Parenting stressors, social support, and mental health of mothers of children with attention deficit hyperactivity disorder

FIGURE 1. Changes in cortical thickness provide one measure of brain maturation. A large longitudinal study found that for most areas of cortex, children with attention deficit hyperactivity disorder (ADHD) reach peak cortical thickness several years later than typically developing children, supporting presence of developmental delay. The rate of cortical thinning also differed between the group who continued to meet diagnostic criteria into adulthood (persistent ADHD) and those who did not (remitted ADHD). Areas of cortex in which the rate of thinning correlated with adult symptom level (green, more symptoms associated with more thinning) are approximated on medial and lateral simplified representations of cortex. An earlier study also identified multiple areas in which cortex was thinner in adults with persistent ADHD compared with controls (orange). In addition, this study noted some areas of thicker cortex in remitted ADHD when compared with persistent ADHD (blue).

Treatment Controversies in Adult ADHD.

ADHD: The Mammoth Task of Disentangling Genetic, Environmental, and Developmental Risk Factors.

Family, twin, and adoption studies show attention deficit hyperactivity disorder (ADHD) to have a substantial genetic component, and some studies have reported an association between ADHD and the dopamine D4 (DRD4) gene. The authors recruited 27 triads that comprised an ADHD adult, his or her spouse, and their ADHD child. These triads were assessed for ADHD, and their DNA was genotyped for DRD4 alleles. A multiallelic transmission disequilibrium test suggested an association between ADHD and the DRD4 7-repeat allele. Among family members, the number of 7-repeat alleles predicted the diagnosis of ADHD. Prior reports of an association between ADHD and DRD4 generalize to families recruited through clinically referred ADHD adults. However, because there are some conflicting studies, further work is needed to clarify the role of DRD4 in the etiology of the disorder.

The aim of this study was to describe and investigate family characteristics in relation to support, behaviour of the child, family functioning and sense of coherence from the parents' perspective in families with a child with attention deficit hyperactivity disorder (ADHD). A further aim was to explore predictors of family functioning. The study population consisted of 1964 parents of children with ADHD aged 15 years old and younger. In all, 265 parents responded to a questionnaire (response rate 48.2%; 217 mothers and 48 fathers). In addition to questions about the parents, children, family characteristics and support from health services, the questionnaire included the Family Assessment Device (FAD), the Strengths and Difficulties Questionnaire (SDQ), Sense of Coherence (SOC) and Social Cohesion and Support Index (SCS). Data were analysed with descriptive, comparative and standard multiple regression analyses. Parents with ADHD reported a weaker SOC and poorer FAD in the family than parents without ADHD. Parents with children medicated for ADHD were significantly more satisfied with social support (SCS), rated their children's behaviour as less problematic and reported better family functioning. Parents' age, SOC, SCS, SDQ and support from the community health services explained 46.2% of the variation in FAD. A strong SOC, social support and support from the community health services were strongly associated with a positive effect on family functioning. Parents with ADHD reported a weaker SOC and poorer family functioning than parents without ADHD. This knowledge may be useful and should be taken into account when planning support for such families.

We still need to know more about adolescents with attention deficit hyperactivity disorder who undergo surgery for severe obesity

The three studies presented in this thesis were designed to test the utility of a model of adjustment to parenting a child with Attention Deficit Hyperactivity Disorder (ADHD). The application of the Double ABCX Model of Family Adaptation to families with a child with ADHD proposes that the level of stressors, pile-up, resources, perceptions and coping strategies experienced by parents affects the way in which they adjust to having a child with the disorder. Five main aims were addressed in order to examine the model. The first aim was to develop an understanding of the ways in which parents of children with ADHD experience the process of adjustment. The second aim was to validate whether constructs identified by previous research as being central to adjustment for parents in general were central to the adjustment of parents of children with ADHD and to clarify the role of variables which had not been clearly examined. The third aim was to identify the coping strategies used by parents in order to develop a coping measure. These aims were addressed through a qualitative research design. The fourth aim was to apply the findings of the qualitative research within the framework of the Double ABCX Model to investigate the gender differences involved in adjusting to having a child with ADHD. The fifth aim was to test the utility of the Double ABCX Model’s in predicting adjustment for mothers and fathers of a child with ADHD both cross-sectionally and longitudinally. These aims were addressed through a quantitative research design. Study 1 involved semi-structured interviews conducted individually with 14 mothers and 8 fathers of a child with ADHD. Parental reports were analysed using content analysis techniques and major themes were organised under the categories of the model. Findings were combined with previous literature in order to develop a series of variables representing each of the factors of the model that were central to adjustment for parents of children with ADHD. These included severity of the child’s ADHD behaviours (stressors), stressful life events (pile-up), use of health professional support, community resources, social support and optimism (resources), attributions of ADHD behaviours and stress appraisal (perceptions), and the use of problem solving, avoidance, social support seeking and concealment coping strategies (coping strategies). Adjustment variables included levels of distress, physical health, parental efficacy and relationship satisfaction. A questionnaire was devised that included a measure of each of these variables using both existing scales and those developed within the present research. In study 2, 143 participants (113 mothers and 30 fathers) completed the questionnaire developed within Study 1. Gender differences in each of the variables relating to adjustment were examined. Findings revealed that gender differences were found to exist in each of the factors of the model. Mothers were more likely than fathers to experience higher levels of stressors and pile-up, less social supports and lower satisfaction with community resources. Mothers were also more likely to experience higher stress appraisal, use more coping strategies and experience higher distress than fathers of a child with ADHD. Study 3 consisted of an examination of the utility of the Double ABCX Model crosssectionally (Time 1) and longitudinally (Time 2). Data from the questionnaire used in Study 2 was used to examine the model at Time 1. Ninety-eight participants from the same sample completed a second questionnaire following an eight month time period (Time 2). Findings supported the utility of the Double ABCX Model in predicting adjustment in parents of children with ADHD both cross-sectionally and longitudinally. Results revealed that stressors, pile-up, resources, attributions and appraisals, and coping strategies were related to levels of adjustment for parents of children with ADHD. Findings also revealed that there were certain variables that were more central to adjustment and that specific sets of variables predicted better outcomes for parents. Results also revealed that certain predictors were more highly associated with particular domains of adjustment. Overall, the three studies provide considerable support for the Double ABCX Model and its application to parents of children with ADHD. Findings also highlight the unique difficulties experienced by these families and clarify the role of certain variables in parental adjustment. The implications for many areas of clinical practice including treatment plans, parent programmes, resilience building and service delivery are discussed.

National Variation of ADHD Diagnostic Prevalence and Medication Use: Health Care Providers and Education Policies

Do specific myelin autoantibodies and increased cerebral dopamine neurotrophic factor in the context of inflammation predict the diagnosis of attention deficit hyperactivity disorder in medication-free children?

Social difficulties have been suggested to exacerbate the risk of loneliness. The social difficulties in social relations often reported for adolescents with attention deficit hyperactivity disorder (ADHD) could be a risk for increased loneliness in adolescents with ADHD. However, current studies of the risk of loneliness in persons with ADHD are limited and their results are mixed. Especially the adolescent age group is poorly investigated and has not been studied as a separate group. In this study we investigate the experience of loneliness and social support in adolescents with attention deficit hyperactivity disorder (ADHD) in a special educational setting. Twenty-five adolescent boys with clinically diagnosed ADHD filled out self-report measures of loneliness, difficulties in making friends, and social support. The boys with ADHD were compared with 199 adolescent boys from regular schools. No difference in the degree of loneliness was found even if more adolescents with ADHD reported difficulties in making friends. These difficulties were related to loneliness in the control group, but not in the ADHD group. Social support from classmates and peers reduced the degree of loneliness in the ADHD group. Adolescent boys with ADHD in a special educational setting do not seem to be at a higher risk of loneliness in adolescence.

BackgroundAttention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder in children that can extend into adulthood and that is often associated with a variety of comorbid psychiatric disorders.AimAssess the comorbidity of ADHD with anxiety disorders and depressive disorders in school-aged children, and the relationship of the severity of ADHD, anxiety, and depressive symptoms in children who have ADHD with the severity of the corresponding symptoms in their parents.MethodsA two-stage screening process identified children 7-10 years of age with and without ADHD treated at the Xin Hua Hospital in Shanghai. ADHD and other DSM-IV diagnoses were determined by a senior clinician using the Schedule for Affective Disorder and Schizophrenia for School-Aged Children (K-SADS-PL). One parent for each enrolled child completed three self-report scales: the ADHD Adult Self Report Scale (ASRS), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). In total 135 children with ADHD and 65 control group children without ADHD were enrolled; parents for 94 of the children with ADHD and 63 of the children without ADHD completed the parental assessment scales.ResultsAmong the 135 children with ADHD, 27% had a comorbid anxiety disorder, 18% had a comorbid depressive disorder, and another 15% had both comorbid anxiety and depressive disorders. Parents of children with ADHD self-reported more severe ADHD inattention symptoms than parents of children without ADHD and were more likely to meet criteria for adult ADHD. Mothers (but not fathers) of children with ADHD had significantly more severe trait anxiety and depressive symptoms than mothers of children without ADHD. Among children with ADHD, the severity of ADHD symptoms was not significantly correlated with the severity of ADHD symptoms in parents, but depressive symptoms and anxiety symptoms in the children were significantly correlated with the corresponding symptoms in the parents.ConclusionSchool-aged children with ADHD commonly suffer from comorbid anxiety and depressive disorders, and the severity of these symptoms parallels the level of anxiety and depressive symptoms in their parents. Self-reported symptoms of ADHD are significantly more common in parents of children with ADHD than in parents of children without ADHD. Longitudinal studies are needed to disentangle the genetic, biological, and social factors responsible for these complex inter-relationships.

Adolescents with attention deficit hyperactivity disorder (ADHD) face significant challenges related to stress, inattention and impulsivity, which can impair their creativity self-efficacy. Social support is a critical protective factor that mitigates stress and enhances resilience, yet its role in fostering creativity self-efficacy among adolescents with ADHD remains underexplored. To examine the levels of stress, perceived social support and creativity self-efficacy among adolescents with ADHD and to explore the mediating role of social support in the relationship between stress and creativity self-efficacy. A cross-sectional study was conducted with 305 adolescents diagnosed with ADHD from six preparatory schools. Validated tools, including the Adolescence Stress Scale, Creative Self-Efficacy Scale and Multidimensional Scale of Perceived Social Support, were used to measure key variables. Data were analysed using Pearson correlation and mediation analysis. Stress was negatively correlated with CSE (r = -0.791, p < 0.001), while perceived social support positively correlated with creativity self-efficacy (r = 0.548, p < 0.001). Social support significantly mediated the relationship between stress and creativity self-efficacy, buffering the negative impact of stress on creativity (B = -0.149, t = 7.987, p < 0.001). The findings underscore the vital role of social support in alleviating stress and bolstering creativity self-efficacy among adolescents with ADHD. Supportive relationships from family, peers, and mentors enhance confidence in creative abilities, creating a nurturing framework for resilience and innovation. Perceived social support effectively mitigates the adverse effects of stress on creativity self-efficacy, highlighting its importance in promoting adaptive outcomes for adolescents with ADHD. Nursing interventions should prioritise strengthening social support systems for adolescents with ADHD. Educating families, schools and communities about the impact of social support can foster resilience, reduce stress and enhance creativity.

Externalizing symptoms are associated with risk of future substance use disorder (SUD). Few longitudinal studies exist using general population-based samples which assess the spectrum of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms. We aimed to study the associations between adolescent ADHD symptoms and subsequent SUD and additionally examine whether the risk of SUD is influenced by comorbid oppositional defiant disorder (ODD) symptoms. The Northern Finland Birth Cohort 1986 was linked to nationwide health care register data for incident SUD diagnoses until age 33 years (n = 6278, 49.5% male). ADHD/ODD-case status at age 16 years was defined using parent-rated ADHD indicated by Strengths and Weaknesses of ADHD symptoms and Normal Behaviors (SWAN) questionnaire with 95% percentile cut-off. To assess the impact of ODD comorbidity on SUD risk, participants were categorized into four groups based on their ADHD/ODD case status. Cox-regression analysis with hazard ratios (HRs) and 95% confidence intervals (CIs) were used to study associations between adolescent ADHD/ODD case statuses and subsequent SUD. In all, 552 participants (8.8%) presented with ADHD case status at the age of 16 years, and 154/6278 (2.5%) were diagnosed with SUD during the follow-up. ADHD case status was associated with SUD during the follow-up (HR = 3.84, 95% CI 2.69-5.50). After adjustments for sex, family structure, and parental psychiatric disorder and early substance use the association with ADHD case status and SUD remained statistically significant (HR = 2.60, 95% CI 1.70-3.98). The risk of SUD remained elevated in individuals with ADHD case status irrespective of ODD symptoms. ADHD in adolescence was associated with incident SUD in those with and without symptoms of ODD. The association of ADHD and SUD persisted even after adjustment for a wide range of potential confounds. This emphasizes the need to identify preventative strategies for adolescents with ADHD so as to improve health outcomes.

Cyberbullying is defined as an intentional online act via electronic media, to harm, embarrass and/or humiliate another person. As adolescents with attention deficit hyperactivity disorder (ADHD) are at a higher risk in being involved in bullying behaviour as perpetrators or victims, the main purpose of this study is to examine the prevalence of their cyber experience and its impact on loneliness, perceived self-efficacy and social support. The study population included 140 adolescent students with ADHD taking part in general classes and 332 students without disabilities, all of whom completed four self-report questionnaires (cyberbullying, perceived feelings of loneliness, self-efficacy and social support). The findings show no significant differences between students with or without ADHD regarding the time spent on the net and their perceived usage expertise. Most participants with ADHD were familiar with the internet and spent a similar amount of time surfing as the adolescents without ADHD. Results revealed significant differences between the student groups (ADHD/Non-ADHD) and some of the social-emotional measures: students with ADHD who were cybervictims and students with ADHD who were cyberwitnesses reported on greater feelings of emotional loneliness and a lower belief in their social self-efficacy than the non-ADHD students. Furthermore, ADHD student cyberwitnesses also reported on feelings of greater social loneliness. Findings revealed that girls were significantly more often cybervictims than boys. However, boys reported on significantly more involvement as cyberperpetrators than girls.

Review question/objective The objective of the systematic review is to identify and synthesize the best available evidence on how parents experience living with a child with attention deficit hyperactivity disorder (ADHD) including their experiences of ADHD health care services. The review questions are: How does living with a child with ADHD affect family life?What are the parental challenges of having a child with ADHD?How do parents experience collaboration with health care settings and professionals? Background Attention deficit hyperactivity disorder is the most prevalent mental disorder among children and adolescents worldwide, and the incidence of ADHD has increased in recent years.1 Attention deficit hyperactivity disorder in children is characterized by inattention, hyperactivity and impulsivity, and these characteristics are often present before the age of seven. The prevalence estimates for ADHD vary considerably worldwide due to demographic, cultural and socioeconomic characteristics of the population as well as the various criteria used for diagnosis. However, it is estimated that the prevalence in school children aged between five and 12 is 4-7%.2,3 Attention deficit hyperactivity disorder occurs in all socioeconomic groups, although it is more frequent in lower socioeconomic groups in society.2-4 Children with ADHD have care needs that reinforce a multimodal approach. They are often treated with medication which is supplemented with a variety of psychosocial and psycho educational interventions to improve their functioning.5 Furthermore, ADHD can be complicated by co-morbid conditions such as depression, anxiety and conduct disorders. Compared with the general population, ADHD is also associated with an increased prevalence of physical conditions including asthma, food allergy, epilepsy and severe headaches.2,8 Attention deficit hyperactive disorder often presents with challenging behavior and is associated with impairment in social, familial, emotional, academic and behavioral functioning.6,7 Attention deficit hyperactivity disorder may impact the lives of children and their families, for example, it affects practical and psychological aspects of daily life, school life and social life.6,7 The lives of families with children with ADHD can be influenced by many factors.9 Studies on parenting experiences show that parents find it challenging to raise and support the child.1,6 Findings indicate that the parents are struggling to maintain a bearable family life and to learn how to successfully handle their child.1,6 In addition, parents raising children with ADHD experience more emotional distress, stress and exhaustion than parents raising children without ADHD.1 Raising a child with ADHD also affects the families' social life as parents are worried how the child with ADHD will behave if they go on visits, holidays etc.9 Mental illness is associated with stigma, and living with a child with ADHD seems to have a significant impact on the families' experiences of stigma.10 Parenting a child with ADHD may cause experiences of social isolation, negative public views and sometimes the characteristics of the child with ADHD provoke negative reactions and intolerance from other parents or family members.9,10 Thus, the parents are concerned how society will judge a child diagnosed with ADHD, and they fear that the diagnosis may have a negative impact on their child's future opportunities.10 Although the majority of studies imply that raising a child with ADHD affects family lives negatively, studies report that the parents benefit from early identification and help and support from professionals.11 Some families develop strategies to cope with the problems related to their child's disorder.6,12 Parenting experiences of living with a child with ADHD include experiences of ADHD care and treatment.20 Children with ADHD are cared for and treated in various settings both in and outside of medical settings. Parents may be challenged by coordinating care and treatment as the diverse settings and professionals do not always tend to collaborate.14,15,20 A study estimates that as the rate of mental illness in the child population continues to increase, an extended use of collaboration with health professionals such as school psychology services, public health nursing, hospital psychiatry etc. is an important factor in providing high quality services.13 Treatment and care for children with mental health problems can involve between six to ten professionals across sectors.13 Studies reveal different perceptions regarding parents' collaboration with professionals. On one hand, parents of children with ADHD are grateful for the help and support from professionals to provide the best possible care for their children.1,4 On the other hand, parents experience barriers to treatment and care, as it is provided in diverse settings with numerous professionals involved.14,15 In addition, professionals and parents may conceptualize ADHD differently and have different perceptions of what collaboration entails.11 Studies show that parents lack directions and help from professionals to make decisions concerning medication.16-18 ADHD treatment and care may also be compromised by lack of continuity of care and if health professionals do not meet the families' individual emotional and educational needs.4,20 Family factors such as conflicts within the family and the psychopathology of the parents may also contribute to barriers in treatment and care.4,19 The literature indicates that parenting children with ADHD is influenced and challenged in different ways.1,20 However, diverse perspectives exist as how parenting a child with ADHD influences the families' daily life, how the parents manage raising the child, which factors parents find important and helpful factors and how parents experience ADHD care in diverse settings and the involvement with professionals across sectors. Studies find that the parents need more intensive support to help their child in the best possible way, and it is also recommended that professionals must be aware of the families' situations and their needs.1,11 An initial search in the databases of PubMed, CINAHL, JBIConnect+, Cochrane Library and PsycINFO showed that no systematic review on this topic exists or in progress currently. It is necessary to aggregate knowledge to further understand parenting experiences of living with a child with ADHD including their experiences of ADHD health care services to identify important and helpful factors in care and treatment. This may contribute to knowledge on how professionals can support the families in managing their situations. It may also contribute to the pertinent discussion on continuity of patient care and on how health care services ought to be organized to ensure the best possible care and treatment for children with ADHD and their parents.