Brendan F. Andrade

The Direct Effects of Inattention and Hyperactivity/Impulsivity on Peer Problems and Mediating Roles of Prosocial and Conduct Problem Behaviors in a Community Sample of Children

Objective: This study tested whether children’s symptoms of inattention and hyperactivity/impulsivity were associated with peer problems and whether these associations were mediated by conduct problems and prosocial behaviors. Method: A community sample of 500 children, including 245 boys and 255 girls, who ranged in age from 6 to 9 years (M = 7.6, SD = 0.91) were recruited. Teachers’ report of children’s inattention, hyperactivity/impulsivity, conduct problems, prosocial behaviors, and peer problems was collected. Results: Symptoms of inattention and hyperactivity/impulsivity were significantly positively associated with peer problems. Conduct problems were associated with more peer problems and prosocial behaviors with less peer problems. Conduct problems and prosocial behaviors partially mediated the association between hyperactivity/impulsivity and peer problems and fully mediated the inattention–peer problems association. Conclusion: Findings show that prosocial behaviors and conduct problems are important variables that account for some of the negative impact of symptoms of inattention and hyperactivity/impulsivity on peer functioning.

Prosocial skills may be necessary for better peer functioning in children with symptoms of disruptive behavior disorders

Children with disruptive behavior disorders experience substantial social challenges; however, the factors that account for (i.e., mediate), or influence (i.e., moderate), peer problems are not well understood. This study tested whether symptoms of Oppositional Defiant Disorder and Conduct Disorder were associated with peer impairment and whether prosocial skills mediated or moderated these associations. Teacher ratings were gathered for 149 children (Mage = 9.09, SD = 1.71, 26% female) referred for behavioral concerns to an urban child psychiatry clinic. Path-analytic linear regressions testing mediation and moderation effects showed that prosocial skills significantly moderated the negative effects of symptoms of Conduct Disorder on peer impairment. Children showed less peer impairment only when they had relatively few conduct symptoms and high prosocial skills. Measurement of prosocial skills, in addition to conduct problems, may best capture factors which contribute to peer problems of children with disruptive behaviors.

Effects of Intensive Behavioral Treatment for Children With Varying Levels of Conduct Problems and Callous-Unemotional Traits

The purpose of this study was to examine whether callous-unemotional (CU) traits moderated the effects of intensive behavior therapy in elementary school-age children with varying levels of conduct problems (CP). Both treatment response (magnitude of change between pre- and posttreatment) and treatment outcomes (likelihood of normalization from treatment) were examined. Participants were 67 children (n = 49 boys, Mage = 9.6 years) with varying levels of CP and CU who participated in an intensive 8-week summer treatment program (STP) in which behavior therapy was delivered to children in recreational and classroom settings and to parents via weekly parent training sessions. Effects of treatment were measured using parent and teacher ratings of oppositional defiant disorder (ODD), conduct disorder (CD), callous behavior, and impairment. Results showed that CU moderated treatment effects for CD and callous behavior but not ODD or impairment. The moderating effects showed some evidence that participants with high CP and high CU before treatment had better treatment responses (larger change between pre- and posttreatment) but worse treatment outcomes (lower likelihood of normalization after treatment). These results suggest that intensive treatment, such as the STP, may be necessary but not sufficient for children with CP and CU traits.

Latent Profiles of Externalizing Psychopathology and Their Relation to Children's Aggression and Social Behavior.

Objective: This study identified profiles of clinic-referred children with disruptive behavior and determined the association between identified profiles and childrens aggression, peer problems, and prosocial skills. Method: Parents and teachers of 208 children (163 boys) aged 6 to 12 years (Mage = 8.80, SD = 1.75) completed measures to assess childrens callous-unemotional (CU) traits, inattentive-impulsive-overactive (IO) and oppositional-defiant (OD) behavior, aggression, and social behaviors. Latent class analysis was used to identify the profiles, and the pseudoclass draw method to test the equality of means for each of the aggression and social behavioral outcomes across the latent classes. Results: Five profiles were identified: (1) Low (35.6% of children), with relatively low levels of CU traits and IO and OD behavior; (2) Low-Moderate (30.8%), with low-moderate levels of CU traits, low IO and moderate OD behavior; (3) Moderate (21.6%), with moderate levels of CU traits and IO and moderate-high OD behavior; (4) Moderate-High (7.2%), with moderate-high levels of CU traits, high IO and moderate-high OD behavior; and (5) High (4.8%), with high levels of CU traits, IO and OD behavior. Conclusion: Children categorized into profiles showed important differences in level of aggression and social behavior. The overlap between CU traits, IO, and OD behavior add to understanding of child psychopathology that influences behavior and clinical outcomes.

Comparing the Multicomponent Coping Power Program to Individualized Parent–Child Treatment for Improving the Parenting Efficacy and Satisfaction of Parents of Children with Conduct Problems

This study compared the multicomponent Coping Power (group) program to individualized parent–child treatment with respect to changing the parenting efficacy and satisfaction of parents of children with conduct problems. One hundred fourteen parents of 9–12-year-old children with conduct problems were randomized to Coping Power or individualized treatment at an urban children’s mental health clinic. Parents reported their pre- and post-treatment parenting efficacy and parenting satisfaction (Parent Sense of Competence Scale). Mixed effect models revealed that parenting efficacy and satisfaction significantly increased from pre- to post-treatment, and there was no evidence that this effect is different between Coping Power and individualized treatment, even after controlling for initial severity of child symptomatology. Findings support the effectiveness of Coping Power as an intervention for parenting efficacy and satisfaction among parents of children aged 9–12 years with conduct problems.

Accounting for the impact of parent internalizing symptoms on Parent Training benefits: The role of positive parenting

Parent Training (PT) is not as effective for parents with histories of internalizing symptoms as it is for other parents. This study aimed to determine which dimensions of parenting, notably parenting efficacy, positive parenting, inconsistent discipline, and poor supervision, mediate the association between parent lifetime internalizing symptoms and post-PT child emotional and behavioral difficulties. One hundred fourteen parents (82% biological mothers) of children aged 9-12 years received PT at an urban childrens mental health clinic. Parents reported their lifetime internalizing symptoms, pre- and post- PT parenting skills, and pre- and post- PT child difficulties. Positive parenting fully mediated the relation between parent lifetime internalizing symptoms and elevated child post-PT emotional and behavioral difficulties. Specifically, parents higher in internalizing symptoms reported lower positive parenting post-PT, which in turn predicted more child difficulties post-PT. Findings suggest that fostering positive parenting in PT may be particularly important for parents with histories of internalizing symptoms.

Person-context interactions and the assessment of attention deficit hyperactivity disorder: developmental and methodological considerations

ABSTRACT This article outlines challenges that emerge during the clinical assessment of attention deficit hyperactivity disorder (ADHD) in children. The importance of person-context interactions is highlighted, especially when attempting to formulate the factors that promote and maintain poor psychosocial functioning in children with ADHD. Additionally, a variety of important methodological and age considerations are highlighted. Brief clinical examples are used to illustrate these principles. The review concludes that best practice assessment of ADHD should be systemic and include consideration of child-level difficulties and problematic contexts that are precipitants, perpetuators, and consequences of poor psychosocial functioning. Furthermore, thorough assessment of ADHD should include consideration of other co-occurring psychosocial challenges, consistent with emerging models of psychopathology as a crosscutting phenomenon.