Disentangling Child and Family Influences on Maternal Expressed Emotion Toward Children With Attention-Deficit/Hyperactivity Disorder

Abstract

Objective: We used multi-level modelling of sib-pair data to disentangle the influence of child-specific and shared family influences on maternal expressed emotion (MEE) towards children and adolescents with attentiondeficit/hyperactivity disorder (ADHD). Method: MEE was measured for 60 ADHD proband-unaffected sibling pairs aged 6-17 years using the Five Minute Speech Sample. Questionnaire measures of conduct and emotional problems were collected for children and measures of depression and ADHD were collected for mothers. Multilevel models partitioned the effects of 5 MEE components (Initial Statement -IS, Relationship -REL, Warmth -WAR, Critical Comments -CC and Positive Comments -PC) into (i) child-specific and (ii) shared family effects. Results: Significant child-specific influences were confirmed for all MEE components, with higher levels of MEE expressed toward probands than siblings. For REL, PC, and CC, this effect was explained by comorbid conduct problems rather than ADHD. Only low WAR was associated with ADHD itself. Furthermore, only low WAR showed shared familial influences which were in part accounted for by maternal depression.Conclusions: MEE towards ADHD children was influenced by child-specific factors. For most components these were driven by comorbid symptoms of conduct problems rather than ADHD itself. WAR was different -it was influenced by both child-specific and shared familial effects and the child effects showed no relation to conduct problems. Further studies utilising a longitudinal design are required to establish the direction of causation and extend our understanding of the relationship between EE components and ADHD.

Differential susceptibility to maternal expressed emotion in children with ADHD and their siblings? Investigating plasticity genes, prosocial and antisocial behaviour

“…In this case the null findings would be expected. However, since evidence has been found for both parent effect [44,45] and child effect models [46,21], it is more likely that both causation models are valid and complementary in capturing the underlying mechanisms. Third, if reverse causation plays a role, the model could become even more complicated if we take into account that mothers could be differentially susceptible to environmental experiences, in this case their children’s behaviour.…”

Multilevel analysis of ADHD, anxiety and depression symptoms aggregation in families

“…Individuals who belong to the same group are under influence of shared stimuli, which may have different impacts on their own personal characteristics and multilevel analyses provide estimates of the influence of each explanatory variable for parental symptoms on offspring symptoms regarding ADHD, anxiety and depression. A few studies [23][24][25][26] have used multilevel analysis in ADHD, however, they have not used Bayesian procedures for the multilevel model analysis as in the present study. Other researchers have used Bayesian procedures but not in family-based epidemiological genetic studies [27,28].…”

“…Cartwright et al [23] investigated the indirect correlations between maternal depressive symptoms and ADHD diagnoses in children using multilevel analyses to investigate the role of an individual variable (ADHD categorical diagnosis) and a family variable (maternal depressive symptoms) on scores of Maternal Expressed Emotions (MEE). Their results showed a significant influence of maternal depressive symptoms on their children's ADHD condition on the MEE.…”

Predicting aggression in children with ADHD

“…In other words, similar parental attitudes may have different influences on different children. Cartwright et al [43] also found that negative maternal emotions expressed towards children with ADHD (e.g., low warmth and hostility/criticism) are more damaging than emotions expressed towards children without ADHD. In this case, in addition to the impact of negative parenting on behavioral problems in children, it is important to also consider the influence of children’s behavioral problems on parents’ attitudes.…”