Comorbid Internalizing and Externalizing Symptoms Among Children with ADHD: The Influence of Parental Distress, Parentin
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ORIGINAL ARTICLE
Comorbid Internalizing and Externalizing Symptoms Among Children with ADHD: The Influence of Parental Distress, Parenting Practices, and Child Routines Elizabeth McRae1 · Laura Stoppelbein2 · Sarah O’Kelley1 · Paula Fite3 · Shana Smith4
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Emotional/behavioral concerns are common among children with ADHD. Familial factors (e.g., parental adjustment, parenting behaviors) are linked to the presence of comorbid internalizing/externalizing symptoms among children with ADHD. The purpose of the present study was to evaluate a model that includes multiple familial variables and their direct and indirect effects on child emotional and behavioral problems among children with ADHD. Participants included parents of children (6–12 years of age; M = 8.87, SD = 1.92) with a diagnosis of ADHD (N = 300). Participants completed measures of child emotional/behavioral concerns, parental distress, routines, and parenting behaviors. Path analyses revealed direct effects for parental distress, parent behavior and routines on child adjustment, after controlling for the other variables. A significant indirect relation between parental distress, routines, and externalizing behavior was observed. These findings highlight one specific path through which parental distress appears to influence specific behavioral concerns that are commonly observed in children with ADHD. Keywords Routines · Parenting · ADHD · Emotional/behavioral problems
Introduction Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity [1]. ADHD is estimated to * Laura Stoppelbein [email protected] Elizabeth McRae [email protected] Sarah O’Kelley [email protected] Paula Fite [email protected] Shana Smith [email protected] 1
University of Alabama at Birmingham, Birmingham, AL, USA
2
Department of Psychology, University of Alabama, PO Box 870161, Tuscaloosa, AL 35487‑0061, USA
3
University of Kansas, Lawrence, KS, USA
4
Jacksonville State University, Jacksonville, AL, USA
affect 11% of children between the ages of 4 and 17 in the United States [2]. Despite the relative effectiveness of stimulant medication [3] and behavioral parent training programs [4], ADHD is one of the most common disorders found among children receiving treatment in a hospital setting. ADHD was observed to be the 3rd most common diagnosis for children and adolescents admitted to the hospital, constituting 19–23% of that population [5]. Thus, admission to inpatient care (acute or long-term) is not an “uncommon” event for children with ADHD. In addition to the core symptoms of ADHD, a range of internalizing and externalizing behavior problems, including anxiety, depression, and conduct problems, often co-occur with ADHD and may increase the risk for more intensive and costly treatments [6]. Higher levels of these co-occurring symptoms demonstrate associations with poorer functional outcomes for children with ADHD [
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