In the context of developmental psychopathology, parenting is considered one of the contributors to psychopathology from childhood to adulthood. Previous studies focused mainly on parenting, while less have discussed perceived parenting attitudes; hence, the current study investigated the association between ADHD symptoms and the associated behavioral problems in ADHD children and their perceived parenting attitudes.
Assessment of ADHD symptoms in the studied group using Conner’s Parent Rating Scale revealed the presence of significant oppositional, inattentive and hyperactivity, and mild social problems. Meanwhile, there was no significant anxiety, perfectionism, or psychosomatic symptoms. Regarding parental attitudes in the current study, ADHD children perceived similar attitudes between the mothers and fathers in the 4 domains of the parenting attitude scale (consistency-acceptance-equality-independence). The highest perceived parenting attitude was acceptance while the lowest perceived parenting attitude is independence. Our results failed to find an association between the severities of ADHD symptoms in the studied children with their perceived parenting attitudes.
Other studies reported different findings from ours; an Eastern study compared 296 ADHD children with 229 controls regarding the father’s parenting style and perceived family support. Compared to controls, children with ADHD experienced less affectionate/care and more paternal overprotection and authoritarian controls and perceived less family support than controls [18]. In their complementary study examining the role of mothering in ADHD, Gau and Chang found that children with ADHD received less affection/care and greater maternal overprotection and control and perceived less family support than non-ADHD children. Child’s report shows that child’s inattention and comorbidity were correlated significantly with low affection/care from the mother and high control, while hyperactivity-impulsivity was correlated significantly with overprotection, and child’s inattention and comorbidity were correlated significantly with diminished family support and disrupted mother-child interactions [19].
Earlier studies conducted by Johnston [20], Keown and Woodword [21], Gerdes et al. [22], and Ellis and Nigg [23] revealed that parents of ADHD children who were perceived by their children as more assertive, uninvolved, and inconsistent faced more severe ADHD symptoms than compared parents [20,21,22,23]. Probably, the explanation of the variation between the results of the current study and the formerly discussed studies comes from assessing different aspects of parenting in those studies rather than aspects assessed in the current study.
In the current study, assessment of associated behavioral problems of the ADHD children using the Child Behavior Checklist revealed the presence of attentional problems as expected, as well as the presence of significant aggressive and externalizing problems in 60.7% of the children. These results come in agreement with the findings of previous studies such as those conducted by Harty et al. [24] and Zenglein et al. [25]. According to Harty et al. [24], among ADHD comorbidities, disruptive behavior disorders are the most prevalent as conduct disorder is present in up to 30–50% of children with ADHD, while oppositional defiant disorder is diagnosed in about 35% of children with ADHD [6].
On examining the correlation between aggressive and externalizing behavior in the ADHD children with their perceived parenting attitude in the current study, it was expected that inconsistency will be associated with disruptive behaviors; surprisingly, consistency in parenting in both mothers and fathers was positively correlated to the disruptive behaviors in ADHD children. These unexpected inconvenient findings could be explained in light of recall bias that is expected to be present in ADHD children or in light of their illusory bias (will be discussed later).
Again, other studies reported different findings; in their study aiming for exploring the association between parenting styles and behavioral problems in 22 Brazilian ADHD children, Teixeira and her colleagues [26] reported the presence of a significant positive correlation between parental inconsistency and aggressive and externalizing problems. The authors emphasized that inadequate parental strategies mainly inconsistent punishment are associated with several patterns of behavioral problems, mainly of the externalizing type [26]. In the same year, 2015, Ni and Gau [27] investigated the severity of ADHD symptoms and externalizing symptoms in relation to perceived parenting in adolescents with ADHD. They observed that correlations of ADHD with externalizing symptoms were inversely linked to the level of care of the father and mother, while the association of ADHD with wide-ranging comorbid conduct or oppositional defiant symptoms was related positively to the level of mothers’ and fathers’ overprotection/control [27].
In an earlier study exploring parenting practices in families of 149 ADHD children, Pfiffner et al. [28] found a significant correlation between maternally negative/ineffective discipline and oppositional defiant disorder and conduct disorder. The lack of mothers’ warmth and involvement and paternal negative/ineffective discipline were associated significantly with comorbid conduct disorder, but not with the oppositional defiant disorder. According to the authors, consistent discipline appears to be important for addressing comorbid oppositional defiant disorder and conduct disorder [28].
In spite of the previous studies contradicting the current study results, other studies came in agreement with the results. In an American study conducted by Gerdes and colleagues [29], perceived parent-child relationship quality was examined for 142 boys with ADHD and 55 non-ADHD control boys. Parent perceptions were also investigated. Parents of ADHD boys have more negative perceptions for their relationships with their kids than parents of non-ADHD boys. Interestingly enough, ADHD boys did not differ from non-ADHD boys in their views of the relation with their parents, considering these gaps in parental perceptions. Furthermore, when perceptions of ADHD boys were directly compared to their parents’ perceptions, ADHD boys’ reports were positively enhanced relative to those of control parent-child dyads. These findings can be considered as evidence for a positive illusory bias in the social self-perceptions of children with ADHD [29].
Positive illusory bias (PIB) is a concept that imposes itself during studying self-perception; it refers to displaying self-perceptions that are over-optimistic relative to external competence metrics [30], whereas social positive illusory bias in children denotes overestimating their social approval in contrast to external criteria, as adults’ scoring [31]. Remarkably, Hoza and her colleagues [32] noticed that, especially after disappointment, ADHD boys overestimate their social self-perceptions. The authors explained that ADHD children may feel a need to exaggerate their perceptions of the relationships with their parents, possibly due to frequent unpleasant experiences with their parents [32]. Diener and Milich [33] postulated this might act as a self-protective mechanism for children with ADHD.
In other words, along with other challenges ADHD children face, bad relationships with their parents can be more they can deal with at one time. As a consequence, in an attempt to prevent them from feeling bad about themselves and their families, they provide exaggerated expectations of their relationships with their parents. Maybe as a result of poor metacognitive abilities, these children are less conscious of the conflict in their relationships with others.
Indeed, a growing body of literature emphasizes the presence of this PIB in ADHD children and explores its causes, functions, future predictors mainly maladjustment, differences between implicit and explicit PIB, its relation with their social behaviors and their executive functions, and its relation with other comorbidities [31, 34,35,36,37,38,39,40,41].
Taking PIB into account, findings reported by Hoza and her colleagues [42] can be explained. The researchers analyzed the self-perceptions of ADHD children in relation to the scores of teachers of boys with ADHD with comorbid aggression or without together with non-ADHD boys. Their study found that all ADHD subgroups exaggerated their ability considerably more than the control non-ADHD group, in relation to teachers’ scores, in the scholastic, social, and behavioral domains. ADHD boys with aggression, however, overrated their abilities within the social domain significantly more than ADHD boys without aggression did. Social competence is a domain that would mostly be influenced by aggressive behavior. Moreover, estimations of the performance in other domains where aggression mostly has less or no effect, such as physical appearance, were not influenced by the presence of comorbid aggression [42]. In a research that involved both boys and girls with ADHD, a similar trend was observed, giving further support to the results [43].
In light of PIB and social PIB in ADHD children, findings of the current study could be viewed, perceiving exactly the same attitude from mothers and fathers, acceptance being the highest attitude perceived from parents, absence of association between severity of ADHD symptoms and perceived parenting attitudes, and finally the presence of this illogical significant positive correlation between aggression in ADHD children with consistent parental attitudes, whereas it is expected that negative parenting attitudes positively correlate with severity of ADHD symptoms and associated aggression in those children.