Relationship of family environment and parental psychiatric diagnosis to impairment in ADHD.
OBJECTIVE
Family environmental factors as well as parental attention-deficit/hyperactivity disorder (ADHD) status have shown associations with variability in ADHD. The purpose of the present study was to examine the links among family environment, parental psychiatric diagnosis, and child impairment within a sample of ADHD-affected sibling pairs (ASPs) ages 5 to 18 years.


METHODS
Parents in 220 ASP families completed a measure of family functioning, the Family Environment Scale. Children's impairment was measured by clinical ratings of global functioning and by maternal ratings of behavior.


RESULTS
Parents of children with ADHD rate their families as higher in conflict and lower in achievement and organization than normative samples. High family conflict is significantly associated with impairment in ADHD ASPs accounting for approximately 40% of the sibling similarity in impairment. Parental psychiatric diagnosis revealed no significant direct link to sibling impairment, but rather a significant indirect link to impairment mediated by family conflict. Direct associations with parental diagnosis depend on birth order of the ASP members despite the comparable mean impairment scores for older and younger ADHD siblings.


CONCLUSIONS
There are strong links between impairment in children with ADHD and family environment. Different processes and mechanisms may contribute to impairment in different children in the same family.
Drs. Pressman, Asarnow, Lynn, McCracken, and McGough are with the Department of Psychiatry, UCLA Semel Institute, Los Angeles; Dr. Lubke is affiliated with the Department of Psychology, Notre Dame University, Notre Dame, Ind.; and Drs. Loo, Carpenter, and Smalley, and May Yang are affiliated with both institutes.
Leah J
LJ
Pressman
Drs. Pressman, Asarnow, Lynn, McCracken, and McGough are with the Department of Psychiatry, UCLA Semel Institute, Los Angeles; Dr. Lubke is affiliated with the Department of Psychology, Notre Dame University, Notre Dame, Ind.; and Drs. Loo, Carpenter, and Smalley, and May Yang are affiliated with both institutes.
Sandra K
SK
Loo
Drs. Pressman, Asarnow, Lynn, McCracken, and McGough are with the Department of Psychiatry, UCLA Semel Institute, Los Angeles; Dr. Lubke is affiliated with the Department of Psychology, Notre Dame University, Notre Dame, Ind.; and Drs. Loo, Carpenter, and Smalley, and May Yang are affiliated with both institutes.
Erika M
EM
Carpenter
Drs. Pressman, Asarnow, Lynn, McCracken, and McGough are with the Department of Psychiatry, UCLA Semel Institute, Los Angeles; Dr. Lubke is affiliated with the Department of Psychology, Notre Dame University, Notre Dame, Ind.; and Drs. Loo, Carpenter, and Smalley, and May Yang are affiliated with both institutes.
Joan R
JR
Asarnow
Drs. Pressman, Asarnow, Lynn, McCracken, and McGough are with the Department of Psychiatry, UCLA Semel Institute, Los Angeles; Dr. Lubke is affiliated with the Department of Psychology, Notre Dame University, Notre Dame, Ind.; and Drs. Loo, Carpenter, and Smalley, and May Yang are affiliated with both institutes.
Deborah
D
Lynn
Drs. Pressman, Asarnow, Lynn, McCracken, and McGough are with the Department of Psychiatry, UCLA Semel Institute, Los Angeles; Dr. Lubke is affiliated with the Department of Psychology, Notre Dame University, Notre Dame, Ind.; and Drs. Loo, Carpenter, and Smalley, and May Yang are affiliated with both institutes.
James T
JT
McCRACKEN
Drs. Pressman, Asarnow, Lynn, McCracken, and McGough are with the Department of Psychiatry, UCLA Semel Institute, Los Angeles; Dr. Lubke is affiliated with the Department of Psychology, Notre Dame University, Notre Dame, Ind.; and Drs. Loo, Carpenter, and Smalley, and May Yang are affiliated with both institutes.
James J
JJ
MCGough
Drs. Pressman, Asarnow, Lynn, McCracken, and McGough are with the Department of Psychiatry, UCLA Semel Institute, Los Angeles; Dr. Lubke is affiliated with the Department of Psychology, Notre Dame University, Notre Dame, Ind.; and Drs. Loo, Carpenter, and Smalley, and May Yang are affiliated with both institutes.
Gitta H
GH
Lubke
Drs. Pressman, Asarnow, Lynn, McCracken, and McGough are with the Department of Psychiatry, UCLA Semel Institute, Los Angeles; Dr. Lubke is affiliated with the Department of Psychology, Notre Dame University, Notre Dame, Ind.; and Drs. Loo, Carpenter, and Smalley, and May Yang are affiliated with both institutes.
May H
MH
Yang
Drs. Pressman, Asarnow, Lynn, McCracken, and McGough are with the Department of Psychiatry, UCLA Semel Institute, Los Angeles; Dr. Lubke is affiliated with the Department of Psychology, Notre Dame University, Notre Dame, Ind.; and Drs. Loo, Carpenter, and Smalley, and May Yang are affiliated with both institutes. Electronic address: ssmalley@mednet.ucla.edu.
Susan L
SL
Smalley
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D016241:Child of Impaired Parents / Q000523:psychology* / Q000706:statistics & numerical data*; D005190:Family / Q000523:psychology*; D006801:Humans; D007406:Interview, Psychological; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology*; D010290:Parents / Q000523:psychology*; D035781:Siblings; D012931:Social Environment; D011795:Surveys and Questionnaires