Families of Children With Attention-Deficit/Hyperactivity Disorder: Review and Recommendations for Future Research

This review integrates and critically evaluates what is known about family characteristics associated with childhood Attention-Deficit/Hyperactivity Disorder (ADHD). Evidence suggests that the presence of ADHD in children is associated to varying degrees with disturbances in family and marital functioning, disrupted parent–child relationships, specific patterns of parental cognitions about child behavior and reduced parenting self-efficacy, and increased levels of parenting stress and parental psychopathology, particularly when ADHD is comorbid with conduct problems. However, the review reveals that little is known about the developmental mechanisms that underlie these associations, or the pathways through which child and family characteristics transact to exert their influences over time. In addition, the influence of factors such as gender, culture, and ADHD subtype on the association between ADHD and family factors remains largely unknown. We conclude with recommendations regarding the necessity for research that will inform a developmental psychopathology perspective of ADHD.     

The Influence of Family and Experimental Context on Cognition in Anxious Children

Examined the influence of family on anxious children's cognition. Research by Barrett, Rapee, Dadds, and Ryan (1996) found anxious children reported increased avoidance after interacting with their parents. They labelled this finding the FEAR effect—Family Enhancement of Avoidant Responses. Whilst some subsequent studies have found similar results, others have not. These contradictory findings question whether the direction of parental influence on anxious children is determined by the perceived demands of the experimental context. Anxious children (N = 101) and their parents were asked to interpret seven ambiguous situations and to discuss what their child would do if the scenario actually occurred. Study 1 found that children in the anxious group and an externalizing control group were more likely to interpret ambiguous situations as threatening than nonclinic children were. Study 2 sought to examine changes in the children's responses from pre- to postfamily discussion, and to identify variables associated with the FEAR effect in anxious families. Interestingly, anxious children whose families completed the discussion task after they (children) had been offered treatment were more likely to show a FEAR effect than anxious families who completed the task as part of assessment. Study 3 examined predictors of enhanced avoidance in anxious families. Treatment context and maternal distress were correlated with the child's increased avoidance following family discussion. Limitations of these studies and directions for future research are discussed.     

Early impact of the BEST intervention for parents stressed by adolescent substance abuse

Youth involvement in substance abuse can be a source of considerable distress for their parents. Unilateral family interventions have been advocated as one means by which concerned family members can be supported to assist substance‐abusing family members. To date there has been little research examining the impact of unilateral family interventions on the directly participating family members. In this study the early impact of an 8‐week parent‐group programme known as Behavioural Exchange Systems Training (BEST) was evaluated using a quasi‐experimental, waiting list control design. The professionally led programme had been developed to support and assist parents in their efforts to cope with adolescent substance abuse. Subjects were 66 parents (48 families) accepted for entry into the programme between 1997 and 1998. Comparison was made between 46 parents offered immediate entry into the programme and 20 parents whose entry to the programme was delayed by an 8‐week waiting list. At the first assessment 87% of parents showed elevated mental health symptoms on the General Health Questionnaire. Evidence suggested exposure to the intervention had a positive impact on parents. Compared to parents on the waiting list, parents entered immediately into the intervention demonstrated greater reductions in mental health symptoms, increased parental satisfaction, and increased use of assertive parenting behaviours. Copyright © 2001 John Wiley & Sons, Ltd.     

Parents' Emotion‐Related Beliefs,Behaviours, and Skills Predict Children's Recognition of Emotion

Children who are able to recognize others' emotions are successful in a variety of socioemotional domains, yet we know little about how school‐aged children's abilities develop, particularly in the family context. We hypothesized that children develop emotion recognition skill as a function of parents' own emotion‐related beliefs, behaviours, and skills. We examined parents' beliefs about the value of emotion and guidance of children's emotion, parents' emotion labelling and teaching behaviours, and parents' skill in recognizing children's emotions in relation to their school‐aged children's emotion recognition skills. Sixty‐nine parent–child dyads completed questionnaires, participated in dyadic laboratory tasks, and identified their own emotions and emotions felt by the other participant from videotaped segments. Regression analyses indicate that parents' beliefs, behaviours, and skills together account for 37% of the variance in child emotion recognition ability, even after controlling for parent and child expressive clarity. The findings suggest the importance of the family milieu in the development of children's emotion recognition skill in middle childhood and add to accumulating evidence suggesting important age‐related shifts in the relation between parental emotion socialization and child emotional development. Copyright © 2014 John Wiley & Sons, Ltd.     

Policy Recommendations for Carrier Testing and Predictive Testing in Childhood: A Distinction That Makes a Real Difference

The genetic testing of children raises many ethical concerns. This paper examines how five position statements from Canada, UK and USA, which present guidelines for good practice in this area produce different recommendations for carrier testing and predictive testing. We find that the genetic information generated through carrier testing is routinely presented as less serious than that generated from predictive testing. Additionally, the reproductive implications of predictive testing are also routinely erased. Consequently, the papers argue strongly against predictive testing but advise caution against carrier testing in somewhat weaker terms. We argue that these differences rest on assumptions about the status of reproduction in people’s lives and on an ethical stance that foregrounds the self over others. We propose that questioning the crude and sharp distinction between carrier and predictive testing in principle may enable practitioners and parents/families to make more nuanced decisions in practice. Parts of this work have been presented in the 1st International CESAGen Conference, London, 2004, and Genetics and Society Meetings, Wales.     

Low‐income parents' warmth and parent–child activities for children with disabilities,suspected delays and biological risks

Warm and responsive parenting is optimal for child development, but this style of parenting may be difficult for some parents to achieve. This study examines how parents' observed warmth and their reported frequency of parent–child activities were related to children's classifications as having biological risks or a range of disability indicators. Children were low‐income prekindergarteners who participated in the Early Head Start Research and Evaluation Project Longitudinal Follow‐up. Data from parent, early care and education staff reports, and direct child assessments were used to classify children into the following groups: disabilities, suspected delays, biological risks, disabilities and biological risk, suspected delays and biological risk, and no disability indicator. Socioeconomic status (ethnicity, maternal education and poverty level) and maternal depression were controlled in the analyses. The parents of children with disabilities and suspected delays evidenced significantly lower levels of warmth and less frequent parent–child activities compared with other parents. The parents of children with biological risk factors who did not also have disabilities or suspected delays did not exhibit decreased warmth and less frequent parent–child activities. Copyright © 2010 John Wiley & Sons, Ltd.     

Mother-child separations among homeless and housed families receiving public assistance in New York City

We examined the incidence, characteristics, and predictors of separations of children from mothers in 543 poor families receiving public assistance, 251 of whom had experienced homelessness during the previous 5 years. Forty-four percent of the homeless mothers and 8% of housed mothers were separated from one or more children. A total of 249 children were separated from 110 homeless families and 34 children from 23 housed families. Children were placed with relatives and in foster care but were rarely returned to their mothers. Maternal drug dependence, domestic violence, and institutionalization predicted separations, but homelessness was the most important predictor, equivalent in size to 1.9 other risk factors. We infer that policies regarding child welfare and substance abuse treatment should be changed to reduce unnecessary placements. Studies of homeless children who remain with families may be biased if separated children are excluded.     

The Psychological Burden Inflicted By Multiple Cancers in Li-Fraumeni Families: Five Case Studies

To gain insight into the psychological, emotional, relational, and family problems of families afflicted by Li-Fraumeni syndrome, we interviewed members of five such families in the Pediatric Oncology Department, Gustave Roussy Institute, where at least one member of the family had been treated. These interviews showed that families were psychologically fragile, that their interactions and thinking patterns were related to a family background plagued by the repeated occurrence of cancer, and was often marked by physical or psychological violence. They had complex imaginary etiologic explanations, and showed an ambivalent willingness to learn about cancer and the risks involved. They expressed their fear of transmitting doom and death, posed questions about whether their parents would have had them had they known the test result, and about what their own attitude would be toward childbearing. Thus genetic testing awoke disconcerting and unsolved questions for them. These first results can contribute to the design of supportive interventions and future clinical research.     

Results of an Intervention for Individuals and Families with <Emphasis Type="Italic">BRCA</Emphasis> Mutations: A Model for Providing Medical Updates and Psychosocial Support Following Genetic Testing

Providing medical management updates and long-term support to families with hereditary cancer syndromes in rural areas is a challenge. To address this, we designed a one-day retreat for BRCA1/2 carriers in our region. The retreat included educational updates about medical management, genetic privacy and discrimination, and addressed psychological and family issues. Evaluations completed at the conclusion of the retreat were overwhelmingly positive with requests for a similar event in the future. The impact of this retreat on a variety of health behaviors was assessed. Eligible participants completed questionnaires before and 6 months after the retreat. Questionnaires focused on lifestyle, cancer screening and prevention practices, psychological history and distress, decision-making regarding genetic testing, and family communication issues. For individuals who completed both the pre and post retreat questionnaires, one-half made lifestyle changes and nearly two-thirds increased cancer screening, initiated chemoprevention, completed or planned to complete preventative surgery in the future. We conclude that this type of forum provides a valuable opportunity for BRCA carriers and their families to receive updated medical information, share personal experiences, provide and receive support, as well as change health behaviors.     

The Importance of Parental Attributions in Families of Children with Attention-Deficit/Hyperactivity and Disruptive Behavior Disorders

Presents a social-cognitive model outlining the role of parental attributions for child behavior in parent–child interactions. Examples of studies providing evidence for the basic model are presented, with particular reference to applications of the model in families of children with Attention-Deficit/Hyperactivity Disorder (ADHD) and/or oppositional defiant/conduct disordered behavior. Parent or child factors that may moderate the operation of links within the model are suggested, and evidence of such moderator effects is presented. The conceptualization and measurement of parental attributions also are discussed. The limitations of the model and existing evidence, as well as recommendations for future research in this area are presented throughout the paper. The paper concludes with a summary of the clinical implications of the model and research on parental attributions with regards to improving interventions for families of children with attentional and disruptive behavior problems.     

Objective and subjective assessments of parenting in hyperactive preschoolers

Objective: To evaluate whether the mother–child interactions of hyperactive preschool children and their typically developing peers differentially vary as a function of situational demands, and whether groupwise differences exist with respect to disciplinary practices and family lifestyles (e.g. level of parental investment, strategies for responding to child‐initiated provocation). Methods: Parenting practices were assessed via videotaped parent–child interactions and self‐report methods in mother–child dyads of 21 hyperactive preschoolers and 48 age‐matched control dyads. Results: Hyperactive preschoolers were significantly more non‐compliant during parent–child interactions. Mothers of hyperactive preschoolers exhibited more negative behaviour and less encouragement with heightened situational demands. Although few significant differences were reported regarding disciplinary practices, parents of hyperactive preschoolers reported greater levels of anger and child rearing difficulty, and perceived their children as more bothersome. Conclusions: Parents of hyperactive preschoolers may profit from interventions that are sensitive to the impact of situational changes on their behaviour and which address possible attributional biases regarding the source of parent–child discord. Copyright © 2006 John Wiley & Sons, Ltd.     

Combining dynamic systems and multivariate analyses to compare the mother-child interactions of externalizing subtypes

A dynamic systems analysis was conducted to distinguish the parent–child interactions of pure externalizing children from children comorbid for externalizing and internalizing problems. Thirty-three parents and clinically referred children (8–12 years old) discussed a problem for 4 min and then tried to wrap up in response to a signal (a perturbation). The perturbation was intended to increase the pressure on the dyad, triggering a reorganization of their behavioral system. We hypothesized that the comorbid group would be distinguished from the externalizing-only group as a result of this reorganization, but not before. The sequential data were analyzed using a combination of case-sensitive (state space grids and chi-square analyses) and group-based, multivariate techniques (log-linear modeling). Results revealed that externalizing dyads engaged in a permissive pattern throughout the problem-solving session, whereas comorbid dyads shifted from a permissive pattern to a mutually hostile pattern after the perturbation. These findings punctuate the need for a dynamic systems approach to the study of relationship processes associated with the development of childhood psychopathology. Theoretical and clinical implications are discussed.     

To Play or Not to Play: Diverse Motives for Latino and Euro‐American Parent–Child Play in a Children's Museum

A popular social discourse in the United States is that play is important for children's learning and that parental involvement maximizes play's learning potential. Past research has concluded that parents who hold this view of play are more likely to play with their children than those who do not. This study investigated the prevalence of this view among Euro‐American and immigrant Latino parents of young children in order to illuminate the extent to which it uniquely and uniformly motivates parent–child play. Parents' models of play were assessed through interviews and naturalistic observations in a children's museum. Analysis revealed ethnic group differences in parent–child play that corresponded with parental beliefs about play. Within‐group analysis, however, revealed diversity in the ways that these play behaviours and beliefs came together to comprise parents' models of play. Discussion focuses on the social nature of play, the dynamic nature of culture, and the issue of individual subject validity. Implications for the interpretation of parent–child play in early childhood settings are considered. Copyright © 2014 John Wiley & Sons, Ltd.     

Mothers' and Fathers' Internal State Language with Their Young Children: An Examination of Gender Differences During an Emotions Task

The current study examined gender differences in mothers' and fathers' internal state language (ISL), children's use of ISL, and whether ISL was related to parents' ratings of the children's social skills. Fifty‐seven (28 boys, 29 girls) toddler/preschool children (M age = 32.5 months, SD = 5.38 months) were observed separately with their mothers and fathers in their homes while they discussed pictures of children's facial expressions of emotions. Parents completed a questionnaire concerning their child's social–emotional behaviours (i.e. BASC‐2). Parents used more ISL with sons compared with daughters, and sons used more ISL with mothers than with fathers. No overall differences were found between mothers' and fathers' ISL. Children's social skills as rated by mothers were predicted by mothers' ISL comments, whereas children's social skills as rated by fathers were predicted by children's age and fathers' ISL clarifications. Implications and limitations of the study are discussed. Copyright © 2012 John Wiley & Sons, Ltd.     

Construction and maintenance of parent–child relationships: Bidirectional contributions from the perspective of parents

The purpose of the present study was to investigate parents' perspectives of parent and child contributions to the construction and maintenance of the parent–child relationship. Twenty‐four mothers and fathers, with a child between 4‐ to 7‐years‐old, completed an open‐ended interview in which they described their parent–child relationship and commented on how they and their child strengthen, damage, and repair the relationship. Findings indicated that parents described their parent–child relationship with relatively similar emphasis on elements of authority, companionship, and intimacy. Parents reported that they were most likely to strengthen the parent–child relationship by interacting with their child in the companionship domain, whereas their overuse of power or authority and non‐responsiveness temporarily created damage in the relationship. Parents reported that their children were most likely to strengthen the relationship by complying with parent requests and engaging in companionate interactions, whereas not complying or challenging parent directives created relational tension. Parents indicated that both they and their children were most likely to repair interactional errors by restoring intimacy (e.g. apology, communication, or affection). Results are discussed from a framework of multiple relationship domains consisting of the interplay of vertical and horizontal dimensions of power. Copyright © 2004 John Wiley & Sons, Ltd.     

The role of child temperament on low‐income preschool children's relationships with their parents and teachers

The current study examined the associations between low‐income preschool children's temperament (reactive and regulatory) and their relationships with parents and teachers. In particular, we focused on the moderating role of regulatory temperament on reactive temperament in the prediction of closeness and conflict with parents and teachers. Two hundred ninety‐one children (M = 53.88 months, SD = 6.44 months), their parents, and teachers from 3 different preschools serving low‐income children in 2 midwestern cities in the United States participated. Parents reported on temperament and parent–child relationships, and teachers reported on teacher–child relationships. Hierarchical regression models using SAS PROC MIXED were employed to allow for nesting of children within classrooms. After controlling for child age, gender, ethnicity, and parent education, children's reactive temperament was negatively associated with parent–child closeness and positively associated with parent–child conflict and teacher–child conflict. Children's regulatory temperament was positively related to teacher–child closeness and negatively associated with teacher–child conflict. Regulatory temperament moderated the association between reactive temperament and teacher–child closeness. These findings suggest that although reactive temperament potentially undermines closeness in relationships with teachers, regulatory temperament can buffer the influence of reactive temperament on teacher–child closeness.

Highlights

• This study examined the association between children's temperament and their relationships with parents and teachers.
• Reactive temperament was positively associated with parent/teacher–child conflict and negatively associated with parent–child closeness. Regulatory temperament was a moderator for the association between reactive temperament and teacher–child closeness.
• Improving children's regulatory temperament may be helpful for children with the reactive temperament to have better social relationships with their teachers.

     

The Voices of Therapists and Children Regarding the Inclusion of Children in Family Therapy: A Systematic Research Synthesis

In 1970, Nathan Ackerman challenged the field of marriage and family therapy to actively involve young children in the family therapy process. How has the field of marriage and family therapy responded to his challenge? Using a systematic research synthesis to review and critique the non-empirical and empirical literature in the area of children in family therapy, the author discovered that the field of marriage and family therapy has not responded to Ackerman's challenge in the way he may have hoped for nearly three decades ago. A summary of the literature's findings is provided and recommendations for future research, as well as implications, for the field of marriage and family therapy are discussed.     

Early parent-child relations and family functioning of preschool boys with pervasive hyperactivity

This study examined the quality of parent–child relationships and family functioning of preschool children with early onset hyperactivity by comparing a community sample of 33 pervasively hyperactive preschool boys with a comparison sample of 34 boys. Mothers and children were assessed at home on a range of interview, parent questionnaire, and observational measures of parenting and family functioning. Results of the study showed that higher rates of reported lax disciplinary practices, less efficient parental coping, lower rates of father–child communication, and less synchronous mother–child interactions were significantly associated with hyperactivity following statistical adjustment for the effects of conduct problems and other confounding factors. The best parenting predictor of hyperactivity was maternal coping. The present findings suggest that the way in which parents interact with their preschool children may make a unique contribution to the development and ongoing behavioral difficulties experienced by children with pervasive hyperactivity. Findings also highlight the importance of considering the role of fathers in the behavioral development of boys with early tendencies to hyperactive and distractible behavior problems.