Table 1.
Characteristics of studies included in meta-analyses of the association of parenting factors to child attention-deficit/hyperactivity disorder (ADHD)
| Article | Risk factorsa | Forest plot Nb | Age at outcome (years)c | Male (%) | ADHD measurement (method of assessment) | Country | Study design | Parenting factor measurement |
|---|---|---|---|---|---|---|---|---|
| Becker-Blease and Freyd (2008) | Maltreatment | 28 | 9.27 | 38–60 | ADHD symptoms (ADHDT; SNAP-IV) | USA | Community sample, recruitment through flyers in public spaces | Retroactive parent report on maltreatment (including physical abuse, sexual abuse, emotional abuse or neglect) |
| Bonde et al. (2004) | Divorce and single parenthood | 1,345 | 3.5 | 69 | Hyperactivity (Behar Scale Questionnaire) | Denmark | Birth cohort (Aarhus) | Retroactive report of family structure at outcome (divorce) |
| Breaux and Harvey (2019) | Parenting | 167 | 6 | 55.8 | ADHD symptoms (DISC) | USA | Longitudinal study of community sample of children at risk for ADHD or ODD | Observer rating of sensitive/warm parenting (play and cleanup interaction); parent self-report of intrusiveness/reactivity (overreactivity using the Parenting Scale) |
| Briscoe-Smith and Hinshaw (2006) | Maltreatment | 228 | 6–12 | 0 | Diagnosis (included CBCL, SNAP, and DISC-IV; DSM-IV) | USA | Community sample, 3 cohorts of summer camp participants, recruitment through educational and healthcare settings | Maltreatment determined from records (including physical abuse, sexual abuse, neglect, witnessing domestic violence, or combination) |
| Cheng et al. (2010) | Media | 241 | 2.5 | 50.7 | ADHD symptoms (SDQ) | Japan | Birth cohort (Japan Children’s Study), 3 study sites | Maternal report of TV exposure (≥ 4 h daily at 18 and 30 months vs < 4 h at both times)d |
| Choenni et al. (2019) | Parenting | 547 | 8 | 51.7 | ADHD symptoms (CPRS-R:S) | Netherlands | Prospective population-based cohort study (Generation R Study) | Observer rating of sensitive/warm parenting and negativity/harsh parenting (do not touch videotaped procedure, supportive presence, negative discipline) |
| Cohen et al. (2002) | Divorce and single parenthood; maltreatment | 62–80 | 15 | 35–63.6 | Diagnosis (K-SADS-E; DSM-III-R) | USA | Cohort of cases from the New York State Central Register for child abuse, randomly selected community control sample |
Parent report of family structure (marital disruption, defined as divorce or separation)e Maltreatment determined from records (physical abuse)f |
| de Paul and Arruabarrena (1995) | Maltreatment | 42 | 5–11 | n/a | Inattention (TRF) | Spain | Sample randomly selected from cases reported to child protective services, matched comparison from a stratified community sample | Maltreatment determined from records (physical abuse)g |
| Famularo et al. (1992) | Maltreatment | 96 | 5–10 | 43–44 | Diagnosis (DICA-6-R; DSM-III-R) | USA | Cases selected from court cases and hospital, comparison from hospital sample | Maltreatment determined from records (abuse or neglect) |
| Fitzpatrick et al. (2012) | Media; parenting | 1,786 | 8.08 | n/a | Inattention (teacher SBQ) | Canada | Birth cohort (Quebec Longitudinal Study of Child Development) |
Parent report of any exposure to violent film/TV content Observer rating of maternal negativity/harsh parenting (hostility using the HOME) |
| Foster and Watkins (2010) | Media | 1,033 | 7 | n/a | Inattention (BPI) | USA | Cohort from the National Longitudinal Survey of Youth | Parent report of TV exposure (> 7 h vs 0 h daily)h |
| Gabel and Shindledecker (1993) | Parental incarceration | 31 | 5.5–12.5 | 70.3 | Inattention (TRF) | USA | Cohort of clinical clients of a day hospital | Parent or caregiver report of prior incarceration of either parent |
| Geller et al. (2012) | Parental incarceration | 2,695 | 5 | 52.1 | Inattention (CBCL) | USA | Birth cohort (Fragile Families) | Father self-report, mother report, and disposition data of parent incarceration |
| Giannotta and Rydell (2017) | Parenting | 596 | 15 | 50 | ADHD symptoms (ADHD-RS) | Sweden | Population-based, regional longitudinal cohort study | Parental self-report of sensitivity/warmth and negativity/harsh discipline (Parental Environment Questionnaire) |
| Graziano et al. (2011) | Parenting | 357 | 2–4.5 | 53.4 | Sustained attention (lab video) | USA | Longitudinal sample selected at risk for behavior problems, 3 cohorts of 2-year-old children from community samples screened for risk | Observer rating of Intrusive/reactive and sensitive/warm parenting (warmth, overcontrol/intrusiveness using the Early Parenting Coding System) |
| Haj-Yahia and Abdo-Kaloti (2008) | Maltreatment | 1,185 | 16.58 | 49.8 | Inattention (YSR) | Palestine | Convenience sample, 3 classes randomly selected from 13 high schools | Maltreatment based on child self-report using Conflict Tactics Scale (aggregate of physical violence by father and mother) |
| Hjern et al. (2010) | Divorce and single parenthood | 1,162,524 | 6–19 | 51.3 | ADHD medication purchase | Sweden | Birth cohort from National Register 1987–2000, excluding foreign-born parents | Family structure based on register information (lone parenting) |
| Hurtig et al. (2005) | Divorce and single parenthood | 4,634 | 15 | 47.9 | ADHD symptoms (SWAN) | Finland | Birth cohort from two provinces | Parent self-report of family structure (divorced or widowed) (always single parent)i |
| Jacobvitz and Sroufe (1987) | Parenting | 68 | 6 | 70.6 | Hyperactivity (CBCL) | USA | Case/control sample of hyperactive with matched comparison selected from a prospective longitudinal sample of primiparous mothers attending prenatal clinics | Observer rating of intrusive/reactive parenting (overstimulation during structured play interaction) |
| Johnson et al. (2007) | Media | 678 | 14–22 | 50 | Inattention (DISC) | USA | Community-based prospective longitudinal sample of adolescents (Children in the Community Study) | Parent report of TV exposure (> 1 h daily)j |
| Kashala et al. (2005) | Divorce and single parenthood | 185 | 8.4 | 45 | ADHD symptoms (SDQ) | Democratic Republic of Congo | School-based sample, Teacher SDQ plus DBD high screened hyperactive/inattentive and matched control (nested case/control) | Parent report of family structure (divorced) (single parent) |
| Kelly et al. (2001) | Divorce and single parenthood | 5,181 | 4–15 | 50 | Hyperactivity (SDQ) | England | Representative survey, Health Survey for England | Parent reported family structure (lone parenting) |
| Keown (2012) | Parenting | 81 | 7 | 100 | ADHD symptoms (ADHD-RS) | New Zealand | Prospective longitudinal community sample, case/control on hyperactivity using PACS |
Observer rating of intrusive/reactive, sensitive/warm parenting by both parents Intrusiveness and sensitivity using Early Head Start 3-bag coding scheme |
| Kerr and Michalski (2007) | Divorce and single parenthood | 1,920 | 4–11 | n/a | ADHD symptoms (interview) | Canada | Cohort of children age 4–5 in 1994 (Canadian National Longitudinal Survey of Children and Youth) | Parent report of family structure (separation or divorce)k |
| Kim et al. (2009) | Divorce and single parenthood | 2,419 | 10 | 48.6 | Diagnosis (DISC-IV) | Korea | School-based sample (Seoul Child and Adolescent Mental Health Survey) | Parent report of family structure (separation or divorce) |
| King et al. (2011) | Maltreatment | 600 | 10–18 | 63.1 | Diagnosis (DISC-III-R/DISC-IV) | USA | Random sample from juvenile temporary detention center | Self-report and record review of maltreatment (presence/absence of combined severe physical and sexual abuse)l |
| Kočovská et al. (2012) | Maltreatment | 66 | 9 | 43.1–51.5 | Diagnosis (clinician, DAWBA) | UK | Sample recruited from adoption charity selected for indiscriminately friendly behavior and history of maltreatment, and matched controls | Maltreatment recorded from adoption records (includes physical abuse, sexual abuse, physical neglect, emotional neglect) |
| Landhuis et al. (2007) | Media | 980 | 3–15 | 52 | Inattention (Quay-Peterson RBPC/Rutter Scale/Child DISC) | New Zealand | Birth cohort (Dunedin Multidisciplinary Health and Development Study) | Parent of TV exposure (hours of daily exposure) |
| Larsson et al. (2011) | Divorce and single parenthood | 2,160 | 8–20 | 49 | Hyperactivity and Inattention Symptoms Checklistm | Sweden | Birth cohort (Twin study of Child and Adolescent Development) | Parent report of family structure (divorce; comparison included single parent, married, widowed) |
| Lifford et al. (2008) | Parenting | 194 | 11–13 | 45.8 | ADHD symptoms (CBCL) | UK | Longitudinal community study | Child report of sensitive/warm parenting (acceptance/rejection using the Child’s Report of Parental Behavior Inventory) |
| Lifford et al. (2009) | Parenting | 282 | 11–14 | 49.6 | ADHD symptoms (CBCL) | UK | Longitudinal community study | Child report of negativity/harsh parenting (hostility using the Iowa Youth Family Project Hostility scale) |
| Liu et al. (2000) | Divorce and single parenthood | 174 | 10.3 | 51.7 | Inattention (CBCL, TRF) | China | Cases and controls (divorced and not divorced) selected from a representative community sample | Parent report of family structure (divorce) |
| Meysamie et al. (2011) | Divorce and single parenthood | 1,403 | 3–6 | 51.8 | ADHD symptoms (parent and teacher BRPC) | Iran | School-based sample from randomly selected kindergartens | Parent report of family structure (single parenting) |
| Miller et al. (2019) | Parenting | 241 | 9 | 46 | ADHD symptoms (SNAP-IV) | USA | Longitudinal study on temperament, oversampled on infant reactivity | Observer rating of sensitivity/warmth (Ainsworth’s Maternal Care Behavior rating scales) |
| Mimouni-Bloch et al. (2013) | Divorce and single parenthood | 107 | 6–12 | 52.9–73.2 | Diagnosis (medical records) | Israel | Retrospective matched study, medical center, case and control (ADHD) | Parent report of family structure (divorce) |
| Mistry et al. (2007) | Media | 2,306 | 5.5 | 49 | Inattention (CBCL) | USA | Prospective longitudinal study (Healthy Steps for Young Children) | Parent report of TV exposure (> 2 vs ≤ 2 h daily) |
| Morrell and Murray (2003) | Parenting | 59 | 5–8 | 52.5 | Hyperactivity (RS) | UK | Case control study (depression) from representative sample, birth cohort | Observer rating of maternal negativity/harsh and sensitive/warm parenting (hostility and positive composite using the HOME) |
| Nolin and Ethier (2007) | Maltreatment | 109 | 6–12 | 55.7 | Inattention (Visual Attention Test – NEPSY) | Canada | Case control study (maltreated vs matched control) | Record review (neglect with physical abuse, comparison)n |
| Obel et al. (2004) | Media | 244 | 3.5–12 | n/a | Probable diagnosis (Rutter Scale, CBCL, SDQ) | Denmark | Longitudinal study of birth cohort from hospital | Parent report of TV exposure (> 2 vs < ½ h daily)o |
| Parkes et al. (2013) | Media | 10,500 | 5–7 | 48.9 | ADHD symptoms (SDQ) | UK | Prospective birth cohort study (UK millennium) | Parent report of TV/video/DVD and electronic games exposure (> 3 vs < 1 h daily)p |
| Pauli-Pott et al. (2018) | Parenting | 120 | 5 | 57 | ADHD symptoms (FBB-ADHS-V and PrePacs composite) | Germany | Longitudinal study of preschooler, oversampled on ADHD risk | Observer rating of sensitivity/warmth (responsiveness scale on the Mannheim Rating Scale for the Assessment of Mother–Child Interaction) |
| Pinto et al. (2006) | Parenting | 104 | 6–8 | n/a | ADHD symptoms (ADHD-RS, mother and teacher) | UK | Community-based case control (stillbirth and matched control) | Observer rating of sensitive/warm parenting (disorganization of attachment scale based on strange situation behavior) |
| Poulain et al. (2018) | Media | 527 | 3–7 | 52 | ADHD symptoms (SDQ) | Germany | Longitudinal childhood cohort study (LIFE Child study) | Parent and child report of TV, videogame, and mobile phone exposure (hours of daily exposure) |
| Robinson et al. (2012) | Maltreatment | 102 | 7.14 | 44.3–53.1 | Inattention (CBCL) | USA | Cohort of maltreated children taken into state custody and matched controls | Record review of maltreatment status (includes physical abuse, sexual abuse, and neglect) |
| Rodriguez et al. (2011) | Divorce and single parenthood | 805 | 7–9 | 51.7 | Hyperactivity (SDQ) | Brazil | Birth cohort, stratified random sampling based on birth weight | Parental report of family structure (single parenting)q |
| Rogosch et al. (2011) | Maltreatment | 247 | 9.42 | 52.2 | Inattention (TRF) | USA | Community-based case control (maltreated and SES matched comparison) | Maltreatment status coded from records (includes neglect, emotional maltreatment, physical abuse, and sexual abuse) |
| Rydell (2010) | Divorce and single parenthood | 1,124 | 10.2 | 52 | ADHD symptoms (ADHD-RS) | Sweden | Population-based random sample of age cohort | Parental report of family structure (single parenting)r |
| Schachar and Wachsmuth (1991) | Divorce and single parenthood | 63 | 7–11 | 100 | Diagnosis (Teacher Rutter Scale, CATRSB, SNAP; parent and child interview) | Canada | Clinic referred case–control study behavior problems and community comparison (boys) | Parental report of family structure (divorce)s |
| Sesar et al. (2008) | Maltreatment | 458 | 15–20 | 39 | ADHD symptoms (YSR) | Bosnia and Herzegovina | Population-based sample of high school students from a specific canton | Self-report of maltreatment based on Child Maltreatment Questionnaire (includes emotional abuse, physical abuse, sexual abuse, neglect, and witnessing family violence) |
| Simmel et al. (2001) | Maltreatment | 808 | 10 (5–18) | 50.7 | ADHD symptoms (BPI, IOWA Connors) | USA | Population-based cohort of adoptive families (California Long-Range Adoption Study) | Parent report of maltreatment based on information by birth parent or social worker (includes physical/sexual abuse and neglect) |
| Stadelmann et al. (2010) | Divorce and single parenthood | 187 | 5.27–6.23 | 59.4 | Hyperactivity (SDQ) | Switzerland | Community sample of Kindergarten students plus participants of longitudinal sample recruited prenatally plus sample of children referred for behavior problems | Parent report of family structure (separation) |
| Stevens and Muslow (2006) | Media | 2,500 | Kindergarten | n/a | ADHD symptoms (SRS) | USA | Random sample from the Early Childhood Longitudinal Study, Kindergarten Class 1998–1999 | Parent report of TV or video exposure (hours daily) |
| Stright and Neitzel (2003) | Parenting | 52 | 8.6 | 55.8–92.3 | Inattention (TRF; behavior observation) | USA | Community sample | Observer rating of negativity/hostile parenting (maternal and paternal rejection using the System for Coding Interaction and Family Functioning) |
| Swing et al. (2010) | Media | 1,323 | 6–12 | 47 | Inattention/impulsivity (ASRS; BSCS, BIS-11) | USA | Sample from obesity prevention study | Parent and child report of TV and videogame exposure (combined average weekly exposure) |
| Thompson and Tabone (2010) | Maltreatment | 242 | 4 | 44.3–48.7 | Inattention (CBCL) | USA | Longitudinal multisite study of high-risk infants | Maltreatment based on case record review (includes physical abuse, sexual abuse, and neglect) |
| Umemura et al. (2015) | Parenting | 85 | 7 | n/a | ADHD symptoms (CBCL and TRF composite) | USA | Longitudinal pregnancy follow-up study | Observer rating of and negativity/harsh discipline (Parental Coping with Children’s Negative Emotions Questionnaire) |
| Wolfe and Mosk (1983) | Maltreatment | 70 | 6–16 | 45.7–51.4 | Hyperactivity (CBP) | Canada | Case control study of abused agency cases, non-abused agency cases, and community groups | Maltreatment based on case record review or on observation (includes physical aggression and coercion) |
| Zimmerman and Christakis (2007) | Media | 391 | 5–10 | n/a | Inattention (BPI) | USA | Longitudinal survey, nationally representative, Panel Survey of Income Dynamics | Parent report (time diary) of violent media exposure (average hours daily) |
| Ziv et al. (2010) | Parental incarceration | 1,347 | n/a | 50–51.1 | Hyperactivity (BPI) | USA | Nationally representative survey (Head Start Family and Child Experiences Survey) | Parent incarceration based on parent report of arrest or charges against household member including parent |
ADHDT Attention Deficit Hyperactivity Disorder Test, ADHD-RS ADHD Rating Scale–IV, ASRS Adult ADHD Self Report, BSCS Brief Self-Control Scale, BRPC Behavior Rating for the Preschool Child, BIS-11 Barratt Self-Control Scale, BPI Behavior Problems Inventory, CATRSB Conners Abbreviated Teacher Rating Scale, CBCL Child Behavior Checklist, CBP Child Behavior Profile, CPRS-R:S Conners’ Parent Rating Scale Revised, DAWBA Development and Well-Being Assessment, DBD Disruptive Behavior Disorder Rating Scale, DICA Diagnostic Interview for Children and Adolescents, DISC Diagnostic Interview Schedule for Children, DSM-III-R Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, Text Revision, DSM-IV Diagnostic and Statistical Manual of Mental Disorders, 4th edition, FBB-ADHS-V preschool version of the ADHD rating scale, HOME Home Observation for Measurement of the Environment, K-SADS-E Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children, epidemiological version, NEPSY developmental neuropsychological assessment, PACS, Parental Account of Children’s Symptoms, PrePACS Parental Account of Children’s Symptoms, preschool version, RBPC Revised Behavior Problem Checklist, SBQ Social Behavior Questionnaire, SDQ Strengths and Difficulties Questionnaire, SNAP Swanson, Nolan, and Pelham, SRS Social Rating Scale, SWAN Strengths and Weaknesses of ADHD Symptoms and Normal Behaviors Questionnaire, TRF Teacher Report Form, YSR Youth Self Report
aEffect size information was extracted whenever possible, regardless of whether the risk factor was the main variable of interest in a study or was simply included as a covariate or statistical control
b N may differ across forest plots for studies with multiple effect sizes
cMean ages are reported if available; otherwise, the range is reported
dChildren who watched ≥ 4 h at one time and < 4 h at the other were not included in the analyses
eDivorce analyses excluded all cases with maltreatment
fMaltreatment analyses excluded all cases with marital disruption
gCases of neglect were not included in the analyses
hChildren with between > 0 and < 7 h were not included in the analyses
iThe sample also included formerly divorced/widowed and now reconstructed families who were not included in the analyses
jChildren with 1–3 h and > 3 h were combined
kThis study also addressed single parenting (lone parenting) but there were insufficient numbers of studies for continuous outcomes, so lone parenting and step families were not included in the analyses
lCases with moderate or severe physical abuse without sexual abuse were not included in the analyses
mJoint trajectory across ages 8–9, 13–14, and 16–17 years, DSM-IV-based symptom scale
nNeglect only cases were not included in the analyses
oChildren who watched between ½ and 2 h were not included in the analyses
pChildren who watched between 1 and 3 h were not included in the analyses
qThe sample also included cohabiting couples who were not included in the analysis. Comparisons were between single and married
rThe sample also included parent and stepparent families who were not included in the analyses. Comparisons were between single and married/two biological parents
sThe sample also included children with learning disability, emotional disability, and conduct disorder who were not included in the analyses. Comparisons were between children with ADHD, alone and combined with conduct disorder, and those without diagnoses