The relationship between child ADHD and maternal expressed emotion: a longitudinal analysis of ...

299 Pages·2014·2.3 MB·English

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UNIVERSITY OF SOUTHAMPTON
Faculty of Social and Human Sciences
Psychology

The Relationship between Child ADHD and
Maternal Expressed Emotion: A longitudinal
Analysis of Child and Family Effects

by

Kim Cartwright

Thesis for the degree of Doctor of Philosophy
October 2013

UNIVERSITY OF SOUTHAMPTON

ABSTRACT
FACULTY OF SOCIAL AND HUMAN SCIENCES
Psychology
Doctor of Philosophy
The Relationship between Child ADHD and Maternal Expressed
Emotion: A Longitudinal Analysis of Child and Family Effects

by Kim Cartwright

High parental expressed emotion (EE) is often associated with ADHD in childhood.
However, the direction of causation in the relationship is not well understood: is it the
behaviour of the child with ADHD (i.e., child effects) or shared characteristics of the parent
or family more generally that are independent of a specific child (i.e., family effects) that
predict parental EE? Furthermore, does parental EE predict child problems over time? In
this thesis, child and family effects on maternal EE and child problems and the specific
child and family characteristics that explain these effects were examined using cross-
sectional and longitudinal multilevel models of sibling pair data in families of children with
ADHD sampled from a longitudinal study. The results revealed a complex picture with
both child and family effects implicated in predicting both maternal EE and child
behaviour. Studies 1 and 2 (which cross-sectionally used Time 1 [T1; n = 72 families] and
Time 2 [T2] data [n = 48 families] respectively) and the longitudinal analysis of Study 3 (n
= 45 families) demonstrated that, except for warmth, child effects were stronger in
predicting maternal EE. Child effects seemed to be driven by oppositional/conduct
problems (OPP/CP) and emotional problems, rather than ADHD per se. Mothers’
depressive symptoms and overall family levels of child OPP/CP largely predicted family
effects on maternal EE. Study 4 (n = 45 families), the second longitudinal analysis, found
similar T1 child and family effects on T2 child problems. Increase in negative maternal EE
from T1 to T2 significantly predicted T2 child OPP/CP. T1 family effects on T2 child
problems were predominantly predicted by T1 maternal ADHD symptoms and average
family (i.e., sibling pair) levels of EE. The results suggested a potential causal role of both
child (especially OPP/CP) and family effects (especially average family levels of child
OPP/CP) in predicting maternal EE. In addition, high EE may be a risk factor for child
OPP/CP over time and maternal ADHD for both behavioural and emotional child
problems. This may have important clinical implications for interventions with families of
children with ADHD.
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List of Contents
Abstract i
List of tables ix
List of figures xi
List of appendices xiii
Author’s declaration xv
Acknowledgements xvii
Definitions and abbreviations xix
Chapter One: ADHD and its Developmental Course
1.1 Overview of Chapter 1 1
1.2 Introduction to ADHD 1
1.3 Epidemiology of ADHD 2
1.4 Diagnostic criteria and types of ADHD 3
1.5 Problems associated with ADHD in childhood 4
1.5.1 Psychiatric comorbidity 4
1.5.2 Functional impairment 5
1.6 Developmental course: ADHD in adolescence and adulthood 7
1.6.1 Controlled prospective follow-up studies 8
1.6.2 Homotypic versus heterotypic continuity 9
1.6.3 Psychiatric status in adolescents and adults with ADHD 10
1.6.4 Functional impairment in adolescents and adults with ADHD 13
1.7 Summary of Chapter 1 15
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Chapter Two: Child ADHD and Parental EE: Child and Family Effects
2.1 Overview of Chapter 2 17
2.2 Gene-environment interplay 17
2.3 Family processes and child developmental outcomes 20
2.4 Introduction to EE 20
2.5 Origins of EE 23
2.6 Measuring EE 24
2.6.1 Camberwell Family Interview (original version) 24
2.6.2 Camberwell Family Interview (abbreviated version) 26
2.6.3 Five Minute Speech Sample 29
2.6.4 Other measures of EE 31
2.7 Associations with child behaviour and other child characteristics: 33
Empirical evidence
2.7.1 Child behaviour 33
2.7.2 Other child characteristics 51
2.8 Associations with parent-related/family characteristics: Empirical 52
evidence
2.8.1 Family socio-demographic characteristics 53
2.8.2 Parental psychopathology 53
2.8.3 Other measures of the family environment 55
2.9 Theoretical framework of the parental EE-ADHD link 57
2.9.1 Parent effects model 58
2.9.2 Child effects model 59
2.9.3 Parent and child reciprocal effects model 63
2.9.4 Extended parent and child reciprocal effects model 64
2.10 Summary of Chapter 2 and aims of the thesis 65
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Chapter Three: The Research Design: A Summary of its Methodological
Advantages
3.1 Overview of Chapter 3 67
3.2 Within-family (sibling pair) design 67
3.3 Prospective longitudinal design 71
3.4 Multilevel model design 71
3.5 Overview of aims and methodology of thesis 75
Chapter Four: Which general family and child-specific characteristics
predict maternal expressed emotion in families of children with ADHD?
4.1 Overview of Chapter 4 79
4.2 Introduction to Studies 1 and 2 80
4.3 Methods for Studies 1 and 2 83
4.3.1 Participants 83
4.3.2 Child-specific measures 86
4.3.3 Parent-related/family measures 94
4.3.4 Procedure for Studies 1 and 2 95
4.4 Overview of the analytic strategy for Studies 1 and 2 97
4.5 Results for Studies 1 and 2 98
4.5.1 Levels of child behavioural and emotional problems 98
4.5.2 Levels of maternal problems and overall family child problems 99
4.5.3 Correlations among EE components, child and family characteristics 103
4.5.4 Child and family effects on maternal EE 106
4.6 Discussion 113
4.7 Conclusions 122
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Chapter Five: Do Time 1 child and family characteristics predict Time 2
high negative maternal EE toward offspring with ADHD and their siblings?
5.1 Overview of Chapter 5 123
5.2 Introduction to Chapter 5 123
5.3 Method 126
5.3.1 Participants 126
5.3.2 Child-specific measures 126
5.3.3 Parent-related/family measures 127
5.3.4 Procedure 128
5.4 Overview of the analytic strategy 128
5.5 Results 128
5.5.1 Continuity of maternal EE 128
5.5.2 Associations between child and family characteristics over time 130
5.5.3 Child and family effects on maternal EE over time 132
5.6 Discussion 135
5.7 Conclusions 140
Chapter Six: Does T1 EE and/or other Time 1 child and family
characteristics predict comorbid problems in offspring with ADHD and
their siblings?
6.1 Overview of Chapter 6 143
6.2 Introduction to Chapter 6 144
6.3 Method 146
6.3.1 Participants 146
6.3.2 Child-specific measures 146
6.3.3 Parent-related/family measures 148
6.3.4 Procedure 148
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6.4 Overview of the analytic strategy 149
6.5 Results 149
6.5.1 Continuity and change in ADHD and other child problems over time 149
6.5.2 Correlations among T1 and T2 child characteristics 150
6.5.3 Correlations among family characteristics and child characteristics over 152
time
6.5.4 Child and family effects on child behaviour over time 156
6.6 Discussion 161
6.7 Conclusions 164
Chapter Seven: General Discussion
7.1 Overview of Chapter 7 166
7.2 Summary of the main findings 166
7.3 Implications for models of EE and development 170
7.4 Limitations 171
7.5 Clinical implications of the findings 176
7.6 Future directions 178
7.7 Concluding remarks 181
Appendices 182
References 235

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