Family Adversity in DSM-IV ADHD Combined and Inattentive Subtypes and Associated Disruptive Behavior Problems

doi:10.1097/01.chi.0000162582.87710.66

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 44, Issue 7, July 2005, Pages 690-698

https://doi.org/10.1097/01.chi.0000162582.87710.66 Get rights and content

ABSTRACT

Objective

This study evaluated the relationship between a family adversity index and DSM-IV attention-deficit/hyperactivity disorder (ADHD) subtypes and associated behavior problems. The relationship of family adversity to symptoms and subtypes of ADHD was examined.

Method

Parents and 206 children aged 7-13 completed diagnostic interviews and rating scales about socioeconomic status, parental lifetime psychiatric disorders, marital conflict, and stressful life events.

Results

Children with ADHD combined type experienced more risk factors than community controls (p = .002) or children with ADHD predominantly inattentive type (p = .02). The families of children with ADHD combined type described more risk factors associated with family adversity than the families of children with ADHD inattentive type and the control group. Parent-rated symptoms of child inattention/disorganization were related uniquely to the adversity index score independently of conduct disorder symptoms. Children's perceptions of marital conflict were independently related to inattention and hyperactivity behaviors as rated by parents and teachers after control of all other risk factors. Oppositional defiant symptoms were independently related to marital conflict and maternal psychopathology, whereas conduct disorder symptoms were uniquely related to low socioeconomic status and maternal psychopathology.

Conclusions

Family adversity is related to ADHD combined type in children and may be related specifically to ADHD symptoms in addition to conduct disorder symptoms.

Section snippets

Participants

A total of 206 boys and girls and 337 parents (206 mothers, 131 fathers) provided at least partial data on symptoms and adversity indexes. Children were classified into three groups: ADHD-C (n = 96), ADHD-PI (n = 38), and non-ADHD (control, n = 72). A generally but not exclusively community-based recruitment strategy was followed in which families with children in the first through sixth grade were recruited from invitation letters sent to parents of children in the local school districts and

RESULTS

Table 1 provides demographics and descriptive information. Diagnostic groups did not differ in gender, ethnic makeup, or age. The sample was 81% white, 10% African American, 5% Latino, 2% Native American, and 2% mixed or other, closely mirroring the ethnic makeup of the local community. Differences in behavioral ratings were consistent with the intended differentiation of children into ADHD subtypes.

DISCUSSION

The current study sought to determine whether previously reported associations of family adversity with child ADHD could be replicated using DSM-IV definitions, whether adversity would be specific to a particular ADHD subtype, and to evaluate specificity of adversity to ADHD versus associated disruptive behavior problems and relative contributions of individual risk factors. The main findings were (1) more adversity in children with ADHD-C than other groups, even with oppositional and conduct

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This study was supported by NIMH grant MH59105. The authors are grateful for the assistance of Marian Philips and the Lansing School District Office of Evaluation Services.

Disclosure: The authors have no financial relationships to disclose.

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ARTICLESFamily Adversity in DSM-IV ADHD Combined and Inattentive Subtypes and Associated Disruptive Behavior Problems

ABSTRACT

Objective

Method

Results

Conclusions

Section snippets

Participants

RESULTS

DISCUSSION

Parenting Stress Index (3rd ed): Manual

Diagnostic and Statistical Manual of Mental Disorders, 4th edition-text revision (DSM-IV-TR)

Current concepts on the neurobiology of attention- deficit/hyperactivity disorder

J Atten Disord

Comorbidity of diagnosis in attention deficit disorders

Predictors of persistence and remission of ADHD into adolescence: results from a four-year prospective follow-up study

J Am Acad Child Adolesc Psychiatry

Differential effect of environmental adversity by gender: Rutter's Index of Adversity in a group of boys and girls with and without ADHD

Am J Psychiatry

Family environment risk factors for attention deficit hyperactivity disorder

Arch Gen Psychiatry

Familial adversities and child psychiatric disorders

J Child Psychol Psychiatry

A short computer interview for obtaining psychiatric diagnoses

Psychiatr Serv

Conners Rating Scales Revised: Technical Manual

Structure of DSM-III R criteria for disruptive childhood behaviors: confirmatory factor models

J Am Acad Child Adolesc Psychiatry

Family dysfunction and the disruptive behavior disorders: a review of recent empirical findings

Adv Clin Child Psychol

Gender differences in ADHD: a meta-analysis and critical review

J Am Acad Child Adolesc Psychiatry

The developmental interface between nature and nurture: a mutual influence model of child antisocial behavior and parent behaviors

Dev Psychol

A meta-analytic review of gender differences in ADHD

J Atten Disord

Representativeness of clinical samples of youth with mental disorders: a preliminary population-based study

J Abnorm Psychol

Assessing marital conflict from the child's perspective: the CPIC

Child Dev

ARTICLES
Family Adversity in DSM-IV ADHD Combined and Inattentive Subtypes and Associated Disruptive Behavior Problems