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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]