The relationship between child ADHD and maternal expressed emotion: a longitudinal analysis of child and family effects

Abstract

High parental expressed emotion (EE) is often associated with ADHD in childhood. However, the direction of causation in the relationship is not well understood: is it the behaviour of the child with ADHD (i.e., child effects) or shared characteristics of the parent or family more generally that are independent of a specific child (i.e., family effects) that predict parental EE? Furthermore, does parental EE predict child problems over time? In this thesis, child and family effects on maternal EE and child problems and the specific child and family characteristics that explain these effects were examined using cross-sectional and longitudinal multilevel models of sibling pair data in families of children with ADHD sampled from a longitudinal study. The results revealed a complex picture with both child and family effects implicated in predicting both maternal EE and child behaviour. Studies 1 and 2 (which cross-sectionally used Time 1 [T1; n = 72 families] and Time 2 [T2] data [n = 48 families] respectively) and the longitudinal analysis of Study 3 (n = 45 families) demonstrated that, except for warmth, child effects were stronger in predicting maternal EE. Child effects seemed to be driven by oppositional/conduct problems (OPP/CP) and emotional problems, rather than ADHD per se. Mothers’ depressive symptoms and overall family levels of child OPP/CP largely predicted family effects on maternal EE. Study 4 (n = 45 families), the second longitudinal analysis, found similar T1 child and family effects on T2 child problems. Increase in negative maternal EE from T1 to T2 significantly predicted T2 child OPP/CP. T1 family effects on T2 child problems were predominantly predicted by T1 maternal ADHD symptoms and average family (i.e., sibling pair) levels of EE. The results suggested a potential causal role of both child (especially OPP/CP) and family effects (especially average family levels of child OPP/CP) in predicting maternal EE. In addition, high EE may be a risk factor for child OPP/CP over time and maternal ADHD for both behavioural and emotional child problems. This may have important clinical implications for interventions with families of children with ADHD.

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