Dissertations and Theses
Early risk factors for school-age ADHD and irritability: The roles of prenatal risk, intrusive parenting style during preschool and caregiver-child attachment quality.
Date of Award
Maternal sensitivity, Maternal intrusiveness, child responsiveness, attachment, pre-natal risk, ADHD, irritability
ADHD is a highly impairing neurodevelopmental disorder and the family context provides a critical early environment where children’s risk for the disorder may be heightened or reduced. A parent’s style, that is their approach to interacting and guiding the child may provide children with warmth and security, or elicit fear, distrust and disappointment, both of which in turn impact behavior. However, the parent-child relationship is not unidirectional; it is dynamic. Children with high ADHD-like behaviors have greater difficulty relating to and interacting with their caregivers, while caregivers become increasingly stressed and show greater hostility and less warmth in their parenting. In turn, children’s frustration and responsiveness to the caregiver may become increasingly impaired. These coercive cycles may increase risk for greater severity of ADHD and childhood irritability as children get older. The present study used a moderated mediation model to assess these complex relations. It was hypothesized that pre- and perinatal risk would be associated with higher rates of less-than-optimal parenting, as seen through higher caregiver intrusiveness during preschool (ages 3-4 years), which in turn, would be associated with more severe ADHD and irritability at school-age (ages 8 – 9 years of age). It was also hypothesized that caregiver-preschool child attachment would moderate the relation between intrusive parenting style during preschool and child behavioral and emotional dysregulation at ages 8-9 years, such that stronger associations would be seen in the context of insecure attachment style than secure attachment style.
An ethnically and racially diverse sample of community-dwelling preschoolers [N=139; baseline Sex (%) = 74 (80) male] was recruited. At baseline, (child mean age = 4.32, SD = .46 years), mothers completed a retrospective account of their pregnancy and delivery of their child, and each child and their mother completed a 15-minute videotaped parent-child interaction. Videos were coded using Biringen’s Emotional Availability Scale. Children were reassessed approximately four to five years later (child mean age = 8.58, SD = .34 years). At this school-age follow-up, caregivers and their children’s teachers were asked to complete questionnaires of ADHD severity (ADHD-RS) and irritability (BASC-2). These responses were integrated with parent responses to the Kiddie SADS, a psychiatric interview to assess children’s psychopathology; specifically, ADHD and ODD severity and diagnoses. Moderated mediation models were run using Hayes’ PROCESS to test study aims. Results showed some evidence that pre/perinatal risk, although not associated with increased maternal intrusiveness, was associated with attachment style, and attachment style moderated the association between maternal intrusiveness and higher ADHD/irritability severity, or increased chance of having an ADHD/ODD diagnosis at ages 8-9. Overall, there has been some support for the association between parenting style moderated by attachment style and ADD/ODD outcomes that highlights a picture of child development and its risk factors as well as its mechanistic pathways in understanding the developmental trajectories of childhood psychopathology.
Rainford, Ashley M., "Early risk factors for school-age ADHD and irritability: The roles of prenatal risk, intrusive parenting style during preschool and caregiver-child attachment quality." (2022). CUNY Academic Works.