of ODD symptoms with those of ADHD that is associated with the greater-than-normal conflicts, anger, poor communications, unreasonable beliefs, and negative interactive styles seen in ADHD adolescents. These same characteristics typify their mothers' interactions as well such that both the adolescents' ODD symptoms and maternal psychological distress (hostility) make unique contributions to the degree of conflict and anger in the parent-teen relations of ADHD adolescents.     

Parenting in mothers with and without attention-deficit/hyperactivity disorder

The authors examined the impact of maternal attention-deficit/hyperactivity disorder (ADHD) on parenting behaviors. Sixty mothers between the ages of 31 and 50 with (n = 30) and without (n = 30) ADHD and their 8- to 14-year-old children with ADHD completed self-report and laboratory measures of monitoring of child behavior, consistency in parenting, and parenting problem-solving abilities. These parenting behaviors were selected because of their established links to the development of child behavior problems. As predicted, mothers with ADHD were found to be poorer at monitoring child behavior and less consistent disciplinarians compared with mothers without ADHD. There was some evidence to support the prediction that mothers with ADHD were less effective at problem solving about childrearing issues than control mothers. The differences between the 2 groups of mothers persisted after child oppositional and conduct-disordered behavior were controlled. These results indicate that parenting is an area of functioning that requires more attention in adult ADHD research.     

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.     

Play Behavior Differences Among Preschoolers with ADHD: Impact of Comorbid ODD and Anxiety

The acquisition of positive peer play behavior is an important aspect of child development and an indicator of social competence. Engaging in peer play may pose challenges for children with internalizing and externalizing disorders, particularly those with comorbid disorders. Existing literature contains little information on the peer play behaviors of children with attention-deficit/hyperactivity disorder (ADHD), and even less research is available examining the play behaviors of children with comorbid disorders. The present study assessed the peer play behaviors and social competence of 107 preschoolers with varying combinations of ADHD, oppositional defiant disorder (ODD), and anxiety symptoms. Assessment methods included direct observations and teacher ratings of child behavior. Results indicated there were no differences in observed peer play behaviors or negative behaviors toward peers, but there were differences in teacher-rated social competence between the groups. Results are discussed in terms of assessment method variations as well as directions for additional research in this critical area and implications for practice.     

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

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

Unintentional Injury Risk in Children with Externalizing Behavior Disorders at Summer Camp

Children with externalizing behavior disorders such as attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) have greatly increased risk of unintentional injury, but it is unclear what mechanisms are responsible for that increased risk. This study followed 22 children participating in a summer camp for children with ADHD. Injury incidents were recorded daily and a set of primary symptoms of behavioral disorders were recorded at 15-min intervals over the course of the 6-week summer camp experience (roughly 300 h of observing each child). We predicted symptoms of ODD and CD would be more strongly related to injury incidence than symptoms of ADHD. Results from univariate Poisson regression models confirmed our prediction. Symptoms of ODD and CD—violations and intentional aggression in particular—were related to injury incidence but symptoms of ADHD were not. This finding is consistent with a growing body of evidence that oppositional, noncompliant, and aggressive behavior patterns might be primarily responsible for increased risk for injury among children with externalizing behavior disorders. Thanks to Sylvie Mrug, Peter Winslett, and the other staff members of the STP camp for their cooperation.     

Mediators and Moderators of the Relation between Parental ADHD Symptomatology and the Early Development of Child ADHD and ODD Symptoms

The present study examined mediators and moderators of the relation between parental ADHD symptomatology and the development of child attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms across the preschool years. Participants included 258 (138 boys) 3-year-old children (M = 44.13 months, SD = 3.39) with and without behavior problems and their parents who took part in a 3-year longitudinal study. Maternal ADHD symptoms predicted later ADHD symptoms in children, controlling for early child symptomatology. Both family history of ADHD and paternal comorbid psychopathology predicted later child ADHD and ODD symptoms, but they did not account for the association between maternal and child ADHD symptoms. Although paternal ADHD symptoms were associated with age 3 child ADHD symptoms, they did not significantly predict later child ADHD symptoms controlling for early symptomatology. Family adversity moderated the relation between maternal ADHD and child ADHD symptoms, such that the relation between maternal and child ADHD symptoms was stronger for families with less adversity. Maternal overreactive parenting mediated the relation between maternal ADHD symptoms and later child ADHD and ODD symptoms. Our findings suggest that targeting paternal comorbid psychopathology and maternal parenting holds promise for attenuating the effects of parental ADHD on children’s ADHD.     

Correlates of attachment at age 3: construct validity of the preschool attachment classification system

This study examined correlates of attachment at age 3 to further validate preschool separation-reunion measures. Three-year-olds (N = 150) and their mothers participated in a separation-reunion protocol, the Preschool Attachment Classification System (PACS: J. Cassidy & R. S. Marvin with the MacArthur Working Group on Attachment, 1992), and a mother-child interaction session during a laboratory visit. Mothers also completed psychosocial measures and, along with teachers, evaluated child behavior problems. The secure and disorganized groups received, respectively, the highest and lowest interaction scores. Disorganized children showed a higher level of teacher-reported externalizing and internalizing problems than did secure children. Mothers of insecure children reported higher child externalizing (all insecure groups) and internalizing (avoidant group) scores, more personal distress related to emotional bonding (disorganized group), childrearing control (ambivalent group), and child hyperactivity (avoidant group). Results strongly support the validity of the PACS as a measure of attachment in 3-year-olds.     

Externalizing Outcomes of Youth with and without ADHD: Time-Varying Prediction by Parental ADHD and Mediated Effects

Although parental attention-deficit/hyperactivity disorder (ADHD) is a risk factor for multiple negative youth outcomes, it is unknown how change in parental ADHD symptoms over time affects change in child ADHD symptoms; moreover, mediators of these predictions are largely unknown. Parents of 230 5–10 year-old children (68 % male) with (n = 120) and without ADHD (n = 110) were followed prospectively for 6–7 years across three separate waves. Parents self-reported their ADHD and depression symptoms and similarly rated offspring ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms; youth self-reported their substance use. Temporally-ordered mediators consisted of parental expressed emotion (EE), derived from the Five Minute Speech Sample, and self-reported positive and negative parenting behavior. Controlling for key demographics and parental depression symptoms, increasing parental ADHD symptoms were a time-varying predictor of worsening youth ADHD and ODD, although it was unrelated to change in CD and alcohol/substance use. Next, although EE facets (i.e., criticism, emotional over-involvement) did not mediate these predictions, negative parenting behavior significantly mediated predictions of youth ADHD (and marginally in predictions of ODD) from parental ADHD symptoms. These quasi-experimental findings suggest that parental ADHD symptoms are a potential unique causal risk factor for offspring ADHD and ODD; also, preventing negative parenting behavior secondary to parental ADHD symptoms is critical to improve trajectories of youth ADHD and ODD. We consider parental ADHD symptoms and family factors underlying emergent externalizing problems utilizing a developmental psychopathology framework, including implications for intervention and prevention.     

Effects of Stimulant Medication Treatment on Mothers' and Children's Attributions for the Behavior of Children with Attention Deficit Hyperactivity Disorder

Participants were 55 children with attention deficit hyperactivity disorder (ADHD) who were receiving ongoing treatment with stimulant medications and their mothers, and 31 children with ADHD who were beginning stimulant medication and their mothers. Mothers and children offered attributions for child behaviors that occurred when the child was medicated and not medicated. Mothers rated child compliance and prosocial behavior as more global and stable when the child was medicated and rated noncompliance, ADHD symptoms, and oppositional behavior as more externally caused, less global and stable, but more controllable by the child when the child was medicated. Children rated both their compliance and noncompliance as more controllable in the medicated condition. On a forced-choice measure, both mothers and children selected ability, effort, and task attributions for compliance more in the not-medicated condition, and pill-taking attributions more in the medicated condition. This was reversed for noncompliance, which was attributed more to effort, task, or ability in the medicated condition and more to not taking a pill in the not-medicated condition. The potential risks and benefits for parent–child interactions and children's self-perceptions of these medication-related differences in attributions are discussed.     

Associations between Maternal Attention-Deficit/Hyperactivity Disorder Symptoms and Parenting

Mothers of children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for an ADHD diagnosis themselves, which is likely associated with impairments in parenting. The present study utilized a multi-method assessment of maternal ADHD and parenting to examine the extent to which maternal ADHD symptoms are associated with maladaptive parenting. Participants included 70 6–10 year old children with DSM-IV ADHD and their biological mothers. Results suggested that mothers with higher levels of ADHD symptoms reported lower levels of involvement and positive parenting and higher levels of inconsistent discipline. During observed parent–child interactions, maternal ADHD symptoms were negatively associated with positive parenting, and positively associated with negative parenting and repeated commands before giving the child an opportunity to comply. Given prior research suggesting that maladaptive parenting behaviors are risk factors for the later development of conduct problems among children with ADHD, these findings have important clinical implications for family-based assessment and treatment of ADHD.     

Mother–Son Interactions in Families of Boys With Attention-Deficit/Hyperactivity Disorder With and Without Oppositional Behavior

Parenting responsiveness and over-reactivity were assessed among 25 mothers of 7–9-year-old sons with Attention-Deficit/Hyperactivity Disorder (ADHD) and oppositional behavior (Oppositional Defiant, OD), 24 mothers of sons with ADHD only, and 38 mothers of nonproblem sons. Responsiveness was observed during mother–son play and clean-up interactions and over-reactivity was assessed using self-reports of parenting in discipline situations. Mothers of sons with ADHD/OD were less responsive and more over-reactive than mothers of nonproblem sons, and mothers of sons with ADHD only did not differ from the other groups. Mothers of sons with ADHD/OD reported more hostility than mothers of nonproblem sons, and controlling for maternal hostility eliminated the significant group differences in responsiveness during clean-up and in over-reactivity. Controlling for the childs ADHD subtype did not alter the pattern of results. The implications for addressing responsiveness and over-reactivity as components of parent-mediated behavioral treatments for ADHD are considered.     

Parent stress and coping in relation to child ADHD severity and associated child disruptive behavior problems.

Examined parent role distress and coping in relation to childhood attention deficit hyperactivity disorder (ADHD) in mothers and fathers of 66 children age 7 to 11 (42 boys, 24 girls; mean age = 10.2). Parents of children with ADHD combined and inattentive subtypes expressed more role dissatisfaction than parents of control children. Parents of ADHD combined and inattentive type children did not differ significantly in levels of distress. For mothers, child inattention and oppositional-conduct problems but not hyperactivity contributed uniquely to role distress (dissatisfaction related to parenting or parenting performance). For fathers, parenting role distress was associated uniquely with child oppositional or aggressive behaviors but not with ADHD symptom severity. Parent coping by more use of positive reframing (thinking about problems as challenges that might be overcome) was associated with higher role satisfaction for both mothers and fathers. Community supports were associated with higher distress for mothers only.     

ODD dimensions, ADHD, and callous-unemotional traits as predictors of treatment response in children with disruptive behavior disorders

To answer several questions pertinent to DSM-V, the authors examined the predictive validity of pretreatment oppositional defiant disorder (ODD) dimensions, attention-deficit/hyperactivity disorder (ADHD), and callous-unemotional (CU) traits in relation to several treatment outcomes in 177 children diagnosed with ODD or conduct disorder (CD). Multiple informants completed diagnostic interviews and rating scales at 6 assessment points (pretreatment to 3-year follow-up) to document emotional and behavioral outcomes. After controlling for pretreatment CD, the ODD dimension of hurtfulness was related to treatment-resistant CD, delinquent behaviors, and externalizing problems. In contrast, the ODD dimension tapping irritability was associated with treatment-resistant ODD, internalizing problems, and global functional impairment following treatment. Whereas pretreatment ADHD was associated with posttreatment ODD and social problems, it was unrelated to posttreatment CD symptoms and diagnosis. Contrary to predictions, CU traits were unrelated to any posttreatment outcomes after controlling for other covariates. These findings remained after controlling for measures of pretreatment global functional impairment.