Examining the Importance of Family History in Pediatric Behavioural Referrals

Abstract

In recent years, there has been a substantial increase in the diagnosis of attention deficit hyperactivity disorder (ADHD) in children. Without appropriate management of symptoms and care, ADHD has been associated with a variety of negative child and adult outcomes. Environmental and familial factors that may contribute to three different pediatric referral types (academic, behavioural, and attentional) associated with ADHD were examined in the current study. In total, data from 477 families who were interviewed as a part of the intake process to a pediatric clinic were included in this study. Data for the current study was extracted from the intake questionnaires and included information on family history of mental health issues, socioeconomic status, and family relationships. The sample included children between the ages of three and 17 and mostly comprised males ( n = 340). A frequency analysis of the data demonstrated relatively high rates of mental health issues within families (61.4%); almost half of the mothers reported some post-secondary education (46.1%) and most reported having normal relationships with their children (mothers, 78%; fathers, 62.9%). Finally, three stepwise regression analyses were conducted to predict referral type. All three regressions yielded significant models. Fifteen percent of the variability of the academic referral type was predicted by being male, age at the time of referral, mother’s education level, and mother’s learning. The behavioural referral types were predicted by a family history of depression, being male, mother-child relationship, and age at the time of referral; these accounted for 23% of the variance. Attentional referral type was predicted only by mother-child relationship that captured 6% of the variance. Overall, this study describes a population of parents of children with academic, behavioural, and attention-related referrals to pediatrics. Results indicate that mothers have a profound influence on their child’s referral types, something that may transfer into later diagnosis and perhaps prognosis. Clinicians and researchers alike should focus their efforts toward developing integrative service assessment and treatment approaches that include important people in the child’s life. The implementation of Community Social Pediatrics (a streamlined, inclusive approach to care) should be considered in urban centres like this one, where referrals like this are prevalent.

Longitudinal relations between impaired executive function and symptoms of psychiatric disorders in childhood

“…First, prospective studies adjusting for prior levels of outcome(s) are needed. Second, only a minority of children with mental health problems receive treatment (Wichstrom, Belsky, Jozefiak, Sourander, & Berg‐Nielsen, 2014 ), and referral is predicted by a range of factors other than mental health problems (e.g., parental mental health, socioeconomic status; Gander, Campbell, Flood, & Crowley, 2019 ; Liddle, Askew, Betts, Hayman, & Alati, 2014 ) which are also associated with poor executive functions (Evans & Schamberg, 2009 ; Hughes, Roman, Hart, & Ensor, 2013 ). Hence, the association between executive functions and mental health may be different in clinical samples compared to the population; thus, community studies are needed.…”

Mother's exposure to domestic and community violence and its association with child's behavioral outcomes

“…Younger mothers (compared to older‐adult mothers) and lower education levels are risk factors for maternal aggression and spanking (Holden, 2020; Lee & Guterman, 2010; Lee, 2009), leading to child behavioral issues. Characteristics of the child such as male gender are known to be risk factors for developing externalizing behaviors (Gander et al, 2019; Hunt et al, 2017). Research works exploring resilience in children have consistently identified living in a secure and stable home environment (Pérez‐González et al, 2017) and having caring adults providing social support (Afifi & MacMillan, 2011) as major protective factors against maladaptive behaviors in the face of childhood adversity.…”