Family functioning in children and adolescents with attention deficit/ hyperactivity disorder and effects of executive functions on family functioning

ABSTRACT Aim: In recent years, hypotheses have been put forward that the underlying cause of ADHD is related to executive function impairments (Russell A. Barkley,1997, Thomas Brown 2009). As a consequence of these hypotheses, it has begun to investigate which executive dysfunctions are seen in ADHD through both performance-based measures and scales based on parents and teachers. ADHD is a disorder that affects parent-child relationships and family functioning (Kandemir et, al., 2014). In this study, we aimed to investigate the effects of ADHD on family functioning and ADHD executive dysfunctions on family functioning. Method: This study was conducted between October 2016 and May 2017 with a group of patients diagnosed with ADHD between the ages of 8-17 who applied to the AİBÜ Medicine School Child and Adolescent Psychiatry. The control group was collected from primary and secondary schools in Bolu. Sociodemographic information was searched by the sociodemographic data form created by the researcher. Psychopathologies in the children and adolescents participating in the research were screened through the K-SADS form. Executive functions were measured via the Stroop test and BRIEF-Parent form. The severity of ADHD symptoms and behavioral problems was measured via the Turgay DSM-IV Disruptive Behavioral Disorders Symptom Screening Scale. The Family Assessment Device (FAD) was used to assess family functioning. Parametric or non-parametric methods were used for comparison of groups according to features of dispersion and path analysis was used to evaluate effects of executive functions on family functioning. Results: In this study, we found that the most common subtype in ADHD is the combined subtype and male / female ratio was found to be 2.6. We found that ADHD was accompanied by a comorbid disorder of 70.4 %. The most common comorbiditon was ODD and it was determined that ADHD was accompanied by 57.4 %. We determined that the most common comorbidities with ADHD are ODD and anxiety disorders. In our study, it was determined that there were differences between ADHD and control groups in FAD-Family involvement and FAD-Affective responsiveness subscales. It has been found that ADHD cases with or without the presence of accompanying ODD differ in communication, roles, family involvement and affective responsiveness subscales. Female controls and female ADHD cases showed significant difference only in terms of Stroop TBAG-5 test correction numbers, male controls and female ADHD cases showed significant difference only in terms of Stroop TBAG-5 test correction numbers. Male controls and male ADHD cases showed significant differences in completion time of Stroop TBAG-3 form. Predominantly inattentive subtype and predomonantly hyperactivity/ impulsivity subtype showed significant differences in BRIEF-Initiate subtest. Predominantly inattentive subtype and combined subtype showed significant differences in BRIEF-Inhibition subtest. Predominatly hyperactivity/ impulsivity subtype and combined subtype showed significant differences in inhibition, planning/ organization, monitoring, organization of materials subtests, behavior regülation index, metacognition index and global executive composite. In ADHD cases, hyperactivity scores were significantly related to FAD-Roles and General functions subscales. ODD scores were significantly related to FAD-Communication and Family Involvement subscales. In the case of ADHD, the BRIEF-Emotional Control subscale was associated with FAD-roles, family involvement, behavioral control, and general functions subscales; metacognitive index and global executive composite were related to the FAD-Behavioral control subscale; behavior regülation index was associated with all subscales except the FAD-problem solving subscale. The closest relation to the BRIEF subtest scores was found to be observed in the Stroop TBAG-4 Test error numbers. It was determined that the Stroop TBAG-4 error numbers were related to the total executive function score of the inhibition and monitoring subtests of BRIEF and the FAD-General functions subscale, and the FAD-General function subscale correlated with scores of behavior problems in which consisting of ODD and CD scores. Conclusions: In our study, it was determined that ADHD cases had disturbances in the family involvement and affective responsiveness subscales. It has been found that the ODD contributes to the deterioration of family functioning in cases of ADHD. Individuals with ADHD have been shown to have executive dysfunctions according to the control group. In our study we found that ODD and hyperactivity symptom levels correlated with family dysfunctions. It has been determined that executive dysfunctions in ADHD are associated with disorders in family functioning. Key words: ADHD, executive functions, family functioning