ADHD and autism in the family: Intersections of child and parental experiences

Abstract

Aims: Through four studies, the thesis examines parenting stress, adverse childhood experiences (ACEs), parental conflict tactics, and the clinically recognized profile of extreme demand avoidance (EDA). The overall aim is to deepen the understanding of how neurodevelopmental disorders (NDDs) relate to family well-being and parent-child interactions. Methods: In studies I-III, families were recruited from the Child and Adolescent Psychiatry (CAP) clinic in Region Jönköping (sites in Jönköping and Värnamo), together with the Child Neuropsychiatric Clinic in Gothenburg. Parents and children 8-18 years old with ADHD or ASD were interviewed separately, and parents completed self-report questionnaires. Study IV was conducted at the Child Neuropsychiatric Clinic in Gothenburg and the CAP clinics in Lund and Hässleholm. Questionnaires were completed by parents of children aged 7-17 years with suspected NDDs. Results: In study I, both mothers and fathers reported high parenting stress. Maternal stress was related to maternal NDD traits and poorer child psychosocial functioning, independent of family- and child-related factors. In study II, mothers reported more ACEs than fathers. Maternal – but not paternal – ACEs were associated with greater child difficulties and more maternal NDD traits, suggesting intergenerational transmission of adversity. In study III, most parents used non-violent conflict strategies, though psychological aggression was relatively common. Compared with controls, fathers of children with NDDs reported significantly higher levels of aggressive strategies. Maternal ADHD traits were linked to more frequent use of both non-violent and aggressive strategies, and maternal aggression predicted more child behavior problems. In study IV, EDA traits were dimensionally distributed and associated with higher general NDD symptoms. Higher levels of parenting stress were reported by parents of children with elevated EDA traits. Conclusions: The findings highlight the need for a systemic, family-centered approach in child psychiatry, acknowledging parenting stress, parental NDD traits, and ACEs alongside the child’s function and symptoms. Supporting parental functioning is essential for a more effective, holistic treatment of children with NDDs.