Negative Impact of Early Morning Functioning Impairment on the Emotional Well-Being of the Family

by Dale Davison, M.Sp.Ed., PCC, BCC, ACAC | www.dale-davison.com

As coaches, we know quite a bit about ADHD/Executive Functioning and its effects on our clients and their families. Earlier studies have shown that caregivers experienced negative emotions and stress while getting their child ready for school. We also know that persistent and impairing symptoms were harmful to the parent-child relationship.

What hasn’t received much research attention to date is the specific impact of early morning functioning (EMF) impairment on the family. This study compared families with a stimulant-treated child who had ADHD with families with a child who did not have ADHD.

Results of this study show that the severity of a child’s ADHD impairments shown during the early morning get-up-get-to-school routine had a significant negative impact on the emotional well-being of all family members, an impact that extended throughout the day.

THE STUDY

Faraone, S.V., Schachar, R. J., Barkley, R. A., Nullmeier, R., and Sallee, F. R. (2017). Early morning functional impairments in stimulant treated children with attention-deficit/hyperactivity disorder versus controls: impact on the family. Journal of Child and Adolescent Psychopharmacology. Mary Ann Liebert, Inc. Online Ahead of Print: April 10, 2017 Pp. 1–8, retrieved from https://doi.org/10.1089/cap.2016.0164

WHY THIS STUDY IS IMPORTANT

EMF (Early Morning Functional) impairments can lead to academic and social difficulties for a child; EMF impairments also impact family members and their relationships with each other.

The authors concluded that in addition to changing the time of a child’s morning
medication dose (i.e., wake the child up to give the medication, then let them go back to sleep so that the medication will provide better symptom control when they finally awaken in the early morning), psychosocial treatment programs should develop modules aimed at EMF impairments (Faraone et al., p.6). Coaching can play an important role in helping families manage EMF impairments as part of the multi-modal treatment for children with ADHD.

THE METHOD

The BSFQ (Before School Functioning Questionnaire) was used in two placebo-controlled trials. A total of 300 primary caregivers of children with ADHD and 50 caregivers of children not diagnosed with ADHD were included in the trials. The children were between the ages of 6 – 17 with 68% males in the ADHD group vs. 44% males in the non-ADHD group. Prior to the study, all participating children with ADHD had been treated with stable doses of stimulants for at least three months. Comparisons were made between families of children with ADHD and parents of those without ADHD.

THE FINDINGS
The emotional well-being of the family unit is set by the tone of morning behaviors. As compared with parents of children not having ADHD, caregivers of children with ADHD were significantly more likely than caregivers of non-ADHD children to report raising their voices more often, punishing more and praising less, enjoying being with their child less, as well as feeling overwhelmed, exhausted, constantly stressed, inadequate as a parent, frustrated that the child takes so much time, and feeling guilty they were neglecting their other children. (Faraone et al., p. 3-4)

Additionally, the parents/caregivers of youth with ADHD reported:
•    More stress from sibling conflict
•    Disruption of breakfast
•    Disruption of parents’ and siblings’ morning routines
•    Greater likelihood of the family’s being late for their own morning activities
•    More conflict with spouses and partners
•    Concern about safety of child and siblings
•    Siblings complaints about child with ADHD

The study also found that there were significant correlations between the severity of the EMF impairments and the impact on the family.

Research Image

WHAT THIS STUDY HAS TO DO WITH COACHING

Coaching provides opportunities to increase positive outcomes by addressing difficulties impacting individuals and their families. Through coaching, children and/or families affected by ADHD and EMF impairments may develop strategies to address time management, working memory, self-regulation skills, sequencing, social skills, and cooperation. Such coaching may positively impact the parent-child and sibling relationships as well as the emotional well-being of all family members throughout the day. As an added bonus, addressing EMF impairments may also positively impact academic and social outcomes at school.

Questions coaches might consider as they coach individuals or families impacted by EMF impairments include:

•    How can parents positively address EMF impairments of their children so that mornings are pleasant for everyone?
•    How do we apply our coaching skills to have a positive impact on early morning behaviors, from waking to getting out the door to school?
•    What are effective ways to help our clients develop the skills and habits needed to (more) independently dress, eat, brush teeth, gather school papers and books and be ready to get out of the house on time?
•    How can we help children to discover motivation and self-rewards for these behaviors?
•    How might organizational charts or other visual prompts be used and how might we, as coaches, help children and families individualize them?
•    How might parents identity ways to change their behaviors?
•    What small steps towards new habits could be helpful?
•    How might praise be used?
•    What changes can be identified to increase positive child and family member emotions in the morning?