Parent and Family Characteristics and Their Associates in a Follow-Up of Outpatient Children with ADHD

We examined associations between child symptoms, demographic variables, parent and family characteristics in a long-term follow-up study of 214 outpatient children with attention-deficit/hyperactivity disorder (ADHD). The children’s mean age was 12.6 (SD = 2.1) years, and the mean interval from diagnosis to follow-up was 3.7 (SD = 2.2) years. We compared the characteristics of the clinical group with a community group (n = 110) recruited from the same catchment area. Parents filled out questionnaires on child symptoms, parent characteristics, and family functioning. The results showed that parents of young boys (<13 years) experienced more parenting stressors than those of adolescent boys (≥13 years), but the opposite was true for parents of girls. Parents of children with both ADHD and oppositional defiant disorder symptoms in the clinical range experienced significantly more parent and family dysfunctions than those of children with ADHD only (even after controlling for levels of ADHD symptoms in the child). Parents of children in the community group experienced significantly less parent and family dysfunctions than those of children with ADHD. Partial correlations between parent characteristics and child symptoms showed that oppositional symptoms were most strongly associated with parent and family dysfunction. Fathers experienced significantly less parenting stress, parental efficacy, and child involvement than mothers. We conclude that parents of children with ADHD experienced considerable strain related to a broad range of parent and family characteristics. Assessment of such characteristics should be part of routine assessment procedures and a prerequisite for family-focused treatment of children with ADHD.     

Disruptive Behavior Disorders in Children and Adolescents: How Do Girls Differ From Boys?

Disruptive behavior disorders in children and adolescents can lead to a lifetime of problems. The 2 disruptive behavior disorders identified in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM‐IV; American Psychiatric Association, 1994) are oppositional defiant disorder and conduct disorder. Although much research has been conducted to learn more about these 2 disorders, little is known about gender differences in the disorders. There is a dearth of specific information regarding girls with disruptive behavior disorders. This article discusses the diagnosis, risk factors, and treatment of oppositional defiant disorder and conduct disorder while incorporating information specific to girls to investigate how disruptive behavior disorders differ for girls.     

Parenting Behaviors and Child Externalizing: A Short-Term Investigation of Directionality

Children (N = 404) provided data during 3rd and 4th grades concerning their mothers’ use of punitive discipline and yielding to coercion. Teachers provided data regarding their perceptions of children’s externalizing behaviors at school. We tested a cross-lagged model examining parental disciplinary behaviors as predictors of child externalizing behavior, as well as child externalizing behaviors as a predictor of parental disciplinary behaviors. For boys and for girls, there was over-time stability in all three variables of interest. For boys only, more externalizing behaviors in Grade 3 predicted greater use of punitive discipline by parents and more parental yielding to coercion in Grade 4, over and above Grade 3 levels of these parenting variables. The reverse direction of effects was not observed.     

Executive Functioning and Engagement in Physical and Relational Aggression among Children with ADHD

Although evidence suggests that executive functioning (EF) impairments are implicated in physically aggressive behavior (e.g., hitting) these cognitive impairments have rarely been examined with regard to relational aggression (e.g., gossip, systematic exclusion). Studies also have not examined if EF impairments underlie the expression of aggression in children with attention-deficit/hyperactivity disorder (ADHD) and if child gender moderates risk. Children with and without clinical elevations in ADHD symptoms (N = 124; ages 8–12 years; 48 % male) completed a battery of EF tests. Parent and teacher report of ADHD and oppositional defiant disorder (ODD) symptoms and teacher report of engagement in physical and relational aggression were collected. Models tested the unique association of EF abilities with physical and relational aggression and the indirect effect through the expression of ADHD or ODD behaviors; child gender was also tested as a moderator. EF impairment was uniquely associated with physical aggression, but better EF ability was associated with relational aggression. For boys, poor EF also was indirectly associated with greater physical aggression through the expression of ADHD behaviors. However, ADHD symptoms were unrelated to relational aggression. ODD symptoms also predicted physical aggression for boys but relational aggression for girls. Results suggest that there are multiple and distinct factors associated with engagement in physical and relational aggression and that better EF may actually promote relational aggression. Established models of physical aggression should not be assumed to map on to explanations of relational aggression.     

Childhood disruptive behaviors and family functioning in clinically referred children: Are girls different from boys?

Baseline assessments of 4 to 8-year-old children, 26 girls and 101 boys, referred to outpatient treatment for disruptive behaviors, were examined, focusing on possible differences between the functioning of boys and girls and their families. Child variables included diagnostic information, measures of disruptive behaviors, social competence, and independent observations of child behaviors. A variety of family variables, such as information regarding parenting practices, parental stress, and depression were included. Teacher reports of disruptive behaviors and social competence at school were included. Teacher ratings of child functioning indicated that boys displayed significantly more externalizing behaviors and they were less socially competent than girls. Parents perceived both girls and boys as highly oppositional and aggressive, and generally speaking, differences were few. Nevertheless, the level of stress was higher in girls' than in boys' families, and mothers of girls reported of higher levels of depressive symptoms. Girls and boys did not differ regarding diagnostic status.     

The structure of childhood disruptive behaviors

Attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) frequently co-occur. Comorbidity of these 2 childhood disruptive behavior domains has not been satisfactorily explained at either a structural or etiological level. The current study evaluated a bifactor model, which allows for a "g" factor in addition to distinct component factors, in relation to other models to improve understanding of the structural relationship between ADHD and ODD. Participants were 548 children (321 boys, 227 girls) between the ages of 6 years and 18 years who participated in a comprehensive diagnostic assessment incorporating parent and teacher ratings of symptoms. Of these 548 children, 153 children were diagnosed with ADHD (without ODD), 114 children were diagnosed with ADHD + ODD, 26 children were diagnosed with ODD (without ADHD), and 239 children were classified as non-ADHD/ODD comparison children (including subthreshold cases). ADHD symptoms were assessed via parent report on a diagnostic interview and via parent and teacher report on the ADHD Rating Scale. ODD symptoms were assessed via teacher report. A bifactor model of disruptive behavior, comprising a "g" factor and the specific factors of ADHD and ODD, exhibited best fit, compared to 1-factor, 2-factor, 3-factor, and 2nd-order factor models of disruptive behaviors. It is concluded that a bifactor model of childhood disruptive behaviors is superior to existing models and may help explain common patterns of comorbidity between ADHD and ODD.     

Parent–Child Synchrony in Children with Oppositional Defiant Disorder: Associations with Treatment Outcomes

Oppositional defiant disorder (ODD), characterized by angry/irritable mood, and argumentative/defiant behavior, is associated with significant negative outcomes in childhood and beyond. Researchers posit that these behaviors arise from poor parenting and/or an incompatibility between characteristics of the child and the child’s parents, resulting in strained interaction styles. The present study examines parent–child synchrony, the inverse of parent–child incompatibility as a predictor of children’s emotional lability, aggression, and overall functioning following psychosocial treatment. Participants were 75 treatment-seeking families with children diagnosed with ODD (46 boys). Families received one of two empirically supported treatments for ODD (Parent Management Training or Collaborative and Proactive Solutions). Findings indicated that pre-treatment parent–child synchrony was associated with decreased emotional lability and aggression following both treatments, as well as improvement in overall functioning, irrespective of treatment condition. These results reflect the importance of parent–child relations at the onset of treatment in predicting response to treatment and suggest potential treatment targets within parent–child relationships.     

父母早期受虐与子女对立违抗症状的关系:亲子虐待和儿童愤怒管理的作用

本研究探讨了父母的早期受虐经历与子女的对立违抗症状的关系,通过构建一个有调节的中介模型,考察了亲子虐待的中介效应和儿童愤怒管理对该效应的调节作用。采用问卷法对359名来自北京市、山东省和云南省的14所小学一至五年级的儿童及其父母进行调查,研究工具包括儿童对立违抗症状评估表、童年期创伤问卷、儿童愤怒管理量表。结果发现：（1）男孩的ODD症状得分显著高于女孩;男孩受到的躯体虐待、情感忽视和躯体忽视显著多于女孩（2）在控制了儿童性别后,父母在童年期的受虐经历仍可显著正向预测其成年期的家庭中子女的ODD症状;（3）亲子虐待在父母受虐和子女ODD症状之间起完全中介作用,即父母受虐通过亲子虐待间接影响子女ODD症状;（4）父母受虐通过亲子虐待影响子女ODD症状的中介效应后半路径受到子女个体水平愤怒失调（AD）的调节,具体来说,当AD水平较高时,亲子虐待对ODD症状的影响更大;但愤怒应对（AC）和愤怒抑制（AI）对中介效应无显著调节作用。     

Early Exposure to Parental Depression and Parenting: Associations with Young Offspring’s Stress Physiology and Oppositional Behavior

Hypothalamic-pituitary-adrenal (HPA) axis reactivity to stress is posited to play a role in the intergenerational transmission of risk for psychopathology and other negative outcomes in the offspring of depressed parents. We tested the hypothesis that the joint, interactive effects of exposure to parental depression during early childhood and parental hostility impact the development of young children’s stress physiology and early emerging behavior problems. A sample of 165 preschool-age children (81 boys, 84 girls), of whom 103 had a parent with a history of depression, was exposed to a stress-inducing laboratory task, and five salivary cortisol samples were obtained. Parents completed clinical interviews and an observational parent–child interaction task. We found that the offspring exposed to maternal depression during early childhood and whose parents displayed hostile parenting behaviors during an observational task evidenced high and increasing cortisol levels in response to a laboratory stressor. In addition, the total amount of exposure to maternal depression over the child’s life exerted a dose–response effect on the positive relation between parental hostility and child observed oppositional behavior. This study underscores the importance of the early rearing environment on young children’s stress physiology and early emerging behavior problems.     

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.     

Examining Influences on Problem Recognition and Help-Seeking for Child Externalizing Behaviors Among African American Mothers

Childhood behavior problems are one of the most common clinical referrals. If left untreated, these behaviors can result in detrimental consequences to the child’s development (Wehmeier et al., 2010; Scholtens et al., 2012). Behavior parent training has been identified as first-line treatment for oppositional behavior; however, many racial minority families fail to enroll in behavior parent training. The current study examines maternal help-seeking for children displaying oppositional behavior in hopes to delineate variables that might influence parent training enrollment among African American families. Participants were 112 African American mothers who were provided child behavior vignettes and completed measures assessing factors related to problem recognition, parental attributions, child rearing values, mental health stigmatization, racial identity, and treatment utilization. Results found that when presented with a child displaying clinically significant externalizing child behaviors, slightly more than half of African American mothers recognized clinically significant child behavior problems. Mothers were more likely to engage in behavioral parent training if problematic behavior was recognized. Additionally, mothers’ attributions of child behavior, cultural values, and mental health stigmatization were influential to help seeking. This study supports the importance of considering cultural variables that impact problem recognition and subsequent treatment utilization among African American families.     

Child sex moderates the association between negative parenting and childhood conduct problems

Although multiple dimensions of negative parenting behavior are associated with childhood conduct problems (CP), there is relatively little research on whether the association is equally robust in boys and girls. To improve the specificity of current models of negative parenting and offspring CP, we explored the potential moderating role of child sex in a sample of 179 5- to 10-year-old ethnically diverse boys and girls with and without attention-deficit/hyperactivity disorder (ADHD) who were assessed using multiple methods (i.e., rating scales, semistructured interviews) and informants (i.e., parents, teachers). Controlling for children's age, race-ethnicity, and ADHD diagnostic status (i.e., ADHD vs. non-ADHD), inconsistent discipline was positively associated with offspring aggression and rule-breaking behavior, whereas harsh punishment was positively associated with aggression, rule-breaking behavior, and oppositional defiant disorder symptoms. Furthermore, child sex significantly moderated the association of inconsistent discipline and aggression and rule-breaking behavior, such that inconsistent discipline was positively associated with CP for boys, but not for girls. Given the centrality of negative parenting to theories of and efficacious interventions for aggression and CP, we discuss these findings within a developmental psychopathology framework and consider their implications for intervention.     

Gender Differences in Family Stories: Moderating Influence of Parent Gender Role and Child Gender

One hundred and twenty families and their 4-year-old children participated in a study on family stories. The participants were primarily White (91%), with the remainder Black (4%), Hispanic (2%), and Asian (2%). The parents were primarily middle class and upper class, with approximately 5% identifying themselves as from a lower socioeconomic background. Parents were asked to tell their son or daughter stories about when the parent was growing up. All parents completed measures of child behavior and a subset of parents completed the Bem Sex Role inventory. Stories were coded for the strength of affiliation, achievement, and autonomy themes. No gender differences were found for parents or child in the strength of affiliation themes. Fathers told stories with stronger autonomy themes than did mothers, and sons were more likely to hear stories with themes of autonomy than were daughters. An interaction was found between gender type of parent and gender of child for strength of achievement theme. Traditional gender-typed parents told stories with stronger achievement themes to their sons, and nontraditional gender-typed parents told stories with stronger achievement themes to their daughters. Exploratory analyses were conducted examining the relations among story theme, parent gender type, and child behavior. Higher levels of externalizing behaviors were found in boys whose fathers endorsed strong masculine attitudes, but told stories with weak achievement themes. Higher levels of internalizing behaviors were found in girls whose mothers told stories with strong affiliation themes, but endorsed weak feminine attitudes. Family stories are proposed to be one aspect of socialization that includes an interaction between child and parent characteristics.     

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.     

Interactive Effects of Psychosocial Stress and Early Pubertal Timing on Youth Depression and Anxiety: Contextual Amplification in Family and Peer Environments

While off-time pubertal development has emerged as a potential risk factor for both symptoms of depression and anxiety in youth, the literature is mixed and inconsistent as to (1) how early versus late pubertal timing confers risk for both boys and girls, (2) if the conferred risk is distinct between symptoms of anxiety and depression, and (3) under what social contexts (e.g., family environment, peer relationships) off-time pubertal development may emerge as a potent risk factor for these symptoms. The present study examined the impact of perceived pubertal timing on symptoms of anxiety and depression in two distinct psychosocial contexts: parent’s perceptions of their own harsh parenting and parent’s perceptions of their child’s peer problems. The sample consisted of 412 parents (M = 38.6 years old, SD = 7.8, 60.4 % mothers) of children between the ages of 8 and 17 (M = 12.13, SD = 2.97, 45.4 % girls). All constructs were assessed by parent reports. Linear multiple regression analyses revealed that the interaction between earlier pubertal timing and greater peer problems was significantly related to higher youth depressive and anxiety symptoms. The interaction between earlier pubertal timing and greater harsh discipline was significantly related to higher youth anxiety but not depressive symptoms. Youth gender did not qualify findings. Results suggest that the contextual amplification process of early pubertal timing may occur in both high stress family and peer environments and impact both girls and boys.     

Dutch Norms for the Eyberg Child Behavior Inventory: Comparisons with other Western Countries

The Eyberg Child Behavior Inventory (ECBI) is one of the most widely used and well-validated parent rating scales for children’s disruptive behavior. This screening instrument is a short, targetted and easy to implement inventory with good psychometric properties and is normed for different countries, among which the United States, Spain, Sweden and Norway. The ECBI has been successfully used for research and clinical purposes, in several countries including The Netherlands. To date, Dutch studies have relied on Scandinavian or US norm scores. However, this may be problematic because of cross-cultural differences in the degree to which certain behaviors are seen as problematic by parents. The main goal of this paper therefore was to obtain norm scores for The Netherlands among 6462 Dutch children aged 4 to 8 years (M _age?=?6.37 years; SD?=?1.32; 50.6% boys). In line with previous research, we found small differences on the mean sum scores across children of different ages (intensity scale) and gender (intensity and problem scale). Therefore, Dutch norm scores were provided age- and gender specific. Our results showed that disruptive behavior of children in the most rural areas was reported as occurring less frequently and was seen as less problematic by parents compared to the disruptive behavior of children in less rural areas. Finally, we found that Dutch norm scores on the ECBI were significantly lower than US norm scores, and significantly higher on the intensity scale (but not the problem scale) than Norwegian and Swedish norm scores.     

The Roles of Child Gender and Parental Knowledge of Child Development in Parent-Child Interactive Play

In our study, we aimed to analyse the effect of child gender on parental and child interactive play behaviour, as well as to determine relations between parental general knowledge of child development and parental play behaviour in two developmental periods, namely toddlerhood and early childhood. The sample included 99 children (50 toddlers 1–3 years-old; 49 preschoolers 3–5 years-old) and their parents. Parent–child interactive play with a standard set of toys was observed and assessed in the home setting. We found that parental and child play behaviours were closely related in both age groups. In addition, child’s gender affected child, but not parental, play behaviour such that girls more frequently established the content of play, sustained play frame, and used more symbolic transformations during play than boys did. Parents’ general knowledge of child development was associated with both parental education and parental play behaviour. The findings are applicable to different professionals working with children and their parents in the preschool period.     

Maternal Weight Control Behaviors for Preschoolers Related to Children’s Gender

The purpose of this study was to identify significant factors associated with Korean mothers’ behaviors in controlling their preschool children’s weight and to examine gender differences among the significant associated factors. This study involved a convenience sample of 223 pairs of mothers and their preschool children (114 boys and 109 girls) in South Korea. Maternal desire for their children to lose weight, concern about children being overweight or obese, and interaction between gender and concern about children being overweight or obese were significant factors associated with maternal behaviors to control children’s weight. Regarding the interaction between gender and concern about children being overweight or obese, mothers who were concerned about their daughter being overweight or obese were more likely to control their child’s weight than those who were concerned about their son being overweight or obese. Additionally, mothers with concerns about their daughter being overweight or obese were more likely to conduct weight control behaviors for their child than mothers of girls without such concern. However, among mothers of boys, there was no difference in maternal behaviors to control their child’s weight between those with concern and without concern. Therefore, health care providers should understand gender specific maternal concerns regarding their child’s weight and provide tailored weight control interventions for mother and child pairs considering the child’s gender.