Parenting Behavior as a Mediator of the Association Between Parental Depression, Anxiety and Stress and Child Externalizing Symptoms in a Clinical Sample

This thesis aimed to highlight the mechanisms underlying the often-found link between parental internalizing symptoms and externalizing symptoms in children. A mediation effect was found for the relationship between parental internalizing symptoms (symptoms of depression, anxiety, and stress) and child oppositional defiant disorder (ODD) symptoms through negative parenting behaviors in two published manuscripts, (Klemp et al., 2022; Klemp et al., 2023) which form the main chapters of this dissertation. Both cross-sectional and longitudinal analyses showed significant associations between parental internalizing symptoms and child attention-deficit/hyperactivity disorder (ADHD) and ODD symptoms, however a mediation effect was only found for the ODD symptoms (Klemp et al., 2022; Klemp et al., 2023). Although they both belong to externalizing disorders, ADHD and ODD should be considered differently, since the results of these studies indicate that negative parenting behaviors influence the child's oppositional symptoms, but not the child's ADHD symptoms. The mechanisms mediating the relationship between parental internalizing symptoms and child ADHD symptoms should be further investigated. In the ODD model, more mediators could also be investigated, as the mediation effects found were small. Given how much parents often unconsciously influence their children and how important the variables studied are, it would make sense to go into more detail in future research. Understanding how these factors intersect, e.g. how parents regulate anxiety, stress and depression and the effect that has on their children and symptoms, could provide valuable insights into the dynamics that contribute to families’ well-being and symptoms

Efficacy of web-assisted self-help for parents of children with ADHD (WASH) - a three-arm randomized trial under field/routine care conditions in Germany

Background Current clinical guidelines recommend parent management training (PMT) in the treatment of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). However, (a) a lack of supply and (b) structural barriers to attending and continuing face-to-face PMT restrict the access to this training. The main purpose of this study is to investigate the efficacy of online PMT in decreasing ADHD symptoms and oppositional behavior problems and to evaluate the effects of additional telephone-based support of the parents. Methods The target sample size is n = 495 children with suspected or even clinical diagnosis of ADHD and current symptoms of ADHD or ODD. The study is based on a randomized three-arm parallel group design, in which the effects of treatment as usual (TAU) are compared to TAU plus web-assisted self-help (TAU+WASH) and to TAU plus web-assisted self-help and telephone-based support (TAU+WASH+SUPPORT). Discussion The results will provide important insights into the efficacy of web-assisted self-help for parents of children with ADHD and the additional effects of telephone-based support

Parenting Behaviors as Mediators of the Association Between Parental Internalizing Symptoms and Child Externalizing Symptoms

This study analyzes whether the association between parental internalizing symptoms (depression, anxiety, stress) and child symptoms of attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD) is mediated by positive and negative parenting behaviors. Cross-sectional data of 420 parents of children (age 6-12 years) with elevated levels of externalizing symptoms were collected in a randomized controlled trial. Measures included parent ratings of their internalizing symptoms and parenting behaviors and of their child's externalizing symptoms. Two mediation models were examined, one including ADHD symptoms and one including ODD symptoms as the dependent variable. Parental internalizing symptoms were modeled as the independent variable and positive and negative parenting behaviors were modeled as parallel mediators. Regression analyses support negative parenting behavior as a mediator of the association between parental internalizing symptoms and child ODD symptoms. For the ADHD model, no significant mediator could be found. Future studies should use prospective designs and consider reciprocal associations