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Child impact on family functioning: a multivariate analysis in multiplex families with children and mothers both affected by attention-deficit/hyperactivity disorder (ADHD)

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ADHD Attention Deficit and Hyperactivity Disorders

Abstract

ADHD seriously impacts family functioning, even the more in families with simultaneous parental and child ADHD. The aim of the study was to examine associations between family impact of child ADHD and child, mother and family characteristics in multiplex families with children and mothers both affected by ADHD. One hundred and forty-four mother–child pairs were assessed (children: mean age 9.4 ± 1.7 years, 73.6 % male). Family impact of child ADHD was rated by mothers using the Family Impact Questionnaire (FIQ). Multiple linear regression analyses were performed with child and maternal psychopathology and basic family characteristics such as employment, partnership status and number of children as predictors and FIQ subscores as criteria. Rates of variance explained by family variables were 49 % for negative feelings towards the child, 37 % for impact on partnership, 31 % for impact on social life and 27 % for impact on finances (p < .001, respectively). Pearson correlations with family impact were especially strong for child externalizing symptoms, maternal ADHD and co-morbid symptoms of the mother. The strongest independent predictor was oppositional defiant child behaviour. In ADHD multiplex families, mothers’ perception of the impact of an ADHD child on its family can be explained to a substantial degree by child psychopathology, maternal psychopathology and basic family characteristics. Although a cross-sectional design does not allow for causal interpretations, the findings of this study offer important targets for the treatment of ADHD in a family context pointing to the need for assessing and treating parental mental health and co-morbid symptoms besides ADHD core symptoms.

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Acknowledgments

Role of the funding source, authorization, registration: The AIMAC study (ADHD in mothers and children) is part of a multicentre research network on the psychotherapy of ADHD which has been funded by the German Federal Ministry of Education and Research (BMBF; 01GV0605, 01GV0606). The study has been registered in Current Controlled Trials (DOI:10.1186/ISRCTN73911400). Members of the AIMAC study group (coordinating investigators: Prof. Dr. A. Warnke, Dr. T. Jans, University Hospital of Würzburg) are our colleagues at the study sites at Freiburg (University Medical Center Freiburg: Department of Psychiatry and Psychotherapy, Director: Prof. Dr. M. Berger; Department of Child and Adolescent Psychiatry and Psychotherapy, Director: Prof. Dr. E. Schulz), Homburg (Saarland University Hospital and Saarland University Faculty of Medicine: Institute for Forensic Psychology and Psychiatry, Director: Prof. Dr. M. Roesler; Department of Child and Adolescent Psychiatry and Psychotherapy, Director: Prof. Dr A. v. Gontard), Mannheim (Central Institute for Mental Health: Clinic for Psychiatry and Psychotherapy, Director: Prof. Dr. A. Meyer-Lindenberg; Clinic for Child and Adolescent Psychiatry and Psychotherapy, Director: Prof. Dr. Dr. T. Banaschewski), Berlin (Charité - University Medicine, Campus Benjamin Franklin, Department of Psychiatry and Psychotherapy, Director: Prof. Dr. I. Heuser; Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Director: Prof. Dr. U. Lehmkuhl), Würzburg (University Hospital of Würzburg: Department of Psychiatry, Psychosomatics and Psychotherapy, Director: Prof. Dr. J. Deckert; Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Director: Prof. Dr. M. Romanos), members of the Clinical Trials Unit at University Medical Center Freiburg (Director: R. Bredenkamp) as well as members of the Data Monitoring and Safety Committee (Prof. Dr. Dr. H. Remschmidt, Prof. Dr. G. Wassmer, PD Dr. N. Wodarz). Independent supervision is carried out by staff members at the Department of Child and Adolescent Psychiatry and Psychotherapy at the Cologne University Hospital (parent training) and at the Institute for Psychology of Freiburg University in cooperation with colleagues in private practice (treatment of mothers). Other projects in our network on psychotherapy research in ADHD (speaker: Prof. Dr. A. Philipsen, Freiburg; 2006–2012: Prof. Dr. A. Warnke, University Hospital of Würzburg) are coordinated by Prof. Dr. A. Philipsen (University Medical Center Freiburg, Psychotherapy of adult ADHD), Prof. Dr. L. Tebartz van Elst (University Medical Center Freiburg, functional and morphometric brain mapping) and Prof. Dr. K.-P. Lesch (University Hospital of Würzburg, molecular genetics). We thank Dr. Fischer (MEDICE Arzneimittel Puetter GmbH & Co. KG) for his advice in preparing the study protocol and case report forms as well as his assistance in SAE management. Prof. Dr. F. Mattejat gave helpful expert advice in planning the study. We are also grateful to HOGREFE and BELTZ publishers for providing free treatment manuals. We thank all participating families and all our partners for their cooperation.

Conflict of interest

C Jacob has received speaker’s honoraria by Medice and is member of the ADHD Advisory Bord of this company; A Warnke received speakers fees by Janssen-Cilag, Medice, Novartis, Lilly and has been involved in clinical trials conducted by Lilly, Novartis, Medice, Shire; A Philipsen: advisory boards, lectures, phase-III studies or travel grants within the last 3 years: Eli Lilly, Janssen-Cilag, Medice Arzneimittel Pütter GmbH, Novartis and Shire; she is the author of books and articles on psychotherapy published by Elsevier, Hogrefe, Schattauer, Kohlhammer and Karger publishers; S Matthies received speakers fees by Janssen-Cilag and has been involved in clinical trials conducted by Janssen-Cilag and Lilly; M Rösler is member of the speakers bureau of Medice, Janssen and Shire, he is member of the advisory boards of Lilly, Shire, Medice and Janssen. He has performed clinical trials for Medice and Lilly; W Retz has received speakers honoraria by Medice and Lilly, he has been involved in a clinical trial by Novartis; A. von Gontard was invited by Eli Lilly for two lectures; C Freitag has received speaker’s honoraria by Eli Lilly and Novartis during the last 3 years. She was an independent clinical consultant for Desitin in 2010; L Poustka has received speaker’s honoraria by Ely Lilly and Shire during the last 3 years; K Becker has been involved in research/clinical trials with Eli Lilly and Shire, is on the Advisory Board of Eli Lilly/Germany, and received speaker’s honoraria by Eli Lilly and Shire; E Sobanski has received speaker’s honoraria by Medice, Eli Lilly and Novartis, is member of Adivisory Bord of Eli Lilly, Shire and Medice and has conducted phase-III-studies or IITs for Eli Lilly, Janssen-Cilag, Medice, Novartis; M Schumacher-Stien has received speaker’s honoraria by Medice; M Colla: advisory boards, speaker’s honoraria or phase-III studies within the last 3 years: Shire, Eli Lilly and Novartis; M Holtmann has served as an adviser, consultant, or speaker or received conference attendance support from Bristol-Myers Squibb, Janssen-Cilag, Lilly, Medice, Neuroconn, Novartis, and Shire. The present work is unrelated to the above grants and relationships. All other authors (K Fleck, E Graf, P Weyers, V Kappel, C Jaite, T Jans, B Haack-Dees, K Hennighausen, S Hänig, L Bliznak, L Gentschow) declare no conflicts of interest.

Ethical standards

The study has received appropriate ethics committee approval from the leading ethics committee (Faculty of Medicine, Würzburg University, 120/06) and the local ethics committees and was authorized by the competent German authorities (EudraCT No.: 2006-001353). The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All subjects gave their informed consent prior to their inclusion in the study.

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    Authors and Affiliations

    1. Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Füchsleinstr. 15, 97080, Würzburg, Germany

      Christian Jacob

    2. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Füchsleinstr. 15, 97080, Würzburg, Germany

      Katja Fleck, Andreas Warnke & Thomas Jans

    3. Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstr. 5, 79104, Freiburg, Germany

      Alexandra Philipsen & Swantje Matthies

    4. Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstr. 8, 79104, Freiburg, Germany

      Klaus Hennighausen & Barbara Haack-Dees

    5. Clinical Trials Unit, University Medical Center Freiburg, Elsässer Straße 2, 79110, Freiburg, Germany

      Erika Graf

    6. Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Kirrberger Straße, 66421, Homburg/Saar, Germany

      Michael Rösler & Wolfgang Retz

    7. Department of Child and Adolescent Psychiatry and Psychotherapy, Saarland University Hospital, Kirrberger Strasse, Gebäude 90.2, 66421, Homburg/Saar, Germany

      Alexander von Gontard, Susan Hänig & Christine Freitag

    8. Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, J 5, 68159, Mannheim, Germany

      Esther Sobanski & Martina Schumacher-Stien

    9. Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, J 5, 68159, Mannheim, Germany

      Luise Poustka, Lucia Bliznak, Katja Becker & Martin Holtmann

    10. Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Eschenallee 3, 14050, Berlin, Germany

      Michael Colla & Laura Gentschow

    11. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

      Viola Kappel & Charlotte Jaite

    12. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg, Hans-Sachs- Str. 6, 35039, Marburg, Germany

      Katja Becker

    13. Hospital for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, LWL University Hospital Hamm of the Ruhr University Bochum, Heithofer Allee 64, 59071, Hamm, Germany

      Martin Holtmann

    14. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Frankfurt University Hospital, Deutschordenstraße 50, 60528, Frankfurt, Germany

      Christine Freitag

    15. Department of Psychology, University of Würzburg, Marcusstr. 9-11, 97070, Würzburg, Germany

      Peter Weyers

    16. Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany

      Wolfgang Retz

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    1. Katja Fleck
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    Corresponding authors

    Correspondence to Katja Fleck or Christian Jacob.

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    Christian Jacob and Katja Fleck have contributed equally to this manuscript.

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    Fleck, K., Jacob, C., Philipsen, A. et al. Child impact on family functioning: a multivariate analysis in multiplex families with children and mothers both affected by attention-deficit/hyperactivity disorder (ADHD). ADHD Atten Def Hyp Disord 7, 211–223 (2015). https://doi.org/10.1007/s12402-014-0164-8

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