Family Correlates of Oppositional and Conduct Disorders in Children With Attention Deficit/Hyperactivity Disorder

Comorbidities among children with ADHD are key determinants of treatment response, course, and outcome. This study sought to separate family factors (parental psychopathology and parenting practices) associated with comorbid Oppositional Defiant Disorder (ODD) from those associated with Conduct Disorder (CD) among children with Attention Deficit/Hyperactivity Disorder. Clinic-referred families (n = 149) were diagnosed using DSM-IV criteria. Parents completed measures of parenting practices. Comorbid ODD and CD were significantly associated with maternal negative/ineffective discipline. Comorbid CD, but not ODD, was significantly associated with lack of maternal warmth and involvement, paternal negative/ineffective discipline, and with paternal Antisocial Personality Disorder (APD). However, the risk of CD posed by parenting appeared concentrated among children without a father having APD. While consistent discipline appears important for addressing comorbid ODD and CD, paternal psychopathology and the quality of the relationship between mother and child may pose risk specifically for comorbid CD. Efforts to prevent and/or treat CD should consider not only provision of structure and prudent discipline, but also the affective qualities of the relationship between the primary caretaker and child.     

The role of comorbid disruptive behavior in the clinical expression of pediatric obsessive-compulsive disorder

This study explored the impact of disruptive behavior disorder (DBD) comorbidity on a number of theoretically relevant outcomes among 192 children and adolescents with obsessive-compulsive disorder (OCD). Youth were divided into three groups: OCD Only, OCD+DBD comorbidity and OCD+Other comorbidity. Relative to those without a comorbid condition and those with any non-DBD comorbidity, comorbid DBD was associated with greater family accommodation and less symptom resistance. Youth with comorbid DBD exhibited greater OCD symptom severity, OCD-related impairment, anxiety, and internalizing problems than those with no comorbidity. Those with comorbid DBD were over 3.6 times as likely to be taking an atypical antipsychotic medication relative to children without comorbidity. The present results suggest that comorbid DBD contributes to more severe illness presentation above and beyond an OCD diagnosis alone, and may be associated with differing pharmacotherapy prescribing practices.     

Parenting Behaviors and Childhood Anxiety: A Psychometric Investigation of the EMBU-C

Parent rearing behaviors, including both behavioral modeling and parent–child interactions, are associated with anxiety in children. Patterns of overprotection or rejecting behavior from parents may lead children to develop behavioral avoidance, lower self-confidence, and higher symptoms of anxiety. Additional research is needed to further elucidate the role that parenting behavior plays in the development of childhood anxiety. Unfortunately, few measures of parenting behavior exist. The EMBU-C is a 40-item child-report measure of these behaviors, but empirical data supporting the psychometric properties of the EMBU-C are limited. The current investigation examined the psychometric properties of the EMBU-C in the context of childhood anxiety. Participants were 213 children with an anxiety disorder and 150 recruited from the community (all aged 8–13 years). Overall, the EMBU-C demonstrated promising psychometrics. In terms of convergent validity, parent rearing behaviors described on the EMBU-C were significantly related to children’s anxiety symptoms, anxiety-related disability, parenting stress, family functioning and children’s externalizing behaviors. Further, the overprotection and anxious-rearing subscales discriminated between clinical and community participants. Finally, parental overprotection significantly predicted increases in child anxiety and anxiety-related disability 1 year later. Thus, the EMBU-C appears to have value as a clinical tool for assessing parental factors that may contribute to anxiety in children. Recommendations for further item development and measure improvement are offered.     

Parenting practices and child disruptive behavior problems in early elementary school. Conduct Problems Prevention Research Group

Examined the hypothesis that distinct parenting practices may be associated with type and profile of a child's disruptive behavior problems (e.g., oppositional, aggressive, hyperactive). Parents of 631 behaviorally disruptive children described the extent to which they experienced warm and involved interactions with their children and the extent to which their discipline strategies were inconsistent and punitive and involved spanking and physical aggression. As expected from a developmental perspective, parenting practices that included punitive interactions were associated with elevated rates of all child disruptive behavior problems. Low levels of warm involvement were particularly characteristic of parents of children who showed elevated levels of oppositional behaviors. Physically aggressive parenting was linked more specifically with child aggression. In general, parenting practices contributed more to the prediction of oppositional and aggressive behavior problems than to hyperactive behavior problems, and parenting influences were fairly consistent across ethnic groups and sex.     

Does Parent-Child Interaction Therapy Reduce Maternal Stress,Anxiety, and Depression Among Mothers of Children with Autism Spectrum Disorder?

Maternal stress, anxiety, and depression are associated with ineffective parenting strategies for families of children with Autism Spectrum Disorders (ASD). We present the use of Parent-Child Interaction Therapy (PCIT) with three mother-child dyads to reduce maternal stress, anxiety, and depression and child disruptive behavior in children with ASD. Results included increases in positive parenting skills, and decreases in maternal anxiety, depression, and stress, as well as child behavior problems. PCIT is a promising alternative to more intensive and costly interventions, both at reducing disruptive behaviors and improving maternal health. Implications of PCIT for dyads affected by ASD are discussed.     

Improved Perceptions of Emotion Regulation and Reflective Functioning in Parents: Two Additional Positive Outcomes of Parent-Child Interaction Therapy

The purpose of this study was to test whether Parent-Child Interaction Therapy (PCIT), a widely used effective therapy for children’s externalizing behaviors and parenting problems, was associated with improvements in parents’ emotion regulation and reflective functioning. We also investigated whether these improvements had unique associations with children’s improvements in externalizing and internalizing symptoms. Participants were 139 Australian children aged 29 to 83 months and their caregivers; all were referred for child externalizing behavior problems coupled with parenting skill deficits or high parent stress. All data were gathered via a questionnaire completed prior to and after completion of PCIT. Significant improvements were found in parents’ self-reported emotion dysregulation and capacity to use cognitive reappraisal for emotion regulation. There was also improvement in parents’ self-report of children’s symptoms, parenting practices, and reflective functioning in the form of prementalizing, which measured a low capacity to understand the emotional world of the child. Multiple regression showed that improvements in cognitive reappraisal, prementalizing, and negative parenting practices were associated with improvement in children’s symptoms. The findings extend the existing evidence for PCIT as an effective parenting intervention, adding parents’ perceived emotion regulation and reflective functioning to the list of positive outcomes from PCIT. Improved emotion regulation and reflective functioning, unique from changes in parenting practices, could be mechanisms that help explain why PCIT has been associated with improvements in children’s externalizing behaviors.     

Family Cohesion and Health-Related Quality of Life of Children with Type 1 Diabetes: The Mediating Role of Parental Adjustment

Despite the increasing number of studies on the health-related quality of life (HRQOL) of children with type 1 diabetes (T1D), little is known about the influence of family and parental factors on this outcome. This study aimed to explore whether family cohesion and children’s HRQOL were connected through three indicators of parental psychological adjustment (parenting stress, depressive symptoms, and anxious symptoms) as well as whether these links varied according to the child’s age. Levels of family cohesion, parenting stress, and depression/anxiety symptoms of parents of children with T1D and parents of healthy children were compared. The sample included 88 child–parent dyads composed of children/adolescents (8–18 years old) with T1D and one of their parents and 121 dyads composed of healthy children/adolescents and one of their parents. The parents completed self-report measures of family cohesion, parenting stress, and emotional adjustment, and the children completed measures of HRQOL. Testing of the hypothesized moderated mediational model showed that higher HRQOL ratings in children were associated with higher levels of cohesion through lower levels of parental stress, regardless of the child’s age. Parents of children with T1D perceived less cohesion and felt more anxiety and stress about parenting tasks compared to parents of healthy children. Our findings suggest that parents of children with T1D are at an increased risk of psychological maladjustment. Moreover, this study highlights the interrelation between family/parental functioning and child adjustment and makes an innovative contribution by identifying a mechanism that may account for the link between family and child variables.     

Parent influences on early childhood internalizing difficulties

Children's internalizing problems are a concerning mental health issue, due to significant prevalence and continuity over time. This study tested a multivariate model predicting young children's internalizing behaviors from parenting practices, parents' anxiety–depression and family stressors. A community sample of 2 year old children (N = 112) was followed longitudinally to 4 years. Parents completed questionnaires and playroom observations provided independent measures of parenting and child variables. Predictors of early childhood internalizing difficulties were over-involved/protective parenting, low warm-engaged parenting, and parental anxiety–depression. Family life-stress and parental anxiety–depression also predicted problematic parenting practices. These findings were discussed within the context of the design of early childhood parenting programs to prevent anxiety and depression in children.     

Validity of the parenting scale for parents of children with attention-deficit/hyperactivity disorder

The present study examined the validity of the parenting scale for parents of elementary school-aged children with attention-deficit/hyperactivity disorder (ADHD). Parents from 109 families with children who had been diagnosed with ADHD (106 mothers and 93 fathers) and from 70 families with non-problem children (69 mothers and 59 fathers) completed the parenting scale and reported on their children's behavior problems. Factor analyses revealed two interpretable factors for both mothers and fathers, corresponding to the overreactivity and laxness factors identified in previous studies of the parenting scale. Overreactivity and laxness scores were significantly higher for mothers and fathers of ADHD children than of non-ADHD children; this effect appeared to be accounted for by comorbid aggression and conduct problems among ADHD children. Results support the validity of the parenting scale for use with parents of ADHD children.     

Temperament,Family Environment and Anxiety in Preschool Children

This research examines the relationship between behavioural inhibition (BI), family environment (overinvolved and negative parenting, parental anxiety and parent-child attachment) and anxiety in a sample of 202 preschool children. Participants were aged between 3 years 2 months and 4 years 5 months, 101 were male. A thorough methodology was used that incorporated data from multiple observations of behaviour, diagnostic interviews and questionnaire measures. The results showed that children categorised as behaviourally inhibited were significantly more likely to meet criteria for a range of anxiety diagnoses. Furthermore, a wide range of family environment factors, including maternal anxiety, parenting and attachment were significantly associated with BI, with inhibited children more likely to experience adverse family environment factors. No interactions between temperament and family environment were found for child anxiety. However, a significant relationship between current maternal anxiety and child anxiety was found consistently even after controlling for BI. Additionally, there was some evidence of a relationship between maternal negativity and child anxiety, after controlling for BI. The results may suggest that temperament and family environment operate as additive, rather than interactive risk factors for child anxiety. This is discussed in the context of theoretical models of child anxiety and directions for future research.     

Development and Validation of a Short Form of the Alabama Parenting Questionnaire

Brief assessments of parenting practices can provide important information about the development of disruptive behavior disorders in children. We examined the factor structure of a widely used assessment of parenting practices, the Alabama Parenting Questionnaire, and produced a 9-item short scale around its three supported factors: Positive Parenting, Inconsistent Discipline and Poor Supervision. The short scale was then validated in independent community samples using confirmatory factor analysis and measures of disruptive behavioral disorders in children. The scale showed good fit to a three-factor model and good convergent validity by differentiating parents of children with disruptive behavioral disorders and parents of children without such disorders. Results indicated that this new measure is an informative tool for researchers and clinicians whom require brief assessments of parenting practices relating to disruptive behavioral disorders in children.     

气质与父母养育对儿童社会适应的交互作用:代表性理论及其证据

最佳适配理论、素质-压力模型、差别易感模型从不同视角阐述了气质、养育方式在儿童社会适应行为中的交互作用机制。最佳适配理论强调气质特质与父母养育方式的良好匹配能促进儿童的社会适应,而不良匹配则会带来适应问题。素质-压力模型强调在不利父母养育条件下,具有"风险"气质特质的儿童更容易出现适应不良,而对"弹性"气质的儿童影响不大。差别易感模型则认为儿童"易感"的气质特质在良好的抚养条件下表现得"更好",而在不利的抚养环境中表现得"更差"。围绕三种代表性理论及其实证研究结果,对当前最新研究结果进行了分析和总结,进一步细分了儿童社会化过程中的风险因素和保护性因素。从气质与积极养育方式的交互作用、养育过程中父母角色分工的差异,以及气质与养育方式动态作用机制三个方面指出了将来进一步探索的方向。     

The contribution of parenting practices in a risk and resiliency model of children's adjustment

A risk and resiliency model of children's adjustment was evaluated, with a focus on the relationship of parenting practices to risk and protective factors. Risk factors included family stress, family conflict, parent psychopathology and low socio‐economic status. Protective factors included family cohesion, family social support and family moral– religious orientation. The research hypothesis was that parenting practices would have a direct effect on child outcomes, as well as a moderating effect on the relationship between risk and protective factors and child outcomes. Three different outcomes were utilized: disruptive behaviour disorders, adaptive emotional functioning and school achievement. Participants were 80 children aged 6–12 years and their mothers. Hierarchical regression analyses suggested that the combination of family risk and protection and parenting practices was highly predictive of child functioning for both disruptive externalizing behaviours and positive emotional adaptation. It was found that negative family factors were more highly associated with negative child outcomes, whereas positive family factors were more highly associated with positive child outcomes. Family risk factors and poor parenting primarily accounted for the variance in externalizing child behaviours. Alternately, family protective factors and positive parenting primarily accounted for the variance in child adaptive behaviours. Parenting practices had a direct effect on child outcomes, but was not a strong moderator of the relationship between risk and protection factors and child outcomes.     

Associations Between Individual and Family Level Characteristics and Parenting Practices in Incarcerated African American Fathers

We investigated the reported parenting practices of fifty incarcerated African American fathers. Fathers were interviewed using hypothetical vignettes adapted from the Parenting Dimensions Inventory (PDI) and received scores on two parenting practices: responsive and restrictive. Father’s individual level (education and length of time spent incarcerated) and family level (number of relationships that have borne children) characteristics were significantly associated with their parenting practices. Based on canonical correlation analysis, on function one, responsive parenting was positively associated with education level and negatively associated with both cumulative incarceration time and more numerous partner fertility. Restrictive parenting was negatively associated with education level and positively associated with both cumulative incarceration time and more numerous partner fertility. Function 2 capitalized on variance in the restrictive parenting predictor that was not utilized in function 1, and likely captured lack of opportunity to parent. On function 2, restrictive parenting was negatively associated with cumulative time spent incarcerated and more numerous partner fertility. In all, results suggest that prison-based education programs should be part of an overall response to incarcerated fathers. These results add to the growing body of research on incarcerated fathers and fragile families.     

Self-Reported Parenting of Clinic-Referred and Non-referred Mexican American Mothers of Young Children

Behavioral parent training (BPT) interventions for child behavior problems have been based on decades of research that demonstrate links between particular parent behaviors and child externalizing problems. However, the majority of this research has been conducted with European-American (EA) families, and less is known about whether these findings can be generalized to Mexican Americans (MAs). In the current study, we investigated self-reported parenting practices that have been associated with externalizing behavior problems among EA families (harsh parenting, inconsistency, and low parental warmth), to determine if those practices can also differentiate MA mothers whose young children have clinically significant behavior problems from MA mothers whose children do not have behavior problems. Participants were 115 MA families with young children, 58 with a child with clinically significant behavior problems and 57 with a child in the normal range for such problems. Results indicated that MA mothers whose children have behavior problems self-reported significantly less warmth and consistency and more harsh parenting compared to parents whose children’s behavior was in the normal range. These findings indicate that parenting behaviors that are associated with externalizing behavior problems among EA families are associated with the same problems among MA families with young children, suggesting that parent training interventions designed to target these behaviors are also likely to be relevant to MA families with children in this age range. However, findings also indicate that parenting behaviors differ depending on acculturation level, suggesting that BPT programs must respond to variation in normative parenting practices for MA families.     

The Potential Mediating Role of Parenting Practices in the Development of Conduct Problems in a Clinic-Referred Sample

Research has consistently found associations among parenting practices, socioeconomic disadvantage, ethnicity and conduct problems in children. We investigated whether parenting practices might mediate the relation between ethnicity and conduct problems and the relation between socioeconomic status (SES) and conduct problems. The subjects were 141 clinic-referred children between the ages of 6 and 17 and their primary custodial parents. Using multiple indicators for each construct, except ethnicity, the mediational role of parenting was tested using structural equation modeling. The results indicated that the effects of SES on conduct problems was largely mediated by the influence of ineffective parenting practices. In contrast, ethnicity was not associated with conduct problems in this clinic-referred sample, even prior to controlling for SES and parenting practices, suggesting that the link between minority status and conduct problems may be dependent on the demographic characteristics of the sample. Exploratory analyses also revealed that there were ethnic differences in the types of parenting practices that were most strongly associated with conduct problems.     

The impact of maternal control on children’s anxious cognitions, behaviours and affect: An experimental study

Controlling parenting is associated with child anxiety however the direction of effects remains unclear. The present study implemented a Latin-square experimental design to assess the impact of parental control on children’s anxious affect, cognitions and behaviour. A non-clinical sample of 24 mothers of children aged 4-5 years were trained to engage in (a) controlling and (b) autonomy-granting behaviours in interaction with their child during the preparation of a speech. When mothers engaged in controlling parenting behaviours, children made more negative predictions about their performance prior to delivering their speech and reported feeling less happy about the task, and this was moderated by child trait anxiety. In addition, children with higher trait anxiety displayed a significant increase in observed child anxiety in the controlling condition. The pattern of results was maintained when differences in mothers’ levels of negativity and habitual levels of control were accounted for. These findings are consistent with theories that suggest that controlling parenting is a risk factor in the development of childhood anxiety.     

Simultaneously Testing Parenting and Social Cognitions in Children At-Risk for Aggressive Behavior Problems: Sex Differences and Ethnic Similarities

In this cross-sectional study we examined a model in which parenting, child social information processing and self-perception are simultaneously tested as risk factors associated with aggression. Sex and ethnicity were tested as moderators of associations. The sample consisted of 206 4th grade children in the Netherlands. Parents reported on parenting, parent–child relationship, and reactive and proactive aggression whereas children reported on self-perception and social information processing. Results give support for both child social cognitive functioning and parenting as risk factors associated with aggressive behavior: For all children, a positive parent–child relationship was associated with less aggression, negative parenting was related to less positive self-perception, and deficits in social-cognitive functioning were related to aggression. Multigroup analyses showed ethnic similarities and sex differences in patterns of associations, which might suggest personalized tailor-made interventions for aggressive behavior.     

Associations Between Family Environment, Parenting Practices, and Executive Functioning of Children with and Without ADHD

We examined the relationships between executive functioning, family environment, and parenting practices in children diagnosed with ADHD as compared to children without ADHD. Participants were parents (N = 134) of 6- to 12-year-old ADHD and non-ADHD-diagnosed children. Compared to the control group, parents of children diagnosed with ADHD reported their children as exhibiting greater problems with behavioral control and metacognitive abilities, and described their family environments as less organized and higher in family conflict. Family environment and parenting practices were not correlated with behavioral control or metacognitive abilities in children with ADHD. In children without ADHD, higher levels of family cohesion, organization, and expressiveness, and lower levels of family conflict, were significantly correlated with greater behavioral control. Higher levels of family cohesion and organization were significantly and positively associated with regulation of metacognitive abilities in children without ADHD. In general, aspects of the family environment and parental limit setting appear to be associated with the development of executive functions in children not diagnosed with ADHD; however, family environment and parenting practices were not associated with executive functions in children diagnosed with ADHD.     

Family Processes and Treatment Outcome in the MTA: Negative/Ineffective Parenting Practices in Relation to Multimodal Treatment

To elucidate processes underlying therapeutic change in a large-scale randomized clinical trial, we examined whether alterations in self-reported parenting practices were associated with the effects of behavioral, medication, or combination treatments on teacher-reported outcomes (disruptive behavior, social skills, internalizing symptoms) in children with attention-deficit hyperactivity disorder (ADHD). Participants were 579 children with Combined-type ADHD, aged 7–9.9 years, in the Multimodal Treatment Study of Children with ADHD (MTA). We uncovered 2 second-order factors of parenting practices, entitled Positive Involvement and Negative/Ineffective Discipline. Although Positive Involvement was not associated with amelioration of the school-based outcome measures, reductions in Negative/Ineffective Discipline mediated improvement in children's social skills at school. For families showing the greatest reductions in Negative/Ineffective Discipline, effects of combined medication plus behavioral treatment were pronounced in relation to regular community care. Furthermore, only in combination treatment (and not in behavioral treatment alone) was decreased Negative/Ineffective Discipline associated with reduction in children's disruptive behavior at school. Here, children in families receiving combination treatment who showed the greatest reductions in Negative/Ineffective Discipline had teacher-reported disruptive behavior that was essentially normalized. Overall, the success of combination treatment for important school-related outcomes appears related to reductions in negative and ineffective parenting practices at home; we discuss problems in interpreting the temporal sequencing of such process-outcome linkages and the means by which multimodal treatment may be mediated by psychosocial processes related to parenting.