Psychologists have always addressed ADHD as a prevalent disorder with negative consequences for children. The present research was conducted to examine the parent-child relationship model and strategies to cope with behavioral problems in children with ADHD.
According to the results of the path analysis of the relationship model among parent-child relationship domains, coping responses, and children’s behavioral problems, among variables that had the most causal relationship with children's behavioral problems, parent-child dependency domain from the parent-child relationship had the most positive relationship. In other words, as dependence in the parent-child relationship increased, so did the children's behavioral problems. Varasteh et al. (2016) reported the positive and significant effects of a positive parenting program on conflicts, intimacy, dependence and overall positive effect. They reported less frequent behavioral problems in children with decreased dependence and conflicts in the parent-child relationship . According to Adili et al. (2019), using intervention methods such as play therapy decreases dependence in the parent-child relationship and significantly reduces conflicts and improves dimensions of health in children . The excessive emotional care and attention received by these children appears to intensify dependence on their parents, increase their expectations and create different problems in their future, which is consistent with the present findings.
The disease duration was positively, significantly and indirectly related to behavioral problems in the children on a single path. Increases in the disease duration increased behavioral problems in the children. As a major daily issue in patients with ADHD, establishing social relationships is exacerbated with age. Attention and concentration problems persist despite the gradual improving effect of age on the symptoms of ADHD as reflected in numerous studies . In line with the present research, a study by Sohrabi et al. (2014) on oppositional defiant disorder in preschool children showed no gradual changes in the symptoms of disobedience in the controls and this disorder persisted over the course of time .
Among the effective variables on both paths, conflicts exerted the highest positive causal effect on behavioral problems in the children. Increases in conflicts in the parent-child relationship increases the behavioral problems. Shafiei et al. (2018) found conflicts in parent-child relationships to cause externalizing disorders in children. They also found treatments focusing on patterns of sensory processing in children with behavioral-emotional problems, training their parents in individual differences and resolving conflicts and increasing positive interactions to decrease problems in these patients . Shapurabadi et al. (2012) found designing positive group parenting programs for the mothers of children with ADHD to significantly decrease conflicts and dependence, increase intimacy and improve mother-child relationships . Memarbashi et al. (2020) found inhibitory control to mediate the relationships of parent-child interactions with social skills and behavioral problems. In other words, parent-child interactions were found to relate to social skills and behavioral problems both directly and indirectly through inhibitory control. Disabilities and lack of concentration in these children cause their failure to complete their normal tasks, increase pressure on their parents in terms of supervision and therefore create conflicts in parent-child relationships .
As a dimension of parent-child relationships, intimacy exerted the highest negative effect on behavioral problems in the children in both direct and indirect paths. In fact, the higher the intimacy score, the lower the behavioral problems in the children. A study by Abbasi et al. (2017) on the mother-child relationship model and effects of positive and negative emotions on anxiety disorders showed that, among the dimensions of parent-child relationships, intimacy was negatively and significantly and conflicts positively and significantly related to anxiety disorders. Conflicting behaviors in a mother towards their children decrease their sense of responsibility and develop their insecurity, anxiety, isolation, carelessness and submissiveness. In contrast, increasing parent-child intimacy reduces anxiety disorders and behavioral problems in children. In other words, parent-child relationships based on intimacy and empathy create joy and positive emotions in children. Conversely, parent-child relationships based on conflicts create doubts about parental support, undesirable feelings and negative emotions in children .
The path analysis suggested positive relationships between coping responses used by parents and behavioral problems in their children. Research suggests properly using coping responses by parents significantly affects the quality of their relationship with and behavioral problems in their child [8, 15]. Hojjati et al. (2018) found behavioral problems to increase stress in children through increasing fatigue and ineffective coping responses in mothers. Fatigue and lack of energy in mothers associated with their children’s behavioral problems cause their adoption of ineffective, emotion-driven and avoidance coping responses, which in turn exacerbates behavioral problems in their child .
Based on the results of the test in the relationship model among positive parent-child relationship, coping responses and children’s behavioral problems, a positive parent-child relationship had the most negative causal relationship with the child's behavioral problems. In other words, increases in the positive score of parent-child relationship decreased behavioral problems in the children. This finding can be explained by the significant effects of positive parent-child relationships on improving the mother-child relationship, reducing conflicts and dependence and increasing intimacy . Research suggests parenting skills and familiarity of parents with training methods and efficient communication with children exert the most significant effect on the emergence or persistence of behavioral problems in children. Positive parent-child interactions can modify this flawed relationship and help improve behavioral problems in children [35, 36]. According to Pajooh et al. (2018), mothers’ familiarity with the nature of behavioral problems in their children, their increased awareness of communication skills and their change in inefficient parent-child patterns to reduce behavioral problems in their children, improve their understanding of their children’s behavior and help them more effectively communicate with their children .
The age of the child indirectly exerted the highest positive causal effect on behavioral problems. Research suggests associations between ADHD and socio-behavioral problems in children. Untreated ADHD can also persist until adolescence and adulthood . Despite the improving effect of age on behavioral problems in children, recovery before the age of 12 years is unlikely and symptoms persist until adulthood in 15–20% of cases . The positive and significant causal relationship observed between the children’s age and their behavioral problems in the present study can be explained by their age being below 12 years. Khoddam et al. (2009) reported a varying incidence of symptoms with age and observed the highest incidence in children aged at most 11 years . The symptoms begin to emerge in 67% of children with ADHS at their preschool age . Research suggests the maximum prevalence of this disorder in children aged 3–5 years. Failing to timely diagnose and treat this disorder, especially in acute cases with social problems, can prolong the condition until the next stages of life [42, 43].