The Relationship between Parental Attention Deficit Hyperactivity Disorder Characteristics, Executive Function and Parental Emotional Distress

Dong Ik Lee; Hee Joon Yoon; Soo Hwan Oh; Eunyoung Choi; Yunhye Oh; Ji Hae Kim; Yoo Sook Joung

doi:10.4306/jknpa.2017.56.4.186

Journal List > J Korean Neuropsychiatr Assoc > v.56(4) > 1017852

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee, Yoon, Oh, Choi, Oh, Kim, and Joung: The Relationship between Parental Attention Deficit Hyperactivity Disorder Characteristics, Executive Function and Parental Emotional Distress

Original Article

Journal of Korean Neuropsychiatric Association 2017; 56(4): 186-193.

Published online: 30 November 2017

DOI: https://doi.org/10.4306/jknpa.2017.56.4.186

The Relationship between Parental Attention Deficit Hyperactivity Disorder Characteristics, Executive Function and Parental Emotional Distress

Dong Ik Lee, MD¹, Hee Joon Yoon, MD¹, Soo Hwan Oh, MD¹, Eunyoung Choi, MD², Yunhye Oh, MD^3,⁴, Ji Hae Kim, PhD^1,³, Yoo Sook Joung, MD, PhD^1,³

¹Department of Psychiatry, Samsung Medical Center, Seoul, Korea.

²Inury & Park Psychiatry Clinic, Busan, Korea.

³Department of Psychiatry, School of Medicine, Sungkyunkwan University, Seoul, Korea.

⁴Department of Psychiatry, National Center for Mental Health, Seoul, Korea.

Address for correspondence: Yoo Sook Joung, MD, PhD. Department of Psychiatry, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea. Tel +82-2-3410-0930, Fax +82-2-3410-0050, yschoung@skku.edu

Received 11 September 2017 Revised 13 October 2017 Accepted 25 October 2017

Korean Neuropsychiatric Association

Abstract

Objectives

Attention deficit hyperactivity disorder (ADHD) is a disease of high heritability. Parents of children with ADHD have high parenting stress and low parenting efficacy. In this study, we assessed parents' characteristics including inattention, hyperactivity, impulsivity, executive function, anxiety/depression severity level, child's ADHD symptom severity, and parents' emotional distress level. The relationships between severity of ADHD symptoms in children, cognitive and emotional characteristics in parents, as well as parenting stress and parenting efficacy were evaluated.

Methods

96 parents participated in the study. Each parent assessed their child's ADHD symptom severity, their own ADHD symptom severity, as well as executive function, depression, anxiety, parenting stress and parenting efficacy. Collected data was analyzed using multiple regression analysis.

Results

The mean ADHD Rating Scale score of 53 children was 22.91 (±9.63). Of these, 26 (49.0%) were taking medication. Eight (8.3%) of the 96 parents had psychiatric illnesses and 12 (12.5%) had the possibility of ADHD. Mothers showed significantly higher levels of parenting stress (p<0.001), depression (p=0.006), and parenting efficacy (p<0.001) compared with fathers. The children's ADHD symptoms, severity, and parental depression were related to high parenting stress. The ADHD symptoms of parents were associated with high parenting stress (p=0.032). Parental executive function was significantly associated with low parenting efficacy (p=0.015).

Conclusion

Children's ADHD symptoms severity, parental depression and ADHD symptom severity were significantly associated with high parenting stress. Parental executive function was significantly associated with low parenting efficacy. In addition to treating the children with ADHD, evaluation and treatment of parents' symptoms is needed in order to reduce parenting stress and provide a stable parenting environment.

Keywords: Adult attention deficit hyperactivity disorder, Executive function, Parenting stress, Depression, Parenting efficacy

Figures and Tables

Table 1

Baseline characteristics in children with ADHD (n=53)

ADHD : Attention deficit hyperactivity disorder, M : Mean, SD : Standard deviation, n : Number, NOS : Not otherwise specified, ARS : ADHD Rating Scale

Table 2

Demographic characteristics in parents of children with attention deficit hyperactivity disorder (n=96)

M : Mean, SD : Standard deviation, n : Number

Table 3

Comparison of clinical characteristics between father and mother

^* : p<0.05. M : Mean, SD : Standard deviation, n : Number, ARS : Attention deficit hyperactivity disorder Rating Scale, ASRS : Adult attention deficit hyperactivity disorder Self-Report Scale, BDEFS : Barkley Deficits in Executive Functioning Scale, PSI-SF : Parenting Stress Index-short form, PSOC : Parenting Sense of Competence, BDI : Beck Depression Inventory, BAI : Beck Anxiety Inventory, Time : Self-management to time, Organization : Self-organization/problem solving, Restraint : Self-restraint, Motivation : Self-motivation, Regulation : Self-regulation of emotion, EF-index : Executive function index

Table 4

Comparison of descriptive statistics between normal and adult ADHD parents

^* : p<0.05. ADHD : Attention deficit hyperactivity disorder, M : Mean, SD : Standard deviation, n : Number, ARS : ADHD Rating Scale, ASRS : Adult ADHD Self-Report Scale, PSI-SF : Parenting Stress Index-short form, PSOC : Parenting Sense of Competence, BDI : Beck Depression Inventory, BAI : Beck Anxiety Inventory

Table 5

Effect of parental gender, ADHD symptom of children, parental ADHD symptom and depression on parenting stress

^* : p<0.05, ^† : Multivariable analysis. ADHD : Attention deficit hyperactivity disorder, β : Estimated regression coefficient, SE : Standard error, CI : Confidence interval, ARS : ADHD Rating Scale, ASRS : Adult ADHD Self-Report Scale, BDI : Beck Depression Inventory

Table 6

Effect of parental gender, ADHD symptom of children, parental executive function and depression on parenting stress

^* : p<0.05, ^† : Multivariable analysis. ADHD : Attention deficit hyperactivity disorder, β : Estimated regression coefficient, SE : Standard error, CI : Confidence interval, ARS : ADHD Rating Scale, BDEFS : Barkley Deficits in Executive Functioning Scale, BDI : Beck Depression Inventory

Notes

^{Conflicts of Interest} The authors have no financial conflicts of interest.

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). 5th ed. Washington, DC: American Psychiatric Association;2013.

2. Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry. 2007; 164:942–948.

3. Jensen PS, Hinshaw SP, Kraemer HC, Lenora N, Newcorn JH, Abikoff HB, et al. ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. J Am Acad Child Adolesc Psychiatry. 2001; 40:147–158.

4. Webster-Stratton C, Hammond M. Maternal depression and its relationship to life stress, perceptions of child behavior problems, parenting behaviors, and child conduct problems. J Abnorm Child Psychol. 1988; 16:299–315.

5. Graziano PA, McNamara JP, Geffken GR, Reid A. Severity of children's ADHD symptoms and parenting stress: a multiple mediation model of self-regulation. J Abnorm Child Psychol. 2011; 39:1073–1083.

6. Mash EJ, Johnston C. Parental perceptions of child behavior problems, parenting self-esteem, and mothers' reported stress in younger and older hyperactive and normal children. J Consult Clin Psychol. 1983; 51:86–99.

7. Theule J, Wiener J, Tannock R, Jenkins JM. Parenting stress in families of children with ADHD: a meta-analysis. J Emot Behav Disord. 2013; 21:3–17.

8. McCormick LH. Depression in mothers of children with attention deficit hyperactivity disorder. Fam Med. 1995; 27:176–179.

9. Kashdan TB, Jacob RG, Pelham WE, Lang AR, Hoza B, Blumenthal JD, et al. Depression and anxiety in parents of children with ADHD and varying levels of oppositional defiant behaviors: modeling relationships with family functioning. J Clin Child Adolesc Psychol. 2004; 33:169–181.

10. Willcutt EG, Doyle AE, Nigg JT, Faraone SV, Pennington BF. Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review. Biol Psychiatry. 2005; 57:1336–1346.

11. Barkley RA, Murphy KR. Impairment in occupational functioning and adult ADHD: the predictive utility of executive function (EF) ratings versus EF tests. Arch Clin Neuropsychol. 2010; 25:157–173.

12. Deater-Deckard K, Wang Z, Chen N, Bell MA. Maternal executive function, harsh parenting, and child conduct problems. J Child Psychol Psychiatry. 2012; 53:1084–1091.

13. Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, et al. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997; 36:980–988.

14. Kim YS, Cheon KA, Kim BN, Chang SA, Yoo HJ, Kim JW, et al. The reliability and validity of Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version-Korean version (K-SADS-PL-K). Yonsei Med J. 2004; 45:81–89.

15. So YK, Noh JS, Kim YS, Ko SG, Koh YJ. The reliability and validity of Korean parent and teacher ADHD Rating Scale. J Korean Neuropsychiatr Assoc. 2002; 41:283–289.

16. Kim JH, Lee EH, Joung YS. The WHO Adult ADHD Self-Report Scale: reliability and validity of the Korean version. Psychiatry Investig. 2013; 10:41–46.

17. Lee H, Yang M, Lee EH, Joung YS, Hwang ST, Hong SH, et al. Reliability and validity of the Korean version of Barkley Deficits in Executive Functioning Scale (K-BDEFS). Korean J Clin Psychol. 2016; 35:519–539.

18. Lee EH, Lee SJ, Hwang ST, Hong SH, Kim JH. Reliability and validity of the Beck Depression Inventory-II among Korean adolescents. Psychiatry Investig. 2017; 14:30–36.

19. Lee HK, Lee EH, Hwang ST, Hong SH, Kim JH. Psychometric properties of the Beck Anxiety Inventory in the community-dwelling sample of Korean adults. Korean J Clin Psychol. 2016; 35:822–830.

20. Lee K, Chung KM, Park J, Kim H. Reliability and validity study for the Korean version of Parenting Stress Index Short Form (K-PSI-SF). Korean J Woman Psychol. 2008; 13:363–377.

21. Shin SJ, Chung MJ. Effects of parenting stress, social support and parenting efficacy on mothers' parenting behaviors [dissertation]. Seoul: Yonsei University;1997.

22. Shin YJ. A study on parenting in books for domestic life education of the Chosen dynasty period - Focusing on parental role of disciplining children. Fam Environ Res. 1995; 33:155–168.

23. Lovejoy MC, Graczyk PA, O'Hare E, Neuman G. Maternal depression and parenting behavior: a meta-analytic review. Clin Psychol Rev. 2000; 20:561–592.

24. Johnston C, Mash EJ. A measure of parenting satisfaction and efficacy. J Clin Child Psychol. 1989; 18:167–175.

25. Barkley RA. Hyperactive children: a handbook for diagnosis and treatment. New York, NY: Guilford Press;2006.

26. Abidin RR. Parenting Stress Index. Odessa, FL: Psychological Assessment Resources, Inc.;1995.

27. Johnston C, Mash EJ, Miller N, Ninowski JE. Parenting in adults with attention-deficit/hyperactivity disorder (ADHD). Clin Psychol Rev. 2012; 32:215–228.

28. kosis.kr [homepage on the Internet]. Daejeon: Korean Statistical Information Service;updated 2017 august 24. cited 2017 august 29. Available from: http://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1L9H002&vw_cd=&list_id=&scrId=&seqNo=&lang_mode=ko&obj_var_id=&itm_id=&conn_path=E1#.

29. Biederman J, Milberger S, Faraone SV, Kiely K, Guite J, Mick E, et al. Family-environment risk factors for attention-deficit hyperactivity disorder. A test of Rutter's indicators of adversity. Arch Gen Psychiatry. 1995; 52:464–470.

30. Kuperman S, Perry PJ, Gaffney GR, Lund BC, Bever-Stille KA, Arndt S, et al. Bupropion SR vs. methylphenidate vs. placebo for attention deficit hyperactivity disorder in adults. Ann Clin Psychiatry. 2001; 13:129–134.

31. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006; 163:716–723.

32. Sonuga-Barke EJ, Daley D, Thompson M. Does maternal ADHD reduce the effectiveness of parent training for preschool children's ADHD? J Am Acad Child Adolesc Psychiatry. 2002; 41:696–702.

TOOLS

Similar articles