This review integrates and critically evaluates what is known about family characteristics associated with childhood Attention-Deficit/Hyperactivity Disorder (ADHD). Evidence suggests that 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 behavior and reduced parenting self-efficacy, and increased levels of parenting stress and parental psychopathology, particularly when ADHD is comorbid with conduct problems. However, the review reveals that little is known about the developmental mechanisms that underlie these associations, or the pathways through which child and family characteristics transact to exert their influences over time. In addition, the influence of factors such as gender, culture, and ADHD subtype on the association between ADHD and family factors remains largely unknown. We conclude with recommendations regarding the necessity for research that will inform a developmental psychopathology perspective of ADHD.
Evidence-based assessment (EBA) emphasizes the use of research and theory to inform the selection of assessment targets, the methods and measures used in the assessment, and the assessment process itself. Our review focuses on efforts to develop and promote EBA within clinical psychology. We begin by highlighting some weaknesses in current assessment practices and then present recent efforts to develop EBA guidelines for commonly encountered clinical conditions. Next, we address the need to attend to several critical factors in developing such guidelines, including defining psychometric adequacy, ensuring appropriate attention is paid to the influence of comorbidity and diversity, and disseminating accurate and up-to-date information on EBAs. Examples are provided of how data on incremental validity and clinical utility can inform EBA. Given the central role that assessment should play in evidence-based practice, there is a pressing need for clinically relevant research that can inform EBAs.
Parental perceptions of child behavior, parenting self-esteem and mothers' reported stress were examined for younger and older hyperactive and normal children. Parenting self-esteem was lower in parents of hyperactives than in parents of normal children. Self-esteem related to skill/knowledge as a parent was age related, with parents of older hyperactives reporting the lowest levels, whereas self-esteem related to valuing/comfort in the parenting role was not related to the child's age. Mothers of hyperactives, especially younger hyperactives, reported markedly higher levels of stress associated with both child characteristics, such as distractibility and degree of bother, and with their own feelings, such as depression, self-blame, and social isolation. Consistent inverse relationships were found between parental self-esteem and perceptions of child problems, whereas ratings of child disburbance and maternal stress were positively correlated. The findings are discussed in terms of the social contexts surrounding hyperactivity and the need for multidimensional assessments and interventions in families of hyperactives.Recent writings have emphasized the need to consider both the social contexts for hyperactivity and the reciprocal influences inherent in these contexts (Routh, 1980; Whalen & Henker, 1980). Although parent characteristics as a "context" for hyperactivity have received some attention (see Paternite &Loney, 1980 andWerner, 1980 for reviews), the focus of this work has been on the identification of possible "causes" of the problem from a predominantly unidirectional perspective, that is, the effect of the parent on the child. Within such a framework, a greater incidence of problems for the parents of hyperactives has been reported, particularly paternal alcoholism and sociopathy and maternal hysteria (Cantwell, 1972;Morrison &
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