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5. Parents and family as ADHD risk factors

5. Parents and family as ADHD risk factors

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The influence of parents and family on children’s ADHD risk can only be clearly classified as a physical or psychological cause in a few cases.
Examples: While physical illnesses of the parents indicate a genetic risk for the offspring and thus a physical cause, this is not clear in the case of mental disorders of the parents. In most cases, these represent a genetic risk, but usually also increase the psychological stress within the family. Low socio-economic status can be a consequence of parental ADHD (ADHD drastically impairs educational opportunities and career prospects) and can also have a psychological impact on children. Even parental behavior (“parenting”), which is certainly a psychological influencing factor, is also reciprocally influenced by ADHD symptoms in children.

Children whose parents were unmarried or unemployed or without social security or had a “very high” economic burden of childcare or where at least one parent had a disability certificate had a 21% increased risk of ADHD, a 36% increased risk of learning disability and an 80% increased risk of ASD at the age of 5.5 years. This affected 10.8% of the 19,185 children.1

5.1. Incomplete families

People with ADHD suffer more frequent separations in their relationships (even in adulthood) than people without ADHD. In this respect, the extent to which an increased divorce or separation rate is a consequence of ADHD in the parents, which is then also genetically transmitted to the children, and the extent to which incomplete / single-parent families contribute to ADHD is an open question.

5.1.1. Divorce (+ 193 % to + 384 %)

Divorce: children’s ADHD risk increased by 193% to 384% (meta-analysis, k = 11, n = 11,929)2 This result is not consistent with our experience. The value seems excessive to us.

5.1.2. Single parents (up to + 163 %)

Single parent:
- 61% increased risk of ADHD (meta-analysis, k = 5, n = 1,174,547)2
- aDHD risk increased by 163% (2.63-fold; 25-year observational cohort study, n = 16,365)3

Single-parent families increase the risk of ADHD in children.4567
Single parents naturally have a higher risk of not being able to give their children enough loving care and security. However, there are single parents who are very good at this. The decisive factor is not the amount of time that (part-time/working) parents can spend (less) with their children, but whether the children have the constant and secure feeling that they are accepted and loved at all times, just as they are.

5.2. Low socio-economic status of the family of origin (+ 63 % to + 310 %)

When determining the % values, the two lowest and the two highest values out of 9 values were not taken into account.

Children from “lower class” families are more likely to have ADHD85 9 and are more likely to receive ADHD medication.106
Children from the lower stratum have about twice the risk of ADHD (+100%) as children from the highest stratum (in a 3 stratum model).11

Cramped living conditions also increase the risk of ADHD in children5
Poor financial resources in the family correlated with

  • a 2.12-fold risk (+ 112%) of ADHD symptoms at kindergarten age in the USA.12
  • 39% increased risk of ADHD and 27% increased risk of ASD (25-year observational cohort study, n = 16,365)3

The overall prevalence of ADHD in children and adolescents was found to be 2.2% in the 2007 Bella study13 (which we consider to be too low). A Bella sub-study with n= 2,500 subjects between the ages of 7 and 1714 puts the prevalence in the parents’ assessment at around 5%. Both studies confirm a strong divergence in prevalence according to social class. According to the 2007 Bella study, the middle class has an average prevalence of 2.3%, while the lower social class has a prevalence of 3.7%, which is more than four times as high (+ 310%) as the upper class (0.9%).15 The Bella sub-study reports an approx. 2.57-fold prevalence of ADHD (+ 157 %) in the lower social stratum (at 7.2 %) than in the upper stratum at 2.8 % (with 3 strata).14
In a Danish cohort study, the children’s risk of ADHD increased16

  • by 2.1 percentage points (+ 57 %) for parents with a low income
  • by 2.3 percentage points (+ 63 %) if the parents are unemployed
  • by 3.5 percentage points (+ 95%) for parents with a low level of education
  • by 4.9 percentage points (+ 133 %) when all three criteria were met.

The fact that this pattern is not limited to ADHD, but is found identically in other mental disorders, e.g. anxiety, depression or disorders of social behavior, is considered by us to be strong evidence for confirmation of the thesis of stress as the cause of mental disorders. These other mental disorders, like ADHD, are also based on a multigenetic disposition that is epigenetically manifested by stress exposure in early childhood.171819

⇒ Candidate genes and early childhood stress as a cause of other mental disorders

5.2.1. Low socio-economic status as a risk factor for ADHD

A genetically predicted one SD lower socioeconomic status causally predicted a 5.3-fold ADHD risk (+ 430%), while conversely ADHD only very slightly causally caused socioeconomic status. A genetically predicted one SD higher family income causally predicted a 65% lower ADHD risk. Here, too, the reverse effect was small.20

Poverty correlated with reduced white and gray matter volume and reduced hippocampal and amygdala volume in children in the US.21 Reduced white and gray matter is a neurophysiological correlate of ADHD.
Poverty in the USA is still associated with higher material resources than the normal standard of living in many other countries. The purchasing power of poverty in the USA is around USD 9,000. This is higher than the average purchasing power in Mexico or South Africa (USD 6,000). Therefore, the objective amount of resources (purchasing power) cannot be the decisive criterion.
In the USA in particular, the social difference between average income (which is significantly higher than in other countries) and poverty is much more drastic than in other countries because, compared to other similarly developed countries, there is much less state social security to cover a minimum standard of living and health costs are borne to a greater extent privately. The USA has one of the highest prevalence of ADHD in the world. In our opinion, this indicates that the relative difference between poverty and average income in particular favors ADHD. This suggests that in addition to the characteristics that people have that make them more likely to slip into poverty (ADHD as a cause of poverty), poverty may be a psychological stressor (belonging less) that promotes ADHD.

Income appears to be most strongly related to brain structure, particularly in the most disadvantaged children. For children from low-income families, small differences in income correlated with relatively large differences in cortical surface area, while for children from higher-income families, similar differences in income were associated with smaller differences in surface area. These correlations were most pronounced in the regions supporting language, reading, executive functions and spatial abilities; cortical surface area mediated socioeconomic differences in certain neurocognitive abilities22

Poorer financial resources also appear to correlate with increased ADHD symptoms among college students.23 However, there was no correlation with (self-induced) student debt.

Low socioeconomic status can therefore be considered a chronic stressor24
Epigenetic studies suggest a possible transmission of the Consequences of chronic stress to the offspring.25 In male rodents, chronic stress affected the epigenetic content of their sperm through altered DNA methylation and microRNA profiles in a way that influenced stress reactivity and brain development in the offspring.26
In humans, men exposed to trauma or adverse conditions were found to have epigenetic traces that they passed on to their offspring, increasing the risk of neurodevelopmental problems.27
The epigenetic changes caused by psychological stress can affect the expression of genes associated with ADHD and autism. These epigenetic effects are environmental and potentially reversible.28

5.2.2. ADHD as a risk factor for low socioeconomic status (?)

ADHD is predominantly genetic. ADHD is associated with reduced educational opportunities, more frequent job losses and lower income. This points to ADHD as a risk factor for low socioeconomic status.

Parents of ADHD children showed elevated scores of cognitive weaknesses (IQ, reading tasks, verbal fluency), the highest stress scores of all parent groups compared, the most ADHD symptoms, and poor reading performance.29

There is also evidence that (with regard to people with ADHD) environment-centered psychotherapies (interventions in the family, with parents, in kindergarten or at school) are more effective than patient-centered behavioral therapies. In some cases, patient-centered behavioral therapies have been denied effectiveness.30 This is likely to be particularly true for younger children (up to 6 or 8 years).
This could indicate that external factors are a significant cause of ADHD in children.

Families with a high socioeconomic status did not benefit from behavioral therapy in addition to drug treatment. Only families with low socioeconomic status benefited more from a combination therapy of medication treatment and behavioral therapy than from medication treatment alone.31

On the one hand, we suspect that it is not so much socio-economic status (income or the size of the home itself) that is the decisive factor, but that these circumstances correlate more frequently with the parents’ own problems, which in turn are associated with inappropriate parenting methods.
Pure behavioral therapy has a clear focus on symptom reduction. It is conceivable that the ability to adapt behaviors to given circumstances could simultaneously lead to greater professional success and thus to a higher socioeconomic status and, on the other hand, better compensate for ADHD symptoms in oneself and in children. Such a higher ability to adapt behavior would already have a behavior-correcting effect per se and would anticipate the behavioral adaptations through behavioral therapy.

5.3. Diabetes of the parents (up to + 286 %)

5.3.1. Diabetes of the father (+ 286 %)

Among 5-year-old children, the risk of ADHD was increased by 286% if the father had diabetes.32 The question was “Does the father of the newborn currently have diabetes mellitus diagnosed by a doctor?”, so the type was not determined.33

5.3.2. Gestational diabetes of the mother (+ 53 %)

Gestational diabetes in the mother increased the risk of ADHD in the offspring by 53%.34

Maternal diabetes before or during pregnancy correlated with an increased risk in studies that took several confounding factors into account (meta-analysis, k = 98)35

  • by 28% for any neurodevelopmental disorder
  • by 25 % for ASS
  • by 30 % for ADHD
  • by 32 % for mental disabilities
  • by 27 % for specific developmental disorders
  • by 20 % for communication faults
  • by 17 % for motor disorders
  • by 16 %for learning disorders

5.3.3. Diabetes of the mother before pregnancy

Children of mothers who already had diabetes before pregnancy had a 39% higher risk of a neuronal developmental disorder than children of mothers with gestational diabetes. (Meta-analysis, k = 202, n = 56,082,462 mother-child pairs)35

5.4. Heart disease of the mother (+ 189 %)

Among 5-year-old children of mothers, the risk of ADHD was increased by 189% if the mother had heart disease at birth.32

5.5. Psychological problems of the parents (up to + 125 %)

Parental mental health problems increase the risk of ADHD in children.366
Parental mental health problems could be an environmental and/or genetic influence.

5.5.1. Depression (+ 42 to 125 %)

Depressive symptoms in the father or mother increase the children’s risk of ADHD9

  • by 110 % to 116 %37
  • by 66 %38
  • by 42 % to 125 %:39
    • before pregnancy
      • Depression of a parent:
        • ADHD + 92 %
        • ASS + 63 %
      • Depression of the mother:
        • ADHD + 125 %
        • ASS + 101 %
    • during the birth
      • Depression of a parent:
        • ADHD + 72 %
        • ASS + 88 %
      • Depression of the mother:
        • ADHD + 75 %
        • ASS + 58 %
    • in the first year of the child’s life
      • Depression of a parent:
        • ADHD + 71 %
        • ASS + 110 %
      • Depression of the mother:
        • ADHD + 55 %
        • ASS + 59 %
    • in the 2nd to 4th year of the child’s life
      • Depression of a parent:
        • ADHD + 52 %
        • ASS + 101 %
      • Depression of the mother:
        • ADHD + 55 %
        • ASS + 64 %
    • from the age of 4 of the child
      • Depression of a parent:
        • ADHD + 42 %
        • ASS + 85 %
      • Depression of the mother:
        • ADHD + 43 %
        • ASS + 65 %
  • maternal depression increases the risk of ADHD and ASD in offspring more than paternal depression40

5.5.2. Bipolar Disorder (+ 100 %)

Bipolar Disorder in one parent doubled the children’s risk of ADHD.41 Another study also found an increased risk of ADHD.42

5.5.3. Antisocial personality disorder of the father

Antisocial Disorder in a parent is a huge (and usually violent) risk for ADHD in the offspring.5

5.5.4. Schizophrenia

Schizophrenia in a parent increased the children’s risk of ADHD.43

5.5.5. Alcohol problems of the father

Alcohol problems in the father increase the risk of ADHD in the offspring.4

5.5.6. ADHD of the parents

Parental ADHD not only increases the risk of the child inheriting ADHD genetically, but also independently represents an increased risk of being taught dysfunctional lifestyle habits. At the same time, it can be an advantage for a child with ADHD if parents have learned to cope well with their ADHD and are therefore much more aware of functional compensatory coping strategies. However, there is a not insignificant proportion of parents who are themselves affected and do not want to admit this to themselves. This often leads to additional conflicts due to a more or less conscious rejection of the behavior of the person with ADHD, for which the child is not responsible.
Furthermore, even the most committed parents - like everyone - may not always be up to date with their own theory.

One study examined the influence of mothers’ ADHD on children’s ADHD to determine whether parent-child similarity improves or worsens parenting. Children’s ADHD symptoms correlated with mothers’ negative comments and mothers’ ADHD symptoms correlated with mothers’ expressed negative emotions. Nevertheless, maternal ADHD symptoms appeared to moderate the effects of children’s ADHD symptoms on negative parenting. Parents’ responses to children with severe ADHD symptoms were more positive and affectionate when the mother also had severe ADHD symptoms.44
Another study from 2006 found that 95% of Polish parents physically punished their children, which can be considered abuse. Parents with ADHD used more severe forms of corporal punishment. Parent training resulted in 72% of parents using other forms of punishment.45 Also among Iranian parents, those with ADHD used corporal punishment more often and showed less parental warmth.46

ADHD symptoms47

  • with the father correlated with
    • more social-emotional difficulties among boys (+ 68 %)
    • fewer socio-emotional difficulties among girls
  • in the mother correlated with
    • more socio-emotional problems among girls (+ 109 %)
  • in both parents correlated with
    • more social-emotional difficulties of the children (+ 343 %).

Mothers with ADHD showed more problems monitoring their children’s dental care and health.48
On the other hand, children with ADHD symptoms in Spain had a higher risk of49

  • Caries (OR: 2.16)
    • a rather annoying study linked MPH (especially immediate release) to tooth decay without including people with ADHD without MPH medication as a comparison group50
  • Extraction (OR: 1.42)
  • Restoration (OR: 1.47)
  • Bleeding gums (OR: 1.64)
    The increased caries risk persisted even when the analyses were restricted to middle/higher social class families and children with low sugar consumption, good oral hygiene habits and regular visits to the dentist.

5.6. One parent in prison (+ 10 % to + 114 %)

Incarceration of a parent: 10% increased risk of ADHD (meta-analysis, k = 3, n = 4,073)2 A registry study found a 114% increase in the risk of ADHD between the ages of 3 and 5 (HR = 2.14) (registry study, n = 631,695).51

5.7. Unintended pregnancy (+ 105 %)

A prospective cohort study (n = 7,910) over 16 years found that unintended pregnancy correlated with hyperactivity symptoms in the children at age 8 (+ 108%), but not with ADHD symptoms at age 16 (+ 13%, not significant).52

5.8. Low level of education of parents (+ 3.5 % to + 95 %)

The benchmark in each case is the highest educational qualification achieved.

5.8.1. Level of education and ADHD risk

A low level of education of the mother53 or parents4 as well as the father increases the children’s ADHD risk (25-year cohort study, n = 16,3653.
Children of parents without a university degree had twice the risk of ADHD as children of parents with a university degree54
A lower level of education of the mother is said to correlate with an increased screen consumption of the children, which in turn correlates with behavioral problems.55
In a cohort study in Denmark, a low level of parental education correlated with a 3.5% increased risk of ADHD in children.16 Children of parents who were unemployed and had a low income and a low level of education were found to have a 4.9% higher risk of ADHD.
An Ethiopian study found an approximately tripled risk of ADHD in children due to illiteracy of the mother56

  • by 72% if the mother has a college degree (college/university) in 5-year-old children in a cohort study in Taiwan 32 (not statistically significant)
  • by 50% for a senior high school graduation (12th grade) of the mother in 5-year-old children in a cohort study in Taiwan 32 (not statistically significant)
  • by 94% for a junior high school graduation (9th grade) of the mother in 5-year-old children in a cohort study in Taiwan 32 (not statistically significant)
  • by 29% for elementary school graduation (6th grade) of the mother in 5-year-old children in a cohort study in Taiwan 32 (not statistically significant)

In a Danish cohort study, the children’s risk of ADHD increased16

  • by 3.5 percentage points (+ 95%) for parents with a low level of education

A genetically predicted one SD higher educational attainment causally predicted a 70% lower risk of ADHD.20

5.8.2. Education level and ADHD severity and treatment

Children of parents with low educational attainment had more severe ADHD symptoms and a nearly doubled risk of severe ADHD symptoms. The association was independent of genetic and family environmental factors. The transfer of this model to depression was weaker and could be fully explained by common genetic factors57
Children of parents with poorer education were significantly less likely to receive adequate treatment for their ADHD.58

5.9. Injuries to a parent (+ 69 %)

Children and adolescents (aged 5 to 17) whose parent had to receive medical treatment for an unintentional injury showed in a registry study:59

  • a 69% increased risk of ADHD
  • a higher Washington Group Composite Disability Scores (OR 1.77)
  • a 129% higher risk of personal injury
  • 49% higher risk of own emergency doctor visits

It remains an open question whether the increases in risk are a psychotraumatic consequence of the parent’s injury or a consequence of the fact that the genetic heritability of ADHD is 80% and the parent’s injury was a consequence of their own ADHD, as ADHD is known to carry a higher risk of injury or emergency room visits.

5.10. Age of parents (+ 14 % to + 66 %)

5.10.1. Young age of parents (+ 14 % to + 66 %)

A Danish coparent study (n = 943,785) found a more than doubled risk of ADHD if the parents were 20 years old or younger, compared to parents 26 to 30 years old.60 Children whose mother does not have ADHD have a 14% increased risk of ADHD if one parent is younger than 20 years old. Children whose mother has ADHD have a 92% increased risk of ADHD if one parent is younger than 20.6162 Another study also reported that younger fathers were more likely to have children with ADHD than older fathers.63 One study reported a 32% reduced risk of ADHD for every 10 years increase in maternal age. However, the correlation was attenuated by other factors. These were:64

  • Family income
  • Training of the caregiver
  • Polygenic ADHD risk score
  • Duration of breastfeeding
  • Prenatal alcohol exposure
  • Prenatal tobacco exposure

In cohort studies, children with ADHD also had younger than average mothers:
under 24 years: 1.66 times (+ 66 %)65
over 24 years: 0.93-fold (minus 7 %)(25-year cohort study, n = 16,365)3
25 to 29 years: 0.92 times (minus 8 %)65
30 to 34 years: 0.66 times (minus 34 %)65
over 35 years: 0.58 times (minus 42 %)65

Father older than 24 years at birth: 0.95-fold risk (minus 5%)(25-year cohort study, n = 16,365)3

Another study also reports this, supplemented by an increase in learning problems among particularly young (20 to 24 years) and particularly old mothers (35 to 39 years).66

In a larger study, almost 2 out of 3 young mothers reported at least one mental health problem. Almost 40% had more than one. Young mothers were two to four times more likely to have an anxiety disorder (generalized anxiety disorder, separation anxiety disorder, social phobia and specific phobia), attention-deficit/hyperactivity disorder, oppositional defiant disorder or conduct disorder than older comparison mothers or women aged 15-17, and two to four times more likely to have more than one psychiatric problem.67

One study found no correlation between the age of the mother and the offspring’s risk of ADHD.68

5.10.2. Increased age of the mother (+ 55 %)

A Taiwanese cohort study found a 55% increased risk of ADHD in 5-year-old children of older mothers32 of 35 years and older33.

5.11. Employment status of parents

5.11.1. Unemployment of parents (up to + 63 %)

Unemployment of parents correlated with an increased risk of ADHD in children

  • by 48% at the age of 5 years if the mother was unemployed in a cohort study in Taiwan, compared to children of mothers who worked during the day (not at night / in shifts / in alternating shifts)32
  • by 4.9 % in children of unemployed parents with a low income and low level of education. Unemployment or occupational problems of the parents increased ADHD symptoms in children.7
  • by 2.3 percentage points (+ 63 %) in a cohort study in Denmark16

5.11.2. Occupation of the mother

The risk of ADHD was increased among 5-year-old children of working mothers

  • by 84 % when switching between night-time and daytime working hours32 (not statistically significant)
  • by 73 % when mothers work at night32 (not statistically significant)
  • by 12 % for working hours that took place during the day and at night32 (not statistically significant)

5.12. Thyroid problems in the mother (+ 23 %)

However, maternal hyperthyroidism, which was first diagnosed and treated after the birth of the child, increased the risk of ADHD in the child by 23%, while hypothyroidism diagnosed in this way increased the risk of ASD by 34%.69

5.13. Parenting / parental behavior

The influence of family factors on the development and maintenance of mental disorders in children and adolescents has been extensively studied.70

5.13.1. Attachment behavior of parents in the (first) years of childhood

5.13.1.1. Poor bonding behavior of the mother/parents in the (first) years of childhood

A child’s lack of secure attachment to the mother, like social and emotional deprivation, has extensive negative effects on the child’s mental health, even later in life.71 Insecure attachment promotes ADHD (meta-analysis, k = 29)72

The security of the infant’s bond with the mother or the central caregiver determines the level of the stress hormone cortisol in the baby’s brain.

Disorganized attachment behavior is a risk element for ADHD.73 Attachment disorders in children in the first years of life lead to activation of the DRD4 gene, which is also frequently involved in ADHD, if there is a corresponding genetic disposition.74 A lack of parental persistence has been cited as a risk factor for ADHD,75 whereby persistence is an ADHD symptom and can therefore also be an expression of ADHD in the parents and thus of genetic transmission.

Massive maternal stress in the first years of childhood causes significant epigenetic changes in the children’s DNA.76

Borderline, which typically results from intense stress-inducing attachment disorders with attachment figures in early childhood (first 2 years) due to physical, sexual or psychological abuse, has a significant comorbidity with ADHD.77

5.13.1.2. Emotionally withdrawn father behavior in infancy

One study observed father-baby behavior and its influence on children’s emotion regulation in infancy and ADHD symptoms in middle childhood.
Fathers’ emotional withdrawal in infancy and minimizing responses to children’s anxiety in toddlerhood predicted the development of ADHD symptoms in middle childhood. Fathers’ parenting performance at 8 and 24 months of children’s age significantly influenced ADHD risk at age 7 years through toddlers’ difficulties with emotion regulation78

5.13.1.3. Rejecting parental behavior

Latent parental rejection or coldness mediated the relationship between parental anxious attachment and child behavior problems and between parental attentiveness and child problems. Parental rejection was the strongest predictor of child difficulties.79

5.13.3. Parents’ parenting behavior

Parental upbringing is likely to have only a minor influence on the development of ADHD in children. The influence on how well children can cope with existing ADHD is likely to be stronger.

Nevertheless, numerous studies confirm an influence of parental education on ADHD in children 80 81 82 83 84 85 86 87 88 89 90 91 9293

In one study, SHR, an ADHD model animal, was raised by non-ADHD rat mothers, and non-SHR rat pups were raised by SHR mothers. This showed that94

  • motor hyperactivity depended entirely on the parentage
  • social behavior was primarily determined by the mother raising the child
  • attentional orienting behavior was influenced by both the parentage of the offspring and the parentage of the mother
  • the anxiety-related behavior was influenced by an interaction between the parentage of the offspring and the mother

This is consistent with the fact that critical maternal behavior was a strong risk factor (+73%) for high externalizing ASD symptoms, while maternal warmth was a significant preventive factor.95

Enriched environment, an environment with plenty of stimulation and manageable challenge, reduced ADHD symptomatology in SHR.96

A distinction must be made in parental education between70

  • Attitude (parents’ internalized cognitions and beliefs about parenting, including parental goals and knowledge)
  • Behavior (way of acting in certain situations)
    even if behavior is strongly influenced by attitude.

Children with ADHD in the USA had received significantly less maternal affection than children without ADHD at 6 observed time points between the ages of 3 and 15. Mothers with a high level of education showed less affection than mothers with a low level of education.97 Children with ADHD were more likely to experience very low maternal support at any age and very low maternal support at two or more ages. Boys with ADHD were more likely than girls with ADHD to experience very low maternal support.

5.13.3.1. Authoritative parenting style

Authoritative parenting involves clear expectations, consistent rules and a supportive, nurturing environment.
Discipline: Focuses on teaching, with explanations of rules and consequences.
Communication: Open and reciprocal. Parents actively respond to the children’s perspectives.
Results: promotes high self-esteem, academic success and social skills in children.
An authoritative parenting style correlated with

  • less frequent cyberbullying98
  • less problematic Internet use98
  • promoted a more positive parent-child relationship98
    • which in turn contributed to a reduction in cyberbullying and problematic internet use
  • less common ADHD99

5.13.3.2. Authoritarian parenting style

Authoritarian education emphasizes high standards, strict rules and obedience.
Little warmth or responsiveness from parents.
Discipline: Punishment-oriented, with little explanation or consideration of the child’s perspective.
Communication: One-way, with limited dialog or opportunities for children to express their opinions.
Results: impairs self-esteem100, promotes anxiety and emotion regulation problems in children
An authoritarian parenting style

  • correlated with more frequent ADHD9910110298103
  • increased learning problems98

Low maternal warmth and increased maternal negativity correlated in the children aged 12 and 18 years104

  • with externalizing symptoms
  • with a worse general psychopathology
  • but not with internalizing symptoms

5.13.3.3. Permissive parenting style

Permissive parenting has few requirements, few rules and provides little structure, combined with a high degree of warmth and responsiveness.
Discipline: indulgent, with a tendency to avoid confrontation or setting boundaries.
Communication: Very open and accepting, children are often treated as equals.
Results: May promote impulsivity, difficulty with self-control, and risky behavior.
A permissive parenting style correlated with

  • more frequent ADHD than with an authoritative parenting style, but less frequent ADHD than with an authoritarian parenting style99
  • less frequent ADHD than with authoritarian and overreactive parenting styles101

5.13.3.4. Overreactive parenting style

  • aDHD more common than permissive parenting style101

5.13.3.5. Overprotective parenting style

  • more frequent ADHD105103
  • frequent anxiety105

Parental warmth and consistency have a positive effect on the social-emotional behavior of children with ADHD.106

A distinction must also be made between:107

  • positive parenting behavior70
    • Emotional responsiveness, parental warmth (the extent to which parents are supportive, accepting, nurturing and warm towards their child)108
      • SMD minus 0.16 (reduced risk of ADHD; meta-analysis, k = 10, n = 2,475)2
    • Behavioral control (parental practices such as guidance, leadership, limit setting, and monitoring where children can identify clear and consistent expectations that help them regulate their behavior)
    • Granting autonomy (the extent to which parents support their children’s autonomy, i.e. the independence with which children are allowed to act and make decisions for themselves)109
  • negative parenting behavior70
    • Overreaction110
    • Psychological control (intrusive and manipulative parental behaviors specifically designed to control the child, taking advantage of the emotional parent-child relationship)
      • SMD 0.17 (meta-analysis, k = 4, n = 682)2
    • Strict control (a range of highly destructive parental practices such as psychological and physical punishment, neglect and intrusiveness)
      • SMD 0.19 (meta-analysis, k = 7, n = 3,407)2
    • Mistreatment
      • physical and emotional abuse, neglect, sexual abuse or unspecified maltreatment: 627% increased risk of ADHD (meta-analysis, k = 6, n = 1,878)2
      • physical abuse: SMD 0.39 (meta-analysis, k = 4, n = 1,406)2

There are feedback effects:111

  • a genetically determined impulsiveness and social withdrawal of the child promoted a strict parental upbringing
  • a genetically determined sunny disposition of the child promoted parental warmth
  • genetically influenced characteristics of the children reinforced positive parental influences on the child’s development or protected the children from strict parental upbringing

Parental parenting behavior was also found to have a significant effect on the child’s ADHD symptoms.

  • ADHD symptoms of the raising mother and hostile parenting behaviors promoted ADHD symptoms of the child in adoptive families as well112
  • genetic ADHD-related temperament traits in the child promoted hostility in genetically unrelated mothers, which in turn increased ADHD symptoms in the child112

Details

How much time parents can spend with their children is not the decisive factor. It is much more important that children can absolutely rely on the fact that they are accepted, welcome and loved in every situation and especially when they misbehave. This does not mean that children are allowed to do whatever they want. Good, warm parenting is able to consistently limit inappropriate behavior by evaluating undesirable behavior without devaluing the child as a person (your behavior is not ok, you are ok). A lack of rules (and even worse: rules that only sometimes apply) are barely tolerable for children because they take away all security. The question of a mandatory “parenting license” is the subject of legal and ethical discussions.88

Figures

10.5 million households in Germany have dogs.113(Stand 2014)
8.1 million families in Germany have underage children (as of 2014).
A Google search for parenting course OR parenting courses finds 169,000 results. (20.10.2015)
A Google search for dog school finds 1,240,000 results. (20.10.2015)

5.13.3.6. Emotion-oriented vs. problem-oriented coping strategies

100% of parents of children with ADHD or ASD (n = 212) used emotion-focused coping strategies, while 94.93% of parents of norm-typical children used problem-focused coping strategies.114

5.14. Stress in the mother during childhood

Stress of the mother of 5 to 13-year-old boys with ADHD tended to increase their ADHD symptoms 12 months later and significantly worsened the children’s quality of life.115 Parental stress generally correlated with increased ADHD symptoms in the children.7
Stress of the mother at the age of 4 years of the child correlated at the age of the child from to 15 years low to medium with116

  • internalizing symptoms
  • externalizing symptoms
  • ADHD symptoms

Parents of children with ASD and ADHD reported significantly higher stress levels than parents of NTD children (M = 116.7 and M = 88.1 to M = 67.2, respectively).114 It remains to be seen whether this is a contributory cause or consequence of the children’s ADHD, or whether it results from the parents’ own dispositions, which genetically determine the children’s risk of ASD or ADHD.

5.15. Family instability, constant arguments between the parents

A high level of stress in the primary family correlates with an increased risk of ADHD.4567

Family conflicts and ADHD

“Chronic family conflicts, reduced family cohesion and confrontation with parental psychopathology (especially on the mother’s side) are found more frequently in families with people with ADHD than in control families”.117
The risk of children developing ADHD (odds ratio) increases with the level of psychosocial stress (Rutter indicator, RI). With an RI of 1, the odds ratio is 7, with an RI of 4 it is 41.7 (68). Odds ratios > 1 indicate an increased risk.118

Progression studies do not find complete persistence even during childhood and adolescence and confirm a frequent coincidence with family problems and parental problems.119 Conversely, a high level of family cohesion and social support has a protective effect against ADHD.120

5.16. Parents are less able to reflect on their parental role

Lower parental reflective functioning correlated with ADHD in children.9 Parental reflective functioning is defined as the parents’ ability to reflect on their own and their child’s inner mental experiences.

5.17. Maternal nasal allergy

Among 5-year-old children, the risk of ADHD was increased by 41% if the mother had a nasal allergy, although the result was not statistically significant by a narrow margin (p = 0.059)32

5.18. High blood pressure in the mother

Among 5-year-old children, the risk of ADHD was increased by 137% (not statistically significant) if the mother had hypertension.32 The information was collected by asking “Do you currently have hypertension diagnosed by a doctor?”. According to Taiwanese guidelines for the prevention and control of hypertension, a diagnosis requires at least three blood pressure measurements and the average of three separate measurements taken at different times, consistently showing a systolic blood pressure of ≥ 140 mmHg or a diastolic blood pressure of ≥ 90 mmHg.33

5.19. Family factors with risk reduction for ADHD

Immigrant status of parents causes a reduced risk of ADHD121 within the first 2 generations.122

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