Maternal parenting styles and mother–child relationship among adolescents with and without persistent attention-deficit/hyperactivity disorder
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)
International consensus statement on ADHD
Journal of American Academy of Child and Adolescent Psychiatry
(2002)- et al.
Predictors of persistence and remission of ADHD into adolescence: Results from a four-year prospective follow-up study
Journal of the American Academy of Child and Adolescent Psychiatry
(1996) - et al.
Father's parenting and father-child relationship among children and adolescents with attention-deficit/hyperactivity disorder
Comprehensive Psychiatry
(2013) - et al.
Parenting practices and attention-deficit/hyperactivity disorder: New findings suggest partial specificity of effects
Journal of American Academy of Child and Adolescent Psychiatry
(2009) - et al.
The Social Adjustment Inventory for Children and Adolescents (SAICA): Testing of a new semistructured interview
Journal of American Academy of Child and Adolescent Psychiatry
(1987) - et al.
Youths with ADHD with and without tic disorders: Comorbid psychopathology, executive function and social adjustment
Research in Developmental Disabilities
(2012) - et al.
Changes in family function and relationships in children who respond to methylphenidate
Journal of Amerian Academy of Child and Adolescent Psychiatry
(1987) - et al.
Clinical course of attention-deficit/hyperactivity disorder from childhood toward early adolescence
Journal of American Academy of Child and Adolescent Psychiatry
(2003) - et al.
Using the CES-D in a two-phase survey for depressive disorders among nonreferred adolescents in Taipei: A stratum-specific likelihood ratio analysis
Journal of Affective Disorder
(2004) - et al.
Perceived parental burden and service use for child and adolescent psychiatric disorders
American Journal of Public Health
(1998)
An ADHD educational intervention for elementary schoolteachers: A pilot study
Journal of Developmental and Behavioral Pediatrics
Adolescents with attention deficit hyperactivity disorder: Mother-adolescent interactions, family beliefs and conflicts, and maternal psychopathology
Journal of Abnormal Child Psychology
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
Age-dependent decline of symptoms of attention deficit hyperactivity disorder: Impact of remission definition and symptom type
American Journal of Psychiatry
Do stimulants protect against psychiatric disorders in youth with ADHD? A 10-year follow-up study
Pediatrics
Perceived family functioning, marital status, and depression in parents of boys with attention deficit disorder
Journal of Learning Disabilities
Reciprocal relationships between parenting behavior and disruptive psychopathology from childhood through adolescence
Journal of Abnormal Child Psychology
Beyond parental control and authoritarian parenting style: Understanding Chinese parenting through the cultural notion of training
Child Development
Mother-child relationships of children with ADHD: The role of maternal depressive symptoms and depression-related distortions
Journal of Abnormal Child Psychology
Depression in Taiwan: Epidemiological survey utilizing CES-D
Psychiatria et Neurologia Japonica
Associations between maternal attention-deficit/hyperactivity disorder symptoms and parenting
Journal of Abnormal Child Psychology
Maternal anxiety and attention problems in children at 5 and 14 years
Journal of Attention Disorders
Statistical analysis for the behavioral sciences
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
Parent-adolescent conflict in teenagers with ADHD and ODD
Journal of Abnormal Child Psychology
Assessing medication effects in the MTA study using neuropsychological outcomes
Journal of Child Psychology and Psychiatry
The maudsley personality inventory
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
ADHD, temperament, and parental style as predictors of the child's attachment patterns
Child Psychiatry and Human Development
Longitudinal relations between parenting and child adjustment in young children
Journal of Clinical Child and Adolescent Psychology
Psychiatric comorbidity of adolescents with sleep terrors or sleepwalking: A case-control study
Australian and New Zeland Journal of Psychiatry
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
Parental and family factors for attention-deficit hyperactivity disorder in Taiwanese children
Australian and New Zeland Journal of Psychiatry
Cited by (97)
Sex-differential patterns of neuropsychological functioning in adults with attention-deficit/hyperactivity disorder
2024, Comprehensive PsychiatryExamining daily parent involvement in caregivers of children with ADHD using electronic diaries
2022, Journal of School PsychologyPersonalised medicine in child and Adolescent Psychiatry: Focus on omega-3 polyunsaturated fatty acids and ADHD
2021, Brain, Behavior, and Immunity - HealthFamily Functioning in Children With ADHD and Subthreshold ADHD: A 3-Year Longitudinal Study
2024, Journal of Attention DisordersThe effect of psycho-education given to mothers of children with attention deficit hyperactivity disorder on mother-child interaction and family functionality
2023, Journal of Child and Adolescent Psychiatric Nursing
- 1
Susan Shur-Fen Gau and Jane Pei-Chen Chang have equal contribution as the first authors.