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Journal ArticleDOI

Parenting Stress in Families of Children With ADHD: A Meta-Analysis

TL;DR: In this article, a meta-analysis was conducted to examine findings on the association between parenting stress and ADHD, finding that parents of children with ADHD experience more parenting stress than nonclinical controls and that severity of ADHD symptoms was associated with parenting stress.
Abstract: Meta-analyses were conducted to examine findings on the association between parenting stress and ADHD. Predictors comprising child, parent, and contextual factors, and methodological and demographic moderators of the relationship between parenting stress and ADHD, were examined. Findings from 22 published and 22 unpublished studies were included. Results confirmed that parents of children with ADHD experience more parenting stress than parents of nonclinical controls and that severity of ADHD symptoms was associated with parenting stress. Child co-occurring conduct problems and parental depressive symptomatology predicted parenting stress. Parents of children with ADHD experienced no more parenting stress than parents of other clinically referred children. Little difference in parenting stress was found between mothers and fathers, but child gender was a significant moderator of parenting stress, with lower stress levels in samples with higher proportions of girls.
Citations
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Journal ArticleDOI
TL;DR: Overall, parenting stress levels were higher for parents ofChildren with ASD/DD compared to parents of children from other clinical groups, and the association between parenting stress and behavior problems was stronger among studies which had mostly male and clinic-recruited samples.
Abstract: Research has demonstrated an association between parenting stress and child behavior problems, and suggested levels of parenting stress are higher among parents of children at risk for behavior problems, such as those with autism and developmental delay (ASD/DD). The goal of the present study was to conduct a systematic review of parenting stress and child behavior problems among different clinical groups (i.e., ASD/DD, chronic illness, with or at-risk for behavioral and/or mood disorders). We also examined demographic and methodological variables as moderators and differences in overall levels of parenting stress between the clinical groups. This systematic review documents a link between parenting stress and child behavior problems with an emphasis on externalizing behavior. One-hundred thirty-three studies were included for quantitative analysis. Parenting stress was more strongly related to child externalizing (weighted ES r = 0.57, d = 1.39) than internalizing (weighted ES r = 0.37, d = 0.79) problems. Moderation analyses indicated that the association between parenting stress and behavior problems was stronger among studies which had mostly male and clinic-recruited samples. Overall, parenting stress levels were higher for parents of children with ASD/DD compared to parents of children from other clinical groups. Findings document the association between parenting stress and child behavior problems and highlight the importance of assessing parenting stress as part of routine care and throughout behavioral intervention programs, especially for groups of children at high risk for behavior problems, such as children with ASD/DD, in order to identify support for both the parent(s) and child.

212 citations

Journal ArticleDOI
TL;DR: Adolescence and young adulthood are associated with high levels of caregiver burden in both disorders; in ASD, the level is comparable to that reported by persons caring for individuals with a brain injury.
Abstract: Objective There is increasing recognition that autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are associated with significant costs and burdens. However, research on their impact has focused mostly on the caregivers of young children; few studies have examined caregiver burden as children transition into adolescence and young adulthood, and no one has compared the impact of ASD to other neurodevelopmental disorders (e.g., ADHD). Method We conducted an observational study of 192 families caring for a young person (aged 14 to 24 years) with a childhood diagnosis of ASD or ADHD (n = 101 and n=91, respectively) in the United Kingdom. A modified stress-appraisal model was used to investigate the correlates of caregiver burden as a function of family background (parental education), primary stressors (symptoms), primary appraisal (need), and resources (use of services). Results Both disorders were associated with a high level of caregiver burden, but it was significantly greater in ASD. In both groups, caregiver burden was mainly explained by the affected young person's unmet need. Domains of unmet need most associated with caregiver burden in both groups included depression/anxiety and inappropriate behavior. Specific to ASD were significant associations between burden and unmet needs in domains such as social relationships and major mental health problems. Conclusions Adolescence and young adulthood are associated with high levels of caregiver burden in both disorders; in ASD, the level is comparable to that reported by persons caring for individuals with a brain injury. Interventions are required to reduce caregiver burden in this population.

211 citations

Journal ArticleDOI
TL;DR: It is suggested that parent, both mothers and fathers, of children with different type of NDDs should be provided with interventions and resources to empower them with the knowledge and skills to reduce their stress and to enhance their quality of life.
Abstract: In recent years, studies have shown that parents of children with Neurodevelopmental Disorders (NDDs) experience more parenting stress than parents of typically developing children, but the relation between the type of disorders and parenting stress is far from clear. The purpose of this study was to compare the parenting stress experienced by parents of 239 children with Specific Learning Disorders (SpLD), Language Disorders (LD), Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), and typical development (TD). Parents of children with NDDs experience more parenting stress than those of children who have TD. Although, parents of children with ASD or ADHD report the most high scores of parenting stress, also the parents of children with SpLD or LD report higher parental stress compared with parent of children without NDDs. Another interesting finding was that IQ level or emotional and behavioral problems are associated with the higher levels of parenting stress. This study suggest that parent, both mothers and fathers, of children with different type of NDDs should be provided with interventions and resources to empower them with the knowledge and skills to reduce their stress and to enhance their quality of life.

167 citations


Cites background from "Parenting Stress in Families of Chi..."

  • ...…the other hand, child behavior problems consistently have been shown to predict parental stress (Baker et al., 2005), particularly autism (Abbeduto et al., 2004; Estes et al., 2009) and Attention Deficit Hyperactivity Disorder (ADHD) (Theule et al., 2013) have been reported as important correlates....

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  • ...A review study confirmed that parents of children with ADHD experience more parenting stress than parents of nonclinical controls and that severity of ADHD symptoms was associated with parenting stress (Theule et al., 2013)....

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  • ...…distress were mainly reported in mothers of children with ASD (Dabrowska and Pisula, 2010; Tehee et al., 2009) or ADHD (Margari et al., 2013; Theule et al., 2013) or SpLD (Brock and Shute, 2001; Karande et al., 2009) or LD (Chaffee et al., 1991), moreover fathers of children with NDDs…...

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  • ...In a meta-analyses study, examining the association between parenting stress and ADHD, some authors reported that child co-occurring externalizing behaviors, in particular conduct problems, predicted parenting stress (Theule et al., 2013)....

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  • ..., 2009) or ADHD (Margari et al., 2013; Theule et al., 2013) or SpLD (Brock and Shute, 2001; Karande et al....

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Journal ArticleDOI
TL;DR: In this article, the authors evaluated the efficacy of an adaptation of a MBCT intervention for 13-18-year olds with ADHD and their parents, and found that adolescents reported reductions in internalizing and externalizing problems, functional impairment, family functioning, parenting stress, and mindfulness.
Abstract: Adolescents with Attention Deficit/Hyperactivity Disorder (ADHD) often experience emotional and behavioural difficulties which contribute to stress and conflict in their family relationships. Mindfulness-based cognitive therapy (MBCT) is a promising intervention for these families. We evaluated the efficacy of an adaptation of a MBCT intervention for 13–18 year olds with ADHD and their parents. Adolescents (n = 18) and parents (n = 17) attended 8 weekly parallel group sessions. Participants completed questionnaires at four time points: 4 weeks before the intervention to control for general time effects, on the first and last days of the intervention, and 6 weeks after the intervention. Participants reported on adolescent ADHD symptoms, internalizing and externalizing problems, functional impairment, family functioning, parenting stress, and mindfulness. There were no significant changes on parent rated variables during the baseline period. Results of repeated measures ANOVA revealed reductions in the adolescents’ inattention, conduct problems, and peer relations problems after the intervention, according to parental report. Parents also reported reductions in parenting stress and increases in mindful parenting. Adolescents did not report improvements on any variables during the intervention period. Paired t-tests indicated that improvements in adolescent symptomatology and mindful parenting were maintained 6 weeks after the intervention ended. Parents reported additional reductions in parenting stress at follow-up. Adolescents reported reductions in internalizing problems at follow-up. Overall, our results support and extend the preliminary findings of previous investigations of MBCT showing it to be a promising treatment for adolescents with ADHD and their parents.

128 citations

Journal ArticleDOI
TL;DR: Initial findings of the nature and impact of remote learning during the COVID-19 pandemic suggest it is imperative for schools and communities to provide the necessary supports to adolescents, particularly those with mental health and/or learning difficulties, and to their parents.

128 citations

References
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Book
01 Dec 1969
TL;DR: The concepts of power analysis are discussed in this paper, where Chi-square Tests for Goodness of Fit and Contingency Tables, t-Test for Means, and Sign Test are used.
Abstract: Contents: Prefaces. The Concepts of Power Analysis. The t-Test for Means. The Significance of a Product Moment rs (subscript s). Differences Between Correlation Coefficients. The Test That a Proportion is .50 and the Sign Test. Differences Between Proportions. Chi-Square Tests for Goodness of Fit and Contingency Tables. The Analysis of Variance and Covariance. Multiple Regression and Correlation Analysis. Set Correlation and Multivariate Methods. Some Issues in Power Analysis. Computational Procedures.

115,069 citations


"Parenting Stress in Families of Chi..." refers methods in this paper

  • ...Effect sizes were interpreted as suggested by Cohen (1977, 1988): for d: ≤.20, small; .50, medium; and ≥.80, large and for r: ≤.10, small; .25, medium; and ≥.40, large....

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Journal ArticleDOI
TL;DR: An issue concerning the criteria for tic disorders is highlighted, and how this might affect classification of dyskinesias in psychotic spectrum disorders.
Abstract: Given the recent attention to movement abnormalities in psychosis spectrum disorders (e.g., prodromal/high-risk syndromes, schizophrenia) (Mittal et al., 2008; Pappa and Dazzan, 2009), and an ongoing discussion pertaining to revisions of the Diagnostic and Statistical Manuel of Mental Disorders (DSM) for the upcoming 5th edition, we would like to take this opportunity to highlight an issue concerning the criteria for tic disorders, and how this might affect classification of dyskinesias in psychotic spectrum disorders. Rapid, non-rhythmic, abnormal movements can appear in psychosis spectrum disorders, as well as in a host of commonly co-occurring conditions, including Tourette’s Syndrome and Transient Tic Disorder (Kerbeshian et al., 2009). Confusion can arise when it becomes necessary to determine whether an observed movement (e.g., a sudden head jerk) represents a spontaneous dyskinesia (i.e., spontaneous transient chorea, athetosis, dystonia, ballismus involving muscle groups of the arms, legs, trunk, face, and/or neck) or a tic (i.e., stereotypic or patterned movements defined by the relationship to voluntary movement, acute and chronic time course, and sensory urges). Indeed, dyskinetic movements such as dystonia (i.e., sustained muscle contractions, usually producing twisting and repetitive movements or abnormal postures or positions) closely resemble tics in a patterned appearance, and may only be visually discernable by attending to timing differences (Gilbert, 2006). When turning to the current DSM-IV TR for clarification, the description reads: “Tic Disorders must be distinguished from other types of abnormal movements that may accompany general medical conditions (e.g., Huntington’s disease, stroke, Lesch-Nyhan syndrome, Wilson’s disease, Sydenham’s chorea, multiple sclerosis, postviral encephalitis, head injury) and from abnormal movements that are due to the direct effects of a substance (e.g., a neuroleptic medication)”. However, as it is written, it is unclear if psychosis falls under one such exclusionary medical disorder. The “direct effects of a substance” criteria, referencing neuroleptic medications, further contributes to the uncertainty around this issue. As a result, ruling-out or differentiating tics in psychosis spectrum disorders is at best, a murky endeavor. Historically, the advent of antipsychotic medication in the 1950s has contributed to the confusion about movement signs in psychiatric populations. Because neuroleptic medications produce characteristic movement disorder in some patients (i.e. extrapyramidal side effects), drug-induced movement disturbances have been the focus of research attention in psychotic disorders. However, accumulating data have documented that spontaneous dyskinesias, including choreoathetodic movements, can occur in medication naive adults with schizophrenia spectrum disorders (Pappa and Dazzan, 2009), as well as healthy first-degree relatives of chronically ill schizophrenia patients (McCreadie et al., 2003). Taken together, this suggests that movement abnormalities may reflect pathogenic processes underlying some psychotic disorders (Mittal et al., 2008; Pappa and Dazzan, 2009). More specifically, because spontaneous hyperkinetic movements are believed to reflect abnormal striatal dopamine activity (DeLong and Wichmann, 2007), and dysfunction in this same circuit is also proposed to contribute to psychosis, it is possible that spontaneous dyskinesias serve as an outward manifestation of circuit dysfunction underlying some schizophrenia-spectrum symptoms (Walker, 1994). Further, because these movements precede the clinical onset of psychotic symptoms, sometimes occurring in early childhood (Walker, 1994), and may steadily increase during adolescence among populations at high-risk for schizophrenia (Mittal et al., 2008), observable dyskinesias could reflect a susceptibility that later interacts with environmental and neurodevelopmental factors, in the genesis of psychosis. In adolescents who meet criteria for a prodromal syndrome (i.e., the period preceding formal onset of psychotic disorders characterized by subtle attenuated positive symptoms coupled with a decline in functioning), there is sometimes a history of childhood conditions which are also characterized by suppressible tics or tic like movements (Niendam et al., 2009). On the other hand, differentiating between tics and dyskinesias has also complicated research on childhood disorders such as Tourette syndrome (Kompoliti and Goetz, 1998; Gilbert, 2006). We propose consideration of more explicit and operationalized criteria for differentiating tics and dyskinesias, based on empirically derived understanding of neural mechanisms. Further, revisions of the DSM should allow for the possibility that movement abnormalities might reflect neuropathologic processes underlying the etiology of psychosis for a subgroup of patients. Psychotic disorders might also be included among the medical disorders that are considered a rule-out for tics. Related to this, the reliability of movement assessment needs to be improved, and this may require more training for mental health professionals in movement symptoms. Although standardized assessment of movement and neurological abnormalities is common in research settings, it has been proposed that an examination of neuromotor signs should figure in the assessment of any patient, and be as much a part of the patient assessment as the mental state examination (Picchioni and Dazzan, 2009). To this end it is important for researchers and clinicians to be aware of differentiating characteristics for these two classes of abnormal movement. For example, tics tend to be more complex than myoclonic twitches, and less flowing than choreoathetodic movements (Kompoliti and Goetz, 1998). Patients with tics often describe a sensory premonition or urge to perform a tic, and the ability to postpone tics at the cost of rising inner tension (Gilbert, 2006). For example, one study showed that patients with tic disorders could accurately distinguish tics from other movement abnormalities based on the subjective experience of some voluntary control of tics (Lang, 1991). Another differentiating factor derives from the relationship of the movement in question to other voluntary movements. Tics in one body area rarely occur during purposeful and voluntary movements in that same body area whereas dyskinesia are often exacerbated by voluntary movement (Gilbert, 2006). Finally, it is noteworthy that tics wax and wane in frequency and intensity and migrate in location over time, often becoming more complex and peaking between the ages of 9 and 14 years (Gilbert, 2006). In the case of dyskinesias among youth at-risk for psychosis, there is evidence that the movements tend to increase in severity and frequency as the individual approaches the mean age of conversion to schizophrenia spectrum disorders (Mittal et al., 2008). As revisions to the DSM are currently underway in preparation for the new edition (DSM V), we encourage greater attention to the important, though often subtle, distinctions among subtypes of movement abnormalities and their association with psychiatric syndromes.

67,017 citations

Journal ArticleDOI

49,129 citations


"Parenting Stress in Families of Chi..." refers methods in this paper

  • ...Effect sizes were interpreted as suggested by Cohen (1977, 1988): for d: ≤.20, small; .50, medium; and ≥.80, large and for r: ≤.10, small; .25, medium; and ≥.40, large....

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Journal ArticleDOI
TL;DR: Results indicate that individuals' coping interventions are most effective when dealing with problems within the close interpersonal role areas of marriage and child-rearing and least effective when deals with the more impersonal problems found in occupation.
Abstract: Coping refers to behavior that protects peoplefrom being psychologically harmed by problematic social experience, a behavior that importantly mediates the impact that societies have on their members. The protective function of coping behavior can be exercised in three ways: by eliminating or modifying conditions giving rise to problems; by perceptually controlling the meaning of experience in a manner that neutralizes its problematic character; and by keeping the emotional consequences of problems within manageable bounds. The efficacy of a number of concrete coping behaviors representing these threefunctions was evaluated. Results indicate that individuals' coping interventions are most effective when dealing with problems within the close interpersonal role areas of marriage and child-rearing and least effective when dealing with the more impersonal problems found in occupation. The effective coping modes are unequally distributed in society, with men, the educated, and the affluent making greater use of the efficacious mechanisms.

7,715 citations


"Parenting Stress in Families of Chi..." refers background in this paper

  • ...…& Greenberg, 1990), the Nijmegen Child-Rearing Situation Questionnaire (n = 1; Wels & Robbroeckx, 1996, cited in Kadesjö et al., 2002), the Pearlin Parental Stress Scale (n = 1; Pearlin & Schooler, 1978), and the Questionnaire on Resources and Stress– Short Form Adapted (n = 2; Salisbury, 1986)....

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Book
18 Aug 2000
TL;DR: This paper presents a meta-analysis procedure called “Meta-Analysis Interpretation for Meta-Analysis Selecting, Computing and Coding the Effect Size Statistic and its applications to Data Management Analysis Issues and Strategies.
Abstract: Introduction Problem Specification and Study Retrieval Selecting, Computing and Coding the Effect Size Statistic Developing a Coding Scheme and Coding Study Reports Data Management Analysis Issues and Strategies Computational Techniques for Meta-Analysis Data Interpreting and Using Meta-Analysis Results

6,930 citations


"Parenting Stress in Families of Chi..." refers background or methods or result in this paper

  • ...Homogeneity analyses were conducted on each analysis using the Q statistic (Lipsey & Wilson, 2001)....

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  • ...Given that the majority of the analyses reflected heterogeneous effect sizes, a random effects model was consistently used in conducting the meta-analysis (Lipsey & Wilson, 2001)....

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  • ...For each analysis, a Forrest plot was created using CMA and inspected visually for outliers (Borenstein et al., 2007; Johnson & Eagly, 2000; Lipsey & Wilson, 2001; Sterne & Harbord, 2004)....

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  • ...…however, the relative statistical simplicity of these studies was not detrimental as the results of t tests and correlations are easily meta-analyzed, whereas results from sophisticated published studies, which included structural equation models and regressions, are not (Lipsey & Wilson, 2001)....

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  • ...The inclusion of unpublished studies in meta-analyses is a strength of this methodology, as the exclusion of these studies may have led to a positive bias in the findings (Lipsey & Wilson, 2001; Rothstein, Sutton, & Borenstein, 2005)....

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