Analysis on the Influence of Family Environment on Symptoms and

Functioning of Chinese Children with Attention Deficit/Hyperactivity

Disorder: Based on Correlational Analysis and Independent

Samples T-Test

Zishi Li

Faculty of Brain Science, University College London, London, WCIE 6BT, U.K.

Keywords: ADHD, Family Environment, Parenting, Adaptive Behavior, Correlation-Analysis, Independent Samples T-Test.

Abstract: This research aimed to test the relationship between family environment and Attention-Deficit/Hyperactivity

Disorder (ADHD)-related symptoms and functioning of Chinese children diagnosed with ADHD. Zhou et al.

(2005) provided evidence for significant differences in family environment ratings (E.g., cohesion,

expressiveness, conflict) between children with and without ADHD (Zhou, 2005). Building on this, the

current research investigated the extent to which family environment factors influence ADHD symptoms and

children’s adaptive behaviors. Data were extracted from the out-patient medical records of 195 children

diagnosed with ADHD at Qingdao Women and Children Hospital. The archived outcomes of the Family

Environment Scale, Swanson, Nolan, and Pelham-IV rating scale, and Adaptive Behavior Assessment System

were adopted as measurements for family environment, ADHD symptoms, and children’s adaptive behaviors

respectively. The correlation-analysis and independent samples t-test conducted by SPSS version 27. were

used to analyze the data. Pearson correlation revealed significant correlation between ADHD symptoms

(inattention and oppositional defiant) and family cohesion, organization, and conflict, which supported the

hypotheses. This laid a foundation for future investigations regarding whether and how improving the family

environment and parenting styles could help children alleviate ADHD symptoms. Nevertheless, no

correlations were found between the hyperactivity/impulsivity dimension of ADHD symptoms and any family

environment factors. Potential alternative explanations and possible modifications of methodologies in future

investigations are discussed.

1 INTRODUCTION

Being characterized by anomalous impulsivity, lack

of concentration, and motor hyperactivity, Attention-

Deficit/Hyperactivity Disorder (ADHD) is one of the

most common neurodevelopmental disorders that

onsets in childhood and usually continues into

adulthood (Price, 2012). Meta-analysis revealed that

5.29% children worldwide could be classified into

one subtype of ADHD (Polanczyk, 2007), either

predominantly inattentive (easily distractable and

disorganized), predominantly hyperactive-impulsive

(excessively fidgety and behave destructively), or

combined type (American Psychiatric Association,

2013). Using correlational analysis, this research

aimed to investigate the extent to which each family

environment subfactor relates to each dimension of

ADHD-related symptoms and adaptive behaviours,

based on the sample of Chinese children diagnosed

with ADHD.

2 LITERATURE REVIEW

Although the precise cause of ADHD remains

undefined, it was strongly approved by family and

twin studies that ADHD has a high heritability of

75% (Faraone, 2005), in which genes in the

dopaminergic pathway (E.g., DRD4, DRD5, DATI)

are involved (Stergiakouli, 2010). Nurture risk

factors mediate with nature factors in contributing to

the development of ADHD. This comprises but is not

limited to maternal stress (Price, 2012), prenatal

toxins exposure (Mill, 2008), and virus infection

(Zhou, 2015). These factors might partially explain

why ADHD is more prevalent among urban than rural

Li, Z.

Analysis on the Inﬂuence of Family Environment on Symptoms and Functioning of Chinese Children with Attention Deﬁcit/Hyperactivity Disorder: Based on Correlational Analysis and

Independent Samples T-Test.

DOI: 10.5220/0011731900003607

In Proceedings of the 1st International Conference on Public Management, Digital Economy and Internet Technology (ICPDI 2022), pages 145-151

ISBN: 978-989-758-620-0

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

145

children (Hinshaw, 1994). Family environment,

which refers to how children are raised, also received

great attention in how it profoundly affects children’s

physical, psychological, and social development, and

consequently serves as a crucial determinant of

individual’s vulnerability to ADHD. In specific, it

was demonstrated that ADHD children tend to

receive more aggressive discipline methods

(Woodward, 1998) and authoritarian parenting styles

(Lange, 2005), as compared to non-ADHD controls.

According to Pressman et al. (2006) (Pressman,

2006), inadequate parenting practices that exacerbate

ADHD symptoms could be triggered by parents

coping with multiple inner family stresses, such as

high conflict, low cohesion, and low involvement

between family members. These dimensions of

family traits are measurable through the Family

Environment Scale (FES), which examines members

interaction and culture within a family (Moos, 1984).

By applying the FES, Schroeder and Kelley (2009)

(Schroeder, 2009) found that positive parenting

(higher family cohesion, expressiveness,

organization and lower conflict) was significantly

correlated with greater behavioural regulation in

children without ADHD. Nevertheless, parenting

practices showed no significant influences on

behavioural regulation and metacognition of children

with ADHD It should be noted that the vast majority

of sample ethnicity was European-American

(67.2%), whereas a mere 3% of sample was Asian-

American. Therefore, results from Schroeder and

Kelley limit in generalizability across cultures, where

there are salient differences in child-rearing practices.

It was highlighted that while American parents

advocate children’s independent styles of thinking

and behaviours through active praising and explicit

expression of intimacy (Wilcox, 1998; Xu, 2005),

parents from non-western societies like China

emphasize on obedience to rules and adult

authorities, driven by Chinese cultural values of

Confucianism and Taoism (Chao, 1994). Zhou et al.

(2005) (Zhou, 2005) investigated the influence of

family environment on ADHD symptoms on a

Chinese sample. As a result, ADHD children scored

significantly lower on several positive dimensions of

family environment (including cohesion,

expressiveness, independence, achievement

orientation, and organization), and scored higher on

family conflict and control, as compared to non-

ADHD controls.

However, as the research from Zhou and

colleagues was conducted in the period where one-

child policy (a family pl

anning strategy to restrict

population growth) was still in place in China, all

participants recruited should be the only child in the

family. Thus, Zhou’s study could limit in the ability

of reflecting later social and economic changes (E.g.,

the multi-child policy being gradually implemented

by the Chinese government since 2011). This is due

to the significant differences in family environment

and parenting style between single-child and

multiple-child families. Child-centeredness is a

notable phenomenon under one-child policy, which

refers to caregivers devoting a large proportion of

their money, time, and effort into child development

(Chow, 1996). This causes both positive and negative

influences on the family environment. For instance,

higher expenditure on entertainments could enhance

cohesion, whereas parents’ higher expectations and

requirements on child’s education could lead to

increased familial conflict.

The current research aimed at investigating the

influence of family environment factors on ADHD

symptoms. Previous research compared between the

family environments and performances of children

with and without ADHD. As a supplementary, the

current study investigated the extent to which each

family environment factor correlates with each

dimension of ADHD symptoms and functioning of

children diagnosed with ADHD. Being carried out in

2021, this research targeted at Chinese children born

in the period that covered either the one-child policy

or the two-child policy (between 2006 and 2016).

Containing both single-child and multi-child families

in the sample could generate results that differ from

if single-child families were recruited solely. This is

because for the latter, ratings on certain factors from

FES (E.g., independence) could be consistently low,

resulting from the unique parenting of the only child

(E.g. parents devote higher cautiousness). Therefore,

for the purpose of maintaining the accuracy of

correlational patterns, samples covered both single-

child and multi-child families in the current research.

Based on what was mentioned above, 2 hypotheses

have been proposed:

• Family cohesion, expressiveness, independence,

achievement orientation, and organization

would be negatively correlated with inattention,

hyperactivity/impulsivity, and oppositional

defiant

• Family conflict and control would be positively

correlated with inattention,

hyperactivity/impulsivity, and oppositional

defiant.

ICPDI 2022 - International Conference on Public Management, Digital Economy and Internet Technology

146

3 METHODS

3.1 Participants

This study obtained data from the out-patient medical

record archived between November 2018 and July

2020 at Qingdao Women and Children Hospital.

Participants were 195 children diagnosed with

ADHD by 8 professional psychiatrists. 16.9% (n=33)

were girls and 83.1% (n=162) were boys. Participants

had a mean age of 8.17 (SD=1.95), ranging from 5 to

15 years old. At the time of diagnosis, 19.5% (n=38)

were in kindergarten, 76.9% (n=150) were in primary

school, and 3.6% (n=7) were in middle school. In

terms of the specific subtypes of ADHD diagnosis,

26.7% (n=52) were predominantly inattentive, 33.3%

(n=65) were predominantly hyperactive-impulsive,

and 40% (n=78) were combined type. There were

cases with comorbidities, in which 6.7% (n=13) had

Tourette Syndrome, 1.1% (n=2) had Autistic

Spectrum Disorder. 1.1% were in Obsessive

Compulsive state, while 0.5% (n=1) suffered from

Emotional Disorder. This study protected patients’

privacy by ensuring data confidentiality.

3.2 Primary Measures

The Chinese version of the Family Environment

Scale (FES-CV) was employed to quantify family

functioning (Fei, 1991). It is 90-item, true or false

self-report questionnaire filled out by the caregivers

of participants, which normally takes 20-30 minutes

to complete. The 10 subscales of family social and

environmental characteristics that FES-CV measures

are classified into three global dimensions (Moos,

1984). One dimension refers to the Social

Relationships domain, which includes the subfactors

of family cohesion (M=7.7, SD=1.9), expressiveness

(M=5.8, SD=1.7), and conflict (M=2.2, SD=1.9).

Another dimension is the Personal Growth domain,

including independence (M=5.8, SD=1.4),

achievement orientation (M=6.8, SD=1.7),

intellectual-cultural orientation (M=5.6, SD=2.1),

active-recreational orientation (M=4.9, SD=2.0),

and moral-religious emphasis (M=5.3, SD=1.4). The

third dimension is the Family System Maintenance

domain, which contains organization (M=6.7,

SD=1.8) and control (M=3.6, SD=1.8). According to

Moos and Moos (2013) (Moos, 2013), the internal

consistency reliability estimates of FES-CV had a

median of .73, which varied between .61 for

independence and .78 for cohesion, moral-religious

emphasis, and intellectual-cultural orientation. For

statistical analysis, the total score of items within

each subscale for each patient was applied.

This study collected participants’ ADHD-related

behaviours from the Chinese version of the Swanson,

Nolan, and Pelham-IV rating scale (SNAP-IV), filled

out by caregivers of patients for the purpose of

diagnosis. This 26-item rating scale measures core

ADHD symptoms defined by the Diagnostic and

Statistical Manual of Mental Disorders (DSM-5)

(Swanson, 1999) from three dimensions, including

Attention deficit (9 items), Hyperactivity/Impulsivity

(9 items), and Oppositional defiant (8 items). Each

item was rated on a 4-point Likert scale (0=not at all;

1=just a little; 2=quite a bit; 3=very much).

Therefore, scores could range from 0 to 78. The

SNAP-IV takes 10 minutes to complete. The

statistical analysis was based on the total score of

items from each dimension for each patient.

3.3 Secondary Measures

This study collected the level of general adaptive

functioning and skills of children with ADHD

through the parent form of the Adaptive Behaviour

Assessment System-version II (ABAS-II) (Harrison,

2000). It illustrates the General Adaptive Composite

(GAC) ability of children and three Domain

Composite Scores that encompasses nine adaptive

skill-related areas. This includes conceptual skills

(Communication, Functional academics, Self-

direction), social skills (Social, Leisure), and

practical skills (Self-care, Home/school living,

Community use, Health and safety, work). The

statistical analysis was based on the composite score

calculated from the raw score. The GAC score of

above/equal to 130 indicates outstanding

performance, and the score of below/equal to 70

indicates inferior performance. The ABAS-II was

rated by clinicians who are not involved in the

diagnosis and treatment of children, through

enquiring about children’s conditions from their

caregivers.

In addition, this study recorded patients’

intelligence scores from the Wechsler Intelligence

Scale for children (WISC) (Wechsler, 1949). The

measurement contains four primary index scores,

including verbal comprehension, fluid reasoning,

working memory, and processing speed. The total

score of above/equal to 130 indicates outstanding IQ,

while the score of below 40 indicates retardation of

IQ. Patients completed the test individually through

face-to-face interaction with a clinician who was

blind to the patient’s condition.

Analysis on the Inﬂuence of Family Environment on Symptoms and Functioning of Chinese Children with Attention Deﬁcit/Hyperactivity

Disorder: Based on Correlational Analysis and Independent Samples T-Test

147

3.4 Procedure

Data extraction of this research gained permission

from the Psychology department of Qingdao Women

and Children Hospital. The demographic information

of patients was concealed when the researcher went

through the archived outpatient medical records

(paper version). The researcher collected data from

patients who completed the measurements of FES-

CV, SNAP-IV, ABAS-II, and WISC, and presented

data on the Excel spreadsheet. This research carried

out the statistical analysis using the SPSS software

version 27. Independent-samples t-test was employed

to examine gender differences on attention deficit,

hyperactivity/impulsivity, and oppositional defiant

measured by SNAP-IV. The Pearson Correlation was

used to identify the relationship between FES-CV,

SNAP-IV, and ABAS-II factors.

4 RESULTS

Building on existing finding from previous

literatures, this research investigated the degree to

which family environment factors correlates with

ADHD-related behaviors and functioning of children

diagnosed with ADHD. Independent samples t-test

was applied to examine whether there were gender

differences for each of the three dimensions of

ADHD symptoms measured by SNAP-IV. As a

result, boys scored significantly higher on

hyperactivity/impulsivity (t(193)=2.95, p=.004),

Oppositional defiant (t(193)=2.12, p=.035), and the

SNAP-IV total score (t(193)=2.15, p=.033), as

compared to girls. There were no significant gender

differences for the Attention deficit dimension,

t(193)=.47, p=.64. Potential confounding effect of IQ

was also eliminated, as it was not significantly

correlated with attention deficit (r=-.09, p=.23),

hyperactivity/impulsivity (r=.05, p=.5), or

oppositional defiant (r=-.006, p=.94).

The summary statistics of subfactors under FES-

CV and SNAP-IV are illustrated on table 1. Based on

the analyses of each FES-CV subfactor, Pearson

Correlation revealed that the SNAP-IV total score

was significantly negatively correlated with cohesion

(r=-.23, p=.001), intellectual-cultural orientation

(r=-.14, p=.04), and organization (r=-.21, p=.003);

and was significantly positively correlated with

conflict (r=.22, p=.002). Findings were consistent for

attention deficit, as it also demonstrated significant

negative correlation with cohesion (r=-.15, p=.04),

intellectual cultural orientation (r=-.17, p=.02), and

organization (r=-.21, p=.003); and significant

positive correlation with conflict (r=.22, p=.002).

However, this only partially supported the

hypotheses, as attention deficit was not correlated

with expressiveness, independence, and achievement

orientation as hypothesized. In accordance with

hypotheses, oppositional defiant was significantly

negatively correlated with cohesion (r=-.26, p<.001),

expressiveness (r=-.16, p=.03), and organization

(r=-.16, p=.02); and was significantly positively

correlated with conflict (r=.24, p<.001). However,

oppositional defiant was not correlated with

independence, achievement orientation, and control

as hypothesized. Results regarding

hyperactivity/impulsivity did not support the

hypotheses of this research, as no significant

correlation was found between

hyperactivity/impulsivity and any family environment

factors.

Table 1: Summary statistics for subfactors of FES-CV and

SNAP-IV.

Measures

Subfactors

Mean (SD)

FES-CV Cohesion

Expressiveness

Conflict

Independence

Achievement Orientation

Intellectual-cultural orientation

Active-Recreational

Orientation

Moral-Religious Emphasis

Organization

Control

6.30 (2.36)

5.03 (1.70)

4.50 (2.28)

5.20 (1.43)

5.79 (1.86)

3.90 (1.88)

4.65 (2.40)

5.22 (1.58)

5.57 (2.11)

4.56 (1.97)

SNAP-IV Attention Deficit

Hyperactivity/Impulsiveness

Oppositional Defiant

16.93(5.55)

13.11(6.44)

11.09(5.89)

This study also examined the relationship

between family environment factors and patients’

adaptive behaviour, as measured by ABAS-II.

Summary statistics are illustrated on table 2. The

General adaptation ability of patients was

significantly positively correlated with cohesion

(r=.21, p=.003), intellectual-cultural orientation

(r=.39, p<.001), active-recreational orientation

(r=.27, p<.001), and organization (r=.175, p=.015).

Similar findings were generated for practical skill, in

which it also demonstrated significant positive

correlation with cohesion (r=.21, p=.003),

intellectual-cultural orientation (r=.35, p<.001),

active-recreational orientation (r=.27, p<.001),

organization (r=.17, p=.018). Conceptual skill

showed significant positive correlation with cohesion

(r=.18, p=.012), intellectual-cultural orientation

(r=.36, p<.001), and active-recreational orientation

ICPDI 2022 - International Conference on Public Management, Digital Economy and Internet Technology

148

(r=.23, p=.001). With respect to social skill, it had

significant positive correlation with cohesion (r=.20,

p=.006), intellectual-cultural orientation (r=.34,

p<.001), active-recreational orientation (r=.25,

p<.001), organization (r=.17, p=.018), as well as

moral-religious emphasis (r=.17, p=.018).

Table 2: Summary statistics for ABAS-II.

Measures Subfactors Mean (SD)

ABAS-II General Adaptation

Conceptual Skill

Social Skill

Practical Skill

88.89 (14.31)

89.70 (14.22)

87.42 (15.26)

90.47 (14.14)

Zhou et al. (2005) (Zhou, 2005) highlighted the

role of several subfactors measured by FES-CV in

contributing to the differences in behaviours between

children with and without ADHD. This includes

family cohesion, expressiveness, independence,

achievement orientation, organization, conflict, and

control. Based on the samples of children with

ADHD, the current research supported the influences

of these factors on patients’ behaviours and

functioning, except for independence. In addition to

these factors, the current research also identified the

involvement of intellectual-cultural orientation,

active-recreational organization, and moral-

religious emphasis in affecting ADHD-related

performance. Results partially supported the

hypotheses, as family environment factors did not

exhibit any influences on the

hyperactivity/impulsivity dimension measured by

SNAP-IV. Potential alternative explanations are

discussed.

5 DISCUSSION

Although the ways in which family environment

contributes to the etiology of neurodevelopmental

disorders like ADHD received extensive research,

inconsistencies in existing findings highlighted the

necessities of further replications. With certain

modifications in the methodologies, the current study

investigated the extent to which each family

environment factor correlates with each dimension of

ADHD-related symptoms and functioning, based on

the sample of Chinese children diagnosed with

ADHD. This study demonstrated the influence of

family cohesion, organization, and conflict on both

attention deficit and oppositional defiant. The most

influential family environment factor on SNAP-IV

total score was cohesion, followed by conflict, then

by organization. Cohesion, intellectual-cultural

orientation, and active-recreational orientation also

exhibited significant influence on multiple aspects of

children’s adaptive behaviours. Intellectual-cultural

orientation was the most strongly correlated factor

with children’s general adaptation, followed by

active-recreational orientation, then by cohesion.

Nevertheless, while family environment was

found to be significantly correlated with SNAP-IV

total score, attention deficit, and oppositional defiant,

it did not exhibit any significant correlation with the

hyperactivity/impulsivity dimension of ADHD

symptoms, which was discrepant from the

hypotheses and existing findings. In addition, no

relationships were generated between attention

deficit and expressiveness, independence, and

achievement-orientation as hypothesized.

Meanwhile, independence, achievement-orientation,

and control showed no significant correlation with

oppositional defiant. Potential alternative

explanations and limitations in the methodologies are

discussed.

5.1 Alternative Explanations

One possible explanation for the lack of correlation

between hyperactivity/impulsivity and family

environment factors refers to the unbalanced gender

ratio of the research sample, as there were four times

more boys as there were girls. Findings regarding

gender differences were congruent with existing

literature (Gaub, 1997), in which

hyperactivity/impulsivity was significantly more

prevalent and was rated more frequently in boys than

in girls. This suggests that the effect of family

environment factors could be confounded by the

relatively high hyperactivity/impulsivity ratings,

which may consequently distort the outcomes of

correlational analyses. In addition, as suggested by

Rhee et al. (1999) (Rhee, 1999), genetic factors are

dominant in influencing boys’ vulnerability to

experiencing hyperactivity/impulsivity, as compared

to environmental factors. Similar patterns could not

be observed on girls.

Findings did not support significant influences of

expressiveness, independence, achievement

orientation, and control on ADHD symptoms. This

could possibly be due to the sole use of FES-CV in

assessing family environment, in which subscales for

each factor vary in reliability (with independence

being the lowest). Being relied entirely on self-

reports from parents, the FES-CV measurement

outcome could involve social desirability bias

(Fisher, 1993), as parents may refuse to display

Analysis on the Inﬂuence of Family Environment on Symptoms and Functioning of Chinese Children with Attention Deﬁcit/Hyperactivity

Disorder: Based on Correlational Analysis and Independent Samples T-Test

149

possible inadequacies in their child-rearing practices

on the questionnaire. Moreover, although FES-CV

reflects the interactions between family members, it

does not control family size, socioeconomic status,

caregivers’ age, and educational background. Thus,

the comparability of parents’ ratings on family

environment factors (E.g., independence ratings for

family with 3 members vs. family with 6 members)

could be affected.

5.2 Limitations

Several inadequacies in the methodologies may

restrain the validity and reliability of findings.

Although samples recruited from the hospital covered

children attending different schools from different

regions, findings may not be generalized to children

outside the Shandong Province, where diversities of

parenting styles could be observed. The size of the

sample is limited, in comparison with the 1000

school-age children with balanced gender ratio

recruited by Khamis (2006) (Khamis, 2006). Khamis

adopted a wide range of measurements to assess the

family environment, and collected information from

multiple perspectives, including children themselves,

caregivers, and teachers. Measures were taken

includes parents’ socio-demographics (E.g.,

education, residential patterns, and household

income), children’s subjective experience of anxiety

through family interaction and degrees of satisfaction

for parental support, as well as children’s behaviour

problems rated by teachers. This enabled more

holistic and accurate analyses into how family

environment could predict ADHD performances. In

relation to the current research, measurements of

family environment and parenting styles other than

FES-CV were not available from out-patient medical

records, which implies how future studies could be

revised.

5.3 Future Investigations and

Implications

Research methodologies could be improved in further

investigations regarding the role of family

environment underlying ADHD. Larger sample with

balanced gender ratio from multiple regions in China

should be recruited. Follow-up investigations could

be conducted on children diagnosed with ADHD. A

variety of rating scales controlling parents’ socio-

demographics and patients’ personalities could be

obtained from several caregivers (E.g., grandparents)

and children themselves, to gain comprehensive

assessment of the family environment. Furthermore,

ADHD-related information could be collected from

teachers, who ideally hold better knowledge

regarding children’s attentiveness in class. Other

behavioural measurement (E.g., Child Behaviour

Checklist) (Achenbach, 1997) could be adopted in

supplement to the SNAP-IV symptom measurement,

to examine the consistency of behavioural outcomes

and enhance the validity of findings.

Through correlational analyses, the current

research provides further evidence for the influences

of family cohesion, organization, and conflict on

ADHD symptoms, in terms of attention deficit and

oppositional defiant. Findings also reveal the crucial

role of cohesion, intellectual-cultural orientation,

and active-recreational orientation underlying

children’s adaptive behaviours. In terms of

implications, the most widely adopted ADHD

interventions comprise pharmacological intervention,

behavioural intervention, and parent-training in home

settings (McGoey, 2002). After recognizing the great

influence of family environment and child-rearing

practices on the severity of ADHD symptoms, future

research could focus on whether enhancing family

cohesion and organization and reducing conflict

could lead to an alleviation of ADHD symptoms.

These modifications in the family environment could

be aided by family therapy delivered by professionals

(Everett, 2001). This would enable caregivers to

realize the critical role of themselves in influencing

children’s ADHD, as well as guide them make

improvements in parenting.

6 CONCLUSION

By conducting a correlational analysis based on

Chinese children diagnosed with ADHD, this

research investigated the extent to which family

environment influences on ADHD-related symptoms

and functioning. Possible explanations for the partial

discrepancies with hypotheses and existing findings

were discussed, which highlighted the necessity of

further investigations with modifications in

methodologies. Nevertheless, this research provided

further evidence that family cohesion is one most

critical factor underlying children’s ADHD

symptoms and related functioning. Other saliently

influential factors include organization, conflict,

intellectual-cultural orientation, and active-

recreational orientation. These findings laid a

foundation for future ADHD clinical research, in

terms of whether and how improving the environment

of families could help Chinese children alleviate

ADHD symptoms.

ICPDI 2022 - International Conference on Public Management, Digital Economy and Internet Technology

150

REFERENCES

Achenbach, T.M., & Edelbrock, C. Child behavior

checklist. Burlington (Vt), 1997(7): 371-392.

American Psychiatric Association, A. P., & American

Psychiatric Association. Diagnostic and statistical

manual of mental disorders: DSM-5. 2013(10).

Washington, DC: American psychiatric association.

Chao, R.K. Beyond parental control and authoritarian

parenting style: Understanding Chinese parenting

through the cultural notion of training. Child

development, 1994, 65(4): 1111-1119.

Chow, E.N.L., & Zhao, S.M. The one‐child policy and

parent‐child relationships: a comparison of one‐child

with multiple‐child families in China. International

Journal of Sociology and Social Policy.1996.

Everett, C.A., & Everett, S.V. Family therapy for ADHD:

Treating children, adolescents, and adults. Guilford

Press. 2001.

Faraone S.V., Perlis R.H., Doyle A.E., Smoller J.W.,

Goralnick J.J., Holmgren M.A,. Sklar P. Molecular

genetics of attention deficit/hyperactivity disorder. Biol

Psychiatry, 2005(57): 1313–13

Fei, L., Shen, Q., Zheng, Y., Zhao, J., Jiang, S., Wang, L.,

& Wang, X. Preliminary evaluation of "Family

Intimacy and Adaptability Scale" and "Family

Environment Scale"-Normal Family and Spirit A

controlled study of family members with schizophrenia.

Chinese Mental Health Journal, 1991(5).

Fisher, R.J. Social desirability bias and the validity of

indirect questioning. Journal of consumer research,

1993, 20(2): 303-315.

Gaub, M., & Carlson, C.L. Gender differences in ADHD: A

meta-analysis and critical review. Journal of the

American Academy of Child & Adolescent Psychiatry,

1997, 36(8): 1036-1045.

Harrison, P.L., & Oakland, T. Adaptive behavior

assessment system. San Antonio, TX: Psychological

Corporation. 2000.

Hinshaw, S.P. Attention deficits and hyperactivity in

children. 1994(29). Sage.

Khamis, V. Family environment and parenting as predictors

of attention-deficit and hyperactivity among Palestinian

children. Journal of Social Service Research, 2006,

32(4): 99-116.

Lange, G., Sheerin, D., Carr, A., Dooley, B., Barton, V.,

Marshall, D., & Doyle, M. Family factors associated

with attention deficit hyperactivity disorder and

emotional disorders in children. Journal of Family

Therapy, 2005, 27(1): 76-96.

Mill, J., & Petronis, A. Pre‐and peri‐natal environmental

risks for attention‐deficit hyperactivity disorder

(ADHD): The potential role of epigenetic processes in

mediating susceptibility. Journal of child Psychology

and Psychiatry, 2008, 49(10): 1020-1030.

McGoey, K.E., Eckert, T.L., & Dupaul, G.J. Early

intervention for preschool-age children with ADHD: A

literature review. Journal of Emotional and Behavioral

Disorders, 2002, 10(1), 14-28.

Moos, R. H., & Moos, B. S. Family Environment Scale

(FES) (3rd ed.). CA: Consulting Psychologists Press

Inc. 1984.

Moos, R.H., & Moos, B.S. Family environment scale.

Handbook of measurements for marriage and family

therapy, 2013(82).

Polanczyk, G., De Lima, M.S., Horta, B.L., Biederman, J.,

& Rohde, L.A. The worldwide prevalence of ADHD: a

systematic review and metaregression analysis.

American journal of psychiatry, 2007, 164(6), 942-948.

Pressman, L.J., Loo, S.K., Carpenter, E.M., Asarnow, J.R.,

Lynn, D., McCracken, J.T., & Smalley, S.L.

Relationship of family environment and parental

psychiatric diagnosis to impairment in ADHD. Journal

of the American Academy of Child & Adolescent

Psychiatry, 2006, 45(3): 346-354.

Price, M., & Raffelsbauer, D. ADHD: A true

neurodevelopmental disorder?. Medical Writing, 2012,

21(2): 114-122.

Rhee, S.H., Waldman, I.D., Hay, D.A., & Levy, F. Sex

differences in genetic and environmental influences on

DSM–III–R attention-deficit/hyperactivity disorder.

Journal of abnormal psychology, 1999, 108(1), 24.

Schroeder, V.M., & Kelley, M.L. Associations between

family environment, parenting practices, and executive

functioning of children with and without ADHD. Journal

of child and family studies, 2009, 18(2): 227-235.

Stergiakouli, E., & Thapar, A. Fitting the pieces together:

current research on the genetic basis of attention-

deficit/hyperactivity disorder (ADHD).

Neuropsychiatric disease and treatment, 2010(6): 551.

Swanson, J., Lerner, M., March, J., & Gresham, F. M.

Assessment and intervention for attention-

deficit/hyperactivity disorder in the schools: Lessons

from the MTA study. Pediatric Clinics of North

America,1999, 46(5): 993-1009.

Wechsler, D., & Kodama, H. Wechsler intelligence scale for

children. New York: Psychological corporation. 1949.

Wilcox, W.B. Conservative Protestant childrearing:

Authoritarian or authoritative?. American Sociological

Review, 1998, 796-809.

Woodward, L., Taylor, E., & Dowdney, L. The parenting

and family functioning of children with hyperactivity.

The Journal of Child Psychology and Psychiatry and

Allied Disciplines, 1998, 39(2), 161-169.

Xu, Y., Farver, J. A., Zhang, Z., Zeng, Q., Yu, L., & Cai, B.

Mainland Chinese parenting styles and parent-child

interaction. International Journal of Behavioral

Development, 2005, 29(6): 524-531.

Zhou, W., Luo, X., Wei, Z., & Zhu, Y. Personality and

behavior characteristics of children with attention

deficit disorder and hyperactivity and their family

environment. China Clinical Rehabilitation, 2005,

9(44): 72-74.

Zhou, R., Xia, Q., Shen, H., Yang, X., Zhang, Y., & Xu, J.

Diagnosis of children’s attention deficit hyperactivity

disorder (ADHD) and its association with

cytomegalovirus infection with ADHD: a historical

review. International journal of clinical and

experimental medicine, 2015, 8(8): 13969.

Analysis on the Inﬂuence of Family Environment on Symptoms and Functioning of Chinese Children with Attention Deﬁcit/Hyperactivity

Disorder: Based on Correlational Analysis and Independent Samples T-Test

151