Volume 27, Issue 3 (Autumn 2021)                   IJPCP 2021, 27(3): 336-349 | Back to browse issues page

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Zargarinejad G, Ebadi Zare S, Gharraee B, Aghebati A, Farahani H, Shirazi E. Inter-parent Agreement and Discrepancy on Core Symptoms and Externalizing Problems in School-age Children With Attention Deficit/Hyperactivity Disorder. IJPCP 2021; 27 (3) :336-349
URL: http://ijpcp.iums.ac.ir/article-1-3269-en.html
Inter-parent Agreement and Discrepancy on Core Symptoms and Externalizing Problems in School-age Children With Attention Deficit/Hyperactivity Disorder
Ghazaleh Zargarinejad1 , Saeed Ebadi Zare1 , Banafsheh Gharraee 2, Asma Aghebati3 , Hojjatollah Farahani3 , Elham Shirazi4
1- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran.
2- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran. , gharraee.b@iums.ac.ir
3- Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran.
4- Department of Psychiatry, Spiritual Health Research Center, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran.
Keywords: Attention Deficit/Hyperactivity Disorder, Behavior Rating Scale, Behavioral Problem
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1. Introduction
ith a worldwide prevalence of 7% in school years, Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common childhood mental disorders [1]. It has a negative correlation with children’s performance in school [5, 6, 7]. Hence, its early diagnosis during school years is of utmost importance. One of the challenges in the diagnosis of ADHD is that the symptoms may not be seen in the presence of the clinician [10]; thus, the reports provided by parents or other informants of the symptoms are of particular importance. Use of rating scales has been suggested for evaluating ADHD [13], although the use of such scales in different types of child psychopathology has some problems including low level of parental agreement [16] and informant discrepancy [14]. getting to know the level of parental agreement on ratings of child's symptoms would help the clinicians with the better interpretation of the results of rating scales. They can also help them to realize if it is enough to get information from one parent or need to add another informant. The present study aims to investigate inter-parent agreement and discrepancy on core symptoms and externalizing problems in school-age children with ADHD. The study also aims to investigate the parental variables as predictors of parent rating discrepancies.
2. Materials and Methods
The study population consists of children diagnosed with ADHD (of any type) by a child and adolescent psychiatrist aged 6-10 years who referred to child and adolescent psychiatric clinics in Tehran, Iran. Of these children, 51 were selected using a convenience sampling method. Inclusion criteria were age 6-10 years, having ADHD diagnosed based on Kiddie schedule for Affective Disorder and Schizophrenia- Present and Lifetime Version (K-SADS-PL), and at least a high school diploma for the mothers of children. Exclusion criteria for the children was the presence of comorbid bipolar spectrum disorders, autism spectrum disorders, or mental retardation. Both Parents separately filled out the Swanson, Nolan and Pelham-IV (SNAP-IV) Questionnaire [27], the Eyberg Child Behavior Inventory (ECBI) [32], and Emotion Regulation Checklist (ERC) [36]. Mothers also filled out the Parenting Stress Index- Short Form (PSI-SF) [40].
3. Results
As shown in Table 1, Intraclass Correlation Coefficient (ICC) values showed fair to moderate agreement between parents (P<0.01).


The Significant Difference Between the Means of Parental Ratings determined by paired t-test indicated that mothers had provided higher ratings compared to fathers in all scales/subscales except SNAP-IV-IN (P<0.05) (Table 2).


Results of regression analysis showed that mothers’ educational level positively correlated with parent discrepancy in all scales except for the inattention subscale of SNAP-IV. Mothers’ total score of PSI-SF had a significant negative correlation with parent discrepancies in ECBI, and fathers’ educational level showed a significant negative correlation in Hyperactivity/Impulsivity and total SNAP-IV total score. These variables explained 24% of the variance in parent discrepancy regarding Hyperactivity/Impulsivity and ECBI score and 18% of the variance in inter-parent discrepancy regarding total SNAP-IV score and emotion lability/negativity.
4. Discussion and Conclusion
The present study revealed the fair to moderate inter-parent agreement in evaluating ADHD symptoms and the related problems, although they observed children’s behavior at a relatively similar situations. Compared to fathers, mothers tended to report higher levels of symptoms and problems in almost every subscale which is consistent with previous studies [18, 19, 44]. Despite the correlation between parents’ ratings, relying on one parent’s ratings may lead to overdiagnosis or underdiagnosis. High levels of mental problems in mothers of children with ADHD [46] and more engagement in the coercive cycle of interaction with a child with ADHD [48] may cause the overestimation of the child’s symptoms and problems by mothers.
Positive correlation between mother’s educational level and parent discrepancy of rating may be due to the higher behavioral and educational expectations of mothers with higher educational levels. Moreover, our study showed that as mothers’ parenting stress increased, parent discrepancies regarding externalizing problems decreased. Considering the mutual relationship between parenting stress and behavioral problems of children [52], higher parenting stress indicates more severe level and thus visibility of externalizing problems in ADHD children; hence, fathers are more likely to acknowledge them and respond more consistently with mothers. It seems that, in applying rating scales for ADHD, the use of the reports of multiple informants such as the other parent or teachers may improve the assessment of ADHD in school-age children.

Ethical Considerations
Compliance with ethical guidelines
Informed consent was obtained from the participants; they were assured of the confidentiality of their information and were free to leave the study at any time.

Funding
This study was extracted from the first author’s PhD. thesis, and was financially supported by Iran University of Medical Sciences. 

Authors contributions
Conceptualization, and investigation: Ghazaleh Zargarinejad, Banafsheh Gharraee; Data collection: Ghazaleh Zargarinejad, Elham Shirazi; Supervision: Saeed Ebadi Zare, Banafsheh Gharraee; Methodology and data analysis: Hojjatollah Farahani; Editing and review: Banafsheh Gharraee, Asma Aghebati.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgements
The authors would like to thank the personnel of Ali Asghar Hospital and Child Psychiatric Clinic of Tehran Psychiatric Institute for their sincere cooperation and Dr. Javad Mahmoudi-Gharaei for their assistance with sampling and conducting the research.


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Type of Study: Original Research | Subject: Psychiatry and Psychology
Received: 2020/06/18 | Accepted: 2020/10/8 | Published: 2021/10/1
References
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20. Yadegari N, Sayehmiri K, Azodi MZ, Sayehmiri F, Modara F. The Prevalence of attention deficient hyperactivity disorder among iranian children: a meta-analysis. Iranian Journal of Psychiatry and Behavioral Sciences. 2018;12(4):10-8. [DOI:10.5812/ijpbs.8990]
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