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Child Routines and Parental Adjustment as Correlates of Internalizing and Externalizing Symptoms in Children Diagnosed with ADHD

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Abstract

Attention deficit hyperactivity disorder (ADHD) is one of the most common disorders of childhood, and the presence of comorbid externalizing and internalizing symptoms often result in severe negative long-term consequences. Multiple etiological factors contribute to the development of co-occurring symptoms. Family stability and consistency appear to be particularly important in effectively managing behavioral concerns. One important factor in producing consistency and stability is the use of routines. The current study examined how routines may be related to internalizing/externalizing symptoms in a clinical sample (N = 371) of children with ADHD (M age = 9.13, SD = 1.96; 77 % male). After controlling for child age, gender, and parental adjustment, routines predicted both internalizing and externalizing symptoms. Specific subtypes of routines including Household, Discipline, and Homework Routines were found to significantly predict symptomatology. A positive relation was found between parental and child adjustment problems; however, support for routines moderating the relation between parent and child adjustment was not supported.

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References

  1. Murphy K, Barkley RA (1996) Prevalence of DSM-IV symptoms of ADHD in adult licensed drivers: implications for clinical diagnosis. J Atten Disord 1(3):147–161

    Article  Google Scholar 

  2. National Institutes of Health (2000) National Institutes of Health consensus development conference statement: diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD). J Am Acad Child Adolesc Psychiatry 39(2):182–193

    Article  Google Scholar 

  3. Polancyzk G, de Lima MS, Horta BL, Biederman J, Rohde LA (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164(6):942–948

    Article  Google Scholar 

  4. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn, text rev. Author, Washington, DC

    Google Scholar 

  5. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O et al (2006) The prevalence and correlates of adult ADHD in the United States: results from the national comorbidity survey replication. Am J Psychiatry 163(4):716–723

    Article  PubMed Central  PubMed  Google Scholar 

  6. Larsson JO, Larsson H, Lichtenstein P (2004) Genetic and environmental contributions to stability and change of ADHD symptoms between 8 and 13 years of age: a longitudinal twin study. J Am Acad Child Adolesc Psychiatry 43(10):1267–1275

    Article  PubMed  Google Scholar 

  7. Barkley RA, Fischer M, Smallish L, Fletcher K (2006) Young adult outcome of hyperactive children: adaptive functioning in major life activities. J Am Acad Child Adolesc Psychiatry 45(2):192–202

    Article  PubMed  Google Scholar 

  8. Connor DF, Edwards G, Fletcher KE, Baird J, Barkley RA, Steingard RJ (2003) Correlates of comorbid psychopathology in children with ADHD. J Am Acad Child Adolesc Psychiatry 42(2):193–200

    Article  PubMed  Google Scholar 

  9. van den Hoofdakker BJ, van der Veen-Mulders L, Sytema S, Emmelkamp PM, Minderaa RB, Nauta MH (2007) Effectiveness of behavioral parent training for children with ADHD in routine clinical practice: a randomized controlled study. J Am Acad Child Adolesc Psychiatry 46(10):1263–1271

    Article  PubMed  Google Scholar 

  10. Weis R (2007) Introduction to abnormal child and adolescent psychology. Sage Publications, Thousand Oaks, CA

    Google Scholar 

  11. Biederman J, Newcorn J, Sprich S (1991) Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. Am J Psychiatry 148(5):564–577

    PubMed  Google Scholar 

  12. Becker SP, Luebbe AM, Langberg JM (2012) Co-occurring mental health problems and peer functioning among youth with attention-deficit/hyperactivity disorder: a review and recommendations for future research. Clin Child Fam Psychol Rev 15(4):279–302

    Article  PubMed  Google Scholar 

  13. Bussing R, Gary FA, Mason DM, Leon CE, Sinha K, Garvan CW (2003) Child temperament, ADHD, and caregiver strain: exploring relationships in an epidemiological study. J Am Acad Child Adolesc Psychiatry 42(2):184–192

    Article  PubMed  Google Scholar 

  14. Podolski CL, Nigg JT (2001) Parent stress and coping in relation to child ADHD severity and associated child disruptive behavior problems. J Clin Child Psychol 30(4):503–513

    Article  PubMed  Google Scholar 

  15. Berg-Nielsen TS, Vikan A, Dahl AA (2003) Specific parenting problems when adolescents have emotional and behavioural disorders. Nord J Psychiatry 57(2):139–146

    Article  PubMed  Google Scholar 

  16. Bogels SM, Brechman-Toussaint ML (2006) Family issues in child anxiety: attachment, family functioning, parental rearing and beliefs. Clin Psychol Rev 26(7):834–856

    Article  PubMed  Google Scholar 

  17. Ge X, Best KM, Conger RD, Simons RL (1996) Parenting behaviors and the occurrence and co-occurrence of adolescent depressive symptoms and conduct problems. Dev Psychol 32(4):717–731

    Article  Google Scholar 

  18. Jones DJ, Forehand R, Rakow A, Colletti CJ, McKee L, Zalot A (2008) The specificity of maternal parenting behavior and child adjustment difficulties: a study of inner-city African American families. J Fam Psychol 22(2):181–192

    Article  PubMed  Google Scholar 

  19. Kim IJ, Ge X, Brody GH, Conger RD, Gibbons FX, Simons RL (2003) Parenting behaviors and the occurrence and co-occurrence of depressive symptoms and conduct problems among African American children. J Fam Psychol 17(4):571–583

    Article  PubMed  Google Scholar 

  20. Koblinsky SA, Kuvalanka KA, Randolph SM (2006) Social skills and behavior problems of urban, African American preschoolers: role of parenting practices, family conflict, and maternal depression. Am J Orthopsychiatry 76(4):554–563

    Article  PubMed  Google Scholar 

  21. Barry TD, Dunlap ST, Lochman JE, Wells KC (2009) Inconsistent discipline as a mediator between maternal distress and aggression in boys. Child Fam Behav Ther 31(1):1–19

    Article  Google Scholar 

  22. Ivanova MY, Israel AC (2006) Family stability as a protective factor against psychopathology for urban children receiving psychological services. J Clin Child Adolesc Psychol 35(4):564–570

    Article  PubMed  Google Scholar 

  23. Jordan SS (2004) Further validation of the Child Routines Inventory (CRI): relationship to parenting practices, maternal distress, and child externalizing behavior. Proquest Information and Learning. Available from EBSCOhost psych database

  24. Eisenberg A, Murkoff H, Hathaway S (1994) What to expect the toddler years. Workman Publication, New York, NY

    Google Scholar 

  25. Kennedy R (2001) The encouraging parent: how to stop yelling at your kids and start teaching them confidence, self-discipline, and joy. Three Rivers Press, New York, NY

    Google Scholar 

  26. McWilliam RA (2010) Routines-based early intervention: supporting young children and their families. Brookes Publishing Company, East Peoria, IL

    Google Scholar 

  27. Nelsen J, Erwin C, Duffy RA (1998) Positive discipline for preschoolers: for their early years-raising children who are responsible, respectful, and resourceful, 2nd edn, rev. Crown Publishing Group, Rocklin, CA

    Google Scholar 

  28. Pantley E (2005) The no-cry sleep solution for toddlers and preschoolers: gentle ways to stop bedtime battles and improve your child’s sleep. McGraw-Hill, New York, NY

    Google Scholar 

  29. Adams LA, Rickert VI (1989) Reducing bedtime tantrums: comparison between positive routines and graduated extinction. Pediatrics 84(5):756–761

    PubMed  Google Scholar 

  30. Bauman KE, Reiss ML, Rogers RW, Bailey JS (1983) Dining out with children: effectiveness of a parent advice package on pre-meal in appropriate behavior. J Appl Behav Anal 16(1):55–68

    Article  PubMed  Google Scholar 

  31. Dadds MR, Sanders MR, Bor B (1984) Training children to eat independently: evaluation of mealtime management training for parents. Behav Psychother 12(4):356–366

    Article  Google Scholar 

  32. Hudson A, Vincent J, Wilks R, Drabman R (1985) ‘Beat the buzzer’ for early morning dawdling: two case illustrations. Behav Change 2(2):136–142

    Google Scholar 

  33. Mash EJ, Barkley RA (2003) Childhood Psychopathology, 2nd edn. Guilford Press, New York, NY

    Google Scholar 

  34. Barkley RA (1998) Attention–deficit hyperactivity disorder: a handbook for diagnosis and treatment, 2nd edn. Guilford Press, New York, NY

    Google Scholar 

  35. National Institute on Mental Health (Archived from original on 2013-4-30) ADHD: complete publication. http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml

  36. Hammerness PG (2008) Treatment challenges in adolescents with ADHD. Medscape Psychiatry. http://www.medscape.org/viewarticle/579478

  37. National Institutes of Health (1996) Attention deficit hyperactivity disorder (NIH Publication No. 96-3572). National Institutes of Mental Health, Washington, DC

  38. National Institutes of Health (2008) Attention deficit hyperactivity disorder (NIH Publication No. 3572). National Institutes of Mental Health, Washington, DC

  39. Forehand R, Long N (2002) Parenting the strong-willed child. McGraw-Hill, New York, NY

    Google Scholar 

  40. Bauman KE, Reiss ML, Rogers RW, Bailey JS (1983) Dining out with children: effectiveness of a parent advice package on pre-meal appropriate behavior. J Appl Behav Anal 16(1):55–68

    Article  PubMed  Google Scholar 

  41. Curtis B (2000) Why routines matter. Christianity Today. http://www.todayschristianwoman.com/articles/2000/september/12.27.html

  42. Barkley RA (2003) Attention-deficit/hyperactivity disorder. In: Mash EJ, Barkley RA (eds) Child psychopathology, 2nd edn. Guilford Press, New York, NY, pp 75–143

    Google Scholar 

  43. Pruitt DB (1998) Your child: what every parent needs to know. William Morrow, New York, NY

    Google Scholar 

  44. Thompson RA, Meyer S (2009) Socialization of emotion regulation in the family. In: Gross JJ (ed) Handbook of emotion regulation. Guilford Press, New York, NY, pp 249–268

    Google Scholar 

  45. McLoyd VC, Toyokawa T, Kaplan R (2008) Work demands, work–family conflict, and child adjustment in African American families: the mediating role of family routines. J Fam Issues 29(10):1247–1267

    Article  Google Scholar 

  46. Loukas A, Prelow HM (2004) Externalizing and internalizing problems in low-income Latino early adolescents: risk, resource, and protective factors. J Early Adolesc 24(3):250–273

    Article  Google Scholar 

  47. Kliewer W, Kung E (1998) Family moderators of the relation between hassles and behavior problems in inner-city youth. J Clin Child Psychol 27(3):278–292

    Article  PubMed  Google Scholar 

  48. Frick PJ, Christian RE, Wootton JM (1999) Age trends in the association between parenting practices and conduct problems. Behav Modif 23(1):106–128

    Article  Google Scholar 

  49. Roche KM, Leventhal T (2009) Beyond neighborhood poverty: family management, neighborhood disorder, and adolescents’ early sexual onset. J Fam Psychol 23(6):819–827

    Article  PubMed  Google Scholar 

  50. Lanza HI, Taylor RD (2010) Parenting in moderation: family routine moderates the relation between school disengagement and delinquent behaviors among African American adolescents. Cultur Divers Ethnic Minor Psychol 16(4):540–547

    Article  PubMed  Google Scholar 

  51. Jenkins JM, Curwen T (2008) Change in adolescents’ internalizing symptomatology as a function of sex and the timing of maternal depressive symptomatology. J Am Acad Child Adolesc Psychiatry 47(4):399–405

    Article  PubMed  Google Scholar 

  52. Kane P, Garber J (2009) Parental depression and child externalizing and internalizing symptoms: unique effects of fathers’ symptoms and perceived conflicts as a mediator. J Child Fam Stud 18:465–472

    Article  Google Scholar 

  53. Pfiffner LJ, McBurnett K, Lahey BB, Loeber R, Green S, Frick PJ et al (1999) Association of parental psychopathology to the comorbid disorders of boys with attention deficit-hyperactivity disorder. J Consult Clin Psychol 67(6):881–893

    Article  PubMed  Google Scholar 

  54. Nigg JT, Hinshaw SP (1998) Parent personality traits and psychopathology associated with antisocial behaviors in childhood attention–deficit hyperactive disorder. J Child Psychol Psychiatry 39(2):145–159

    Article  PubMed  Google Scholar 

  55. Hadley W, Hunter HL, Tolou-Shams M, Lescano C, Thompson A, Donenberg G et al (2011) Monitoring challenges: a closer look at parental monitoring, maternal psychopathology, and adolescent sexual risk. J Fam Psychol 25(2):319–323

    Article  PubMed Central  PubMed  Google Scholar 

  56. Harvey E, Stoessel B, Herbert S (2011) Psychopathology and parenting practices of parents of preschool children with behavior problems. Parent Sci Pract 11(4):239–263

    Article  PubMed Central  PubMed  Google Scholar 

  57. Middleton M, Scott SL, Renk K (2009) Parental depression, parenting behaviors, and behavior problems in young children. Infant Child Dev 18(4):323–336

    Article  Google Scholar 

  58. Greening L, Stoppelbein L, Luebbe A (2010) The moderating effects of parenting styles on African-American and Caucasian children’s suicidal behavior. J Youth Adolesc 39(4):357–369

    Article  PubMed  Google Scholar 

  59. Patock-Peckham JA, Morgan-Lopez AA (2006) College drinking behaviors: mediational links between parenting styles, impulse control, and alcohol-related outcomes. Psychol Addict Behav 20(2):117–125

    Article  PubMed  Google Scholar 

  60. Patock-Peckham JA, Morgan-Lopez AA (2009) Mediational links among parenting styles, perceptions of parental confidence, self-esteem, and depression on alcohol-related problems in emerging adulthood. J Stud Alcohol Drugs 70(2):215–226

    PubMed  Google Scholar 

  61. Bauermeister JJ, Shrout PE, Ramirez R, Bravo M, Alegria M, Martinez-Taboas A et al (2007) ADHD correlates, comorbidity, and impairment in community and treated samples of children and adolescents. J Abnorm Child Psychol 35(6):883–898

    Article  PubMed Central  PubMed  Google Scholar 

  62. Blatt-Eisengart I, Drabick DA, Monahan KC, Steinberg L (2009) Sex differences in the longitudinal relations among family risk factors and childhood externalizing symptoms. Dev Psychol 45(2):491–502

    Article  PubMed Central  PubMed  Google Scholar 

  63. Piche G, Bergeron L, Cyr M, Berthiaume C (2011) Maternal lifetime depressive/anxiety disorders and children’s internalizing symptoms: the importance of family context. J Can Acad Child Adolesc Psychiatry 20(3):176–185

    PubMed Central  PubMed  Google Scholar 

  64. Achenbach TM, Rescorla LA (2001) Manual for the ASEBA school-age forms and profiles. University of Vermont, Research Center for Children, Youth, & Families, Burlington, VT

  65. Sytsma SE, Kelley ML, Wymer JH (2001) Development and initial validation of the child routines inventory. J Psychopathol Behav Assess 23(4):241–251

    Article  Google Scholar 

  66. Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L (1974) The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci 19(1):1–15

    Article  PubMed  Google Scholar 

  67. Hair JF, Anderson RE, Tatham RL, Black WC (1995) Multivariate data analysis, 4th edn. Prentice-Hall, Upper Saddle River, NJ

    Google Scholar 

  68. Pan Y, Jackson RT (2008) Ethnic differences in the relationship between acute inflammation and serum ferritin in US adult males. Epidemiol Infect 136(3):421–431

    PubMed  Google Scholar 

  69. Tabachnick BG, Fidell LS (2000) Using multivariate statistics, 4th edn. Allyn & Bacon, Boston, MA

    Google Scholar 

  70. Fiese BH (1992) Dimensions of family rituals across two generations: relation to adolescent identity. Fam Process 31(2):151–162

    Article  PubMed  Google Scholar 

  71. Hill CR (2007) Effects of family routines and family stress on child competencies. Proquest Information and Learning. Available from EBSCOhost psych database

  72. Day RD, Padilla-Walker LM (2009) Mother and father connectedness and involvement during early adolescence. J Fam Psychol 23(6):900–904

    Article  PubMed  Google Scholar 

  73. Sowislo JF, Orth U (2013) Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychol Bull 139(1):213–240

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Psychology, University of Alabama at Birmingham, 1300 University Dr, Birmingham, AL, 35294, USA

    Abbey N. Harris & Laura Stoppelbein

  2. Glenwood Autism and Behavioral Health, 150 Glenwood Lane, Birmingham, AL, 35242, USA

    Laura Stoppelbein

  3. Department of Psychiatry, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS, 39216, USA

    Leilani Greening

  4. Department of Psychology, Miami University, 90 N. Patterson Ave, Oxford, OH, 45056, USA

    Stephen P. Becker & Aaron Luebbe

  5. Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave. MLC 10006, Cincinnati, OH, 45229, USA

    Stephen P. Becker

  6. Departments of Psychology and Applied Behavioral Sciences, University of Kansas, 1415 Jayhawk Blvd, Lawrence, KS, 66045, USA

    Paula Fite

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  1. Abbey N. Harris
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  2. Laura Stoppelbein
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Correspondence to Laura Stoppelbein.

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Harris, A.N., Stoppelbein, L., Greening, L. et al. Child Routines and Parental Adjustment as Correlates of Internalizing and Externalizing Symptoms in Children Diagnosed with ADHD. Child Psychiatry Hum Dev 45, 243–253 (2014). https://doi.org/10.1007/s10578-013-0396-4

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  • DOI: https://doi.org/10.1007/s10578-013-0396-4

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