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Association between autism symptoms and family functioning in children with attention-deficit/hyperactivity disorder: a community-based study

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Abstract

Autism spectrum disorder (ASD) symptoms are elevated in populations of children with attention-deficit/hyperactivity disorder (ADHD). This study examined cross-sectional associations between ASD symptoms and family functioning in children with and without ADHD. Participants were recruited to a longitudinal cohort study, aged 6–10 years (164 ADHD; 198 controls). ADHD cases were ascertained using community-based screening and diagnostic confirmation from a diagnostic interview. ASD symptoms were measured using the Social Communication Questionnaire. Outcome variables were parent mental health, family quality of life (FQoL), couple conflict and support, and parenting behaviours. After adjustment for a range of child and family factors (including other mental health comorbidities), higher ASD symptoms were associated with poorer FQoL across all three domains; emotional impact (p = 0.008), family impact (p = 0.001) and time impact (p = 0.003). In adjusted analyses by subgroup, parents of children with ADHD+ASD had poorer parent self-efficacy (p = 0.01), poorer FQoL (p ≤ 0.05), with weak evidence of an association for less couple support (p = 0.06), compared to parents of children with ADHD only. Inspection of covariates in the adjusted analyses indicated that the association between ASD symptoms and most family functioning measures was accounted forby child internalising and externalising disorders, ADHD severity, and socioeconomic status; however, ASD symptoms appear to be independently associated with poorer FQoL in children with ADHD. The presence of ASD symptoms in children with ADHD may signal the need for enhanced family support.

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References

  1. Polanczyk GV, Willcutt EG, Salum GA, Kieling C, Rohde LA (2014) ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. Int J Epidemiol 43(2):434–442. doi:10.1093/ije/dyt261

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kotte A, Joshi G, Fried R, Uchida M, Spencer A, Woodworth KY, Kenworthy T, Faraone SV, Biederman J (2013) Autistic traits in children with and without ADHD. Pediatrics. doi:10.1542/peds.2012-3947

    PubMed  PubMed Central  Google Scholar 

  3. Green JL, Rinehart NJ, Anderson V, Nicholson JM, Jongeling B, Sciberras E (2015) Autism spectrum disorder symptoms in children with ADHD: a community-based study. Res Dev Disabil

  4. Cooper M, Martin J, Langley K, Hamshere M, Thapar A (2014) Autistic traits in children with ADHD index clinical and cognitive problems. Eur Child Adolesc Psychiatry 23(1):23–34. doi:10.1007/s00787-013-0398-6

    Article  PubMed  Google Scholar 

  5. Van der Meer JMJ, Oerlemans AM, van Steijn DJ, Lappenschaar MGA, de Sonneville LMJ, Buitelaar JK, Rommelse NNJ (2012) Are autism spectrum disorder and attention-deficit/hyperactivity disorder different manifestations of one overarching disorder? cognitive and symptom evidence from a clinical and population-based sample. J Am Acad Child Adolesc Psychiatry 51(11):1160–1172

    Article  PubMed  Google Scholar 

  6. Johnston C, Mash EJ (2001) Families of children with attention-deficit/hyperactivity disorder: review and recommendations for future research. Clin Child Fam Psychol Rev 4(3):183–207. doi:10.1023/A:1017592030434

    Article  CAS  PubMed  Google Scholar 

  7. Modesto-Lowe V, Danforth JS, Brooks D (2008) ADHD: does parenting style matter? Clin Pediatr (Phila) 47(9):865–872

    Article  Google Scholar 

  8. Cussen A, Sciberras E, Ukoumunne O, Efron D (2012) Relationship between symptoms of attention-deficit/hyperactivity disorder and family functioning: a community-based study. Eur J Pediatr 171(2):271–280. doi:10.1007/s00431-011-1524-4

    Article  PubMed  Google Scholar 

  9. Pressman LJ, Loo SK, Carpenter EM, Asarnow JR, Lynn D, McCracken JT, McGough JJ, Lubke GH, Yang MH, Smalley SL (2006) Relationship of family environment and parental psychiatric diagnosis to impairment in ADHD. J Am Acad Child Adolesc Psychiatry 45(3):346–354. doi:10.1097/01.chi.0000192248.61271.c8

    Article  PubMed  Google Scholar 

  10. van Steijn DJ, Oerlemans AM, van Aken MA, Buitelaar JK, Rommelse NN (2014) The reciprocal relationship of ASD, ADHD, depressive symptoms and stress in parents of children with ASD and/or ADHD. J Autism Dev Disord 44(5):1064–1076. doi:10.1007/s10803-013-1958-9

    Article  PubMed  Google Scholar 

  11. van Steijn DJ, Oerlemans AM, van Aken MA, Buitelaar JK, Rommelse NN (2015) The influence of parental and offspring autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) symptoms on family climate. J Child Fam Stud 24(7):2021–2030. doi:10.1007/s10826-014-0002-9

    Article  Google Scholar 

  12. Hurtig T, Ebeling H, Taanila A, Miettunen J, Smalley S, McGough J, Loo S, Jarvelin MR, Moilanen I (2007) ADHD and comorbid disorders in relation to family environment and symptom severity. Eur Child Adolesc Psychiatry 16(6):362–369. doi:10.1007/s00787-007-0607-2

    Article  PubMed  Google Scholar 

  13. Wymbs BT, Pelham WE, Gnagy EM, Molina BSG (2008) Mother and adolescent reports of interparental discord among parents of adolescents with and without attention-deficit hyperactivity disorder. J Emot Behav Dis 16(1):29–41. doi:10.1177/1063426607310849

    Article  Google Scholar 

  14. Sikora D, Moran E, Orlich F, Hall TA, Kovacs EA, Delahaye J, Clemons TE, Kuhlthau K (2013) The relationship between family functioning and behavior problems in children with autism spectrum disorders. Res Autism Spectr Dis 7(2):307–315. doi:10.1016/j.rasd.2012.09.006

    Article  Google Scholar 

  15. Jellett R, Wood CE, Giallo R, Seymour M (2015) Family functioning and behaviour problems in children with autism spectrum disorders: the mediating role of parent mental health. Clin Psychol 19(1):39–48. doi:10.1111/cp.12047

    Article  Google Scholar 

  16. Meadan H, Halle JW, Ebata AT (2010) Families with children who have autism spectrum disorders: stress and support. Except Child 77(1):7–36

    Google Scholar 

  17. Brobst JB, Clopton JR, Hendrick SS (2009) Parenting children with autism spectrum disorders: the couple’s relationship. Focus Autism Other Dev Disabil 24(1):38–49. doi:10.1177/1088357608323699

    Article  Google Scholar 

  18. Hartley SL, Barker ET, Seltzer MM, Floyd F, Greenberg J, Orsmond G, Bolt D (2010) The relative risk and timing of divorce in families of children with an autism spectrum disorder. J Fam Psychol JFP J Div Fam Psychol Am Psychol Assoc (Division 43) 24(4):449–457. doi:10.1037/a0019847

    Google Scholar 

  19. Blacher J, Baker B, Kaladjian A (2013) Syndrome specificity and mother-child interactions: examining positive and negative parenting across contexts and time. J Autism Dev Disord 43(4):761–774. doi:10.1007/s10803-012-1605-x

    Article  PubMed  PubMed Central  Google Scholar 

  20. Boonen H, Esch L, Lambrechts G, Maljaars J, Zink I, Leeuwen K, Noens I (2015) Mothers’ parenting behaviors in families of school-aged children with autism spectrum disorder: an observational and questionnaire study. J Autism Dev Disord. doi:10.1007/s10803-015-2506-6

    PubMed  Google Scholar 

  21. van Steijn DJ, Oerlemans AM, de Ruiter SW, van Aken MA, Buitelaar JK, Rommelse NN (2013) Are parental autism spectrum disorder and/or attention-deficit/Hyperactivity disorder symptoms related to parenting styles in families with ASD (+ADHD) affected children? Eur Child Adolesc Psychiatry 22(11):671–681. doi:10.1007/s00787-013-0408-8

    Article  PubMed  Google Scholar 

  22. van Steijn D, Oerlemans A, van Aken MG, Buitelaar J, Rommelse NJ (2015) The influence of parental and offspring autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) symptoms on family climate. J Child Fam Stud 24(7):2021–2030. doi:10.1007/s10826-014-0002-9

    Article  Google Scholar 

  23. Sciberras E, Efron D, Schilpzand E, Anderson V, Jongeling B, Hazell P, Ukoumunne O, Nicholson J (2013) The children’s attention project: a community-based longitudinal study of children with ADHD and non-ADHD controls. BMC Psychiatry 13(1):18

    Article  PubMed  PubMed Central  Google Scholar 

  24. Shaffer D, Fisher P, Lucas CP, Dulcan MK, Schwab-Stone ME (2000) NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. J Am Acad Child Adolesc Psychiatry 39(1):28–38. doi:10.1097/00004583-200001000-00014

    Article  CAS  PubMed  Google Scholar 

  25. Conners C (2008) Conners 3rd Edition. 3rd edition edn. Multi-Health Systems, Toronto

  26. Rutter M, Bailey A, Lord C (2003) Social Communication Questionnaire Western Psychological Services (WPS), Los Angeles, CA

  27. Wiggins LD, Bakeman R, Adamson LB, Robins DL (2007) The utility of the Social Communication Questionnaire in screening for autism in children referred for early intervention. Focus Autism Other Dev Disabil 22(1):33–38. doi:10.1177/10883576070220010401

    Article  Google Scholar 

  28. Norris M, Lecavalier L (2010) Screening accuracy of level 2 autism spectrum disorder rating scales: a review of selected instruments. Autism 14(4):263–284. doi:10.1177/1362361309348071

    Article  PubMed  Google Scholar 

  29. Eaves LC, Wingert H, Ho HH (2006) Screening for autism: agreement with diagnosis. Autism 10(3):229–242. doi:10.1177/1362361306063288

    Article  PubMed  Google Scholar 

  30. Landgraf J, Abetz LW, JR (1996) Child Health Questionnaire (CHQ): a user’s manual. The Health Institute Boston, MA

  31. Waters E, Salmon L, Wake M (2000) The parent-form Child Health Questionnaire in Australia: comparison of reliability, validity, structure, and norms. J Pediatr Psychol 25(6):381–391

    Article  CAS  PubMed  Google Scholar 

  32. Furukawa TA, Kessler RC, Slade T, Andrews G (2003) The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being. Psychol Med 33(2):357–362

    Article  CAS  PubMed  Google Scholar 

  33. Kessler RC, Green JG, Gruber MJ, Sampson NA, Bromet E, Cuitan M, Furukawa TA, Gureje O, Hinkov H, Hu C-Y, Lara C, Lee S, Mneimneh Z, Myer L, Oakley-Browne M, Posada-Villa J, Sagar R, Viana MC, Zaslavsky AM (2010) Screening for serious mental illness in the general population with the K6 screening scale: results from the WHO world mental health (WMH) Survey Initiative. Int J Methods Psychiatr Res 19(0 1):4–22. doi:10.1002/mpr.310

    Article  PubMed  PubMed Central  Google Scholar 

  34. Cornelius BL, Groothoff JW, van der Klink JJ, Brouwer S (2013) The performance of the K10, K6 and GHQ-12 to screen for present state DSM-IV disorders among disability claimants. BMC Public Health 13:128. doi:10.1186/1471-2458-13-128

    Article  PubMed  PubMed Central  Google Scholar 

  35. Zubrick S, Lucas N, Westrupp EM, Nicholson JM (2013) Parenting measures in the Longitudinal Study of Australian Children: Construct validity and measurement quality, Waves 1 to 4. Department of Social Services (formerly the Department of Families, Housing Community Services and Indigenous Affairs), Canberra: Canberra, ACT

  36. Turner M (1999) Annotation: repetitive behaviour in autism: a review of psychological research. J Child Psychol Psychiatry 40(6):839–849. doi:10.1111/1469-7610.00502

    Article  CAS  PubMed  Google Scholar 

  37. Harold GT, Leve LD, Barrett D, Elam K, Neiderhiser JM, Natsuaki MN, Shaw DS, Reiss D, Thapar A (2013) Biological and rearing mother influences on child ADHD symptoms: revisiting the developmental interface between nature and nurture. J Child Psychol Psychiatry 54(10):1038–1046. doi:10.1111/jcpp.12100

    Article  PubMed  PubMed Central  Google Scholar 

  38. Rezendes DL, Scarpa A (2011) Associations between parental anxiety/depression and child behavior problems related to autism spectrum disorders: the roles of parenting stress and parenting self-efficacy. Autism Res Treat 2011:395190. doi:10.1155/2011/395190

    PubMed  PubMed Central  Google Scholar 

  39. Weiss JA, Robinson S, Fung S, Tint A, Chalmers P, Lunsky Y (2013) Family hardiness, social support, and self-efficacy in mothers of individuals with autism spectrum disorders. Res Autism Spectrum Dis 7(11):1310–1317. doi:10.1016/j.rasd.2013.07.016

    Article  Google Scholar 

  40. van Steijn DJ, Oerlemans AM, van Aken MA, Buitelaar JK, Rommelse NN (2014) The reciprocal relationship of ASD, ADHD, depressive symptoms and stress in parents of children with ASD and/or ADHD. J Autism Dev Disord 44(5):1064–1076. doi:10.1007/s10803-013-1958-9

    Article  PubMed  Google Scholar 

  41. van Steijn D, Oerlemans A, van Aken MG, Buitelaar J, Rommelse NJ (2013) Match or mismatch? influence of parental and offspring ASD and ADHD symptoms on the parent-child relationship. J Autism Dev Disord 43(8):1935–1945. doi:10.1007/s10803-012-1746-y

    Article  PubMed  Google Scholar 

  42. van Steijn DJ, Richards JS, Oerlemans AM, de Ruiter SW, van Aken MA, Franke B, Buitelaar J, Rommelse NN (2012) The co-occurrence of autism spectrum disorder and attention-deficit/hyperactivity disorder symptoms in parents of children with ASD or ASD with ADHD. J Child Psychol Psychiatry 53(9):954–963. doi:10.1111/j.1469-7610.2012.02556.x

    Article  PubMed  Google Scholar 

  43. Gillberg C, Fernell E (2014) Autism plus versus autism pure. J Autism Dev Disord 44(12):3274–3276. doi:10.1007/s10803-014-2163-1

    Article  PubMed  Google Scholar 

  44. Gillberg C (2010) The essence in child psychiatry: early symptomatic syndromes eliciting neurodevelopmental clinical examinations. Res Dev Disabil 31(6):1543–1551. doi:10.1016/j.ridd.2010.06.002

    Article  PubMed  Google Scholar 

  45. Sciberras E, Mulraney M, Anderson V, Rapee RM, Nicholson JM, Efron D, Lee K, Markopoulos Z, Hiscock H (2015) Managing anxiety in children with ADHD using cognitive-behavioral therapy: a pilot randomized controlled trial. J Atten Disord. doi:10.1177/1087054715584054

    Google Scholar 

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Correspondence to Jessica L. Green.

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This study was approved by the Royal Children's Hospital Human Ethics Committee (#31056) and the Victorian Department of Education and Early Development (#2011_001095).

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Green, J.L., Rinehart, N., Anderson, V. et al. Association between autism symptoms and family functioning in children with attention-deficit/hyperactivity disorder: a community-based study. Eur Child Adolesc Psychiatry 25, 1307–1318 (2016). https://doi.org/10.1007/s00787-016-0861-2

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