Prospective study on the impact of parental anxiety on academic performance in children with attention deficit

Table 1 Baseline demographic and clinical characteristics (n = 118)

Characteristics	n (%) or mean ± SD
Child characteristics
Age (year)	8.3 ± 1.9
Sex
Male	72 (61.0)
Female	46 (39.0)
Race/ethnicity
White/Caucasian	54 (45.8)
Black/African American	28 (23.7)
Hispanic/Latino	24 (20.3)
Asian	8 (6.8)
Multiracial	4 (3.4)
ADHD presentation
Combined	68 (57.6)
Inattentive	38 (32.2)
Hyperactive-impulsive	12 (10.2)
Comorbid conditions
Oppositional defiant disorder	50 (42.4)
Anxiety disorders	34 (28.8)
Learning disabilities	23 (19.5)
Depression	8 (6.8)
Full scale IQ	98.4 ± 12.6
Medication status
Stimulant	76 (64.4)
Non-stimulant	18 (15.3)
No medication	24 (20.3)
Parent characteristics
Primary caregiver
Mother	94 (79.7)
Father	12 (10.2)
Both parents equally	12 (10.2)
Parental education
Less than high school	8 (6.8)
High school diploma	22 (18.6)
Some college	34 (28.8)
Bachelor's degree	36 (30.5)
Graduate degree	18 (15.3)
Family structure
Two-parent household	78 (66.1)
Single parent	32 (27.1)
Other arrangement	8 (6.8)
Annual household income (USD)
< 25000	16 (13.6)
25000-50000	28 (23.7)
50000-75000	32 (27.1)
75000-100000	24 (20.3)
> 100000	18 (15.3)
Baseline measures
PSI-4 total stress (percentile)	78.6 (18.2)
Parent domain	76.4 (19.8)
Child domain	80.2 (16.5)
Parental anxiety scale	62.4 (14.3)
Academic performance	2.1 (0.8)
WJ-IV standard score	89.6 ± 13.2

WJ-IV: Woodcock-Johnson Tests of Achievement, Fourth Edition.

Table 2 Multilevel models predicting academic performance over time, β (SE)

Parameter	Model 1 unconditional	Model 2 main effects	Model 3 full model
Fixed effects
Intercept	2.14 (0.07)a	3.82 (0.24)a	3.96 (0.28)a
Time (6-month intervals)	0.08 (0.03)b	0.06 (0.03)c	0.05 (0.03)
Parental anxiety (PSI-4)	-	-0.42 (0.08)a	-0.38 (0.09)a
Time × parental anxiety	-	-0.04 (0.02)c	-0.03 (0.02)
Child age	-	-	0.08 (0.04)c
Child sex (female)	-	-	0.22 (0.10)c
ADHD severity	-	-	-0.28 (0.07)a
Medication use	-	-	0.18 (0.11)
Family income	-	-	0.12 (0.05)c
Comorbid anxiety	-	-	-0.16 (0.11)
Comorbid ODD	-	-	-0.24 (0.10)c
Random effects
Level 2 (between-person)
Intercept variance	0.48 (0.08)a	0.36 (0.07)a	0.28 (0.06)a
Slope variance	0.24 (0.06)a	0.22 (0.06)a	0.21 (0.05)a
Level 1 (within-person)
Residual variance	0.32 (0.04)a	0.28 (0.03)a	0.26 (0.03)a
Model fit
AIC	1426.8	1398.2	1376.4
BIC	1445.3	1428.6	1436.8

^aP < 0.001.

^bP < 0.01.

^cP < 0.05.

PSI-4: Parenting Stress Index-4; ADHD: Attention deficit hyperactivity disorder; ODD: Oppositional defiant disorder; AIC: Akaike information criterion; BIC: Bayesian information criterion.

Table 3 Group differences based on parental anxiety levels, mean (SD)

Outcome	Low anxiety (n = 42)	Moderate anxiety (n = 48)	High anxiety (n = 28)	F-statistic
Baseline
Academic performance (APQ)	2.6 (0.7)	2.1 (0.6)	1.5 (0.6)	18.42a
WJ-IV standard score	96.2 (11.4)	89.8 (12.6)	81.4 (13.8)	12.36a
GPA	3.1 (0.6)	2.7 (0.7)	2.2 (0.8)	14.28a
36-month follow-up
Academic performance (APQ)	3.2 (0.6)	2.5 (0.7)	1.8 (0.7)	26.84a
WJ-IV standard score	98.6 (10.8)	91.2 (13.2)	82.6 (14.4)	14.92a
GPA	3.3 (0.5)	2.8 (0.7)	2.1 (0.9)	22.16a
Change scores
Academic performance	+0.6 (0.4)	+0.4 (0.5)	+0.3 (0.6)	3.84c
WJ-IV standard score	+2.4 (4.2)	+1.4 (5.6)	+1.2 (6.8)	0.52
GPA	+0.2 (0.3)	+0.1 (0.4)	-0.1 (0.5)	5.62b

^aP < 0.001.

^bP < 0.01.

^cP < 0.05.

WJ-IV: Woodcock-Johnson Tests of Achievement, Fourth Edition; APQ: Academic Performance Questionnaire; GPA: Grade point average.

Table 4 Mediation analysis results

Path	Estimate (SE)	95%CI	P value
Total effect
Parental anxiety - academic performance	-0.42 (0.08)	-0.58 to -0.26	< 0.001
Direct effect
Parental anxiety - academic performance	-0.09 (0.09)	-0.27 to 0.09	0.317
Indirect effects via parent-child interaction
Parental anxiety - P-C interaction	-0.36 (0.07)	-0.50 to -0.22	< 0.001
P-C interaction - academic performance	0.48 (0.10)	0.28 to 0.68	< 0.001
Indirect effect	-0.18 (0.04)	-0.26 to -0.10	< 0.001
Indirect effects via homework supervision
Parental anxiety - homework quality	-0.28 (0.06)	-0.40 to -0.16	< 0.001
Homework quality - academic performance	0.52 (0.11)	0.30 to 0.74	< 0.001
Indirect effect	-0.15 (0.04)	-0.22 to -0.08	< 0.001
Total indirect effect	-0.33 (0.06)	-0.45 to -0.21	< 0.001
Proportion mediated (%)	78.6

Table 5 Moderation effects on the parental anxiety-academic performance relationship

Moderator	β (SE)	95%CI	P value
Child age	-0.06 (0.03)	-0.12 to -0.01	0.042
Child sex (female × anxiety)	0.14 (0.06)	0.02 to 0.26	0.021
ADHD severity	-0.08 (0.04)	-0.16 to -0.01	0.038
Comorbid anxiety	-0.12 (0.05)	-0.22 to -0.02	0.018
Family income	0.09 (0.04)	0.01 to 0.17	0.026
Two-parent household	0.16 (0.07)	0.02 to 0.30	0.024

ADHD: Attention deficit hyperactivity disorder.

Table 6 Effects of parental anxiety on specific academic domains

Academic domain	β (SE)	95%CI	P value
Reading achievement	-0.34 (0.09)	-0.52 to -0.16	< 0.001
Mathematics achievement	-0.46 (0.10)	-0.66 to -0.26	< 0.001
Written expression	-0.38 (0.09)	-0.56 to -0.20	< 0.001
Homework completion	-0.52 (0.08)	-0.68 to -0.36	< 0.001
Classroom attention	-0.41 (0.09)	-0.59 to -0.23	< 0.001
Test performance	-0.48 (0.10)	-0.68 to -0.28	< 0.001

Table 7 Clinical outcomes by parental anxiety level, n (%)

Outcome	Low anxiety	Moderate anxiety	High anxiety	χ²
Meeting grade-level standards	36 (85.7)	28 (58.3)	8 (28.6)	24.16a
Requiring academic support services	12 (28.6)	26 (54.2)	22 (78.6)	18.42a
Individualized education program/504 plan	14 (33.3)	24 (50.0)	20 (71.4)	10.28b
Grade retention (over 3 years)	2 (4.8)	6 (12.5)	8 (28.6)	8.64c
Disciplinary actions	8 (19.0)	16 (33.3)	14 (50.0)	7.82c

^aP < 0.001.

^bP < 0.01.

^cP < 0.05.