Author
DEAULT Louise C.;
Title
A systematic review of parenting in relation to the development of comorbidities and functional impairments in children with attention-deficit/hyperactivity disorder (ADHD).
Journal citation/publication details
Child Psychiatry & Human Development, 41(2), April 2010, pp168-192.
Summary
The majority of the 22 studies included in this narrative review focused on the association between family functioning and comorbid oppositional defiant disorder (ODD) and conduct disorder (CD) in children with ADHD. The evidence suggests that parental psychopathology and family conflict are more strongly associated with these comorbidities than with ADHD symptoms but it is limited by the methodological variability of the studies. Very little research on internalising problems, such as depression or anxiety, or functional impairments was identified.
Context
Children with a diagnosis of ADHD are at risk for a number of comorbid diagnoses, as well as social and academic functional impairments. The aim of this review was to examine parenting variables such as parent characteristics, parent-child interactions and family stress, 'that may contribute to different outcomes of children with ADHD, including frequently co-occurring externalizing disorders (ODD, CD), internalizing disorders (depression, anxiety) as well as functioning in academic and social domains'.
Methods
What sources were searched?
The two databases searched were PsycINFO and PubMed (Ovid).
What search terms/strategies were used?
Keywords included: 'attention deficit hyperactivity disorder', and 'parenting', 'parent child relations', 'parenting skills', 'parenting style', 'parent child communication', 'parent-child interactions', or 'parental characteristics'. Searches were limited to studies published from 2000-2008, in English.
What criteria were used to decide on which studies to include?
Studies including samples of children and/or adolescents with ADHD and their parents that were empirical investigations of the present family context reporting parent predictor variables and at least one child outcome were eligible for inclusion. Only studies of children diagnosed with ADHD using standard assessment procedures were included. The review was limited to research published in North America or internationally in peer reviewed journals. Treatment studies were excluded.
Who decided on their relevance and quality?
Screening process was carried out in two stages with titles and abstracts and then full text papers examined for relevance. The quality of evidence was assessed based on the use of: a clear screening process for diagnostic categories; validated measures of parent predictor variables; multiple parent variables as predictors of child outcome and; a consideration of variability in child outcome beyond symptoms of ADHD.
How many studies were included and where were they from?
Initially 365 articles were retrieved; 95 were obtained for further analysis. After the removal of duplicates 59 articles were screened in depth and 22 were included in the systematic review.
How were the study findings combined?
The results are presented as a narrative synthesis with separate headings for parental variables associated with: comorbid externalising disorders in ADHD; comorbid internalizing disorders in ADHD, and; functional impairments in ADHD. Study design details including sample characteristics and the scales and measures used are outlined in Table 1.
Findings of the review
Eighteen of the 22 studies included were correlational, the remaining four were longitudinal. The correlational studies focused mainly on the differences between families of boys with ADHD and those with the additional diagnosis of ODD or CD. Overall, results indicated that ODD and CD problems were related to negative parenting practices and increased family conflict, more than to ADHD symptoms. There was little consistent evidence on the specific parenting characteristics and parenting behaviours due to the variable methodology of the studies included.
The evidence from the very few studies investigating the association between parental factors and internalising problems and academic or social functioning was inconsistent.
Authors' conclusions
'While correlational research has highlighted a range of factors that are potentially related to the development of oppositional and conduct symptoms in children with ADHD, such as maternal depressive symptoms, parental ADHD, less positive parental involvement and higher family conflict, the specific pattern of associations still appears inconsistent'.
Implications for policy or practice
None are discussed.