SYMPTOMS OF DEPRESSION IN SIBLINGS OF CHILDREN WITH ADHD BY KATHERINE A. WOLCOTT A DISSERTATION SUBMITTED TO THE FACULTY OF ALFRED UNIVERSITY IN PARTIAL FULFILLMENT OF THE REQUIRMENTS FOR THE DEGREE OF DOCTOR OF PYSCHOLOGY IN SCHOOL PSYCHOLOGY ALFRED, NEW YORK April 20, 2016 SYMPTOMS OF DEPRESSION IN SIBLINGS OF CHILDREN WITH ADHD BY KATHERINE A. WOLCOTT UNIVERSITY AT BUFFALO, B.A. (2008) ALFRED UNIVERSITY, M.A. (2010) ALFRED UNIVERSITY, CAS (2011) AUTHOR ___________________Katherine A. Wolcott_____________________________ APPROVED BY ________________Dr. Cris Lauback_________________________________ Committee Chairperson ________________Dr. Jana Atlas___________________________________ Committee Member ________________Dr. Larry Greil__________________________________ Committee Member ________________Dr. Hannah Young_______________________________ Committee Member ACCEPTED BY Mark Fugate, Ph.D. ______ Chairperson, Division of Counseling & School Psychology ACCEPTED BY Nancy J. Evangelista, Ph.D. Associate Provost & Director of Graduate Studies Dean, College of Professional Studies ACCEPTED BY W. Richard Stephens, Ph.D. Provost & Vice President for Academic Affairs Acknowledgements It is my sincere pleasure to thank those who made it possible for me to achieve my long- awaited personal goal of receiving my Doctor of Psychology degree from Alfred University. I first need to thank God for continually reminding me over the past five years that His timing is perfect and that not achieving a desired goal within my timeframe does not mean that the result was not meant to be, but rather, I was not ready for the outcome of the result. I would also like to acknowledge and thank my committee members: Drs. Jana Atlas, Larry Greil, and Hannah Young for their thoughtful guidance, expertise, and patience throughout this process. A special thank you goes out to my Committee Chairperson, Dr. Cris Lauback. Thank you for always being there to listen, encourage, and offer new suggestions/possible solutions. I truly appreciate your dedication to your students and the field of school psychology. Thank you, mom and dad for always being my biggest fans and believing in me. From an early age, you have demonstrated and instilled in me that hard work, perseverance, and an unfailing belief and love for God is always the answer. Without this guidance, I am not sure I would be where I am today. Lastly, I would like to thank my husband and best friend, Ben. Thank you for graciously dealing with the countless days, weeks, months, and years of researching and writing (not to mention tuition payments). Despite the countless setbacks, you had a way of remaining positive. You never gave up on me, and you encouraged me to keep going. iv Table of Contents Acknowledgements…………………………………………………………………………….....iv Table of Contents………………………………………………………………………………….v Abstract………………………………………………………………………………………….viii Chapter1: Introduction………………………………………………………………………….…1 Depression and Having a Sibling with ADHD……………………………...............................1 Limitations of the Reviewed Literature………………………………………………………..3 Conclusions……………………...……………………………………………………………..3 Chapter 2: Literature Review……………………………………………………………………...5 Description of Disabilities…………………………………………………………………......5 ADHD………………………………………………………………………………………5 Depression…………………………………………………………………………………..7 Past Research on the Effects of Having a Sibling with a Disability………………………….11 Depression and Having a Sibling with ADHD…………………………………………....14 Conclusions..……………………………………………………………………………….....17 Research Hypotheses…………………………………………………………………………18 Chapter 3: Method……………………………………………………………………………….19 Participants and Demographic Data….…………………………………………………..…...19 Instrumentation……………………………………………………………………………….20 Parent Measures…………………………………………………………………………...20 Demographic Questionnaire…………………………………………………………...20 Conners Rating Scale for ADHD, Third Edition, Short Form (Conners-3)….………..21 Target Participant Measures………………………………………………………………22 v Center for Epidemiological Studies Depression Scale for Children (CES-DC)……….22 Procedure……………………………………………………………………………………..22 Data Analysis…………………………………………………………………………………23 Chapter 4: Results………………………………………………………………………………..25 T-Test Results…………………………………………………………………...……………25 Regression Results……………………………………………………………………………25 Seventeen Participant Sample……………………………………………………………25 Eighteen Participant Sample……………………………………………………………..26 Sensitivity Analysis……………………………………………………………………...27 Chapter 5: Discussion……………………………………………………………………………28 Limitations……………………………………………………………………………………29 Future Research………………………………………………………………………………31 Implications for Practice……………………………………………………………………...34 Conclusion…………………………………………………………………………………….35 References………………………………………………………………………………………..36 Table 1: Participant Demographic Information……………………………………………….…40 Table 2: Independent Samples T-Test Results for CES-DC Scores……………………………..41 Table 3: Multiple Regression Results for the 17 Participant Sample…..………………………..42 Table 4: Multiple Regression Results for the 18 Participant Sample..…………………………..43 Appendices Appendix A: Demographic Questionnaire……………………………………........…………44 Appendix B: Explanation of Research & Informed Consent…....……………………………48 Appendix C: Assent for Participation………………………………….…...………………...51 vi Appendix D: Cover Letter for Parent/Guardian Questionnaires in the ADHD Group…….....53 Appendix E: Cover Letter for Parent/Guardian Questionnaires in the Control Group….....…54 Appendix F: Cover Letter for Target Participant Questionnaire…………....………………..55 Appendix G: Thank you Letter…………………………………………………………….....56 vii Abstract Having a sibling with a disability has been found to have negative psychological effects, such as depression; however, very little research has focused solely on siblings of children with attention deficit hyperactivity disorder (ADHD). The current study attempted to highlight whether siblings of children with ADHD experience depression symptomology to a greater degree than siblings of children without disabilities. Participants were included in the current study based on meeting the following criteria: target participants were between the ages of 6 and 17 with a biological sibling who may or may not carry a diagnosis of ADHD. Families came from 2 groups based on the siblings’ diagnosis. Seven families with at least 1 child with ADHD, and 11 families with all non-disabled children participated. Parents were asked to complete an informed consent and demographic questionnaire, as well as the Conners Rating Scale for ADHD, Third Edition, Short Form (Conners-3) on the target participant to ensure that he/she did not meet the diagnostic criteria for ADHD. Target participants were asked to complete an assent form, as well as the Center for Epidemiological Studies Depression Scale for Children (CES-DC). Two multiple regressions were completed. Results, omitting a statistical outlier within the group consisting of families with a child with ADHD, indicated that siblings of non-disabled children experienced more symptoms of depression than siblings of children with ADHD; however, results including the statistical outlier indicated that both groups of siblings experience similar symptomology of depression. Both results were contrary to the researcher’s hypothesis. Given the small sample size of the current study, the individuals that participated in the study may not be a representative sample, and additional research is therefore needed. Overall, the findings of the current study will guide researchers in further investigating this most important topic, and therefore, addressing how to better support families with children with ADHD. viii DEPRESSION IN SIBLINGS OF CHILDREN WITH ADHD 1 Chapter 1: Introduction To date, there is an abundance of empirically-based literature highlighting the negative psychological effects of having a sibling with a disability (Bågenholm & Gillberg, 1991; Breslau & Prabucki, 1987; Coleby, 1995; Fisman, Wolf, Ellison, & Gillis, 1996; Gold, 1993; Kendall, 1999; Lyons-Sjostrom, 2004; Macks & Reeve, 2006; McHale & Gamble, 1989; Petalas, Hastings, Nash, Lloyd, & Dowey, 2009; Rossiter & Sharpe, 2001; Singer, 1997). For instance, siblings of children with autism (Bågenholm & Gillberg, 1991; Fisman et al., 1996; Gold, 1993; Macks & Reeve, 2006), as well as those with attention deficit hyperactivity disorder (ADHD) (Kendall, 1999; Singer, 1997) have often exhibited greater symptoms of depression than siblings of non-disabled children. Given that Individualized Family Service Plans (IFSPs) are meant to support families of children with disabilities, and school psychologists are tasked with understanding family influences that shape student wellness and academic achievement, it is imperative that service providers have an understanding of the issues faced by siblings of children with disabilities (American Legion Child Welfare Fund, 2009; Thomas & Grimes, 2008). Depression and Having a Sibling with ADHD Since the early 1980s, a large body of research has developed regarding the effects of having a sibling with a disability. Researchers have assessed numerous characteristics of the non- disabled sibling, including his/her self-concept, behavior, locus of control, self-efficacy, symptoms of depression, relationship with the sibling with a disability, and parentification. Much of the research is split or more supportive of the theory that siblings of children with disabilities are no different than siblings of non-disabled children, with the exception of depressive symptomology. It appears that the majority of research supports the premise that siblings of DEPRESSION IN SIBLINGS OF CHILDREN WITH ADHD 2 children with disabilities exhibit more symptoms of depression than siblings of non-disabled children (Stoneman, 2005). Although there have been significantly fewer studies that have assessed symptoms of depression in siblings of children with ADHD than studies addressing siblings of children with autism (Bågenholm & Gillberg, 1991; Fisman et al., 1996; Gold, 1993; Macks & Reeve, 2006; Petalas et al., 2009), existing research has shown that siblings of children with ADHD often suffer from symptoms of depression (Kendall, 1999; Singer, 1997). Kendall (1999) conducted a qualitative study focusing on an individual’s interpretation of interactions with others to examine how siblings of children with ADHD cope with having a sibling with a disability. Results revealed that siblings of children with ADHD regarded disruption, such as aggression, hyperactivity, immaturity, limited academic achievement, learning problems, family conflict, and poor relationships with peers and extended family members, caused by the symptoms of ADHD, as the most significant problems. Kendall (1999) also discovered that siblings of children with ADHD often experienced disruption through sorrow and loss. Non-disabled siblings identified what they thought they missed out on in life because of having a sibling with ADHD (i.e., having a typical childhood), and they indicated that they felt as though they were expected to be invisible and not require a lot of attention because their parents were preoccupied with their sibling with ADHD. Similarly, Singer (1997) conducted a qualitative study focusing on life experiences of individuals to explore the effects of having a sibling with ADHD. Results indicated that 50% of siblings endorsed arguing and fighting with his/her sibling as common aspects of everyday life. It was also revealed that sibling and parent-child power struggles using manipulation and intimidation frequently occurred within families. In addition, many siblings described the limited parental attention they receive, double standards that exist, and the high parental expectations to