ABSTRACT
Low activity of the hypothalamic-pituitary-adrenal axis (HPAA) has been found in children with attention deficit hyperactivity disorder (ADHD). The condition may be related to the reduced attention regulation capacity and/or to comorbid oppositional defiant or conduct disorder (ODD/CD). Sex differences are probable but not sufficiently studied. We analyzed the HPAA activity and sympathetic nervous system reactivity (SR) in children with ADHD while accounting for ADHD symptom presentation, comorbidity, and sex differences. The sample comprised 205 children, 98 (61 boys, 37 girls) with ADHD and 107 (48 boys, 59 girls) healthy controls. DSM-5 phenotypic symptom presentation and comorbid ODD/CD were assessed using clinical interviews. Hair cortisol concentration (HCC) was used to assess the long-term, cumulative activity of the HPAA. SR was assessed via skin conductance response (SCR). For control purposes, comorbid internalizing symptoms and indicators of adverse childhood experiences (ACE) were assessed. Children were medication naive. Boys presenting with predominantly inattentive symptoms (ADHD-I) showed lower HCC than healthy boys. Girls presenting with combined symptoms (ADHD-C) showed higher HCC than did healthy girls (p's < 0.05, sex-by-group interaction, F (2,194) = 4.09, p = 0.018). Boys with ADHD plus ODD/CD showed a blunted SR (p < 0.001, sex-by-group interaction, F (2,172) = 3.08, p = 0.048). Adjustment for ACE indicators led to non-significant differences in HCC but did not affect differences in SR. HCC constitutes an easily assessable, reliable, and valid marker of phenotypic ADHD-related features (i.e. symptom presentation and comorbidity). It indicates more homogenous subgroups of ADHD and might point to specifically involved pathophysiological processes.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Conduct Disorder , Child , Humans , Male , Female , Attention Deficit Disorder with Hyperactivity/diagnosis , Hydrocortisone , Hypothalamo-Hypophyseal System , Pituitary-Adrenal System , Conduct Disorder/epidemiology , Comorbidity , Attention Deficit and Disruptive Behavior Disorders/epidemiologyABSTRACT
Children with autism spectrum disorders often exhibit comorbid behavioral problems. These problems have an impact on the severity of the core symptoms, the progression of the disorder as well as on the families' quality of life. We evaluated the effectiveness of the Stepping Stones Triple P group parent training program as a supplementary intervention in the treatment of children with autism spectrum disorder. Therefore, we employed a single group repeated measures design and assessed child variables via parents' and teachers' judgments at four successive time points. The participants were parents of 24 children with autism spectrum disorder aged between 3.6 and 12 years. We found a significant reduction of comorbid behavioral problems in the children, primarily in the parents' judgment at follow-up. Furthermore, a reduction of the autism spectrum disorder core symptoms emerged. The teachers' judgment particularly revealed an improvement in children's social relationships. Effect sizes were large (Æ2 ranging from 0.14 to 0.23). The findings demonstrate the effectiveness of the Stepping Stones Triple P as a supplementary intervention for reducing comorbid behavioral problems in the treatment of children with autism spectrum disorder. Higher parental self-efficacy and parental attributions, including parents' ability to influence child problem behaviors, are discussed as important factors for the effectiveness of Stepping Stones Triple P.
Subject(s)
Autism Spectrum Disorder , Education, Nonprofessional/methods , Parenting , Parents/education , Problem Behavior , Child , Child, Preschool , Conditioning, Operant , Conditioning, Psychological , Female , Humans , Male , Self EfficacyABSTRACT
Parents of children with autism spectrum disorders (ASD) often are faced with the challenges of difficult parenting situations. We explored the effectiveness of the Stepping Stones Triple P (SSTP) group parent training as an additional intervention in the treatment of ASD. Parents (n = 23) went through a waiting period and participated afterwards in the training program. We assessed parenting variables via self-report measures. After the intervention, there was a significant reduction of over-reactive parenting behaviors, role restriction and an increase in parental self-efficacy. At follow-up, the effects remained stable and we additionally found a reduction of laxness and less parenting stress. Effect sizes were high (η2: 0.18-0.24). The SSTP, offered as an additional intervention in the treatment of ASD, proved to be effective in enhancing parenting.
