Parent-adolescent conflict in teenagers with ADHD and ODD

1. Parent-adolescent conflict in teenagers with ADHD and ODD

2. 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)

3. 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

4. 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

5. 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)

6. 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

7. 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 >= 80 • Exclusions = deafness, blindness, severe language delay, cerebral palsy, epilepsy, autism, and/or psychosis

8. Selection Measures – Nil Methylphenidate/Risperidone • Parental Interview • Child Behaviour Checklist – Parent form (CBCL: Achenbach, 1991) • Ratings of ADHD/ODD Symptoms • Kaufmann Brief Intelligence Test (KBIT; Kaufmann & Kaufmann, 1990)

9. 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)

10. Dependent Measures - Ratings of Parent/Teen Conflict • Conflict Behaviour Questionnaire (CBQ; Prinz, Foster, Kent, & O’Leary, 1979) • Issues Checklist (Prinz et al., 1979) • Conflict Tactics Scale – Parent-Teen Version (CTSPT) • Direction Behaviour Observations of Parent-Teen Interactions

11. Ratings of Parent-teen conflict

12. 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.

13. 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

14. 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

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

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

17. 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 one’s 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 =< six months

18. 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 one’s 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