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Research Article
Associations between Inadequate Parenting Practices
and Behavioral Problems in Children and Adolescents with
Attention Deficit Hyperactivity Disorder
Copyright 2015 Maria Cristina Triguero Veloz Teixeira et al. This is an open access article distributed under the Creative
Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
Children and adolescents with ADHD present behaviors such as impulsiveness, inattention, and difficulties with personal
organization that represent an overload for parents. Moreover, it also increases their level of stress and leads them to resort to
inadequate educational strategies. The present study verifies associations between inadequate parenting practices and behavioral
profiles of children and adolescents with ADHD. The sample was composed of 22 children with ADHD (age range 616 years) and
their mothers. Spearman correlation analyses were made with the scores of Parenting Style Inventory (PSI) and Child Behavior
Checklist for ages 618 (CBCL/618). Results indicate statistically significant associations between behavioral problems and the use
of punishment practices and negligence. When assessing a child with ADHD, it is important to verify the predominant types of
parenting practices that can influence both immediate interventions and the prognosis of the disorder.
to routine in the family environment [14], among others, voluntary right to participate in this study and a written
represent an overload to parents and increase the levels consent was obtained prior to data collection.
of parental stress [12]. Psychological and physical overload
for parents often lead to the use of inappropriate parenting 2.2. Instruments
practices [17] as an attempt to reduce behaviors which 2.2.1. Parenting Style Inventory (PSI). The inventory assesses
are considered disruptive, many of them typical for chil- seven parenting practices, two of them positive (positive
dren with ADHD of the hyperactive-impulsive type [14, monitoring and moral behavior) and five negative (negative
18]. Previous studies have verified the association between monitoring, inconsistent punishment, discipline absence,
externalizing and internalizing behavioral problems in chil- negligence, and physical abuse). It consists of 42 items to
dren and adolescents and parenting practices [19, 20], espe- be responded by parents about strategies adopted to orient
cially those characterized by negligence, parental rejection, the child [31]. For this study the following practices were
lack of discipline [21], and inconsistent punishment [22]. considered: (a) negligence: the parent does not meet the
Thus, improving parenting skills through behavioral training childs emotional or practical needs and is absent from
appears as an effective intervention for children with ADHD parental responsibilities; (b) inconsistent punishment: the
[23]. parent punishes or reinforces a behavior according to his/her
Another situation that can aggravate behavioral problems mood and not to contingencies; (c) physical abuse: the parent
is the lack of or delay in providing proper intervention for uses physical strength to hurt or bruise the child on the
children with a psychiatric disorder such as ADHD. In Latin grounds of educating them.
American countries such as Mexico, in population cohorts of
adolescents aged 12 to 17 years, it was verified that 1 out of 7 2.2.2. Child Behavior Checklist for Ages 618 (CBCL/618).
individuals with psychiatric disorders (including ADHD) did The inventory was responded by parents considering the
not have access to mental health services [24]. In developed behavior of their children in the previous six months. It is
countries, the existence of public health services does not composed of 136 items and is divided into two parts. The
always guarantee that they are broadly accessible, considering first part assesses social competence/adaptive functioning,
the intervenience of factors such as place of residence and and the second part identifies behavioral problems grouped
financial conditions of the users [25, 26]. In Brazil, a lack in the syndromes scales, DSM-oriented scales, internalizing,
of mental health services for children and adolescents was externalizing, and total behavior problems scales. This study
verified, while the existing specialized services are still not considered only behavioral problems of syndromes, external-
enough and unequally distributed [27]. The present study izing, internalizing, and total problems scales [32, 33].
aims to verify associations between inadequate parenting
practices (negligence, physical abuse, and inconsistent pun- 2.3. Data Analysis Procedures. Spearman correlation anal-
ishment) and behavioral profiles of children and adolescents yses were made with the scores from both instruments to
with ADHD. verify associations between parenting practices (negligence,
inconsistent punishment, and physical abuse) and behavioral
2. Material and Method problems in children with ADHD.
2.1. Participants. The sample was selected from a neu- 3. Results and Discussion
ropsychological, behavioral, and clinical assessment proto-
col involving children and adolescents with complaint of Results of correlation analyses among the studied
inattention and hyperactivity, which was carried out by a variables can be seen in Table 1. The scale Attention
national reference center that identifies signs compatible with Deficit/Hyperactivity Problems of CBCL covers behaviors
ADHD in the community [28]. The protocol assessed 138 such as cannot sit still, restless, or hyperactive, fails
children and adolescents between 2014 and 2015. Initially, 52 to finish things he/she starts, and impulsive or acts
of them were diagnosed with ADHD, but only 22 parents without thinking. Correlations coefficients indicate positive
agreed to fill in the Parenting Style Inventory. The sample and statistically significant associations with parenting
was thus composed of 22 children and adolescents with practices of physical abuse and inconsistent punishment.
ADHD (616 years; M = 9,77; SD = 2,91), enrolled from Parents of children with inattention and hyperactivity
1st grade of elementary school to 1st grade of high school symptoms are more likely to resort to practices of physical
and their mothers (in the condition of main caregiver). All abuse and inconsistent punishment [34, 35]. According
participants were assessed by the same child neurologist to Hadianfard [36], children with ADHD are more likely
who established the ADHD diagnosis based on DSM-IV to be victims of violent parenting practices, especially
clinical criteria [29], with predominance of combined type. psychological abuse and negligence, when compared to
Children and adolescents were assessed to exclude psychiatric children without the disorder. Mothers of children with
disorders and cognitive deficits through Wechsler Intelli- ADHD of the hyperactive type employ physical disciplinary
gence Scale for Children (WISC-III) [30]. The study was practices more frequently than mothers of children with
approved by the Ethics Committee in Research Involving ADHD of combined or inattentive types or mothers of
Humans of Universidade Presbiteriana Mackenzie, Sao Paulo, children without the disorder. Hyperactivity seems to be
Brazil (CEP/UPM number 1232/04/2010 and CAAE number related to an experience of increased stress by parents. This
0039.0.272.000-10). Participants were informed about their is caused by the difficulty to manage this behavior and
The Scientific World Journal 3
Table 1: Statistically significant correlations between inadequate parenting practices and behavioral problems in children with ADHD.
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