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OJHAS Vol. 11 Issue 1:
(Jan-Mar 2012) |
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| Frequency of Parental Psychopathology in Children
with Attention Deficit Hyperactivity Disorder |
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Latha KS, Professor, Dr. AV Baliga Memorial Hospital, Udupi,
Rajmohan
B Nair, Medical Counselor,
Community Health Centre, Government of Goa, Valpoi, Goa,
Shripathy M Bhat Professor, Dept.of Psychiatry, KMC Hospital,
Manipal University, Manipal-576 104. |
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Address for Correspondence |
Dr. AV Baliga Memorial Hospital,
Udupi.
E-mail:
drlathaks@yahoo.com |
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Latha KS, Nair RB, Bhat SM. Frequency of Parental Psychopathology in Children
with Attention Deficit Hyperactivity Disorder. Online J Health Allied Scs.
2012;11(1):7 |
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Submitted: Feb 17,
2012;
Accepted: Mar 31, 2012; Published: Apr 15, 2012 |
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| Abstract: |
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Parental mental health concerns
place children at a significantly greater risk of lower social, psychological
and physical health than children in families not affected by mental
illness. Several studies have examined
the extent to which psychopathology in children are closely related
to parental substance use disorders or to other mental disorders. This
study intended to investigate the frequency of occurrence of parental
psychopathology in children with Attention Deficit/Hyperactivity Disorder
and compare the characteristics of children with and without parental
psychopathology. Fifty children between 7-14 years
of either sex fulfilling the ICD-10 criteria for ADHD comprised the
sample of this study.It would be a chart review of in-patients and out-patients
who have consulted at Kasturba Hospital, Department of Psychiatry, Manipal
over a two year period. Parents diagnosed with Substance Use Disorders
(SUD) and other psychiatric morbidity according to ICD-10 was compared
with those parents without any psychiatric illness on various Sociodemographic,
clinical characteristics. Most of the parents were in the
second or third decade of their life. Of the fifty patients 41(82%)
were males and 9 (18%) were females. In 36(87.0 %) of the fathers had
a history of substance use disorder and 5(13.0 %) it was absent. Other
morbidities were also present in both parents. The findings are discussed
in light of the implications.
Key Words:
ADHD; Parental psychopathology; Substance use; Alcohol
Dependence Syndrome
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Attention deficit hyperactivity disorder (ADHD) is
a chronic and pervasive condition characterized by developmental deficiencies
in sustained attention, impulse control, and the regulation of motor
activity in response to situational demands.[1] ADHD also carries with
it a variety of comorbid disorders. These include oppositional behaviors
and aggressive-spectrum disorders, learning disorders, depression and
anxiety. Unfortunately, each comorbid condition has its own associated
difficulties and impairments. When present, ADHD very often can be highly
disruptive, adversely affecting many areas of child psychosocial functioning.[2] For
example, virtually all children with ADHD display significant
academic underachievement.[3] As many as 65% may exhibit aggressive
behavior or oppositional defiant tendencies as well.[4] Low self-esteem,
anxiety, depression, and other emotional complications also are quite
common.[5] So too are peer relationship problems.[6-7]
Although a direct causal connection has yet to be
firmly established, there is correlational evidence suggesting that
ADHD impacts far more than the functioning of the child. Parent functioning
may be affected as well. Of particular clinical significance is that
parents of children with ADHD very often experience considerable
stress in their parenting roles.
The presence of ADHD in children is associated to
varying degrees with disturbances in family and marital functioning,
disrupted parent-child relationships, specific patterns of parental
cognitions about child’s behaviour and reduced parenting self-efficacy,
and increased levels of parenting stress and parental psychopathology.[8-9]
Importantly, while all parents experience stress to some degree,
parents of children with externalizing behavior problems report significantly
more stress than parents of children without externalizing behaviour
symptoms. Parents of children with externalizing behaviour problems
view themselves as having less parenting knowledge, less parental competence,
and less social support.[10]
Parent psychopathology, including parental depression,
anxiety, substance abuse, personality disorders, and ADHD, has been
shown to be related to children's behavior development.[11]
Another detrimental effect that the stress of having
a child with ADHD can have on the parents is increasing their rate of
alcohol consumption. Pelham and Lang (1999) [12] examined how interacting
with a child with ADHD would affect alcohol consumption in adults. They
based this study on the assumption that if stress in general could increase
alcohol consumption, then it may be possible that parenting stress could
also lead to increased alcohol consumption. They found that when college
students interacted with a child who had externalizing behavioural problems,
the students increased their rate of alcohol consumption. When they
replicated this study using parents of children with ADHD as their subjects,
they found an interesting result. They found that interacting with a
child with externalizing behaviour problems was related to increased
drinking only when the parents had a significant family history for
alcoholism.[12] This suggests that while parents of ADHD children who
have a family history of alcoholism may cope with their stress by drinking,
parents without this family history find more productive ways to cope
with their stress.
Studies examining the frequency of occurrence of
parental psychopathology in children with ADHD are almost modest hence
the aim of this study was to determine the extent to which parental
psychopathology associated
with children with ADHD and to compare the characteristics of children
with and without parental psychopathology.
This was a retrospective chart review of child cases
seen in Child Guidance Clinic, diagnosed with Attention Deficit Hyperactive
Disorder according to ICD-X, in Dept. of Psychiatry at Kasturba Medical
College Hospital, Manipal. The sample comprised of fifty children from
7 to 14 years, with ADHD with/without other co morbid psychiatric illness
(ICD-10).
Socio-Demographic data, patient related variables like age of onset
of ADHD, sex, developmental milestones, temperament of the child, and
family history of psychiatric illness with special consideration to
parental psychopathology were selected and those cases where there was
no parental psychopathology were also included as a comparison group. Charts
with incomplete data, those children who were adopted, separated parents
or children suffering from neurological disorders were excluded. Institutional
Ethics Committee clearance was obtained.
The SPSS statistical package (Windows version 11.0)
used for data analysis. Descriptive statistics were used
to determine categorical variables and chi square/Fisher’s Exact Test was carried
to find the statistical significance across genders on sociodemographic
and some clinical variables.
Fifty children diagnosed as ADHD with complete sociodemographic
and clinical details formed the sample for analysis. Of this 26(52%)
parents had a psychiatric illness; out of which 19 (73%) were males and 7(27%) females diagnosed with ADHD. Twenty four (48%)
parents did not meet any ICD criteria for a psychiatric illness majority
i.e. 75% being males. However there was statistically no significant
difference between the two groups i.e. those with and those children
without parental psychopathology. Majority from both the groups hailed
from middle socioeconomic status. There was statistically no significant
difference across the two groups as regards the age of onset of ADHD;
developmental milestones and temperament [Table 1].
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Table 1: Socio demographic characteristics
of the child |
Variables |
Parents With illness (26) |
Parents without illness (24) |
Total (50)
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Fisher exact DF
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P value <.001
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Sex |
Male |
19 |
18 |
37 |
0.56 / 1 |
NS |
Female |
7 |
6 |
13 |
Economic status |
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USES1 |
- |
-
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- |
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NS |
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MSES2 |
19 |
20 |
39 |
0.67 / 1
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LSES3 |
7 |
4 |
11 |
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Age of onset of illness |
7 - 10 |
16 |
16 |
32 |
0.71 / 7 |
NS |
11 - 14 |
10 |
8 |
18 |
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Development Milestones
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Normal |
15 |
12 |
27 |
0.39 / 1 |
NS |
Delayed |
11 |
12 |
23 |
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Temperament |
Easy |
6 |
5 |
11 |
0.56 / 1 |
1.000 NS |
Difficult |
19 |
20 |
39 |
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1Upper 2middle &
3lower socioeconomic status |
The diagnostic break up of children with ADHD in both the groups i.e.
children with and without parental psychopathology was not statistically
significant. Children in both groups manifested with ADHD alone 11 (42.3%)
in parents with illness and 9(37.5%) parents without illness. Next around
6(23.1%) in the first group and 9 (37.5% ) in the second group had SLD
in addition to ADHD, about 15.4% in the first group and 16.6%in the
other suffered from Mental retardation and ADHD. Other co morbid conditions
along with ADHD was less common [Table 2]. In short the
pattern of disorders in children across both the groups were similar.
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Table 2: Distribution of Diagnostic
break- up of children |
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Variables |
Parents With illness [26] |
Parents without illness [24] |
Total [50]
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Fisher exact DF
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P value <.001
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Diagnostic break-up of children
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0.63 / 1 |
0.002 NS |
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ADHD* |
11 |
9 |
20 |
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ADHD + SLD** |
6 |
9 |
15 |
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ADHD +Tic Disorder |
2 |
1 |
3 |
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ADHD + Mild MR*** |
4 |
4 |
8 |
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ADHD + Moderate MR |
1 |
0 |
1 |
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ADHD+SLD +Seizure Disorder |
1 |
0 |
1 |
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ADHD+SLD+MR |
1 |
1 |
2 |
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ADHD-Attention Deficit Hyperactivity Disorder; SLD-Specific
Learning Disability; MR-Mental Retardation
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Characteristics of parents:
The mean age of the father in the sample was 42.3(S.D.4.3)
with a minimum age of 34 and maximum of 53 with range of 19 years and
that of the mother was 35.7 (S.D. 4.26); minimum of 28 and maximum of
47 with a range of 19 years. Overall mothers were about seven years
younger than the fathers in the study sample.
There was no statistical significance in the characteristics
of father and mothers in the two groups’ current age of the parents
however most of the mothers were above 30 years and fathers above 35
years. There were also no differences in the age of the mother at the
time of the index child’s birth across the two groups [Table 3 &
4].
In the first group of parents with psychopathology
of the 26 mothers around 8(30.8%) had a history of both medical and
psychiatric illness. Diabetes mellitus and hypertension or both were
the most common diagnosis and mood disorders were the psychiatric diagnosis.
[Table 3]
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Table 3: Characteristics of Mothers
with and without psychopathology |
Variables |
With illness (26)
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Without illness(24) |
Total (50)
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Fisher's Exact DF
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p-value |
Mother's age at Birth of child |
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0.79 / 2
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19 – 20 |
2 |
1 |
3 |
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0.06 |
21 – 25 |
13 |
11 |
24 |
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Above 26 |
11 |
12 |
23 |
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Mother’s Current age |
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0.60 / 2 |
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25 – 30 |
4 |
0 |
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0.023 |
31 - 35 |
11 |
11 |
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Above 36 |
11 |
13 |
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Co morbid condition positive |
8 |
0 |
50 |
0.61 / 2 |
>0.001 |
Maternal Illness |
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Diabetes Mellitus( DM) |
2 |
- |
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DM+ Hypertension(HTN) |
1 |
- |
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HTN |
2 |
- |
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Schizotypal Disorder |
1 |
- |
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Bipolar Affective Disorder |
1 |
- |
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Depression |
1 |
- |
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p-<0.001 |
Among the fathers all 26 fathers suffered from psychiatric
disorders rather than medical conditions. There was a high proportion
with substance use disorders, around 18 of the 26 i.e. 69% with substance
use disorders. Common psychiatric diagnosis included Alcohol dependence
syndrome 7 (26.9%) tobacco dependence syndrome 4 (15.4%);
both ADS and TDS- 7 (26.9 %), 3 (11.5%) diagnosed with personality disorders
and mood disorders were less common [Table 4].
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Table 4: Characteristics of Fathers
with and without psychopathology |
Variables |
With illness (26)
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Without illness (24) |
Total |
Fisher's Exact DF
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p-value |
Father’s Current age
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0.455 / 2 |
NS |
30 – 35 |
2 |
1 |
3 |
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36 – 40 |
8 |
6 |
14 |
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Above 41 |
16 |
17 |
33 |
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Paternal Illness |
26 |
0 |
50 |
0.48 / 1 |
<0.001 |
ADS* |
7 |
- |
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TDS** |
4 |
- |
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ADS + TDS |
7 |
- |
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Seizure Disorder |
2 |
- |
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Depression |
2 |
- |
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ASPD*** + ADS |
1 |
- |
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ADS + DM |
1 |
- |
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AAPD***** |
1 |
- |
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BPAD1 |
1 |
- |
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p-value <0.001 *Alcohol Dependence
Syndrome, **Tobacco Dependence Syndrome,
**Antisocial Personality Disorder,
*****Anxious Avoidant Personality Disorder, 1 Borderline
personality disorder
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In 18 (36%) both the parents of children were affected
with some psychiatric disorder.
The present study examined the frequency of parental
psychopathology in children suffering from Attention Deficit Hyperactivity
Disorders. The finding reveals that overall 36 % in which both parents
were affected and that more fathers were diagnosed than the mothers.
The most common diagnosis was substance use disorders in 69% of the
fathers. Studies have reported increases in mental disorders among children
of parents with substance use disorders.[13-16] Children-of alcoholic parents (COAs) are at increased
risk for various psychiatric, cognitive and interpersonal difficulties,
as well as developing alcohol use disorders.[17]
Of particular relevance, significantly elevated
rates of attention deficit hyperactivity disorder (ADHD) have been reported
in COAs.[2,18-21] In addition children of fathers with substance use disorders
are at increased risk for psychopathology, including conduct
disorder, attention deficit hyperactivity disorder (ADHD), major
depressive disorder, and anxiety disorders.[13-14,22]
The extent to which these mental disorders in children
are a consequence of parental substance use disorders or
more specifically associated with corresponding parental
psychopathology remains
an open question. Parents with substance use disorders typically
have had other mental disorders. Analogous to their children,
fathers with substance use disorders often have childhood histories
of conduct disorder and ADHD as well as major depressive disorder
and anxiety disorders.[23]
The genetic and environmental mechanisms through
which paternal psychopathology and substance use disorders
influence offspring outcomes have yet to be fully determined.
Paternal-maternal concordance for
specific mental disorders is common, in part due to assortative
mating, and may increase risk in offspring for like disorders.[24-26]
Most studies on parent and child psychopathology have focused exclusively
on mothers, ignoring fathers.[27]
The relationship between parents’ mental disorders
and their children’s development is complex and is
influenced by the interaction between multiple factors.[28] Although
some useful generalizations can be made about the effects of parental mental disorders as a whole,
a detailed understanding must take into account the nature, severity
and duration of the parental mental disorders, as well as social, economic and cultural factors.
The existing literature gives only a partial understanding of these complex issues.
The children of parents with mental disorders constitute
a high-risk population that demonstrates abnormalities of functioning
in a wide range of psychological and social domains. This is in addition
to their increased rates of suffering from mental disorders during childhood
and/or adult life. These high-risk children are potentially identifiable
and ensuring their well-being provides a challenge and an opportunity
to health and social services. In some cases, the risk to the well-being
of the child is so severe that child protection measures, including
alternative care, must be considered. Interventions which address parental
psychopathology may yield more potent or durable effects than treatment
focusing only on the child’s problems.
The study has several limitations. Retrospective
assessments of childhood and adolescent periods collected
in adult samples (i.e., parents) may be influenced by recall
bias. Parental perceptions
of child behavior may also be influenced by parental psychopathology.[29-30] Further exploration of parent-child
transmission of comorbid conditions may be feasible with larger
samples or study designs focusing on this issue.
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- Vanyukov MM, Neale MC, Moss HB, Tarter RE. Mating
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