Transcript A Risk Factor for Children with ADHD?

Childhood Attention
Deficit/Hyperactivity Disorder
Symptomatology in Parents: A Risk
Factor for Children with ADHD?
Presented at the
UCI Undergraduate Research Symposium
by
David A. Hallowell
May 15, 2004
Acknowledgments:






Professor Carol Whalen
Professor Valerie Jenness
Dr. Sharon Ishikawa
Project Coordinators Tina
Merrilees and Cara Kiff
This ongoing study is being
supported by funding from Eli
Lilly and Company
The Parents and Children from
the Community who
Participated in Week-Long,
Labor Intensive Study
Attention/Deficit Hyperactivity
Disorder (ADHD)



Difficulty paying attention, following directions, or being
quiet from time to time are features intrinsic to childhood
Children with ADHD display these problems more
frequently, causing significant disruptions for those in their
social environment
According to the DSM-IV, the diagnostic criteria are:
a) Displaying at least 6 of the 9 symptoms for either
the
inattentive, the hyperactive/impulsive, or
combined
subtype features of the disorder
b) Problematic behaviors must surface prior to age
7
and have persisted for at least 6 months
c) The symptoms must be negatively affecting the
child
across at least two settings
Constructs





Perceptions of Parenting Efficacy- An individual’s
beliefs about their level of ability to function in the role
of parent
Attributions- Perceived causes that people assign to
events that occur in their environment
Learned Helplessness- Attribution style that assigns
stable, internal, uncontrollable causes to negative
events associated with an individual
Dyad- A group of two units that are related to each
other in some way
Affect- Emotional State
Parenting Efficacy
Perceptions of
Parenting Efficacy
Socio-Economic
Status
Depression
Ratings of
Actual Parenting
Competence
Perceptions of
Infant Temperament
Teti & Gelfand, 1991
Efficacy and Mood
Learned Helplessness
Negative Event
Assign Causation
Possible Attribution Style
Locus
Stability Controllability
Internal Stable Uncontrollable
Negative
Affect
Efficacy and Mood (Continued)
Past Research: Relationships found Between
Low Perceptions of Parenting Learned Helplessness
Efficacy and
Attribution Style for Child
Behaviors1
Parent Attributions for Child
Behaviors and
Child Attributions for Child
Behaviors2
Childhood ADHD and
Learned Helplessness and
Adult Learned Helplessness3
Major Depressive Disorder3
1
Mash & Johnston, 1983, Coleman and Karraker, 1997;
2 Bugental & Johnston, 2000; 3 Rucklidge & Kaplan, 2000
Research: Negative Affect
Attributions
Emotions
Bidirectional Priming Effect
Bandura, 1989
Psychological Symptoms
13-Year Follow-Up Study
Adulthood
(Fischer et al., 2002)
ADHD
Childhood
Hyperactivity
Major Depressive
Disorder
Personality
Disorders
Methodology
Parents
Children
N
24
24
Mean Age
43.6
10.6
Gender
M=1, F=23
M=14, F=10
• All
but one dyad white, non-hispanic ethnicity. Participants mostly
well-educated, upper-middle class.



Convenience sample of 24 parent-child dyads
recruited from local area schools and from physician
practices
Children’s ages between 8 and 12 years old
All children diagnosed with ADHD and being treated
with a long-acting stimulant medication, taken once
daily during the study
Methodology (Continued)
Measures
Childhood ADHD
Characteristics
Assessment of
Hyperactivity (AHA)
Psychological Symptoms
Brief Symptom Inventory
(BSI)
Derogatis, 1983
The Mood Disorder
Questionnaire (MDQ),
Hirschfeld, 2000
Mehringer et al., 2002
Methodology (Continued)



Rationale: Observe the daily lives of children
and parents in their natural environment
Child Moods: Diary Programs on PalmPilots
Parental Perceptions of Their Own Parenting
Efficacy: Morning and evening summary diaries
completed daily
Palm Pilot Child Diary Screenshots
Positive Mood
Negative Mood
Hypothesis One
1) Among parents of children with ADHD,
parents whose self-reported childhood ADHD
characteristics meet DSM-IV criteria will
exhibit more adult psychological symptoms
than parents whose self-reported ADHD
characteristics do not meet diagnostic criteria
Hypothesis Two
2) Among parents of children with
ADHD, parents whose self-reported
childhood ADHD characteristics meet
DSM-IV criteria will report lower
perceptions of parenting efficacy than
parents whose
self- reported ADHD
characteristics do not meet diagnostic
criteria
Hypothesis Three
3) Among children with ADHD, those whose
parents’ self-reported childhood ADHD
characteristics meet DSM-IV criteria will
report more negative moods and fewer
positive moods than children whose parents’
self-reported ADHD characteristics do not
meet DSM-IV criteria
Results: Psychological Symptoms
Brief Symptom Inventory
0.5
0.45
0.4
0.35
0.3
0.25
0.2
0.15
0.1
0.05
0
Low ADHD
Group
High ADHD
Group
Brief Symptom Inventory *
* Results significant for  < 0.05
Mood Disorder Questionnaire
9
8
7
6
5
4
3
2
1
0
Low ADHD
Group
High ADHD
Group
Mood Disorder Questionnaire+
+ Results significant for  < 0.01
Results: Perceptions of Parenting Efficacy
Parenting Efficacy for Morning Summary Diaries
3.5
3.4
3.3
3.2
3.1
3
2.9
2.8
2.7
2.6
2.5
Low ADHD
Group
High ADHD
Group
Parenting Efficacy *
* Results approached significance (p = .106).
Tendency not present for evening summary diaries
Results: Child Moods
Composite Child Mood Profiles
1.8
1.6
1.4
1.2
1
0.8
0.6
0.4
0.2
0
Children of Low
ADHD Group
Children of
High ADHD
Group
Positive
Moods
Negative
Moods
No Significant Differences
Discussion: Psychological
Symptoms

Parents exhibiting a childhood history of
high childhood ADHD characteristics may
be at greater risk for psychological
symptoms than their low childhood ADHD
counterparts
Discussion: Parenting Efficacy



Group differences in perceptions of parenting
efficacy during morning times approached
significance
Perhaps interactions before school are
particularly stressful and parents with a
history of high childhood ADHD
characteristics come away from challenging
interactions feeling less capable than those
without such a history
We are continuing to enroll participants in this
study so that we will be able to repeat these
analyses with an adequate sample size
Discussion: Mood Profiles

The lack of group differences may have been
related to methodological limitations:
- Emotions were reported on a three-point scale
- Positive response bias may have operated

Pharmacology treatment in children linked to
reversal of the learned helplessness
attribution style in parents (Johnston et al, 2000)
Limitations






Non-representative Convenience Sample
Small Sample Size
Self-Selection Process May Have Precluded the
Most Severely Affected Families (Whalen et al,
2002)
Retrospective Self-Diagnosis of Parental ADHD in
Childhood
Efficacy measures were pen-and-paper surveys
Primarily Mother-Child Dyad Characteristics
Implications

These findings suggest that parents with
childhood histories of ADHD may benefit from
special resources and training aimed at:
- Helping them manage their own
children
with ADHD
- Improving their perceived parenting efficacy
For further information I can be reached at:
David Hallowell
Dept. of Psychology and Social Behavior
University of California, Irvine
[email protected]