Parenting style and functional outcomes of children with ADHD: a community-based longitudinal study

Abstract

© 2017 Dr. Sampada BhideBackground: Many children with Attention Deficit Hyperactivity Disorder (ADHD) have trouble with social, emotional and academic functioning. Theoretical perspectives backed by evidence suggest that parenting style is associated with the development of functional competence in typically developing children; however, this association remains less well studied for children with ADHD. Aim: To investigate the role of parenting style in determining the social, emotional and academic functioning of children with ADHD. This aim was examined across three sub-studies. Sub-study 1 examined differences in parenting style between children with ADHD and non-ADHD controls. Sub-studies 1 and 2 investigated whether parenting style is associated with concurrent and prospective child functioning in ADHD respectively, and whether associations differ from non-ADHD controls. Sub-study 2 also investigated changes in parenting style over time. Sub-study 3 examined whether parenting style mediates the relationship between ADHD status and prospective child social functioning. Method: This study is part the Children’s Attention Project (CAP). Participants were 179 children with ADHD and 212 non-ADHD controls, their parents (93.5% female) and teachers. Children (66.2% male) were assessed at baseline (Time 1; Mage = 7.3 years; SD = 0.4) and after 18 months (Time 2; Mage = 8.9 years; SD = 0.4). ADHD status was assessed at baseline using the Conners ADHD index and Diagnostic Interview Schedule for Children-IV. At both time points, parenting style was assessed via parent-reported measures of warmth, consistency and anger; and child social, emotional and academic functioning was measured using parent- and teacher-reported subscales from the Strengths and Difficulties Questionnaire, and Social Skills Improvement System. The Wide Range Achievement Test-4 was also administered at Time 1. Results: Sub-study1: Parents reported less consistency and more anger in the ADHD group compared to non-ADHD controls, with no differences in warmth. Group differences in parenting consistency attenuated following consideration of parent distress. Parenting warmth, consistency and/or anger were concurrently associated with parent-reported aspects of child socio-emotional functioning. These associations were largely similar between groups. All associations held despite adjusting for socio-demographic factors, externalising co-morbidities, ADHD symptom severity and parent distress. Sub-study 2: Parenting warmth and anger at Time 1 were associated with parent-reported social outcomes in children at Time 2, while parenting consistency related to these outcomes, but through teacher-report. Pattern of associations was largely similar between groups. All associations held despite adjusting for socio-demographic factors, externalising co-morbidities, ADHD symptom severity, parent distress and child ASD. Following adjustment of social functioning at Time 1, associations for parenting consistency and parenting warmth remained, but most associations of parenting anger attenuated. From Time 1 to Time 2, there was a small decline in parenting warmth and anger, and an increase in parenting consistency. Sub-study 3: Parenting anger at Time 1 partially mediated the relationship between ADHD status at this age, and child social functioning at Time 2. Specifically, higher levels of parenting anger in the ADHD group, partially accounted for lower levels of social functioning in this group relative to non-ADHD controls over time. No mediating effect held following consideration of prior social functioning at age Time 1. Conclusion: Greater parenting anger at the commencement of primary school partially accounts for poorer social functioning over time for children with ADHD relative to typically developing children. However, factors such as parent distress and level of social competence at the beginning of primary school, contribute to disrupting parenting style and/or later social functioning, and undermine the contribution of parenting style to child social outcomes over time. Support for parents experiencing distress, and promotion of affectionate, calm and consistent parenting for children with ADHD may be necessary prior to the early years of primary school, to bridge the gap between future social outcomes for these children and their typically developing peers