Attention-Deficit/Hyperactivity disorder and Family …2019...Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability

Deakin University CRICOS Provider Code: 00113B

Sampada Bhide1,2,5, Daryl Efron2,3,4, Emma Sciberras1,2,3

1School of Psychology, Deakin University, Geelong;

2Centre For Community Child Health, Murdoch Children’s Research Institute, Melbourne;

3Department of Pediatrics, University of Melbourne, Melbourne;

4 The Royal Children’s Hospital, Melbourne;

5Allied Health Department, The Royal Melbourne Hospital, Melbourne

Attention-Deficit/Hyperactivity

disorder and Family Functioning:

A 36-month longitudinal study of community-

based primary school children

Sampada Bhide


• Presence of ADHD in children has been associated with difficulties in family functioning across a range of domains 1

• Family functioning variables examined individually, creating heterogeneity across sampling methods and measures2,3

• Limited number of studies have comprehensively examined family functioning outcomes, with no known study in Australia4,5

Family Functioning in ADHD

2

Family QoL

Parent mental health

Parent-child

relations

Adverse life events

Marital discord


• Subthreshold disorders:

“conditions with relevant psychiatric symptoms which do not meet the full criteria of a disorder according to the prevailing classification systems”

• Recent review concluded that subthreshold ADHD is associated with interpersonal, educational and functional impairment in children 6

• Less known about family functioning outcomes for this group6,7

Subthreshold ADHD

3


Current Study

4

AimCompare a range of family functioning outcomes for children with ADHD, subthreshold ADHD, and non-ADHD controls from the community


Participants & ProcedureGroup Allocation

5

Eligible screening sample (n = 5922)

Complete parent & teacher screening data (n = 3734)

Positive Screens(n = 412)

Consent to follow-up(n = 267)

ADHD criteria met

ADHD

(n = 179)

ADHD criteria not

met

ST-ADHD

(n = 86)

Negative Screens

(n = 412)

Consent to follow-up (n = 231)

ADHD criteria not

met

Control

(n = 212)

Diagnostic Interview Schedule for Children Version IV (DISC-IV) 8

completed for case confirmation

Conner’s 3 ADHD index7

completed

Children’s Attention Project8:

• Participants: Children in 2nd year of

primary school, parents & teachers

recruited through 43 schools

around Melbourne


• Family quality of life: impact of child emotional and behavioural difficulties

on time for family activities, parent emotional functioning and parent time

• Child Health Questionnaire (CHQ) 9

• Psychological distress experienced by parents

• Kessler-6 (K-6) 10

• Parent-partner relationship: Conflict and Support

• Longitudinal Study of Australian Children (LSAC) 11

• Negative life events

• List of Threatening Experiences Questionnaire (LTE-Q) 12

Measures

6


Results

7

ADHD ADHD-ST Control

ADHD vs

Control

ADHD-ST vs

Control

ADHD vs

ADHD-STMean (SD) Mean (SD) Mean (SD) β p β p β p

Family quality of lifeaFamily activities 60.6 (24.7) 74.6 (24.3) 84.6 (18.3) -.31 <.001 -.12 .03 -.16 .009

aParent emotional functioning

48.6 (27.9) 59.3 (26.7) 76.3 (22.5) -.35 <.001 -.21 <.001 -.10 .103

aParent’s time 68.4 (28.9) 73.5 (29.3) 88.3 (18.1) -.27 <.001 -.20 <.001 -.03 .63

aParent distress 5.9 (4.9) 4.8 (4.5) 3.1 (2.9) .21 <.001 .13 .015 .05 .45

aStressful life events 0.82 (1.2) 0.66 (1.0) 0.62 (1.2) .05 .42 .01 .87 .04 .57

bCouple Relationship

Support 12.9 (2.1) 13.1 (1.9) 13.6 (1.7) -.10 .19 -.07 .28 -.01 .89

Conflict 9.1 (3.1) 8.6 (3.2) 7.9 (2.6) .13 .08 .07 .26 .04 .64

a N = 477 (imputed data) . b N =268 (not imputed data).Analyses adjusted for child age, child sex, parent education, externalising co-morbidities and single-parent family.


• Families of children with ADHD and ST-ADHD experience lower QoL and greater parent distress compared to families of children without ADHD

• More attention to parent mental health and focus on family quality of life as outcomes measures in intervention studies is needed and inclusion of children with ST-ADHD13

• Longitudinal research is needed to identifying modifiable predictors of FQoL and parent distress overtime

• We will be looking at this in our next Aim

Summary, Conclusions & Future Directions

8


Thank You!

9


References

10

1. Johnston, C., & Mash, E. J. (2001). Families of children with attention-deficit/hyperactivity disorder: review and recommendations for future research. Clinical child and family psychology review, 4(3), 183-207.

2. Deault, L. C. (2010). A systematic review of parenting in relation to the development of comorbidities and functional impairments in children with attention-deficit/hyperactivity disorder (ADHD). Child Psychiatry & Human Development, 41(2), 168-192.

3. Cussen, A., Sciberras, E., Ukoumunne, O. C., & Efron, D. (2012). Relationship between symptoms of attention-deficit/hyperactivity disorder and family functioning: a community-based study. European journal of pediatrics, 171(2), 271-280

4. Breaux, R. P., & Harvey, E. A. (2018). A Longitudinal Study of the Relation Between Family Functioning and Preschool ADHD Symptoms. J Clin Child Adolesc Psychol, 1-16. doi: 10.1080/15374416.2018.1437737

5. Kilic, B. G., & Sener, S. (2005). Family functioning and psychosocial characteristics in children with attention deficit hyperactivity disorder with comorbid oppositional defiant disorder or conduct disorder. Turk PsikiyatriDerg, 16(1), 21-28.

6. .


References

11

6. Balázs, J., & Keresztény, Á. (2014). Subthreshold attention deficit hyperactivity in children and adolescents: a systematic review. European child & adolescent psychiatry, 23(6), 393-408.

7. Scahill, L., Schwab-Stone, M., Merikangas, K. R., Leckman, J. F., Zhang, H., & Kasl, S. (1999). Psychosocial and clinical correlates of ADHD in a community sample of school-age children. Journal of the American Academy of Child & Adolescent Psychiatry, 38(8), 976-984

8. Sciberras, E., Efron, D., Schilpzand, E. J., Anderson, V., Jongeling, B., Hazell, P., . . . Nicholson, J. M. (2013). The Children’s Attention Project: a community-based longitudinal study of children with ADHD and non-ADHD controls. BMC psychiatry, 13(1), 18.

9. Conners, C. K. (2008). Conners 3rd edition: Manual: Multi-Health Systems.10. Shaffer D, Fisher P, Lucas CP, Dulcan MK, Schwab-Stone ME. NIMH Diagnostic

Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child & Adolescent Psychiatry. 2000;39(1):28-38.


References

12

11. Landgraf JM, Abetz L, Ware JA. (1996) The CHQ User’s Manual. 1st edn. Boston: The Health Institute, New England Medical Centre.

12. Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S.-L., . . . Zaslavsky, A. M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(06), 959-976.

13. Zubrick, S., Lucas, N., Westrupp, E., & Nicholson, J. (2014). Parenting measures in the Longitudinal Study of Australian Children: Construct validity and measurement quality, Waves 1 to 4. Canberra: Australian Government.

14. Brugha, T., Bebbington, P., Tennant, C., & Hurry, J. (1985). The List of Threatening Experiences: a subset of 12 life event categories with considerable long-term contextual threat. Psychological medicine, 15(1), 189-194.

15. Danckaerts, M., Sonuga-Barke, E. J., Banaschewski, T., Buitelaar, J., Döpfner, M., Hollis, C., . . . Steinhausen, H.-C. (2010). The quality of life of children with attention deficit/hyperactivity disorder: a systematic review. European child & adolescent psychiatry, 19(2), 83-105.


Sample CharacteristicsBaseline

13

ADHD

(an = 179)

ADHD-ST

(bn = 100)

Non-ADHD

(cn = 212)

P

Age, mean (SD) 10.5 (0.4) 10.5 (0.5) 10.5 (0.4) .38

Boys, n (%) 48 (48) 124 (69.3) 135 (63.7) .002

ADHD symptom severity, mean (SD) 13.7 (4.0) 8.8 (4.4) 1.3 (1.9) < .001

Externalising co-morbidities, n (%) 97 (54.2) 24 (24) 17 (8.0) < .001

Parent did not complete high school, n (%) 62 (37.1) 25 (27.5) 37 (18.3) < .001

Single-parent family, n (%) 42 (25.2) 14 (15.4) 23 (11.4) .002

an range = 167 to 179. bn range = 91 to 100. cn range = 202 to 212


Limitations

14

• Cannot infer causality

– Reciprocal relationship between family functioning and ADHD

• Parent ADHD symptoms not taken into account

– Potential confounding effects on parent distress and family quality of life

• Single-informant reports on family functioning

– Parent ADHD symptoms not taken into account


• T-tests and Chi-square

• Linear regression analyses

• Missing data

• Multiple imputation

• Covariates: parent education, age, externalizing co-morbidities, single parent, gender

Analyses

15


• Parent psychological distress

• Family QoL –subjective measure

– Impact of child functioning on family activities

– Impact of child behavior on parent time

– Impact of child behavior on parent’s emotional time

• Couple relationship

– Parent and partner relationship conflict

– Parent and partner relationship support

• Stressful life events

Outcomes

16


17

▪ Age: 7.3 years

▪ Conners ADHD index7

▪ Diagnostic Interview Schedule for Children Version IV (DISC-IV) 8

▪ Socio-demographic measures: Parent education, age, gender, single-parent status

Documents

Attention-Deficit/Hyperactivity disorder and Family …2019...Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability