Parent-adolescent conflict in teenagers with ADHD and ODD
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Transcript Parent-adolescent conflict in teenagers with ADHD and ODD
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 >= 80
Exclusions = deafness, blindness, severe language delay,
cerebral palsy, epilepsy, autism, and/or psychosis
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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)
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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, &
O’Leary, 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 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
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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 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,
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leading to behavioural change