PARENTING 1996 Parent Characteristics and Parent-Child Interactions in Families of Nonproblem...

8/13/2019 PARENTING 1996 Parent Characteristics and Parent-Child Interactions in Families of Nonproblem Children and ADHD Children

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Journal o f Abnormal Child Psychology, Vol. 24, No. 1, 1996

Pa re n t C h a ra c t e r is t ic s a n d Pa re n t C h i l dIn t e ra c t i o n s i n Fa mi l i e s o f No n p ro b l e m C h i l d re na n d A D H D C h i l d r e n w i t h H i g h e r a n d L o w e rLeve l s o f O ppo s i tiona l De f i an t Beha v io r

C h a r l o t t e J o h n s t o n 1 2

This study e xam ined pa rent-c hi ld interact ions an d pa ren t character istics infam il ies o f non prob lem children an d at tent ion deficit hyperact ivity disorder

A D H D ) c hild re n w it h l ow e r A D H D - L O D ) a n d h ig h er A D H D - H O D ) le ve lso f opposi t ional-defiant behavior. F amil ies o f A D H D children were recrui tedfro m a pa ren t t raining program. Observed a nd parent-reported chi ld behavior

prob lem s were h ighes t in the A D H D -H O D group. Observed paren t behaviorrevealed fe w differences, but dai ly reports indicated tha t paren ts in both A D H Dgroups used m ore negat ive-reactive an d few er posi t ive paren t ing strategies thancon t ro l pa ren t s. M ate rna l p sycho log ica l func t ion in g d i ffe red b e tween theA D H D and n onprob lem g roups, bu t no t be tween the two A D H D g roups.Fa ther s o f A D H D - H O D child ren repo rted more psycho log ical d is tu rbancethan controls . Paren t ing sel f-es teem was lowest in the A D H D -H O D group a ndhighes t in the nonproblem group . The resu l t s suppor t the LOD and HODdis t inct ion , bu t a l so suggest that, a l thou gh cer ta in d i ff icu l t ies are mo rec o m m o n in t h e f am i li es o f A D H D - H O D child ren , f am i li es o f A D H D - L O Dchildren also differ fro m controls on a nu m be r of dimensions.

M an u sc r ip t r ece iv ed in f i n a l fo rm D ecem b er I 1 9 94 .T h i s r e s e a r c h w a s s u p p o r t e d b y g r a n t s f r o m t h e M e d i c a l R e s e a r c h C o u n c i l o f C a n a d a a n dt h e B r i t is h C o l u m b i a H e a l t h R e s e a r c h F o u n d a t i o n . A p p r e c i a ti o n i s e x t e n d e d t o J o s i e G e l l e rK i m B e h r e n z S u s a n G r e a v e s a n d S o n i a P ie t zs c h w h o a s si st ed w i t h d a t a c o l le c t io n a n dco d in g an d to t h e f ami l ie s wh o g en ero u s ly g av e th e i r t ime to p a r t i c ip a t e i n t h e r esea rch .T h a n k s a ls o t o t w o a n o n y m o u s r e v i ew e r s f o r t h e i r c o m m e n t s .

1 D ep ar tm en t o f P sy ch o lo g y Un iv er s i t y o f Br i t i sh Co lu m b ia Van co u v er Br i t i sh Co lu mb iaC a n a d a V 6 T 1Z 4 .

2 Ad d ress al l c o r r e s p o n d e n c e i n c lu d i n g r e q u e s t s f o r r e p r in t s t o C h a r l o t t e J o h n s t o nD ep ar tm en t o f P sy ch o lo g y Un iv er s i t y o f Br i t i sh Co lu m b ia Van co u v er Br i t i sh Co lu m b iaC a n a d a V 6 T 1Z 4 .

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0091 0627/96/0200 0085509.50/0 1996 Plenum Publishing Corporation


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8 o h n s t o n

W ith p reva lence e s t ima ted a t 5 o f the school -aged popula t ion (Am er icanPsych ia t r ic Associa t ion, 1987; Sza tmari , Offord , & Boyle , 1989), a t tent iondef ic it hyperac tiv i ty d isorder (A D H D ) is a re la t ive ly co m m on c hi ldhood dis-order. In addi t ion to the def in ing di ff icul ties of A D H D , these c hi ldren of te nexpe r ience disruptions in the i r fam i ly re la t ionships. F or exam ple , s tudies byCunningham and BarNey (1979) and Mash and Johns ton (1982) ind ica tedtha t, i n con t ra st t o non prob lem m othe r-ch i ld dyads, A D H D ch i ld ren we rele ss com pl ian t and m ore nega t ive and the i r mothe rs gave more comm ands ,few er rewa rds, and w ere less interact ive in lab ora tory sett ings. Similar par-ent -c hi ld d i fficult ies have bee n o bserved in s tudies wi th AD H D chi ldren ofdiffering ages (Barkley, Karlsson, & Pollard, 1985 ), A D H D girls (Be fera &B a r k l e y, 1 98 5), a n d i n f a t h e r - A D H D c h i ld i n t e r a c t io n s ( Ta l l m a d g e &BarNey, 1983). Pa ren t s o f A D H D ch i ld ren have a l so bee n the focus o f re -se a r c h . Fo r e xa m p l e , Ma sh a nd Johns t on ( 19 83 ) f ound t ha t m o t h e r s o fA D H D ch i ld ren repo r t ed l ess pa ren t ing se lf -e s teem and m ore s t re ss thanm othe rs o f norm al chi ldren. Increa sed levels o f depression, o th er psychia t ricd iagnoses , and mar i t a l d i ssa t i s fac t ion have a l so been found in pa ren t s o fA D H D ch i ld ren com pare d to con t ro ls (Befe ra & BarNey, 1985; Can twe l l,1972; Cunn ingh am , Benne ss, & Siegel, 1988; M orrison, 1980).

How ever, t hi s l i t e ra tu re desc r ib ing the fami li e s o f AD H D ch i ld ren isbased on samples o f A D H D ch i ld ren tha t were no t d i ffe ren ti a t ed in t e rms o foppo s i t iona l -de f i an t (O D) behav iors . Cons ide rab le ev idence now ex ists tosuppor t the dis tinc tive, a l though in terre la ted, na ture of AD H D symptom s andopp osi t ional -def iant behaviors (Abik off & Kle in , 1992; Hinshaw, 1987) . In-deed , r ecen t r e sea rch has sugges ted tha t pa ren ta l d i s tu rbance and pa ren t -ch i ld conf li c t i n A D H D samples a re m ore l ike ly to be a ssoc ia ted wi th thepresen ce o f opposi t ional -defiant behaviors than wi th the symptom s of AD H D .

Se v e r a l s t ud i e s ha ve c o m pa r e d r a t e s o f d i s t u r ba nc e i n pa r e n t s o fA D H D ch i ld ren wi th and w i thou t a concu r ren t d iagnosi s o f opposi tiona l o rconduc t d i sorde r (e .g . , Anas topoulos , Guevremont , She l ton , & DuPaul ,1992; Aug ust , Stewart , & Holm es, 1983; Fara one , Bied erm an, Keen an, &Tsuan g, 199 1; Lahey, Piacent in i , M cBu rnet t , Stone , Ha r tdage n, & Hy nd,1988; Schach ar & W achsm uth, 1990) . Sum mariz ing across this research, i thas g enera l ly be en foun d th a t p sychia tr ic d isorders , substance abuse , fami lyadversi ty, mari tal separat ions, parent ing stress, and criminal act ivi t ies arem or e c o m m o n in f a m il ie s o f AD H D c h i ld r e n who a r e c om o r b id f o r opp o -s it iona l o r conduc t d i sorde r than in fami li e s o f AD H D ch i ld ren who do no thave these accompanying diagnoses . Indeed , the fami li e s o f pure ly A D H Dchi ldren of ten do not d i ffer f rom normal cont rols . However, th is researchis no t w i thout inconsistenc ies and l imi ta tions. Fo r exam ple , Reeves, W erry,E lk ind , and Zam etk in (1987) foun d tha t, a l though AD H D ch i ld ren wi th con-duc t d i sorde r expe r i enced m ore fami ly advers ity than A D H D ch i ld ren with -


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F a m i l i es o f A D H D C h i l d re n 8

ou t cond uct d isorder, the tw o groups d id no t d i ffer in ra tes o f paren ta l psy-chopa tho logy, l i f e s t r ess , o r mar i t a l d i s sa t i s f ac t ion . S imi l a r ly, a l thoughSchachar and Wachsmuth (1990) found more overa l l paren ta l psych ia t r icd iagnoses in f ami li es o f A D H D p lus conduc t d i so rder ch i ldren , t hey f a i ledto rep l ica te p rev iou s repor ts (e.g ., La hey e t a l ., 1988) o f m ore paren ta l an-t isocia l persona l i ty d isorder in th is g roup . T his are a o f research i s a lso l im-i ted by a focus on paren ta l psych ia tr ic d isorders and m aternal repor ts o ffunc tion ing . T he p resen t s tudy was des igned to expand on p rev ious r esea rchcon t ras t ing pa ren t s o f A D H D ch i ld ren who d i sp lay lower and h igher l eve lsof opp osi t ional -def ian t behavior. A range of characteri s tics , inc lud ing par-ent ing self-esteem, social relat ionships, l i fe s t ress, and psychological d istur-bance were exam ined in bo th m o ther s and f a the rs o f A D H D ch ild ren . Agroup o f fami l ies o f nonp rob lem ch ild ren was inc luded to p rov ide a no rm a-t ive ancho r fo r t he com par isons o f A D H D fami li es .

Fe w s tud ies have com pared paren t -ch i ld in t e rac t ions in fami l i es o fA D H D ch i ld ren wi th lower and h igher leve ls o f oppos i t i ona l -de f i an t be -hav io r. Summ ar iz ing ac ross a num ber o f s tud ies, Lo ney (1987 ) conc lu dedtha t , among ADHD ch i ld ren , i t i s oppos i t i ona l -de f i an t behav io r s r a the rt h a n A D H D s y m p t o m s th a t a r e m o s t r e l a te d t o re p o r t s o f p a r e n t - c h i l dd i ff icu l t ies and fami ly hos t i l i ty. Using paren t responses to a ques t ionnai re ,S c h a c h a r a n d W a c h s m u t h ( 19 9 1) d e m o n s t r a t e d t h a t p a r e n t s o f c h i ld r e nw i t h b o t h A D H D a n d c o n d u c t d i s o r d e r d i a g n o s e s r e p o r t e d m o r e p r o b l e m sin the pa ren t -ch i ld re la t ionsh ip than pa ren ts o f ch i ld ren wi th a so le d iag-n o si s o f A D H D w h o d i d n o t d i ff e r f r o m a n o n p r o b l e m c o n t r o l g r o u p . H o w -e v e r, t h e s e s t u d ie s r e m a i n l im i t e d b y t h e m e t h o d s u s e d t o m e a s u r eparen t -ch i ld in te rac tions . Ra t ings o f pa t i en t s ' cha rt s o r pa re n t -co m ple t e dcheck li st s (Loney, Langho rne , Pa te rn i te , 1978; Schachar W achsm uth ,1991) have been the m os t comm on m easu res o f pa re n t -ch i ld in t e rac t ions.N o pub l i shed r epo r t s o f obse rved paren t -ch i ld in t e rac t ions in fami l i es o fADHD ch i ld ren ca t ego r i zed acco rd ing to the ch i ld ' s l eve l o f oppos i t i ona lbeh av io r ex is t. In the p resen t s tudy th ree m eth od s - - l a bo ra to ry obse rva -t ions , da ily r epo r t s o f pa ren t -ch i ld in t e rac t ions in the hom e, and paren t -c o m p l e t e d q u e s t i o n n a i r e s - - w e r e u s e d t o as se ss b o t h m o t h e r - c h i l d a n dfather-ch i ld in teract ions .

Prev ious research has re l ied on a d iversity o f me thods fo r subgroup ingA D H D c h i ld r e n a c c o r d in g t o t h e i r le v e l o f o p p o s i ti o n a l - d e f ia n t b e h a v i o r.M os t s tudies (e.g ., Au gu st et al., 1983; La he y et al ., 1 988; R ee ve s et al ., 1987)have re l ied on a d iagnost ic approach , us ing s t ructured in terv iews concern ingchi ld behavior. However, as Loney (1987) has noted, d iagnost ic cr i ter ia, par-t icular ly prior toDiagnostic a nd Statist ical M an ua l o f M enta l Disorders 3rded.,rev.) (DS M -II I -R; AP A, 1987), are un l ikely to p rov ide the m axim um discr imi-na t ion be twe en A D H D symptoms and oppos i t iona l -de f ian t behav io r s. In th is


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J o h n s t o n

study, rather than using categorical diagnostic criteria, ADHD children weresubgrouped using a dimensional measure of oppositional-defiant behavior, theAggression subscale of the IOWA Conners (Loney Milich, 1982). TheIOWA Conners was designed to provide a maximum distinction between op-positional-defiant behaviors and the inattention-overactivity symptoms ofADHD. The items chosen for the Aggression subscale have demonstrated rea-sonable divergent and convergent validity from ADHD symptoms in a numberof studies, and subgroups of ADHD children formed using this subscale havebeen shown to differ on a number of dimensions (e.g., Johnston, Patenaude,Inman, 1992; Johnston Pelham, 1986; Loney, 1987; Loney Milich, 1982;Milich Fitzgerald, 1985).

In summary, this study employed the IOWA Conners Aggressionsubscale to divide ADHD children into groups with lower and higher levelsof oppositional-defiant behavior. These groups, and a control group of non-problem children, were compared on measures of mother-child and father-child interactions and parent characteristics. It was predicted thatparent-child conflict and parental disturbance would appear more often infamilies of ADHD children with higher levels of oppositional-defiant be-havior than in either ADHD children with lower levels of oppositional-de-fiant behavior or the control group.

M E T H O

Subjects

Forty-eight families referred to a parenting program for parents of5- to ll-year-o ld children with ADHD participated in the study. All familiesparticipated prior to beginning treatment. In addition to the child havinga referring diagnosis of ADHD, a semistructured parent interview and par-ent ratings on the ADHD Rating Scale (DuPaul, 1991) were used to con-firm the diagnosis. Consistent with the criteria specified in DSM-III-R(APA, 1987), information from the parent interview served to exclude chil-dren who had not displayed ADHD symptoms prior to age 7 or for at least6 months' duration, or who had developmental disabilities (e.g., autism,mental reta rdation). The ADHD Rating Scale (DuPaul, 1991) lists theDSM-III-R diagnostic criteria for ADHD and asks parents to rate howdescriptive each symptom is of the child on a 4-point scale ranging fromno t at al l to very much .Ratings above the median pret ty mu chor very mu ch )were taken to indicate symptom presence and children were required tohave at least 8 of the 14 ADHD symptoms based on an average of motherand father ratings, if both were available.


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F a m i l ie s o f A D H D C h i l d r en 9

T h e 4 8 A D H D c h il d re n w e r e d i v id e d in t o g r o u p s w i th l o w e r a n dh ig h e r le ve ls of o p p o si ti on a l d ef ia n t b eh a v i o r ( A D H D - L O D a n d A D H D -

H O D , r e s p ec t iv e l y ) u s in g p a r e n t r a t in g s ( a g ai n , a v e r a g e d f o r m o t h e r s a n df a t h e r s in t w o - p a r e n t f a m i li e s) o n t h e I O W A C o n n e r s A g g r e s s i o n s u b s c a le( L o n e y & M i l ic h , 1 9 82 ). T h e f iv e i t e m s o n t h i s su b s c a l e a r e r a t e d o n a 0t o 3 s c a le a c c o r d i n g t o t h e i r d e s c r i p t i v e n e s s o f th e c h il d , w i t h a n c h o r s r a n g -i ng f r o m not at all to very much T h e A g g r e s s i o n s u b s c a l e s c o r e i s c a l c u l a t e db y s u m m i n g a c r o s s t h e f i v e i t e m s a n d c a n r a n g e f r o m 0 t o 1 5 . A l t h o u g hp a r e n t n o r m s a r e n o t a v a il a b le f o r t hi s r a ti n g s c al e, t e a c h e r n o r m s h a v eb e e n p r o v i d e d b y P e l h a m , M i lic h , M u r p h y, a n d M u r p h y ( 19 8 9) . F o l lo w i n gt h e i r r e c o m m e n d a t i o n , a c u t o f f s c o r e o f 9 o n t h e A g g r e s s i o n s u b s c a le w a su s e d t o c la ss if y A D H D c h il d re n a s h a v in g l o w e r ( A D H D - L O D ) o r h ig h e r( A D H D - H O D ) l ev el s o f O D b e h a vi o r. Tw e n t y - t h r e e ch i ld r e n w e r e c l as se da s A D H D - L O D a n d 25 a s A D H D - H O D . 3

T h i r t y - t h r e e f a m i li e s o f n o n p r o b l e m c h i ld r e n w e r e r e c r u i t e d t h r o u g hn e w s p a p e r a n d c o m m u n i t y n o ti ce s. C h i l d re n w e r e c l as se d a s n o n p r o b l e mi f p a r e n t r a t i n g s ( a v e r a g e d i n t w o - p a r e n t f am i l i e s ) d i d n o t e x c e e d 9 o n t h eI O W A A g g r e s s i o n s u b s c a le o r T- s c o re s o f 7 0 o n t h e I n t e r n a li z i n g a n d E x -t e rn a l iz i n g s c al es o f t h e C h i l d B e h a v i o r C h e c k l is t ( A c h e n b a c h & E d e l b r o c k ,1983) .

Ta b l e I p r e s e n t s d e s c r ip t iv e i n f o r m a t i o n f o r t h e t h r e e g r o u p s . O n e -w a y an a l y se s o f v a r i a n c e ( A N O V A s ) c o m p a r i n g t h e g r o u p s o n c h il d a n dp a r e n t a g e , a n d f a m i l y s o c i o e c o n o m i c s t a tu s ( S E S ) i n d i c a t e d n o s i g n i f ic a n td i f f e r e n c e s ( a ll p s > .3 0 ). C h i - s q u a r e s ta t is ti c s c o m p a r i n g t h e t h r e e g r o u p so n t h e n u m b e r o f a d o p t e d c h il d re n , m a l e c h i ld r e n , a n d s in g le p a r e n t s w e r ea l s o n o n s ig n i f i c a n t ( p s o f .1 3 , .2 6 a n d .0 8, r e s p e c t i v e ly ) . F in a l ly, a c h i s q u a r ec o n t ra s ti n g t h e tw o A D H D g r o u p s o n th e n u m b e r o f m e d i c a t e d c h i ld r e nw a s a ls o n o n s ig n i f i c a n t ( p = . 11 ).

Procedures

I n it ia ll y, p a r e n t s o f A D H D c h i ld r e n a t t e n d e d a n i n t e rv i e w s e ss i o n a n dw e r e g i v e n q u e s t i o n n a i r e m e a s u r e s t o c o m p l e t e a t h o m e . T h e y r e t u r n e d ,a p p r o x i m a t e l y 1 w e e k l a te r , w i t h th e i r A D H D c h il d fo r th e l a b o r a t o r y o b -

3parents also rated their children on the symptom s of op positional de fian t and conductdisorders. Parent ratings were av eraged in tw o-paren t families. On a 0 to 3 sca le, using ratingsof 2 or 3 as indicative of symptom presence, 13 of the A DH D- LO D children were ratedas meeting criteria for oppositional defiant disorder (ODD ) and 84 of the A D H D -H O Dchildren met this criteria. No ne of the AD HD -LO D children and 36 of the A D H D -H O Dm et criteria for con duct disorder. Reanalysis of the data excluding A D H D -L O D childrenwho met O DD criteria and AD H D -H O D children who did not meet OD D criteria essentiallyreplicated the results reported for the full groups.


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90 o h n s t o n

Table I. Descriptive Information for Families of Nonproblem Children and ADHDChildren with Low er and Higher Levels of Oppo sitional-Defiant Behavior

N o n p r o b l e m A D H D -L O D A D H D - H O D(n = 33) (n = 23) (n = 25)

Child age b 101.58 20.39) 98 .1 3 25.52) 1 0 5 . 0 0 20.62)Mother agec 35.64 (3.66) 37.27 (4.37) 35.92 (5.40)Father agec 38.68 (3.86) 38.94 (6.73) 4 0 .2 9 (7 .1 2)Socioecono mic status 2.48 (1.12) 2.52 (1.12) 2.92 (1.15)Percen t boy s 82 87 96Percent adopted 3 0 12Percen t single mo thers 12 17 36Percent medicated 0 22 48

aStandard deviations in parentheses. AD HD = attent ion deficit hyperactivity disorder;AD HD -L OD = ADH D children with lower levels of oppositional-de fiant behavior;AD HD -H OD = ADHD children with higher levels of oppositional-defiant behavior.

bChild age in months.Cparent age in years.dSocioeconomic status calculated accord ing to the Ho llingshead Fou r F actor In dex of SocialStatus (Hollingshea d, 1975).

s e r v a t i o n s e s s i o n . C o m p l e t e d q u e s t i o n n a i r e s w e r e t o b e r e t u r n e d a t t h a tt im e . W h e n r e s p o n d i n g t o r e c r u i tm e n t n o t ic e s, f am i l ie s o f n o n p r o b l e m c h il -d r e n c o m p l e t e d a b r ie f t e l e p h o n e s c r e e n i n g i n te r v ie w a n d w e r e m a i l e d th eq u e s t i o n n a i r e s f o r c o m p l e t i o n p r i o r t o t h e i r l a b o r a t o r y vis it. E a c h p a r e n tw a s p a i d 1 0 f o r p a r t ic i p a ti o n . M o t h e r s a n d f a th e r s w e r e i n s t r u c te d t o c o m -p l e t e t h e q u e s t i o n n a i r e s i n d e p e n d e n t l y o f e a c h o t h e r.

T h e l a b o r a t o r y o b s e r v a t i o n w a s c o n d u c t e d i n a r o o m f u r n i s h e d w i ths o f a s , e n d t a b l e s a n d l a mp s , b o o k s h e l v e s , a f i l e c a b i n e t , a t a b l e a n d c h a i r s ,a c h i l d ' s t a b l e a n d c h a i r , a n d n u m e r o u s t o y s ( e . g . , l e g o , v e l c r o d a r t s a n d

b o a r d , t o y t r u c k s, c o l o r in g b o o k s ) . P a r e n t - c h i l d i n t e r ac t i o n s w e r e v i d e -o t a p e d f r o m b e h i n d a n o b s e r v a ti o n m i r r o r a n d a u d i o - r e c o r d e d w i th a m i -c r o p h o n e s u s p e n d e d f r o m t h e c ei li ng . E a c h p a r e n t e n g a g e d i n a 3 0 - m i ni n t e r a c ti o n w i t h t h e c h ild , w i t h t h e o r d e r o f m o t h e r - c h i l d a n d f a t h e r - c h i l di n t e r a c t i o n s c o u n t e r b a l a n c e d a c r o s s t w o - p a r e n t f a m i l i e s . T h e f i r s t 1 0 m i no f th e p a r e n t - c h i l d i n t e ra c t i o n w e r e d e v o t e d t o f r e e p l a y a n d s e r v e d a s ah a b i t u a t i o n p e r i o d . T h e n , t h e p a r e n t w a s g i v e n a se t o f w r i t t e n i n s t ru c t i o n sa n d m a t e r i a l s f o r t a s k s t h e c h i l d w a s t o c o m p l e t e . Ta s k s i n c l u d e d a c t i v i t i e ss u c h a s s h a r p e n i n g a p e n c i l , d u s t i n g a s ma l l t a b l e , s o r t i n g a n d f o l d i n g s o c k s ,a n d s o r t i n g c a r d s b e l o n g i n g t o d i f f e r e n t d e c k s . Tw o p a r a l l e l s e t s o f 1 0 t a s k sw e r e u s e d a n d c o u n t e r b a l a n c e d a c r o ss m o t h e r s a n d f a t h e r s. I n t h e r e m a i n -i ng 1 0 m i n u t e s , t h e c h i ld w a s to c o m p l e t e a s e t o f a g e - a p p r o p r i a t e a c a d e m i ct a s k s . P a r e n t s w e r e i n s t r u c t e d t o h a v e t h e c h i l d r e n w o r k a s i n d e p e n d e n t l y


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as poss ib l e on these t a sks . Da ta fo r t he pa ren t -ch i ld in t e rac t ions du r ingthe 10 m in o f t a sks and 10 r a in o f academ ics a re r epo r t ed . A D H D ch i ld renwh o were r eceiv ing st imu lan t me d ica t ion t r ea tm en t (n = 17) were wi th -d rawn f rom th i s med ica t ion 24 hou rs p r io r t o the l abo ra to ry obse rva t ion .Ar ra ngem en t s we re mad e a t t he conc lu s ion o f t he obse rva t ion session tocomplete dai ly phone in terv iews over the nex t 7 days .

Measures

Parent Child Interactions. R e p o r t s o f p a r e n t - c h i ld i n te r a c ti o n s w e r e

assessed u s ing the H om e S i tua tions Qu es t ionna i re (Bar ldey & Ed e lb rock ,1987). Th i s measu re asks pa ren t s fo r t he num ber o f com m on ho m e s i tu-a t ions in wh ich the ch i ld 's behav io r is p rob lem at i c (N um ber o f P rob lem s)and the sever i ty o f these p rob lems (Sever ity o f P rob lem s) . The m easu re isr e l i ab le and va l id , and no rmat ive da t a a re ava i l ab le (Bark ley & Ede lb rock ,1987).

Pa ren t -ch i ld in teract ions were a l so assessed as par t o f the dai ly te le-phone in t e rv i ews conduc ted fo r 7 days fo l lowing the obse rva t ion sess ions .Alm os t a ll i n te rv iews were cond uc ted wi th the m o ther s (86 .3 ) . The da i ly

p h o n e i n te r vi e w w a s m o d e l e d a f te r t h e t e c h n i q u e d e s c r ib e d b y C h a m b e r l a inand Re id (1987 ) . The in t e rv i ews asked abou t t he p rev ious 24 hou rs andwere comple t ed each even ing a f t e r t he ch i ld ren ' s bed t imes . Mother s r a t edthe i r m oo d (Dai ly M ood ) , mar i ta l sa t is f ac t ion (D a i ly M ar i ta l ) , and l if es t r ess (Da i ly S t ress ) . Mo ther s a l so ind ica t ed whe ther o r no t t he i r ch i ld renhad p rese n ted a p rob lem in 13 o f t he s i tua t ions f rom the H om e S i tua t ionsQu es t ionna i re (Da i ly P rob lem s) and , i f so, wha t t he p a ren t ing r espon sehad been . Us ing each day 's ra t ing as an it em, an es t imate o f t he in t e rna lcons i s t ency o f t he Da i ly P rob lems index was ca l cu la t ed as .84 u s ing Cron -

bach ' s a lpha . Paren t ing r esponses to ch i ld p rob lem behav io r s were g roupedin to four ca tegor ies : negat ive consequences ( i .e . , verbal repr imands , t ime-out , physical punishm ent , loss o f p riv i leges) , non react ive o r pos i t ive conse-quences ( i .e . , ignor ing , a l lowing natura l consequences to occur, reward ingincompat ib l e behav io r, d i scuss ing the p rob lem wi th the ch i ld ) , p reven t ion(e.g . , set t ing clear rules, prompting the chi ld , al ter ing the si tuat ion) , ando ther r esponses . Sco res a re exp ressed as t he pe rcen tage o f t ime each typeo f s t r a tegy was u sed . These ca t ego r ies we re ada p ted f rom p rev ious r esea rchon paren t ing (Grusec & Kuczynsk i , 1980; Johnston & Behrenz, 1993) . Be-cause m any paren t s r e po r t e d days wi th no ch ild behav io r p rob lems , an dhence no r ep o r t ed pa ren t ing s tr a teg ies , in t e rna l cons i s tency cou ld no t bees t imated fo r t hi s measu re . H owe ver, t he in t erv iews were co ndu c ted b y in-d iv iduals t ra ined to use th e s t ra teg ies cod ing sys tem in s tud ies o f ch i ld -


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rearing discussions. Interrater reliabilities in these studies ranged between.67 and .93 (Johnston & Behrenz, 1993), and .72 and .90 (Johnston, 1994).

Finally, parent-child interactions were assessed via observational cod-ing of the videotaped interactions. Five female coders were trained to usethe Response Class Matrix (RCM; Mash, Terdal & Anderson, 1973) andindependently coded mother-child and father-child interactions during the10 min of tasks and 10 minutes of academics. The RCM codes specificclasses of parent and child behaviors every 15 sec. Summary measures in-dicating the percentage of intervals in which the parent was directive, nega-tive, social, gave praise, or didn't respond and the percentage of intervalsin which the child was compliant, oppositional, social, or didn't respondare reported. Such summary measures have proven sensitive to parent-ADHD child interactions difficulties (Cunningham & BarNey, 1979; Mash& Johnston, 1982). Observers were blind as to the OD status of the ADHDchildren, however, it was not always possible to keep observers unaware ofthe ADHD versus nonproblem status of the child. Videotapes were codedin a randomly determined order. Seventeen percent of the tapes were in-dependently coded by two observers to provide estimates of reliability. An-other 2 were group coded as part of training or because observers failedto reach an adequate level of agreement.

The reliability of RCM observations was calculated in two ways forthe 101 parent-child interactions that were independently coded by twoobservers. First, interobserver agreement was calculated on an interval-by-interval basis and ranged from 70 to 96 , with an average of 84 . Sec-ond, for each summary category, correlations were calculated betweenobservers' scores. For parent behaviors, the correlations were .87 for di-rectiveness, .89 for social behavior, .93 for praise, and .95 for not respond-ing. No parent negative behaviors were coded in the reliability sample socorrelations were not computed. For child behaviors, the correlations were.95 for compliance, .67 for not responding, .96 for social behavior, and .83for oppositional behavior. All correlations were significant at the .001 level.

Pa re n t Cha rac te r is ti c s The Symptom Checklist 90--Revised (SCL 90-R; Derogatis, 1983) was used to measure psychological distress. This meas-ure has demonstrated reliability and validity, and normative data areavailable (Derogatis, 1983). Mother and father T-scores on the Obsessive-Compulsive (includes items such as forgetfulness, indecisiveness, andtrouble concentrating, which may reflect ADHD), Depression, and Hostilitysubscales were examined. These scales were chosen to reflect dimensionsof psychological functioning that have been identified as problematic inprevious studies of parents of ADHD children (e.g., Cunningham et al.,1988; Faraone et al., 1991, Lahey et al., 1988). The average rating fromthe Daily Mood item on the phone interview was also used to reflected


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maternal psycholog ical d i s t ress . Th is ra t ing cou ld range f rom l to 7 , wi thancho rs o fv ery h ap p ya n d very sad.Across the 7 days , the in ternal consis-tency of th i s ra t ing was es t imated a t .78 .

Paren t ing se l f - est eem was assessed u sing the to t a l sco re f rom the P ar-en t ing Sense o f Co m peten ce Sca le (PSOC ; Johns ton M ash , 1989). Th i smeasu re t aps the ex ten t t o wh ich paren t s f ee l con f iden t and sa t i s f i ed inthe pa ren t ing ro le . The qu es t ionna i re has de m ons t ra t e d ev idence o f r e li -ab i l ity and val id i ty, and norm at ive data are avai lab le ( Joh nsto n M ash ,1989).

The Perce ived Soc ial Supp or t Sca le (P roc idano Hel l e r, 1983) wasused to assess pe rce ived suppor t f rom f r i ends . Th i s measu re has demon-s t r a t ed in t e rna l cons i st ency and expec ted r e l a t ionsh ip s wi th o th e r p sycho -l o gi c al c o n s t r u c t s ( P r o c i d a n o H e l l e r, 1 9 83 ). T h e D y a d i c A d j u s t m e n tScale (DAS; Spanier, 1976) was used to measure mar i ta l sa t i s fac t ion , andraw sco res a re r epo r t ed fo r mo ther s and f a the r s . Th is com m only u sed meas -u re shows h igh in t e rna l cons i s t ency and co r re l a t es wi th o the r i nd ices o fmar i t a l ad ju s tmen t (Span ie r, 1976 ) . The average r a t ing f rom the Da i lyM ar i ta l i t em on the phone in te rv iew was al so r epo r t ed and c ou ld r angefrom 1 to 7 , wi th anchors o fvery posi t ive m ar i ta l re la t ionsh ipand very negat ive mar i ta l re la t ionsh ip .In ternal consis tency was es t im ated a t .83 for th israting.

F i n a ll y, t h e L i f e E x p e r i e n c e s S u r v e y ( L E S ; S a r a s o n , J o h n s o n ,Siegel , 1978) , completed by mothers , was used to assess fami ly s t ress . Th ism easu re asks respon den t s t o r a t e t he va l ence and severi ty o f bo th pos i t iveand nega t ive even t s t ha t have occu r red in the pas t yea r. Th i s measu re hassound p sychom et r i c p roper t i e s an d ev idence suggest s t ha t t he sever ity o fnega t ive ev en ts i s the m ost sens i t ive ind ica tor o f s t ress (Sa rason e t a l.,1978) . The average ra t ing f rom the Dai ly S t ress i tem on the phone in ter-v iew was a l so included . This ra t ing cou ld range f rom 1 to 7 , wi th a ncho rso f no l i fe stressto a lot of life stress.Rat ings o f Da i ly S t ress y i e lded anin ternal consis tency es t imate o f .80 .

R S U L T S

To p ro tec t aga in s t Type I e r ro r i n the mu l t ip l e compar i sons con -duc ted in the s tudy, each grou p of var iab les ( i.e ., pa ren t rep or ts o f par-e n t - c h i l d i n t e ra c t i o n s , o b s e r v a t i o n s o f p a r e n t - c h i l d i n t e r a c t io n s , a n dm easu res o f pa ren t character is t ics) wa s in it ia lly con sidered in a m ul t ivar ia tea n al ys is o f c o v a ri a n ce ( M A N C O VA ) c o n d u c t e d s e p a r a t e l y f o r m o t h e r s a n dfathers . C hi ld age serve d as the cova r ia te in a l l analyses. I f the m ul t ivar ia tetes t ind icated a s ign if ican t d i fference am ong the groups , foUow up un iva r ia te


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F - te s ts w e r e c o n d u c t e d w i th S t u d e n t - N e w m a n - K e u l spost hoc c o m p a r i s o n sa t th e .0 5 a lp h a l ev e l. T h e o n e ex ce p t io n to th i s g en era l s t r a t eg y was th e

m a r i t a l m e a s u r e s . I n c l u d i n g th e s e m e a s u r e s i n t h e g e n e r a l m u l t i v a r ia t e te s t sw o u l d h a v e r e s u l t e d i n t h e e x c l u si o n o f a ll si n gl e m o t h e r s f r o m t h e a n a ly s is(b eca u se miss in g d a ta a re ex c lu d e d o n an an a ly s is -b y -an a ly s i s b as is ) . T h ere -f o r e , m o t h e r a n d f a t h e r D A S s co r es a n d t h e D a i l y M a r i ta l i te m w e r e e a c he x a m i n e d u s i n g u n i v a r i a t e a n a l y s e s o f c o v a r i a n c e ( A N C O VA s ) .

T h e f i r st s e t o f v a r ia b l e s r e p r e s e n t e d m o t h e r s r e p o r t s o f p a r e n t - c h i l di n t e ra c t i o n s , a n d i n c l u d e d N u m b e r o f P r o b l e m s a n d S e v e r it y o f P r o b le m s ,D a i l y P r o b l e m s , N e g a t iv e C o n s e q u e n c e s , P o s i t iv e - N o n r e a c t i v e C o n s e -q u e n c e s , a n d P r e v e n t i o n . T h e M A N C O VA c o m p a r i n g t h e t h r e e g r o u p s o n

thes e s ix var iab les was s ign i f ican t , F (12 , 144) = 13.92 , p < .001 . Fo l low upu n i v a r i a t e t e s t s i n d i c a t e d s i g n i f i c a n t d i f f e r e n c e s o n t h e N u m b e r o f P r o b -lem s, F( 2 , 77) = 59.07, p < .001; Se veri ty of Pr ob lem s, F( 2 , 77) = 103.52,p < .001; D ai ly Prob lem s, F(2 , 77) = 17.21, p < .001 ; Ne gat ive Co nse-q u en ces , F (2 , 7 7 ) = 9 .6 4, p < .0 1; an d P o s i t iv e -N o n reac t iv e Co n seq u en ces ,F (2 , 77) = 4.45, p < .02. ost hoc co mp ar i so n s in d ica ted th a t , fo r a l l v a r i -a b l e s, t h e n o n p r o b l e m g r o u p w a s s i g n i fi c a n t ly d i f f e r e n t f r o m t h e t w oA D H D g r o up s ; ho w e v e r, o n ly f o r S e v er it y o f P r o b l e m s d i d t h e tw o A D H Dg r o u p s d if fe r , w i t h m o r e s e v er e p r o b le m s r e p o r t e d f o r th e A D H D - H O Dg r o u p .

F o r f a t h e r r e p o r t s o f p a r e n t - c h i l d i n t e ra c t i o n s, th e t w o H o m e S i tu -a t i o n s Q u e s t i o n n a i r e s c o r e s w e r e f i r s t e x a m i n e d i n a M A N C O VA w h i c hrev ea led a s ign i f ican t g ro up d i ffere nc e , F (4 , 112) = 17 .37, p < .001 . U ni-v a r i a t e F s r e v e a l e d s i g n i fi c a n t e f f e c ts f o r b o t h N u m b e r o f P r o b l e m s , F ( 2 ,57) = 32.63, p < .001, an d Sev eri ty of Pro blem s, F( 2 , 57) = 27.30, p

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