Completed suicide, ideation and attempt in attention deficit hyperactivity disorder – Impey – 2011 – Acta Psychiatrica Scandinavica – Wiley Online Library

Completed suicide, ideation and attempt in attention deficit hyperactivity disorder – Impey – 2011 – Acta Psychiatrica Scandinavica – Wiley Online Library.

Attention Research Update: Daily Distress in Mom’s of Children with ADHD

———- Forwarded message ———-
From: Attention Research Update <attentionresearchupdate@helpforadd.com>
Date: 2011/11/15

******************************************************************************************************************************* Daily Distress in Mom’s of Children with ADHD **
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Parents of children with ADHD have been found to experience elevated levels of parenting stress and distress in multiple studies. This is not surprising given the greater challenges associated with raising a child who consistently exhibits high levels of ADHD symptoms.

Studies of child ADHD and parenting stress have typically relied on global and static measures of both children’s behavioral problems, e.g., having parents complete rating scales and parents’ reports of stress/distress. Correlating these reports provides useful information on how children’s ADHD symptoms relate to parents’ average distress level, but say little about the moment-to-moment fluctuations in parents’ stress that may occur in response to fluctuations in their child’s behavior. This dynamic aspect of the parent child relationship can only be captured by relating parents’ stress to children’s behavior as it occurs in real time.

Examining the ebb and flow of parents’ distress in relation to children’s behavior was the focus of an interesting study published recently in the Journal of Family Psychology [Whalen et al., (2011). Dissecting daily distress in mothers of children with ADHD: An electronic diary study. Journal of Family Psychology, 25, 402-411. Participants were 51 8- to 12-year old children with ADHD and their mothers (about 70% boys) and 58 comparison dyads where the child did not have ADHD. The authors had intended to include fathers but were unable to recruit a sufficient number. All children with ADHD were being treated with a long acting medication during the study and were reported by their mothers to be doing well on medication.

Over a 7-day period during nonschool hours, mothers and children rated their moods and behavior using Personal Digital Assistants, i.e., PDAs, roughly every thirty minutes when prompted by a beep from the device. Each time the beep occurred, mothers rated the child’s level of attention/concentration, hyperactive-impulsive behavior, and oppositional behavior. They also rated how stressed, worried, worried about their child, and sad they were feeling in the moment. These ratings were averaged to obtain a measure of moms’ overall distress at each recording point.

Children used their eDiary device to rate their mood and behavior by indicating how angry, restless, impatient, and focused they were feeling each time they were prompted.

Moms and children were instructed to completed their diaries independently and privately without consulting each other so as not to influence one another’s ratings. Compliance was excellent with mothers and children in the ADHD and comparison group completing ratings at over 90% of the prompts. Thus, researchers were able to obtain data that provided an especially fine-grained look at how mothers’ distress varied directly in relation to children’s behavior over the course of a typical week.

Additional Measures

The researchers also obtained measure of ‘maternal risk’ at baseline using a composite of mothers’ self-reported ADHD symptoms, depression, and the intensity of child-related stressors that she experienced during the prior 6 months. Obtaining an estimate of maternal risk at baseline enabled the researchers to test whether mothers at higher risk were more negatively reactive to their child’s behavior in the moment.

- Results -

Baseline characteristics of mothers

Not surprisingly, baseline risk scores were substantially higher in mothers of children with ADHD compared to other mothers. These mothers were more depressed, reported more ADHD behaviors in themselves, and were experiencing significantly greater stress related to their children.

Question 1: Do ongoing child behaviors and maternal distress fluctuate together?

As expected, the answer to this question was clearly yes. In both groups of mothers, elevated levels of distress were reported during times when the mother perceived her child to be hyperactive, oppositional, or lacking in concentration. Similarly, maternal distress was higher when the child reported him or herself to be angry, impatient, or restless.

Question 2: Are mothers of children with ADHD more reactive to their child’s negative behaviors?

Again, the answer was yes. The increase in maternal distress reported by moms whose child had ADHD was significantly greater when the child displayed negative behaviors/moods compared to the other mothers. Thus, even though distress increased during these times for all mothers, distress levels in moms in the ADHD group were negatively affected to a greater degree.

Question 3: Is the link between negative child behavior and maternal distress stronger in moms at higher risk?

The answer to this question was also clearly yes. Moms with higher baseline scores on the risk index reported greater increases in distress when their child displayed negative behaviors than did moms with lower risk scores. This was true for both groups of moms but recall that moms of children with ADHD had substantially higher risk scores to begin with. Thus, this was especially problematic for these mothers.

- Summary and Implications -

Results from this study go beyond prior research demonstrating that mothers of children with ADHD have higher parenting stress by documenting how this association operates during the ebb and flow of daily life. When children display negative behaviors or mood states, e.g. oppositional behavior, hyperactivity, anger, mothers’ distress level increases significantly. And, these increases are greater in moms whose child has ADHD and who report higher rates of ADHD symptoms, depression and child-related stress to begin with. These moms appear to be especially sensitive to negative behaviors in their child and are prone to respond by experiencing increasing distress.

Results from this study have several important implications. First, the higher baseline risk scores in mothers from the ADHD group, and the greater reactivity of these moms to their child’s behavior, highlights the importance of recognizing the impact that ADHD can have on parents and of providing parents with necessary treatment and support. Too often, children themselves are the sole focus of ADHD treatment and important issues that parents are struggling with do not receive sufficient attention.

Second, these findings highlight the particular struggles that mothers experience dealing effectively with the negative behaviors that occur more frequently in children with ADHD. Because such behavior triggers significant increases in what may already be high levels of distress, responding consistently in the ways that are often discussed in behavioral parent training programs may be especially difficult. This suggests that there would be important value in helping mothers develop skills to manage their distress in the moment, and to learn to recognize particular triggers of increased distress. This could decrease the “:..cumulative emotional toll of raising a child with a chronic disorder.” And, reducing negative emotional reactions to challenging child behavior could make it easier for mothers to follow through consistently with behavioral strategies they are trying to implement.

In future work it would be important to include fathers so that the processes studied here can be investigated in dads as well. It would also be valuable to include larger number of females so that potential differences in mothers’ reactions to sons and daughters could be investigated. Using these findings to develop ways to help mothers manage their distress in the moment would also be valuable to pursue.

In sum, results from this study highlight the links between mothers’ distress and children’s negative behavior and the fact that these links are stronger in families where a child has ADHD. As the authors conclude “This type of information can help guide not only interventions targeted on improving quality of life in families of children with ADHD, but also programs to help all parents recognize and manage the daily stressors of child rearing.”

El estrés maternal prenatal se ha asociado a rasgos TDAH y autistas.

Frontiers | Prenatal Maternal Stress Associated with ADHD and Autistic Traits in early Childhood | Frontiers in Developmental Psychology.

Citation: Ronald A, Pennell CE and Whitehouse AJO (2011) Prenatal maternal stress associated with ADHD and autistic traits in early childhood. Front. Psychology 1:223. doi: 10.3389/fpsyg.2010.00223.

 

Psiquiatria.com – El TDA/H y los trastornos coexistentes: Tics y síndrome de Tourette

Psiquiatria.com – El TDA/H y los trastornos coexistentes: Tics y síndrome de Tourette.

El TDA/H es una afección neurobiológica común que afecta a entre el 3 y el 7 por ciento de los niños en edad escolar de nivel primario.1 Sin embargo, los estudios más recientes señalan que la incidencia del TDA/H podría ser mayor.2 No obstante, en apenas alrededor del 30 por ciento de esos niños, el TDA/H es el único diagnóstico. Entonces, las dos terceras partes de los niños con TDA/H tienen al menos una afección adicional coexistente.3 Cualquier trastorno puede coexistir con el TDA/H, pero ciertos trastornos parecen ocurrir más comúnmente.4 Entre ellos se encuentran los tics y el síndrome de Tourette. Es importante diagnosticar y, si es necesario, tratar esas afecciones adicionales al TDA/H porque, al igual que el TDA/H no tratado puede tener efectos duraderos, estos otros trastornos también pueden tenerlo. Si no se diagnostican, pueden causar sufrimiento innecesario en las personas con TDA/H y sus familias. Documento extraído de la web: http://help4adhd.org/

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TDAH en la infancia y riesgo de depresión en la adolescencia

Young children with ADHD are at increased risk of depression and suicidal behaviour in adolescence — 14 (1): 15 — Evidence-Based Mental Health.

Abstract

Question: Are young children with attention-defi cit/hyperactivity disorder (ADHD) at increased risk for depression and  suicidal ideation and attempts during adolescence?

Population: 125 children with DSM-IV ADHD at 4–6 years  of age and a control group of 123 children without ADHD  who were matched to the children with ADHD for gender,  race/ethnicity and age, and were from similar neighbourhoods and schools.

Exclusions: Children not living with their biological mothers, pervasive developmental disorder, intellectual disability or  seizure disorder.

Setting: Chicago, Illinois and Pittsburgh, Pennsylvania, USA;  time period not stated.

Prognostic factors: DSM-IV ADHD diagnosis at age 4–6  years made using the Diagnostic Interview Schedule for  Children completed by the primary care giver and the teacher-  completed Disruptive Behavior Disorders Rating Scale. Children were considered to have ADHD if they met diag-  nostic criteria according to either teacher or parent report, and  showed functional impairment in at least one setting (home/  peer environments or school). Analyses were adjusted for gen-  der, intelligence and maternal depression.

Outcomes: DSM-IV depressive disorders or suicidal behav-  iour at age 9–18, based on the Diagnostic Interview Schedule  for Children completed by the child and primary care giver,  and the teacher-completed Disruptive Behavior Disorders  Rating Scale. Children were considered to have depression if  they met diagnostic criteria for major depressive disorder or  dysthymia based on self or parent report, and to have func-  tional impairment in at least one setting. Recurrent depression  was defi ned as two or more episodes occurring between the  ages of 9–18 years. Suicide attempts or ideation were based on parent and child reports. There were seven assessments during follow-up, with 8.1% of participants completing between one and three assessments, 32.2% between four and fi ve assess- ments and 59.7% six to seven assessments.

MAIN RESULTS Compared with the non-ADHD control group, children diag-  nosed with ADHD between the ages of 4 and 6 years were  at greater risk for depression between the ages of 9 and 18  years (HR 4.32; p<0.001). Children with ADHD in early child-  hood were also at greater risk of recurrent depression than  controls (18.4% of children with early ADHD vs 1.6% of con-  trols; adjusted OR: 12.15, 95% CI 2.62 to 56.32). Seventeen  out of all 248 participants (6.9%) reported having a specifi c  suicide plan (concrete suicidal ideation) at least once between  the ages of 9 and 18. Children with ADHD in early childhood  were at greater risk of concrete suicidal ideation than controls  between the ages of 9 and 18 (HR 5.79; p=0.03). Among the  children with early ADHD, 18.4% made at least one suicide  attempt by age 18 compared to 5.7% in the control group (HR  3.60; p=0.005). Within the ADHD group, girls were at greater  risk of depression and suicide risk than boys. Maternal depres-  sion and concurrent child emotional and behaviour problems  at 4–6 years of age predicted later depression and suicidal  behaviour among children with early ADHD.

CONCLUSIONS ADHD in young children predicts adolescent depression, as  well as concrete suicide ideation and/or suicide attempts.

Arch Gen Psychiatry 2010;67:1044–51.

Correspondence to: Dr Benjamin Lahey, Department of Health Studies, University  of Chicago, 5841 S Maryland Ave, MC 2007, Chicago, IL 60637, USA;  blahey@uchicago.edu