Predictors of impairment in school-aged children with a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD)

Background: Many children exhibit hyperactive/inattentive behaviours, but only some experience significant impairment. However, little is known about the reasons some symptomatic children are more impaired than others. This study examined whether child, paternal, or teacher factors predicted level of functioning in school-aged children diagnosed with ADHD, above and beyond child ADHD symptom severity. Method: A sample of children aged 5 to 11 years who were all diagnosed with ADHD (n = 88), participated in this study. Child measures included FSIQ scores, parent and teacher reported ADHD symptom severity and temperament attributes, and clinician-rated Children’s Global Assessment Scale (CGAS) ratings which were used to determine level of child functioning. Parent- and teacher-rated child expectations and actual child behaviour, parenting/teaching stress, and parent reports of parenting style were obtained. Results: Analyses showed that after controlling for child ADHD symptom severity, lower maternal parenting-efficacy beliefs were significantly associated with higher maternal stress and maternal parenting styles. Higher child ADHD symptom severity and a lax maternal parenting style were significantly related to higher child impairment above and beyond maternal parenting beliefs. After controlling for child temperament attributes, paternal stress was approaching significance to an over-reactive paternal parenting style, which was in turn approaching significance to child functioning, above and beyond child temperament attributes. After controlling for child ADHD symptom severity, higher teacher responsibility for student failure, lower teacher credit for student success, and lower Goodness of Fit (GoF) between teacher expectations and student behaviour in regard to general activity level and adaptability to changes, were significantly associated with higher teaching stress, above and beyond child ADHD symptom severity. Lower teacher credit for student success and lower teacher expectations GoF in regard to adaptability were approaching significance in relation to higher child impairment, above and beyond child ADHD symptom severity, teacher attributions for student failure, and teacher expectations GoF in regard to general activity level. Conclusions: Child, parent and teacher factors were related to level of impairment in school-aged children with ADHD, with strongest effects found for maternal factors. The results suggest that ADHD interventions for school-aged children which help mothers to develop greater parenting-efficacy beliefs may help reduce parenting stress and maladaptive parenting. Furthermore, teaching mothers strategies to better manage parenting stress, along with firm and consistent parenting behaviours, may improve the functioning of school-aged children with ADHD. Fathers of children with ADHD may benefit particularly from gaining parenting stress management skills in order to better control expressed irritability towards their child while maintaining a clear communication style with them. Involving teachers in ADHD interventions by encouraging development of more balanced teaching beliefs about student success, as well as strategies to better manage teaching stress and student behaviour which deviates from teacher expectations (particularly in regard to activity level and adaptability), may also increase the functioning of school-aged children with ADHD