Improvements in Negative Parenting Mediate Changes in Children's Autonomic Responding Following a Preschool Intervention for ADHD

Abstract

Abnormal patterns of sympathetic- and parasympathetic- linked cardiac activity and reactivity are observed among externalizing children, and mark deficiencies in central nervous system regulation of behavior and emotion. Although changes in these biomarkers have been observed following treatment, mechanisms remain unexplored. We used MEMORE-a new approach to analyzing intervening variable effects-to evaluate improvements in parenting as mediators of changes in SNS- and PNS-linked cardiac activity and reactivity among 99 preschoolers with attention-deficit hyperactivity disorder who were treated using an empirically supported intervention. Decreases in negative parenting (criticism, negative commands, physical intrusions) were associated with increases in resting RSA and PEP reactivity to incentives from pre- to post-intervention. Increases in positive parenting were not associated with changes in autonomic function. These findings suggest socially-induced plasticity in peripheral biomarkers of behavior and emotion regulation, and underscore the importance of reducing aversive interactions between parents and children when treating externalizing behavior.

Keywords: ADHD; HRV; PEP; RSA; externalizing; intervention; mediation; parenting.

Conflict of interest statement

Carolyn Webster-Stratton has disclosed a potential conflict of interest because she disseminates these treatments and stands to gain from favorable reports. She has voluntarily agreed to distance herself from certain critical research activities, including recruitment, consenting, primary data handling, and data analysis. The University of Washington has approved these arrangements. M. Jamila Reid performs Incredible Years interventions as an independent contractor.

Figures

Figure 1

Mediation of changes in resting RSA during treatment by changes in negative parenting. In the figure, 1 represents treatment, a represents the link between treatment and changes in parenting (the mediator), b represents the association between change in RSA (the dependent variable) as a function of changes in parenting (the mediator), and c′ represents the association between treatment and change in RSA. The a×b product quantifies the indirect effect of changes in parenting on changes in RSA.