Attention Deficit and Hyperactivity Disorder (ADHD)

in Internationally Adopted Children in Spain

Neus Abrines Jaume, neus.abrines@campus.uab.cat

Marre, D; Brun, C.; Fornieles, A.; Barcons, N.; Fumadó, V.

SCCR/SASci/AAACIG. Albuquerque, New México.

2010 Meeting of the Society for Cross-Cultural Research

1. Framework of the research project

Framework of the research project

Research project MEC R+D SEJ 2006-2009 15286 International Adoption: social and familial inclusion of the internationally adopted children. Interdisciplinary and comparative perspectives

Period 2010-2012: National and international adoption: family, education and pertinence: interdisciplinary and comparative perspectives. (CSO2009-14763-C03-01) (subprogram SOCI)

Risk factors and Resilience in Internationally Adopted children

2. Theoretical Introduction

BIOLOGICALENVIRONMENTAL

ADHD: Prevalence and Etiology

ADHD

ADHD: Attention Deficit and Hyperactivity Disorder Defined as a neurobiological disorder Prevalence: 3 – 7% of children (higher among boys) Etiology:

ADHD: Diagnostic criteria (DSM-IV)

INATTENTION(6 or more symptoms)

Often has difficulties with:• Giving close attention to

details.• Sustaining attention• Listening• Following through

instructions• Organizing tasks and

activities

HYPERACTIVITY

IMPULSIVITY(6 or more symptoms)

Often:• Runs about excessively• Acts as if “driven by a

motor”• Talks excessively• Has difficulty waiting

his/her turn• Interrupt

• Symptoms must appear before the age of 7

• One of the symptoms is presented in two different situations (for example, at home and in the school).

• Attachment disorders.

• Emotional disorders.

• Anxiety disorders.

• Behavior disorders.

• Chronic brain syndromes.

• Neglect, maltreatment and abuse.

ADHD: Differential diagnosis

ADHD: Treatment

PHARMACOLOGICAL

• Methylphenidate

• Atomomoxetine

PSYCHOLOGICAL

• Cognitive Behavior therapy

• Social Abilities Training

• Psychopedagogic treatment

• Parent training

Theoretical Introduction

A marked increase of ADHD diagnostics in internationally adopted children it’s been observed (Bimmel et al. 1990; Verrier, 2003), and this incidence seems to be higher among children adopted from Eastern Europe countries (Lindblad et al., 2010; Gunnar & Van Dulmen, 2007).

In International Adoption, there are several risk factors which can favor the existence of Attachment Disorders and these disorders seem to be related to the ADHDsymptomatology. (Franc et al., 2009; Niederhofer, 2009; Erdman, 1998).

Theoretical Introduction

Parenting styles are related with the ADHD symptomatology and the attachment disorders (Finzi-Dottan, Manor, & Tyano, 2006; Öngel, 2006).

The existence of pre-adoptive and post-adoptive factors, which favor the appearance of ADHD-like symptoms, it’s been observed (Bimmel et al., 2003). These symptoms can lead to misdiagnosis of ADHD and can be followed by an inappropriate treatment.

3. Hypothesis

Hypothesis

Adoptats a Europa de l’Est

Hº 1: Differences in the frequency of ADHD-like symptoms, depending on the country of origin, will be found.

Adopted in Russia

Adopted in Ethiopia

With ADHD-like symptoms

With ADHD-like symptoms

Adopted in China

With ADHD-like symptoms

Hº 2: The relation between some factors and the existence of ADHD-like symptoms will be observed..

Attachment Pattern

Age at adoption

Hypothesis and objectives

Parenting styles

4. Method

Participants Material

Procedure

Participants

Children aged 7 and 8 years. Inclusion requirement: Minimum of 2 years since the adoption date. N = 58 (total sample 200) More frequent countries of origin

Adopted in Russia(n = 24)

Boys: 12Girls: 12

Adopted in Ethiopia(n = 11)

Boys: 6Girls: 5

Adopted in China

(n = 23)

Boys: 0 Girls: 23

Material

Family data questionnaire

ADHD Symptoms

• Behavioral Assessment System for Children (BASC) (Reynolds y Kamphaus, 1992)

o Attention problems

o Hyperactivity

Parenting styles:

• Egna Minnen Beträffande Uppfostran (EMBU)

(Perris, Jacobsson, Lindström, Von Knorring, and Perris, 1980)

o Rejection

o Overprotection

o Favouring

o Emotional warmth

Material

Attachment pattern

• Friends and Family Interview (FFI) (Steele & Steele, 2006)

o Semi-structured interview (30 min.)

o Video-recorded and transcribed

o Double coded (Reliability inter-raters = 90%)

o Assess the attachment pattern according to:1. Coherence

2. Reflective functioning

3. Evidence of secure base

4. Evidence of self esteem

5. Peer relations

6. Sibling relations

7. Anxieties and defense

Procedure

1. Contact the Pediatric Service of the Hospital Sant Joan de Déu, specialized in international adoption.

2. Select the sample, according to the age.

3. Invite the families to participate

4. Inform and give an appointment to the families who showed their interest.

5. Assess the child (45 min.)

6. Obtain the results of the assessment

7. Return to the families a Psychological report

8. Statistical analysis of the data

5. Results

Hyperactivity and country of origin

Attention problems and country of origin↓

Less hyperactivity symptoms

p: 0,02

Results

Girls from CHINA

14

21

6

10

2

5

0

5

10

15

20

25

30

Russia China Ethiopia

Clinical scores

Normal scores

1720

7

73

4

0

5

10

15

20

25

30

Russia China Ethiopia

Clinical scores

Normal scores

Results

Girls from CHINA

SexAge at adoption

NO SIGNIFICANT

DIFFERENCES

LESS

HYPERACTIVITY

SYMPTOMS

Hyperactivity and age at adoption (months)

Results

RELATED WITH

HYPERACTIVITY

SYMPTOMSp:0,02

Age at adoption27,33

51,3

12,83

0

10

20

30

40

50

60

Russia Ethiopia China

Russia

Ethiopia

China

21,97

35

0

5

10

15

20

25

30

35

40

Normal scores Clinical scores

Age at adoption (months)and country of origin

Results Attachment and Attention problems

↓ Less hyperactivity

symptomsp:0,001

↓ Less attention

deficitp: 0.055

Attachment and hyperactivity

32

12

3

11

0

5

10

15

20

25

30

35

40

Secure Insecure

Clinical scores

Normal scores

28

13

7

10

0

5

10

15

20

25

30

35

40

Secure Insecure

Clinical scores

Normal scores

Secure Attachment

Parenting styles

Overprotection correlates with:• Hyperactivity. (Pearson’s r = .31; p: 0,05)

• Attention problems. (Pearson’s r = .37; p: 0.01)

Rejection correlates with:• Attention problems. (Pearson’s r = .31; 0.05)

An Insecure attachment is related with more rejective parents (p: 0.04):

1,31

1,42

1,24

1,26

1,28

1,3

1,32

1,34

1,36

1,38

1,4

1,42

1,44

Secure Insecure

6. Conclusions

Conclusions

1. Girls adopted from China show less Hyperactivity symptoms.

2. When older adopted, the probability to show Hyperactivity symptoms increases.

3. The secure attachment pattern seems to be related to less existence of ADHD-like symptoms.

4. An overprotective parent style correlates with Hyperactivity and Attention problems.

5. A rejective parent style correlates with Attention problems.

6. An Insecure attachment seems to be related with more rejective parents.

Conclusions

Limitations of the research project:

o Size of the sample

o Unequal distribution of the groups

o Absence of a control group from general population

Acknowledgements

To the Pediatric Service of the Hospital Sant Joan de Déu, (Barcelona).

To all the families who participate in the research project.