psychopathology and personality in parents -steinhausen

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Following the increasing awareness that ADHD is a life-long condition in many afflicted individuals, there has been a strong interest in the psychopathology, personality, and everyday life functioning of adults with ADHD. Typically, the samples for these studies have been recruited from long-term follow-up studies of former child or adolescent patients or among newly diagnosed adult patients (e.g., Barkley, Murphy, & Fischer, 2008; Biederman et al., 1993; Deault, 2010; Johnston & Mash, 2001; Kashdan et al., 2004; Kessler et al., 2006; Murphy & Barkley, 1996; Ninowiski, Marh, & Benzies, 2007; Satterfield et al., 2007; Weiss & Hechtman, 1993).

In a smaller number of studies, there has been a specific focus on parents of children with ADHD due to the obser-vation that ADHD runs in families. Using this recruiting strategy, parents of children with ADHD came into the focus of research on parenting stress (Minde et al., 2003; Murray & Johnston, 2006; Sonuga-Barke, Daley, & Thompson, 2002; Tzang, Chan & Liu, 2009). So far, both strategies of research have led to rather similar findings, namely, that ADHD in adults including parents is associ-ated with a high load of other-than-ADHD psychopathol-ogy and psychosocial dysfunctioning.

Research strategies have used different sorts of assess-ments for adults with ADHD, including symptom checklists based on and modified from the Diagnostic and Statistical

Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) criteria developed for children, interview schedules aiming at the categorical ADHD diagno-sis, and various sorts of dimensional self-reports assessing ADHD and other psychopathology. Only a few studies have also incorporated the assessment of personality dimensions (e.g., Nigg et al., 2002; Robin, Tzelepsis, & Bedway, 2008)

Within the Multilevel Family Assessment of ADHD project (MFAA) which includes behavioral, neuropsycho-logical, neurophysiological, and genetic assessments in ADHD children plus one of their siblings and their parents, we have been following the dimensional approach of behav-ioral assessment in the various family members (Steinhausen et al., 2010), along with quantitative neuropsychological and neurophysiological assessments (Valko et al., 2009) in search of potential endophenotypes that might have an

427562 JAD17110.1177/1087054711427562Steinhausen et al.Journal of Attention Disorders© 2013 SAGE Publications

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1University of Zurich, Switzerland2University of Basel, Switzerland3Aarhus University Hospital, Aalborg, Denmark4University of Heidelberg, Mannheim, Germany5Hochschule für Heilpaedagogik, Zurich, Switzerland

Corresponding Author:Hans-Christoph Steinhausen, Department of Child and Adolescent Psychiatry, University of Zurich, Neptunstrasse 60, CH-8032 Zurich, Switzerland Email: [email protected]

Psychopathology and Personality in Parents of Children With ADHD

Hans-Christoph Steinhausen1,2,3, Julia Göllner2, Daniel Brandeis1,4, Ueli C. Müller1,5, Lilian Valko1, and Renate Drechsler1

Abstract

Objective: To compare psychopathology and personality in parents of children with ADHD and control parents. Method: A total of 140 parents were subdivided according to presence and duration of ADHD. Assessment was based on various ADHD self-rating scales, the revised Symptom Checklist (SCL-90-R), the Patient Health Questionnaire (PHQ), and the revised NEO Five Factors Inventory (NEO-FFI). Results: Parents with lifelong persistent ADHD were most abnormal on all dimensions of ADHD psychopathology, the SCL-90-R, the PHQ, and the neuroticism and conscientiousness dimensions of the NEO-FFI. The scores of parents with current ADHD approached those of parents with persistent ADHD on most dimensions, and both groups scored higher than did parents with either remitted ADHD or no ADHD, or controls. The scores of the latter three groups were not significantly different from each other. Conclusion: Among parents of children with ADHD, parents with lifelong persistent or current ADHD show highest scores of psychopathology. (J. of Att. Dis. 2013; 17(1) 38-46)

Keywords

adult ADHD, parents, personality, psychopathology

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Steinhausen et al. 39

association with certain genotypes. The present contribu-tion had the aim of studying the impact of ADHD in parents on other psychopathology and major personality dimen-sions by differentiating various manifestations of ADHD in these parents, namely, lifelong persistent ADHD, current ADHD, and remitted ADHD. In addition, it was intended to control for the impact of ADHD in the child rather than the parent by including a subgroup of parents with an ADHD child but without parental ADHD and a normal control group (CG) of parents.

MethodSamples

The recruitment of children with ADHD included referred and nonreferred participants. The referred children came from a public child and adolescent psychiatric service and from local pediatricians and child and adolescent psychia-trists in private practice. Further participants came from a large national ADHD self-help group or responded to vari-ous campaigns in the media providing information on the project.

The 70 participating ADHD families consisted of bio-logical parents and two children aged 8 to 16 years, with at least one sibling meeting criteria for DSM-IV combined type. Based on specific ADHD assessment procedures (see the following sections), there were 70 ADHD index chil-dren (M age = 11.4, SD = 2.0 years; male:female (m:f) ratio 3:1; M IQ = 115.9, SD = 16.5). The 34 control children (M age = 11.1, SD = 2.1 years; m:f ratio 1.25:1; M IQ = 119.5, SD = 16.5) were recruited from regional elementary schools, friends, or local sport clubs. The 140 parents of children with ADHD included 70 fathers (M age = 44.3, SD = 4.6 years) and 70 mothers (M age = 41.9, SD = 4.4 years). In addition, there were 17 fathers (M age = 45.6, SD = 6.1 years) and 17 mothers (M age = 43.8, SD = 4.7 years) in the CG. Age did not differ significantly between these two groups, t(172) = 1.67, p = n.s.

Based on diagnostic assessments (see the following sec-tions), the 140 parents of children with ADHD were classi-fied into the following four groups: (a) parents with a lifelong history of persistent ADHD (ADHD-L, n = 30, m:f = 0.76:1), (b) parents with current ADHD (ADHD-C, n = 20, m:f = 0.43:1), (c) parents with remitted ADHD (ADHD-R, n = 9, m:f = 0.8:1), and (d) parents with ADHD not present (ADHD-NP, n = 81, m:f = 1.4:1).

AssessmentsRating scales used to quantify ADHD symptoms in children have been described in detail in a recent companion article (Steinhausen et al., 2010). In brief, the procedure included

as a first step the German versions of the Conners’ Parent Rating Scale (CPRS; Conners, Sitarenios, Parker, & Epstein, 1998a) and the Conners’ Teacher rating Scale (CTRS; Conners, Sitarenios, Parker, & Epstein, 1998b). Parents and teachers were asked to rate the behavior of the child when off medication. The Parental Account of Children’s Symptoms (PACS; Taylor, Schachar, Thorley, & Wieselberg, 1986), a semistructured, standardized, investigator-based interview was administered to children suspected having ADHD. Children along with their families were included if at least one child met criteria of the DSM-IV combined type, as resulting from the PACS and the CTRS. For control chil-dren, CPRS and CTRS were completed, and nonclinical scores were required for inclusion.

Diagnosis of ADHD in the parents included the follow-ing instruments. Current ADHD was assessed by use of the German ADHD-Self-Rating Scale (ADHD-SR) for adults and the German version of the Wender–Reimherr Interview (WRI). The ADHD-SR is based on the modified 18 DSM-IV criteria for ADHD with each item scored on a 0 to 3 scale leading to a total score. According to the suggestions of Rösler et al., (2004), a cutoff of 15 on the total score was used for diagnosis. In addition, each parent was interviewed by use of the German version of the structured WRI consist-ing of 28 items each rated on a 0 to 2 scale (Rösler et al., 2008). Following empirically based recommendations by Rösler et al. (2008), a cutoff of 30 on the total score was used for diagnosis. Furthermore, ADHD during childhood and adolescence was assessed retrospectively by use of the German version of the short form of the Wender Utah Rating Scale (WURS-s) containing a total of 21 items each rated on 0 to 5 scale. A cutoff of 27 on the total score was used for diagnosis according to the empirically based sug-gestions by Retz-Junginger et al. (2003). Control parents had to score below the cutoff scores of the ADHD-SR and the WURS-s.

To qualify for the diagnosis of persistent ADHD-L, par-ents had to be positive on either all three ADHD instruments or on either the ADHD-SR or the WRI and the WURS-s. Current ADHD was designated to parents who were posi-tive on either the ADHD-SR or the WRI but negative on the WURS-s. Remitted ADHD was diagnosed when parents fulfilled only the WURS-s criterion.

All parents responded to three questionnaires measuring psychopathology and personality. The German version of the Symptom Checklist 90–Revised (SCL-90-R; Derogatis, 1986) contains 90 items with 83 covering the following dimensions: somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ide-ation, and psychoticism. In addition, a global severity index (GSI), a positive symptom distress index (PSDI), and a posi-tive symptom total (PST) may be calculated. The German version of the SCL-90-R is based on a representative sample



40 Journal of Attention Disorders 17(1)

and provides standardized T-scores for the nine scales and the three global scores (Franke, 2002). The second instru-ment assessing psychopathology consisted of the German version of the Patient Health Questionnaire (PHQ; Spitzer, Kroenke, & Williams, 1999). This questionnaire covers all major mental disorders according to DSM-IV criteria. Following suggestions by Löwe, Spitzer, Zipfel, and Herzog (2002), the authors of the German version, three dimensional scores measuring depression, somatic symptoms, and stress were calculated in the present examination. Finally, the NEO Five Factors Inventory (NEO-FFI; Costa & McCrae, 1992) was used for personality assessment. This questionnaire cov-ers the so-called big five personality dimensions, namely, neuroticism, extraversion, openness to experience, agree-ableness, and conscientiousness. In the present study, the German version of the questionnaire (Borkenau & Ostendorf, 1993) was used and raw scores of the five dimensions were computed.

Statistical analysesTwo parallel statistical procedures were performed when comparing the findings in the four samples. To control for unequal sample sizes, normal distribution of variables (ana-lyzed with the Kolmogorov–Smirnov test), homogeneity of variances (Levene test), and homogeneity of variance–covariance matrices (Box’s M test) were checked first. With a few exceptions, in most of the variables, there was a viola-tion of these prerequisites of the analysis of variance model. As a consequence, the nonparametric Kruskal–Wallis test was performed as a first strategy of data analysis.

In a second approach, group comparisons were per-formed by use of MANCOVA controlling for age and sex and followed by post hoc comparisons based on Bonferroni corrections. If these analyses did not explain more variance than MANOVA without these covariables, the latter were followed by Hochberg post hoc tests (in the case of equal variances) or Games–Howell post hoc tests (in the case of unequal variances). Finally, if there were no differences in the level of significance between the nonparametric and the parametric approach, the MANOVA model was preferred because of a better control of chance findings.

After controlling for the potential impact of the covari-ables and after comparing both statistical approaches, the final data to be reported here are based only on MANOVA and MANCOVA models. All analyses were performed with the help of the Statistical Program for Social Sciences (SPSS, version 16.0).

ResultsFindings based on a comparison of the SCL-90-R scores of the five groups are presented in Table 1. For the sake of

easier inspection, these findings are represented also graphically in Figure 1. There is a highly significant group factor in the two MANOVAs based on the nine primary scales and the three global indices, respectively. Post hoc tests based on comparisons of pairs of groups indicate that on all scales, ADHD-L scores significantly higher than do ADHD-NP and CG and in the majority of scales higher than ADHD-R. Furthermore, except for the scales measur-ing somatization, interpersonal sensitivity, and paranoid ideation, the scores of ADHD-C do not differ significantly from ADHD-L and in most instances also not from the CG. The overall picture of the SCL-90-R findings indicates clearly abnormal profiles for ADHD-L and ADHD-C with little differentiation among each other on one hand and very similar profiles for ADHD-NP, ADHD-R, and ADHD-C on the other hand.

The analogous findings based on the PHQ are shown in Table 2 and Figure 2. The MANCOVA findings indicate a highly significant sex effect with higher scores for females and a highly significant effect for groups. Post hoc compari-sons show that on the depression scale, ADHD-L scores significantly higher than ADHD-NP, ADHD-R, and the CG and that ADHD-C scores higher than ADHD-NP and the CG. On the somatic symptoms scale, there is less differen-tiation with only ADHD-L scoring higher than ADHD-NP and the CG. Comparisons on the stress scale indicate that ADHD-L scores higher than all other groups.

Finally, results of comparisons based on the NEO-FFI are shown in Table 3 and Figure 3. Again, there is a highly sig-nificant effect for sex with females scoring higher than males and a highly significant group effect in the MANCOVA. Post hoc comparisons of groups indicate that there is a clear differentiation on two of the five dimensions. On the neu-roticism scale, ADHD-L scores higher than ADHD-NP and CG whereas ADHD-C scores higher than ADHD-NP only. Both ADHD-L and ADHD-C score lower than ADHD-NP and the CG on the conscientiousness scale.

DiscussionThe first main finding of the present study is a remarkable abnormality of the group of parents with a lifelong history of persistent ADHD on all scales measuring psychopathol-ogy and in the personality domains of high neuroticism and low conscientiousness. Second, there is strong evidence that parents with current ADHD without clear indication of a lifelong history of the disorder have a very similar profile of abnormality like the ADHD-L group with no real significant differentiation. Third, these two groups differ significantly from the other two groups containing parents with remitted ADHD and parents without ADHD but both having children with ADHD. Finally, in terms of psychopa-thology and personality, these two groups of parents with




Table 1. Comparison of Symptom Checklist 90–Revised (SCL-90-R) Findings in Five Groups

ADHD lifelong

(ADHD-L)

ADHD current

(ADHD-C)

ADHD remitted

(ADHD-R)

ADHD not

present (ADHD-

NP)

Control group (CG)

M SD M SD M SD M SD M SD F p Post hoc comparisons

Somatization 52.8 9.5 51.0 6.9 47.0 8.0 45.7 8.8 44.3 6.5 6.09 <.001 aL > NP, CG Obsessive-

compulsive60.4 7.4 58.7 8.7 52.1 7.4 50.1 8.1 48.6 8.9 13.39 <.001 aL > NP, CG C > NP, CG

Interpersonal sensitivity

59.7 9.6 54.4 11.0 50.3 8.2 49.0 7.5 47.8 7.2 11.44 <.001 aL > R, NP, CG

Depression 60.6 9.9 56.0 9.4 49.6 9.0 48.8 8.9 48.9 8.7 11.14 <.001 aL > R, NP, CG C > NPAnxiety 57.4 6.8 56.3 7.7 48.6 9.3 47.9 7.8 47.7 6.8 13.02 <.001 aL > R, NP, CG C > NP, CGHostility 59.7 8.0 55.9 9.1 49.3 4.6 49.5 8.5 49.9 7.5 10.51 <.001 aL > R, NP, CG C > NPPhobic

anxiety54.9 9.5 54.2 7.7 50.4 9.4 49.0 6.6 46.9 4.4 7.25 <.001 bL > NP, CG C > CG

Paranoid ideation

58.7 9.3 53.5 8.8 49 11.0 49.2 6.9 46.9 7.2 11.12 <.001 bL > NP, CG

Psychoticism 54.7 8.8 54.2 8.9 50.7 7.9 48.0 7.0 48.8 6.1 6.16 <.001 aL > NP, CG C > NPGSI 59.6 7.7 55.6 8.9 48.9 9.3 48.1 8.2 47.1 7.9 14.23 <.001 aL > R, NP, CG C > NP, CGPST 58.0 6.9 56.0 6.9 49.0 8.5 48.5 8.0 47.8 8.1 11.93 <.001 aL > R, NP, CG C > NP, CG

PSDI 58.1 7.2 54.0 8.8 47.4 7.8 47.2 8.0 45.8 6.1 15.22 <.001 aL > R, NP, CG C > NP, CG

Note: GSI = global severity index; PST = positive symptom total; PSDI = positive symptom distress index. Multivariate group of the scales first order: Wilks’s lambda = .605, F = 2.29; df = 36, 601; p <.001. Multivariate group effect of the scales second order (GSI, PST, PSDI): Wilks’s lambda = .679; F = 5.76; df = 12, 439; p < .001.aHochberg’s post hoc tests.bGames–Howell post hoc tests.

40

45

50

55

60

65

T-S

core

s

SCL-90-R Scales

ADHD-L

ADHD-C

ADHD-R

ADHD-NP

CG

Figure 1. Symptom Checklist 90–Revised (SCL-90-R) profiles in five groupsNote: ADHD-L = parents with a lifelong history of persistent ADHD; ADHD-C = parents with current ADHD; ADHD-R = parents with remitted ADHD; ADHD-NP = parents with ADHD not present; CG = control group.***p < .001




remitted ADHD or without ADHD are not different from parents with children having no ADHD.

The present study had a particular focus on the parents of children with ADHD. They were shown to have a broad range of increased psychopathology covering somatiza-tion, obsessive-compulsive, social insecurity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psy-choticism, neuroticism, and stress. Overall, the present findings add to a growing body of literature indicating that adults with ADHD suffer from an additional load of other psychopathology and personality dysfunctioning interfer-ing with the organization of their daily life (Barkley et al., 2008; Biederman et al., 1993, 2006; Kashdan et al., 2004; Kessler et al., 2006; Murphy & Barkley, 1996; Murray &

Johnston, 2006; Satterfield et al., 2007; Weiss & Hechtman, 1993).

Furthermore, and in line with Barkley et al. (2008) and Faraone et al. (2006), the present findings provide additional evidence that the differentiation between lifelong persistent and current ADHD in adulthood does not lead to much dif-ferentiation in other domains so that the validity of these potential subtypes may be questioned. Particularly the differentiating age criterion of onset of the disorder before age 7 is difficult to assess reliably in retrospective history taking and may not be reinstalled in the upcoming DSM-V revisions after some criticism has been raised repeatedly (Applegate et al., 1997; Barkley & Biederman, 1997; Kessler, Berglund, Demler, Jin, & Walters, 2005). However, it should not be overlooked that on the dimension of stress as mea-sured by the PHQ, there was a single and clear differentiation indicating that persistent lifelong ADHD in a parent may have a different impact than does current ADHD only.

In general, the present findings also add to the notion that remitting ADHD with only a previous history of ADHD in childhood leads to normal adult functioning. In the majority of scales, the remitted ADHD parent group was clearly significantly less abnormal than the persistent ADHD group and, at the same time, not distinguishable from both parent groups without ADHD and a child with ADHD or a normal child, respectively. These findings tend to replicate those of the follow-up study of ADHD children and adolescents by Barkley et al. (2008). Due to the differ-ent sample structure, the latter study had a much higher rate of remitting ADHD participants than the present study so that the differentiation between persistent and remitting ADHD based on the SCL-90-R was even stronger.

In the present study, the consideration of a subgroup of parents with an ADHD child but without having ADHD themselves allowed to test whether it is the ADHD in the parent or in the child that has a major impact on parental functioning. The present findings revealed that parents with

Table 2. Comparison of Patient Health Questionnaire (PHQ) Findings in Five Groups

ADHD lifelong

(ADHD-L)

ADHD current

(ADHD-C)

ADHD remitted

(ADHD-R)

ADHD not

present (ADHD-

NP)

Control group (CG)

M SD M SD M SD M SD M SD F p aPairwise comparisons

Depression 8.7 4.6 6.3 3.4 4.1 2.8 3.1 2.9 3.1 2.4 18.9 <.001 C > NP, CG L > R, NP, CGSomatic symptoms

7.2 3.8 6.4 4.5 4.0 9.0 4.3 3.3 3.5 2.6 6.09 <.001 L > NP, CG

Stress 7.1 3.9 5.5 3.0 4.7 3.5 3.4 3.2 3.3 2.5 7.77 <.001 C < L L > C, R, NP, CG

Note: Multivariate effect of group: Wilks’s lambda = .650, F = 6.43, df = 12, 437; p <.001. Multivariate effect of sex: Wilks’s lambda = .886, F = 7.07, df = 3, 165; p < .001.aPairwise comparisons have been performed with a Bonferroni correction.

2

3

4

5

6

7

8

9

10

Raw

scor

es

PHQ-D Scales

ADHD-L

ADHD-C

ADHD-R

ADHD-NP

CG

Figure 2. Patient Health Questionnaire (PHQ) profiles in five groupsNote: ADHD-L = parents with a lifelong history of persistent ADHD; ADHD-C = parents with current ADHD; ADHD-R = parents with remitted ADHD; ADHD-NP = parents with ADHD not present; CG = control group.***p < .001




an ADHD child but without having ADHD themselves showed identical and normal profiles like the CG of parents without an ADHD child. Furthermore, the profiles of these parents were clearly distinct from those of parents with either persistent or current ADHD. Thus, there is clear evi-dence that it is mainly the ADHD in the parents themselves rather than the ADHD in the child that has an impact on parental functioning in other domains of psychopathology and personality. This conclusion is very much in concor-dance with findings from a few other studies (Minde et al., 2003; Murray & Johnston, 2006; Sonuga-Barke et al., 2002) and reviews (Barkley et al., 2008; Deault, 2010; Johnston & Mash, 2001).

Finally, the methods used in the present study deserve a brief comment. The various indicators of psychopathology and personality were selected to cover a broad range of mental phenomena that potentially might serve in the iden-tification of endophenotypes in association with future analyses of potential genotypes. All three measures, the SCL-90-R, the PHQ, and (perhaps a little less well) the NEO-FFI, served these purposes well by differentiating the various groups under study. The SCL-90-R findings have been used repeatedly in previous studies and findings across studies are congruent by showing the high load of psychopathology in adults with ADHD (Barkley et al., 2008; Murphy & Barkley, 1996; Murphy, Barkley, & Bush, 2002; Weiss & Hechtman, 1993).

To our knowledge, the PHQ has not been used before in other adult ADHD studies. In the present contribution, we have abstained from presenting other outcome variables of the PHQ, that is, the various indications of DSM-IV disor-ders. Our reluctance to present this information is due to the screening type of this self-report which provides only an indication of a disorder that requires more intensive clinical interviewing to establish reliable diagnoses. However, the three presented quantitative scores of depression, somatic symptoms, and stress represent reliable and valid dimen-sions of psychosocial dysfunction and potential endopheno-types for further analysis. So far, the NEO-FFI had served better in two other studies by differentiating adult ADHD from controls in all five dimensions (Nigg et al., 2002; Robin et al., 2008).

Limitations of the present study include a disproportionate number of female participants. There were more mothers than fathers in the ADHD-L group (m:f ratio = 0.76:1), the ADHD-C group (0.43:1), and the ADHD-R group (0.8:1). This is, however, in line with some other studies on adult ADHD, where female patients are overrepresented (Almeida Montes, Hernandez Garcia, & Ricardo-Garcell, 2007;

Table 3. Comparison of NEO Five Factors Inventory (NEO-FFI) Findings in Five Groups

ADHD lifelong

(ADHD-L)

ADHD current

(ADHD-C)

ADHD remitted

(ADHD-R)

ADHD not present (ADHD-

NP)

Control group (CG)

M SD M SD M SD M SD M SD F p aPairwise comparisons

Neuroticism 2.2 0.8 2.1 0.7 1.7 0.8 1.4 0.6 1.5 0.6 8.14 <.001 C > NP L > NP, CGExtraversion 2.2 0.7 2.2 0.7 2.4 0.3 2.3 0.5 2.4 0.5 0.87 .483 Openness to

experience2.3 0.5 2.5 0.6 2.5 0.4 2.4 0.6 2.4 0.4 0.29 .887

Agreeableness 2.5 0.5 2.5 0.6 2.7 0.5 2.7 0.4 2.6 0.4 2.47 .047 Conscientiousness 2.4 0.6 2.3 0.8 2.7 0.6 3.0 0.5 2.9 0.5 11.38 <.001 C > NP, CG L > NP, CG

Note: Multivariate effect of group: Wilks’s lambda = .693, F = 3.14, df = 20, 538; p < .001. Multivariate effect of sex: Wilks’s lambda = .841, F = 6.12, df = 5, 162; p < .001. Multivariate effect of age: Wilks’s lambda = .936, F = 2.21, df = 5, 162; p = .055.aPairwise comparisons have been performed with a Bonferroni correction.

1

1.5

2

2.5

3

3.5

Raw

scor

es

NEO-FFI Scales

ADHD-LADHD-CADHD-RADHD-NPCG

Figure 3. NEO Five Factors Inventory (NEO-FFI) profiles in five groupsNote: ADHD-L = parents with a lifelong history of persistent ADHD; ADHD-C = parents with current ADHD; ADHD-R = parents with remitted ADHD; ADHD-NP = parents with ADHD not present; CG = control group.*p < .05; ***p < .001




DuPaul et al., 2001) or where the gender ratio is at least balanced (see the meta-analysis by Simon, Czobor, Bálint, Mészáros, & Bitter, 2009). The recruitment of whole fami-lies with an index child with ADHD as the defining crite-rion and a greater willingness of ADHD mothers than ADHD fathers to participate may have contributed to this different sex distribution in the adult sample. Sex was con-trolled in all analyses as a covariate which clearly indicated a higher symptom load in the mothers as compared with the fathers. This finding may reflect valid sex differences and a greater honesty of the mothers to admit their symp-toms. Furthermore, the sample sizes of the various adult samples were relatively small so that replications of the present findings with larger samples may be warranted.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was financially supported by a grant from the Swiss National Science Foundation to the first author.

References

Almeida Montes, L. G., Hernandez Garcia, A. O., & Ricardo-Garcell, J. (2007). ADHD prevalence in adult outpatients with nonpsychotic psychiatric illnesses. Journal of Attention Disor-ders, 11, 150-156.

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Applegate, B., Lahey, B. B., Hart, E. L., Waldmann, I., Biederman, J., Hynd, G. W., . . . Shaffer, D. (1997). Validity of the age of onset criterion for ADHD: A report from the DSM-IV field trials. Journal of the American Academy of Child & Adoles-cent Psychiatry, 36, 1211-1221.

Barkley, R. A., & Biederman, J. (1997). Toward a broader defini-tion of the age-of-onset criterion for attention deficit hyperac-tivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 1204-1210.

Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). ADHD in adults: What the science says. New York, NY: Guilford.

Biederman, J., Faraone, S. V., Spencer, T., Wilens, T., Norman, D., Lapey, K. A., . . . Doyle, A. (1993). Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. American Jour-nal of Psychiatry, 150, 1792-1798.

Biederman, J., Monuteaux, C., Mick, E., Spencer, T., Wilens, T. E., Silva, J. M., . . . Faraone, S. V. (2006). Young adult outcome of attention deficit hyperactivity disorder: A controlled 10-year follow-up study. Psychological Medicine, 36, 167-179.

Borkenau, P., & Ostendorf, F. (1993). NEO-Fünf-Faktoren-Inventar (NEO-FFI) nach Costaund McCrae (Handanweisung)

[NEO-FFI by Costa and McCrae. Manual]. Göttingen, Germany: Hogrefe.

Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998a). The Revised Conners’ Parent Rating Scale (CPRS-R): Factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 257-268.

Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998b). Revision and restandardization of the Conners’ Teacher Rating Scale (CTRS-R): Factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.

Costa, P. T., & McCrae, R. R. (1992). Revised NEO personality inventory and NEO five factor inventory professional manual. Odessa, FL: Psychological Assessment Resources.

Deault, L. C. (2010). A systematic review of parenting in relation to the development of comorbidities and functional impairments in children with attention-deficit/hyperactivity disorder (ADHD). Child Psychiatry & Human Development, 41, 168-192.

Derogatis, L. (1986). Manual of the Symptom Checklist 90 revised (SCL-90). Baltimore, MD: Author.

DuPaul, G. J., Schaughency, E. A., Weyandt, L. L., Tripp, G., Kiesner, J., Ota, K., & Stanish, H. (2001). Self-report of ADHD symptoms in university students: Cross-gender and national prevalence. Journal of Learning Disability, 34, 370-379.

Faraone, S. V., Biederman, J., Spencer, T., Mick, E., Murray, K., Petty, C., . . . Monuteaux, M. C. (2006). Diagnosing adult attention-deficit-hyperactivity disorder: Are late onset and subthreshold diagnosis valid? American Journal of Psychia-try, 163, 1720-1729.

Franke, G. H. (2002). SCL-90-R Symptomcheckliste von L. R. Derogatis, Deutsche Version. 2: Vollständige überarbeitete und neu normierte Auflage [SCL-90-R by L. R. Derogatis: Revised and standardized edition].Göttingen, Germany: Beltz.

Johnston, C., & Mash, E. J. (2001). Families of children with attention deficit/hyperactivity disorder: Review and recom-mendations for future research. Clinical Child and Family Psychology Review, 4, 183-207.

Kashdan, T. B., Jacob, R. G., Pelham, W. E., Lang, A. R., Hoza, B., Blumenthal, J. D., & Gnagy, B. M. (2004). Depression and anxiety in parents of children with ADHD and varying levels of oppositional defiant behaviors: Modeling relationships with family functioning. Clinical Child and Adolescent Psychol-ogy, 33, 168-181.

Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., . . . Zaslavsky, A. M. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. American Jour-nal of Psychiatry, 163, 716-723.

Kessler, R. C., Berglund, P., Demler, O., Jin, R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distribution of DSM-IV disorders in the National Comorbidity Survey repli-cation. Archives of General Psychiatry, 62, 593-602.

Löwe, B., Spitzer, R. L., Zipfel, S., & Herzog, W. (2002). PHQ-D. Gesundheitsfragebogen für Patienten. Manual Komplettversion




und Kurzform (2. Auflage) [Patient Health Questionnaire. Manual]. Karlsruhe, Germany: Pfizer GmbH.

Minde, K., Eakin, L., Hechtmann, L., Ochs, E., Bouffard, R., Greenfield, B., & Looper, K. (2003). The psychological func-tioning of children and spouses of adults of ADHD. Journal of Child Psychology and Psychiatry, 44, 637-646.

Murphy, K. R., & Barkley, R. A. (1996). Attention deficit hyper-activity disorder adults: Comorbidities and adaptive impair-ments. Comprehensive Psychiatry, 37, 393-401.

Murphy, K. R., Barkley, R. A., & Bush, T. (2002). Young adults with ADHD: Subtype differences in comorbidity, educational, and clinical history. Journal of Nervous and Mental Disease, 190, 147-157.

Murray, C., & Johnston, C. (2006). Parenting in mothers with and without attention-deficit/hyperactivity disorder. Journal of Abnormal Psychology, 157, 1156-1159.

Nigg, J. T., Blaskey, L. G., Huang-Pollock, C., Hinshaw, S. P., John, O. P., Willcutt, E. G., & Pennington, B. (2002). Big five dimensions and ADHD symptoms: Links between personal-ity traits and clinical symptoms. Journal of Personality and Social Psychology, 83, 451-469.

Ninowiski, J. E., Marh, E. J., & Benzies, K. M. (2007). Symptoms of attention-deficit/hyperactivity disorder in adults. American Journal of Psychology, 116, 35-60.

Retz-Junginger, P., Retz, W., Blocher, D., Stieglitz, R. D., Georg, T., Supprian, T., . . . Rösler, M. (2003). Reliability and validity of the Wender-Utah-Rating-Scale short form: Retrospective assessment of symptoms for attention deficit/hyperactivity disorder. Nervenarzt, 74, 987-983.

Robin, A., Tzelepsis, A., & Bedway, M. (2008). A cluster analysis of personality style in adults with ADHD. Journal of Attention Disorders, 12, 254-263.

Rösler, M., Retz, W., Retz-Junginger, P., Hengesch, G., Schneider, M., Supprian, T., . . . Thome, J. (2004). Prevalence of attention deficit/hyperactivity disorder (ADHD) and comorbid disorders in young male prison inmates. European Archives of Psychiatry & Clinical Neuroscience, 254, 365-371.

Rösler, M., Retz, W., Retz-Junginger, P., Stieglitz, R. D., Kessler, H., Reimherr, F., & Wender, P. H. (2008). ADHS Diagnose bei Erwachsenen. Nach DSM-IV, ICD-10 und den Utah-Kriterien [Diagnosis of ADHD in adults according to DSM-IV, ICD-10, and the Utah criteria]. Nervenarzt, 79, 320-327.

Satterfield, J. H., Faller, K. F., Crinella, F. M., Scjell, A. M., Swanson, J. M., & Homer, L. D. (2007). A 30-year prospective follow-up study of hyperactive boys with conduct problems: Adult criminality. Journal of the American Academy of Child & Adolescent Psychiatry, 46, 601-610.

Simon, V., Czobor, P., Bálint, S., Mészáros, A., & Bitter, I. (2009). Prevalence and correlates of adult attention-deficit hyperactiv-ity disorder: Meta-analysis. British Journal of Psychiatry, 194, 204-211.

Sonuga-Barke, E. J. S., Daley, D., & Thompson, M. (2002). Does maternal ADHD reduce the effectiveness of parent training

for preschool children’s ADHD? Journal of the American Academy of Child & Adolescent Psychiatry, 41, 696-702.

Spitzer, R., Kroenke, K. R. L., & Williams, J. B. (1999). Validation and utility of a patient self-report of PRIME-MD: The PHQ primary care study. Journal of the American Medical Associa-tion, 283, 1737-1744.

Steinhausen, H.-C., Zülli-Weilenmann, N., Brandeis, D., Müller, U., Valko, L., & Drechsler, R. (2010). The behavioural profile of children with attention-deficit/hyperactivity disorder and their siblings. Manuscript submitted for publication.

Taylor, E., Schachar, R., Thorley, G., & Wieselberg, M. (1986). Conduct disorder and hyperactivity: I. Separation of hyperactivity and antisocial conduct in British child psychiatric patients. British Journal of Psychiatry, 149, 760-767.

Tzang, R.-F., Chang, Y.-U., & Liu, S.-I. (2009). The association between children’s ADHD subtype and parenting stress and parental symptoms. International Journal of Psychiatry in Clinical Practice, 13, 318-325.

Valko, L., Doehnert, M., Müller, U., Schneider, G., Albrecht, B., Drechsler, R., . . . Brandeis, D. (2009). Differences in neuro-physiological markers of inhibitory and temporal processing deficits in children and adults with ADHD. Journal of Psycho-physiology, 23, 235-246.

Weiss, G., & Hechtman, L. (1993). Hyperactive children grown up (2nd ed.). New York, NY: Guilford.

Bios

Hans-Christoph Steinhausen is professor and chairman emeritus at the Department of Child and Adolescent Psychiatry, University of Zurich, Switzerland, Honorary Professor at the Institute of Psychology, University of Basel, Switzerland, and Professor of Child and Adolescent Psychiatry at Aalborg Psychiatric Hospital, Aarhus University Hospital, Denmark. He graduated with an MD in medicine (1970), a PhD in psychology (1975), and a postdoc-toral dissertation in medicine (DMSc. 1976). His current major research interests include developmental psychopathology and various neuroscientific, genetic, and clinical issues in child and adolescent psychopathology.

Julia Göllner graduated in 2010 with an MA in psychology. In her master thesis, she worked on psychopathology and personality issues in the parents of children with ADHD. Currently she spe-cializes in clinical child and adolescent psychology.

Daniel Brandeis is professor at the Departments of Child and Adolescent Psychiatry, University of Zurich, Switzerland, and the Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany. He graduated with diploma and doctorate in Biological Sciences (1979, 1986) and holds a MA in Psychology (1981). His current main research interests include the developmental neuroscience of ADHD and dyslexia and their treat-ments, using neurophysiological, multimodal imaging, and genetic approaches.




Ueli C. Müller is lecturer at the Hochschule für Heilpaedagogik, Zurich, Switzerland. He graduated with a MAS in Cognitive Behavioral Therapy (2004) and with a PhD in Psychology (2009). His main research interests include evaluation of psychotherapy and neuropsychology of ADHD.

Lilian Valko graduated with a PhD in Psychology (2009) on neu-rophysiological and neuropsychological aspects of time process-ing in ADHD. Currently she specializes in clinical child and adolescent psychology.

Renate Drechsler, PhD, is research associate at the Department of Child and Adolescent Psychiatry, University of Zurich, Switzerland. She graduated in Linguistics and Psychology and specialized in clinical neuropsychology. Her current research interests include neuropsychological aspects of ADHD, interven-tions for children with ADHD, executive functions, emotion pro-cessing, and neuropsychological assessment.



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