Comorbid Internalizing and Externalizing Symptoms Among Children with ADHD: The Influence of Parental Distress, Parenting Practices, and Child Routines

Externalizing and Internalizing Behaviors in Children with ADHD during Lockdown for COVID-19: The Role of Parental Emotions, Parenting Strategies, and Breaking Lockdown Rules

“…Nevertheless, our findings could also suggest that these factors were associated with children’s externalizing behavioral problems and that preventive measures implemented during the lockdown exacerbated externalizing behaviors, independently of negative parental factors. Consistently with several pre-pandemic studies on ADHD [ 24 , 28 , 29 , 30 ], the positive association between negative parental factors and externalizing behaviors seemed related to conflictual models of child-parent interaction. Although this maladaptive interactive circle is not directly caused by pandemic measures, the lockdown promoted the conditions for critical changes in family lifestyle, including, for example, increased occasions for child-parent arguments [ 21 ].…”

“…Moreover, the lack of a defined pace of time, previously marked by school and other activities away from home, created critical changes in the previous sleep-wake and screen-time exposure habits compared to the pre-pandemic conditions [ 22 ]. Structured family habits and routines are protective factors for children’s behavioral adjustment and positive child-parent interactions [ 24 ]. Presumably, parents with high negative emotions had more difficulty contrasting the disruption of these routines, making them more likely to engage in harsh-punitive parenting behaviors exacerbating externalizing children’s behaviors.…”

“…Less obvious is the negative association between positive parenting and externalizing behaviors. McRae et al [ 24 ] point out that, unlike coercive-authoritarian behaviors, positive parenting strategies require more parents’ conscious effort and self-emotional control skills, often acquired after specific training, and it is also possible that other factors related to pandemic measures could have contributed to the quality of parenting strategies. In particular, the interruption of support by trainers, especially for parents who had difficulties accessing the internet, and the missing support of structured contexts (e.g., school), and the disruption of previously established routines, could have weakened parents’ confidence in/or interrupted the continuity of these parenting practices.…”

“…Based on recent literature [ 24 ], we hypothesized that the levels of youths’ externalizing behaviors would be associated with parents’ high negative emotions and negative parenting strategies and more difficulties complying with lockdown rules. Moreover, we expected that the levels of youths’ internalizing behaviors would be associated with parents’ positive and negative emotions and supportive parenting strategies.…”

The Impact of Internalizing Symptoms on Impairment for Children With ADHD: A Strength-Based Perspective

“…Additionally, negative parenting practices appear to play a role in the development of comorbid disorders. Children who are exposed to negative parenting practices such as harsh, disengaged, or inconsistent parenting, are more likely to develop further externalizing symptoms and internalizing symptoms (Aunola & Nurmi, 2005; Deault, 2010; Kaiser et al, 2011; McRae et al, 2020; Pfiffner & McBurnett, 2006).…”