Family structure, birth order, and aggressive behaviors among school-aged boys with attention deficit hyperactivity disorder (ADHD)
- 10 Downloads
To evaluate the associations between family structure, birth order, and aggressive behaviors among school-aged boys with attention deficit hyperactivity disorder (ADHD).
We conducted a matched case–control study. Data were retrieved from medical records at a psychiatry center in northern Taiwan. School-aged boys with ADHD who first visited the outpatient department at the psychiatric center between 2000 and 2011 were identified. The Child Behavior Checklist was used for aggressive behavior assessment. Boys with ADHD with T scores higher than 70 on the aggressive subscale were classified as cases and others with T scores lower than 70 were classified as controls at a 1:4 ratio. After controlling for other familial, personal, and parental factors, a multivariate conditional logistic regression was performed to evaluate the effects of family structure and birth order on aggressive behaviors of boys with ADHD.
277 cases and 1108 controls were included in the final analysis. Compared with living in a traditional family with both parents, living in a non-traditional family in which one or both parents were absent increased the risk of aggressive behaviors by 1.47-fold, with the highest risk for those in single parent families. Being the firstborn increased risk by 1.45-fold and the risk was higher when the firstborn had siblings.
Living in non-traditional families in which one or both parents were absent, and being the firstborn increased risk of aggression in school-aged boys with ADHD. Identification of this high-risk population and development of adequate preventive strategies are warranted.
KeywordsADHD Aggression Family structure Birth order
This work was supported by a funding Grant from the Ministry of Health and Welfare, Taiwan. We thank the team at Tao-Yuan Psychiatric Center for data collection and management. We also appreciate all the helpful suggestions from professors and students at National Yang-Ming University, Taiwan.
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Ethical approval for this study was obtained from the institution review board of the Tao-Yuan Psychiatric Center, Ministry of Health and Welfare, Taiwan. The study was conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
- 1.Cherkasova M, Sulla EM, Dalena KL, Ponde MP, Hechtman L (2013) Developmental course of attention deficit hyperactivity disorder and its predictors. J Can Acad Child Adolesc Psychiatry J de l’Academie canadienne de psychiatrie de l’enfant et de l’adolescent 22(1):47–54Google Scholar
- 2.Rockhill C, Violette H, Stoep AV, Grover S, Myers K (2013) Caregivers’ distress: youth with attention-deficit/hyperactivity disorder and comorbid disorders assessed via telemental health. J Child Adolesc Psychopharmacol 23(6):379–385. https://doi.org/10.1089/cap.2013.0019 CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Quintero J, Ramos-Quiroga JA, Sebastian JS, Montanes F, Fernandez-Jaen A, Martinez-Raga J, Giral MG, Graell M, Mardomingo MJ, Soutullo C, Eiris J, Tellez M, Pamias M, Correas J, Sabate J, Garcia-Orti L, Alda JA (2018) Health care and societal costs of the management of children and adolescents with attention-deficit/hyperactivity disorder in Spain: a descriptive analysis. BMC Psychiatry 18(1):40. https://doi.org/10.1186/s12888-017-1581-y CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Ruiz-Goikoetxea M, Cortese S, Aznarez-Sanado M, Magallon S, Luis EO, Alvarez Zallo N, Castro-Manglano P, Soutullo C, Arrondo G (2017) Risk of unintentional injuries in children and adolescents with ADHD and the impact of ADHD medications: protocol for a systematic review and meta-analysis. BMJ Open 7(9):e018027. https://doi.org/10.1136/bmjopen-2017-018027 CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Erskine HE, Norman RE, Ferrari AJ, Chan GC, Copeland WE, Whiteford HA, Scott JG (2016) Long-term outcomes of attention-deficit/hyperactivity disorder and conduct disorder: a systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry 55(10):841–850. https://doi.org/10.1016/j.jaac.2016.06.016 CrossRefPubMedGoogle Scholar
- 12.Cha J, Fekete T, Siciliano F, Biezonski D, Greenhill L, Pliszka SR, Blader JC, Roy AK, Leibenluft E, Posner J (2015) Neural correlates of aggression in medication-naive children with ADHD: multivariate analysis of morphometry and tractography. Neuropsychopharmacology 40(7):1717–1725. https://doi.org/10.1038/npp.2015.18 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Connor DF, Glatt SJ, Lopez ID, Jackson D, Melloni RH Jr (2002) Psychopharmacology and aggression. I: a meta-analysis of stimulant effects on overt/covert aggression-related behaviors in ADHD. J Am Acad Child Adolesc Psychiatry 41(3):253–261. https://doi.org/10.1097/00004583-200203000-00004 CrossRefPubMedGoogle Scholar
- 14.Zhang Y, Ming QS, Yi JY, Wang X, Chai QL, Yao SQ (2017) Gene-gene-environment interactions of serotonin transporter, monoamine oxidase A and childhood maltreatment predict aggressive behavior in Chinese adolescents. Front Behav Neurosci 11:17. https://doi.org/10.3389/fnbeh.2017.00017 CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Cleverley K, Szatmari P, Vaillancourt T, Boyle M, Lipman E (2012) Developmental trajectories of physical and indirect aggression from late childhood to adolescence: sex differences and outcomes in emerging adulthood. J Am Acad Child Adolesc Psychiatry 51(10):1037–1051. https://doi.org/10.1016/j.jaac.2012.07.010 CrossRefPubMedGoogle Scholar
- 17.Stover CS, Zhou Y, Kiselica A, Leve LD, Neiderhiser JM, Shaw DS, Natsuaki MN, Scaramella LV, Reiss D (2016) Marital hostility, hostile parenting, and child aggression: associations from toddlerhood to school age. J Am Acad Child Adolesc Psychiatry 55(3):235–242. https://doi.org/10.1016/j.jaac.2015.12.008 CrossRefPubMedGoogle Scholar
- 19.Carballo JJ, Garcia-Nieto R, Alvarez-Garcia R, Caro-Canizares I, Lopez-Castroman J, Munoz-Lorenzo L, de Leon-Martinez V, Baca-Garcia E (2013) Sibship size, birth order, family structure and childhood mental disorders. Soc Psychiatry Psychiatr Epidemiol 48(8):1327–1333. https://doi.org/10.1007/s00127-013-0661-7 CrossRefPubMedGoogle Scholar
- 20.Rydell AM (2010) Family factors and children’s disruptive behaviour: an investigation of links between demographic characteristics, negative life events and symptoms of ODD and ADHD. Soc Psychiatry Psychiatr Epidemiol 45(2):233–244. https://doi.org/10.1007/s00127-009-0060-2 CrossRefPubMedGoogle Scholar
- 22.Kwok MK, Leung GM, Schooling CM (2016) Associations of birth order with early adolescent growth, pubertal onset, blood pressure and size: evidence from Hong Kong’s “Children of 1997” birth cohort. PLoS One 11(4):e0153787. https://doi.org/10.1371/journal.pone.0153787 CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Keshavarzi Z, Bajoghli H, Mohamadi MR, Holsboer-Trachsler E, Brand S (2014) Attention deficit hyperactivity disorder in children is found to be related to the occurrence of ADHD in siblings and the male gender, but not to birth order, when compared to healthy controls. Int J Psychiatry Clin Pract 18(4):272–279. https://doi.org/10.3109/13651501.2014.957704 CrossRefPubMedGoogle Scholar
- 36.Schaeffer CM, Petras H, Ialongo N, Masyn KE, Hubbard S, Poduska J, Kellam S (2006) A comparison of girls’ and boys’ aggressive-disruptive behavior trajectories across elementary school: prediction to young adult antisocial outcomes. J Consul Clin Psychol 74(3):500–510. https://doi.org/10.1037/0022-006x.74.3.500 CrossRefGoogle Scholar
- 42.Biederman J, Monuteaux MC, Greene RW, Braaten E, Doyle AE, Faraone SV (2001) Long-term stability of the Child Behavior Checklist in a clinical sample of youth with attention deficit hyperactivity disorder. J Clin Child Psychol 30(4):492–502. https://doi.org/10.1207/s15374424jccp3004_06 CrossRefPubMedGoogle Scholar
- 43.Uchida M, Faraone SV, Martelon M, Kenworthy T, Woodworth KY, Spencer TJ, Wozniak JR, Biederman J (2014) Further evidence that severe scores in the aggression/anxiety-depression/attention subscales of child behavior checklist (severe dysregulation profile) can screen for bipolar disorder symptomatology: a conditional probability analysis. J Affect Disord 165:81–86. https://doi.org/10.1016/j.jad.2014.04.021 CrossRefPubMedPubMedCentralGoogle Scholar
- 44.Biederman J, Petty CR, Day H, Goldin RL, Spencer T, Faraone SV, Surman CB, Wozniak J (2012) Severity of the aggression/anxiety-depression/attention child behavior checklist profile discriminates between different levels of deficits in emotional regulation in youth with attention-deficit hyperactivity disorder. J Dev Behav Pediatr JDBP 33(3):236–243. https://doi.org/10.1097/DBP.0b013e3182475267 CrossRefPubMedGoogle Scholar