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. 2022 Dec 2;16(1):96.
doi: 10.1186/s13034-022-00529-z.

The importance of familial risk factors in children with ADHD: direct and indirect effects of family adversity, parental psychopathology and parenting practices on externalizing symptoms

Lea Teresa Jendreizik  1 , Christopher Hautmann  2 , Elena von Wirth  2 , Christina Dose  2 , Ann-Kathrin Thöne  2 , Anne-Katrin Treier  2 , Tobias Banaschewski  3 , Katja Becker  4   5 , Daniel Brandeis  3   6   7 , Julia Geissler  8 , Johannes Hebebrand  9 , Sarah Hohmann  3 , Martin Holtmann  10 , Michael Huss  11 , Thomas Jans  8 , Anna Kaiser  3 , Sabina Millenet  3 , Luise Poustka  12 , Priska Schneider  13 , Manfred Döpfner  2   14
Affiliations

The importance of familial risk factors in children with ADHD: direct and indirect effects of family adversity, parental psychopathology and parenting practices on externalizing symptoms

Lea Teresa Jendreizik et al. Child Adolesc Psychiatry Ment Health. .

Abstract

Background: Children experiencing unfavorable family circumstances have an increased risk of developing externalizing symptoms. The present study examines the direct, indirect and total effects of family adversity, parental psychopathology, and positive and negative parenting practices on symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in children with ADHD.

Methods: Data from 555 children (M = 8.9 years old, 80.5% boys) who participated in a multicenter study on the treatment of ADHD (ESCAschool) were analyzed using structural equation modeling (SEM).

Results: The SEM analyses revealed that (a) family adversity and parental psychopathology are associated with both child ADHD and ODD symptoms while negative parenting practices are only related to child ODD symptoms; (b) family adversity is only indirectly associated with child ADHD and ODD symptoms, via parental psychopathology and negative parenting practices; (c) the detrimental effect of negative parenting practices on child ADHD and ODD symptoms is stronger in girls than in boys (multi-sample SEM); (d) there are no significant associations between positive parenting practices and child ADHD or ODD symptoms.

Conclusions: Family adversity, parental psychopathology, and negative parenting practices should be routinely assessed by clinicians and considered in treatment planning. Trial registration (18th December 2015): German Clinical Trials Register (DRKS) DRKS00008973.

Keywords: Attention-deficit/hyperactivity disorder; Family adversity; Oppositional defiant disorder; Parental mental health; Parenting; Structural equation modeling.

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Conflict of interest statement

CD received royalties from Hogrefe as an author of self-help books for parents and teachers of preschool- and school-age children with ADHD. A-KTh receives royalties from Hogrefe for the publication of a diagnostic instrument (DISYPS-ILF). TB served in an advisory or consultancy role for ADHS digital, Infectopharm, Lundbeck, Medice, Neurim Pharmaceuticals, Oberberg GmbH, Roche, and Takeda. He received conference support or speaker’s fees from Medice and Takeda. He received royalties from Hogrefe, Kohlhammer, CIP Medien, Oxford University Press. KB receives or has received research grants from the German Research Foundation (DFG), German Federal Ministry for Education and Research (BMBF), Philipps-University Marburg, Federal Joint Committee (G-BA), German Ministry for Health, University Hospital Giessen and Marburg and Rhön Klinikum. Additionally, she receives royalties from Thieme. JG has received a research grant from the Bavarian State Ministry of Family, Labor and Social Affairs. She receives royalties from Hogrefe for the publication of an ADHD treatment manual. MHo served in an advisory role for Shire, Takeda and Medice and received conference attendance support or was paid for public speaking by Medice, Shire and Takeda. He received research support from the German Ministry of Education and Research (BMBF). He receives royalties as Editor-in-Chief of the German Journal for Child and Adolescent Psychiatry and for textbooks from Hogrefe. MHu has served as a member of the advisory boards of Eli Lilly and Co., Engelhardt Arzneimittel, Janssen-Cilag, Medice, Novartis, Shire, and Steiner Arzneimittel within the past five years; served as a consultant to Engelhardt Arzneimittel, Medice, and Steiner Arzneimittel; received honoraria from Eli Lilly and Co., Engelhardt Arzneimittel, Janssen-Cilag, Medice, Novartis, and Shire; and received unrestricted grants for investigator-initiated trials from Eli Lilly and Co., Medice, Engelhardt Arzneimittel, and Steiner Arzneimittel. LP served in an advisory or consultancy role for Takeda, Roche, and Infectopharm. She has received speaker’s fees from Takeda, Medice and Infectophar and royalties from Hogrefe, Kohlhammer, and Schattauer. MD is supervisor and lecturer and received income as head of the School of Child and Adolescent Behavior Therapy at the University of Cologne and royalties from treatment manuals, books, and psychological tests published by Guilford, Hogrefe, Enke, Beltz, and Huber. He received consulting income and research support from Medice, Shire, and eyelevel. All other authors (LTJ, CH, EvW, A-KTr, DB, JH, SH, TJ, AK, SM, PS) declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Structural equation model (SEM 2). Structural equation model depicting factor loadings, covariances and standardized path coefficients. Solid lines indicate significant paths, p < .05. The SEM 2 shown differs from SEM 1 by the added error covariance between positive and negative parenting practices. DCL-ADHS = clinician-rated child attention-deficit/hyperactivity disorder, DCL-SSV = clinician-rated child oppositional defiant disorder, FBB-ADHS = parent-rated child attention-deficit/hyperactivity disorder, FBB-SSV = parent-rated child oppositional defiant disorder, pADHD = parental attention-deficit/hyperactivity disorder (ADHS-SB), pAGG = parental aggression (AQ 12), pDAS = parental depression, anxiety and stress (DASS21). +p < .10, *p < .05, **p < .01, ***p < .001
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