Parent-adolescent conflict in teenagers with ADHD and ODD

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Parent-adolescent conflict in teenagers with ADHD
and ODD
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Diagnostic Criteria for 314.01 ADHD Inattention
(Cognitive Component)

• Often fails to give close attention to details or
  makes careless mistakes in schoolwork, work, or
  other activities
• Often has difficulty sustaining attention in
  tasks or play activities
• Often does not seem to listen when spoken to
  directly
• Often does not follow through on instructions and
  fails to finish schoolwork, chores, or duties in
  the workplace (not due to oppositional behaviour
  or failure to understand instructions)

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Diagnostic Criteria for 314.01 ADHD Inattention
(continued)

• Often has difficulty organizing tasks and
  activities
• Often avoids, dislikes, or is reluctant to engage
  in tasks that require sustained mental effort
  (such as schoolwork or homework)
• Often loses things necessary for tasks or
  activities (e.g., toys, school assignments,
  pencils, books, or tools)
• Is often easily distracted by extraneous stimuli
• Is often forgetful in daily activities

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Diagnostic Criteria for 314.01 ADHD
Hyperactivity (Motor Component)

• Often fidgets with hands or feet or squirms in
  seat
• Often leaves seat in classroom or in other
  situations in which remaining seated is expected
• Often runs about or climbs excessively in
  situations in which it is inappropriate (in
  adolescents or adults, may be limited to
  subjective feelings of restlessness)
• Often has difficulty playing or engaging in
  leisure activities quietly
• Is often "on the go" or often acts as if "driven
  by a motor
• Often talks excessively

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Diagnostic Criteria for 314.01 ADHD Impulsivity
(Social Component)

• Often blurts out answers before questions have
  been completed
• Often has difficulty awaiting turn
• Often interrupts or intrudes on others (e.g.,
  butts into conversations or games)

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Diagnostic Criteria for 313.81 ODD

• Often loses temper
• Often argues with adults
• Often actively defies or refuses to comply with
  adults' requests or rules
• Often deliberately annoys people
• Often blames others for his or her mistakes or
  misbehaviour
• Is often touchy or easily annoyed by others
• Is often angry and resentful
• Is often spiteful or vindictive

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Participants

• N 302
• ADHD/ODD group, n 225
• Community Control group, n 77
• Adolescents aged between 12 and 18
• Biological child or adopted at birth
• IQ gt 80
• Exclusions deafness, blindness, severe language
  delay, cerebral palsy, epilepsy, autism, and/or
  psychosis

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Selection Measures Nil Methylphenidate/Risperido
ne

• Parental Interview
• Child Behaviour Checklist Parent form (CBCL
  Achenbach, 1991)
• Ratings of ADHD/ODD Symptoms
• Kaufmann Brief Intelligence Test (KBIT Kaufmann
  Kaufmann, 1990)

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Dependent Measures Parental Adjustment

• Beck Depression Inventory (BDI Beck, Steer,
  Garbin, 1988)
• Symptom Checklist 90 Revised (SCL-90-R
  Derogatis, 1992)
• Locke-Wallace Marital Adjustment Test (LW-MAT
  Locke Wallace, 1959)
• Adult ADHD Rating Scale (Barkley Murphy, 1998)

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Dependent Measures - Ratings of Parent/Teen
Conflict

• Conflict Behaviour Questionnaire (CBQ Prinz,
  Foster, Kent, OLeary, 1979)
• Issues Checklist (Prinz et al., 1979)
• Conflict Tactics Scale Parent-Teen Version
  (CTSPT)
• Direction Behaviour Observations of Parent-Teen
  Interactions

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Ratings of Parent-teen conflict
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Observed/video recorded interactions

• Teens in the ADHD/ODD group had significantly
  higher levels of negative behaviour during
  neutral discussions compared to the control
  group.
• Differences in dyadic and triadic interactions?
• - Yes, but only in the control group.
• However, mothers and teens in the ADHD/ODD group
  rated the neutral discussions as significantly
  less similar compared to the mothers and teens
  ratings in the control group.

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Parents Psychological Adjustment

• Factors contributing to the level of conflict
  beyond ADHD and ODD.
• - For mother-teen interactions
• - For father-teen interactions
• Worst tactic used

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Family Coercion Theory

• Patterson (1982) hypothesised that aggressive
  behavior is performed insofar as it forces other
  people to give in to the aversive demands that
  make up that behaviour
• A child does not learn about cause and
  consequence in relation to his/her actions
• Parents of ADHD/ODD children are excessively
  intrusive, demanding, argumentative and provide
  little in terms of positive reinforcement
• A child quickly learns about the power of
  coercion

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A summary of the major significant differences
regarding parent-adolescent conflict comparing
experimental and control families.
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Discussion

• What implications does this study have for
  interventions to reduce parent adolescent
  conflict?

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Pharmacological Treatment

• Medication Ritalin (ADHD) and Risperdal (ODD)
• Ritalin amphetamine and CNS stimulant
• Giving a stimulant to a hyperactive child would
  appear to be counter-intuitive, however
  researchers believe it increases concentration
  and attention span, thus improving ones
  alertness
• Studies indicate a 60-90 improvement in terms of
  disruptive behaviour
• Psychoactive medication does NOT permanently
  change behaviour and has both physiological and
  psychological side effects Ritalin recommended
  for lt six months

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Parenting Programs

• Systematic training for effective parenting
  (STEP) - change parental attitude to change
  parental behaviour to change child behaviour
  i.e., identify what it is that the child is
  trying to achieve
• Parent effective training (PET) change family
  attitude to change parental behaviour to change
  child behaviour i.e., the recognition and
  understanding of others by encouraging free
  expression of ones feelings
• Positive parenting programme (PPP) change
  parenting skills to change child skills leading
  to a change in family attitudes i.e., an emphasis
  on parenting skills to teach child self-control,
  leading to behavioural change