A multi-factorial perspective on ADHD and ODD in school-aged children: What is the role of cognitive regulation, temperament, and parental support?

Introduction: It is well established that attention-deficit/hyperactivity disorder (ADHD) is a disorder of self-regulation. As such, ADHD is associated with disturbed cognitive regulation, extreme temperament traits, and deficient extrinsic regulation such as parenting. Despite these associations, cognitive regulation, temperament, and parenting have not previously been examined simultaneously in relation to ADHD symptoms in school-aged children. To bridge this gap of knowledge, we examined effects of these important aspects of self-regulation on symptoms of inattention, hyperactivity/impulsivity, and comorbid symptoms of oppositional defiant disorder (ODD) in children with and without a diagnosis of ADHD. Method: The sample consisted of 77 children aged 8 to 12 years (similar to 40% had a diagnosis of ADHD). We assessed cognitive regulation (i.e., complex inhibition and working memory) during a lab visit and parents rated child temperament (negative affect, surgency, and effortful control) and parental support. Parents and teachers rated ADHD and ODD symptoms in the child. We performed continuous analyses, informed by a dimensional perspective on ADHD. Results: Working memory contributed independently to inattention (beta = -.19, p < .05). Effortful control contributed independently to inattention and hyperactivity/impulsivity (beta s = -.50 and -.49, ps < .01). Negative affect contributed to ODD symptoms as moderated by parental support (beta = .58, p < .01). Specifically, for children who received lower levels of parental support there was a significant positive association between negative affect and ODD symptoms. Conclusions: The results propose that both cognitive regulation and effortful control influence ADHD symptoms. Moreover, different factors seem to be involved in ADHD and ODD, with regulatory deficits specifically related to ADHD symptoms, and elevated negative affect specifically related to ODD symptoms. Interestingly, parenting moderated the relationship between negative affect and ODD symptoms, with a suggested protective effect of high parental support for children with high levels of negative affect.