title: A follow-up study of maternal expressed emotion toward children with Attention-Deficit/Hyperactivity Disorder (ADHD): relation with severity and persistence of ADHD and comorbidity.
abstract: OBJECTIVE
  Attention-deficit/hyperactivity disorder (ADHD) is associated with conflicted parent-child relationships. The underlying mechanisms of this association are not yet fully understood. We investigated the cross-sectional and longitudinal relationships between externalizing psychopathology in children with ADHD, and expressed emotion (EE; warmth and criticism) and psychopathology in mothers.
  
  
  METHODS
  In this 6-year follow-up study, 385 children with an ADHD combined subtype were included at baseline (mean, 11.5 years, 83.4% male), of which 285 children (74%) were available at follow-up (mean, 17.5 years, 83.5% male). At both time points, measures of child psychopathology (i.e., ADHD severity, oppositional, and conduct problems), maternal EE, and maternal psychopathology (i.e., ADHD and affective problems) were obtained.
  
  
  RESULTS
  EE was not significantly correlated over time. At baseline, we found a nominally negative association (p ≤ .05) between maternal warmth and child ADHD severity. At follow-up, maternal criticism was significantly associated with child oppositional problems, and nominally with child conduct problems. Maternal warmth was nominally associated with child oppositional and conduct problems. These associations were independent of maternal psychopathology. No longitudinal associations were found between EE at baseline and child psychopathology at follow-up, or child psychopathology at baseline and EE at follow-up.
  
  
  CONCLUSIONS
  The results support previous findings of cross-sectional associations between parental EE and child psychopathology. This, together with the finding that EE was not stable over 6 years, suggests that EE is a momentary state measure varying with contextual and developmental factors. EE does not appear to be a risk factor for later externalizing behavior in children with ADHD.
authors.affiliation: Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands; Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands. Electronic address: Jennifer.Richards@radboudumc.nl.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Richards
authors.affiliation: Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Alejandro Arias
authors.initials: AA
authors.lastname: Vásquez
authors.affiliation: Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands.
authors.forename: Nanda N J
authors.initials: NN
authors.lastname: Rommelse
authors.affiliation: Vrije Universiteit (VU) Amsterdam, the Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Oosterlaan
authors.affiliation: University Medical Centre Groningen, University of Groningen, the Netherlands.
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Hoekstra
authors.affiliation: Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Barbara
authors.initials: B
authors.lastname: Franke
authors.affiliation: University Medical Centre Groningen, University of Groningen, the Netherlands.
authors.forename: Catharina A
authors.initials: CA
authors.lastname: Hartman
authors.affiliation: Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands; Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands.
authors.forename: Jan K
authors.initials: JK
authors.lastname: Buitelaar
mesh_terms: D000293:Adolescent; D000328:Adult; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000503:physiopathology*; D002648:Child; D015897:Comorbidity; D019260:Expressed Emotion / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology*; D012720:Severity of Illness Index
keywords: attention-deficit/hyperactivity disorder (ADHD); conduct problems; follow-up study; maternal expressed emotion; oppositional problems