Maternal parenting styles and mother–child relationship among adolescents with and without persistent attention-deficit/hyperactivity disorder

https://doi.org/10.1016/j.ridd.2013.02.002Get rights and content

Abstract

We investigated mothering and mother–child interactions in adolescents with and without persistent attention-deficit/hyperactivity disorder (ADHD) in a sample of 190 adolescents with persistent DSM-IV ADHD, 147 without persistent ADHD, and 223 without ADHD. Both participants and their mothers received psychiatric interviews for diagnosis of ADHD and other mental disorders; and reported on the Parental Bonding Instrument about mother's parenting style, the Social Adjustment Inventory for Children and Adolescents for interactions with mothers and home behavioral problems. The mothers also reported on their ADHD and neurotic/depressive symptoms. Our results based on both informants showed that both ADHD groups obtained less affection/care and more overprotection and control from the mothers, and perceived less family support than those without ADHD. Child's inattention and comorbidity, and maternal depression were significantly correlated with decreased maternal affection/care and increased maternal controls; child's hyperactivity–impulsivity and maternal neurotic trait were significantly correlated with maternal overprotection; and child's inattention and comorbidity, and maternal neurotic/depressive symptoms were significantly correlated with impaired mother–child interactions and less family support. Our findings suggested that, regardless of persistence, childhood ADHD diagnosis, particularly inattention symptoms and comorbidity, combining with maternal neurotic/depressive symptoms was associated with impaired maternal process.

Highlights

► The first to examine mothering in adolescents with non-persistent ADHD. ► Childhood ADHD, regardless of persistence, predicted poor mother–child interactions. ► Hyperactivity–impulsivity and maternal neurosis related to maternal overprotection. ► Inattention, comorbidity, and maternal depression correlated with impaired mothering. ► Early detection and treatment of ADHD symptoms to offset adverse maternal measures.

Introduction

Attention-deficit/hyperactivity disorder (ADHD), a common [5–10% worldwide (Spencer, Biederman, & Mick, 2007) and 7.5% in Taiwan (Gau, Chong, Chen, & Cheng, 2005)] yet under-diagnosed disorder in Asia (Gau et al., 2010c), greatly impacts affected children and their families. ADHD symptoms and associated negative and incompliant behaviors (Johnston, 1996) may lead to parental challenges (Pelham & Lang, 1999), insufficient parenting (Pelham & Lang, 1999), parent-adolescent conflicts (Edwards, Barkley, Laneri, Fletcher, & Metevia, 2001), and parental anxiety and mood problems (Edwards et al., 2001, Gau, 2007, Gerdes et al., 2007, Pelham and Lang, 1999), particularly with the mothers (Lifford, Harold, & Thapar, 2008). Mothers, commonly the main caretakers of the family (Chao, 1994), were more likely to be affected by their children's ADHD behaviors than fathers (Patterson, 1982), because they often interacted with these children in situations influenced by ADHD symptoms such as doing homework, following instructions for daily activities etc., and were more likely to be blamed for child's poor academic and social performances (Chao, 1994). Hence, having a child with ADHD markedly increased care burden, stress and frustration to the mothers (Barkley, Fischer, Edelbrock, & Smallish, 1991).

Parent–child interactions were often influenced by several factors such as emotional stability (Gerdes et al., 2007, Nelson et al., 2009), behavioral disturbances (Johnston, 1996, Podolski and Nigg, 2001), parent–child bonding (Barkley et al., 1992, Gau, 2007), and parenting styles (Gau, 2007). Bidirectional relationships were observed between overt child behavioral problems and hostile parenting (Lifford et al., 2008), and between parent–child relationship and the severity of ADHD symptoms (Lifford et al., 2008). The severity of negative mother–child relations also increased with age in youths with ADHD. As the child grew older, he/she would resist parental instruction and monitoring and would start to bargain with the rules (Barkley et al., 1992). Increased risky behaviors, deviant peer influence, peer rejection at early adolescence, often found in adolescents with ADHD, had been found to be associated with increased maternal overprotection and authoritarian controls (Fanti & Henrich, 2010); authoritarian mothering, on the other hand, may reflect increased caregiver burden (Barkley et al., 1991) while dealing with conflicted-irritable children, who were more moody, fearful and vulnerable to stressors (Gau et al., 2008), or who had oppositional/conduct problems (Thompson, Hollis, & Dagger, 2003).

Parental dysfunctional disciplines (laxness, reactive parenting, and verboseness) also predicted poorer treatment outcomes in ADHD (Hoza et al., 2000), while parental stress mediated between parental depression and parenting (Gerdes et al., 2007). For example, child ADHD symptoms were associated with inconsistent maternal discipline (Ellis & Nigg, 2009) and increased maternal rejections (Lifford et al., 2008). The inconsistent maternal discipline was considered as ineffective parenting, subsequently causing emotional distress in the children (Ellis & Nigg, 2009). Taken together, both the severity of ADHD symptom and maternal characteristics contributed to the severity of maternal stress derived from having a child with ADHD (Gerdes et al., 2007). Contrariwise, reduction in child ADHD symptoms was linked to increased warmth and affection from the mothers rather than the fathers (Schachar, Taylor, Wieselberg, Thorley, & Rutter, 1987).

In addition to its influence on maternal parenting, ADHD also contributed to disturbed family functioning (Barkley et al., 1992), disrupted parent–child relationships (Barkley et al., 1992), and conflicting communications (Edwards et al., 2001). Increased physical and behavioral problems during the developmental stage from childhood to adolescence in youths with ADHD further added the burden and difficulties to their families (Angold et al., 1998, Gau et al., 2010c, Spencer et al., 2007). In fact, families of ADHD children with comorbid conditions encountered even greater parental stress (Podolski & Nigg, 2001), more negative parenting, and poorer parent–child relationships (Burke, Pardini, & Loeber, 2008) than their counterparts without comorbid conditions. Overall, in the families of having a child with ADHD, the child perceived more negative and controlling parenting (Finzi-Dottan, Manor, & Tyano, 2006), while the parents perceived their families as less supportive and more stressful (Brown & Pacini, 1989). Despite extensive research on the relationship between ADHD and family/parental process, no studies had been done to identify the effect of specific ADHD core symptoms on different aspects of parent–child interactions. Additionally, none had discussed the parent–child relationships or family function in adolescents with past history of ADHD who currently do not meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) diagnostic criteria of ADHD.

Despite many western studies on mothering in ADHD, few had been conducted in Asian populations (Gau, 2007), and none of them had investigated impaired mother–child relationship in non-persistent ADHD families. No studies had further examined whether specific childhood ADHD symptoms affect mother/family measures in adolescents with ADHD in non-Western countries. Hence, the present study aimed to test the following research questions: (1) whether adolescents with childhood diagnosis of ADHD were more likely to have impaired mothering, mother–child relationships, and perceived family support? (2) Whether mothering, mother–child relationships, and perceived family support are different between adolescents with persistent ADHD and adolescents with non-persistent ADHD as compared with adolescents without ADHD? And (3) what are the specific ADHD core symptoms and other correlates for mothering, mother–child relationship, and perceived family support? We hypothesized that both ADHD groups had more impaired maternal and family measures than adolescents without ADHD with greater severity in the persistent ADHD group; and that both child ADHD symptoms and maternal psychopathology were associated with different aspects of impaired mother–child interactions and family function.

Section snippets

Participants

We assessed 337 adolescents (male, 80.4%) aged 11–18, clinically diagnosed with ADHD according to the DSM-IV at the mean age of 6.7 (SD = 3.0) by the corresponding author, and 223 comparison adolescents without ADHD, who were recruited from the similar school districts of the ADHD group through the school principals and teachers rather than advertisement. The adolescents in the ADHD group had their first or regular visits to the Children's Mental Health Center, Department of Psychiatry, National

Sample description

Males were more prevalent in the two ADHD groups (p < 0.001) (Table 1). More adolescents with persistent ADHD were treated with methylphenidate before (p < 0.001) and currently (p = 0.019) than adolescents with non-persistent ADHD. There were no statistically significant differences across the three groups in terms of treatment duration (p = 0.794), child age (p = 0.141), mother's and father's educational levels and job types (p = 0.096  0.872), and household (p = 0.065).

Mothering, mother–child relationship, and maternal characteristics

Adolescents with ADHD, regardless of

Discussions

As the first report of maternal and family measures in adolescents with and without persistent ADHD, we found that both ADHD groups had less maternal affectionate/care, family support, and interactions with mothers, more maternal overprotection and authoritarian control, and more severe behavioral problems at home. Furthermore, inattentive symptoms and psychiatric comorbid conditions were highly associated with negative outcomes of all the mother/family measures; while hyperactivity/impulsivity

Conclusion

Our findings indicated that adolescents with childhood diagnosis of ADHD, regardless of persistence of ADHD, encountered more negative mothering, more impaired mother–child relationships and less perceived family support, and still had more disturbing behaviors at home. The study further suggested that childhood ADHD diagnosis predicts impaired mother–child interactions, which are mainly influenced by child inattention and psychiatric comorbid conditions, and maternal neurotic and depressive

Acknowledgments

This work was supported by grants from the National Health Research Institute (NHRI-EX95-9407PC, NHRI-EX96-9407PC, NHRI-EX97-9407PC, NHRI-EX98-9407PC), Taiwan. The manuscript preparation was supported by a grant from the National Science Council (NSC98-3112-B-002-004), Taiwan. We would like to express our thanks to the participants and their parents for their contribution and Chi-Mei Lee at Eastern Michigan University for assistance in data analysis and preparation of tables. The authors have

References (66)

  • W.J. Barbaresi et al.

    An ADHD educational intervention for elementary schoolteachers: A pilot study

    Journal of Developmental and Behavioral Pediatrics

    (1998)
  • R.A. Barkley et al.

    Adolescents with attention deficit hyperactivity disorder: Mother-adolescent interactions, family beliefs and conflicts, and maternal psychopathology

    Journal of Abnormal Child Psychology

    (1992)
  • R.A. Barkley et al.

    The adolescent outcome of hyperactive children diagnosed by research criteria – III. Mother-child interactions, family conflicts and maternal psychopathology

    Journal of Child Psycholology and Psychiatry

    (1991)
  • J. Biederman et al.

    Age-dependent decline of symptoms of attention deficit hyperactivity disorder: Impact of remission definition and symptom type

    American Journal of Psychiatry

    (2000)
  • J. Biederman et al.

    Do stimulants protect against psychiatric disorders in youth with ADHD? A 10-year follow-up study

    Pediatrics

    (2009)
  • R.T. Brown et al.

    Perceived family functioning, marital status, and depression in parents of boys with attention deficit disorder

    Journal of Learning Disabilities

    (1989)
  • J.D. Burke et al.

    Reciprocal relationships between parenting behavior and disruptive psychopathology from childhood through adolescence

    Journal of Abnormal Child Psychology

    (2008)
  • R.K. Chao

    Beyond parental control and authoritarian parenting style: Understanding Chinese parenting through the cultural notion of training

    Child Development

    (1994)
  • T.C. Chi et al.

    Mother-child relationships of children with ADHD: The role of maternal depressive symptoms and depression-related distortions

    Journal of Abnormal Child Psychology

    (2002)
  • C.P. Chien et al.

    Depression in Taiwan: Epidemiological survey utilizing CES-D

    Psychiatria et Neurologia Japonica

    (1985)
  • A. Chronis-Tuscano et al.

    Associations between maternal attention-deficit/hyperactivity disorder symptoms and parenting

    Journal of Abnormal Child Psychology

    (2008)
  • A.M. Clavarino et al.

    Maternal anxiety and attention problems in children at 5 and 14 years

    Journal of Attention Disorders

    (2010)
  • J. Cohen

    Statistical analysis for the behavioral sciences

    (1988)
  • B.J. Cox et al.

    The parental bonding instrument: Confirmatory evidence for a three-factor model in a psychiatric clinical sample and in the National Comorbidity Survey

    Social Psychiatry and Psychiatric Epidemiology

    (2000)
  • G. Edwards et al.

    Parent-adolescent conflict in teenagers with ADHD and ODD

    Journal of Abnormal Child Psychology

    (2001)
  • J.N. Epstein et al.

    Assessing medication effects in the MTA study using neuropsychological outcomes

    Journal of Child Psychology and Psychiatry

    (2006)
  • H.J. Eysenck

    The maudsley personality inventory

    (1962)
  • K.A. Fanti et al.

    Trajectories of pure and co-occurring internalizing and externalizing problems from age 2 to age 12: Findings from the National Institute of Child Health and Human Development Study of Early Child Care

    Developmental Psychology

    (2010)
  • R. Finzi-Dottan et al.

    ADHD, temperament, and parental style as predictors of the child's attachment patterns

    Child Psychiatry and Human Development

    (2006)
  • E. Gadeyne et al.

    Longitudinal relations between parenting and child adjustment in young children

    Journal of Clinical Child and Adolescent Psychology

    (2004)
  • S.F. Gau et al.

    Psychiatric comorbidity of adolescents with sleep terrors or sleepwalking: A case-control study

    Australian and New Zeland Journal of Psychiatry

    (1999)
  • S.S. Gau et al.

    An open-label, randomized, active-controlled equivalent trial of osmotic release oral system methylphenidate in children with attention-deficit/hyperactivity disorder in Taiwan

    Journal of Child and Adolescent Psychopharmacology

    (2006)
  • S.S. Gau

    Parental and family factors for attention-deficit hyperactivity disorder in Taiwanese children

    Australian and New Zeland Journal of Psychiatry

    (2007)
  • Cited by (97)

    View all citing articles on Scopus
    1

    Susan Shur-Fen Gau and Jane Pei-Chen Chang have equal contribution as the first authors.

    View full text