Social Psychiatry and Psychiatric Epidemiology

, Volume 45, Issue 2, pp 233–244 | Cite as

Family factors and children’s disruptive behaviour: an investigation of links between demographic characteristics, negative life events and symptoms of ODD and ADHD

Original Paper



Oppositional defiant disorder behaviours (ODD) and attention deficit/hyperactivity disorder symptoms (ADHD) are common disruptive childhood problems and co-occur to a large extent. In this study, prime questions were the specificity of relations between demographic factors and negative life events, respectively, and ADHD and ODD symptoms, and the role of negative life events in the relations between demographic factors and ODD and ADHD symptoms.


Concurrent relations between maternal education, family structure, ethnicity/immigrant background and symptoms of ADHD and ODD were investigated in a Swedish population sample of 1,200 10-year-old children (52% boys). Parents completed questionnaires containing information about demographic characteristics and negative life events and rated the child’s ADHD and ODD symptoms using DSM-IV criteria.


Low maternal education, single/step-parenthood and non-European descent were associated with higher numbers of ODD and ADHD symptoms. Regression analyses identified ethnicity as specifically associated with ODD symptoms and single/step-parenthood as specific to ADHD symptoms, while there was no specificity with regard to negative life events. Experiences of multiple negative life events were more common in families in non-optimal circumstances. Negative life events had mainly additive effects on the level of ODD and ADHD symptoms above effects of the demographic stressors and especially conflicts between adults around the child were related to high symptom levels. The few gender effects pointed to boys as being more vulnerable than girls to non-optimal family factors expressed in relations to ODD and ADHD symptoms.


Even in an affluent and egalitarian society, children’s life circumstances are related to their mental health. Further, there seems to be some specificity in the demographic risk factors associated with ODD and with ADHD symptoms, while negative life events act as general stressors.


Maternal education Ethnicity Family structure Life events ODD symptoms ADHD symptoms 



This research was supported by a grant from the Swedish Council for Working Life and Social Research.


  1. 1.
    Aiken L, West SG (1991) Multiple regression: testing and interpreting interactions. Sage Publications, Newbury ParkGoogle Scholar
  2. 2.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th Edn. Washington, D.CGoogle Scholar
  3. 3.
    August GJ, Realmuto GM, MacDonald AWIII, Nugent SM, Crossby R (1996) Prevalence of ADHD and comorbid disorders among elementary school children screened for disruptive behaviour. J Abnorm Child Psychol 24:571–595CrossRefPubMedGoogle Scholar
  4. 4.
    Barkley RA (1998) Attention-deficit hyperactivity disorder. A handbook for diagnosis and treatment, 2nd edn. Guildford Press, New YorkGoogle Scholar
  5. 5.
    Barkley RA (2006) Attention-deficit hyperactivity disorder. A handbook for diagnosis and treatment, 3rd edn. Guildford Press, New YorkGoogle Scholar
  6. 6.
    Berden GF, Althaus M, Verhulst FC (1990) Major life events and changes in behavioural functioning in children. J Child Psychol Psychiatry 31:949–959CrossRefPubMedGoogle Scholar
  7. 7.
    Biederman J (2005) Attention-deficit hyperactivity disorder: a selective overview. Biol Psychiatry 57:1215–1220CrossRefPubMedGoogle Scholar
  8. 8.
    Biederman J, Faraone SV, Monuteaux MC (2002) Differential effect of environmental adversity by gender: Rutters index of adversity in a group of boys and girls with and without ADHD. Am J Psychiatry 159:1556–1562CrossRefPubMedGoogle Scholar
  9. 9.
    Bird HR, Canino GJ, Davies M, Zhang H, Ramirez R, Lahey B (2001) Prevalence and correlates of antisocial behaviours among three ethnic groups. J Abnorm Child Psychol 29:465–478CrossRefPubMedGoogle Scholar
  10. 10.
    Bussing R, Fernandez M, Harwood M, Hiu W, Wilson Garvan C, Eyberg SM, Swanson J (2008) Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms: psychometric properties and normative ratings from a school district sample. Assessment 15:317–328CrossRefPubMedGoogle Scholar
  11. 11.
    Claycomb CD, Ryan JJ, Miller LJ, Schnakenberg-Ott SD (2004) Relationships among attention deficit hyperactivity disorder, induced labor and selected physiological and demographic variables. J Clin Psychol 60:693–698CrossRefGoogle Scholar
  12. 12.
    Conger RD, Wallace LE, Sun Y, Simons RL, McLoyd VC, Brody GH (2002) Economic pressure in African American families: a replication and extension of the family stress model. Dev Psychol 38:179–193CrossRefPubMedGoogle Scholar
  13. 13.
    Counts CA, Nigg JT, Stawicki JA, Rappley MD, von Eye A (2005) Family adversity in DSM-IV ADHD combined and inattentive subtypes and associated disruptive behaviour problems. J Am Acad Child Adolesc Psychiatry 44:690–698CrossRefPubMedGoogle Scholar
  14. 14.
    Cuffe SP, McKeown RE, Jackson KL, Addy CL, Abramson R, Garrison CZ (2001) Prevalence of attention-deficin/hyperactivity disorder in a community sample of older adolescents. J Am Acad Child Adolesc Psychiatry 40:1037–1044CrossRefPubMedGoogle Scholar
  15. 15.
    Cuffe SP, Moore CG, McKeown RE (2005) Prevalence and correlates of ADHD symptoms in the National Health Interview Survey. J Atten Disord 9:392–401CrossRefPubMedGoogle Scholar
  16. 16.
    Cunningham CE, Boyle MH (2002) Preschoolers at risk for attention-deficit hyperactivity disorder and oppositional defiant disorder: family, parenting and behavioural correlates. J Abnorm Child Psychol 30:555–569CrossRefPubMedGoogle Scholar
  17. 17.
    Daud A, Skoglund E, Rydelius P-A (2005) Children in families of torture victims: transmission of parent’s traumatic experiences to their children. Int J Soc Welfare 14:23–32CrossRefGoogle Scholar
  18. 18.
    Drabick DA, Gadow KD, Carlson GA, Bromet EJ (2004) ODD and ADHD symptoms in Ukrainian children: external validators and comorbidity. J Am Acad Child Adolesc Psychiatry 43:735–743CrossRefPubMedGoogle Scholar
  19. 19.
    DuPaul GJ, Power TJ, Anastopoulos AD, Reid R (1998) ADHD rating scale—IV checklists, norms, and clinical interpretation. Guilford Press, New YorkGoogle Scholar
  20. 20.
    Eakin L, Minde K, Hechtman L, Ochs E, Krane E, Bouffard R et al (2004) The marital and family functioning of adults with ADHD and their spouses. J Atten Disord 8(1):1CrossRefPubMedGoogle Scholar
  21. 21.
    Ersan EE, Dogan O, Dogan S, Sumer H (2004) The distribution of symptoms of attention-deficit/hyperactivity disorder and oppositional defiant disorder in school age children in Turkey. Eur Child Adolesc Psychiatry 13:354–361CrossRefPubMedGoogle Scholar
  22. 22.
    Foley DL, Pickles A, Rutter M, Gardner CO, Maes HH, Silberg SL, Eaves LJ (2004) Risk for conduct disorder symptoms associated with parental alcoholism in stepfather families versus intact families from a community sample. J Child Psychol Psychiatry 45:687–696CrossRefPubMedGoogle Scholar
  23. 23.
    Ford T, Collishaw S, Meltzer H, Goodman R (2007) A prospective study of childhood psychopathology: independent predictors of change over three years. Soc Psychiatry Psychiatr Epidemiol 42:953–961CrossRefPubMedGoogle Scholar
  24. 24.
    Ford T, Goodman R, Meltzer H (2004) The relative importance of child, family, school and neighbourhood correlates of childhood psychiatric disorder. Soc Psychiatry Psychiatr Epidemiol 39:487–496CrossRefPubMedGoogle Scholar
  25. 25.
    Goldstein LH, Harvey EA, Friedman-Weieneth JL, Pierce C, Tellert A, Sippel JC (2007) Examining subtypes of behaviour problems among 3-year-old-children, part II: investigating differences in parent psychopathology, couple conflict and other family stressors. J Abnorm Child Psychol 35:111–123CrossRefPubMedGoogle Scholar
  26. 26.
    Goodyear I, Wright C, Altham P (1990) The friendships and recent life events of anxious and depressed school age children. Br J Psychiatry 156:689–698CrossRefGoogle Scholar
  27. 27.
    Graetz BW, Sawyer MG, Hazell PL, Arney F, Baghurst P (2001) Validity of DSM-IV subtypes in a nationally representative sample of Australian children and adolescents. J Am Acad Child Adolesc Psychiatry 40:1410–1417CrossRefPubMedGoogle Scholar
  28. 28.
    Grant KE, Compas BE, Thurm AE, McMahon SD, Gipson PY, Campbell AJ, Krochock K, Westrholm RI (2006) Stressor and child and adolescent psychopathology: evidence of moderating and mediating effects. Clin Psychol Rev 26:257–283CrossRefPubMedGoogle Scholar
  29. 29.
    Holmberg K, Hjern A (2008) Bullying and attention-deficit-hyperactivity disorder in 10-year-olds in a Swedish community. Dev Med Child Neurol 50:134–138CrossRefPubMedGoogle Scholar
  30. 30.
    Huss M, Hölling H, Kurth B-M, Schlack R (2008) How often are German children and adolescents diagnosed with ADHD? Prevalence based on the judgement of health care professionals results of the German health and examination survey (KiGGS). Eur J Child Adolesc Psychiatry 17:52–58CrossRefGoogle Scholar
  31. 31.
    Jonston C (1996) Parent characteristics and parent-child interactions in families with non-problem children and ADHD children with higher and lower levels of oppositional-defiant behaviour. J Abnorm Child Psychol 24:85–104CrossRefGoogle Scholar
  32. 32.
    Johnston C, Mash EJ (2001) Families in children with attention-deficit/hyperactivity disorder: review and recommendations for future research. Clin Child Fam Psychol Rev 4:183–207CrossRefPubMedGoogle Scholar
  33. 33.
    Kadesjö C, Kadesjö B, Hägglöf B, Gillberg C (2001) ADHD in Swedish 3- to 7-year-old children. J Am Acad Child Adolesc Psychiatry 40:1021–1028CrossRefPubMedGoogle Scholar
  34. 34.
    Kline RB (1998) Principles and practice of structural equation modeling. Guilford Press, New YorkGoogle Scholar
  35. 35.
    Kolko DJ, Dorn LD, Bukstein O, Burke JD (2008) Clinically referred ODD children with or without CD and healthy controls; comparisons across contextual domains. J Child Fam Stud 17:714–734CrossRefGoogle Scholar
  36. 36.
    Lansford JE, Malone PS, Stevens KI, Dodge KA, Bates JE, Pettit GS (2006) Developmental trajectories of externalizing and internalizing behaviours: factors underlying resilience in physically abused children. Dev Psychopathol 18:35–55CrossRefPubMedGoogle Scholar
  37. 37.
    Latimer WW, August GJ, Newcomb MD, Realmuto GM, Hektner JM, Mathy RM (2003) Child and familial pathways to academic achievement and behavioural adjustment: a prospective six-year study of children with and without ADHD. J Atten Disord 7:101–116CrossRefPubMedGoogle Scholar
  38. 38.
    Leadbeater BJ, Kuperminc GP, Blatt SJ, Herzog C (1999) A multivariate model of gender differences in adolescents’ internalizing and externalizing problems. Dev Psychol 35:1268–1282CrossRefPubMedGoogle Scholar
  39. 39.
    Lindencrona F, Ekblad S, Hauf E (2008) Mental health of recently resettles refugees from the Middle East in Sweden: the impact of pre-settlement trauma, resettlement stress and capacity to handle stress. Soc Psychiatry Psychiatr Epidemiol 43:121–131CrossRefPubMedGoogle Scholar
  40. 40.
    McMahon SD, Grant KE, Compas BE, Thurm AE, Ey S (2003) Stress and psychopathology in children and adolescents: is there evidence of specificity? J Child Psychol Psychiatry 44:107–133CrossRefPubMedGoogle Scholar
  41. 41.
    Masten AS, Neemann J, Andenas S (1994) Life events and adjustment in adolescents: the significance of event dependence, desirability, and chronicity. J Res Adolesc 4:71–97CrossRefGoogle Scholar
  42. 42.
    Mathijssen JJJP, Koot HM, Verhulst FC (1999) Predicting change in problem behaviour from child and family characteristics and stress in referred children and adolescents. Dev Psychopathol 11:305–320CrossRefPubMedGoogle Scholar
  43. 43.
    Maughan B, Rowe R, Messer J, Goodman R, Meltzer H (2004) Conduct disorder and oppositional defiant disorder in a national sample: developmental epidemiology. J Child Psychol Psychiatry 45:609–621CrossRefPubMedGoogle Scholar
  44. 44.
    Miech RA, Caspi A, Moffitt TE, Entner Wright BR, Silva PA (1999) Low socioeconomic status and mental disorders: a longitudinal study of selection and causation during young adulthood. Am J Sociol 104:1096–1131CrossRefGoogle Scholar
  45. 45.
    Niederhofer H, Hackenberg B, Stier R, Lanzendörfer K, Kemmler G, Lechner T (2003) Features in families of boys with hyperkinetic and emotional disorders. Psychol Rep 92:849–852CrossRefPubMedGoogle Scholar
  46. 46.
    Nigg JT (2006) What causes ADHD? Understanding what goes wrong and why. The Guilford Press, New YorkGoogle Scholar
  47. 47.
    Pineda D, Ardila A, Rosselli M, Arias BE, Henao GC, Gomez LF, Mejia SE, Miranda ML (1999) Prevalence of attention-deficit/hyperactivity disorder symptoms in 4–17-year-old children in the general population. J Abnorm Child Psychol 27:455–462CrossRefPubMedGoogle Scholar
  48. 48.
    Pumariega AJ, Rothe E, Pumariega JB (2005) Mental health of immigrants and refugees. Commun Ment Health J 41:581–597CrossRefGoogle Scholar
  49. 49.
    Rowe R, Maughan B, Pickles A, Costello EJ, Angold A (2002) The relationship between DSM-IV oppositional defiant disorder and conduct disorder: findings from the Great Smoky Mountain Study. J Child Psychol Psychiatry 43:365–373CrossRefPubMedGoogle Scholar
  50. 50.
    Shanahan L, Copeland W, Costello EJ, Angold A (2008) Specificity of putative psychosocial risk factors for psychiatric disorders in children and adolescents. J Child Psychol Psychiatry 49:34–42CrossRefPubMedGoogle Scholar
  51. 51.
    Sauver JLS, Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Jacobsen SJ (2004) Early risk factors for attention-deficit/hyperactivity disorder: a population-based cohort study. Mayo Clin Proc 79:1124–1131CrossRefGoogle Scholar
  52. 52.
    Sourander A, Helstelä L (2005) Childhood predictors of externalizing and internalizing problems in adolescence. A prospective follow-up study from age 8 to 16. Eur Child Adolesc Psychiatry 14:415–423CrossRefPubMedGoogle Scholar
  53. 53.
    Sowa H, Crijnen AAM, Bengi-Arslan L, Verhulst FC (2000) Factors associated with problem behaviours in Turkish immigrant children in the Netherlands. Soc Psychiatry Psychiatr Epidemiol 35:177–184CrossRefPubMedGoogle Scholar
  54. 54.
    Statistics Sweden (2005)
  55. 55.
    Statistics Sweden (2006)
  56. 56.
    Statistics Sweden (2008) Graviditeter, förlossningar och nyfödda barn. Medicinsk födelseregistrering 1973–2006
  57. 57.
    Stevens GWJM, Vollebergh WAM, Pels TVM, Crijnen AAM (2005) Predicting externalizing problems in Moroccan immigrant adolescents in the Netherlands. Soc Psychiatry Psychiatr Epidemiol 40:571–579CrossRefPubMedGoogle Scholar
  58. 58.
    Tolani N, Brooks-Gunn J (2006) Are there socioeconomic disparities in children’s mental health? In: Fitzgerald HE, Lester BM, Zuckerman B (eds) The crisis in youth mental health. Praeger Publishers, WestportGoogle Scholar
  59. 59.
    Vollebergh VAM, ten Have M, Dekovic M, Oosterwegel A, Pels T, Veenstra R, de Winter A, Ormel H, Verhulst F (2005) Mental health in immigrant children in the Netherlands. Soc Psychiatry Psychiatr Epidemiol 40:489–496CrossRefPubMedGoogle Scholar
  60. 60.
    Vostanis P, Graves A, Meltzer H, Goodman R, Jenkins R, Brugha T (2006) Relationship between parent psychopathology, parenting strategies and child mental health. Soc Psychiatry Psychiatr Epidemiol 41:509–514CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Uppsala UniversityUppsalaSweden

Personalised recommendations