Biases in ratings of disruptive behavior in children: effects of sex and negative halos

OBJECTIVE: Behavior disorders are more prevalent among boys than girls, but the etiology of this difference is unclear. Studies have not tested for sex bias in ratings as a contributing factor to the differential sex prevalence rates. However, there are several studies showing "negative halo effects" in ratings of boys (i.e., the presence of one type of behavior artificially inflating ratings of another behavior). These findings have only been extended to girls in one recent study. The current study is designed to test for sex difference in (a) ratings of boys and girls who exhibit the same degree of disruptive behavior and (b) negative halo effects. METHOD: Two hundred and thirty-nine college students participated. Sex differences in ratings are not found. Nonetheless, bidirectional negative halo effects are found for boys and girls (i.e., the presence of oppositionality artificially increased ratings of inattention and hyperactivity; the presence of inattention and hyperactivity artificially increased oppositionality).     

Negative Halo Effects in Parent Ratings of ADHD,ODD, and CD

Attention-deficit/hyperactivity disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) are highly comorbid, with symptoms that share some similarities. The evidence-based diagnostic process for these disorders includes ratings from adults in the child’s life to assess behavior across settings, so it is important to understand how these raters think about potentially overlapping symptoms. Researchers have identified negative halo effects in ratings of ADHD and ODD symptoms, but ratings of CD have not been examined in these prior studies. Thus, the current study extended past research to examine negative halo effects in parent ratings of the predominantly hyperactive-impulsive presentation of ADHD (i.e., ADHD/HI), ODD, and CD. Parent participants read one of four vignettes that portrayed an 11-year-old boy displaying symptoms of ADHD/HI, ODD, CD, or typical development, and then completed a disruptive behavior scale. The general trend we found was that the presence of a relatively more severe disorder (i.e., CD) artificially inflated ratings of - or showed a negative halo effect for - the relatively less severe disorder (i.e., ADHD/HI), but with some nuance as discussed in the paper. These findings explain and validate how important it is that clinicians conduct evidence-based psychological assessments to decrease the chance of misdiagnosis.

     

The Contribution of Maternal ADHD Symptomatology,Maternal DAT1, and Home Atmosphere to Child ADHD Symptomatology at 7 Years of Age

Children of mothers with attention-deficit/hyperactivity disorder (ADHD) have an increased genetic and environmental risk for ADHD. The unique and interactive contributions of a maternal dopamine receptor gene (DAT1), maternal ADHD symptoms (hyperactive- impulsive, inattentive), and home atmosphere to the prediction of ADHD symptoms (hyperactive- impulsive, inattentive) in 7- year-old boys (N = 96) were examined using data from a longitudinal study of familial risk for ADHD. During the first 6 months of the study, mothers and their spouses completed a questionnaire about the mother’s ADHD symptoms. Home atmosphere questionnaire data were collected 4 years later. At the 7-year assessment, mothers reported on their child’s ADHD symptoms. Negative home atmosphere was significantly associated with child hyperactive-impulsive and inattentive symptoms. Maternal inattentive symptoms were significantly correlated with both child symptom dimensions. Regression models, with child genotype and maternal education controlled, showed main effects for maternal inattentive symptoms, maternal DAT1 10/10 genotype, and home atmosphere in the prediction of child inattentive symptoms. Only home atmosphere predicted child hyperactive-impulsive symptoms. There was a significant home atmosphere x maternal hyperactive-impulsive symptoms interaction in the prediction of child hyperactive-impulsive symptoms. Boys with higher levels of symptoms came from homes characterized by higher levels of negative atmosphere and had mothers with higher levels of hyperactive-impulsive symptoms. There was also a trend (p = 0.075) for a maternal DAT1 x home atmosphere interaction. Boys with higher levels of inattentive symptoms came from homes with higher levels of negative atmosphere and had mothers with the homozygous 10/10 genotype. The maternal heterozygous 9/10 genotype did not predict child symptoms.     

Halo Effects in Ratings of ADHD and ODD: Identification of Susceptible Symptoms

Halo effects in the assessment of ADHD and ODD were examined. Participants were 159 undergraduate college students who rated children described as showing disruptive behaviors. Bidirectional halo effects were found. Specifically, the presence of oppositionality artificially inflated ratings of inattention and hyperactivity, and the combined presence of inattention and hyperactivity artificially inflated ratings of oppositionality. Several specific items were found to be particularly susceptible to halo effects. Due to these halo effects caution should be exercised when diagnosing multiple behavior disorders, especially with items found to be particularly susceptible. Clinical interviews conducted by mental health professionals may help distinguish between the true presence of multiple disorders and halo effects based on ratings. Future research should determine whether structured interviews conducted by mental health professionals are less susceptible to halo effects than rating scales.     

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.     

The Role of Maternal and Child ADHD Symptoms in Shaping Interpersonal Relationships

The current study investigated the influence of maternal ADHD symptoms on: (a) mothers’ own social functioning; (b) their child’s social functioning; and (c) parent–child interactions following a lab-based playgroup involving children and their peers. Participants were 103 biological mothers of children ages 6–10. Approximately half of the children had ADHD, and the remainder were comparison youth. After statistical control of children’s ADHD diagnostic status and mothers’ educational attainment, mothers’ own inattentive ADHD symptoms predicted poorer self-reported social skills. Children with ADHD were reported to have more social problems by parents and teachers, as well as received fewer positive sociometric nominations from playgroup peers relative to children without ADHD. After control of child ADHD status, higher maternal inattention and hyperactivity/impulsivity each predicted children having more parent-reported social problems; maternal inattention predicted children receiving more negative sociometric nominations from playgroup peers. There were interactions between maternal ADHD symptoms and children’s ADHD diagnostic status in predicting some child behaviors and parent–child relationship measures. Specifically, maternal inattention was associated with decreased prosocial behavior for children without ADHD, but did not influence the prosocial behavior of children with ADHD. Maternal inattention was associated with mothers’ decreased corrective feedback and, at a trend level, decreased irritability toward their children with ADHD, but there was no relationship between maternal inattention and maternal behaviors for children without ADHD. A similar pattern was observed for maternal hyperactivity/impulsivity and mothers’ observed irritability towards their children. Treatment implications of findings are discussed.     

Maternal positive parenting style is associated with better functioning in hyperactive/inattentive preschool children

Many preschoolers are highly inattentive, impulsive, and hyperactive; but only some are impaired in their functioning. Yet factors leading to functional impairment, above and beyond the severity of inattentive and hyperactive symptoms, have not been systematically examined. This study examined a model suggesting that after controlling for attention‐deficit/hyperactivity disorder (ADHD) symptom severity, child temperament is uniquely associated with parenting stress; that parenting stress affects parenting style, above and beyond child characteristics; that parenting style is related to the level of child impairment, above and beyond the effects of child symptoms, temperament, and parenting stress; and finally that parenting style moderates the relationship between ADHD symptom severity and child functioning. Child measures included parent‐ and teacher‐rated ADHD symptom severity, teacher‐rated temperament, and clinician‐rated functioning in a sample of 138 inattentive/hyperactive preschoolers. Maternal self‐ratings of parenting style and parenting stress were obtained. Analyses indicated that, after controlling for symptom severity, child temperament was related to maternal parenting stress, which was additionally related to both maternal parenting style and child functioning. Maternal positive parenting style moderated the relationship between ADHD symptom severity and child impairment, indicating that a positive parenting style plays a protective role in the functioning of hyperactive/inattentive preschoolers. Copyright © 2010 John Wiley & Sons, Ltd.     

Cognitive Behavioral Therapy for Attention-Deficit/Hyperactivity Disorder in College Students: A Review of the Literature

The current review presents a theory-guided review of the existing cognitive behavioral therapy (CBT) interventions for attention-deficit/hyperactivity disorder (ADHD) in college students. Across the eight studies that investigated this topic, moderate reductions were shown in inattentive symptoms but little to no change was reported in hyperactive/impulsive symptoms. Results indicated a moderate treatment effect on self-reported quality of life and school/work functioning, yet less of an impact on GPA, response inhibition, social functioning, and executive functioning. Methodological and statistical problems and inconsistencies were noted. Since college students are emerging adults, it is likely that the optimum CBT intervention for college students with ADHD lies somewhere in between the existing clinic-based adult ADHD CBT interventions as well as the school-based adolescent ADHD psychosocial interventions. Directions for future research and recommendations for clinicians in university settings are provided in an attempt to further develop the existing college students CBT clinical research evidence base.     

Agreement between teachers' ratings and observations of hyperactivity,inattentiveness, and defiance

The relationship of directly observed classroom behavior and teacher ratings on questionnaires with a judgemental (Conners Teacher Rating Scale) or operational format was examined for 33 boys aged 6 years 5 months to 7 years 7 months. Results showed a high degree of association between observed and rated behavior. This association did not vary with the format of the rating scales but did vary with the nature of the behavior being rated. Defiance was more reliably rated than hyperactivity or inattentiveness. Several behaviors exerted a halo effect on ratings of hyperactivity, inattentiveness, and behavior problems. In particular, defiance toward a teacher increased the likelihood that a child would be rated as hyperactive or inattentive regardless of his observed level of activity or attentiveness. These results support the validity of behavior rating scales as screening measures for hyperactivity, inattentiveness, and defiance and indicate that a child's defiance and disobedience are significant causes of misclassification.     

Adult ADHD: Associations with Personality and Other Psychopathology

The goals of this study were to explicate adult ADHD’s relations with personality at both the domain and facet levels and to examine its associations with other psychological symptoms. Community members (N?=?294) completed measures assessing ADHD inattentive and hyperactive/impulsive symptoms, five-factor model personality domains and facets, and other internalizing and externalizing symptoms. Inattentiveness showed strong negative relations with conscientiousness and extraversion and strong positive relations with neuroticism; in contrast, hyperactivity/impulsivity related negatively to agreeableness, positively to extraversion, and weakly to neuroticism. Whereas inattentiveness emerged as a positive predictor of internalizing psychopathology—and depression in particular—hyperactivity/impulsivity related weakly to internalizing but more strongly to externalizing psychopathology. Thus, inattentive and hyperactive/impulsive symptoms showed differential relations with personality—at both the domain and facet levels—and with other psychological symptoms. These results demonstrate the value in examining ADHD’s relations with personality facets and with a wide range of psychopathology within the same study.     

Parent perceptions of an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering

PurposeRecent research has identified approximately half of children who stutter present with self-regulation challenges. These manifest in elevated inattentive and/or impulsive behaviours, aligned with attention deficit hyperactivity disorder (ADHD) symptoms. These symptoms have been found to influence the child’s responsiveness to their stuttering treatment, and may exacerbate the psychosocial consequences of stuttering for them and their families. Early stuttering intervention identifies parents as key agents of change in the management of their children’s stuttering. This study sought feedback from parents regarding their experiences with an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering, addressing the child’s self-regulation challenges.MethodEight parents of children who stutter who had co-occurring self-regulation challenges completed the integrated program. This incorporated the Triple P--Positive Parenting Program adapted for the developmental stuttering population, and the Curtin University Stuttering Program (CUSP). Semi-structured qualitative interviews were conducted to capture parents’ reflections on, and experiences with, the integrated program.ResultsThematic analysis identified several major themes regarding the parents’ experiences with the integrated program: emotional impact on parents, child self-regulation, link between stuttering and behaviour, parent self-regulation, impact on family dynamics, and overall positive perceptions of the integrated program. All of the parents indicated they would recommend the program to future parents of children who stutter.ConclusionThis study provides insights into parents’ perceptions regarding an integrated intervention approach for early stuttering and behavior management. It also indicates how adopting a holistic approach to stuttering intervention is positive and has social validity.     

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.     

Parental Divorce, Familial Risk for Depression, and Psychopathology in Offspring: A Three-Generation Study

Research suggests a link between parental divorce and negative child outcomes; however, the presence of parental depression may confound this relationship. Studies exploring the simultaneous effects of depression and parents’ divorce on the adjustment of their children are scarce and rarely have a longitudinal design. This is the first three-generation study of the relative effects of depression and divorce on offspring psychopathology, based on data from a 25-year longitudinal study with families at high and low risk for depression. One hundred seventy-eight grandchildren (mean age?=?13.9?years) of depressed and nondepressed parents and grandparents were evaluated by raters blind to their parents’ and grandparents’ clinical status. We found that in both low and high-risk children, divorce had a limited impact on child adjustment over and above familial risk for depression. Divorce had a significant effect on child outcomes only among high-risk grandchildren with a depressed grandparent and non-depressed parents, with this group showing a threefold risk for anxiety disorders. Results support previous findings suggesting that familial risk for depression largely overshadows the effect of parental divorce on child psychopathology. Possible reasons for the lack of association between divorce and child psychopathology among low-risk offspring are discussed.     

A multidimensional assessment of parent-identified behavior problem toddlers

Sixty-eight 2-and 3-year-olds (46 parent-referred, 22 controls) participating in an identification, assessment, and follow-up study of hyperactivity and related behavior problems were evaluated on parent-report, observational, and cognitive measures. Referred youngsters were described by both parents as more active, inattentive, difficult to discipline, and aggressive with peers than were controls. Mothers of referred children also reported a more difficult infancy period. Laboratory assessments confirmed parental reports of current problems. Referred children shifted activities more during free play, were more active and inattentive during structured tasks, and made more impulsive responses on a delay task than did controls. Discriminant function analysis indicated that parental ratings of activity paired with laboratory measures of sustained attention and impulsivity correctly classified 88% of the sample. These data suggest that the core symptoms of hyperactivity can be identified in very young children, although their prognostic significance remains to be determined.This research was supported by Grant No. R01 MH 32735 from the National Institute of Mental Health to the first author. Thanks are due to the parents and children who participated so enthusiastically in this study. The dedication of Patricia Cluss is gratefully acknowledged. Mady Fingeret, Frank McKee, Jenny Palermo, Susan Riley, Elizabeth Schaughency, Sheree Thomas, and Russell Walters are also thanked for their help in data collection.     

Parents' depressive symptoms and children's adjustment over time are mediated by parenting,but differentially for fathers and mothers

Parenting has been found to act as a mediator of the relation between parents' depressive symptoms and children's adjustment. The present study replicated this result, and also found specific effects of gender for both parents and children. A total of 319 parents provided reports of their depressive symptoms (BDI) and two parenting styles (APQ; inconsistent discipline and positive parenting) as well as of their elementary schoolchildren's adjustment (VBV-EL; oppositional-defiant behaviour, hyperactivity, internalizing, social-emotional competence). The first and second measurement occasions were six months apart. Bivariate correlations showed the expected pattern of positive associations between parental depression, child maladjustment and problematic parenting. However, the results differed for mothers and fathers, and the mediation was moderated by the children's gender. Inconsistent discipline was a mediator for both fathers and mothers. The path from fathers' depression was additionally negatively mediated by positive parenting. Boys were more vulnerable than girls.     

The effects of attitudes toward feminism and perceived feminism on physical attractiveness ratings

The effects of perceived feminism of females and attitudes toward feminism of males on physical attractiveness ratings of female stimulus persons (SPs) were investigated, using two alternative hypotheses: first, SPs who are perceived as feminists would be rated as less attractive than SPs not perceived as feminists; second, profeminist males would rate profeminist women as more attractive than nonfeminist women, and vice versa for nonfeminist males. Seventy-six male college students responded to the Smith-Ferree-Miller questionnaire on attitudes toward feminism and then rated on an 8-point scale of attractiveness 6 photographs of female SPs which had been selected from a pretested sample of 18 photographs. Perceived feminism of the SPs in the photographs was manipulated by presenting the raters with four attitude statements, two of which related to feminism. Although there were no main effects for the two variables, significant interaction did occur, confirming the second (attitude similarity) hypothesis. A negative halo effect, as opposed to a belief in the unattractiveness of feminists, was offered as an explanation of the difference in results between this study and the Goldberg, Gottesdiener, and Abramson (1975) study.     

Rating ability in performance judgments: The joint influence of implicit theories and intelligence

The purpose of this study was to approach the issue of rating ability by examining the influence of rater implicit theories and rater intelligence on rating outcomes. Using the inferential accuracy model (Jackson, 1972), raters were identified as either possessing a normative or idiosyncratic implicit theory of the occupation of college instructor. In a laboratory setting, 50 normative and 50 idiosyncratic raters judged the videotaped performance of either a good or poor lecturer. Results showed that (a) intelligence was positively related to rating accuracy and to possessing a normative implicit theory, (b) rater type moderated the relationship between intelligence and rating accuracy, and (c) controlling for intelligence, normative raters committed stronger halo effects than idiosyncratic raters. These results were discussed in relation to furthering the understanding of rating ability.     

Parental Separation and Children's Behavioral/Emotional Problems: The Impact of Parental Representations and Family Conflict

In this longitudinal study, we examine whether the effect of parental separation on kindergarten children's behavioral/emotional problems varies according to the level of family conflict, and children's parental representations. One hundred and eighty seven children were assessed at ages 5 and 6. Family conflict was assessed using parents' ratings. Children's parental representations were assessed using a story-stem task. A multiinformant approach (parent, teacher, child) was employed to assess children's behavioral/emotional problems. Bivariate results showed that separation, family conflict, and negative parental representations were associated with children's behavioral/emotional problems. However, in multivariate analyses, when controlling for gender and symptoms at age 5, we found that children of separated parents who showed negative parental representations had a significantly greater increase in conduct problems between 5 and 6 than all other children. In terms of emotional symptoms and hyperactivity, symptoms at 5 and (for hyperactivity only) gender were the only predictors for symptoms 1 year later. Our results suggest that kindergarten children's representations of parent-child relationships moderate the impact of parental separation on the development of conduct problems, and underline play and narration as a possible route to access the thoughts and feelings of young children faced with parental separation.     

The predominantly inattentive subtype of attention-deficit/hyperactivity disorder

The predominantly inattentive (IN) subtype of attention-deficit/hyperactivity disorder (ADHD) is a recently defined condition that is often overlooked by professionals and is still not completely understood. Characterized by symptoms of inattentiveness, such as distractibility, failure to complete work, forgetfulness, and disorganization, the IN subtype differs from the more commonly recognized combined (CB) subtype of ADHD in that symptoms of hyperactivity and impulsivity are absent or minimal. Large-scale epidemiologic studies suggest that the IN subtype is at least as prevalent as the CB subtype, and is at least as likely to be associated with academic and/or social impairment. Diagnosis of the IN subtype, however, may be more challenging because in addition to inattentiveness, other symptoms, including learning problems, depression, and anxiety, may also present without externalizing behaviors. Several studies have shown that compared with the CB subtype, the IN subtype has a later age of onset and referral, a relatively larger proportion of affected females, and is much less likely to be associated with symptoms of oppositional defiant disorder or conduct disorder. Research is currently under way to examine the cognitive characteristics of the IN subtype and its genetic and neurobiologic underpinnings, as well as to evaluate the effectiveness of pharmacotherapy and other treatments.     

Effects of the EXAT neuropsychological multilevel intervention on behavior problems in children with executive function deficits

This is a clinical intervention study of children with executive function (EF ) deficits. A neuropsychological multimodal group intervention called EXAT (rehabilitation of EX ecutive function and AT tention) was developed at the Psychology Clinic of the University of Tampere. Based on the principles of neuropsychological rehabilitation and behavioral modification, EXAT combines child group training, parent training, and teacher consultations. The aims of this study were to investigate behavior problems before and after the intervention in children attending EXAT and in controls, and to compare intervention effects in hyperactive, inattentive, and EF subgroups based on the primary deficit described in the referral. The participants were 86 children (6–12 years) with a mean IQ of 91.4 attending EXAT and 45 controls. The participants’ parents and teachers completed the Conners’ Rating Scales‐Revised. In addition, the Strengths and Difficulties Questionnaire was completed by the parents attending EXAT . The parents reported statistically significant decreases with medium effect sizes for the CPRS ‐R subscales for impulsivity, hyperactivity, and oppositional behavior. In the controls within the same time interval, there was increase in restless and impulsive behavior, and a decrease in total problems. The teachers reported positive changes after the intervention in ADHD symptoms and anxiousness/shyness, but the effects sizes were small. The intervention effects were larger in the hyperactive subgroup. Positive intervention effects were related to a younger age, lower IQ , and simultaneous learning support. In conclusion, EXAT – a structured multilevel group intervention – has positive effects on children's behavior regulation skills by decreasing impulsivity and restless behavior.