Parent–child interaction of mothers with depression and their children with ADHD

Abstract

Attention deficit/hyperactivity disorder (ADHD) is a developmental disorder that may have a chronic and pervasive impact on the child's function and cause long-term stress to parents. A higher rate of depression is associated with mothers of children with ADHD. This observational study aimed to investigate the effect of maternal depression and the child's ADHD on the quality of the parent–child interaction in children with ADHD and their mothers with depression. The study participants comprised 39 mother–son dyads including children with ADHD and mothers with depression, children with ADHD and mothers without depression, and children without ADHD and mothers without depression. The Specific Affect Coding System, 20-code version was used to code interactional affect, including positive engagement, negative engagement, negative disengagement, and neural affect. There were no statistically significant group-by-context interaction effects or group effects on all affective variables between the group of children with ADHD and mothers without depression and the group of children without ADHD and mothers without depression. Stimulant medication may account for these nonsignificant findings. No significant difference of positive affect between neutral and conflict-solving contexts was observed in depressed mothers whose children were diagnosed as ADHD. Children with ADHD whose mothers were depressed were less positive in their parent–child interaction compared with children in the other groups. Maternal depression may play an important role in the affective presentation of dyads of children with ADHD and mothers with depression. Implications for clinical practice and future research are provided.

Introduction

Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by three core symptoms – inattention, hyperactivity, and impulsivity – and effects on family, peer, and academic relationships (American Psychiatric Association, 2000). Environmental support or stressors appear to contribute modestly to outcomes of this disorder (Barkley, 2005, Hudziak et al., 2005). There has been little research exploring the transaction between contextual variables within the family and the functioning of children with ADHD (Deault, 2010).

Disruptive parent–child interaction in children with ADHD has been observed across different age ranges, from preschool to adolescence (Deault, 2010, Johnston and Mash, 2001). In a developmental analysis, Reid, Patterson, and Snyder (2002) indicated that parent–child interactions of children with behavioral problems are stressful and contribute to the development of more severe behavioral problems in children such as noncompliance, oppositional defiant disorder (ODD), or aggression (Patterson, 1982). Interactions are characterized by negative cycling: parental demand for compliance, the child's refusal to comply, and parental surrender or fierce control over the child occurs. Parents and children negatively reinforce each other in ways that increase the probability and severity of the child's problem behavior and decrease parental control over their child's disruptive behavior.

In addition to behavioral contingency exchanged between parents and children, Granic and Patterson (2006) proposed the socioemotional process in the negative dyadic interaction. Emotions emerge with personal evaluations of the interactions relative to the individual's goal. Through many conflicting interactions, parents and children both might be angry or distressed, perceive the other as intentionally frustrating some goal, and demonstrate extreme negative behavior or emotion trying to control the other (Granic, 2000). Interaction behaviors, emotion, and goal evaluation between parents and children may work together to constitute a persistent and self-maintaining relationship.

Although most observational studies of children with ADHD have examined the behavioral dimension of the parent–child interaction (e.g., Campbell et al., 1986, DuPaul et al., 2001, Keown and Woodward, 2002), the affective interaction is receiving more attention but remains underinvestigated (Feng, Shaw, Skuban, & Lane, 2007). Expressed emotion is an attitudinal construct, a measure of the emotional climate experienced by family members, and is related to the association between maternal depression and the child's maladjustment (Bolton et al., 2003, Peris and Baker, 2000, Peris and Hinshaw, 2003). Emotional regulation of children with ADHD during the parent–child interaction in a frustration task is a pivotal variable that predicts the child's noncompliance and peer relationships (Melnick & Hinshaw, 2000). Predictors of noncompliance and peer relationships include a child's diminished capacity to reinterpret the frustration in an acceptable way and a tendency to focus on the negative or threatening parts of the condition (Melnick & Hinshaw, 2000). Children with ADHD may maintain high levels of negative emotion in a frustrated interaction and prompt them to disengage or interrupt significant interpersonal relationship.

Conflict with parents is pervasive and frequent in preadolescence (e.g., 10–12 years old, 5th–7th grade) and may decline over time (Laursen, Coy, & Collins, 1998). Melnick and Hinshaw (2000) studied emotional regulation of children with ADHD, ages 6–12 years with a frustrating task, but did not specifically analyze how children in preadolescence manage their emotion when interacting with their parents in a difficult condition. Conflict resolution is emotionally arousing and critical to parent–child relationship (Riesch et al., 2003). Seventh graders in Taiwan go to junior high school, while 4th to 6th-grade children go to elementary school and have a similar educational and social interaction experience. Therefore, this study was designed to explore how 4th to 6th grade children with ADHD and their mothers communicate their emotion when discussing neutral and conflict topics.

Observational studies of children or adolescents with ADHD mostly focus on examining the effect of the child's behavioral difficulties (i.e., ADHD alone or ADHD combined with other disruptive behaviors) on parent–child interactions (Barkley et al., 1991, Barkley et al., 1992, Woodward et al., 1998). The parents of children with ADHD in these studies were reported to have significantly more psychopathology, such as depression or parental stress, than parents of children in the control group, but the role of maternal distress on parent–child interaction of children with ADHD has not yet been explored.

Parent–child interaction is a reciprocal process: parents influence their children and the children's behaviors may influence the way they are treated by their parents (Maccoby, 2000). Another line of research found mothers with depression were more negative, coercive, and disengaged, as well as less positive, when interacting with their children compared with mothers without depression (Downey and Coyne, 1990, Goodman and Tully, 2006, Lovejoy et al., 2000). A meta-analysis of 33 studies found children of mothers with depression generally had more behavioral problems than children of mothers without depression (Beck, 1999). Exposure to the mother's negative and/or maladaptive cognitions, behaviors, and affect was considered to be one of the key mediating factors contributing to the possible causal relationships between maternal depression and the child's behavioral or emotional problems (Goodman and Gotlib, 1999, Goodman, 2007).

This study aimed to investigate the differences in the quality of affect in parent–child interaction among three groups: (1) boys with ADHD and mothers with depression, (2) boys with ADHD and mothers without depression, and (3) boys without ADHD and mothers without depression. We hypothesized that among the three groups, boys with ADHD and mothers with depression would have the significantly highest percentages of time of negative engaging emotion and negative disengaging emotion and the lowest percentages of time of positive emotion when discussing conflict topics. Boys with ADHD and mothers without depression were hypothesized to have higher percentages of time of negative engaging emotion and negative disengaging emotion and lower percentages of time of positive emotion than boys without ADHD and mothers without depression when discussing conflict topics. We also hypothesized that there would be no significant differences in the percentages of time of negative engaging emotion, negative disengaging emotion, and positive emotion among the three groups when discussing neutral topics.