ADHD symptom persistence and parental criticism

Study results published in the February 2016 issue of Journal of Abnormal Psychology indicate that persistent parental criticism appears to be among the reasons why attention deficit hyperactivity disorder (ADHD) symptoms persist with age among some children, as opposed to decreasing with age as seen with many children with ADHD.   The researchers found that parental criticism, an index of the family environment, was uniquely associated with divergent developmental trajectories among children with ADHD in addition to those associated with oppositional-defiant disorder (ODD) symptoms.   “Why ADHD symptoms decline in some children as they reach adolescence and not for others is an important phenomenon to be better understood,” said study lead author Erica Musser, PhD, assistant professor of psychology at Florida International University. “The finding here is that children with ADHD whose parents regularly expressed high levels of criticism over time were less likely to experience this decline in symptoms.”   For the study, Musser and colleagues assessed 388 children with ADHD and 127 controls using multi-informant, multimethod diagnostic procedures at up to three time points one year apart in an accelerated longitudinal design that covered ages 7 to 13 years. The team also identified developmental trajectories for parent- and teacher-rated ADHD and ODD symptoms within the ADHD sample. Of those with ADHD, 69% were male, 795 were Caucasian, and 75% were from two-parent households.

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Musser ED, Karalunas SL, Dieckmann N, Peris TS, Nigg JT.

Attention-deficit/hyperactivity disorder developmental trajectories related to

parental expressed emotion. J Abnorm Psychol. 2016 Feb;125(2):182-95.

Abstract

In the transition from childhood to adolescence, attention-deficit/hyperactivity disorder (ADHD) developmental trajectories diverge. Family environment, as indexed by parental expressed emotion, may moderate these trajectories. 388 children with ADHD and 127 controls were assessed using multi-informant, multimethod diagnostic procedures at up to 3 time points 1 year apart in an accelerated longitudinal design spanning ages 7-13 years. Latent-class growth analysis was used to identify developmental trajectories for parent- and teacher-rated ADHD and oppositional-defiantdisorder (ODD) symptoms within the ADHD sample. Parental expressed emotion, criticism, and emotional overinvolvement were coded from a 5-min speech sample at 2 time points, 1 year apart, for 208 of these children and compared among ADHD trajectory groups.

RESULTS:

Parent-rated hyperactivity yielded a 4-class trajectory solution in latent-class growth analysis; teacher-rated inattention yielded a 3-trajectory solution. Teacher-rated ODD also yielded 3-trajectory solution. A parent-rated high persistent hyperactive group was more likely than the other ADHD groups to have parents with stable high criticism (34.6%, p < .001), with ODD symptoms controlled. A teacher-identified high ODD-worsening group was more likely to experience high criticism, particularly the initial time point; (87.5%, p < .001), with hyperactivity controlled.Parental criticism, an index of the family environment, is uniquely associated with divergent developmental trajectories among children with ADHD in addition to those associated with ODD symptoms. Lay summary: For many children, ADHD symptoms decrease as they transition to adolescence. Family environmental factors, such as parental criticism, may help explain for whom symptom remission is less likely.