Revisiting parent–child interactions in early childhood as relevant factor in the development of ADHD

Abstract

In this issue of European Child and Adolescent Psychiatry, Joseph and colleagues investigated the presentation of depressive symptoms in a large, community-based sample of young children (6–8 years) with and without ADHD. This study extends previous work by showing that increased depressive symptom levels are already present in children with ADHD as young as age six. Sadness, irritability, insomnia, psychomotor agitation, feeling bad about oneself, difficulty concentrating, and making decisions were among the symptoms more frequently occurring in children with ADHD as compared to those without. These findings highlight the importance of early detection and treatment of depressive symptoms in young children with ADHD. Although mechanisms explaining the high frequency of depressive symptoms in these young children were not investigated, the authors notice that caregiver’s mental health difficulties may be a relevant factor. This would indeed be in line with the existing literature, showing that (1) parents of children with ADHD often experience mental health problems themselves (including ADHD and depression) [1, 2] (2) depression in parents increases the development of depressive symptoms in (very) young children amongst other factors through influencing parenting practices [3, 4], and (3) treatment of parental depression and/or parent–child interaction therapy may reduce depression in young children [5]. Indirectly these findings support the relevance of including the early parent–child interaction as relevant domain in the search for early risk pathways towards the development of ADHD and its comorbidities. We propose that Emotion Dysregulation (ED) in parent–child interaction is such a risk pathway. Parents play a pivotal role in supporting and promoting emotion regulation during early childhood. The literature on children’s social development, a field of research which has developed virtually independent of the ADHD literature, clearly shows that parents are the most influential in facilitating and promoting young children’s ability to develop effective strategies to regulate their emotions. The early development of effective emotion regulation abilities—especially in easily dysregulated children—is strongly dependent on a context of safe, supportive, and well-adapted parent–child relationships, wherein parents are able to support and stimulate the child’s emotion regulation capacities [6]. Of great relevance is that a recent study indicates that parental use of emotion socialization practices (both supportive and non-supportive) has a relatively stronger impact on children with high ADHD symptomatology [7]. This suggests that parental use of adaptive emotion socialization practices may be particularly relevant in the context of susceptibility towards developing ADHD. Reversely, children do also play a pivotal role in influencing parental emotion regulation. Studies show that parents who have toddlers with disruptive behavior problems exhibited more hostile attributional biases and emotion flooding, as well as more negative discipline practices [8]. Toddlers who continue to exhibit strong emotion dysregulation in the context of challenging temperamental styles (so-called ’difficult temperament’) tend to elicit more negative, unresponsive, and/or punitive reactions from parents during this age period [6]. Children’s behavior problems and parents’ * N. Rommelse [email protected]