Persistent Parental Criticism and Ongoing ADHD Symptoms

Study results published in the February 2016 issue of Journal of Abnormal Psychology indicate that persistent parental criticism appears to be among the reasons why attention deficit hyperactivity disorder (ADHD) symptoms persist with age among some children, as opposed to decreasing with age as seen with many children with ADHD.

The researchers found that parental criticism, an index of the family environment, was uniquely associated with divergent developmental trajectories among children with ADHD in addition to those associated with oppositional-defiant disorder (ODD) symptoms.

“Why ADHD symptoms decline in some children as they reach adolescence and not for others is an important phenomenon to be better understood,” said study lead author Erica Musser, PhD, assistant professor of psychology at Florida International University. “The finding here is that children with ADHD whose parents regularly expressed high levels of criticism over time were less likely to experience this decline in symptoms.”

For the study, Musser and colleagues assessed 388 children with ADHD and 127 controls using multi-informant, multimethod diagnostic procedures at up to three time points one year apart in an accelerated longitudinal design that covered ages 7 to 13 years. The team also identified developmental trajectories for parent- and teacher-rated ADHD and ODD symptoms within the ADHD sample. Of those with ADHD, 69% were male, 795 were Caucasian, and 75% were from two-parent households.

Parental expressed emotion, criticism (harsh, negative statements about the child, rather than his or her behavior), and emotional over-involvement (overprotective feelings toward the child) were coded from a five-minute speech sample at two time points, one year apart, for 208 of these children and compared among ADHD trajectory groups. Experts rated levels of each based on audio recordings of these sessions.

Musser and colleagues found that parent-rated hyperactivity yielded a four-class trajectory solution in latent-class growth analysis; teacher-rated inattention yielded a three-trajectory solution, as did teacher-rated ODD.

Children with parent-rated high persistent hyperactivity were more likely than other ADHD groups to have parents with stable high criticism, after controlling for ODD symptoms. Those with teacher-identified high ODD-worsening were more likely to experience high criticism, particularly at the initial time point, after controlling for hyperactivity. Only sustained parental criticism was associated with the continuance of ADHD symptoms in children.

“The novel finding here is that children with ADHD whose families continued to express high levels of criticism over time failed to experience the usual decline in symptoms with age and instead maintained persistent, high levels of ADHD symptoms,” said Musser.

Musser noted that although the study findings indicate an association between sustained parental criticism and ADHD symptoms over time, they do not suggest a causal relationship.

“We cannot say, from our data, that criticism is the cause of the sustained symptoms,” she said. “Interventions to reduce parental criticism could lead to a reduction in ADHD symptoms, but other efforts to improve the severe symptoms of children with ADHD could also lead to a reduction in parental criticism, creating greater well-being in the family over time.”