Risk factors for the difficulties in general activities across the day in Chinese children and adolescents with attention-deficit/hyperactivity disorder

Figures & data

Table 1 Summary of the characteristics of the included ADHD patients and their parents

Characteristics	Mean (SD)/n (%)
The included ADHD patients
Age (years, mean [SD])	10.4 (2.66)
Male, n (%)	155 (77.5%)
No. of family members, median (first quantile, third quantile)	4 (3–5)
Single-child family, n (%)	137 (68.5%)
ADHD subtype, n (%)
Combined	98 (49.0%)
Predominantly inattentive	91 (45.5%)
Predominantly hyperactive-impulsive	11 (5.5%)
ADHD diagnosis duration (weeks, mean [SD])	62.6 (96.59)
Currently on medication for ADHD, n (%)	127 (63.5%)
Any psychiatric comorbidities, n (%)	65 (32.5%)
Learning disability	49 (24.5%)
Tic disorder	21 (10.5%)
Oppositional defiant disorder	20 (10%)
Personality disorder	11 (5.5%)
Stress	10 (5.0%)
Parents of the included ADHD patients
Education of mother, n (%)
> High school	117 (58.50%)
≤ High school	83 (41.50%)
Smoking father, n (%)	112 (56.10%)
Drinking father, n (%)	133 (66.20%)
With parent–child interaction activities, n (%)	132 (66.0%)
Parenting style, n (%)
Authoritarian	47 (23.5%)
Authoritative	71 (35.5%)
Permissive	59 (29.5%)
Uninvolved	23 (11.5%)

Abbreviation: ADHD, attention-deficit/hyperactivity disorder.

Table 2 Summary of the rated scores of QCD in the included ADHD patients

Questionnaire	Mean (SD)
Early morning/before going to school (items 1–4)	6.0 (2.88)
1. Can your child promptly get out of his/her bed?	1.24 (0.94)
2. Can your child promptly groom himself/herself (for example, washing face, brushing teeth and getting dressed)?	1.30 (0.93)
3. Can your child behave in an age-appropriate manner at breakfast?	1.78 (0.96)
4. Can your child spend his/her time before going to school in the morning without getting into trouble or having quarrels with his/her parents or siblings?	1.72 (1.00)
School (items 5–7)	5.4 (2.03)
5. Does your child like going to school?	1.93 (0.97)
6. Can your child behave in class as other children do?	1.51 (0.86)
7. Does your child have friends who accept him/her at school?	1.92 (0.88)
After school (items 8–10)	6.0 (2.14)
8. Can your child discuss events that happened at school with his/her parents/guardian?	1.85 (0.90)
9. Does your child have friends of his/her own age?	2.10 (0.87)
10. Can your child confidently participate in extracurricular activities, such as sports, with children of his/her own age?	2.04 (0.92)
Evening (items 11–14)	6.6 (2.44)
11. Can your child do his/her homework at home without difficulties?	0.85 (0.83)
12. After everyone returns home (including parents/guardians), can your child enjoy family time without constantly quarreling with others?	1.79 (0.86)
13. Can your child converse in a calm manner during dinnertime conversations?	1.91 (0.84)
14. Do the parents feel comfortable being together with the child when engaging in activities (for example, going out or shopping)?	2.02 (0.83)
Night (items 15–18)	5.2 (2.42)
15. Adolescent child (12 years or older): Can your child engage in activities at night with friends of his/her own age? These activities may include playing, studying, going to cram school, taking private lessons (for example, playing a musical instrument and/or calligraphy), and playing sports.	1.54 (1.09)
16. Younger children (younger than 12 years): Can your child follow instructions at night (for example, brushing teeth, changing clothes)?	1.77 (0.88)
17. Can your child go to sleep without any difficulties?	1.69 (1.08)
18. Is your child sleeping without waking up during the night?	1.79 (1.11)
Overall behavior (items 19–20)	2.9 (1.43)
19. Does your child have self-confidence? Is your child socially accepted by others (such as belonging to a group of his/her friends), and emotionally stable?	1.49 (0.84)
20. Does your child have more days in the week, where he/she is able to spend the day without facing confusion, getting into quarrels or displaying rebellious behavior?	1.43 (0.92)
Total score	32.0 (9.77)

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; QCD, Questionnaire-Children with Difficulties.

Figure 1 Multivariate linear regression analysis exploring risk factors for the QCD total score associated with the included Chinese children and adolescents with ADHD.

Note: Statistically significant values are shown in bold.
Abbreviations: ADHD, attention-deficit/hyperactivity disorder; SE, standard error; QCD, Questionnaire-Children with Difficulties.

Table 3 The results of the univariate linear regression analysis exploring risk factors associated with QCD total score throughout the day in the included children and adolescents with ADHD

Independent variables	Coefficient (SE)	P-value
Characteristics of ADHD patients
Age ≥10 years old (vs <10 years old)	1.00 (1.38)	0.4677
Female (vs male)	2.91 (1.64)	0.0754
Any psychiatric comorbidities (yes vs no)	−5.71 (1.41)	<0.0001
ADHD diagnosis duration (per 10 weeks)	−0.12 (0.07)	0.0973
ADHD subtype (vs combined)
Predominantly inattentive	4.99 (1.37)	0.0003
Predominantly hyperactive-impulsive	0.47 (3.00)	0.8761
Medication treatment (yes vs no)	−0.20 (1.43)	0.8889
Characteristics of parents
Smoking father (yes vs no)	0.04 (1.39)	0.9753
Drinking father (yes vs no)	−0.43 (1.46)	0.7669
No. of family members	0.40 (0.65)	0.5385
Multiple children at home (vs single-child family)	−1.17 (1.48)	0.4284
Parenting style (vs authoritarian)
Authoritative	0.82 (2.47)	0.7387
Permissive	0.96 (1.83)	0.5997
Uninvolved	2.24 (1.90)	0.2386
Parent–child interaction activities (yes vs no)	5.74 (1.40)	<0.0001
Education of mother ≤ high school (vs > high school)	1.53 (1.39)	0.2734

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; SE, standard error; QCD, Questionnaire-Children with Difficulties.

Table 4 The results of univariate linear regression analysis exploring risk factors associated with QCD subscale scores for the five time domains throughout the day in the included children and adolescents with ADHD

QCD time domain	Early morning before school		School time		After school time		Evening time		Night time
Independent variables	Coefficient (SE)	P-value	Coefficient (SE)	P-value	Coefficient (SE)	P-value	Coefficient (SE)	P-value	Coefficient (SE)	P-value
Characteristics of ADHD patients
Age (≥10 years vs <10 years)	0.61 (0.40)	0.1319	0.03 (0.29)	0.9277	0.09 (0.30)	0.7634	0.02 (0.34)	0.9592	0.11 (0.34)	0.7405
Gender (female vs male)	0.71 (0.48)	0.1407	0.52 (0.34)	0.1251	0.52 (0.36)	0.1492	0.54 (0.41)	0.1891	0.54 (0.41)	0.1822
Number of family members	0.15 (0.19)	0.4244	0.14 (0.13)	0.2878	0.21 (0.14)	0.1383	−0.01 (0.16)	0.9513	0.01 (0.16)	0.9609
Number of children at home (multiple vs single)	−0.31 (0.44)	0.4717	−0.23 (0.31)	0.4497	0.22 (0.33)	0.4951	−0.33 (0.37)	0.3709	−0.38 (0.37)	0.3007
Disease duration after diagnosis (per 10 weeks)	−0.02 (0.02)	0.3077	−0.01 (0.01)	0.4917	−0.03 (0.02)	0.0958	−0.04 (0.02)	0.0205	−0.02 (0.02)	0.2597
Any psychiatric comorbidity (yes vs no)	−1.09 (0.43)	0.0111	−1.02 (0.30)	0.0006	−0.67 (0.32)	0.0361	−1.49 (0.35)	<0.0001	−1.02 (0.36)	0.0043
Current medication treatment (yes vs no)	0.10 (0.42)	0.8053	0.25 (0.30)	0.4017	0.05 (0.31)	0.8813	−0.30 (0.36)	0.3934	−0.23 (0.35)	0.5076
ADHD subtype (vs combined)
Hyperactivity/impulsivity	1.42 (0.88)	0.1055	−0.32 (0.63)	0.6094	−0.56 (0.67)	0.4018	0.28 (0.75)	0.7062	−0.61 (0.76)	0.425
Inattention	1.61 (0.40)	<0.0001	0.70 (0.29)	0.0164	0.57 (0.31)	0.062	1.22 (0.34)	0.0004	0.54 (0.35)	0.123
Characteristics of parents
Smoking father (yes vs no)	0.13 (0.41)	0.75	0.37 (0.29)	0.1999	0.34 (0.31)	0.2639	0.08 (0.35)	0.8151	−0.93 (0.34)	0.006
Drinking father (yes vs no)	−0.28 (0.43)	0.5092	0.11 (0.30)	0.7275	0.72 (0.32)	0.0233	−0.06 (0.37)	0.8652	−0.80 (0.36)	0.0252
Parenting style (vs authoritarian)
Uninvolved	0.65 (0.73)	0.3701	0.17 (0.51)	0.7305	−0.24 (0.54)	0.6519	0.13 (0.61)	0.8286	0.09 (0.61)	0.8833
Authoritative	−0.21 (0.54)	0.6944	0.10 (0.38)	0.7933	0.36 (0.40)	0.3671	0.44 (0.45)	0.3343	0.27 (0.45)	0.5551
Permissive	−0.06 (0.56)	0.9154	0.86 (0.39)	0.0282	0.37 (0.42)	0.3741	1.03 (0.47)	0.0277	−0.18 (0.47)	0.704
Parent–child interaction activities (yes vs no)	0.93 (0.42)	0.0284	1.33 (0.29)	<0.0001	0.63 (0.32)	0.0461	1.27 (0.35)	0.0003	1.07 (0.35)	0.0022
Education level of month (≤ high school vs > high school)	0.31 (0.41)	0.4556	0.58 (0.29)	0.0456	0.08 (0.31)	0.7845	−0.01 (0.35)	0.9774	0.41 (0.34)	0.2306

Note: Statistically significant values are shown in bold.

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; SE, standard error; QCD, Questionnaire-Children with Difficulties.

Table 5 Summary of the results of the multivariate linear regression analyses exploring the risk factors associated with subscale scores of QCD time domains in the included ADHD patients

Independent variables	Morning		At-school score		After school		Evening score		Night before bed
	Coefficient (SE)	P-value	Coefficient (SE)	P-value	Coefficient (SE)	P-value	Coefficient (SE)	P-value	Coefficient (SE)	P-value
Characteristics of ADHD patients
Age ≥10 years (vs <10 years)	0.71 (0.41)	0.086	0.13 (0.28)	0.643	0.34 (0.31)	0.279	0.23 (0.34)	0.487	0.38 (0.35)	0.284
Female (vs male)	0.36 (0.47)	0.442	0.06 (0.32)	0.842	0.33 (0.36)	0.353	0.02 (0.39)	0.952	0.33 (0.40)	0.406
Any mental comorbidity (yes vs no)	−0.73 (0.43)	0.091	−0.64 (0.29)	0.028	−0.49 (0.33)	0.141	−1.06 (0.35)	0.003	−0.50 (0.37)	0.176
Time after ADHD diagnosis (per 10 weeks)	−0.02 (0.02)	0.293	−0.01 (0.01)	0.712	−0.03 (0.02)	0.047	−0.03 (0.02)	0.059	−0.02 (0.02)	0.358
ADHD subtype (vs combination type)
Inattention	1.33 (0.41)	0.001	0.67 (0.28)	0.017	0.37 (0.31)	0.234	1.09 (0.34)	0.001	0.26 (0.35)	0.461
Hyperactivity/impulsivity	1.41 (0.87)	0.104	−0.15 (0.58)	0.794	−0.66 (0.66)	0.314	0.45 (0.70)	0.521	−0.50 (0.73)	0.489
Characteristics of ADHD patients’ parents
Education of mother ≤ high school (vs > high school)	NA		0.80 (0.27)	0.003	NA		NA		NA
Parent–child interaction activity (yes vs no)	0.64 (0.43)	0.137	1.18 (0.29)	<.0001	0.40 (0.33)	0.226	0.89 (0.36)	0.013	0.96 (0.36)	0.009
Father with drinking (yes vs no)	NA		NA		0.87 (0.31)	0.005	NA		−0.42 (0.37)	0.249
Father with smoking (yes vs no)	NA		NA		NA		NA		−0.72 (0.35)	0.038
Parenting style (vs authoritarian)
Uninvolved	NA		0.70 (0.48)	0.14	NA		1.13 (0.43)	0.008	NA
Permissive	NA		1.10 (0.36)	0.002	NA		0.33 (0.41)	0.42	NA
Authoritative	NA		0.25 (0.35)	0.478	NA		0.72 (0.58)	0.216	NA

Notes: NA, due to the statistically significant association not detected in the univariate analysis. Statistically significant values are shown in bold.

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; NA, not assessed; SE, standard error; QCD, Questionnaire-Children with Difficulties.