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Are family variables associated with ADHD, inattentive type? A case–control study in schools

European Child & Adolescent Psychiatry volume 20, pages 137–145 (2011)Cite this article

Abstract

Attention-deficit/hyperactivity disorder (ADHD) seems to be associated with significant psychosocial adversity. However, few studies assessed the role of environmental, social and interpersonal factors specifically in ADHD, inattentive type (ADHD-I). Thus, this study aims to investigate whether family environment risk factors are associated with ADHD-I. In a case–control study, we assessed a non-referred sample of 100 children and adolescents with ADHD-I and 100 non-ADHD controls (6–18 years old). They were systematically evaluated through structured diagnostic interviews. The following family adversity measures were used: Rutter’s family adversity index (marital discord, low social class, large family size, paternal criminality, maternal mental disorder), Family Environment Scale (FES) (subscores of cohesion, expressiveness and conflict) and Family Relationship Index (FRI) (based on the subscores above). After adjusting for confounding factors (social phobia and maternal history of ADHD), the odds ratio (OR) for ADHD-I increased as the number of Rutter’s indicators increased. Families of children with lower FES cohesion subscores presented higher OR for ADHD-I (OR 1.24; 95% confidence interval 1.05–1.45). Lower levels of FRI, a general index of family relationship, were also related to higher risk of ADHD-I (OR 1.11; 95% confidence interval 1.03–1.21). Our findings suggest that family adversity (in general), low family cohesion and low FRI (in particular) are associated with an increase in the risk for ADHD-I. However, the cross-sectional nature of the study limits our ability to infer causality.

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References

  1. American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition—text revised (DSM-IV-TR). American Psychiatric Publishing, Washington

    Book  Google Scholar 

  2. American Psychiatric Association (2010) DSM-5: Options being considered for ADHD. http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=383#. Accessed Feb 2 2010

  3. Baeyens D, Roeyers H, Walle JV (2006) Subtypes of attention-deficit/hyperactivity disorder (ADHD): distinct or related disorders across measurement levels? Child Psychiatry Hum Dev 36:403–417

    PubMed  Article  Google Scholar 

  4. Banerjee TD, Middleton F, Faraone SV (2007) Environmental risk factors for attention-deficit hyperactivity disorder. Acta Paediatr 96:1269–1274

    PubMed  Article  Google Scholar 

  5. Biederman J, Milberger S, Faraone SV, Kiely K, Guite J, Mick E, Ablon S, Warburton R, Reed E (1995) Family-environment risk factors for attention-deficit hyperactivity disorder. Arch Gen Psychiatry 52:464–470

    CAS  PubMed  Google Scholar 

  6. Biederman J, Milberger S, Faraone SV, Kiely K, Guite J, Mick E, Ablon JS, Warburton R, Reed E, Davis SG (1995) Impact of adversity on functioning and comorbidity in children with attention-deficit hyperactivity disorder. J Am Acad Child Adoles Psychiatry 34:1495–1503

    CAS  Article  Google Scholar 

  7. Biederman J, Faraone SV, Monuteaux MC (2002) Differential effect of environmental adversity by gender: Rutter’s index of adversity in a group of boys and girls with and without ADHD. Am J Psychiatry 159:1556–1562

    PubMed  Article  Google Scholar 

  8. Biederman J, Faraone SV, Monuteaux MC, Bober M, Cadogen E (2004) Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. Biol Psychiatry 55:692–700

    PubMed  Article  Google Scholar 

  9. Biederman J (2005) Attention-deficit/hyperactivity disorder: a selective overview. Biol Psychiatry 57:1215–1220

    PubMed  Article  Google Scholar 

  10. Clavarino AM, Mamun AA, O’Callaghan MO, Williams GM, Marrington S, Najman JM, Alati R (2010) Maternal anxiety and attention problems in children at 5 and 14 years. J Atten Disord 13:658–667

    PubMed  Article  Google Scholar 

  11. Counts CA, Nigg JT, Stawicki JA, Rappley MD, Eye AV (2005) Family adversity in DSM-IV combined and inattentive subtypes and associated disruptive behavior problems. J Am Acad Child Adolesc Psychiatry 44:690–698

    PubMed  Article  Google Scholar 

  12. Faraone S, Biederman J, Chen WJ, Krifcher B, Keenan K, Moore C, Sprich S, Tsuang MT (1992) Segregation analysis of attention deficit hyperactivity disorder: evidence for single gene transmission. Psychiatr Genet 2:257–276

    Article  Google Scholar 

  13. Hosmer D, Lemeshow S (2000) Applied logistic regression. Wiley-Interscience, Hoboken

    Book  Google Scholar 

  14. Jannuzzi PM, Baeninger R (1996) Qualificação socioeconômica e demográfica das classes da escala Abipeme. Revista de Administração, São Paulo 31:82–90

    Google Scholar 

  15. Johnston C (1996) Parent characteristics and parent-child interactions in families of nonproblem children and ADHD children with higher and lower levels of oppositional-defiant behavior. J Abnorm Child Psychol 24:85–104

    CAS  PubMed  Article  Google Scholar 

  16. Johnston C, Mash EJ (2001) Families of children with attention-deficit/hyperactivity disorder: review and recommendations for future research. Clin Child Fam Psychol Rev 4:183–207

    CAS  PubMed  Article  Google Scholar 

  17. Katz MH (2003) Multivariable analysis: a primer for readers of medical research. Ann Intern Med 138:644–650

    PubMed  Google Scholar 

  18. Kazdin AE, Kagan J (1994) Models of dysfunction in developmental psychopathology. Clin Psychol (New York) 1:35–52

    Google Scholar 

  19. Kirkwood BR, Sterne JAC (2003) Essential medical statistics. Blackwell Science, Massachusetts

    Google Scholar 

  20. Landolt MA, Grubenmann S, Meuli M (2002) Family impact greatest: predictors of quality of life and psychological adjustment in pediatric burn survivors. J Trauma 53:1146–1151

    PubMed  Article  Google Scholar 

  21. Lewis K (1992) Family functioning as perceived by parents of boys with attention deficit disorder. Issues Ment Health Nurs 13:369–386

    CAS  PubMed  Article  Google Scholar 

  22. Mari JJ, Williams P (1986) A validity of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of Sao Paulo. Br J Psychiatry 148:23–26

    CAS  PubMed  Article  Google Scholar 

  23. Mick E, Biederman J, Faraone SV, Sayer J, Kleinman S (2002) Case-control study of attention-deficit hyperactivity/disorder and maternal smoking, alcohol use, and drug use during pregnancy. J Am Acad Child Adolesc Psychiatry 41:378–385

    PubMed  Article  Google Scholar 

  24. Moos RH (1990) Conceptual and empirical approaches to developing family-based assessment procedures: resolving the case of the Family Environment Scale. Fam Proc 29:199–208

    CAS  Article  Google Scholar 

  25. Nikolas MA, Burt SA (2010) Genetic and environmental influences on ADHD symptom dimensions of inattention and hyperactivity: a meta-analysis. J Abnorm Psychol 119:1–17

    PubMed  Article  Google Scholar 

  26. Orvaschel H (1985) Psychiatric interviews suitable for use in research with children and adolescents. Psychopharmacol Bull 21:737–745

    CAS  PubMed  Google Scholar 

  27. Pfiffner LJ, Mikami AY, Huang-Pollock C, Easterlin B, Zalecki C, McBurnett K (2007) A randomized, controlled trial of integrated home-school behavioral treatment for ADHD, predominantly inattentive type. J Am Acad Child Adolesc Psychiatry 46:1041–1050

    PubMed  Article  Google Scholar 

  28. Polanczyk GV, Eizirik M, Aranovich V, Denardin D, Silva TL, Conceição TV, Pianca TG, Rohde LA (2003) Interrater agreement for the schedule for affective disorders and schizophrenia epidemiological version for school-age children (K-SADS-E). Rev Bras Psiquiatr 25:87–90

    PubMed  Article  Google Scholar 

  29. Polanczyk GV, Lima MS, Horta BH, Biederman J, Rohde LA (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164:942–948

    PubMed  Article  Google Scholar 

  30. Pressman LJ, Loo SK, Carpenter EM, Asarnow JR, Lynn D, McCracken JT, McCough JJ, Lubke GH, Yang MH, Smalley SL (2006) Relationship of family environment and parental psychiatric diagnosis to impairment in ADHD. J Am Acad Child Adolesc Psychiatry 45:346–354

    PubMed  Article  Google Scholar 

  31. Rohde LA (2002) ADHD in Brazil: the DSM-IV criteria in a culturally different population. J Am Acad Child Adolesc Psychiatry 41:1131–1133

    PubMed  Article  Google Scholar 

  32. Rutter M, Cox A, Tupling C, Berger M, Yule W (1975) Attainment and adjustment in two geographical areas, I: the prevalence of psychiatric disorders. Br J Psychiatry 126:493–509

    CAS  PubMed  Article  Google Scholar 

  33. Satake H, Yamashita H, Yoshida K (2004) The family psychosocial characteristics of children with attention-deficit hyperactivity disorder with or without oppositional or conduct problems in Japan. Child Psychiatry Hum Dev 34:219–235

    PubMed  Article  Google Scholar 

  34. Schmitz M, Denardin D, Silva TL, Pianca T, Hutz MH, Faraone S, Rohde LA (2006) Smoking during pregnancy and attention-deficit/hyperactivity disorder, predominantly inattentive type: a case-control study. J Am Acad Child Adolesc Psychiatry 45:1338–1345

    PubMed  Article  Google Scholar 

  35. Schmitz M, Denardin D, Silva TL, Pianca T, Roman T, Hutz MH, Faraone SV, Rohde LA (2006) Association between alpha-2a-adrenergic receptor gene and ADHD inattentive type. Biol Psychiatry 60:1028–1033

    CAS  PubMed  Article  Google Scholar 

  36. Schmitz M, Ludwig H, Rohde LA (2010) Do hyperactive symptoms matter in ADHD-I restricted phenotype? J Clin Child Adolesc Psychol 39:741–748

    PubMed  Article  Google Scholar 

  37. Sukhodolsky DG, Rosario-Campos MC, Scahill L, Katsovich L, Pauls DL, Peterson BS, King RA, Lombroso PJ, Findley DB, Leckman JF (2005) Adaptive, emotional, and family functioning of children with obsessive-compulsive disorder and comorbid attention deficit hyperactivity disorder. Am J Psychiatry 162:1125–1132

    PubMed  Article  Google Scholar 

  38. Swanson JM (1992) School-based assessments and interventions for ADD students. K.C. Publishing, Irvine

    Google Scholar 

  39. Tiet QQ, Bird HR, Hoven CW, Moore R, Wu P, Wicks J, Jensen PS, Goodman S, Cohen P (2001) Relationship between specific adverse life events and psychiatric disorders. J Abnorm Child Psychol 29:153–164

    CAS  PubMed  Article  Google Scholar 

  40. Van den Bergh BRH, Marcoen A (2004) High antenatal maternal anxiety is related to ADHD symptoms, externalizing problems, and anxiety in 8- and 9-year-olds. Child Dev 75:1085–1097

    PubMed  Article  Google Scholar 

  41. Weschler D (1991) WISC-III Manual. The Psychological Corporation, New York

    Google Scholar 

  42. Woo BS, Rey JM (2005) The validity of the DSM-IV subtypes of attention-deficit/hyperactivity disorder. Aust N Z J Psychiatry 39:344–353

    PubMed  Google Scholar 

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Conflict of interest

Dr. Pheula, Rohde, and Schmitz are with the Federal University of Rio Grande do Sul, Brazil; Dr. Rohde is vice-director of the Instituto Nacional de Psiquiatria do Desenvolvimento. This work was partially supported by research grants from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq, Brazil; grant 307780/2004-0), Hospital de Clínicas de Porto Alegre and an unrestricted grant from Eli Lilly. Dr Luis Augusto Rohde was on the speakers’ bureau and/or acted as consultant for Eli-Lilly, Janssen-Cilag, Novartis and Shire in the last 3 years (less than U$ 10,000 per year and reflecting less than 5% of his gross income per year). He also received travel support (air tickets and hotel) for attending two Child Psychiatric Meetings from Novartis and Janssen-Cilag in 2010. The ADHD and Juvenile Bipolar Disorder Outpatient Programs chaired by him received unrestricted educational and research support from the following pharmaceutical companies in the last 3 years: Abbott, Bristol-Myers Squibb, Eli-Lilly, Janssen-Cilag, Novartis, and Shire. He also receives research support from Brazilian government institutions (CNPQ, FAPERGS, HCPA and CAPES).

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  1. Serviço de Psiquiatria da Infância e Adolescência, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, 90035-003, Brazil

    Gabriel Ferreira Pheula, Luis Augusto Rohde & Marcelo Schmitz

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  1. Gabriel Ferreira Pheula
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  2. Luis Augusto Rohde
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  3. Marcelo Schmitz
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Correspondence to Luis Augusto Rohde.

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Pheula, G.F., Rohde, L.A. & Schmitz, M. Are family variables associated with ADHD, inattentive type? A case–control study in schools. Eur Child Adolesc Psychiatry 20, 137–145 (2011). https://doi.org/10.1007/s00787-011-0158-4

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  • DOI: https://doi.org/10.1007/s00787-011-0158-4

Keywords

  • Attention-deficit/hyperactivity disorder, inattentive type
  • Inattention
  • Family environment scale
  • Family adversity index
  • Family relationship