Chan Wendy W Y, Shum Kathy Kar-Man, Downs Johnny, Sonuga-Barke Edmund J S
School of Academic Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Department of Psychology, The University of Hong Kong, Hong Kong, China.
J Child Psychol Psychiatry. 2025 Jun;66(6):892-905. doi: 10.1111/jcpp.14103. Epub 2024 Dec 22.
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.
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).
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.
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.
注意力缺陷多动障碍（ADHD）通常归因于遗传和/或产前/围产期环境因素导致的神经认知缺陷。索努加 - 巴克提出了另一种解释，认为ADHD行为是延迟厌恶的功能性表现——一种强烈的动机倾向，即避免或逃避由延迟引发的负面情绪状态。据推测，这种倾向的强度虽然有神经生物学根源，但在与等待相关的情境中，早期负面社交互动会使其加剧。本文报告了一项初步概念验证研究的结果，该研究在非临床样本中专门检验了这一假设。
来自英国伦敦和中国香港的学龄前儿童（n = 112；平均年龄 = 46.2个月）及其父母参与了一项纵向研究。在基线时进行亲子延迟挫折任务（PC - DeFT）和两项非等待控制任务。观察儿童的表现、行为和情绪反应以及父母的反应。教师在基线和随访时（12 - 18个月后）对儿童的ADHD行为和延迟厌恶进行评分。
在基线时，PC - DeFT期间儿童的适应不良表现和父母的负面反应相互关联，并且与教师对ADHD和延迟厌恶的评分相关。基线时PC - DeFT期间父母的负面反应预测了随访时教师评定的ADHD行为增加，但在非等待任务中未观察到基线时父母反应有类似关联。基线时与父母负面反应相关的儿童ADHD症状增加在统计学上由延迟厌恶介导。这些纵向效应在英国和香港样本中是一致的。
研究结果首次证明，父母对学龄前儿童应对延迟尝试的负面反应与ADHD行为随时间增加有关，并且与延迟厌恶增加有关。它们强调了早期社会环境作为ADHD行为发展轨迹影响因素的潜在重要性。未来需要使用一系列不同厌恶环境（即难以完成的任务）对临床样本进行更长时间框架的研究。
