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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 39  |  Issue : 3  |  Page : 100-104

Case–control study of depression in mothers of children with attention deficit hyperactivity disorder


Department of Psychiatry, Menoufia University, Shebeen El-Kom, Egypt

Date of Submission09-Jan-2017
Date of Acceptance07-Feb-2017
Date of Web Publication11-Oct-2018

Correspondence Address:
Ayman A Elhadad
Department of Psychiatry, Menoufia University, Shebeen El-Kom, 32511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejpsy.ejpsy_5_17

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  Abstract 


Background Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood-onset psychiatric disorders. It is characterized by inattention, hyperactivity, and impulsivity. ADHD can affect the social, cognitive, and academic performance of the child. Mothers of ADHD children tend to experience more stress, social isolation, self-blame, and depression.
Aim The aim of this study was to identify the spread of depression in a sample of mothers with children having ADHD who were being followed up at the outpatient clinic of Abha Psychiatric Hospital.
Patients and methods Sixty biological mothers of children with ADHD were incluced in this study. Each mother was evaluated for the presence of a major depressive disorder using the Beck Depression Inventory scale. A control group of 60 mothers of children without any psychiatric disorder or chronic medical condition was also included.
Results On the basis of the Diagnostic and Statistical Manual of Mental Disorders V criteria, about 41.6% of mothers with ADHD children were found to be depressed.
Conclusion An overall 41.6% of mothers of ADHD children had major depressive disorder, suggesting that routine screening for maternal depression needs to be considered when children are diagnosed with ADHD.

Keywords: attention deficit hyperactivity disorder, case–control study, depression, mothers


How to cite this article:
Elhadad AA. Case–control study of depression in mothers of children with attention deficit hyperactivity disorder. Egypt J Psychiatr 2018;39:100-4

How to cite this URL:
Elhadad AA. Case–control study of depression in mothers of children with attention deficit hyperactivity disorder. Egypt J Psychiatr [serial online] 2018 [cited 2018 Oct 23];39:100-4. Available from: http://new.ejpsy.eg.net/text.asp?2018/39/3/100/243030




  Introduction Top


Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood-onset psychiatric disorders that is characterized by inattention, hyperactivity, and impulsivity (Robert et al., 1997; Martin et al., 2002)

Gerberding et al. (2005) estimated the prevalence of ADHD to be 2–18% (an average of 10%) and reported it to be the most common behavioral and/or emotional disorder in school-aged children.

The prevalence of ADHD is influenced by many factors. Gerberding et al. (2005) classified these factors as follows: (a) sex: boys exhibit ADHD symptoms (American Psychiatric Association 1994; Gerberding et al., 2005) more frequently than do girls; (b) age: symptoms prevail until the age of 13–14 years; (c) demographic variables: ADHD is a common disorder in lower social and economic classes of society; and (d) disagreement among practitioners with regard to clinical practices in diagnosing this disorder.

The revised 4th ed., of the Diagnostic and Statistical Manual of Mental disorders described three major symptoms for the diagnosis of ADHD: (a) inattention, which includes the child’s inability to pay attention and/or remain focused in situations where attention is expected; (b) hyperactivity, which represents the main pillar of ADHD diagnosis, and the main reason that parents and caregivers seek help for the child; and (c) impulsivity, which is associated with hastiness. These symptoms should be evident at both school and home and revealed before the age of 7 so that the child can be diagnosed with ADHD (American Psychiatric Association, 1994).

ADHD is diagnosed by two main approaches as per the American Academy of Child and Adolescent Psychiatry (2007): (a) medical diagnosis, which includes electroencephalography, MRI, and biochemical tests; and (b) rating scales. These rating scales are widely used at both home and school. It includes a set of behaviors that are perceived by parents and teachers as troubled behaviors and cause disturbance to others. An example of such a rating scale is the Conners’ Parent and Teacher Rating Scale (Conners, 1998), which is the most accepted instrument for diagnosing ADHD (Kashdan et al., 2004). Conner’s scale will be affected by emotions of the parents and caregivers as responndents to rating scales (Kashdan et al., 2004).

The American Academy of Child and Adolescent Psychiatry (2007) indicated that the inappropriate behaviors of ADHD children at home and at school would cause conflicts between the child and his or her parents, teachers, and peers. It is estimated that 25–40% of ADHD children exhibit antisocial personality disorders as well as oppositional defiant disorders (Bagwell et al., 2001) and conduct disorders (Barkley and Murphy, 2000). Longitudinal studies (Biederman et al., 1996; Treuting and Hinshaw, 2001; Fischer et al., 2002) indicated that parents of children with ADHD had levels of anxiety and depression compared to controls.

Wiener and Dulcan (1991) reported that ADHD can affect the social, cognitive, and academic performance of the child.

Raising children is a continuous, challenging process that places considerable demands on parents, bringing restrictions on the lifestyle practiced by parents before the birth of the child. Raising an ADHD child entails additional challenges because of the disturbed behavior of the child (Harison and Sofronoff, 2002).

McAuley et al. (2009) found that mothers of ADHD children tend to experience more stress, social isolation, self-blame, and depression. Various studies have looked at interaction between parents and children with ADHD. Most researchers have studied mothers, as mothers are more vulnerable. Mothers of children with ADHD have higher rates of depression and anxiety. They experience higher levels of daily child-rearing stress. As their child has a greater number of problems, the stress is also greater. Mothers need a strong support system for long-term coping. Parents my benefit from parental training in problem solving and communication.


  Aim Top


The aim of this study was to estimate the prevalence of major depressive disorder in a sample of mothers with ADHD children and compare it with that of a control group of mothers with children with a medical condition.


  Patients and methods Top


The study included 60 mothers with children who had a diagnosis of ADHD. The mothers were selected from consecutive referrals to the child psychiatric clinic at Abha Psychiatric Hospital, located in Aseer region of the Kingdom of Saudi Arabia.

All the children who were brought to the clinic with chief complaints of inattention and hyperactivity were evaluated using the ADHD rating scale to confirm the diagnosis. The diagnosis was made by certified child and adolescent psychiatrists.

Inclusion criteria for mothers for inclusion into the study were as follows: (a) having ADHD children aged between 6 and 12 years; (b) no signs of major medical condition, mental retardation, psychosis, or bipolar disorder in mothers and children; (c) willingness to participate in the study with their children.

The control group included 60 mothers without any psychiatric or chronic medical disorders who were referred to the pediatric clinic for other problems.

The selected mothers were evaluated for the presence of a basic psychiatric disorder by a psychiatrist, after which they completed the Beck Depression Inventory (BDI) scale.

The study procedure was explained to the parents of the children and written informed consent was obtained.

Instruments

The BDI was used to assess maternal depressive symptoms (Beck et al., 1987). It includes 21 items, each scored from 0 to 3 according to the severity of the depressive symptoms, with a total score of 63. Cutoff scores were up to 9 for normal, 10–15 for mild, 16–29 for moderate, and more than 30 for severe. This widely used self-report scale had excellent construct validity in both psychiatric samples (Beck et al., 1987; Beck et al., 1988).

Ethical considerations

Approval from the local medical ethical committee and from the director of the hospital was obtained. The data were entered into the computer anonymously.


  Results Top


All mothers of children with ADHD as well as the control group completed the self-report measures of BDI.

There was no significant difference in the demographic characteristics of the two groups, as shown in [Table 1].
Table 1 Demographic variability of the two groups

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The results of maternal depressive symptoms are shown in [Table 2]. There was a significant difference in the rated severity of depression between the two groups, as the mothers of ADHD children had higher levels of depressive symptoms compared with the control group.
Table 2 Maternal depressive symptoms in cases and controls according to Beck Depression Inventory results

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The study found a correlation between the severity of depressive symptoms and increase in the age of the mothers, as shown in [Table 3].
Table 3 The correlation between the severity of depressive symptoms in a mother with an attention deficit hyperactivity disorder child and the increased mother’s age

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There was no significant relation between ADHD subtypes and depressive symptom severity, as shown in [Table 4].
Table 4 Relation between attention deficit hyperactivity disorder subtypes in children and depressive symptom severity in their mothers

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  Discussion Top


This study investigates the rate and severity of depression in mothers of children with ADHD in a case–control study.

The study found that the severity of depression in mothers of children with ADHD was significantly higher than that in mothers of the control group. These results were consistent with those of Bawalsah (2014) at Amman University.

In another study conducted by Segenreichd et al. (2009) in a Brazilian University, higher prevalence rates of anxiety and depression were reported in parents of children with ADHD.

Mothers of ADHD children presented higher depressive and anxiety levels. However, trait anxiety levels were higher in mothers with ADHD children than in controls (Sadock and Sadock, 2003).

In a study conducted by Ghanizadeh in Shiraz University of medical sciences in 2008, the most common psychiatric disorder in parents of ADHD children was mood disorder. The incidence of major depression in mothers and fathers of those children was 48.1 and 43.0%, respectively (Ghanizaleh et al., 2008).

In our study the incidence of depression in mothers of ADHD children was 40%, which was higher than that in the control group.

The study by Atefeh Soltaniar et al. (2009) found that the rate of depression in mothers of ADHD children was 30%, which is higher than that in the control group.

Mc Cromic (1995) evaluated the severity of depression in mothers of children with ADHD and reported that the prevalence of major depressive disorder was 17.9% and that of minor depression was 20.5%.

According to Gerdes et al. (2007) mothers experience life events that they find uncontrollable and evaluate parenting stress as severe. They proposed that experiencing uncontrollable life events and consequently having elevated stress lead mothers to be unresponsive to the child’s negative behavior. This limits the problem-solving ability of the mother as well as increasing depressive symptoms. Similar to these hypotheses, the study showed that mothers of children with ADHD have elevated levels of depression and those factors may be important in the treatment process of the child.

In our study there was a correlation between the mother’s severity of depressive symptoms and increase in their age.

This is consistent with most studies that have examined age as a risk factor for depression, basing the results on cross-sectional data (Bawalsah, 2014).

There was no significant relation between ADHD subtypes and severity of depression.

Raising an ADHD child is challenging because of the child’s behavioral problems (Ghanizaleh et al., 2008).

Harison and Sofronoff (2002) suggested that children with ADHD have adverse effects on their parent’s mental health.

Kashdan et al. (2004) reported that parents may find themselves incapable of dealing with the inappropriate maladaptive behavior of the child.

Kashdan et al. (2004) also indicated that raising a child with ADHD may exacerbate the social difficulties faced by parents, and those parents perceive their family environment as less supportive and more stressful. They indicated that depressive symptoms are greater in parents of children with disruptive behavior in comparison with parents of nondisruptive children.


  Conclusion Top


The levels of depression in mothers of ADHD children are higher than those in the control group; therefore, additional attention should be paid to the clinical symptoms of depression, specifically toward understanding the way they affect family functioning over time.

These results also have important educational implications. First we need to understand that behind any child with special needs there is a family with special needs. Therefore, additional efforts should be directed toward parents with children with ADHD as they are forced to deal with the disruptive behavior of the child and its consequences. These efforts should include but are not limited to family counseling, training programs, group sessions, and peer support discussions. Second, teachers and educators of children with ADHD should empower parents with strategies to deal with the disruptive behavior of their child; that is, parents should be a part of any remedial intervention with the ADHD child. Third, any positive improvement in the behavior of the ADHD child must be amplified and shared with parents as an indicator that the ADHD child is capable of positive change; this might have a positive impact on the psychological well-being of the parents.

Recommendations

The results of this study signify the importance of maternal mental health assessments and the use of appropriate interventions not only for ADHD children but also for their parents, especially mothers.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
American Academy of Child and Adolescent Psychiatry (2007). Practice for the assessment and treatment of children, adolescents, and adults with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatr 36:870–884.  Back to cited text no. 1
    
2.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed. Washington, DC: American Psychiatric Association. ISBN-10:0890420629.  Back to cited text no. 2
    
3.
Bagwell CL, Molina BS, Pelham WE, Hoza B (2001). Attention deficit hyperactivity disorder and problems in peer relations: predictions from childhood to adolescence. J Am Acad Child Adolesc Psychiatry 40:1285–1292.  Back to cited text no. 3
    
4.
Barkley RA, Murphy KR (2000). A clinical workbook: attention deficit hyperactivity disorder. 2nd ed. The Guilford Press.  Back to cited text no. 4
    
5.
Bawalsah J (2014). Levels of depression in parents of children with ADHD in Jordan. Int J Adult Nonformal Educ. 2:031–042.  Back to cited text no. 5
    
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8.
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Conners CK (1998). The revised conner’s parent rating scale: factor structure, reliability, and criterion validity − CPRS-R. J Abnorm Child Psychol 8:256–273.  Back to cited text no. 9
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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  In this article
Abstract
Introduction
Aim
Patients and methods
Results
Discussion
Conclusion
Introduction
Aim
Patients and methods
Results
Discussion
Conclusion
References
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