ATTENTION DEFICIT / HYPERACTIVITY DISORDER IN SCHOOL-AGE

CHILDREN: EFFECTS OF PARENTING AND TRANSGENERATIONAL

PARENTING ON EXPRESSION OF ADHD SYMPTOMS

Thesis submitted to the International Psychology of Excellence Program at

Munich Ludwig Maximilians University in partial satisfaction of the

requirements for the degree of

Master of Arts in Psychology

by

Lütfiye Kaya

Address in Germany (until 15 July 2004): Address in Turkey:

Connollystrasse 7 Apt. K7 Fahriye Hanim sk. No: 5-6
80809 MÜNCHEN Cam Apt. Kücükyali
Maltepe- Istanbul.

First Reader: Prof. Dr. Heinz NEBER

Second Reader: Prof. Dr. Kurt HELLER

Date of Deadline: 28.04.2004

Extended Until: 19.05.2004

Ludwig Maximilians University

2004

0
 ACKNOWLEDGEMENTS

I would like to express a warm gratitude to Dr. Sabine Dörning. She was the

leader of self-help group in München where she helped me to

administer my questionnaires to the parents of children with ADHD. I would

also like to thank Prof. Dr. Heinz Neber for guiding me through my thesis,

and not restricting me with blind deadlines. Lastly, I would like to thank

Prof. Kurt Heller, for being my second reader.

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 Table of Contents

Page

Introduction 1

I. General

I.1. Definition of basic terms 1

I.2. History of ADHD 3

I.3. Symptoms of ADHD 3

I.4. Changing symptoms through development 4

I.5. DSM-IV criteria for ADHD 5

I.6. Hyperactivity versus attention deficit 7

I.7. Psychological, neurological and social problems

comorbid with ADHD 10

II. Multiple Routes to ADHD: Genetic and

Environmental Factors 16

III. Parental Psychopathology and

Transgenerational Parental Discipline 28

III. Assessment of ADHD, Parental Behavior,

Transgenerational Discipline Style 33

Hypotheses 39

Methods 40

I. Participants 40

II. Instruments 42

ADHD-Symptoms Rating Scale (ADHD-SRS)

 Parental Authority Questionnaire-Revised (PAQ-R) Der

Fragebogen zum erinnerten elterlichen

Erziehungsverhalten (FEE)

III. Procedure 48

Results 49

Discussion 64

References 73

Appendix 83
 INTRODUCTION

Despite the large clinical literature on Attention Deficit

Hyperactivity Disorder (ADHD), little has been written about the effects of

parenting and trasgenerational parenting on the etiology and

prognosis of this disorder in school age children. This thesis presents the

literature on related topics followed by the survey study

investigating the possible impacts of parental and grandparental child- rearing

attitudes on the differential history of causation and symptom- based

identification of ADHD. Following an inductive technique, the

essential parts will lead to the broader picture of topic in the end.

Definition of Basic Terms

“Attention” is one of the cognitive expressions, which had been related

to a wide range of atypical populaces. It refers to several

aspects of functioning leading to a coordinated brain activity. Attention is

sometimes delineated as the ability to select, focus on the selected element, and

forget about the rest. Almost always, people ignore most of the sights,

sounds and stimuli in their setting and focus attention to only a small number

of stimuli at a time. Attention may be bound under alert control (such as to

memorize a telephone number) or may swing according to external stimuli

(such as a sudden blazing in the air which

immediately took the passer-bys’ attention). Divided attention refers to the

ability to process multiple stimuli at the same time, as in being able to sing

when riding a bicycle. Long attended stimuli are more likely to

enter into long-term memory, while unattended / or insufficiently

attended stimuli are more likely to elapse from deep processing.

Sustained attention is generally defined as the willing allotment of

attention to a stimulus for a certain period of time which suffices the

stimulus to enter into long term memory.

Although attention has been studied since 1890s there is no

agreement on how its different parts such as selective and sustained

attention can be defined and assessed. Therefore, it is wise only to tell that

currently attention is considered to be a multidimensional

construct. Barkley (1991a) states that deficits in attention refer to deficits in

alertness, arousal, selectivity, sustained attention, and

distractibility. As attentional processes came to be considered basic to all

aspects of mental functioning, the inability to attend was considered as a

source of behavioral, intellectual and/or emotional problems.

Children who show signs of attentional problems such as failure to

attend, short attention span, and incapability to concentrate on a task for a

prolonged time have been a distress to parents, teachers, and

clinicians alike. Troubles with attention are identified as the most

widespread cause of learning and behavioral difficulties in school age

children (Levine, 1996). Often these weaknesses are lumped together as a

syndrome called Attention Deficit Hyperactivity Disorder

(ADHD). ADHD is a disorder that affects approximately 4–6% of the child

population (American Psychiatric Association, 2000) and is

associated with a range of current and long-term impairments (Barkley, 1998).

 History of ADHD

More than a century ago, in 1902, a medical doctor called George Still

gave a sequence of lectures in which he portrayed the “lack of

moral control” among children without apparent physical disorders [Barkley,

1998]. Until recent decades, a series of different names,

including minimal brain damage syndrome, minimal brain dysfunction,

hyperkinetic reaction of childhood, and attention deficit disorder have been

utilized to illustrate the disorder now named as Attention Deficit

Hyperactivity Disorder [American Psychiatric Association, 1994]. Even as the

American Psychiatric Association's Diagnostic and Statistical Manual IV

(DSM-IV) records ADHD in a part including disorders of

infancy, childhood, and adolescence, it embraces a roll of allusions to the dire

effects of ADHD on occupational life, thereby providing

instructions about the diagnosis of adults with ADHD (Ball, Wooten,

Crowell, 1999). Thus, the DSM-IV gives adequate guidelines for

spotting out adults with ADHD but does it rather covertly than overtly;

therefore attention-deficit/hyperactivity disorder is still accepted as the most

familiar neurodevelopmental disorder of early years of life.

Symptoms of ADHD

ADHD usually appears before the age of 7 years, and those

symptoms which develop after age 7 are often linked with some type of

neurologically disturbing experience. A projected 30% to 50% of ADHD cases

are conjectured to be genetic in nature (Barkley, 1990a;

Cantwell, 1985). The etiology of ADHD is not identified yet but latest

studies suggest both a strong genetic link as well as environmental

factors such as a record of preterm delivery and possibly, maternal

smoking throughout pregnancy. Children and adolescents with ADHD apply

to health and mental health centers more often than their peers

and take up further anti-health behaviors such as smoking, and alcohol and

substance abuse (Rowland, Lesesne, Abramowitz, 2002).

Fundamental knowledge about how the occurrence of ADHD differs by

race/ethnicity, sex, age, and socioeconomic status is still

scantily explained. That is mostly because the complexity of diagnosing

ADHD has converted into complexity of producing an ample case

portrayal for epidemiological studies. It is well-known that ADHD consists

mainly of a noticeable and permanent pattern of

developmentally inapt inattention and/or hyperactivity-impulsivity, giving way

to clinically noteworthy harm in social, academic, and/or

occupational functioning (American Psychiatric Association, 1994). The

Diagnostic and Statistical Manual of Mental Disorders (DSM IV; APA,

1994) has listed the criteria for the diagnosis of three ADHD subtypes, a

predominantly inattentive type where attention deficits predominate, a

hyperactive/impulsive type, characterized by impulsiveness and

heightened activity, and a combined type characterized by both

problems of inattention and hyperactive/impulsive behavior.

Changing Symptoms Through Development

Some researchers have proposed that numerous children with

ADHD pursue a developmental pathway in which they meet criteria for

ADHD predominantly hyperactive for the period of the preschool years,

ADHD-comorbid as they get faced with harder academic tasks at which they

fail due to significant inattention, and ADHD-predominantly

inattentive after symptoms of hyperactivity and impulsivety fade away

when the children grow up into adolescence and young adulthood

(Barkley, 1997b; Lahey, Pelham, Stein, et al, 1998).The

disproportionate motor activity observed in hyperactive children is likely to fall

down by puberty (Weiss and Hectman, 1986). Conversely, for the majority of

children who has ADHD, attention troubles and allied

academic, psychological, and social symptoms keep on into grown-up years

(Barkley, 1990b; Goldstein, 1991).

DSM-IV Criteria for ADHD

1. Either (A) or (B):

(A) six or more of the following symptoms of inattention have persisted

for at least 6 months to a degree that is maladaptive and inconsistent

with developmental level:

Inattention:

1) often fails to give close attention to details or makes careless

mistakes in schoolwork, work, or other activities

2) often has difficulty sustaining attention in tasks or play activities

3) often does not seem to listen when spoken to directly

4) often does not follow through on instructions and fails to finish

schoolwork, chores, or duties in the workplace (not due to oppositional

behavior or failure to understand instructions)

5) often has difficulty organizing tasks and activities

6) often avoids, dislikes, or is reluctant to engage in tasks that require

sustained mental effort (such as schoolwork or homework)

7) often loses things necessary for tasks and activities (e.g., toys,

school assignments, pencils, books, or tools)

8) is often easily distracted by extraneous stimuli

9) is often forgetful in daily activities

(B) six or more of the following symptoms of hyperactivity-impulsivity

have persisted for at least 6 months to a degree that is maladaptive and

inconsistent with developmental level:

Hyperactivity

1) often fidgets with hands or feet or squirms in seat

2) often leaves seat in classroom or in other situations in which

remaining in seat is expected

3) often runs about or climbs excessively in situations in which it is

inappropriate (in adolescents or adults, it may be limited to subjective

feelings of restlessness)

4) often has difficulty playing or engaging in leisure activities quietly

5) is often “on the go” or often acts as if “driven by a motor”

6) often talks excessively

Impulsivity

7) often blurts out answers before questions have been completed

8) often has difficulty awaiting turn

9) often interrupts or intrudes on others (e.g., butts into conversations

or games)

2. Some hyperactive-impulsive or inattentive symptoms that caused

impairment were present before age 7 years.

3. Some impairment from the symptoms is present in two or more

settings (e.g., at school [or work] and at home).

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4. There must be clear evidences of clinically significant

impairment in social, academic, or occupational functioning.

5. The symptoms do not occur exclusively during the course of

Pervasive Developmental Disorder, Schizophrenia, or other

Psychotic Disorder and are not better accounted for by another

mental disorder (e.g., Mood disorder, Anxiety Disorder,

Dissociative Disorder, or a Personality Disorder).

Based on these criteria, three specific subtypes of ADHD are identified:

1. ADHD, Combined Type: if both criteria 1A and 1B are met for the

past 6 months

2. ADHD, Predominately Inattentive Type: if criterion 1A is met but

criterion 1B is not met for the past six months.

3. ADHD, Predominately Hyperactive-Impulsive Type: if criterion 1B

is met but criterion 1A is not met for the past six months.

Hyperactivity versus Attention Deficit

Chhabildas, Pennington and Willcutt (2001) thought that children with

abnormally high inattention symptoms might be impaired in

processing speed, vigilance and inhibition and children with

hyperactivity/ impulsivity would have meager inhibition. Their study

showed that contrary to their prediction, only symptoms of inattention were

correlated with all of these dependent measures. ADHD children with

dominant hyperactivity were not significantly impaired on inhibition

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than control groups. Chhabildas et al. interpreted the findings asserting that

symptoms of inattention rather that symptoms of hyperactivity/

impulsivity, are associated with neuropsychological impairment.

Collings (2003) compared two samples of school-age boys with

attention-deficit/hyperactivity disorder (ADHD-combined and ADHD-

inattentive Types) and a non-ADHD control group using an “AX” version of

the continuous performance task (CPT) to examine specific sustained attention

deficits. Three levels of time-on-task were included to study

performance declines, and 3 interstimulus intervals were included to examine

vigilance deficits. Collings says that as predicted by R. A.

Barkley’s and H. C. Quay’s behavior inhibition deficit models (please

see “R. A. Barkley, 1997” or “H. C. Quay, 1997” if you are interested in their

reports), the performance of the ADHD-combined type (ADHD-C) participants

declined more speedily than the other samples. No

significant evidence of vigilance deficits among the inattentive (ADHD- IA)

sample was found. Collings interpreted the findings suggesting that distinct

criteria for the two ADHD subtypes may be warranted when the CPT is used

for diagnostic assessment, and sustained attention-related

declines in performance may be typical of the ADHD-C Type only. Other

studies reveal that children with the ADHD-predominantly hyperactive

subtype exhibit little or no impairment in intelligence, reading ability, or math

ability, whereas children with the other two subtypes exhibit large deficits in

each of these areas when compared to controls (Faraone,

Biedermann, Weber, et al., 1998; Lahey et al., 1998). Because of their

inattention and messy impetuous handling of school responsibilities,

ADHD children habitually underachieve at school although they have

adequate aptitude, even specific learning and/or reading difficulties are not

present (Weiss, 1990). Tannock has suggested three areas as

potential core deficits: executive functions including deficits in working

memory, visual-spatial orienting, and energetic state, particularly

activation (Tannock in Paule et al., 2000).

Numerous researchers (Barkley, 1997a; Pennington and Ozonoff, 1996)

have proposed that the specific deficits seen in individuals with ADHD are

related to impairments in the frontal lobes, and consequently

are evident as executive function (EF) deficits. These views derive from a

comparison of the deficits exhibited in individuals with frontal lobe

lesions, and those seen in individuals with ADHD symptomatology.

Pennington and Ozonoff (1996) notify that the behavioral problems

caused by aberrations in frontal lobe functioning are totally related

with goal-directed behavior, usually in new contexts with rival and

incorrect response options. Regardless of perceiving the purpose of the assignment,

patients with frontal problems are reported to be

unsuccessful achieving it, either because of irrelevant self-defense, early

withdrawal, interference of unrelated stimuli, or start-up

difficulties. Therefore, researchers accepted that the frontal lobes are

accountable for “executive” features of task performance. The term

executive function is described as the capacity to carry on a proper

problem solving set for attainment of a future goal, and includes

organizational ability, scheduling, continuation of preplanned

successive actions, self-regulation, selective attention and sustained

attention. Executive functions entail the skills to hinder an inappropriate

reaction, the ability to outline a tactical action plan, and the ability to
form a mental representation of the task, entirely for the

accomplishment of a potential target. Specific functions included under the

definition of EFs contain interference control, inhibition, and

integration across space and time, planning, and working memory

(Pennington and Ozonoff, 1996). These behaviors are all thought to be under

the control of the prefrontal cortex.

Psychological, Neurological, and Social Problems

Comorbid With ADHD

Verification of the co-occurrence of Learning Disability (LD) and

ADHD is largely acknowledged by experimental and survey

investigations. In cases identified with LD, ADHD has been expected to accompany 41%

to 80% of the time (Robins, 1992). Similarly, in

diagnosed ADHD cases, 30% to 60% are also documented to have LD (Tarnowski

and Nay, 1989).

Presence of cognitive deficits in children with ADHD has been well

recognized. There are many studies whose findings indicate that

children with ADHD show decreased productivity and success in written

arithmetic tasks, verbal recall tasks, verbal fluency tasks and on

measures of speech production, and motor control (For a review, please see

Siklos and Kerns, 2003). Although these deficits in production,

fluency, and motor control have been discussed in terms of motivation and

executive function, Siklos et al. (2003) asserts that difficulty with higher

levels of initiation could also account for some of the findings. The number

of initiated tasks on a human figure drawing task is found to be a significant

predictor of psychostimulant response in children

with ADHD (Conners 1971, in Siklos et al, 2003) suggesting that difficulties

with initiation may be a fundamental deficit in ADHD.

A complicated cognitive model which explains the deficits seen in

individuals with “frontal lobe syndromes” suggests that there is an

executive control system, called the Supervisory Attentional System

(SAS; Norman and Shallice, 1986 in Siklos et al, 2003), which controls goal-

directed behaviors in novel situations, such as goal expression,

plan formulation, decision-making, marker creation, and marker

triggering. Therefore, individuals with impairments in the SAS would be

likely to show normal performance on everyday tasks, whereas their

performance on non-routine, or unfamiliar tasks, would be harmed. On routine

tasks, the markers cueing behaviors and decisions are present, however, in

non-routine situations, no markers are present to help

determine the course of action, and thus the SAS must be activated.

Successful performance of new tasks involves devising a plan and self-

monitoring one’s moves needed to achieve the final goal. Children with ADHD,

in general, have difficulty with novel situations that involve

decision-making and self-monitoring (Siklos et al., 2003), in line with

the conceptual circumstances under which the SAS would be activated.

When neuropsychological deficits of children with ADHD and reading

disability are compared, it is spotted by researchers that

children with ADHD-only are impaired on executive functions, on the

other hand children with reading disability are impaired on phonological

processing. Against this backdrop, reading and comprehension troubles of

ADHD children can be interpreted as a function of impulsivity,

inattentiveness, deprived organization deprived automatization,

inefficient word recognition, and limited or inconsistent focus of

attention. In literature, the highest level of cognitive deficit is reported

to be evidenced in achievement of demanding tasks which require slow-

processing. According to the research reports, cognitive functions of

these children improve by methyphenidate (MPH) treatment. Although

children with ADHD have academic problems, they do not necessarily have

deficits on objective measures of reading. Still, there is high rate of ADHD in

reading disability samples suggesting either a common

etiology or a directional progress originating from reading disability and

expressing as ADHD symptoms in an important percent of cases. While the

probability of ADHD emergence in children with reading disability is very high,

twin studies yield no proof for genetic association. Therefore, these disorders

are treated as they are genetically unrelated

(Pennington, 1991).

Several researchers investigated whether poor motor control in children

with Attention-Deficit Hyperactivity Disorder (ADHD) was

associated with a state regulation deficit. With respect to attention capacity

it appears that when reaction time attention tasks are short, and when

administered under supervision, ADHD children are able to split their

attentional assets between concurrently presented difficult items (Meere and

Sergeant, 1987), to center their attention, and to

overlook unrelated stimuli in order to better process relevant stimuli

(Meere and Sergeant, 1988a), and to obtain definite learning abilities

spending no more time than their cohorts (Meere and Sergeant, 1988b). As

soon as tasks are striking, ADHD children can sustain attention for more than

36 min in paced (Meere and Sergeant, 1988c), and in self-

paced CPT conditions (Meere et al., 1991). Conversely, when tests are

extremely uninteresting, especially when there is nobody to watch over,

ADHD children cannot sustain attention for even a very short period.

More recently, Börger and Meere (2000), tested whether poor motor

control in ADHD can be explained better in terms of a state

regulation deficit frame. They explored state regulation using cardiac

measures of ADHD children, because these measures are less sensitive to

characteristic behaviors of ADHD children (body and eye movements) than

electrocortical measures. They found that a slow presentation rate of stimuli

brings the ADHD child in a non-optimal activation state. Steer, Kumar, and

Beck (2001) also indicated the presence of state regulation deficit in the

ADHD children. In their study, children were not able to

adapt their actual activation state (measured in reaction time) towards

the presentation rate of the stimuli. The ADHD children were not able to

adjust their activation state towards the task demands, with poor

response inhibition as a result. They concluded that ADHD is

associated with a poor readiness to respond. Lastly, Siklos and Kerns

(2003) found that children with ADHD do not have problems with

retrospective memory; rather, the ADHD children appear to have a

specific deficit in monitoring their ongoing behaviors and generating useful

strategies for task completion. Their findings support the

hypothesis that impairments in strategy generation, strategy

application, planning, and self-monitoring may be the primary deficits in

children with ADHD.

Teenagers showing symptoms of ADHD are commonly diagnosed with

comorbid psychiatric disorders, such as major depression,

anxiety, and impulsive disorders (Milberger, Biederman, Faraone,

Murphy, Tsuang, 1995). Biederman, Mick, and Faraone (1998) have

stated that symptoms of depression are often associated with symptoms of

ADHD. What is more, quite a few of the decisive factors for ADHD

are also standard for other psychiatric abnormalities. In the Diagnostic and

Statistical Manual of Mental Disorders (DSM-IV; APA, 1994), a

“diminished ability to think or concentrate, or indecisiveness, nearly every

day” is reported to be one of the nine criteria for a major

depressive episode (MDE), and “often has difficulty in sustaining attention in

tasks or play activities” is reported to be one of the 12 criteria for ADHD

(Steer, Kumar, Beck, 2001).

Children with learning disabilities (LD) and behavioral problems

such as attention deficit/hyperactivity disorder (ADHD) have often been

perceived as having trouble with interpretation of social cues which

hardens the acquirement of social skills (Nabuzoka and Smith, 1995).

Stormont (2001), in her research report on social outcomes of research on

children with ADHD put forth that children with hyperactivity prefer to use

aggressive ways for managing states of affairs and have more

difficulty acclimatizing their attitudes according to varying roles and

settings. They may not be familiar with how to handle social situations, and

may also have problems generating the fitting behaviors in

changing circumstances. Stormont notes that social knowledge and

production problems are further compounded by research that has found

that children with ADHD appear to overestimate their social

abilities and attribute social successes and failures to external factors.

Therefore, these children also have problems during social interactions

with peers. Sprouse, Hall, Webster and Bolen (1998) found that

students with LD/ADHD do not misperceive nonverbal social cues

significantly more often than their regular education counterparts. Yet, they

are rated as less socially perceptive by their teachers. Keefe

(1988) suggests that social incompetence may be either a skill deficit, a performance

deficit, or a self-control deficit (Sprouse et al., 1998).

Therefore Sprouse and his colleagues indicate that children with ADHD might

be perceiving nonverbal social cues correctly, but having more

difficulty maintaining a sequence of correct behaviors and adapting those

behaviors to changing situations. They put forth that social

perception ability may be available to these children, but there might be a

performance or self-control deficit in applying their perceptions

effectively (Sprouse et al., 1998).

To summarize the results, in light of Leimkuhler’s (1994)

observations, cognitive and clinical presentation of adult ADHD has

been organized into nine categories: attention/concentration problems,

difficulty organizing and planning, heightened physical and mental

activity, disinhibition of impulses, problems initiating desired behaviors,

learning and memory problems, abstract reasoning, social and

interpersonal problems, and mood instability. Because when these children

with ADHD grow into adults with ADHD, they show hasty

decision-making, poor decisions and recklessness. Hence, people with ADHD

demonstrate abnormally more car crashes, quarrels, bodily

damages, lackadaisical expenditure, unsuitable utterances,

interpersonal irritation and bad temper (Leimkuhler, 1994).

 MULTIPLE ROUTES TO ADHD: GENETIC AND ENVIRONMENTAL

FACTORS

The detailed presentations by many researchers powerfully hint that

ADHD runs in families. Evidence from molecular genetic studies

has demonstrated precise genes that might be implicated in the etiology of

hyperactivity. Even though facts for genetic effect on hyperactive

behavior are well-built, there may be multiple pathways which are

proposed to lead to the development and maintenance of hyperactive

symptoms (Sam Whalen and Henker, 1999). Further research on social and

interpersonal aspects of the disorder as supplement to ones

looking into the biological and cognitive nature of ADHD is thought to

clarify those pathways. Numerous epidemiological studies have pointed

toward an important association between incoherent parenting styles

and childhood hyperactivity (Jacobvitz and Sroufe, 1995). In some children,

biological-genetic factors may act together with family

atmosphere variables in shaping the progress of hyperactivity, while in other

cases psychosocial variables may play a primary role. For

instance, Carlson, Jacobvitz, and Sroufe (1995), in a longitudinal study of 191

children from birth to 11 years, found that maternal intrusive

care and overstimulation assessed at 6 months and 42 months

respectively, significantly predicted children’s subsequent risk of

hyperactivity during middle childhood. Thus, the role of parental child-

rearing practices in the growth and continuation of children’s

externalizing behaviors has been the focal point of an extensive body of

research.
 Parenting stressors may be of extraordinary significance

concerning their likely effect on parent, child, and family functioning.

These outcomes include the progressive change in parenting styles that may

increase negative child behavior, increased levels of perceived

stress, increases in parental psychopathology, and strained marital

relationships, as well as other possibly negative outcomes (Johnson

and Reader, 2002). Because mothers are generally more occupied with

caregiving, it is hypothesized that parent anxiety and depressive

symptoms would be more marked and have larger bad effects in

mothers compared to fathers (Kashdan, Jacob, Pelham, Lang, Hoza,

Bulumenthal, Gnary, 2004). Kashdan et al. (2004) established that parental

anxiety was negatively related with Parental Warmth and

Positive Involvement, Intrusiveness and Negative Discipline, and Social

Distress. Sex of parent moderated the effects of parental anxiety on

Parental Warmth and Positive Involvement such that only for mothers did

greater anxiety cause less Parental Warmth and Positive

Involvement.

As regards the reasonable impact of ADHD related stress on the family,

studies have shown that mothers of children with ADHD have

higher rates of psychological difficulties (Fischer, 1990) and seek

treatment for personal psychopathology significantly more often than mothers

of normal children (Gillberg, Carlstrom, Rasmussen, 1983).

High levels of everyday parenting hassles have been shown to link with poorer

life satisfaction, more negative mood and affect, and increased maternal

distress (Crnic and Acevedo, 1995). If the mother of the ADHD child does not

acknowledge the validity of the diagnosis, denial is often

a concern for handling. As reported, mothers usually attribute the origin of the

problem to the people (e.g., psychologist, counselor, or teacher) they deal

with, to child’s diet and eating habits, or to other grounds

which may bring an explanation to their children’s’ disability (Barkley,

1991a). Besides, parental psychopathology, marital conflict, and

negative life events have also been allied with child behavior problems either

directly, or indirectly, as end results of their upsetting influences on parenting

(Campbell, 1995).

Facts and figures imply that the incidence of ADHD in children is

coupled to certain extents with family and marital functioning disorders, upset

parent–child interactions, definite models of parental cognitions

about child behavior and reduced parenting self-efficacy, and increased levels

of parenting stress and parental psychopathology, mainly when

ADHD is cooccuring with conduct problems (Collett, Gimpel, Greenson,

Gunderson, 2001). According to Segal (2001), the mother, who needs her

child as a selfobject to bolster her own fragile self, will surely

require more from the therapist as she takes care of her ADHD child.

Segal contends that some of these mothers may respond with temper if the

child can not meet their expectations, countering with verbal or

physical abuse. Some psychologically weak mothers may be incapable to form

a self object tie with their children, which cause their bodily and emotional

neglect of these children. Strain between mothers and their

husbands may also start and increase. Conversely, Segal explains that if the

husband looks like an adult with ADHD (thinking of the genetic

transmission of ADHD), a conversation over this likelihood may allow the

wife to be more empathic. The wife may empower the husband to

have his condition diagnosed and, entertain the assistance derived from medication and

therapy. Really, family studies have found an

augmented incidence of ADD/ADHD in the genetic relatives of

ADD/ADHD probands (Biederman et al., 1992). After the ADHD child is born,

the mother’s attachment with the child may block the time and

energy previously going to her husband and he may react with rage.

Consequently, the husband, who has ADHD himself and is dependent

on the organization provided by his wife, may feel disjointed without her assistance

(Segal, 2001).

Family studies explore the amount of phenotypical similarity genetically

related individuals demonstrate. If there is no likeness

between family members on a particular characteristic, genetic factors do not

influence the phenotypic discrepancy on the trait (Kuntsi and

Stevenson, 2000). Zahn-Waxler, Schmitz, Fulker, Robinson, and Emde (1996)

established that between 56% (father report) and 72% (mother

report) of the divergence in the Attention Problems subscale for a group of 5-

year-old twins was due to genetic reasons.

In their study, Keown, and Woodward (2002), examined the

quality of parent–child relationships and family functioning of preschool

children with early onset hyperactivity by comparing a community

sample of 33 pervasively hyperactive preschool boys with a comparison

sample of 34 boys. Mothers and children were assessed at home on a

range of interview, parent questionnaire, and observational measures of

parenting and family functioning. Results of the study showed that

higher rates of reported lax disciplinary practices, less efficient parental

coping, lower rates of father–child communication and less synchronous

mother–child interactions were significantly associated with

hyperactivity following statistical adjustment for the effects of conduct

problems and other confounding factors. The best parenting predictor of hyperactivity

was maternal coping. Keown and Woodward’s findings

(2002) suggest that the way in which parents interact with their

preschool children may make a unique contribution to the development and

ongoing behavioral difficulties experienced by children with

pervasive hyperactivity. Results of their study also emphasize the

function of fathers in the behavioral development of boys with early

inclination to hyperactive and distractible conduct problems. Nigg and

Hinshaw (1998) reported that, weighed against non-ADHD boys, boys with

ADHD and comorbid antisocial behavior identification had fathers with

poorer Agreeableness, higher Neuroticism, and a greater

probability of Generalized Anxiety Disorder

Present findings seem steady with the view that the negative

behaviors of children with ADHD are able to elicit negative parenting

behavior (Johnson and Reader, 2002). Interruption in positive parenting gives

the impression of a sound basis for escalations in negative child behaviors

(Barkley, 1998) which may promote parent tension. A vicious circle may

follow in which parent and child equally bring forth mutual

negative behaviors, culminating in both increased tension and

unpleasant influences on both parent and child lives (Webster-Stratton, 1990).

The researches presenting the consequences of child Disruptive Behavior

Disorder (DBD) on parenting behaviors, and those discovering how parental

behaviors exacerbate child DBD indicators (Klein and

Mannuzza, 1991), also imply that there are recursive loops between child

and parent behaviors.

In his “coercion theory” Patterson (2002) describes a multistep

family process called “coercion training” that occurs recurrently in

families of aggressive boys and that includes escape-conditioning

contingencies. The first step is an aversive intrusion of the parent which is

classically a slight one, such as a mother’s reproach for the child’s

untidiness. The second step includes retaliation by the child, through disagreement,

shouting, crying, or protesting about the parent’s

command. The third step, the parent’s reaction to the child’s coercive

attempt, critical. If the parent does not insist on the command, the child is

rewarded for his coercive behavior. The problem with this step lies in the

behavioral catch intrinsic to negative reinforcement. The catch here is due to

the fact that coercion works in only for a short period and

shows the way to disturbing long-effect products.

In the short period, a coercive response efficiently ends the conflict. In

the long period, the probability of coercive behavior in

following conflicts is increased. At the fourth step, the child stops the attack,

and the parent is reinforced for her or his patronage. In this

way, both parent and child reinforce each other in the use of coercive

strategies. These reinforcements raise the probability that the coercive mutual

behaviors will be repeated in future exchanges. Not simply will

the maladaptive exchange be continual; as the interaction sets enhance in

length and antagonism, it may also escalate (Patterson, 2002).

Prospective outcome of the coercive training the young child receives at home

is enormous social skills and school deficits.

 Mash and Johnston (1982) tell about the field studies in which it is

observed that negative mother–child interactions of hyperactive children are at

their worst during the infantile years. The group predominantly

susceptible to the impacts of maladaptive parenting is preschool

children, because of their reliance on parents for daily management and

emotional back up (Campbell, Pierce, Moore, et al., 1996). Theoretical models

of psychopathology inclination in young children have

underscored the function of parenting and family related factors at the

emergence and perseverance of child behavior problems (Campbell,

1997). Consecutively, parallel studies revealed significant links

between child behavior problems, and an array of negative parenting

behaviors involving cruel, castigatory, and inconsistent parenting

attitudes (Campbell, 1995); coercive parent–child interactions

(Patterson, 1982); and maternal negative control (Campbell, 1997).

Inadequate positive parenting behaviors such as maternal care and

sensitivity embodied in the terms “responsiveness” (Shaw, Keenan,

Vondra, 1994) and “positive involvement” (Gardner, 1994) have also been

concerned with the appearance and continuance of infantile and nursery

years behavior problems.

The extent of parental warmth, responsiveness, positive

involvement, appropriate limit setting, and the use of proactive parenting

strategies such as reasoning and explanation are very

important for the development of ADHD children (Kochanska, 1991).

Segal (2001) underlines the importance of monitoring, the process of

watching or checking a child, as an ongoing component of the mother’s work

because of the child’s extreme distractibility. She says that much

of the time the mothers had to be hypervigilant; while at home, they had to

guard that the child was doing what he/she should have been doing, whether

preparing for school or for bed. Crnic and Acevedo (1995)

highlight “daily parenting hassles,” and describe them as routine

caregiving and childrearing responsibilities that parents may, in the form of

chronic demands, find irritating, frustrating, annoying, and distressing.

Formally classified under the heading of Disruptive Disorders of

Childhood (APA, 1994), children with ADHD vary in the degree to which their

behaviors are experienced as disruptive or place excessive stress or caretaker

burden on parents or others in their environment. The

stress experienced by parents of children with ADHD does not result solely

from dealing with the symptoms of inattention, impulsivity, and activity level

but also from the other demands placed on parents as a result of child problem

behaviors. Therefore, parents of children with

ADHD are obliged to tackle with complaints of teachers regarding their child’s

naughtiness and disobedience, they often have to apologize for their child’s

misbehavior from others, they are almost always limited

concerning their social affairs since it is very hard to get a stable

caregiver, they are usually absent from work to visit doctor's office, and they

frequently get upset about the likelihood of an unintended injury to their child

as a result of his/her impulsiveness. These represent only a

few of the daily hassles that are commonly related by parents of

children with ADHD.

Parents of children with Disruptive Behavior Disorder also have

troubles in their emotional relationships, occupations, and public affairs

(Johnston and Mash, 2001), since it is very hard to fulfill other positions while

also serving as a parent. These parents may have more

arguments and endorse more castigatory discipline and management tactics

than corresponding parents of normal children (Barkley et al., 1991). It is

suggested that parenting behavior may play an important role for ADHD

children. While many investigators do not believe that parental discipline

plays a huge etiological role in the progress of

ADHD for each child (Barkley, 1998; Whalen and Henker, 1999), discipline is

considered to play a crucial role in controlling ADHD

symptoms and in contributing to the development of ODD and conduct

disorder among ADHD children (Barkley, 1990; Whalen & Henker,

1998). It is reported that observational studies have found differences between

parents of ADHD and non-ADHD children and poor parenting behavior is

most marked between parents of ADHD children with

comorbid ODD (Harvey, Danforth, Ulaszek, and Eberhardt , 2001).

Correlations between parental discipline styles and children’s ADHD

behaviors are statistically significant but reasonably small in size

(Collett, Gimpel, Greenson, Gunderson, 2001). There is a more

powerful relationship between parental “Overreactivity” and ADHD

behaviors than parental “Laxness” and ADHD behaviors (Collett et al., 2001).

Another study shows that cruel, whimsical, and incoherent

parental discipline, parental monitoring, and child antisocial behavior are

vastly correlated (Patterson, 1982). The efficacy of parent training programs

that focus on discipline of ADHD props up the vital role of

discipline in managing ADHD symptoms and allied behavior problems

(Harvey et al., 2001).

 Parent and children characteristics may have a straight influence on

children’s externalizing behavior problems. However, as expressed earlier, it

may also be arbitrated by the parenting practices (Hill, 2002).

Moreover, parenting disciplinary practices take shape according to

parents’ education level. It is well-documented that parents who did not

complete high school self-reported their involvement in more

dysfunctional parenting behaviors than those parents who had

graduated from high school or gone to college (Collett et al., 2001).

Recent literature offers ample evidence that there is a substantial

relation between dysfunctional parenting practices and the development of

conduct problems in children (Patterson and Fisher, 2002). Lower

parental educational level has been linked to increased child behavior

problems (Fox, Platz, Bentley, 1995) and thus, low parent educational

standing may be seen as a real risk factor for a variety of difficulties.

According to these studies, negative (i.e. harsh, authoritarian)

discipline by parents is correlated with behavior problems in children

(Patterson, 2002). According to Patterson (2002), disrupted parenting practices

lead to the production of antisocial behavior which is also

seen in children with ADHD.

As a summary, theory and research findings superimpose on that the

heterogeneity of ADHD hints at the presence of multiple causal

routes, with genes and environment interacting in a huge number of ways to

manufacture the behavioral silhouettes of the disorder.

Contained by this developmental agenda, numerous researchers

suggest that the most common pathway to ADHD development is one in which

children are born with a genetic, or perhaps hereditary tendency

to ADHD. This tendency is seen as comparatively strong, but many

other researchers agree that genetics is hardly ever the only cause of ADHD

considering mono-zigot concordance rates which do not

approach 100% (Faraone et al., 1998; Kuntsi and Stevenson, 2000) and up to

50% of children with ADHD do not show the inborn biological

abnormality (Swanson et al., 1998). Therefore, even if a child seems to have a

considerable genetic tendency for ADHD, family environment

should not be overlooked in estimating the progress, expression, and effects

of the disorder. The nerve-racking, challenging, and pushy

nature of the ADHD child are likely to stir up negative reactions from other

family members and to exert a disruptive influence on family

interactions and on the psychology and mood-state of parents. Of

course parents’ education level assists greatly in the configuration of a

coercive, recursive, and negative interaction loop.

The significance of daily parenting stress is all-agreed especially in

grasping how the families of children with ADHD runs, since parents of

children with this disorder often have to deal with problematic

behaviors with perseverance for years long and also much more

strongly than families having normal children. Therefore, the more

severe the hyperactivity of children the more their parents likelihood is to

look for psychological, medical, and therapeutic help (Gillberg et al., 1983).

Because parenting lies at the heart of developmental approach

to child psychopathology, superior concern needs to be allotted to a

broader spectrum of parenting behaviors and their probable donation to the

emergence and continuation of children’s hyperactive behavior

problems. Undue intensity of parental aggression and overcontrol has

constantly been shown to worsen psychiatric symptoms and perceived stress

in children and adults equally (Coiro and Gottesman, 1996).

Finally, it must be remembered that ADHD may represent a shared genetic

risk among family members, father, mother, and other family members may

also have undiagnosed ADHD.

PARENTAL PSYCHOPATHOLOGY AND TRANSGENERATIONAL

PARENTAL DISCIPLINE

There is converging evidence that for many individuals, abnormal

behaviors can be sketched at least back to the preschool years and

conceivably to earlier times. Not considering the age of first

appearance, the coexistence of diverse behavior problems is more probable to

come out of a developmental pathway. This pathway is

reported to be underlined by a risk diathesis that is embedded within a risky

environment where the children are brought up (Fitzgerald,

Puttler, Mun, Zucker, 2000). In line with this hypothesis, Moffitt (1993)

suggested that severe and stable antisocial behavior begins

etiologically with malformations in fetal brain development and exhibits itself

with difficult temperament during infancy and early childhood.

According to this view, early physical manifestations of disturbing

behaviors are aggravated by family milieus that are characterized by

intergenerational transmission of difficult temperament, antisocial

behavior, low cognitive functioning, poor parenting practices, and poor family

economic resources (Moffitt, 1993).

Mun, Fitzgerald, Eye, Puttler, Zucker, (2001) investigated

whether the relationships between dimensions of early child

temperament and externalizing and internalizing behavior problems differ in

relation to the degree of parental psychopathology to which

children are exposed. A sample of 215 boys (mean age 4.22) and their parents

were assessed when the boys were 3–5 years old and again

when they were 6–8 years old. If the parents had a life-span history of at

least two psychopathology diagnoses, their children were found to display

extreme activity, short attention span/distractibility, and high

reactivity, symptoms allied to externalizing behavior problems, whereas

withdrawal was connected to internalizing behavior problems. If children come

from low parental psychopathology families, only reactivity was

connected to externalizing behavior problems, and again withdrawal was

connected to internalizing behavior problems. Interestingly,

children from high parental psychopathology families such as

alcoholism and antisocial personality disorder displayed lower stability

(autoregression) estimates of behavior problems. If at least one parent had

alcoholism and/or antisocial personality disorder, developmental

risk for children escalated significantly.

In summary, this study (Mun et al., 2001) showed that children in

families having higher parental psychopathology were found to be more

distractible and reactive in comparison to the children in families having lower

parental psychopathology. These findings indicate that the

relative hazards of risky temperament, especially externalizing and

internalizing behavior problems, in children are hidden in risky familial

rearing environments characterized with high parental psychopathology. Obviously,

child temperament, externalizing and internalizing behavior

problems, and parental psychopathology are found to be highly

interconnected.

Mun et al. (2001) interpret their findings from a transactional

perspective, emphasizing that the early relationships between

temperament and behavior problems are strengthened for children with parents

who are high in psychopathology, especially when the

exacerbating and intensifying role of interactions between child and family

related variables on the potential outcomes are taken into

consideration.

Study of Brook, Zheng, Whiteman, and Brook (2001) established that

maternal rearing served as a mediator for parental aggression but

parental aggression has also a direct effect on toddler aggression. They interpreted

defiance and anger of children as a function of negative

affect provided by mothers who are high in negative emotionality and

disagreeableness. These mothers reported using more power-assertive and less

nurturing parenting behaviors, giving way to less secure

attachment, more behavioral problems, and lower internalization rules in

their children. In a previous research, when mothers reported more negatively

authoritative parental behaviors, child aggression and

behavior problems among difficult-temperamental male toddlers were

observed (Rubin, Hastings, Chen, Stewart, McNichol, 1998). These two

studies confirm the mutually exacerbating relationships between child

temperament and familial/environmental factors, demonstrating that

parenting practices modify the bond between child temperament and

development of psychological and behavior problems. Therefore,

parental psychopathology is unarguably expected to have dire effects on the

cognitive and behavioral development of child.

Confirming the previously related results, Wong, Zucker, Puttler, and

Fitzgerald (1999) found a stronger association between risky

temperament and externalizing behavior problems among 3 –5-year-old

children of high parental psychopathology, supporting the idea of

parental psychopathology as a moderator between child risky

temperament and externalizing behavior problems.

Previous experiences of harsh corporeal chastisement coupled with the

desire to conceal or not to confess that offensive record right after it took

place, in addition grown-up attitudes about physical

discipline were correlated with opting for more punitive disciplinary policies

as soon as individuals confront with wrongdoings of their

children. Now, established evidence shows that physical disciplinary

strategies employed by parents towards their children causes important health

and social problems in those children, since physical abuse does not only give

rise to severe damage of the body, it may also be a

causal aspect of child antisocial behavior and violence (Knutson and

Schartz, 1997).

The transgenerational hypothesis of maltreatment in explaining the

etiology of psychopathology in children has attracted the attention

of a lot of scientists. Approximately thirty years ago, the impression that

physical abuse might be transgenerational had attained almost manifest status,

gathering confirmation from numerous research findings

(Baldwin and Oliver, 1975; Justice and Justice, 1976).

Transgenerational delegation of physical mistreatment was measured to

approach 30% (Zaidi, Knutson, Mehm, 1989), whereas it did not mean that

physically abused children would turn into the physically abusive parents in

the next generation. Nonetheless, even 30% transmission

rate is not negligible. Even if shared biological or familial factors could

underlie transgenerational persistence (DiLalla and Gottesman, 1991),

evidence supporting social learning view, whereby vicarious learning of the

abusive disciplinary practices of one’s parents is recognized to be of chief

significance in the transgenerational hand-over of abusive

discipline, is present (Muller, Hunter, Stollak, 1995). A corollary of this

hypothesis states that parents who adopt transgenerational abuse

behaviors have unswerving personal norms and attitudes that fail to

accept the incongruity of severe physical discipline with good parenting.

Bower and Knutson, 1996 report that subjects are less likely to label

specific disciplinary events as abusive if they reported having actually

experienced those events themselves.

The research study by Bower-Russa, Knutson, and Winebarger (2001)

was designed to assess attitudes toward specific forms of

physical discipline as a function of childhood disciplinary histories and in the

context of specific disciplinary tasks. Bower-Russa et al. (2001) measured

attitudes toward discipline, and related disciplinary histories to disciplinary

preferences. They used several attitude scales that

require subjects to specify the degree to which they view disciplinary events

(such as hitting a child with a belt) as harsh, inappropriate

(abusive), and ineffective. The scores were examined taking into

account the respondents’ self reported childhood experiences. A video analog

measure of attitudes was added to present a more life-like

depiction of parental behaviors to which participants could respond. The

findings showed that experience of physical maltreatment creates a

positive attitude toward its application. As a consequence, the results of the

study confirmed that the experience of severe physical discipline

during childhood can increase approval of bodily damaging disciplinary acts

in adulthood.

ASSESSMENT OF ADHD, PARENTAL BEHAVIOR, AND

TRANSGENERATIONAL DISCIPLINE STYLE

An assessment of ADHD is possible with interviews, rating scales, observations,

psychological and educational testing, and a medical

evaluation. Psychological tests such as cognitive tests or achievement tests

may be used in the identification of comorbid disorders (e.g.,

learning disabilities), but are not suitable especially for the evaluation

of ADHD (Gordon and Barkley, 1998). Neuropsychological tests such as continuous

performance tests may be used to reveal the main

symptoms of ADHD. Continuous performance tests typically measure

vigilance and sustained attention as well as impulsivity. These

measures can sort out children with ADHD and distinguish them from

children without ADHD. Additionally, they are sensitive to therapeutic

effects (Barkley, 1998). Yet, their ecological validity is not well-

documented (Landau and Burcham, 1996), and possible false negatives

endanger the establishment of its validity (DuPaul, Anastopoulos,

Shelton, et al., 1992). Therefore, along with other tests, it is

recommended that children suspected of having ADHD should obtain a

medical examination in the assessment process to provide a differential

diagnosis of ADHD from other medical conditions (Barkley, 1998).

Behavioral rating scales as derivatives of diverse versions of DSM keep

on being employed broadly as assessment instruments for the

assessment of children and adolescents (Barkley, 1990b; Cantwell,

1996). The indomitable weakness of an ADHD rating scale is that the

diagnosis is entirely subjective and often depends on the tolerance of the

observer. Behaviors perceived as hyperactivity by some, might be

seen within the standard limits. According to Barkley (1998) three main

targets in the assessment of ADHD are to discover the presence of

symptoms of ADHD and to exclude other potential disorders, to develop

prospective treatment policies, and to settle on whether any comorbid

disorders are present. In spite of the narrow usefulness of rating inventories

for identification (Hinshaw, 1994), as well as practical

problems common to their structure and related data analyses (Rowe

and Rowe, 1992a), advantages brought about by their use include ease of

administration and the ease of acquiring impressions of child

behaviors in home and school settings from a lot of adult respondents.

Rating scales are rather simple to manage, and are well-organized in terms of

time and cost. They supply normative data, which is useful in finding out

how much a child’s behavior moves away from his or her

cohorts and same-gender peers. Alternatively, in behavioral rating scales,

stress on negative identification at the cost of a more fair assessment adds to

the risk of harmful searches for pathology, not

considering its presence or absence. One more obvious shortcoming of many

accessible behavioral rating inventories is their duration.

Inventories of 30 or more items with multiple-response categories take

considerable time to fill. Prejudice and reporter bias are also important

difficulties. To neutralize these problems, it is usually best to have

manifold respondents (e.g., parent and teacher) to complete rating

scales during the assessment. However, low interrater reliability is also an

important problem (Mandal et al., 1999). Accord is usually low to

moderate among raters in dissimilar surroundings, however, multiple ratings

may be considered useful as they collectively provide more

information about a child than a single rating (Elliott, Busse, Gresham, 1993).

Concerning the above-mentioned disadvantages, it is a

disappointment that diagnosis of ADHD depends greatly on parent and teacher

reports owing to the fact that no laboratory tests dependably

spot out ADHD. Occurrence statistics of ADHD are susceptible to who is

asked what, and how information is pooled (Rowland et al., 2002). The

significance of getting ratings from parents has been underscored in a

review of connected study by McGee and Feehan (1991), who argued that

since occurrence estimates based on teacher ratings (but not

parent ratings) give in inconsistent intensity of inattentive and

hyperactive behavior in boys, there is increasing data to designate that

teachers fall short of perceiving inattentive behaviors if they do not

come about with upsetting and out-performing behaviors in the school setting

(James & Taylor, 1990). Given that such behaviors are more

probable to be exhibited by boys, teachers tend to ignore females and

exaggerate males who show inattentive-impulsive behaviors.

 In evaluation of behavioral problems, broad band and narrow band rating

scales can be used. With broad band scales the core dimensions of childhood

psychopathology, such as depression, anxiety, aggression, withdrawal,

inattention, and hyperactive-impulsive behaviors can be

measured. Narrow band scales zoom more in the symptoms relevant to the

disorder being assessed In initial diagnosis of ADHD, Barkley

(1998) recommends the use of both broad and narrow bandf scales.

There are several methods for assessing parenting behavior

(Collett, et al., 2001). According to Collett et al., one approach involves

having parents interact with their child in analogue situations including child-

directed play, parent-directed play, and parent-directed tasks.

Although such observations are helpful in appraising parent–child

relationships and monitoring changes over the course of parent training, these

procedures have quite a few limitations (Collett et al., 2001). In

particular, observational procedures can be long and costly.

Additionally, this method may be less useful in assessing practices of parents

of older children who tend to be more negatively responsive to observational

procedures (Shelton, Frick, Wooton, 1996). When the

limitations of observational techniques were taken into consideration,

several researchers decided to produce self-report measures to assess parenting

behaviors (Collett et al., 2001). Such tools have included a

small number of items in the past and were designed to assess parental

attitudes rather than straightly measuring parenting practices (Arnold et al.,

1993). Yet, precisely reliable self-report instruments have recently been

generated to assess parenting behaviors more directly.

 Information about childhood experiences, particularly parental

rearing behavior, is of importance in the clinical investigation of

psychiatric patients and in research. Regarding assessment among adult

individuals, it has the inadequacy that these data are solely

retrospective by nature implying the risk of various biases. An influence of

mood states, mostly depression, onto autobiographical memories has been well-

known in different studies on the background of mood

dependent recall. Richter and Eisemann (2002) found that reported parental

rearing behavior is constant even at the heart of significant

clinical changes, in severe depression and in more specific depressive

disorders.

Therefore, recollections of parental rearing behavior measured by self-

report scales are thought to be relatively reliable. Lundberg, Perris, and

Adolfsson (1999) conducted a study to investigate the perceptions of

remembered parental attitudes in different cohorts divided into four

age groups corresponding to various historical and cultural epochs, ranging

from those who had experienced World War I and the great

depression to those growing up in modern times. The results showed that

small but significant changes between the age groups have

occurred. In particular, a consecutive increase in the perception of

parents as emotionally warm and caring, and a consecutive decrease in the

experience of parental rejection, was found. The results verified the importance

of the historical cultural background in studies investigating factors which may

contribute to the development of individual

vulnerability. Lundberg, et al., (1999) stated that if the self-reports of

childhood rearing experiences were completely devoid of any overlap

with the actual conditions in childhood, then one would scarcely expect any

significant change in subjective experiences to occur in

transgenerational studies. This was not the case in their investigation.

For this reason, since the results appear sensible considering the

community changes that have occurred in Northern Sweden for the era during

their study, the authors propose that these results could be

assumed to attach validity to investigations of this kind in which self- reports

are employed.
 HYPOTHESES

1- The access motor activity in children with Attention Deficit /

Hyperactivity Disorder tends to subside by adolescence,

2- Level of attention deficit can be predicted by the presence of

comorbid disorders like learning disability, reading disability

calculation disability, and writing disability.

3- Hyperactivity level of boys is higher than of girls.

4- Higher rate of permissive parenting is associated with

hyperactivity. Therefore, more hyperactivity means more

permissive parenting. (The parenting attitudes of mothers and severity

of hyperactivity in their children with ADHD are

correlated).

5- Maternal life satisfaction can predict authoritative parental

behaviors.

6- Transgenarational parental attitudes can predict attention deficit and

hyperactivity levels of children with ADHD.

7- Parents’ lower educational level is positively correlated with

increased child behavior problems. Therefore, parents of children with

ADHD are expected to have low education.

 METHOD

Participants

Participants were 43 mothers with children who had been

previously diagnosed with ADHD. The mothers were recruited from a self-

help group serving the parents of children with ADHD. Target

children ranged in age from six to seventeen (M=11.19 years).

Approximately eighty percent (N=34) of the ADHD children were boys,

affirming the former studies which indicated a higher rate of ADHD in males

than females. The sample did not differ in socioeconomic status or ethnicity;

the ethnic composition of the overall sample was 39

German, 3 Austrian, and 1 Italian; all participants were representatives of

lower to middle classes. With respect to classification according to ADHD

subtype, twenty-three percent (N=10) of children were assessed by their

parents as predominantly inattentive, two percent (N=1) as

predominantly hyperactive, and seventy-five percent (N=32) as

combined. Approximately ninety-eight percent of the mothers (N=42)

reported having a partner, and ninety-five percent (N=41) of them were

married to the father of their child with ADHD. In the tables 1, 2 and 3,

information on the education levels, jobs, and life satisfaction states of the

mothers are provided.

Table 1
 EDUCATION
LEVEL Primary Secondary Technical University University
School School School Drop- Out Gr aduate Total

N 4 14 2 16 7 43

% 9. 3 32. 6 4. 7 37. 2 16. 3 100

Table 2

PARENT
JOB Free- Civil Self- House-
Jobless Employee Worker lance Servant Craftsman employee wife Total

N 1 25 1 2 1 2 1 10 43

% 2.3 58.1 2.3 4.7 2.3 4.7 2.3 23.3 100

Table 3

LIFE
SATISFACTION
OF MO THERS Satisfied Not- satisfied Total

N 29 14 43

% 67. 4 32. 6 100

Instruments

All of the children in the sample had received an official diagnosis of

ADHD before participation in this study. Mothers provided all of the

information regarding their children, their own parental styles towards their

children, and their remembrances about their parents’ parenting attitudes. In

structuring the questionnaire package, to prevent

exhaustion and attention distraction on the part of respondent mothers equal

number of questions representing each factor was included

instead of intact scales. Afterwards, the scales which had originally been in

English were translated into German by two psychology

students whose native languages were German, and who could

command English at an advance level. Later on, the translations and

originals were inspected for meaning concordance by the leader of self help

group, who is a psychologist with doctoral degree. In line with the information

above, the mothers completed selected portions of the

following scales independently.

1- ADHD-Symptoms Rating Scale. ADHD-SRS is a behavior

rating scale designed by Holland, Gimpel, and Merrell (1998) to

measure Attention Deficit Hyperactivity Disorder in the school-age

(grades up to 12) population. Holland et al., (1998) indicate that the

ADHD-SRS possesses strong internal consistency reliability, test-retest

reliability and moderate cross-informant reliability. Their data suggest

that the ADHD-SRS has strong content validity. Convergent validity of this

instrument was also reported to be high, as shown by correlations with three

previously validated behavior rating scales. Factor 1 is

named “Hyperactive-Impulsive” and Factor 2 is named “Inattention.” These

two factors and the items they include are quite similar to the two categories

listed in the DSM-IV for ADHD (Holland et al., 1998). The second page of

the survey package consisted in 28 questions of

this scale. The 1 st , 3 rd , 4 th , 9 th , 14 th , 15 t h , 16 t h , 17 th , 18 t h , 19 t h , 20 th ,

23 r d , 25 t h , and 27 th questions build up the Attention-Deficit factor. The rest

makes up the Hyperactivity factor. The original dichotomous

character of the scale which includes 0(does not happen at all) and

1(happens once to many times an hour) was endorsed.

2- Parental Authority Questionnaire-Revised (PAQ-R). PAQ

was originally developed by Buri in 1988 to measure parental styles

through retrospective adolescent ratings and revised again by Buri in

1991 and renamed PAQ-R. Buri’s 30-item instrument consisted of three 10-

item subscales measuring authoritative, authoritarian, and

permissive parenting styles based on Baumrind’s parenting style prototypes.

The PAQ appeared to have good internal consistency (range, .74 to .87) and

test-retest reliability (range, .77 to .92).

Additionally, PAQ scores did not reflect an inclination towards social

desirability response bias. Reitman, Rhode, Hupp, and Altobello (2002)

conducted a new study to assess the reliability and validity of the

parent self-report version of the PAQ-R. Overall, their results indicated a

modest reliability and validity. Psychometric characteristics of the

PAQ-R and its relation to other measures across diverse populations differed

from those hypothesized by Baumrind in several ways. Buri’s study (1988)

suggested that the factor structure of the PAQ-R is

influenced significantly by sample characteristics such as SES or

ethnicity or both (Reitman et al., 2002). Several items loaded on

unpredicted or multiple factors, particularly those items intended to

discriminate between authoritative and authoritarian disciplinary

practices. Reliability data were generally consistent with the results of

 the factor analyses. Two of the three scales of the PAQ-R have modest

reliability, with Authoritativeness demonstrating the lowest reliability in

lower SES, primarily African American samples. For the purpose of this

study, 12 questions were employed on the third page of questionnaire package.

Each factor was measured by 4 questions. The 1 st , 5 th , 8 th ,

11th questions formed the “Permissive Parenting” factor. The 2 nd , 3 rd , 6 th , 10 th

questions made up the “Authoritarian Parenting” factor. The rest four

questions are included under the “Authoritative Parenting”

factor. Original Lickert-type scale of 1(do not agree at all) to 5 (agree totally)

was protected. In the following table, Baumrind’s theory of

parenting styles on which PAQ-R bases is shortly presented.

Table 4

Parenting Styles (According to Baumrind’s Theory)

thoritarian Parent is high in control and maturity demands and low in responsiveness and communicati
thoritative Parent is high in control, responsiveness, communicati on, and maturity demands
rmissive Parent is low in control and maturity demands and high in communicati on and responsivene
3- Der Fragebogen zum erinnerten elterlichen

Erziehungsverhalten (FEE). Schumacher, Eisemann, and Brähler

(1999), developed the Questionnaire of Recalled Parental Rearing

Behavior (QRBRB), validated it and normalized it based on a large

German sample. FEE stems theoretically from the Swedish instrument called

“Egna Minnen Beträffende Uppfostan (EMBU),” an acronym for “Own

memories of upbringing”. EMBU is one of the most broadly

employed scales with satisfactory reliability and validity in a range of

psychopathological circumstances. By and large, the practices of

parental nurturing were examined by means of EMBU and

accompanying measures of psychopathology were looked into. It

encompasses 14 critical groupings attained by a far-reaching

exploration of the medical and experiential literature. These groupings are

“Abusive, Depriving, Punitive, Shaming, Rejecting, Favouring the siblings

over the subject, Overprotective, Overinvolved, Tolerant,

Affectionate, Favoring the subject over siblings, Performance oriented, Guilt

engendering, and Stimulating”. As reported by Lundberg and

Andersson (2002), Arrindell et al. (1983) carried out a large scale Dutch study

which gave in only four focal comprehensive factors which are

Rejection, Emotional Warmth, Overprotection, and Favouring subject, which

have turned out to be the accepted variables investigated in

subsequent studies. Then, as a part of an extensive international study, the

EMBU was translated into numerous languages and modified for

application in around 25 countries (Lundberg, Andersson, 2000 ).

Additional inspection of survey results in 14 countries demonstrated that

three of the four factors (rejection, emotional warmth, and

overprotection) acquired by Dutch study, holds intercultural stability. As a

result, only these three factors are employed nearly every time in

previous EMBU researches. The EMBU was publicized to contain the

facility to distinguish healthy subjects from patients suffering a variety

of psychological disorders. A serious assessment of the content validity of the

EMBU by Arrindell and van der Ende in 1984 confirmed that the concerns

considered to be significant for the appraisal of parental

rearing are agreeably enclosed by the questionnaire (Lundberg, Perris, and

Adolfsson, 1999). Items of the questionnaire are checked on four- point

scales.

QRBRB is based on EMBU and it was originally produced in German. It

is named “Der Fragebogen zum erinnerten elterlichen

Erziehungsverhalten (FEE).” The QRPRB assesses memories of alleged

parental rearing behavior independently for the father and mother,

although it can also be used for assessing parenting behaviors of only mothers

or fathers. It covers factor-analytically developed subscales of

a) rejection and punishment b) emotional warmth and c) control and

overprotection. The developers of QRBRB found noteworthy

associations between recalled parental rearing behavior and life

satisfaction, subjective body complaints, self-concept and interpersonal

problems (Schumacher et al., 1999).

The fourth page of the survey package used in the current study

consists in nine questions from QRPRB. The 1 st , 6 th , 11 th questions

build up the “Rejection and Punishment” factor. The 2 nd , 5 th , 7 t h

questions belong to the “Emotional Warmth” factor, and the rest fit in the

“Control and Overprotection” factor. The original 4 point scale of

QRPRB ranging from 1 (no, never) to 4 (yes, regularly) was employed.

Procedure

The questionnaire packages were presented to parents in three self-help

group meetings designed for parents of children with severe ADHD

symptoms. These meetings were directed by a psychologist

group leader having a doctoral degree. The group leader made an

explanatory speech each time the questionnaires were presented. Afterwards,

whenever there is problem on the side of respondent parents in

understanding the questions, the group leader brought

needed clarifications. Most of the time fathers did not want to fill in the questionnaires,

therefore in statistical analysis only the mother

responses were included.

RESULTS

1) The access motor activity in children with Attention Deficit /

Hyperactivity Disorder tends to subside by adolescence,

Because this alternative hypothesis calls for a classification of

children according to their age, firstly a median test was conducted

to divide children into older and younger age group. The median was 12

years. Therefore, the younger group was composed of the

children who are from lowest age limit 6 years up to the median 12 years.

The children between 12 and 17, the highest age limit made up the older

children group.

The mean scores of older and younger children on hyperactivity and

attention deficit subscales of ADHD-SRS were compared by an independent

samples t-test. The result confirmed the alternative

hypothesis: The younger children have more hyperactivity symptoms

compared to their elders, t (41) = -2, 40, p > .05. In addition, no

 difference between the means of attention deficit scores of older and younger

groups was found, t (41) =

-1.42, p > .05. To double check if child age and hyperactivity are really

connected variables, a bivariate correlation of Hyperactivity scores *

Child Age was run. The results indicated a significant

negative linear relationship at the .05 level, r= -.313, n= 43, p < .

05. Therefore, this alternative hypothesis is accepted.

Table 5

CHILD
AGE t- Significance
Number Mean df SD score (2-tailed)

>= 12 22 9.09 3.98

HYPERACTIVITY 41
SCORE -2.40 .021
< 12 21 11.5 2.83

ATTENTION >= 12 22 11.6 2.10

DEFICIT
SCORE 41 -1.42 .162
< 12 21 12.4 1.72

Table 6

Pearson
Correlation
Number (2-tailed) Significance

CHILD AGE 43

-.376* .013
HYPERACTIVITY 43
SCORE
2) Level of attention deficit can be predicted by the presence of

comorbid disorders like learning disability, reading disability

calculation disability, and writing disability.

The GLM Univariate procedure allows one to model the value of a

dependent scale variable based on its relationship to other

categorical variables. In this alternative hypothesis, attention deficit is the

dependent scale vaiable. In its operationalized form, the

attention deficit subscale scores obtained by each child with ADHD on the

ADHD-SRS questionnaire yield the dependent variable data

for Univariate tests. The other variables mentioned in the alternative hypothesis,

namely learning, reading, calculation, and writing

disabilities are categorical variables. They are either comorbid or not

comorbid with ADHD. The GLM Univariate procedure provides

regression analysis and analysis of variance for “attention deficit

level (dependent variable) * comorbid disorders (the factors)”. The

factor variables divide the population into groups, such as children

having ADHD comorbid with only writing disorder, children having

ADHD comorbid with writing, reading, and calculation disorder, or

children with ADHD having no comorbid disorder. Interactions

between these comorbid disorders as factors as well as the effects of

individual factors can also be investigated by GLM. Additionally, after an

overall F test has shown significance, post hoc tests can be used to

evaluate differences among specific means. Therefore, a

univariate analysis would give in the right test results for this

alternative hypothesis. The following tables show the mean and

standard deviation of attention deficit scores across 43 children (1 s t

 table); and the number of children having / not having each comorbid

disorder.

Table 7

Mean Standard Deviation Number

ATTENTION
DEFICIT 12 1.952 43
SCORES

Table 8

COMORBID
DISORDERS Learning Reading Calculation Writing
Disorder Disorder Disorder Disorder

Yes 28 14 12 28

No 15 29 31 15

Total 43 43 43 43

The results of Levene’s Test which investigated the null hypothesis that the

error variance of the attention deficit scores is equal across the six groups

depicted above, has shown that these groups did not differ from each other

significantly in terms of error variance,

F (11, 31) = 1,545, p > .05. Since, there is no reason to believe that the equal

variances assumption is violated; therefore, the alternative hypothesis was

not accepted.
 Table 9

F df1 df2 Significance

1,548 11 31 .165

Levene's Test of Equality of Error Variances

Dependent Variable: attention deficit scores

Design: Intercept+learning+writing+calculation+reading disorders

By the Tests of Between-Subjects Effects each factor in the model, plus the

model as a whole, is tested for its ability to account for

variation in the attention deficit scores. The partial eta squared statistic reports

the "practical" significance of each factor, based upon the ratio of the

variation (sum of squares) accounted for by the factor, to the sum of the

variation accounted for by the factor and the variation left to

error. Larger values of partial eta squared indicate a greater amount of

variation accounted for by the model factor, to a maximum of 1.00. In

the table below, none of the individual factors are statistically significant.
 Table 10

Mean Partial Eta

Factors df Square F Significance Squared

LEARNING 1 .556 .158 .694 .004

DISORDER

READING 1 .525 .149 .702 .004

DISORDER

CALCULATION 1 13.585 3.849 .057 .092

DISORDER

WRITING 1 2.878 .816 372 .021

DISORDER

In conclusion, the second alternative hypothesis is not confirmed by

statistical analysis.

3) Hyperactivity level of boys is higher than of girls.

To test this hypothesis, an independent samples t-test comparing the mean

hyperactivity scores of boys and girls was employed. The

independent variable of this hypothesis is child gender. The

dependent variable is composed of the scores each child got on

hyperactivity subtest of ADHD-SRS which was filled out by their mothers.

The result of t-test affirmed the alternative hypothesis. Boys were rated

by their parents as showing significantly more hyperactivity symptoms

than girls,

t (41)= -3.159, p < .01. To see whether boys also show more

attention deficit symptoms than girls, the mean attention deficit

scores of both genders were compared, as well. The corresponding results

indicated no significant difference,

 t (41) = .190, p >.05, showing that boys and girls having ADHD differ concerning the

type of cognitive and behavioral symptoms they

predominantly express. While boys are characterized more by the

predominance of hyperactivity symptoms (M=11.3), they do not differ from

girls in expressing attention deficit symptoms (M=12.0). Girls,

on the other hand, show much more attention deficit symptoms (M=12.1)

than hyperactivity symptoms (M=7.4).

Table 11

CHILD
GENDER Significance
Number Mean df SD t- (2-tailed)
score

girl 9 7.4 5.05

HYPERACTIVITY 41
SCORE -3.16 .003
boy 34 11.3 2.63

ATTENTION girl 9 12.1 1.45

DEFICIT
SCORE 41 .190 .850
boy 34 12.0 2.08

4) Higher rate of permissive parenting is associated with

hyperactivity. Therefore, more hyperactivity means more

permissive parenting. (The parenting attitudes of mothers and

severity of hyperactivity in their children with ADHD are

correlated).

Permissive parenting is operationalized in terms of the score each parent

obtained on the permissive parenting subtest of Parenting Attitudes

Questionnaire-Revised. Since both hyperactivity and

permissive parenting variables are composed of scores, correlation rather

than mean comparision should be computed. Therefore, a

bivariate correlation between mother-report child hyperactivity scores

and mother permissiveness scores was run. The result

indicated a very slight negative correlation, r= -.118, n= 43, p > .05.

This finding points to the fact that the frequency of hyperactivity behaviors

of a child with ADHD is not associated with permissive parenting attitudes of

his /her mother. Therefore, the alternative hypothesis is refuted.

Table 12

Pearson
Correlation
Number (2-tailed) Significance

PERMISSIVE
PARENTING 43
SCORE
-.118 .457

HYPERACTIVITY 43
SCORE

To test whether other parenting styles might have any direct link with hyperactivity

symptoms, two more bivariate correlations of

“Authoritarian Parenting Score * Hyperactivity Score” and

“Authoritative Parenting Score * Hyperactivity Score” were carried

out. No significant correlations were found between hyperactivity and

either authoritative, r=-.083, n= 43, p> .05; and authoritarian

parenting, r=-.068, n= 43, p> .05.

 Table 13

Pearson
Correlation
Number (2-tailed) Significance

AUTHORITARIAN
PARENTING 43
SCORE
-.068 .671

HYPERACTIVITY 43
SCORE

Table 14

Pearson
Correlation
Number (2-tailed) Significance

AUTHORITATIVE
PARENTING 43
SCORE
-.083 .600

HYPERACTIVITY 43
SCORE

Starting from the point that an interaction between levels of

authoritative, authoritarian, and permissive parenting attitudes a mother has

may have an effect on the hyperactivity and attention deficit levels of her

ADHD child, a General Linear Model Multivariate analysis was

computed for the model of interaction “authoritative* authoritarian*

permissive parenting.” The model is operationalized by grouping

hyperactivity and attention deficit scores of children with ADHD

according to the interaction of scores each mother obtained on each of authoritarian,

authoritative, and permissive parenting subscales of

Parental Authority Questionnaire-Revised. The results point at no

significant interaction effect which suffices to group the children into

meaningfully different levels of hyperactivity and attention deficit.

Altogether, these results indicate that it is not possible to predict the level of

hyperactivity and attention deficit a child with ADHD has just looking at the

parenting attitudes of the mother who raises that child.

Therefore, the effects of other factors other than “parenting style” on

the differential symptoms and differential symptom severity of children with

ADHD should be investigated. Below is the table showing the

results of Multivariate Tests. Only Pillai’s Trace was included in the

table, because there is evidence that Pillai's trace is more robust than the other

statistics to violations of model assumptions ( for a review,

please see Olson, 1974, or SPSS 12 th version tutorial). Pillai's trace is a

positive-valued statistic. Increasing values of the statistic indicate

effects that contribute more to the model. The multivariate statistic (Pillai’s

Trace Value= 1.853) is transformed into a test statistic (F=

.628) with an exact F distribution. The hypothesis (numerator=80) and error

(denominator=4) degrees of freedom for that F distribution are

shown. The significance value of the interaction is more than 0.05,

indicating that the interaction effect does not contribute to the model.
 Table 15

Multivariate Tests

Interaction
Variables Hypothesis Error
Value F df df Significance

AUTHORITATIVE
* Pillai’s
AUTHORITARIAN Trace 1.853 .628 80 4 .816
*
PERMISSIVE

Design: autaritative * autharitarian * permissive

5) Maternal life satisfaction can predict authoritative parental

behaviors.

This hypothesis is rejected, since maternal satisfaction or

dissatisfaction could not discriminate mothers’ scores on

authoritativeness subscale as significantly higher or lower,

t (41)= .059, p>.05. Calculations were also made investigating i f maternal

satisfaction can predict other two parental styles. The

results indicated that it can neither predict authoritarian parental style t

(41) = -748, p> .05, nor permissive parental style, t(41)=

.127, p>.5.
 Table 16

LIFE t- Sig.
SATI SFA CTION N Mean SD test (2 -
tailed)

AUTHORITARIAN nein 14 10.14 1.75

PARENTING -.748 .458
SCORE 29 10.72 2.63
ja

AUTHORITATIVE 14 16.00 1.56

nein
PARENTING .059 .953
SCORE 29 15.97 1.89
ja
14 10.29 1.49
PERMISSIVE nein .127 .900
PARENTING
SCORE 29 10.21 2.08
ja

6) Transgenarational parental attitudes can predict attention

deficit and hyperactivity levels of children with ADHD.

Two regression analyses were carried out to see if transgena-

rational parental attitudes expressed by the variables “rejecting,”

“overcontrolling,” “emotionally-warm” behavior scores measured by the

Questionnaire of Recalled Parental Rearing Behavior (QRBRB) can predict

attention deficit and hyperactivity scores of children. A stepwise linear

regression analysis revealed “rejecting parental

attitudes” as the only entered variable. The other two variables

representing emotionally-warm parental attitude and overcontrolling

parental attitude were removed. The regression was a very poor fit (R²=

14.9%), but the overall relationship was significant, F (1, 41)

=7.167, p < 0.05. The significance value of the F statistic is less than 0.05,

which means that the variation explained by the model based

on rejecting parental attitudes is not due to chance. R², the

coefficient of determination, is the squared value of the multiple

 correlation coefficient. It shows that about 15 % of the variation in

attention deficit scores is explained by the model. Below is the table

illustrating the summary results of linear stepwise regression

analysis:

Table 17

Entered Regression Residua

Predictor Sum of l Sum Regressio Residua
R² Squares of n df l df F Sig.
Squares

REJECTNG .149 23.808 136.192 1 41 7.17 .011

PARENTING

Dependent Variable= Attention-deficit Scores

Another linear regression was computed for hyperactivity. This time,

“enter” function was employed to include all three regressors, namely,

rejecting parenting, emotionally-warm parenting, and

overcontrolling parenting attitudes. The R² was found to be .053 for all

predictors. This means, all of these three predictors can predict only

5.3 % of the variation in hyperactivity scores. This is an absolute poor fit. The

F statistic (F= .729) confirmed that variation explained by the model may be due

to chance factors.

Finally, these analyses have shown that only rejecting

trasgenerational parental attitudes can predict the attention deficit

level. The other variables do not seem to be predictive value for either

attention-deficit, or hyperactivity scores.

 Table 18

Entered Regression Residual

Predictors Sum of Sum of Regressio Residua
R² Square Square n df l df F Significance
s s

REJECTING
OVERCONTROLLING .053 27.340 487.311 3 39 .729 .541
EMOTIONALLY WARM
PARENTAL STYLES

Dependent Variable= Hyperactivity Scores

7) Parents’ lower educational level is positively correlated with

increased child behavior problems. Therefore, parents of

children with ADHD are expected to have low education.

To test this hypothesis, two bivariate correlations were computed.

The results have shown that, contrary to the alternative hypothesis,

educational level is not correlated significantly with either

hyperactivity, r= -.208, n= 43, p> .05, or attention deficit, r= .009, n= 953,

p>.05, scores. Therefore, this hypothesis is rejected.

Table 19

Pearson
Correlation
Number (2-tailed) Significance

PARENTAL
EDUCATIONAL 43
LEVEL
-.208 .180
HYPERACTIVITY 43
SCORE
 Table 20

Pearson
Correlation
Number (2-tailed) Significance

PARENTAL
EDUCATIONAL 43
LEVEL
.009 .953
ATTENTION
DEFICIT 43
SCORE
 DISCUSSION

The American Psychiatric Association's Diagnostic and Statistical

Manual IV (DSM-IV) classifies ADHD as a childhood disorder of early

years of life. Yet, it includes numerous declarations concerning the

occupational life of ADHD adults, thereby giving criteria about the

diagnosis of adults with ADHD (Ball, Wooten, Crowell, 1999). The age of

onset is early (before age 7), lasts for 6 months or longer, and

exhibits itself in two or more surroundings. ADHD runs in families,

therefore if a family has a child with ADHD, it is highly probable that the mother

or father also expresses the symptoms and/or carries the genes for it. Aside

from these, the clinical diagnosis takes into consideration

the extent of functional impairment it causes at home, at school, or in leisure

time activity. Children with ADHD have short attention span,

poor inhibitory control, and an aimless restlessness. These

characteristics have been found to impair social, emotional, and

academic development (Semrud-Clikeman, Biederman, Sprich-

Buckminster et al., 1992). Because the children with ADHD today will

become the adults with ADHD tomorrow, with multiplied problems for

themselves and their environments, scientists try to identify the

potential causal variables which might be implicated in the emergence and

perseverance of ADHD symptoms.

Attention deficit is typically marked by a developmentally improper

attention span. Several variables influence ADHD children’s ability to

focus attention. These consist of, self-pacing, the form of feedback

presented to the child, situational characteristics, and the presence of within

task stimulation (Carlson and Rapport, 1989). While ADHD

children are more distractible by outside stimulation than normal

children, their performance worsens by irrelevant stimulation provided within

the task (Barkley, 1991b). They also feel great difficulty in

effortful, repetitive/sequential tasks such as reading, and writing.

Levine (1996) identifies troubles with attention as the most widespread cause

of learning and behavioral difficulties in school age children.

Although researchers from diverse areas come up with quite

interesting findings, the key opening all doors about ADHD has not been

found, yet. Certain pieces of knowledge well-established in

research of ADHD are, that as its name suggests, inattention and extreme

activity are the core symptoms of this disorder, that

significantly more boys are diagnosed with the disorder than girls, that the

symptoms of hyperactivity decrease as child becomes an

adolescent, and that both genetic and environmental variables play role in its

etiology and prognosis.

Concerning the effects of family atmosphere on ADHD, Johnson and

Reader (2002) stated that the stress-infusing, unsympathetic,

negative behaviors of children with ADHD easily elicit negative

parenting behaviors (Johnson and Reader, 2002). Contrary to Johnson and

Reader (2002), Whitmore, Kramer, and Knuston (1993) had come

up with different results. They contrasted the experiences of abuse and family

atmosphere of adult males who had been diagnosed with ADHD with that of

their non-ADHD siblings. Probands and brothers did not

vary in confessions of physical punishment, discipline, parental

rejection, or positive parental contact, nor did they diverge in their insight of

the general atmosphere of their home environments. The

findings indicated that neither the amount of hyperactive symptoms, nor the

extent of aggressive symptoms, and the interaction of the two was

related with the amount of physical punishment reported. According to

Whitmore and colleagues (1993), these data challenge the "scapegoat" or

"target child" hypothesis prevalent in the child abuse literature by

suggesting that punitive parenting may not be significantly controlled by the

behavioral characteristics of ADHD children. Against this picture,

plentiful epidemiological studies have pointed toward an important association

between inappropriate parenting styles and childhood

hyperactivity ( i.e., Jacobvitz and Sroufe, 1995). The results revealed that In

some children, biological-genetic factors may act together with family

atmosphere variables in shaping the progress of hyperactivity, while in other

cases psychosocial variables may play a primary role.

Harvey, Danforth, Wendy, Ulaszek, and Eberhardt, (2001)

examined the validity of a parenting scale for parents of elementary

school-aged children with attention-deficit/hyperactivity disorder

(ADHD). Parents from 109 families with children who had been

diagnosed with ADHD (106 mothers and 93 fathers), and from 70

families with non-problem children (69 mothers and 59 fathers) reported on

their children’s behavior problems. Results illustrated that

overreactivity and laxness scores were considerably elevated for mothers and

fathers of ADHD children than of non-ADHD children.

In spite of the extensive literature on ADHD, little has been

written about the effects of parenting and trasgenerational parenting on the

causes and course of this disorder in school age children.

Therefore, this thesis attempts at completing this vacancy to a certain

degree, with a survey study. This study investigated the possible

impacts of parental and grandparental child-rearing attitudes on the

differential history of causation and symptom-based identification of

ADHD. Additional hypotheses about the general nature of ADHD such as if

its incidence is really more frequent in boys compared to girls, if

hyperactivity fades with years but attentional difficulties persist into

adult life, and if comorbid disorders such as learning, writing, reading,

calculation disorders can predict the symptoms of attention deficit or

hyperactivity, were also investigated.

Cantwell (1996) reviewed ten years of ADHD studies and

described ADHD as a relentless problem that may change its

expression with growth from preschool through adult life. The first

hypothesis in the current study “The access motor activity in children with

Attention Deficit/Hyperactivity Disorder tends to subside by

adolescence” was confirmed by the results. The younger children in the

sample have demonstrated statistically more hyperactivity symptoms

compared to their elders. Additional analyses have indicated that there is no

difference between the means of attention deficit scores of older and younger

groups.

The second hypothesis “Level of attention deficit can be predicted by the

presence of particular comorbid disorders like learning disability, reading

disability calculation disability, and writing disability” was not

confirmed by the results. Most of the children with ADHD in this sample had

a similar set of these disorders; therefore the cooccurence of

particular impairments cited above could not help in differentiating the

children according to their attention-deficit and hyperactivity severity.

 The third hypothesis “Hyperactivity level of boys is higher than of girls”

was accepted, since boys were rated by their parents as showing significantly

more hyperactivity symptoms than girls. Boys and girls

having ADHD differ in the type of cognitive and behavioral symptoms

they predominantly express. While boys are characterized more by the predominance of

hyperactivity symptoms, they do not differ from girls in expressing attention deficit

symptoms. Girls, on the other hand, show

much more attention deficit symptoms than hyperactivity symptoms.

The fourth hypothesis “Higher rates of permissive parenting are

associated with hyperactivity. Therefore, more hyperactivity means

more permissive parenting. (The parenting attitudes of mothers and

severity of hyperactivity in their child with ADHD are correlated)” could not

find support. Correlation between mother-report child hyperactivity scores

and mother permissiveness scores indicated a very slight

negative correlation which points to the fact that the frequency of

hyperactivity behaviors of a child with ADHD is not associated with permissive

parenting attitudes of his /her mother. No significant

correlations were found between hyperactivity and either authoritative

or authoritarian parenting. A potential interaction between authoritative, authoritarian,

and permissive parenting attitudes on hyperactivity and

attention deficit levels of children with ADHD was also looked into, but the

results pointed at no significant interaction effect which suffices to

group the children into meaningfully different levels of hyperactivity and

attention deficit. On the whole, these results show that it is not likely to predict

the level of hyperactivity and attention deficit a child with ADHD has just

looking at the parenting attitudes of the mother who raises that

child. For that reason, the effects of other factors except “parenting

style” on the differential symptoms and differential symptom severity of

children with ADHD should be investigated.

Concerning the huge impact of ADHD related stress on the family;

studies have shown that mothers of children with ADHD have higher

rates of psychological difficulties (Fischer, 1990). Elevated amount of

parenting stress was revealed to relate with poorer life satisfaction,

more negative mood and affect, and increased maternal distress (Crnic and

Acevedo, 1995). To investigate whether life satisfaction results in more

positive parenting behaviors the fifth hypothesis “Maternal life

satisfaction can predict authoritative parental behaviors” was put forth.

Since maternal satisfaction or dissatisfaction could not discriminate

mothers’ scores on authoritativeness subscale as significantly higher or lower,

this hypothesis was rejected. Estimates of if maternal

satisfaction can predict other two parental styles were also made. The results

indicated that it can neither predict authoritarian parental style, nor permissive

parental style.

Hemenway, Solnick, and Carter (1994), report that in 1989, they

questioned a national, random sample of 801 adults about the

punishment they received as children and the way they discipline their own

offspring. Investigation revealed that verbal and physical

disciplines are usually used simultaneously. Parents who shout

habitually also beat regularly, and vice versa. Besides, both physical and

verbal abuse appears to be transgenerational. Respondents who

were yelled at commonly as they were children are more inclined to yell at

their own children regularly. In spite of this, most of the parents are
able to recover from their childhood experiences and do not participate in the

transgenerational cycle of punitive child rearing. This result may be found

chiefly among those who believe themselves to have been

abused by their parents.

As it was expressed in previous pages, the extent of parental

warmth, responsiveness, positive involvement, appropriate limit setting, and

the use of proactive parenting strategies such as reasoning and

explanation are very important for the development of ADHD children

(Kochanska, 1991). If parental disciplinary strategies are transmitted from

older to younger generations, and if the grandparents of children with ADHD

had employed rejecting and overcontrolling parental

strategies, rather than emotionally warm, proactive ones, then the

parents of ADHD children may have a more-than-normal potential to employ

such dysfunctional disciplinary practices. This may lead to

different symptom severity in children with ADHD. The sixth hypothesis

“Transgenarational parental attitudes can predict attention deficit and

hyperactivity levels of children with ADHD” showed that only “rejecting”

trasgenerational parental attitudes predicted the attention deficit level.

The other variables do not seem to be predictive value for either

attention-deficit, or hyperactivity scores.

Parent and children related variables may have a direct impact on

children’s externalizing behavior problems, such as ADHD. But,

externalizing behaviors may also be mediated by the parenting

behaviors (Hill, 2002). Furthermore, parenting behaviors develops

according to parents’ education level. It is established by research that parents

who did not complete high school self-reported their practicing

more dysfunctional parenting behaviors than those parents who had

graduated from high school or gone to college (Collett et al., 2001). The

seventh hypothesis “ Parents’ lower educational level is positively

correlated with increased child behavior problems; Therefore, parents of

children with ADHD are expected to have low education levels”

directed to further analyze this problem. Since educational level was not

found to be correlated significantly with either hyperactivity, or

attention deficit scores this hypothesis was not proven.

The study had a number of limitations. In particular, although subject

groups were clearly defined, the present study is based on a

relatively small number of mothers and children. These sample sizes limit

the precision of results and the statistical power of the tests.

Therefore, it is possible that some of the non-significant results may

reflect the limited statistical power of the study rather than an abscence of

association. The generalizability of the findings would also have

been improved with a larger and more representative sample of mothers and

children. More specifically, the sample in the present study was

almost limited to boys. Future studies also need to establish the extent to

which parenting is influential for hyperactive behavior problems in

girls, particularly given evidence for the effects of child gender on parenting.

Half of statistical analyses used here is correlational in nature and correlational

studies present little insight of how associations between

family factors and child problems develop over time. Replication of

these findings using a design that relies less heavily on parent report is also

needed. As noted in the method section, the majority of mothers

that participated in this study were German. Replication of these

findings with samples of greater ethnic diversity would be better for generalizability. It

is recommended that future research incorporate

normal children as control group. Future research should also include

measures of multiple respondents, from different settings. A final

cautionary note is about the underrepresentation of girls when the

different characteristics of girls and boys are taken into consideration.

Therefore, it is hard to make generalizations about family associations for the

two genders. Further studies which spotlight both parents and other family

sub-systems, including sibling interactions are called for.

 REFERENCES

American Psychiatric Association. (1994). Diagnostic and statistical manual of

mental disorders (4th ed.). Washington, DC: APA.

Ball, J., Wooten, V., Crowell, T. (1999). Adult ADHD and / or sleep apnea? Differential

diagnostic considerations with six case studies. Journal of Clinical Psychology

in Medical Settings, 6 (3).

Baldwin, J., Oliver, J. (1975). Epidemiology and family characteristics of severely-

abused children. British Journal of Preventive and Social Medicine, 29, 205–221.

Barkley, R. A., Fischer, M., Edelbrock, C., Smallish, L. (1990a). The adolescent outcome of

hyperactive children diagnosed by research criteria: I. An 8 year prospective follow-

up study. Journal of the American Academy of Child and Adolescent Psychiatry, 29,

546–557.

Barkley, R. A., DuPaul, G. J., McMurray, M. B. (1990b). Comprehensive evaluation of

attention deficit disorder with and without hyperactivity as defined by research

criteria. Journal of Consulting and Clinical Psychology, 58, 775–789.

Barkley, R. A. (1991a) Attention Deficit Hyperactivity Disorder. Psychiatric

Annals, 21 (12), 725-733.

Barkley, R. A. (1991b). The ecological validity of laboratory and analogue

assessment methods of ADHD symptoms. Journal of Abnormal Child

Psychology, 19 (2), 149– 178.

Barkley, R. A. (1997a). Behavioral inhibition, sustained attention, and executive functions:

Constructing a unifying theory of ADHD. Psychological Bulletin, 121(1), 65–94.

Barkley, R. A. (1997b). ADHD and the nature of self-control. New York: Guilford Press.

Barkley, R. A. (1998). Attention-deficit hyperactivity disorder: A handbook for

diagnosis and treatment (2nd ed.). New York:Guilford.

Biederman, J., Mick, E., Faraone, S. V. (1998). Depression in attention deficit hyperactivity

disorder (ADHD): “True” depression or demoralization? Journal of Affective

Disorders, 47, 113–122.

Biederman, J., Faraone, S. V., Keenan, K., Benjamin, J., Krifcher, B., Moore, C., Sprich-

Buckminster, S., Ugaglia, K., Jellinek, M. S., Steingard, R., Spencer, T., Norman, D.,

Kolodny, R., Kruas, I., Perrin, J., Keller, M. B., & Tsuang M. T. (1992). Further

evidence for family-genetic risk factors in attention deficit hyperactivity disorder.

Patterns of comorbidity in probands and relatives of psychiatrically and pediatrically

referred samples. Archives of General Psychiatry, 49, 728–738.

Bower-Russa, M., Knutson, J., Winebarger, A. (2001). Disciplinary history, adult disciplinary

attitudes, and risk for abusive parenting. Journal of Community Psychology, 29 (3),

219-240.

Brook, J. S., Zheng, L., Whiteman, M., & Brook, D.W. (2001). Aggression in toddlers:

Associations with parenting and marital relations. The Journal of Genetic Psychology,

162, 228–241.

Börger, N., Meere, J. (2000).Motor control and state regulation in children with ADHD: a

cardiac response study. Biological Psychology, 51: 247-267.

Campbell, S. B. (1995). Behavior problems in preschool children: A review of recent

research. Journal of Child Psychology and Psychiatry, 36, 113–149.

Campbell, S. B., Pierce, E. W., Moore, G., Marakovitz, S., & Newby, K. (1996). Boys’

externalizing problems at elementary school age: Pathways from early behavior

problems, maternal control, and family stress. Development and Psychopathology,

8, 701–719.

Campbell, S. B. (1997). Behavior problems in preschool children: Developmental and

family issues. In T. H. Ollendick and R. J. Prinz (Eds.), Advances in clinical child

psychology (Vol. 19, pp. 1–26). New York: Plenum Press.

Cantwell, D. P. (1985). Hyperactive children have grown up. Archives of

General Psychiatry, 42, 1026-1028.

Cantwell, D. P. (1996). Attention Deficit Disorder: A review of the past ten years. Journal

of American Academy of Child and Adolescent Psychiatry, 35 (8), 978-987.

Carlson, G. A., Rapport, M. D. (1989). Diagnostic classification issues in attention deficit

hyperactivity disorder. Psychiatric Annals, 19 (11), 576-583.

Carlson, E. A., Jacobvitz, D., & Sroufe, L. A. (1995). A developmental investigation of

inattentiveness and hyperactivity. Child Development, 66, 37–54.

Chhabildas, N., Pennington, B., Willcutt, E. (2001). A comparison of the neuropsychological

profiles of the DSM-IV subtypes of ADHD. Journal of Abnormal Child Psychology, 2

(6), 529-540.

Coiro, M., Gottesman, I. (1996). The diathesis and/or stressor role of expressed emotion

in affective illness. Clinical Psychology: Science and Practice, 3, 310–322.

Colett, B., Gimpel, G., Greenson, J., Gunderson, T. (2001). Assessment of discipline styles

among parents of pre-school through school-age children. Journal of

Psychopathology and Behavioral Assessment, 23 (3).

Collings, R. (2003). Differences between ADHD inattentive and combined types on CPT.

Journal of Psychopathology and Behavioral Assessment, 25 (3).

Crnic, K., Acevedo,M. (1995). Everyday stresses and parenting. In M. H. Bornstein (Ed.),

Handbook of parenting: Vol. 4. Applied and practical parenting (pp. 277– 297).

Nahwah, NJ: Erlbaum.

DiLalla, L., Gottesman, I. (1991). Biological and genetic contributors to violence—

Widom’s untold tale. Psychological Bulletin, 109, 125–129.

DuPaul, G.J., Anastopoulos, A.D., Shelton, T.L., Guevremont, D.C., & Metevia, L.
 (1992). Multimethod assessment of attention-deficit hyperactivity disorder: The

diagnostic utility of clinic-based tests. Journal of Clinical Child Psychology, 21, 394–

402.

Faraone, S., Biederman, J.,Weber, W., Russell, R. (1998). Psychiatric, neuro-

psychological, and psychosocial features of DSM-IV subtypes of attention deficit /

hyperactivity disorder: Results from a clinically referred sample. Journal of the

American Academy of Child and Adolescent Psychiatry, 37, 185–193.

Fischer, M. (1990). Parenting stress and the child with attention deficit hyperactivity

disorder. Journal of Clinical Child Psychology, 19, 337–446.159.

Fitzgerald, H.E., Puttler, L.I., Mun, E., & Zucker, R.A. (2000). Prenatal and postnatal

exposure to parental alcohol use and abuse. In J.D. Osofsky & H.E. Fitzgerald (Eds.),

WAIMH handbook of infant mental health (Vol. 4). Infant mental health in groups at

high risk (pp. 123–159). New York: Wiley.

Fonagy, P. (2003). The development of psychopathology from infancy to adulthood: The

mysterious unfolding of disturbance in time. Infant Mental Health Journal, 24 (3),

212- 239.

Fox, R., Platz, D., Bentley, K.S. (1995). Maternal factors related to parenting practices,

developmental expectations, and perceptions of child behavior problems.

Journal of Genetic Psychology, 156, 431–441.

Gardner, F. E. M. (1994). The quality of joint activity between mothers and their children

with behavior problems. Journal of Child Psychology and Psychiatry, 35, 935–948.

Gillberg, C., Carlstrom, G., Rasmussen, P. (1983). Hyperkinetic disorders in seven-year

old children with perceptual, motor, and attentional deficits. Journal of Child

Psychology and Psychiatry, 24, 233–246.

Goldstein, S. (1991). Managing attention and learning disorders in late adolescence

and adulthood: A guide for practitioners. New York: John Wiley & Sons, Inc.
Gordon, M., & Barkley, R.A. (1998). Tests and observational measures. In R.A. Barkley

(Ed.), Attention-Deficit Hyperactivity Disorder: A handbook for diagnosis and

treatment (2nd ed., pp. 263–293). New York: The Guilford Press.

Harvey, E. A., Danforth, J. S., Ulaszek, W. R., Eberhardt, T. L. (2001). Validity of

the parenting scale for parents of children with attention-deficit/hyperactivity disorder.

Behaviour Research and Therapy, 39, 731–743.

Hemenway D, Solnick S, Carter J. Child rearing violence. Child Abuse and Neglect 1994

(December);18(12):1011-20.

Hill, J. (2002). Biological, psychological and social processes in the conduct disorders.

Journal of Child Psychology and Psychiatry, 43, 133–164.

Hinshaw, S. R (1994). Attention deficits and hyperactivity in children (Developmental

Clinical Psychology and Psychiatry Series, Volume 29). London, England: Sage.

Holland,M. L.,Gimpel,G. A, Merrell, K. W. (1998). Innovations in assessing ADHD:

development,psychometric properties,and factor structure of the ADHD symptoms

rating scale (ADHD-SRS). Journal of Psychopathology and Behavioral Assessment,

20,307–332.

Johnston, C., Mash, E. (2001). Families of children with attention-deficit / hyperactivity

disorder: Review and recommendations for future research. Clinical Child and

Family Psychology Review, 4 (3).

Johnson, J., Reader, J. (2002). Assessing stress in families of children with ADHD:

Preliminary development of the disruptive behavior stress inventory (DBSI).

Journal of Clinical Psychology in Medical Settings, 9 (1).

Justice, B., Justice, R. (1976). The abusing family. New York: Human Services Press.

Barkley, R. A. (1990). Attention-deficit hyperactivity disorder: A handbook

for diagnosis and treatment. New York: Guilford Press.

Kashdan, T., Jacob, R., Pelham, W., Lang, A., Hoza, B., Bulumenthal, J., Gnary, E.

(2004). Depression and anxiety in parents of children with ADHD and varying levels

of oppositional defiant behaviors: Modeling relationships with family

functioning. Journal of Clinical Child and Adolescent Psychology, 33 (1), 169-181.

Keefe, C. H. (1988). Social skills: A basic subject. Academic Therapy, 23, 367-373.

Klein, R. G., & Mannuzza, S. (1991). Long-term outcome of hyperactive children: A

review. Journal of the American Academy of Child and Adolescent Psychiatry,

30, 383–387..

Keown, L., Woodward, L. (2002). Early parent-child relations and family functioning of

preschool boys with pervasive hyperactivity. Journal of Abnormal Child Psychology,

30 (6), 541-553.

Knutson, J.F., Schartz, H.A. (1997). Physical abuse and neglect of children. In T.A.

Widiger, A.J. Frances, H.A. Pincus, R. Ross, M.B. First, & W. Davis, Eds. DSM-

IV sourcebook (Vol. 3). American Psychiatric Association.

Kochanska, G. (1991). Socialization and temperament in the development of guilt and

conscience. Child Development, 62, 1379–1392.

Kuntsi, J., Stevenson, J. (2000). Hyperactivity in children: A focus on genetic research and

psychological theories. Clinical Child and Family Psychology Review, 3 (1).

Lahey, B. B., Pelham, W. E., Stein, M. A., Loney, J., Trapani, C., Nugent, K., Kipp, H.,

Schmidt, E., Lee, S., Cale, M., Gold, E., Hartung, C. M., Willcutt, E. G., &

Baumann, B. (1998). Validity of DSM-IV Attention-deficit/Hyperactivity Disorder

for young children. Journal of the American Academy of Child and Adolescent

Psychiatry, 37, 695–702.

Landau, S., & Burcham, B.G. (1996). Best practices in the assessment of children with

attention disorders. In Best Practices in School Psychology III, 817–829. Bethesda,

MD: National Association of School Psychologists.

Leimkuhler, M. E. (1994). Attention deficit disorder in adults and adolescents: Cognitive,

behavioral, and personality styles. In J. M. Ellison (Ed.), Psychotherapists guide to

neuropsychiatry (pp. 175-216). New York: Plenum.

Levine, M. (1996). A system for understanding and helping children with learning

problems at home and in school. Cambridge: Educators Publishing Service, Inc.

Lundberg, M., Andresson, P. (2000). Parental rearing when growing up in a single parent

home. Clinical Psychology and Psychotherapy, 7, 275-278.

Mandal, R.L., Olmi, S.M., & Wilczynski, S.M. (1999). Behavior rating scales:

Concordance between multiple informants in the diagnosis of Attention-

Deficit/Hyperactivity Disorder. Journal of Attention Disorders, 3, 97–103.

Mash, E. J., & Johnston, C. (1982). A comparison of the mother–child interactions of

younger and older hyperactive and normal children. Child Development, 53,

1371–1381.

McGee, R., & Feehan, M. (1991). Are girls with problems of attention underrecognized?

Journal of Psychopathology and Behavioral Assessment, 13, 187-198.

Milberger, S., Biederman, J., Faraone, S. V., Murphy, J., Tsuang, M. T. (1995). Attention

deficit disorder and comorbid disorders: Issues of overlapping symptoms.

American Journal of Psychiatry, 152, 1793–1799.

Moffitt, T.E. (1993). Adolescence-limited and life-course-persistent antisocial behavior: A

developmental taxonomy. Psychological Review, 100(4), 674–701.

Muller, R.T., Hunter, J.E., Stollak, G. (1995). The intergenerational transmission of

corporal punishment: A comparison of social learning and temperament models. Child

Abuse & Neglect, 19 (11), 1323–1335.

Mun, E., Fitzgerald, H., Eye, A., Puttler, L., Zucker, R. (2001). Temperamental characteristics

as predictors of externalizing and internalizing child behavior problems in the contexts

 of high and low parental psychopathology. Infant Mental Health Journal, 22 (3), 393-

415.

Nabuzoka, D., Smith, P. (1995). Identification of Expressions of emotions by children with

and without learning disabilities. Learning Disabilities Research and Practice, 10 91–

101.

Nigg, J. T., Hinshaw, S. P. (1998). Parent personality traits and psychopathology

associated with antisocial behaviors in childhood attention deficit hyperactivity

disorder. Journal of Child Psychology and Psychiatry and Allied Disciplines, 39.

Patterson, G. R. (1982). Coercive family processes. Eugene, OR: Castalia.

Patterson, G. R. (2002). The early developmental of coercive family process. In J. B. Reid,

G. R. Patterson, & J. Snyder (Eds.), Antisocial behavior in children and adolescents:

Developmental theories and models for intervention (pp. 25–44). Washington, DC:

American Psychological Association.

Patterson, G., Fisher, P. (2002). Recent developments in our understanding of parenting:

Bidirectional effects, causal models, and the search for parsimony. In M. Bornstein

(Ed.), Handbook of parenting: Practical and applied parenting (2nd ed., Vol. 5, pp.

59–88). Mahwah, NJ: Erlbaum.

Paule MG, Rowland AS, Ferguson SA, et al. 2000. Attention deficit/hyperactivity

disorder: characteristics, interventions, models. Neurotoxicology and

Teratology 22:631–651.

Pennington, B.F. (1991). Diagnosing Learning Disorders: A neuropsychological framework.

New York: Guilford Press.

Pennington, B. F., & Ozonoff, S. (1996). Executive functions and developmental

psychopathology. Journal of Child Psychology and Psychiatry, 37, 51–87.

Reitman, D., Rhode, P. C., Hupp, S. D. A., & Altobello, C. (2002). Development and

validation of the Parental Authority Questionnaire-Revised. Journal of

 Psychopathology and Behavioral Assessment, 24, 119-127.

Richter, J., Eisemann, M. (2000). Stability of memories of parental rearing among

psychiatric inpatients. Clinical Psychology and Psychotherapy, 7, 256-261.

Robins, P. M. (1992). A comparison of behavioral and attentional functioning in children

diagnosed as hyperactive or learning-disabled. Journal of Abnormal Child

Psychology, 20, 65-82.

Rowe, K. J., & Rowe, K. S. (1992a) The relationship between inattentiveness in the

classroom and reading achievement (Part A): Methodological issues. Journal of

the American Academy of Child and Adolescent Psychiatry, 31, 349-356.

Rowland, A., Lesesne, C., Abramowitz, A. (2002). The epidemiology of attention-deficit /

hyperactivity disorder (ADHD). A public health view. Mental Retardation and

Developmental Disabilities Research Reviews, 8: 162-170.

Rubin, K.H., Hastings, P., Chen, X., Stewart, S., & McNichol, K. (1998). Interpersonal

and maternal correlates of aggression, conflict, and externalizing problems in toddlers.

Child Development, 69(6), 1614–1629.

Schumacher, J., Eisemann, M. & Brähler, E. (1998). Rückblick auf die Eltern: Der

Fragebogen zum erinnerten elterlichen Erziehungsverhalten (FEE).

Segal, E. (2001). Learned mothering: Raising a child with ADHD. Child and

Adolescent Social-Work Journal, 18 (4).

Semrud-Clikeman, M., Bieaderman, J., Sprich-Buckminster, S., Lehman, B.K., Faraone, S.

V., Norman, D. (1992). Comorbidity between ADHD and Learning Disability: A

review and report in a clinically referred sample. Journal of American Academy

of Child and Adolescent Psychiatry, 31 (3), 439-448.

Shaw, D. S., Keenan, K., & Vondra, J. I. (1994). Developmental precursors of externalizing

behavior: Ages 1 to 3. Developmental Psychology, 30, 355–365.

Shaw, D. S., Owens, E. B., Vondra, J. I., Keenan, K., & Winslow, E. B. (1996). Early risk

factors and pathways in the development of early disruptive behavior problems.

Development and Psychopathology, 8, 679–699.

Shelton, K., Frick, P., Wooton, J. (1996). Assessment of parenting practices in families of

elementary school-age children. Journal of Clinical Child Psychology, 25, 317–329.

Siklos, S., Kerns, K. (2003). Assessing multitasking in children with ADHD using modified

six elements test. Archives of Clinical Neuropsychology, XXX-XXX.

Sprouse, C., Hall, C., Webster, R., Bolen, L. (1998). Social perception with learning

disabilities and attention deficit / hyperactivity disorder. Journal of

Nonverbal Behavior, 22 (2).

Steer, R., Kumar, G., Beck, A. (2001). Use of the Conners-Wells’ adolescent self-report

scale: Short form with psychiatric outpatients. Journal of Psychopathology and

Behavioral Assessment, 23 (4).

Stormont, M. (2001). Social outcomes of children with AD/HD: Contributing factors and

implications for practice. Psychology in the Schools, 38 (6).

Swanson, J., Sunohara, G., Kennedy, J. L., Regino, R., Fineberg, E., Wigal, T., Lerner, M.,

Williams, L., LaHoste, G., Wigal, S. (1998). Association of the dopamine receptor D4

(DRD4) gene with a refined phenotype of attention deficit hyperactivity disorder

(ADHD): a family-based approach. Molecular Psychiatry, 3, 38–41.

Tarnowski, K. J., Nay, S. M. (1989). Locus of control in children with learning disabilities

and hyperactivity: A subgroup analysis. Journal of Learning Disabilities, 22, 381-

383.

Meere, J.J., Sergeant, J.A. (1987). A divided attention experiment with pervasively

hyperactive children. Journal of Abnormal Child Psychology, 15, 379–391.

Meere, J.J., Sergeant, J.A. (1988a). Focused Attention in pervasively hyperactive

children. Journal of Abnormal Child Psychology, 16, 627–639.

Meere, J.J., Sergeant, J.A. (1988b). Acquisition of attention skill in pervasively hyperactive

children. Journal of Child Psychology and Psychiatry Allied Disorders, 29, 301–310.

Meere, J.J., Sergeant, J.A. (1988c). Controlled processing and vigilance in hyperactivity:

time will tell. Journal of Abnormal Child Psychology, 16, 641–655.

Webster-Stratton, C. (1990). Stress:Apotential disruptor of parent perceptions and family

interactions. Journal of Clinical Child Psychology, 19, 302–312.

Weiss, G., Hectman, L. (1986). Hyperactive children grown up. New York: Guilford Press.

Weiss, G. (1990). Hyperactivity in childhood. The New England Journal of Medicine, 323

(20), 1413-1415.

Whalen, C. K., & Henker, B. (1999). The child with attentiondeficit/ hyperactivity disorder

in family contexts. In H. C. Quay & A. E. Hogan (Eds.), Handbook of disruptive

behavior disorders (pp. 139–155). New York: Kluwer Academic/Plenum.

Whitmore, E.A., Kramer, J.R. & Knutson, J.F. (1993). The association between punitive

childhood experiences and hyperactivity. Child Abuse and Neglect, 17, 357-366.

Wong, M.M., Zucker, R.A., Puttler, L.I., Fitzgerald, H.E. (1999). Heterogeneity of risk

aggregation for alcohol problems between early and middle childhood: Nesting

structure variations. Development and Psychopathology, 11, 727–744.

Zahn-Waxler, C., Schmitz, S., Fulker, D., Robinson, J., & Emde, R. (1996). Behavior

problems in 5-year-old monozygotic and dizygotic twins: Genetic and environmental

influences, patterns of regulation, and internalization of control. Development and

Psychopathology, 8, 103–122.

Zaidi, L., Knutson, J., Mehm, J. (1989). Transgenerational patterns of abusive parenting:

Analog and clinical tests. Aggressive Behavior, 15, 137–152.

APPENDIX
ID:

Es gibt keine richtigen oder falschen Antworten. Bitte lassen Sie keine Frage unbeantwortet.

1-)Sind Sie 2-) Was ist Ihre Nationalität?

-die Mutter □ -der Vater □

3-)Wie alt sind Sie? --------------- 4-)Wie alt ist Ihr Kind? -------------

5-) Ist Ihr hyperaktives Kind

-ein Mädchen □ -ein Junge □

6-) Partnerschaft
-ja (lebe mit Partner) □ nein (lebe ohne Partner) □

7-) Schulabschluß
-ohne Abschluß □ -Hauptschule/8. Klasse □

-mittlere Reife/10. Klasse □ -Fachschule □

-Abitur/o. abgeschl. Studium □ -abgeschl. Hoch/FHStudium □

8-)Beruf
noch nie berufstätig □ Arbeiter □ Facharbeiter □

Landwirte □ freie Berufe □ Selbständige □

Angestellte □ Beamte □ Hausfrau □

9-) Geben Sie bitte die Position Ihres Kindes in der Schulklasse an, entsprechend
der Beurteilung durch ihre/seine Lehrer und Noten.

--erfolgreich □ --durchschnittlich □ --erfolglos □

10-) Leben sie mit dem Vater/der Mutter Ihres Kindes zusammen?
--ja □ --nein □
11-) Hat Ihr Kind Schwierigkeit beim
--Schreiben □ --Lernen □ --Rechnen □
--Keine von diesen □ --Lesen □

12-) Habt Ihr Kind bis jetzt irgendeine Therapie bekommen? Wenn ja, welchen ?

13-) Sind Sie zufrieden mit ihrem Leben?

--ja □ --nein □
 trifft

B Mein Kind… trifft ein bis mehrmals

nicht pro Stunde zu
zu
1 hat eine kurze Aufmerksamkeitsspanne 0 1
2 redet zu viel 0 1
3 verliert Sachen, die er / sie benötigt 0 1
4 muss Fragen und Anweisungen wiederholt bekommen 0 1
5 hat Schwierigkeiten auf Belohnungen zu warten 0 1
6 ist zappelig 0 1
7 kann Aufschub schlecht tolerieren, kann nicht warten 0 1
8 kann sich übermäßig aufregen 0 1
9 hört nicht all das, was gesagt wurde 0 1
10 ist rastlos oder überaktiv 0 1
11 hat Schwierigkeit Spielregeln zu beachten 0 1
12 wechselt von einer Aktivität zur anderen 0 1
13 macht sonderbare / störende / lästige Geräusche 0 1
14 ist schlecht organisiert 0 1
15 hat Schwierigkeiten sich auf ein Spiel zu konzentrieren 0 1
16 macht Leichtsinns-oder Flüchtigkeitsfehler 0 1
17 folgt Anweisungen nicht 0 1
18 ist leicht ablenkbar 0 1
19 stellt belanglose Fragen 0 1
20 ist vergesslich (er / sie vergisst Sachen) 0 1
21 unterbricht andere, wenn sie sprechen 0 1
22 hat Schwierigkeiten zu warten bis sie/er an der Reihe ist 0 1
23 ist unaufmerksam 0 1
24 spricht in unangemessenen Situationen 0 1
25 hat Schwierigkeiten sich auf Aufgaben zu konzentrieren 0 1
26 zappelt / rutscht beim Sitzen auf dem Stuhl herum 0 1
27 ist bei Schul- oder Hausaufgaben unorganisiert 0 1
28 klettert in unpassenden Situationen herum 0 1
 Es gibt keine richtigen oder trifft trifft
C falschen Antworten. Bitte lassen überhaupt trifft unsicher trifft zu vollständig
Sie keine Fragen unbeantwortet. nicht zu nicht zu zu

1 In einer gut funktionierenden

Familie, sollten Kinder ihren
Willen so häufig durchsetzen 1 2 3 4 5
können wie ihre Eltern.
2 Es ist für das Wohl meiner
Kinder das zu tun, was ich für
richtig halte, selbst wenn sie 1 2 3 4 5
selbst nicht zustimmen.
3 Wenn ich meine Kinder bitte
etwas zu tun, erwarte ich, dass sie 1 2 3 4 5
es sofort und ohne Rückfragen tun.
4 Wenn Familienregeln aufgestellt
worden sind, bespreche ich die
Gründe für diese Regeln mit 1 2 3 4 5
meinen Kindern.
5 Kinder müssen die Freiheit haben,
eigene Entscheidungen für
Tätigkeiten zu treffen, selbst
wenn diese Entscheidung keine 1 2 3 4 5
Zustimmung bei Vater/Mutter
findet.
6 Ich erlaube meinen Kindern nicht,
meine Entscheidungen in Frage 1 2 3 4 5
zu stellen.
7 Ich kontrolliere die Tätigkeiten
und Entscheidungen meiner
Kinder, indem ich mit ihnen
darüber rede und Belohnungen und 1 2 3 4 5
Bestrafungen verwende.
8 Meine Kinder brauchen Richtlinien
nicht zu befolgen, nur weil andere
Autoritätspersonen es von ihnen 1 2 3 4 5
verlangen.
9 Meine Kinder wissen was ich
von ihnen erwarte, sie wissen
aber auch, dass sie mit mir reden
können, falls sie meine 1 2 3 4 5
Erwartungen nicht angemessen
finden.
10 Eltern sollten ihren Kindern
früh beibringen, wer der Chef in 1 2 3 4 5
der Familie ist.
11 Wenn Familienentscheidungen
getroffen werden, folge ich
meistens dem, was meine 1 2 3 4 5
Kinder
wünschen.
12 Ich richte mich nach meinen
Kindern, wenn ich Entscheidungen
treffe. Ich entscheide mich jedoch
nicht nur für etwas, weil meine 1 2 3 4 5
Kinder es so wünschen.

Nein, Ja, Ja, Ja,

D über erinnerte elterliche Erziehungsverhalten... niemals gelegentlich oft stän

1 Wurden Sie von Ihren Eltern hart bestraft, auch für Kleinigkeiten? 1 2 3 4

2 Spürten Sie, dass Ihre Eltern Sie gern hatten? 1 2 3 4

Versuchten Ihre Eltern Sie zu beeinflussen, etwas "Besseres" zu
3 werden? 1 2 3 4
Fanden Sie, dass Ihre Eltern versuchten, Sie zu trösten und
4 aufzumuntern, wenn Ihnen etwas daneben gegangen war? 1 2 3 4
Lehnten Ihre Eltern die Freunde und Kameraden ab, mit denen Sie
5 sich gerne trafen? 1 2 3 4
1 2 3 4
6 Zeigten Ihre Eltern vor anderen, dass sie Sie gern hatten?
Gebrauchten Ihre Eltern folgende Redensart: "Wenn Du das nicht 1 2 3 4
7 tust, bin ich traurig“?

8 Wurden Sie von Ihren Eltern getröstet, wenn Sie traurig waren? 1 2 3 4
Setzten Ihre Eltern bestimmte Grenzen für das, was Sie tun und
9 lassen durften, und bestanden sie eisern darauf? 1 2 3 4
 I, Lütfiye Kaya, hereby confirm that I completed this

Master's thesis independently, that I have not heretofore

presented this thesis to another department or university,

and that I have listed all references used, and have given

credit to all additional sources of assistance.

Lütfiye Kaya