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30 Aug 2017

Pollak Y et al. J Atten Disord 2017; Epub ahead of print

There exists a complex relationship between ADHD symptoms, risk-taking behaviour and level of parental monitoring in adolescents with ADHD. It has been proposed that presentation of ADHD symptoms can lead to reduced parental monitoring, which may in turn lead to increased risk-taking behaviour. This study aimed to explore this relationship, with a particular focus on the direct effects of ADHD symptoms on risk-taking behaviour in adolescents and the indirect effects mediated by reduced parental knowledge.

A total of 92 adolescents plus one of their parents were recruited through an outpatient ADHD clinic at a public medical centre or from local schools (adolescents with ADHD: n=55; adolescents without ADHD: n=37). ADHD symptom severity was measured using the Inattention, Hyperactivity-Impulsivity and Oppositional-defiance scales of the Disruptive Behaviour Disorder Rating Scale; risk-taking behaviour was measured using the Risk Behaviour Questionnaire*; and parental practices, as perceived by the adolescents, were measured using the Behavioural Control scale of Barber’s Parental Control Questionnaire.

The reliability of the ADHD and Parental Knowledge scales was deemed to fall within an acceptable range; however, the reliability of the Family Disengaged Relationships and Excessive Behavioural Autonomy scales was questionable. Greater risk-taking behaviour was reported by older participants; however, age was not deemed to affect parental knowledge. Moreover, participant gender did not appear to confer a significant effect on any of the dependent measures.

Following correlational analysis, it was observed that a positive correlation existed between:

  • Mean ADHD symptom score and risk-taking behaviour (Spearman’s rho correlation: 0.24, p<0.05).
  • Disengaged relationships and excessive behavioural autonomy (0.27, p<0.05).
  • Disengaged relationships and risk-taking behaviour (0.23, p<0.05).

Mediation analysis indicated both direct effects of ADHD symptoms on risk-taking behaviour in adolescents with ADHD, and indirect effects through effects on parental knowledge. Also, level of parental knowledge negatively correlated with engagement in risk-taking behaviour. This model accounted for 32.3% of the variability in risk-taking behaviours (p<0.0001). It was also observed that, after accounting for indirect effects, ADHD symptoms still predicted risk-taking behaviour among adolescents. A direct effect of ADHD symptoms on risk-taking behaviour was noted (0.13, 95% confidence interval [CI] 0.029–0.247), as well as an indirect effect mediated by parental knowledge (0.062, 95% CI 0.017–0.141).

Limitations of this study included: 1) the cross-sectional design – longitudinal studies are required to determine directionality between ADHD symptoms, parental knowledge and risk-taking behaviour; 2) only high-severity risk-taking behaviours were evaluated; 3) specific parental monitoring techniques were not investigated; 4) the use of adolescents’ self-reporting on risk-taking behaviours and parental monitoring, without validation from collateral report, could have led to the possibility of biased results; and 5) the reliability of the Family Disengaged Relationships and Excessive Behavioural Autonomy scales used was questionable.

The authors concluded that parental knowledge is negatively influenced by the presentation of ADHD symptoms. Furthermore, this negative association may lead to increased risk-taking behaviour in adolescents with ADHD. It is suggested that efforts to reduce risk-taking behaviour in this population should include management/treatment of ADHD symptoms and improving parent knowledge.

Read more about the parental role in mediation of adolescents with ADHD and risk-taking behaviour here

 

*The Risk Behaviour Questionnaire consists of 16 items assessing different kinds of risk-taking behaviour (e.g. smoking, hitchhiking) and enables participants to rate the frequency with which they currently indulge in these behaviours
The Behavioural Control scale of Barber’s Parental Control Questionnaire consists of three subscales, which probe Excessive Behavioural Autonomy, Disengaged Family Relationships and Parental Monitoring/Knowledge

Pollak Y, Poni B, Gershy N, et al. The role of parental monitoring in mediating the link between adolescent ADHD symptoms and risk-taking behaviour. J Atten Disord 2017; Epub ahead of print.

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