All three cardinal symptoms of attention deficit hyperactivity disorder (ADHD) describe impaired stimulus control over behavior. Children with ADHD require more frequent and explicit behavioral cues from others and thereby increase parental stress. Both self-control deficits and parental stress manifest depending on the situation and possess intra-individual variability. Common measures of externalizing behavior and parental stress rarely address this and target generalized impressions instead. Intraindividual differences in externalizing and stressful child behavior can be assessed with a family situations inventory including two rating scales. It rests on the HSQ and supplements the original with a parental stress scale. Method: Parents of children with (male = 204, female = 33; mean = 8.6 years) and without confirmed ADHD (male = 206, female = 155; mean = 7.6 years) took part. They were asked to rate 16 family situations concerning the extent of child externalizing behavior and their own associated stress. Three established scales (CBCL, PSI, BAP) were employed in the clinical sample to determine the external validity of the German HSQ adaption. Results: Both HSQ scales share the same two-factorial structure with satisfying explained variance (56.02–60.38%) and acceptable external and discriminant validity. “Accomplishments” (factor 2) discriminates better than “agreeableness” (factor 1) between children with and without ADHD. Discussion: “Accomplishments” refers to behavior in regularly recurring situations and demands rule following. Parental stress associated with child externalizing behaviors in family situations appears to represent regulation load rather than mental load.

Symptomatic externalizing behaviors in attention deficit hyperactivity disorder (ADHD) can only be described in relation to environmental stimuli. Inattentive and hyperactive-impulsive behavior do not correspond to relevant stimuli such as rules. It is less a matter of isolated behavior and more one of describing its functional relations to situative environmental stimuli [Barkley, 1989, p. 204]. Children with ADHD do what they should not do in a given situation and do not do what they should do in the situation. In ADHD, the target behavior scheduled for reinforcement under given antecedent conditions (e.g., compliance with rules or instructions) rarely occurs “on its own.” There is a consensus that ADHD is a deficit of self-regulation [Barkley, 1997a; Christiansen, 2016; Nigg, 2017]. Like other nouns with the prefix “self-,” self-regulation poses conceptual difficulties. Mentalistic definitions and the assumption of a controlling homunculus have sparked criticism [Bördlein, 2016; Baum, 2017; Reinecke et al., 2018; Perez Alvarez, 2021]. They prompt the desire to return to a behaviorally oriented conceptual framework that lends itself to the experimental analysis of dependent and independent variables. From this viewpoint, self-regulation refers to manipulating the variables of which one’s own behavior is a function [Hartig, 1973; Kanfer and Goldstein, 1977; Barkley, 2001].

In complex or conflictual situations, a precurrent behavior modifies the variables governing subsequent behavior and performs a controlling (“executive”) function [Skinner, 1953; O’Leary and Dubey, 1979; Pierce and Cheney, 2017]. Executive functions denote a class of behavior for modifying the prevailing antecedent or executive control [Barkley, 2001; Egger et al., 2007]. For example, (1) inner speech generates and maintains stimuli, such as rules, relevant to a target behavior [Hayes et al., 1996; Barkley, 2012]. (2) Looking or listening carefully, including self-observation, intensifies stimuli. (3) Active waiting (for example, by counting to 10) weakens the influence of emotionally significant and “alluring” stimuli and has an inhibitory effect. Executive dysfunctions, on the other hand, promote behavior driven by momentary contingencies rather than antecedent stimuli. Longitudinal studies have shown that executive dysfunctions in early childhood predict a later diagnosis of ADHD [Berlin et al., 2003; Sjöwall et al., 2017]. Children with ADHD cannot themselves generate the conditions for situation-appropriate target behavior. Therefore, their behavior is strongly under the control of immediate contingencies and displays high situational dependency [Barkley, 1989, 1994, 1997; Rommelse et al., 2015].

The Home Situation Questionnaire (HSQ) was developed to elucidate the situational variability in behavior at home by those with ADHD in a time-efficient manner, and has been repeatedly adapted ever since [Barkley, 1981, p. 133; Barkley and Edelbrock, 1987; Altepeter and Breen, 1989, 1992; DuPaul and Barkley, 1992; Breuer and Döpfner, 1997; Lauth and Heubeck, 2006]. In the original version, the HSQ specifies 16 standard family situations and captures the problem behavior that occurs [Barkley, 1981, p. 133]. A rating scale for the occurrence and extent of situation-specific problem behavior is used for this purpose. First, the parents are asked “yes” or “no” questions about the occurrence of problem behavior in a given situation. If the answer is “yes,” the parents are asked to rate the extent of the problem behavior on a 9-point scale (1 = weak to 9 = very strong). Although designated as a questionnaire, the HSQ can be described more precisely as a family situations inventory with a rating scale. Subsequent adaptions of the HSQ diverge from the original scale but draw on the established family situation inventory. The target variable in the original version of the scale is externalizing rather than just attentional or internalizing behavior [Altepeter and Breen, 1992, p. 724]. In line with this, the scale version used in the German-language HSQ is directed at the child’s externalizing behavior [Lauth and Heubeck, 2006]. Another scale captures the parental stress associated with the child’s externalizing behavior in the 16 family situations.

With the expanded scale, the German-language adaptation takes into account the state of research on parental stress: numerous studies, including meta-analytical ones, document the influence of childhood ADHD on parental stress [Johnson and Reader, 2002; Miranda et al., 2007; Graziano et al., 2011; Theule et al., 2011, 2013; Ciesielski et al., 2020]. Questionnaires and checklists are the predominant measures of parental stress with ADHD. These aim at giving a global impression of externalizing behavior and parental stress that is generalized across different situations. Generalized parental judgments are suitable for the categorial diagnosis of ADHD and large-scale comparisons between groups. Collapsing ratings across time and situations may confer a disadvantage [Altepeter and Breen, 1989]. These include the lack of information about situational variability in externalizing behaviour and stress. Theoretical statements about disorders and stress highlight the need for a situational assessment of children’s externalizing behavior and associated parental stress. Like the disorder of self-regulation, parental stress exceeds the manifestation threshold in some situations but not others. According to the transactional stress model, stress varies as a function of situational conditions [Lazarus, 1999]. The factorial validity of the scales of the German-language family situations inventory has so far not yet been checked.

All scale versions of the HSQ that have been subjected to a factor-analysis differ from this German-language adaptation. Just as the adaptations and scale versions of the HSQ differ, so do the results of factor analysis. When interpreting the previously reported factor solutions, there are also a number of methodological limitations to consider. In an examination of the original version, four factors were identified with an overall explained variance of 57% (principal factor analysis, varimax rotation) [Breen and Altepeter, 1991]: (1) interaction with people outside the family (e.g., when visitors come, when the parents are on the phone); (2) home situations in which the child is expected to meet expectations (e.g., at mealtimes, at bedtime); (3) tasks and duties that the child is expected to perform (e.g., doing homework, helping with household chores); (4) situations in which the child is engaged alone (e.g., playing alone, watching television). Parental ratings of problem behavior have been obtained for a total of 955 children. However, it is a non-clinically sample and the factor structure obtained does not necessarily apply to children with ADHD. The factor naming also says little about the common underlying properties of factor-analytically bundled problem behavior in the different family situations.

A German-language adaptation was tested for the first time using factor analysis in a clinical sample of 76 children with ADHD [Breuer and Döpfner, 1997]. The result was a three-factor solution with an explained variance of 41.2%: (1) interaction with people in the home (e.g., when the father is at home, when the child is supposed to be doing something; explained variance 23.7%); (2) interactions with people outside the family (e.g., when visitors come, when you visit others; explained variance 7.1%); (3) behavioral expectations of the child (e.g., when washing and bathing, when dressing and undressing; no information on explained variance). However, the authors rightly problematize their unstable factor structure. Their scale version also differs considerably from the original and captures “any” problem situations [Breuer and Döpf­ner, 1997]. In another factor analysis, both the scale version and the situational inventory differ from the original [DuPaul and Barkley, 1992]. In this case, the scale version of the HSQ captures attention- or concentration-related problems in 14 family situations. Parents of 625 typically developing children were asked to rate the problem occurence and -severity in each situation. Two factors of child attentional or concentrative problems in family situations were extracted which explain 59% of the variance. All 14 items with loadings of at least 0.60 and 52% of the variance can be attributed to factor 1. Basically, a single-factor solution was found.

Research Rationale

In sum, the previous factor analyses have examined different scale versions of the HSQ and each has methodological limitations. These include: (1) the inventory survey format used, with a two-option answer modality, that leads to numerous missing values. (2) There were either small clinical samples [Breuer and Döpfner, 1997] or children without confirmed ADHD [Breen and Altepeter, 1991; DuPaul and Barkley, 1992]. Such discrepant and methodologically debatable findings provide the research rationale for an exploratory factor analysis on a broader empirical level. Indeed, the inconsistent findings do not allow the formation of hypotheses on the factor structure and pose the need for an explorative analysis. However, a cautious hypothesis can be derived from the situation-dependent manifestation of children’s self-regulation deficits associated with parental stress: children’s externalizing behavior and associated parental stress in family situations are based on the same factor structure. In addition to this hypothesis, the present work examines the construct and criterion validity of the exploratively obtained factor structure, using correlation, discrimination, and variance analysis.

Sample

A total of 598 children aged 6 to 12 were each rated by their primary caregiver (see Table 1). Depending on whether there was a confirmed ADHD diagnosis, this total sample was first subdivided into a clinical and a typically developing group. In addition to the required ADHD diagnosis, children from the clinical group may also have comorbidities and differ in their pharmacological treatment. Therefore, the clinical subsample was stratified based on comorbidities (yes/no) and medication (yes/no). According to information provided by the parents, the typically developing children have neither ADHD nor any other disorder requiring treatment.

Table 1.

Personal characteristics of the sample

 Personal characteristics of the sample
 Personal characteristics of the sample

Clinical Sample: Children with a Confirmed ADHD Diagnosis (n = 237)

As part of a multicenter German Research Foundation project on parent-centered interventions, this subsample was recruited from four child and adolescent psychiatric facilities in North Rhine-Westphalia. Psychologists on the scientific project staff there clarified the following inclusion and exclusion criteria and were responsible for the relevant and guideline-compliant diagnostics.

Inclusion criteria

1. Age of parents ≥18 years

2. Responsibility and legal capacity of parents

3. The diagnosis of the child according to the Diagnostik-System für psychische Störungen im Kindes- und Jugendalter (Diagnostic System for Mental Disorders in Children and Adolescents, DISYPS) is ADHD

4. The child is between the ages of 6 and 11

5. The parents and children have given their consent

Exclusion criteria

1. Parental or child participation in other interventional procedures that may interfere with this study

2. The primary caregiver is in psychotherapeutic treatment

3. The subjects are in a dependent or employment relationship with the sponsor or one of the participating institutions

4. Diagnosis of the child according to DISYPS is a pervasive developmental disorder

5. The presence of several manifest critical life events according to DSM-IV-TR (Interview to Assess Psychosocial and Environmentally Determined Problems Based on DSM-IV-TR)

6. The parents are of sound mind, have a command of the German language, and are not subject to any physical or mental limitations in understanding or implementing the training content

7. Insufficient parental resources to implement the training content

According to the inclusion and exclusion criteria, a multi-stage guideline-compliant diagnosis was performed on two consecutive dates. It included a case history of the illness, an examination of the parents, a report from the teacher and a self-report from the child, elucidation of the behavioral symptoms, and a concluding pediatric psychiatric examination. The DISYPS-KJ was used for the standardized evaluation of the disorder-specific and comorbid diagnostic status according to ICD-10 [Döpfner and Lehmkuhl, 2003]. This showed that 66.2% of the children had a comorbid disorder (e.g., oppositional defiant disorder).

At the time of data collection, no interventions other than medication were occurring. A total of 60.8% of the children included in the sample were receiving pharmacotherapy with methylphenidate.

Control Sample: Children without ADHD or Other Externalizing Behaviors (n = 361)

German and Austrian schools were contacted for recruitment of the sample and calls for participants were published in online forums. The parents were informed about the aim of the study and were guaranteed that their participation was voluntary and that the data were collected and processed anonymously. A non-clinical diagnostic and treatment status of the children according to the primary caregiver was defined as an inclusion criterion. None of the children in this sample were receiving psychological, psychotherapeutic, or psychiatric treatment at the time of the survey. At the schools, the questionnaire was handed out by teachers to parents. Parents recruited through the online forums filled out the questionnaire in the online format.

In both samples, the scales treated as dependent variables were filled out by the primary caregivers. Mostly the mothers performed this function and provided the data described under “dependent variables” (n = 544 out of 598). Of these, 19.6% (parents of children with ADHD) and 23.3% (parents of children with a non-clinical (typically developing) diagnostic status) were single parents. In 75% of the participating families, the affected child has another sibling.

Independent and Dependent Variables

Diagnostic status is studied as the independent variable of externalizing and stressful behavior in family situations. Depending on the objective, diagnostic status is either coded in binary (clinical vs. non-clinical) or the ADHD is divided into four levels (1. exclusively ADHD, 2. medicated ADHD, 3. comorbid ADHD, and 4. comorbid and medicated ADHD). The child’s primary caregiver rated the following as dependent variables in both groups:

  • Family situations inventory with rating scales for a child’s externalizing behavior and associated parental stress [Lauth and Heubeck, 2006, p. 47; see above]. Instructions: “First, please indicate how unusual your child’s externalizing behavior is in the situations described. Then state how much this bothers you.” According to the instructions, the severity of the child’s externalizing behavior in the individual situations is assessed on a 10-point scale (from 1 = little to 10 = very severe; maximum score 160). Parental stress associated with the behavior in the situation is then assessed on a 10-point scale (from 1 = little to 10 = very severe; maximum score 160).

In the group of children with a confirmed ADHD diagnosis, the following dependent variables were also captured:

  • Total score on the Child Behavior Checklist (CBCL) [Arbeitsgruppe Deutsche Child Behavior Checklist et al., 1998]. The questionnaire comprises a total of 113 items. It was filled out by the primary caregiver. Each item has 3 possible answers (not applicable = 0, sometimes applicable = 1, exactly or often applicable = 2; maximum possible score 226).

  • Total score on the Eltern-Belastungs-Inventar (Parenting Stress Index, EBI) [Tröster, 1999]. This is an inventory of self-reported parental stress. Parents indicate their agreement with the items on a 5-point response scale (agree completely = 5, agree somewhat = 4, not certain = 3, disagree somewhat = 2, disagree completely = 0). In the short form used here, the inventory comprises 67 items divided into 14 subscales.

  • “Challenge posed by the child” scale from the EBI [Tröster, 1999]. The scale consists of four items (e.g., “It is harder to care for my child than for most children”; “My child does some things that are very challenging for me”; “My child makes more demands on me than other children do on their parents”). The items are answered on a 5-point scale (“does not apply at all” to “applies completely”) and the range of scores is from 4 to 20.

  • The “Child’s adaptability” scale from the EBI [Tröster, 1999] consists of six items (e.g., “My child reacts very strongly when something happens that he/she doesn’t like”; “My child finds it harder than other children to adapt to changes in the daily routine or in the home environment”), which are answered on a 5-point scale (see above); the range of scores is between 6 and 30.

  • “Acceptability of the child’s characteristics and behavior” scale from the EBI [Tröster, 1999]. The scale comprises five items (e.g., “Sometimes it bothers me that my child does not learn things as quickly as other children”; “Sometimes I have the feeling that my child does not smile as often as other children”), which are answered on a 5-point scale; the range of scores is between 4 and 20.

  • Being a Parent (BAP) [Heubeck and Russell, 1998]. This surveys parental perceived self-competence. The questionnaire comprises 23 items. The parents were asked to rate their parenting skills on a 5-point Likert scale (“strongly agree” to “don’t agree at all”) (e.g., “My children know exactly where they stand with me”; “As a mother/father I am very consistent: What I say is what I do”; “Sometimes I lose control of myself with my child/my children and later I regret it”). The scores could range between 1 and 115.

Statistical Evaluation Methods

SPSS 25 was used for statistical data analysis and missing values were excluded on a case-by-case basis.

  • Factor analysis of the structure of externalizing and stressful behavior in family situations. The factorial validity of the two scales of the family situation inventory [Lauth and Heubeck, 2006, p. 47] has not been tested up to now. Previously published factor analyses refer to different versions of the instrument, which differ greatly from the original. This paper draws from this its rationale for an exploratory factor analysis. Separate factor analyses were calculated for externalizing behavior and stress within the total sample. A principal component analysis with varimax rotation was used to determine the factor structure. The Kaiser-Maier-Olkin (KMO) criterion and Bartlett’s test were used to check the metrological requirements: the KMO is used to ascertain the suitability of the intercorrelation matrix and a correlation coefficient of 0.90 or higher is classified as very good [Kaiser and Rice, 1974]. Both childhood externalizing behavior (KMO criterion = 0.94; Bartlett test: χ2 = 5,271.92; df = 120; p < 0.001) and parental stress (KMO criterion = 0.94; Bartlett test: χ2 = 4,495.81; df = 120; p < 0.001) met these requirements.

  • Descriptive statistical scale analysis or item analysis of the internal consistency and item discriminatory power of the obtained factors. The Cronbach’s alpha of the factors and the discriminatory power of the relevant items were ascertained.

  • Correlation analyses to check the construct validity of the identified factor structure. In the clinical sample, the factor-specific scores for externalizing and stress were correlated with the results of the above-mentioned scales.

  • Discriminant analyses to check the discriminant validity of the identified factor structure. Univariate discriminant analyses were performed with regard to the differentiation of the two samples (clinical vs. non-clinical). A discriminant analysis was calculated for each of the factors on the externalizing behavior scale and the stress scale of the family situation inventory. As a distribution-free test, this assumes neither multivariate normal distribution nor variance or covariance homogeneity, and therefore does not require parametric prerequisite checking.

Factor-specific bundled scores for childhood externalizing behavior and parental stress represent the (independent) characteristic variable. The Wilks Lambda quality measure is used to assess the discriminatory power of the discriminant function.

  • Simple analyses of variance for between-group comparison of the mean externalizing or stress scores for factors. Factor-specific externalizing behavior and stress scores were each processed with a simple ANOVA with post-hoc multiple comparisons between the five groups. These are the five groups based on diagnosis and treatment status (including medication and comorbidity): children without ADHD, children with ADHD, children with ADHD on medication, children with ADHD and comorbid disorder, children with ADHD and comorbid disorder on medication (see Table 6).

Factor Structure of the Externalizing Behavior and Stress Scale of the Family Situations Inventory

The Kaiser-Guttman criterion was applied for extracting the factors, and accordingly an eigenvalue of ≥1 was assumed [Kaiser, 1960]. On each of the two scales, this criterion is met by two components and a two-factor solution is therefore assumed (factor 1: agreeableness; factor 2: accomplishments). With an explained variance of 60.4% (externalizing behavior) and 56.02% (parental stress), the factor structure can be considered satisfactory. Table 2 shows the respective factor loadings for the two scales.

Table 2.

Exploratory factor analysis with varimax rotation for the externalizing behavior and stress scale across the total sample (N = 598)

 Exploratory factor analysis with varimax rotation for the externalizing behavior and stress scale across the total sample (N = 598)
 Exploratory factor analysis with varimax rotation for the externalizing behavior and stress scale across the total sample (N = 598)

There are high correlations between the subscales of externalizing behavior and stress determined by factor analysis. For “agreeableness,” the values for externalizing and stress correlate with 0.926 (N = 531, p < 0.001), for “accomplishments” with 0.948 (N = 584, p < 0.001).

Internal Consistency of Factors and Item Discriminatory Powers with Part-Whole Correction

Both factors show high internal consistency according to Cronbach’s alpha (see Table 2) and contain items with discriminatory power (see Table 3).

Table 3.

Discriminatory power with part-whole correction of the items on factor level (total sample)

 Discriminatory power with part-whole correction of the items on factor level (total sample)
 Discriminatory power with part-whole correction of the items on factor level (total sample)

Factor Naming

The following items load high on factor 1 of the externalizing behavior and parental stress scale and share a commonality that substantiates their denomination: Item 09: when you are visiting somewhere else; Item 08: when you have visitors; Item 01: when the child is playing; Item 02: when the child is playing with others. These are descriptions of interactive events without circumscribed target behavior or uniformly defined expectations. Rather, the interactions are variable and require the child to make flexible adjustments and/or learn to discriminate. For example, the child receives positive feedback from the neighbors for his funny stories. When visiting work colleagues, the same behavior may incur a reprimand. In this respect, factor 1 consists of socially disruptive behavior by children in their interactions. The following items load high on factor 2 and describe situations with a certain target behavior: Item 13: when the child is supposed to help around the house; Item 04: when dressing and undressing; Item 05: in the bathroom. These are regularly recurring and task-oriented situations with defined expectations and corresponding instructions from the parents. Externalizing and stressful behavior in these situations pertains to the child’s discipline problems.

Construct Validity of the Factor Structure of the Externalizing and Stress Scales of the Family Situations Inventory

The correlations with the CBCL total score as well as the “child’s adaptability” and the “challenges posed by the child” (EBI in each case) are medium-high; there are only low correlations with the scales “acceptability of the child’s idiosyncrasies and behaviors” and “depression in the primary caregiver” (EBI) (Table 4).

Table 4.

Correlations in the group of “children with a confirmed ADHD diagnosis” (n = 237)

 Correlations in the group of “children with a confirmed ADHD diagnosis” (n = 237)
 Correlations in the group of “children with a confirmed ADHD diagnosis” (n = 237)

Univariate Tests of the Discriminatory Property of the Externalizing Behavior and Parental Stress Scores for Individual Factors

The χ2 test statistic for the significance testing of the discriminant functions was calculated based on the Wilks Lambda quality measure (see Table 5).

Table 5.

Univariate tests of the discriminatory property of externalizing behavior and parental stress scores for individual factors

 Univariate tests of the discriminatory property of externalizing behavior and parental stress scores for individual factors
 Univariate tests of the discriminatory property of externalizing behavior and parental stress scores for individual factors

According to the simple Welch ANOVAs, there are significant differences in externalizing between groups for the first factor (Welch’s test F(4, 98.91) = 57.83, p < 0.001) and the second factor (Welch’s test F(4, 109.02) = 135.56, p < 0.001). The scores for factor 1 (Welch’s test F(4, 93.75) = 73.45, p < 0.001) and factor 2 (Welch’s test F(4, 107) = 140.79, p < 0.001) for parent stress also differed significantly between the groups. The individual group differences were broken down using Games-Howell post-hoc tests with significance level under Bonferroni adjustment (<0.0026) (see Table 6): in comparison, the typically developed group achieved the lowest scores for both factors of the externalizing behavior and stress scales. Only those children with ADHD and those with an additional comorbid and/or medication status do not differ significantly from one another in externalizing or stress scores. Measured by effect size, the externalizing and stress scores for factor 2 differ especially between the groups.

Table 6.

Results of the Games-Howell post-hoc test for multiple comparisons between group means

 Results of the Games-Howell post-hoc test for multiple comparisons between group means
 Results of the Games-Howell post-hoc test for multiple comparisons between group means

In line with the tentative assumption, children’s externalizing behavior and the resulting parental stress in family situations are based on an identical factor structure, which is comprised of “agreeableness” and “accomplishments” and explains 60.38% of the variance in externalizing and 56.02% in stressful behavior. Both factors show a high internal consistency according to Cronbach’s alpha and contain items with discriminatory power. However, the discriminatory power of the items based on the factors is mostly in the medium range. In this respect, the two factors differentiate less well if there is very high or very low externalizing and parental stress in family situations. Plausible correlations with the CBCL and the EBI demonstrate construct validity. Measured by the correlation coefficients, however, the factors provide at best moderate proof of their construct validity. In view of the different format of the measures subjected to factor analysis and verified by test theory, the low correlation is hardly surprising, because the rating scales examined here capture externalizing and stressful behavior in relation to the situations presented in the inventory. In so doing, they relied on theoretical statements pertaining to disorders and stress, about the situational dependency of symptomatic externalizing behavior and the associated parental stress. By comparison, common checklists and rating scales contain generalized descriptions of behavior and collect impressions collapsed accross different times and situations.

Univariate discriminant analyses provide confirmatory evidence for the discriminatory power of the identified factors. Based on the externalizing behavior and parental stress scores for the factors, children with ADHD and those without it can mostly be correctly distinguished from one another. Group comparisons according to the child’s diagnosis and treatment status also support the discriminative validity of the factors. There are significant and more pronounced differences in accomplishment of tasks between each group with ADHD and without it. Compared to agreeable behavior, the accomplishments raise symptomatic self-regulation deficits more strongly above the manifestation threshold. Overall, this differential effect coheres with the state of research and discussion on the “executive” requirement of task- or rule-compliant behavior [Barkley, 1989; Hayes et al., 1996]. Executive behavior such as self-verbalized instructions maintains stimulus control over time. Unlike typically developed children, however, those with ADHD do not bring themselves under the influence of executive or controlling self-instructions. As a result, they require increased external control by the parents. This can be associated with increased “regulation load” imposed on parents in family situations.

In the following points, these results and their explanation differ from the previous research literature [Barkley, 1981; Barkley and Edelbrock, 1987; Altepeter and Breen, 1989; DuPaul and Barkley, 1992; Breuer and Dopfner, 1997]. First of all, the factor structure obtained relates to the scale versions of a German-language adaptation of the HSQ [Lauth and Heubeck, 2006]. In the initial publication of the questionnaire, the original problem behavior scale measures externalizing behavior [Barkley, 1981]. Based on the original, the adaptation used here contains a scale for externalizing behavior [Lauth and Heubeck, 2006]. Despite the similarity in content of the original scale and that used for investigating externalizing behavior here, the factor structures obtained in each case do not match. However, factor analysis conclusions about the original problem behavior scale come from a typically developed sample [Breen and Altepeter, 1991]. Scale versions studied later departed from the initial behavioral orientation and captured attention-related problems [DuPaul and Barkley, 1992] or “any” problems [Breuer and Döpfner, 1997] in family situations. The reported effects on the factor structure vary just like the scale versions examined, and therefore deviate greatly from the original.

In conclusion, the two-factorial solution concurs with the extant literature on child self-regulation [Barkley, 1997a; Christiansen, 2016; Nigg, 2017]. Both factors constitute plausible subscales with a very good internal homogeneity according to Cronbach’s alpha. They are suitable for the event-related assessment of children’s externalizing behavior and the resulting parental stress consistent with the guideline [cf. Banaschewski et al., 2018]. By means of factor-specific manifestations of childhood externalizing behavior and parental stress, for example, intervention goals can be derived. Furthermore, the subscales identified by factor analysis can serve as an efficacy outcome measure for variations in experimental intervention conditions, such as parent training. Such behavioral analytic research activities correspond to the increased demand for generating scientific knowledge based on functional analyses [Baumeister et al., 2007]. “Such an analysis has no need to posit inner states, mental constructs, perceptual gatekeepers, constructs from computer processing, or behavioral initiators within the mind” [Barkley, 1989, p. 207]. Accordingly, regulation load, which is grounded in the physical and social environment, offers itself as a conceptually precise alternative to mental load, which is currently the predominant subject of discourse.

Limitations

The following methodological characteristics of this study limit the conclusions obtained from the data: (1) Both the externalizing behavior and stress scores obtained for agreeableness and accomplishments correlate strongly with each other and suggest their interdependence. (2) There is a lack of information on the comorbid disorders and the exact medication given to the children with ADHD. Prior research has already underscored the need for an examination of comorbidities and medication status [cf. Ciesielski et al., 2020]. (3) In the control group, the diagnosis and treatment status of the children is ascertained from parental reports. Additional sources of information, such as symptom screening, are required to reliably rule out possible disorders. (4) The historicity of the family situations inventory remains to be considered in the interpretation.

Research Outlook

Further research may be untertaken on the interaction effect of diagnostic group membership and factor structure. It seems promising to conduct situation-specific group comparisons within the factors of externalizing and stressful behavior in family situations. This includes comparisons both within and between groups of children with ADHD and typically developed ones. In perspective, it would be advisable to examine whether the family situations in the inventory reflect contemporary daily life. Following up on the explorative analysis, a confirmatory factor analysis of externalizing behavior and associated parental stress can be conducted in (updated) family situations. Future studies should investigate the direction in which the correlation works and clarify, for example, whether parental stress predicts the rating of child externalizing behaviors.

In this study, the ethical standards were observed according to the expanded and revised Declaration of Helsinki [World Medical Association, 1997]. After being fully informed about the study, the subjects voluntarily consented to participate. Clinical Trial Registration Number ISRCTN 49671147 (www.isrctn.com), DFG No.: LA 433/8.

The authors have no conflicts of interest in connection with this work.

The study was supported by the Deutsche Forschungsgemeinschaft (German Research Foundation).

M.L.: data analysis and manuscript production; M.P.: recruitment of the control sample and collection of the data; G.L.: recruitment of the clinical sample and data collection; editing of the manuscript.

All data generated or analyzed during this study are included in the article. Further questions may be directed to the corresponding author.

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