Family coherence and ADHD

A lack of perseverance, poor attention, and poorly modulated behaviour are important criteria of Attention Deficit Hyperactivity Disorder (ADHD). Instructions often must be repeated, sometimes even by different family members, before a child with ADHD attends and complies. The hyperkinetic child might cause less disruption in families with high coherence. Families of 15 boys (aged 6 to 12 years) diagnosed with ADHD using the Mannheim Parent's Interview and the teacher's form of the Conners scale were compared with a matched healthy control group of 15 boys. Parents completed a form assessing the family's cooperation and childrearing practices. Intrafamilial coherence seems to have little positive association with the family's characteristics, especially for boys with Attention Deficit Hyperactivity Disorder. Low coherence among family members may reduce ADHD symptoms and may have protective effects on children with ADHD.     

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.     

Family conflict tendency and ADHD

A lack of perseverance, poor attention, and poorly modulated behaviour are important criteria of Attention Deficit Hyperactive Disorder (ADHD). Instructions often have to be repeated, sometimes even by different family members before a child with ADHD attends and complies. We hypothesised that a child with ADHD might cause less disagreement in families with almost no conflicts. Responses to the Mannheim Parents Interview and teacher's form of the Conners scale completed by families of 15 boys (ages 6 to 12 years), diagnosed with ADHD were compared with those of a matched, healthy control group of 15 boys. Parents completed a form assessing the family's cooperation and child-rearing practices. Having few family conflicts, i.e., almost no Verbal Disagreement may reduce Physical Punishment and Anger and Disregard and augment the Openness to another's needs and, for that reason, have protective effects on children's behaviour modulation.     

Parent ADHD and Evidence-Based Treatment for Their Children: Review and Directions for Future Research

One fourth to one half of parents of children with attention-deficit/hyperactivity disorder (ADHD) have ADHD themselves, complicating delivery of evidence-based child behavioral and pharmacological treatments. In this article, we review the literature examining the relation between parent ADHD and outcomes following behavioral and pharmacological treatments for children with ADHD. We also review research that has incorporated treatment of parent ADHD (either alone or in combination with child treatment) with the goal of improving parenting and child outcomes. Finally, we offer recommendations for future research on the relation between parent ADHD and evidence-based treatment outcomes for their children, with the purpose of advancing the science and informing clinical care of these families.     

The Influence of Child Gender on the Prospective Relationships between Parenting and Child ADHD

The aims of the current study were to (i) explore the potential bidirectional, prospective relationships between parenting and child ADHD, and (ii) explore whether these relationships differed on the basis of child gender. Data were obtained from waves 1 (children aged 4- to 5-years) to 5 (children aged 12- to 13-years) of the Longitudinal Study of Australian Child (LSAC) dataset (child cohort). In order to examine dimensions of both mothers’ and fathers’ parenting, a subsample of nuclear families with mothers, fathers and children present at all waves was extracted (final sample = 1932; sons = 981, daughters = 951). Child ADHD measures included the hyperactive-impulsive subscale of the strengths and difficulties questionnaire for symptoms, and parent-report question for diagnosis. Mothers and fathers completed scales on dimensions of Angry, Warm and Consistent Parenting. A cross-lagged panel model demonstrated (i) higher child ADHD symptoms at wave 1 led to a global increase in less-than-optimal parenting at wave 2, and (ii) child ADHD symptoms and Angry Parenting shared a prospective, bi-directional relationship (whereby increases in one predicted increases in the other over time) during earlier years of development. Latent growth curve models demonstrated that increases in Angry Parenting across time were significantly predicted by increases in child ADHD symptoms. A logistic regression demonstrated that both mothers’ and fathers’ Angry Parenting at wave 1 significantly predicted an ADHD diagnosis in children at wave 3. No predictive relationships differed between child genders; thus, it appears these prospective pathways are similar for both sons and daughters.     

RD,ADHD, and their comorbidity from a dual route perspective

In order to achieve further insight into the comorbidity of reading disorder (RD) and attention deficit/hyperactivity disorder (ADHD), lexical processing and rapid naming were studied in RD and ADHD. The Dual Route Cascaded model postulates that lexical processing contains two parallel processes: lexical route processing and sublexical route processing. An orthographic decision task and a phonological decision task were used to measure lexical and sublexical route processing, respectively. In addition, a rapid naming task was used to compare 27 children with RD, 18 children with ADHD, 20 children with ADHD+RD, and 29 controls. RD and ADHD shared impairments in accuracy of orthographic and phonological decision making as well as in rapid naming, which suggest that RD and ADHD may be overlapping disorders that share deficits in both lexical route and sublexical route processing. RD was dissociated from ADHD by being slower in both orthographical and phonological decision making that indicates unique deficits in RD on lexical and sublexical speed.     

RD, ADHD, and their comorbidity from a dual route perspective

In order to achieve further insight into the comorbidity of reading disorder (RD) and attention deficit/hyperactivity disorder (ADHD), lexical processing and rapid naming were studied in RD and ADHD. The Dual Route Cascaded model postulates that lexical processing contains two parallel processes: lexical route processing and sublexical route processing. An orthographic decision task and a phonological decision task were used to measure lexical and sublexical route processing, respectively. In addition, a rapid naming task was used to compare 27 children with RD, 18 children with ADHD, 20 children with ADHD+RD, and 29 controls. RD and ADHD shared impairments in accuracy of orthographic and phonological decision making as well as in rapid naming, which suggest that RD and ADHD may be overlapping disorders that share deficits in both lexical route and sublexical route processing. RD was dissociated from ADHD by being slower in both orthographical and phonological decision making that indicates unique deficits in RD on lexical and sublexical speed.     

Responsiveness in Interactions of Mothers and Sons with ADHD: Relations to Maternal and Child Characteristics

We observed mother–child interactions, at baseline, in 136 families of 7–10-year-old boys with attention-deficit/hyperactivity disorder (ADHD) who were part of a large clinical trial, the Multimodal Treatment Study of Children with ADHD. Independent coders rated stylistic aspects of maternal behavior and factor analyses revealed a responsiveness factor that included overall responsiveness and sensitivity to the child, warmth and acceptance, and appropriate control. We examined relations between maternal responsiveness and (a) maternal depressive symptoms and maternal childhood ADHD symptoms, and (b) boys' ADHD and conduct problem symptoms. Controlling for all other variables, maternal responsiveness displayed a unique negative association with mother-reported child conduct problems, but not with child ADHD symptoms, and also was negatively related to maternal depressive symptoms. We discuss the unique association between mother-reported child conduct problems and parenting, and note the utility of studying parenting style in families of children with ADHD. We describe the results within the framework of a transactional model.     

Parent-Child Interaction Therapy for Puerto Rican Preschool Children with ADHD and Behavior Problems: A Pilot Efficacy Study

This study evaluates the initial efficacy of the Parent-Child Interaction Therapy (PCIT) for Puerto Rican preschool children aged 4–6 years with a diagnosis of attention-deficit/hyperactivity disorder (ADHD), combined or predominantly hyperactive type, and significant behavior problems. Thirty-two families were randomly assigned to PCIT ( n =20) or a 3.5-month waiting-list condition (WL; n =12). Participants from both groups completed pretreatment and posttreatment assessments. Outcome measures included child's ADHD symptoms and behavior problems, parent or family functioning, and parents' satisfaction with treatment. ANCOVAs with pretreatment measures entered as covariates were significant for all posttreatment outcomes, except mother's depression, and in the expected direction ( p <.01). Mothers reported a highly significant reduction in pretreatment hyperactivity and inattention and less aggressive and oppositional-defiant behaviors, conduct problems assessed as problematic, parenting stress associated with their child's behavior, and an increase in the use of adequate parenting practices. For the WL group, there were no clinically significant changes in any measure. Treatment gains obtained after treatment were maintained at a 3.5-month follow-up assessment. PCIT seems to be an efficacious intervention for Puerto Rican families who have young children with significant behavior problems.     

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.     

Predicting Parenting Stress in Families of Children with ADHD: Parent and Contextual Factors

We examined parental ADHD symptoms and contextual (parental education, social support, marital status) predictors of parent domain parenting stress (parental distress) as a function of child ADHD symptoms in a sample of 95 parents of 8 to 12 year-old children with and without ADHD. Parents’ perceptions of parental distress and social support were inversely-related. Parental ADHD symptomatology was the strongest predictor of parental distress of the variables considered. Models using teacher reports of child ADHD symptomatology and oppositionality differed from ones using parent reports, in that child oppositionality was only predictive of parental distress in the parent-report model. A post-hoc analysis showed that child factors did not predict parental distress over and above parent ADHD symptoms and contextual factors. These results suggest that parental ADHD symptomatology and parenting stress reduction should be considered in development of interventions for families of children with ADHD.     

Professional and Provider Perspectives on Family Involvement in Therapeutic Foster Care

Therapeutic foster care (TFC) offers a promising community-based treatment option for children with serious emotional and behavioral disorders in the child welfare system. Family involvement is believed to contribute to achieving the goal of family reunification in TFC, but there has been little attention to family involvement in TFC. I present findings of a qualitative study of child welfare professionals' and TFC providers' perspectives on family involvement. Respondents' views of parent-child contact, parent-professional communication and information sharing, and family involvement in decision making were examined. Values and attitudes toward family involvement, practices related to family involvement, barriers to involvement, and strategies to promote involvement emerged as themes. Professionals in this study believed in the value of family involvement, but there were challenges at the organizational level and related to some TFC providers' lack of training to work with families.     

The Relation Between Maternal ADHD Symptoms &; Improvement in Child Behavior Following Brief Behavioral Parent Training is Mediated by Change in Negative Parenting

This study examined the extent to which maternal attention-deficit/hyperactivity disorder (ADHD) symptoms predict improvement in child behavior following brief behavioral parent training. Change in parenting was examined as a potential mediator of the negative relationship between maternal ADHD symptoms and improvement in child behavior. Seventy mothers of 6–10 year old children with ADHD underwent a comprehensive assessment of adult ADHD prior to participating in an abbreviated parent training program. Before and after treatment, parenting was assessed via maternal reports and observations and child disruptive behavior was measured via maternal report. Controlling for pre-treatment levels, maternal ADHD symptomatology predicted post-treatment child disruptive behavior problems. The relation between maternal ADHD symptomatology and improvement in child behavior was mediated by change in observed maternal negative parenting. This study replicated findings linking maternal ADHD symptoms with attenuated child improvement following parent training, and is the first to demonstrate that negative parenting at least partially explains this relationship. Innovative approaches combining evidence-based treatment for adult ADHD with parent training may therefore be necessary for families in which both the mother and child have ADHD. Larger-scale studies using a full evidence-based parent training program are needed to replicate these findings.     

Preparing Families for Evidence-Based Treatment of ADHD: Development of Bootcamp for ADHD

Objective: Many families of children with attention-deficit/hyperactive disorder (ADHD) do not initiate evidence-based treatments (EBTs), placing these children at risk for poor outcomes. Bootcamp for ADHD (BC-ADHD) is a novel, four-session, group intervention designed to prepare parents as informed consumers to engage in multimodal EBTs for ADHD. This paper describes the theory of change and the development of BC-ADHD, outlines its components, and provides an initial proof of concept of the program. Method: Participants were 11 families of children with ADHD (ages 5–11; 55% male; 91% non-Hispanic; 55% White, 27% Black, 18% more than one race) who were the initial participants receiving BC-ADHD during a small-scale, randomized controlled trial. Parent-report outcome measures assessed parental empowerment, treatment preferences, affiliate stigma, intention to pursue treatment, and treatment initiation at baseline, posttreatment, and 6-week follow-up. Results: Parent engagement was high, as indicated by an 86% session attendance rate and high ratings of program satisfaction. Parents reported an increase in empowerment to access systems of care. Ratings of acceptability for behavior therapy increased at posttreatment and follow-up with minimal or no concerns about feasibility. The acceptability of medication was high at each assessment, although parents expressed increased concerns about stigma and adverse effects of medication at posttreatment and follow-up. Nonetheless, there was a marked increase in parental intention to use medication at posttreatment and follow-up. Accounting for ceiling effects, parents reported substantial increases in intention to use medication, behavioral parent training (BPT), and school services. Changes in treatment initiation were in the expected direction. Conclusions: BC-ADHD has the potential to promote family empowerment in seeking services and increase their intent to initiate EBTs, as well as actual initiation of these treatments.     

Maternal Executive Functioning and Scaffolding in Families of Children with and without Parent-Reported ADHD

Parental scaffolding robustly predicts child developmental outcomes, including improved self-regulation and peer relationships and fewer externalizing behaviors. However, few studies have examined parental characteristics associated with a parent’s ability to scaffold. Executive functioning (EF) may be an important individual difference factor associated with maternal scaffolding that has yet to be examined empirically. Scaffolding may be particularly important for children with attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorder (DBD) symptoms due to their core difficulties with inattention, disorganization, EF, and self-regulation, their need for greater parental structure, and higher-than-average rates of parental EF deficits. Yet, little research has examined child ADHD in relation to parental scaffolding. This cross-sectional study examined: (1) the association between maternal EF (as measured by the Hotel Test, Barkley’s Deficits in Executive Functioning Scale, and Digit Span) and observed scaffolding, (2) the association between parent-reported child ADHD/DBD symptoms and scaffolding, and (3) the interaction between child ADHD/DBD symptoms and maternal EF in predicting scaffolding. In a sample of 84 mothers and their 5–10 year-old biological children (62% male) with and without parent-reported ADHD, we found that maternal EF, as measured by Digit Span and the Hotel Test, predicted observed maternal scaffolding. However, child ADHD/DBD symptoms did not significantly predict maternal scaffolding controlling for child age, maternal education, and maternal EF, nor did the interaction of maternal EF and parent-reported child ADHD/DBD symptoms. Working memory and task shifting may be key components of parental EF that could be targeted in interventions to improve parental scaffolding.     

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

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

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.     

Children with ADHD in Residential Care

Little is known about the characteristics or functioning of children with ADHD in residential care as compared to their non-ADHD peers. This study evaluated data on 538 children with (n = 125) and without (n = 413) ADHD in residential care to determine demographic, mental health, behavioral, and treatment (i.e., medication use) characteristics. Results revealed that both groups presented elevated risks, however, scores for children with ADHD indicated even greater levels of need. Specifically, differences were found between the two groups on demographics (e.g., family reunification status, restrictiveness of prior out-of-home placements), behavior (e.g., attention problems, rule-breaking and aggressive behaviors) and medication status. Findings suggest there is a need for aftercare services to help support families as children transition from care, interventions to address behavior, and medication management through assessment and monitoring.     

Examining Latino Family Participation in Treatment for Childhood ADHD: The Role of Parental Cultural Factors and Perceptions

Attention-deficit/hyperactivity disorder (ADHD) is a common mental health disorder in childhood. Unfortunately, Latino youth and their families are at increased risk of demonstrating poor treatment outcomes. The current study examined the impact of parental cultural factors and perceptions on Latino family participation in a psychosocial intervention for childhood ADHD. Sixty-one Latino youth and at least one of their primary parents and teachers participated in the current study. Results indicated that parental acculturation, attitudes regarding treatment, and baseline severity of child symptomatology and functional impairment were related to treatment participation outcomes. Implications and future directions are discussed.     

Cognitive-behavioral depression treatment for mothers of children with attention-deficit/hyperactivity disorder

An adaptation of the Coping With Depression Course (CWDC) was evaluated in mothers of children with attention-deficit/hyperactivity disorder (ADHD), a population at risk for depression. Mothers were randomly assigned to receive the CWDC either immediately following an intensive summer treatment program targeting their child's behavior or after a wait-list period. Measures of maternal functioning, cognitions about child behavior, parent-child and marital relationship quality, child behavior, and ADHD-related family impairment were obtained at pretreatment, posttreatment, and 5-month follow-up. The CWDC resulted in improvements in maternal depressive symptoms, maternal self-esteem, child-related cognitions, and family impairment at posttreatment compared to a wait-list control group that were maintained at follow-up. Findings suggest that the CWDC is a promising intervention for mothers of children with ADHD, particularly those with current depressive symptomatology.