Are ADHD trajectories shaped by the social environment? A longitudinal study of maternal influences on the preschool origins of delay aversion.

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is commonly attributed to neuro-cognitive deficits of genetic and/or prenatal/perinatal environmental origins. Sonuga-Barke proposed an alternative formulation, suggesting that ADHD behaviors are functional expressions of delay aversion-a strong motivational disposition to avoid or escape negative affective states evoked by delay. It is hypothesized that the strength of this disposition, though neuro-biologically rooted, is exacerbated by early negative social interactions during waiting-related encounters. This paper reports findings from an initial proof-of-concept study that specifically tests this hypothesis in a nonclinical sample.

METHODS

Preschoolers (n = 112; mean age = 46.2 months) and their parents from London, UK, and Hong Kong participated in a longitudinal study. The Parent-Child Delay Frustration Task (PC-DeFT) and two nonwaiting control tasks were administered at baseline. Children's performance, behavioral and emotional responses, and parents' reactions were observed. Teachers rated children's ADHD behaviors and delay aversion at baseline and follow-up (12-18 months later).

RESULTS

At baseline, children's maladaptive performance and parental negative reactions during the PC-DeFT were correlated with each other and with teacher ratings of ADHD and delay aversion. Negative parental reactions during the PC-DeFT at baseline predicted an increase in teacher-rated ADHD behaviors at follow-up, but similar associations were not observed for baseline parental responses in the nonwaiting tasks. The increase in child ADHD symptoms associated with negative parental reactions at baseline was statistically mediated by delay aversion. These longitudinal effects were consistent across the UK and HK samples.

CONCLUSIONS

The findings provide the first evidence that parent's negative reactions to preschooler's attempts to manage delay are associated with increases in ADHD behaviors overtime, and linked to delay aversion increases. They underscore the potential significance of the early social environment as a contributor to developmental trajectory of ADHD behaviors. Future studies with clinical samples over an extended time-frame using a range of different aversive environments (i.e. difficult tasks to complete) are indicated.