Parental Cognitive Errors Mediate Parental Psychopathology and Ratings of Child Inattention

• Author: Kevin Delucchi,Yuan Jiang,Nina Kaiser,Linda Pfiffner,Lauren M. Haack,Stephen Hinshaw,Keith McBurnett
• DOI: http://doi.org/10.1111/famp.12252
• Date: 01 September 2017
• Published date: 01 September 2017

Parental Cognitive Errors Mediate Parental

Psychopathology and Ratings of Child Inattention

LAUREN M. HAACK*

YUAN JIANG*

KEVIN DELUCCHI*

NINA KAISER*

KEITH MCBURNETT*

STEPHEN HINSHAW

†

LINDA PFIFFNER*

We investigate the Depression-Distortion Hypothesis in a sample of 199 school-aged chil-

dren with ADHD-Predominantly Inattentive presentation (ADHD-I) by examining rela-

tions and cross-sectional mediational pathways between parental characteristics (i.e.,

levels of parental depressive and ADHD symptoms) and parental ratings of child problem

behavior (inattention, sluggish cognitive tempo, and functional impairment) via pare ntal

cognitive errors. Results demonstrated a positive association between parental factors and

parental ratings of inattention, as well as a mediational pathway between parental depres-

sive and ADHD symptoms and parental ratings of inattention via parental cognitive

errors. Specifically, higher levels of parental depressive and ADHD symptoms predicted

higher levels of cognitive errors, which in turn predicted higher parental ratings of inatten-

tion. Findings provide evidence for core tenets of the Depression-Distortion Hypothesis,

which state that parents with high rates of psychopathology hold negative schemas for

their child’s behavior and subsequently, report their child’s behavior as more severe.

Keywords: ADHD; Inattention; Assessment; Sluggish Cognitive Tempo; Depression

Fam Proc 56:716–733, 2017

Child psychopathology assessment guidelines emphasize comprehensive multimethod,

multimodal, and multiinformant methodologies (e.g., Pelham, William, Fabiano, &

Massetti, 2005). Yet, maternal-report symptom rating scales often serve as the predomi-

nant type of behavioral data employed by clinicians and researchers alike. Unfortunately,

at least a subset of parents have a tendency to over-report the presence and severity of

psychopathology in their children (De Los Reyes & Kazdin, 2005). Thus, relying solely on

parental reports can lead to inaccurate and inappropriate diagnoses and treatment plan-

ning. A leading explanation for this phenomenon is the Depression-Distortion Hypothesis,

which theorizes that parents with depressive features hold more negative schemas for

their child’s behavior and consequently over-report the severity of their child’s

*Department of Psychiatry, University of California, San Francisco (UCSF), San Francisco, CA.

†

UC Berkeley, University of California, Berkeley, CA.

Correspondence concerning this article should be addressed to Lauren M. Haack, University of Califor-

nia, San Francisco (UCSF), 401 Parnassus Avenue G06, San Francisco, CA 94143. E-mail: lauren.haack@

ucsf.edu.

This research was supported by National Institute of Mental Health Grant MH077671 and prepared

during Dr. Haack’s NRSA F32 Fellowship (1F32MH101971-01) titled “Culturally Sensitive School-Home

Behavioral Program for Latino Children With ADHD.”

716

Family Process, Vol. 56, No. 3, 2017 ©2016 Family Process Institute

doi: 10.1111/famp.12252

psychopathology (Richters, 1992). Although Richters (1992) originally suggested that the

empirical evidence supporting the Depression-Distortion Hypothesis is limited, the

phenomenon now has been documented utilizing a variety of empirical method s (e.g.,

cross-sectional, longitudinal), within different types of populations (e.g., community, clini-

cally referred), and across various outcomes (e.g., internalizing and externalizing psy-

chopathology, social functioning; as reviewed by De Los Reyes & Kazdin, 2005). It has

been estimated that between 1.7% and 16.0% of the variance in parental reports of psy-

chopathology is associated with maternal depression (Fergusson, Lynskey, & Horwood,

1993).

The Depression-Distortion Hypothesis is grounded in well-supported cognitive theories

of depression stating that individuals with depression hold global, stable, and internal

attributions for negative events, sometimes described as “distortions,” “maladaptive think-

ing,” or “cognitive errors” (Abramson, Metalsky, & Alloy, 1988; Sweeney, Anderson, & Bai-

ley, 1986; Yurica & DiTomasso, 2005). Common cognitive errors include “jumping to

conclusions” (i.e., one event seemingly is reflective of a generalized negative conclusion),

“mentally filtering” (i.e., disqualifying positive evidence and only focusing on negative evi-

dence), and “personalization” (i.e., blaming someone for causing negative events or situa-

tions without adequate evidence; Yurica & DiTomasso, 2005). The connection between

depression and cognitive errors has been supported in a multitude of populations and

within various contexts (e.g., parental attributions of child misbehavior and negative fam-

ily functioning). Specifically, parents with depressive features are likely to perceive their

child’s misbehavior as controllable, intentional, and caused by negative, internal child fac-

tors (Bolton et al., 2003; Leung & Slep, 2006). Furthermore, parents with depressive fea-

tures are likely to display stable, global, and dispositional attributions for their own role

in their child’s misbehavior, creating a sense of “learned helplessness” in the assessment

of their parenting and perceived control over the family (Leung & Slep, 2006).

It is not difficult to imagine how cognitive errors may distort a parent’s response style on

a child behavior rating scale. In comparison to parents with lower rates of depression, who

are more likely to attribute child misbehavior as unintentional, controllable by the parent,

and attributable to environmental or transient causes, a parent with higher symptoms of

depression and associated cognitive errors may exaggerate the frequency and severity of the

child’s misbehavior when considering and responding to scale items. For example, many

children experience difficulty getting along with peers; however, one mother with a high

level of depressive features may view an instance in which her child experiences social con-

flict and think, “My child always gets into fights because she is mean and bossy. She’s never

going to have any friends and there is nothing I can do to help her because I’m a lousy

mom!” Another mother with a low level of depressive features may view the same instance

and think, “My child had a rough day on the playground today. Maybe she didn’t get enough

sleep and was cranky. We can talk about problem-solving strategies tonight and she’ll have

a better day tomorrow.” Subsequently, when completing a behavior rating scale, the first

mother may be more likely than the second to display cognitive errors when recalling

instances to support her item responses, such as “jumping to conclusions” (e.g., remember-

ing one negative event when making generalizedratings), “mentally filtering” (e.g., disqual-

ifying instances in which her child behaved and only focusing on instances of misbehavior),

or “personalizing” (e.g., blaming the child and/or a lack of parental control for generalized

negative behavior andfamily functioning), thus over-reporting specific symptomratings.

Depression-Distortion Hypothesis in Reports of ADHD

Parental ratings of ADHD may be vulnerable to the type of distortion specified by the

Depression-Distortion Hypothesis given that depression is prevalent in caregivers of

Fam. Proc., Vol. 56, September, 2017

HAACK ET AL.

/

717