Psychopathology and Neuropsychology Laboratory, Paris 8 Vincennes - St Denis University, Saint-Denis, France.
UR2NF - Neuropsychology and Functional Neuroimaging Research Group at CRCN - Center for Research in Cognition and Neurosciences, Free University of Brussels, Brussels, Belgium.
Child Adolesc Ment Health. 2021 May;26(2):122-133. doi: 10.1111/camh.12399. Epub 2020 Jun 19.
Impairing irritability is highly prevalent in children with attention deficit/hyperactivity disorder (ADHD), although manifestations of irritability are not necessarily present in all settings (home, school, with peers). At the moment, little is known about the relative prevalence, stability, and etiologies of contextual versus cross-situational manifestations of irritability in ADHD. In this study, levels of dysfunctional parenting practices and sleep problems were compared in irritable versus nonirritable children with ADHD, in cases of family-restricted versus cross-situational irritability, and examined as predictors of irritability levels over a one-year interval. Stability of irritability manifestations over time was investigated, and prevalence of cross-situational disruptive mood dysregulation disorder (DMDD) versus 'family-restricted' DMDD was compared.
One hundred and seventy children with ADHD (age 6-11) were examined. Parents completed a semi-structured interview and questionnaire to assess irritability, and parent-report questionnaires were used to evaluate parenting practices and sleep problems. Questionnaires were completed for a second time after a one-year interval.
Parenting practices were more dysfunctional in the irritable group compared to the nonirritable group, while sleep problems did not differ between these two groups. Levels of parenting practices and sleep problems did not predict later irritability after correction for multiple comparison nor did they differ between the family-restricted and cross-situational irritable groups. Finally, family-restricted irritability was as prevalent and as stable over time as cross-situational irritability and family-restricted DMDD as prevalent as cross-situational DMDD.
Factors associated with contextual versus cross-situational manifestations of irritability in ADHD remain elusive. More subtle measures of parenting practices should be considered, including psychological control or accommodation, and other constructs such as social inhibition. Despite not being captured by current nosography, severe forms of family-restricted irritability may be as prevalent as severe forms of cross-situational irritability.
在患有注意缺陷多动障碍（ADHD）的儿童中，情绪不稳定的情况非常普遍，尽管并非所有情况下（家庭、学校、与同龄人相处）都存在情绪不稳定的表现。目前，对于 ADHD 儿童情绪不稳定的情境与跨情境表现的相对发生率、稳定性和病因学知之甚少。在这项研究中，比较了具有情绪不稳定和无情绪不稳定的 ADHD 儿童的功能失调性养育实践水平和睡眠问题，比较了家庭限制与跨情境情绪不稳定的情况，并作为一年后情绪不稳定水平的预测因素进行了检查。还调查了情绪不稳定表现随时间的稳定性，并比较了跨情境破坏性情绪失调障碍（DMDD）与“家庭限制”DMDD 的患病率。
检查了 170 名患有 ADHD 的儿童（年龄 6-11 岁）。父母完成了半结构化访谈和问卷，以评估其情绪不稳定情况，并且使用父母报告问卷评估养育实践和睡眠问题。在一年后再次完成问卷。
与无情绪不稳定组相比，情绪不稳定组的养育实践更具功能失调性，而两组之间的睡眠问题没有差异。经过多次比较校正后，养育实践和睡眠问题的水平都不能预测以后的情绪不稳定，家庭限制和跨情境情绪不稳定组之间也没有差异。最后，家庭限制的情绪不稳定与跨情境的情绪不稳定一样普遍和稳定，家庭限制的 DMDD 与跨情境的 DMDD 一样普遍。
与 ADHD 儿童的情境与跨情境情绪不稳定表现相关的因素仍不清楚。应考虑更细微的养育实践措施，包括心理控制或适应，以及其他概念，如社交抑制。尽管目前的分类法未涵盖，但严重的家庭限制情绪不稳定可能与严重的跨情境情绪不稳定一样普遍。
