Screen use: Its association with caregiver mental health, parenting, and children's ADHD symptoms

• Published date: 01 December 2023
• Author: Franziska Waller,Katharina Prandstetter,Elena Jansen,Gordana Nikolova,Jamie M. Lachman,Judy Hutchings,Heather M. Foran
• Date: 01 December 2023
• DOI: http://doi.org/10.1111/fare.12869

RESEARCH

Screen use: Its association with caregiver mental

health, parenting, and children’s ADHD symptoms

Franziska Waller

1

|Katharina Prandstetter

1

|Elena Jansen

2

|

Gordana Nikolova

3

|Jamie M. Lachman

4

|Judy Hutchings

5

|

Heather M. Foran

1

1

Institute of Psychology, University of

Klagenfurt, Klagenfurt, Austria

2

School of Medicine, Johns Hopkins

University, Baltimore, MD

3

Department of Child and Adolescent

Psychiatry, University Clinic of Psychiatry,

Skopje, North Macedonia

4

Department of Social Policy and Intervention,

University of Oxford, Oxford,

United Kingdom

5

Department of Psychology, Bangor

University, Bangor, United Kingdom

Correspondence

Franziska Waller, University of Klagenfurt,

Universitätsstr 65-67, Klagenfurt 9020,

Austria.

Email: franziska.waller@aau.at

Funding information

Horizon 2020 Framework Programme, Grant/

Award Number: 779318

Abstract

Objective: The aim was to examine the relationship

between caregiver’s mental health (parental psychologi-

cal distress, and parenting stress), dysfunctional parent-

ing (lax or overreactive parenting), and the screen media

use in understanding attention-deficit/hyperactivity dis-

order (ADHD) symptoms of children within an inte-

grated model framework.

Background: Familial factors and screen use have shown

to be significantly related to ADHD in children. However,

theoretical models of the role of family environment,

screen use, and ADHD have rarely been tested jointly,

and little is known about these associations in southeastern

European middle-income countries (MICs).

Method: Data from 835 primary caregivers (92% biologi-

cal mother, 4% biological father, 3% grandmother or

grandfather, 1% other) of children (2 to 9 years) from three

MICs were analyzed using path analyses, and models were

tested for generalizability across education levels and mari-

tal status using multigroup analyses. ADHD-related symp-

toms were assessed with a structured clinical interview

(Mini International Neuropsychiatric Interview for Chil-

dren and Adolescents–Parent Version [MINI-KID-P]) and

the Child Behavioral Checklist (CBCL).

Results: Whereas screen use was directly associated with

ADHD symptoms across measures, a significant indirect

effect of lax parenting on attentional problems via screen use

was found only for the CBCL parent report. The final

models were tested using multigroup analyses across educa-

tion levels and marital status with no significant differences.

Received: 13 April 2022Revised: 23 December 2022Accepted: 28 January 2023

DOI: 10.1111/fare.12869

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and

reproduction in any medium, provided the original work is properly cited.

© 2023 The Authors. Family Relations published by Wiley Periodicals LLC on behalf of National Council on Family Relations.

Family Relations. 2023;72:2499–2515. wileyonlinelibrary.com/journal/fare 2499

Conclusion: Investments in resource and capacity building

for children’s primary caregivers that target lax parenting

and limiting of screen use may impact children’s atten-

tional problems across educational levels and married and

nonmarried caregivers.

KEYWORDS

ADHD symptoms, attentional problem behavior, dysfunctional

parenting, parental psychological distress, parenting stress, screen

media use

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neu-

rodevelopmental disorders among children and often persists into adulthood with large societal

and economic impacts. It is characterized by hyperactivity, inattention, and impulsivity, and

has been shown to be associated with dysfunction in daily activities (Danckaerts et al., 2010;

Sayal et al., 2018). According to meta-analytic reviews, ADHD affects 2% to 7% of school-aged

children worldwide (Polanczyk et al., 2007; Willcutt, 2012). Global estimates of the prevalence

in public health systems vary (i.e., clinically diagnosed or recorded in health care surveillance

systems; Sayal et al., 2018), andADHD particularly remains an underresearched topic in low-

and middle-income countries (LMICs; Bitta et al., 2018). Several studies were published on ADHD

in children in North Macedonia, with estimates of the incidence being 2% (Pop-Jordanova, 2009).

In a meta-analysis (Bitta et al., 2018) on the burden of neurodevelopmental disorders in LMICs,

the prevalence of ADHD in children was estimated to be 3%. However, there is reason to believe

that the number of children affected by ADHD in LMICs is underestimated due to a lack of epide-

miological studies.

The etiology of ADHD is complex and involves multiple causes. Following a multifactorial

genesis framework, genetic factors are assumed to play a crucial role in the development of

ADHD, whereas psychosocial factors are assumed to significantly influence the form and

course of the disorder (Sciberras et al., 2017). A range of social determinants was found to

impact the symptomatology of ADHD in high-income countries (HICs), such as low socioeco-

nomic status (SES), low parental education, family conflict, and parental mental disorders

(Biederman, 2005; Biederman & Faraone, 2005). However, even if moderating effects have been

partially investigated, the mediating mechanisms of how these variables relate to ADHD

among children, especially in low resource settings such as low- and middle-income countries

(LMICs), are less well researched. Furthermore, they do not always correspond to findings

from HICs as the importance, and distribution, of social variables (e.g., socioeconomic status

and gender) differ substantially from what is observed in HICs (Maselko, 2017).

Family environmental factors and ADHD

Past research has pointed to parenting as an important family environmental factor involved in

the etiology and, in particular, the persistence of ADHD (Deault, 2010; Modesto-Lowe

et al., 2008). Especially, overreactive and lax parenting practices have been consistently linked

to behavioral problems in children (Lachman et al., 2019). Evidence has further shown that par-

ents of children with ADHD experience higher parenting stress and more mental health difficul-

ties which, in turn, not only reinforce the disrupting behavior but also promote the use of

dysfunctional parenting strategies (Modesto-Lowe et al., 2008; Theule et al., 2013).

Furthermore, past research has shown that parenting interventions are effective in reducing

child ADHD symptoms through a reduction of parenting stress and dysfunctional parenting

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