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Parental Stress and Child Irritability in ADHD: A Two-Wave Longitudinal Serial Mediation Model via Experiential Avoidance and Negative Parent-Child Relationship

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Title: Parental Stress and Child Irritability in ADHD: A Two-Wave Longitudinal Serial Mediation Model via Experiential Avoidance and Negative Parent-Child Relationship
Language: English
Authors: Armagan Aral (ORCID 0000-0001-5098-3664), Gizem Gerdan (ORCID 0000-0001-6066-7059), Yilmaz Orhun Gürlük (ORCID 0000-0002-1134-3776)
Source: Journal of Attention Disorders. 2026 30(3):342-353.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 12
Publication Date: 2026
Document Type: Journal Articles
Reports - Research
Descriptors: Attention Deficit Hyperactivity Disorder, Child Rearing, Stress Variables, Symptoms (Individual Disorders), Parenting Styles, Parent Child Relationship, Children, Preadolescents, Predictor Variables, Psychological Patterns, Parent Influence, Foreign Countries
Geographic Terms: Turkey
DOI: 10.1177/10870547251407731
ISSN: 1087-0547
1557-1246
Abstract: ADHD is complex neurodevelopmental disorder that causes considerable individual and social difficulties, creating significant parental stress. This study aimed to examine the indirect associations between parental stress and child irritability through two sequential parenting mechanisms: experiential avoidance and negative parent-child relationship, within a sample of school-aged children with ADHD (ages 6-12). Using a two-wave longitudinal serial path analysis based on parent-reported data collected at two time points 1-month apart (Time 1 and Time 2), the study investigated whether early parental stress predicted subsequent child irritability via its influence on experiential avoidance and the quality of the parent-child relationship. Findings supported the hypothesized model. More precisely, higher parental stress was associated with greater experiential avoidance, which in turn predicted more negative parent-child relationship, ultimately resulting in elevated child irritability. Longitudinal serial mediation effects confirmed that all Time 1 variables significantly predicted corresponding Time 2 outcomes across the proposed sequential pathway. Notably, the model explained 41.1% of the variance in child irritability at Time 2, underscoring how stress-related disruptions in experiential avoidance and parent-child relationship can affect child irritability even over a short period of time. Taken together, these findings provide empirical support for a stress-driven sequence of parental mechanisms through which parental stress may contribute to child irritability in ADHD. In this context, interventions targeting parental experiential avoidance and improving the quality of parent-child relationship may help mitigate the early development of irritability in children with ADHD. Clinical implications are discussed.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1496445
Database: ERIC
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  Value: <anid>AN0191330933;gs001mar.26;2026Feb05.05:30;v2.2.500</anid> <title id="AN0191330933-1">Parental Stress and Child Irritability in ADHD: A Two-Wave Longitudinal Serial Mediation Model via Experiential Avoidance and Negative Parent–Child Relationship </title> <p>ADHD is complex neurodevelopmental disorder that causes considerable individual and social difficulties, creating significant parental stress. This study aimed to examine the indirect associations between parental stress and child irritability through two sequential parenting mechanisms: experiential avoidance and negative parent–child relationship, within a sample of school-aged children with ADHD (ages 6–12). Using a two-wave longitudinal serial path analysis based on parent-reported data collected at two time points 1-month apart (Time 1 and Time 2), the study investigated whether early parental stress predicted subsequent child irritability via its influence on experiential avoidance and the quality of the parent–child relationship. Findings supported the hypothesized model. More precisely, higher parental stress was associated with greater experiential avoidance, which in turn predicted more negative parent–child relationship, ultimately resulting in elevated child irritability. Longitudinal serial mediation effects confirmed that all Time 1 variables significantly predicted corresponding Time 2 outcomes across the proposed sequential pathway. Notably, the model explained 41.1% of the variance in child irritability at Time 2, underscoring how stress-related disruptions in experiential avoidance and parent-child relationship can affect child irritability even over a short period of time. Taken together, these findings provide empirical support for a stress-driven sequence of parental mechanisms through which parental stress may contribute to child irritability in ADHD. In this context, interventions targeting parental experiential avoidance and improving the quality of parent–child relationship may help mitigate the early development of irritability in children with ADHD. Clinical implications are discussed.</p> <p>Keywords: attention-deficit/hyperactivity disorder; child irritability; experiential avoidance; parent–child relationship; parental stress</p> <p>PHOTO (COLOR): Graphical Abstract This is a visual representation of the abstract.</p> <hd id="AN0191330933-2">Introduction</hd> <p>ADHD is a complex neurodevelopmental disorder that not only manifests as inattention and hyperactivity but also marked by persistent difficulties in managing irritability and externalizing behaviors, which often disrupt daily routines and increase parenting demands ([<reflink idref="bib41" id="ref1">41</reflink>]; [<reflink idref="bib47" id="ref2">47</reflink>]). Parents of children with ADHD have been widely documented to exhibit parental stress, particularly when externalizing behaviors such as oppositionality, irritability, emotion dysregulation, and conduct problems create challenges in the management of daily caregiving responsibilities ([<reflink idref="bib34" id="ref3">34</reflink>]; [<reflink idref="bib41" id="ref4">41</reflink>]). Notably, these difficulties often overwhelm parents' coping capacities and are consistently identified as major sources of stress in parents of children with ADHD ([<reflink idref="bib34" id="ref5">34</reflink>]; [<reflink idref="bib41" id="ref6">41</reflink>]). Numerous studies has framed the relationship between externalizing behaviors and parental stress have mostly utilized cross-sectional designs and simple mediation models, consistently showed that child irritability and externalizing behaviors exacerbate parental stress ([<reflink idref="bib4" id="ref7">4</reflink>]; [<reflink idref="bib34" id="ref8">34</reflink>]). However, this unidirectional, child-to-parent perspective may oversimplify the complex nature of parent-child dynamics. Recent developmental models emphasize that children's behavioral outcomes are shaped by their interaction with caregiving environments, underscoring the importance of studying how stress within the caregiving context may impact child behavior ([<reflink idref="bib49" id="ref9">49</reflink>]). To date, relatively few studies have considered the potential reverse directionality—namely, that elevated parental stress may serve as a risk factor for the development of child externalizing behaviors ([<reflink idref="bib16" id="ref10">16</reflink>]; [<reflink idref="bib45" id="ref11">45</reflink>]). Understanding this direction is critical, as persistent parental stress may increase the likelihood of negative parenting practices, which can, in turn, exacerbate child irritability and externalizing behaviors. Consistent with [<reflink idref="bib1" id="ref12">1</reflink>] parental stress model, chronic stress may shape children's behavioral outcomes indirectly through its disruptive impact on parenting behaviors, as supported by findings that mediate parental stress to child externalizing problems via impaired parenting practices ([<reflink idref="bib38" id="ref13">38</reflink>]). Despite increasing evidence of transactional processes ([<reflink idref="bib13" id="ref14">13</reflink>]; [<reflink idref="bib22" id="ref15">22</reflink>]), few models have tested how parental stress prospectively predicts child outcomes in ADHD samples ([<reflink idref="bib16" id="ref16">16</reflink>]; [<reflink idref="bib45" id="ref17">45</reflink>]). Moreover, much of the existing research on parental stress mechanisms has centered on oppositional behavior profiles, reducing its applicability to broader ADHD populations ([<reflink idref="bib13" id="ref18">13</reflink>]; [<reflink idref="bib36" id="ref19">36</reflink>]).</p> <p>Building on emerging insights, theoretical frameworks such as the coercion model provide a deeper understanding of how stress-induced disruptions in parent-child relationship can perpetuate maladaptive cycles ([<reflink idref="bib15" id="ref20">15</reflink>]; [<reflink idref="bib43" id="ref21">43</reflink>]). Studies have shown that parents of children with ADHD consistently experience conflictual and less supportive interactions, particularly during problem-solving contexts, where stress intensifies interactional difficulties ([<reflink idref="bib14" id="ref22">14</reflink>]; [<reflink idref="bib53" id="ref23">53</reflink>]). These disrupted interactions have been shown to predict increased externalizing behavior and emotional dysregulation in children with ADHD ([<reflink idref="bib15" id="ref24">15</reflink>]; [<reflink idref="bib30" id="ref25">30</reflink>]). Coercive parent-child cycles are shaped not only by observable interactions but also by how parents internally manage stress in response to child behavior. From the ACT perspective, psychological inflexibility, especially in the form of experiential avoidance, may destabilize parental consistency and emotional responsiveness, undermining children's ability to regulate negative emotions and behavioral impulses ([<reflink idref="bib8" id="ref26">8</reflink>]). Recent literature has increasingly emphasized the role of parental experiential avoidance as a transdiagnostic process, defined as the tendency to suppress or escape difficult internal experiences, has been linked to parental stress and disrupted family functioning, ultimately affecting the mental health of both parents and children ([<reflink idref="bib17" id="ref27">17</reflink>]; [<reflink idref="bib24" id="ref28">24</reflink>]). In particular, parents with higher levels of experiential avoidance tend to perceive their children's behavioral and emotional challenges as more severe and less manageable, which in turn exacerbate their own stress levels and undermines positive parenting efforts. Extending these findings, emerging research in ADHD populations has shown that experiential avoidance is linked to parental stress and oppositional child behaviors, suggesting its potential relevance for intervention ([<reflink idref="bib50" id="ref29">50</reflink>]). While the relationships between externalizing behaviors in children with ADHD, parental stress, parent-child relationship, and experiential avoidance have been examined in pairs ([<reflink idref="bib50" id="ref30">50</reflink>]; [<reflink idref="bib52" id="ref31">52</reflink>]), no prior research has integrated these variables into a single longitudinal framework. Doing so allows us to clarify how parental stress may influence child irritability through a sequence of psychological and relational processes, rather than treating each factor in isolation. Establishing this pathway not only advances theoretical understanding but also has practical implications, as it highlights specific parental mechanisms—such as experiential avoidance and the quality of the parent–child relationship—that may be targeted in interventions designed to reduce child irritability ([<reflink idref="bib39" id="ref32">39</reflink>]; [<reflink idref="bib48" id="ref33">48</reflink>]). Relatedly, [<reflink idref="bib18" id="ref34">18</reflink>] identified similar associations in a non-clinical sample using a cross-sectional design; however, the broad age range (4–17 years) and inclusion of children without formal diagnoses limit the developmental and clinical specificity addressed in the current longitudinal ADHD-focused model. Existing cross-sectional studies also leave open the possibility that alternative orderings of mediators and outcomes may better reflect underlying dynamics, underscoring the need for longitudinal designs to clarify causal pathways.</p> <p>From the above background, this study applies a two-wave longitudinal serial path analysis to test a unidirectional framework in which parental stress prospectively predicts child irritability via theoretically grounded mediators. We tested a serial multiple mediator model between parental stress and child irritability that included a direct path from experiential avoidance to negative parent-child relationship. It was hypothesized that parental stress would predict child irritability both concurrently and over time through the mediating roles of experiential avoidance and negative parent–child relationship. Specifically, higher parental stress at Time 1 (T1) was hypothesized to predict greater experiential avoidance and more negative parent–child relationship, which would be associated with elevated child irritability at the same time point. Moreover, stress at Time 1 was expected to influence Time 2 (T2) outcomes through sequential effects on experiential avoidance and parent–child relationship. The hypothesized model is outlined in Figure 1.</p> <p>Graph: Figure 1. Conceptual model illustrating the longitudinal mediating effects of experiential avoidance and parent–child relationship.</p> <hd id="AN0191330933-3">Method</hd> <p>This study, conducted between June 2024 and May 2025 at a child and adolescent psychiatry clinic, employed a two-wave longitudinal design with a 1-month interval (T1 and T2), during which parents were assessed at both time points. A control group was not included. The 1-month interval was chosen based on clinical guidelines recommending monthly follow-ups to monitor symptom progression and treatment adherence in children with ADHD ([<reflink idref="bib2" id="ref35">2</reflink>]; [<reflink idref="bib42" id="ref36">42</reflink>]). This timeframe allows for the observation of short-term changes and the effectiveness of interventions. The absence of a control group reflects the study's intent to examine parent–child processes within the naturalistic context of routine clinical care.</p> <hd id="AN0191330933-4">Participants and Data Collection</hd> <p>A total of 140 volunteer participants were recruited using purposive sampling from parents of children aged 6 to 12 diagnosed with ADHD. The focus on children aged 6 to 12 years was informed by evidence that behavioral problems are particularly prevalent during the school-age period, when parental practices serve as proximal contributors to the emergence and maintenance of behavioral difficulties ([<reflink idref="bib21" id="ref37">21</reflink>]). Additionally, symptoms of ADHD and related behavioral problems often emerge before age 12 and tend to persist into adolescence if left untreated ([<reflink idref="bib54" id="ref38">54</reflink>]). Participants were recruited during routine visits to the child and adolescent psychiatry clinic and invited to participate in the study. Of the initial pool of participants, 12 were excluded due to failure to attend the second wave (T2) of data collection and 3 were excluded for providing incomplete data; after these exclusions, the final sample consisted of 140 parent-child dyads. The participant recruitment and assessment procedure is summarized in Figure 2. Participants completed the initial assessment at T1, and the same parents completed follow-up questionnaires regarding their child and themselves 1-month later (T2). Details of the children's characteristics are presented in Table 1.</p> <p>Graph: Figure 2. Flowchart of participant recruitment and data collection process.</p> <p>Table 1. Descriptive Statistics of Child and Family Characteristics (N = 140).</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left">Variable</th><th align="center"><italic>n</italic></th><th align="center">%</th><th align="center"><italic>M</italic></th><th align="center"><italic>SD</italic></th><th align="center">Range</th></tr></thead><tbody><tr><td>Child age (years)</td><td>140</td><td /><td>9.66</td><td>1.72</td><td>6–12</td></tr><tr><td colspan="6">Child gender</td></tr><tr><td> Male</td><td>114</td><td>81.4</td><td /><td /><td /></tr><tr><td> Female</td><td>26</td><td>18.6</td><td /><td /><td /></tr><tr><td>Time since ADHD diagnosis (months)</td><td /><td /><td>20.85</td><td>18.92</td><td>0–80</td></tr><tr><td colspan="6">ADHD subtype</td></tr><tr><td> Predominantly inattentive</td><td>81</td><td>57.9</td><td /><td /><td /></tr><tr><td> Predominantly hyperactive-impulsive</td><td>13</td><td>9.3</td><td /><td /><td /></tr><tr><td> Combined type</td><td>46</td><td>32.9</td><td /><td /><td /></tr><tr><td colspan="6">ADHD treatment</td></tr><tr><td> Methylphenidate only</td><td>112</td><td>80.0</td><td /><td /><td /></tr><tr><td> Atomoxetine only</td><td>8</td><td>5.7</td><td /><td /><td /></tr><tr><td> Guanfacine only</td><td>4</td><td>2.9</td><td /><td /><td /></tr><tr><td> Combination therapy</td><td>16</td><td>11.4</td><td /><td /><td /></tr><tr><td> Antipsychotic use</td><td>24</td><td>17.1</td><td /><td /><td /></tr><tr><td> Psychiatric comorbidity (any)</td><td>35</td><td>25.0</td><td /><td /><td /></tr><tr><td> ODD</td><td>18</td><td>12.8</td><td /><td /><td /></tr><tr><td> Conduct disorder</td><td>5</td><td>3.5</td><td /><td /><td /></tr><tr><td> Specific learning disorder</td><td>10</td><td>7.1</td><td /><td /><td /></tr><tr><td> Family history of mental illness</td><td>19</td><td>13.6</td><td /><td /><td /></tr><tr><td colspan="6">Parent informant</td></tr><tr><td> Mother</td><td>111</td><td>79.3</td><td /><td /><td /></tr><tr><td> Father</td><td>29</td><td>20.7</td><td /><td /><td /></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note. N</emph>: 140. <emph>M</emph> = mean; <emph>SD</emph> = standard deviation; ODD = oppositional defiant disorder.</p> <hd id="AN0191330933-5">Inclusion Criteria</hd> <p>The following inclusion criteria were applied:</p> <p></p> <ulist> <item> Children: Children of both genders, aged 6 to 12 years, diagnosed with ADHD</item> <p></p> <item> Parents: Literate parents with no linguistic barriers that could hinder comprehension of the questionnaires and no significant mental or physical disabilities (e.g., developmental delays)</item> </ulist> <hd id="AN0191330933-6">Exclusion Criteria</hd> <p>Participants were excluded from the study based on the following criteria:</p> <p></p> <ulist> <item> Participants who discontinued participation during data collection and failed to provide sufficient data for analysis</item> <p></p> <item> Children diagnosed with autism spectrum disorder (ASD) or intellectual disability (ID)</item> <p></p> <item> Children requiring inpatient treatment as determined by the healthcare provider</item> </ulist> <hd id="AN0191330933-7">Procedure</hd> <p>Children were diagnosed with ADHD based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria by a certified child and adolescent psychiatrist. The diagnostic process included a comprehensive developmental and psychiatric evaluation, which incorporated reports from parents and teachers, the DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV-S), and a unstructured clinical interview with both the parents and the child. Upon confirming the ADHD diagnosis, appropriate treatment was initiated, which included stimulant medications or other approved treatments for ADHD.</p> <p>As part of the diagnostic procedure, the psychiatrist completed the Personal Information Form based on details provided by the parents. Following this, verbal assent to participate was obtained from all children, and their parents provided written informed consent after being thoroughly informed about the study's purpose and procedures. Only participants whose children met the inclusion criteria and did not meet any exclusion criteria were included in the study.</p> <p>Parents then completed a set of four questionnaires during the initial assessment (T1): the Acceptance and Action Questionnaire-II (AAQ-II), the Affective Reactivity Index-Parent Form (ARI-P), the Parent-Child Relationship Scale (PCRS), and the Parent Stress Scale (PSS). At the 1-month follow-up (T2), both children and parents were reassessed. Then, parents completed the same set of four questionnaires as at T1, allowing for comparability and supporting longitudinal analysis.</p> <hd id="AN0191330933-8">Measurement</hd> <p></p> <ulist> <item> 1. Personal Information Form</item> </ulist> <p>This form, constructed by the researchers, is designed to collect comprehensive sociodemographic and clinical data from the sample. Administered during participant interviews, it includes information on children's gender, age, ADHD subtype, time since the initial ADHD diagnosis (months), psychiatric comorbidities, current psychiatric treatments, and family history of mental illness.</p> <p></p> <ulist> <item> 2. Parent Stress Scale (PSS)</item> </ulist> <p>The PSS is a unidimensional scale consisting of 16 items designed to assess the stress parents experience in their relationships with their children in Turkish sample ([<reflink idref="bib44" id="ref39">44</reflink>]). It employs a 4-point Likert-type format, with scores ranging from a minimum of 16 to a maximum of 64. Higher scores reflect greater levels of parental stress. Reliability analyses for children aged 5 to 12 years yielded a Cronbach's alpha of.85 and a Spearman-Brown coefficient of.82 ([<reflink idref="bib44" id="ref40">44</reflink>]). The researchers who conducted the scale development study found that the scale was one-dimensional through exploratory factor analysis and then determined that the scale was appropriate through confirmatory factor analysis, χ<sups>2</sups> (<emph>df</emph>) = 252.98 (<reflink idref="bib104" id="ref41">104</reflink>), χ<sups>2</sups>/<emph>df</emph><emph>=</emph> 2.43, RMSEA = 0.05, GFI = 0.93, CFI = 0.91 ([<reflink idref="bib44" id="ref42">44</reflink>]). In this study, the alpha value of the scale was calculated as.897.</p> <p></p> <ulist> <item> 3. Parent-Child Relationship Scale (PCRS)</item> </ulist> <p>The PCRS, developed by [<reflink idref="bib25" id="ref43">25</reflink>], measures the quality of the parent-child relationship, with a focus on the parent's perspective. It includes 15 items distributed across two subscales: Positive Parent-Child Relationship (PCRS-P; Cronbach's alpha =.71) and Negative Parent-Child Relationship (PCRS-N; Cronbach's alpha =.74). The scale uses a 5-point Likert-type (1 = "not at all," 5 = "extremely"). Higher scores on the PCRS-P reflect stronger relationship quality, while elevated scores on the PCRS-N denote greater conflict and dysfunctional interaction patterns. The Turkish adaptation was validated by [<reflink idref="bib3" id="ref44">3</reflink>]. According to confirmatory factor analysis results, the scale was fitted, χ<sups>2</sups>/<emph>df</emph> = 3.24, RMSEA = 0.07, GFI = 0.92, CFI = 0.89 ([<reflink idref="bib3" id="ref45">3</reflink>]). In this study, the negative subscale of the PCRS (PCRS-N) was used to assess negative parent-child relationship. In this study, the alpha value of the scale was calculated as.721.</p> <p></p> <ulist> <item> 4. Acceptance and Action Questionnaire-II (AAQ-II)</item> </ulist> <p>The AAQ-II is a 7-item self-report scale developed by [<reflink idref="bib5" id="ref46">5</reflink>], to evaluate experiential avoidance. Items are rated using a 7-point Likert-type scale ranging from 1 ("never true") to 7 ("always true"), with higher scores indicating greater experiential avoidance. The Turkish version of the scale was adapted and validated by [<reflink idref="bib56" id="ref47">56</reflink>]. Reliability analyses revealed a Cronbach's alpha of.84. Construct validity, assessed through Principal Component Analysis (PCA), yielded a Kaiser-Meyer-Olkin (KMO) index of 0.83, confirming the suitability of the scale's factor structure ([<reflink idref="bib56" id="ref48">56</reflink>]). In the construct validity study examined with confirmatory factor analysis too, it was stated that sufficient values were reached (χ<sups>2</sups>/<emph>df</emph> = 3.746, RMSEA = 0.079, SRMR = 0.021, GFI = 0.972, CFI = 0.971) and the relationships of the scale with general health (<emph>r</emph> = −.292), vitality (<emph>r</emph> = −.295), social functioning (<emph>r</emph> = −.474) and mental health (<emph>r</emph> = −.324) were also found to be significant, <emph>p<subs>all</subs></emph> < 0.001 ([<reflink idref="bib56" id="ref49">56</reflink>]). In this study, the alpha value of the scale was calculated as.897.</p> <p></p> <ulist> <item> 5. Affective Reactivity Index (ARI)-Parent Form</item> </ulist> <p>The ARI-P, developed by [<reflink idref="bib51" id="ref50">51</reflink>], is a widely used tool in research and clinical contexts for evaluating irritability. Available in self-report and parent-report versions, the scale consists of seven items. The first six items assess symptoms of irritability, while the final item evaluates functional impairment caused by irritability. Each item is scored using a 3-point Likert-type, with responses ranging from 0 to 2. The total score (α =.92), calculated by summing the first six items, ranges from 0 to 12. Separate scores are provided for the self-report and parent-report forms. The Turkish adaptation and validation study of the ARI-P were conducted by [<reflink idref="bib33" id="ref51">33</reflink>], confirming its reliability and validity for assessing irritability in children and adolescents. Only the parent-report form was utilized in the present study. Construct validity was also examined by [<reflink idref="bib33" id="ref52">33</reflink>], and the model was found to have an acceptable fit, χ<sups>2</sups>(<emph>df</emph>) = 14.946(<reflink idref="bib9" id="ref53">9</reflink>), χ<sups>2</sups>/<emph>df</emph> = 1.667, RMSEA = 0.024, SRMR = 0.033, TLI = :995, CFI = 0.997 ([<reflink idref="bib33" id="ref54">33</reflink>]). Furthermore, the relationship between the adolescent and parent forms was presented as evidence of criterion validity, <emph>r</emph> =.491, <emph>p</emph> <.001. In this study, the alpha value of the scale was calculated as.812</p> <hd id="AN0191330933-9">Statistical Analysis</hd> <p>Data analysis for the descriptive statistics presented in Table 1 was conducted using IBM SPSS Statistics version 25. Means, standard deviations, frequencies, and percentages were calculated to summarize the sociodemographic and clinical characteristics of the participants. Descriptive analyses were employed to examine the distribution of categorical variables (e.g., gender, ADHD subtype, treatment type). For continuous variables, measures of central tendency and dispersion (mean and standard deviation) were reported, while for categorical variables, frequencies and proportions were provided.</p> <p>In this study, a model was proposed to examine how parental stress influences the child's irritability level through parents' experiential avoidance and negative parent-child relationships. Accordingly, a two-wave longitudinal serial path analysis was conducted to assess both the predictive effects within each time point and the predictive effects from T1 to T2. In addition, correlations among the variables and their descriptive statistics were examined. Prior to model testing, repeated measures t-tests were conducted to determine whether the study variables demonstrated significant changes over time. All the analyses about hypothesized model were performed using JASP version 0.18.1. The analysis employed the SEM (structural equational modeling) module which is R based code that works directly with LAVAAN syntax.</p> <p>As per traditional criteria ([<reflink idref="bib7" id="ref55">7</reflink>]; [<reflink idref="bib32" id="ref56">32</reflink>]), fit coefficients indicates that the Root Mean Square Error of Approximation (RMSE-A) is below 0.10, SRMR is below 0.09, the Comparative Fit Index (CFI), Tucker-Lewis Index (TLI) and Goodness of Fit Index (GFI) are approximately 0.90, and the norm chi-square (CMIN) value is less than 5, which is considered acceptable. In order to test the significance of direct and indirect mediator effects throughout all analyses, the Bootstrap method was used with 5,000 samples.</p> <hd id="AN0191330933-10">Statement of Ethical Considerations</hd> <p>The City Hospital of Izmir Ethical Committee regarding non-interventional clinical research reviewed and approved the study on May15, 2024 (No. 2024/36). Participants provided written informed consent after being informed of the study's purpose. Confidentiality was maintained, and access to personal information was restricted to the research team.</p> <hd id="AN0191330933-11">Results</hd> <p></p> <hd id="AN0191330933-12">Descriptive Statistics and Correlations</hd> <p>It was observed that the normal distribution assumption was met in all repeated measures <emph>t-</emph>tests conducted to see the change over time, skewness<subs>max.</subs> =.293, kurtosis<subs>max.</subs> = −.927. According to the <emph>t</emph> test results, parental stress (<emph>t</emph>[<reflink idref="bib139" id="ref57">139</reflink>] = 4.018, <emph>p</emph> <.001, <emph>d<subs>Cohen</subs></emph> =.340), experiential avoidance (<emph>t</emph>[<reflink idref="bib139" id="ref58">139</reflink>] = 5.393, <emph>p</emph> <.001, <emph>d<subs>Cohen</subs></emph> =.456), negative parent-child relationship (<emph>t</emph>[<reflink idref="bib139" id="ref59">139</reflink>] = 4.566, <emph>p</emph> <.001, <emph>d<subs>Cohen</subs></emph> =.386), and child irritability level (<emph>t</emph>[<reflink idref="bib139" id="ref60">139</reflink>] = 3.308, <emph>p</emph> <.001, <emph>d<subs>Cohen</subs></emph> =.280) decreased over time.</p> <p>Then, correlations between the variables were examined. The highest correlation was found between parental stress and experiential avoidance (<emph>r</emph> =.625, <emph>p</emph> <.001) at T1, while the lowest correlation was between negative parent-child relationship at T1 and parental stress at T2 (<emph>r</emph> =.325, <emph>p</emph> <.001). When correlations between T1 and T2 measurements of the same variables were analyzed, significant associations were observed for parental stress (<emph>r</emph> =.577, <emph>p</emph> <.001), experiential avoidance (<emph>r</emph> =.612, <emph>p</emph> <.001), negative parent-child relationships (<emph>r</emph> =.537, <emph>p</emph> <.001), and child irritability (<emph>r</emph> =.608, <emph>p</emph> <.001). Descriptive statistics and correlation coefficients are shown in Table 2.</p> <p>Table 2. Correlations and Descriptive Statistics.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left">Variable</th><th align="center">1</th><th align="center">2</th><th align="center">3</th><th align="center">4</th><th align="center">5</th><th align="center">6</th><th align="center">7</th><th align="center">8</th></tr></thead><tbody><tr><td>1. PSS T1</td><td>-</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>2. PSS T2</td><td>.577<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>-</td><td /><td /><td /><td /><td /><td /></tr><tr><td>3. AAQ-II T1</td><td>.626<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.370<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>-</td><td /><td /><td /><td /><td /></tr><tr><td>4. AAQ-II T2</td><td>.491<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.636<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.612<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>-</td><td /><td /><td /><td /></tr><tr><td>5. PCRS-N T1</td><td>.432<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.315<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.527<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.318<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>-</td><td /><td /><td /></tr><tr><td>6. PCRS-N T2</td><td>.432<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.451<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.551<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.644<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.537<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>-</td><td /><td /></tr><tr><td>7. ARI-P T1</td><td>.513<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.382<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.535<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.404<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.579<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.425<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>-</td><td /></tr><tr><td>8. ARI-P T2</td><td>.398<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.421<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.434<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.516<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.479<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.645<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>.608<xref ref-type="table-fn" rid="tfn3">***</xref></td><td>-</td></tr><tr><td>Mean</td><td>34.364</td><td>31.450</td><td>23.100</td><td>19.336</td><td>15.371</td><td>13.671</td><td>5.607</td><td>4.829</td></tr><tr><td>Standard deviation</td><td>9.057</td><td>9.576</td><td>9.428</td><td>9.328</td><td>3.862</td><td>5.039</td><td>3.234</td><td>3.049</td></tr></tbody></table> </ephtml> </p> <ulist> <item>2 <emph>Note</emph>. PSS = Parental Stress Scale; AAQ-II = Acceptance and Action Questionnaire-II (experiential avoidance); PCRS-N = Parent–Child Relationship Scale – Negative subscale; ARI-P = Affective Reactivity Index – Parent Form (child irritability); T1 = time 1; T2 = time 2.</item> <item>3 p <.001.</item> </ulist> <hd id="AN0191330933-13">Longitudinal Path Analysis</hd> <p>Longitudinal serial path analysis was conducted to examine how predictive effects changed over time and how variables influenced each other within the same time point; in other words, both longitudinal and cross-sectional effects were investigated. The model was found to be significant, χ<sups>2</sups>(<emph>df</emph>) = 30.694(<reflink idref="bib15" id="ref61">15</reflink>), χ<sups>2</sups>/<emph>df</emph> = 2.046, <emph>p</emph> =.010, RMSEA (90% CI) = 0.086 (0.045–0.127), SRMR = 0.106, CFI = 0.970, TLI = 0.944, GFI = 0.947. When considering the fit indices, it was observed that all fit indices were good except SRMR. Since it is known that SRMR can be high in longitudinal models with high structural complexity and that the model will be considered suitable when more than 2/3 of the fit indices are high, it was accepted that the model showed fit ([<reflink idref="bib27" id="ref62">27</reflink>]; [<reflink idref="bib32" id="ref63">32</reflink>]).</p> <p>The analysis began with the examination of effects at T1. Parental stress significantly predicted experiential avoidance (β =.626, <emph>SE</emph> = 0.051, <emph>z</emph> = 12.181, <emph>p</emph> <.001), experiential avoidance predicted negative parent-child relationship (β =.527, <emph>SE</emph> = 0.061, <emph>z</emph> = 8.638, <emph>p</emph> <.001), and negative parent-child relationship predicted child irritability (β =.579, <emph>SE</emph> = 0.056, <emph>z</emph> = 10.295, <emph>p</emph> <.001). At T1, the model explained 39.2% of the variance in experiential avoidance, 27.8% of the variance in negative parent–child relationship, and 33.5% of the variance in child irritability. When examining the effects at T2, parental stress continued to predict experiential avoidance (β =.524, <emph>SE</emph> = 0.063, <emph>z</emph> = 8.276, <emph>p</emph> <.001), which in turn predicted negative parent-child relationship (β =.493, <emph>SE</emph> = 0.068, <emph>z</emph> = 7.262, <emph>p</emph> <.001), and negative parent-child relationship again predicted child irritability (β =.490, <emph>SE</emph> = 0.064, <emph>z</emph> = 7.618, <emph>p</emph> <.001). At T2, the model explained 42.5% of the variance in experiential avoidance, 45.4% of the variance in negative parent–child relationship, and 41.1% of the variance in child irritability, indicating an increase in the model's explanatory power.</p> <p>Finally, the predictive effects of T1 variables on outcomes at T2 were examined. Parental stress at T1 significantly predicted experiential avoidance at T2 (β =.190, <emph>SE</emph> = 0.073, <emph>z</emph> = 2.584, <emph>p</emph> =.010), experiential avoidance at T1 predicted negative child-parent relationship at T2 (β =.248, <emph>SE</emph> = 0.075, <emph>z</emph> = 3.327, <emph>p</emph> <.001), and lastly, negative child-parent relationship at T1 predicted child irritability at T2 (β =.227, <emph>SE</emph> = 0.073, <emph>z</emph> = 3.121, <emph>p</emph> =.002). Figure 3 illustrates a summary of the results. Main indirect effects were shown on Table 3. Based on these results, parental stress was found to predict child irritability cross-sectionally through simultaneously existing experiential avoidance and a negative parent–child relationship, and longitudinally through experiential avoidance and a negative parent–child relationship at later time points. A similar pattern was observed for the mediating variables: both experiential avoidance and the negative parent–child relationship had a longitudinal effect on child irritability.</p> <p>Graph: Figure 3. Standard coefficients of longitudinal serial path analysis (Curvilinear lines represent standardized covariances, and straight lines represent standard regression coefficients).</p> <p>Table 3. Main Indirect Effects of the Model.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left">Indirect effect path</th><th align="center">β</th><th align="center"><italic>SE</italic></th><th align="center"><italic>z</italic></th><th align="center">95% CI</th><th align="center"><italic>p</italic></th></tr></thead><tbody><tr><td>PS1<xref ref-type="table-fn" rid="tfn5">a</xref>→EA1→ PCRS-N1→CI1</td><td>.191</td><td>0.037</td><td>5.203</td><td>[0.119, 0.263]</td><td><.001</td></tr><tr><td>PS2→EA2→ PCRS-N2→CI2</td><td>.127</td><td>0.030</td><td>4.239</td><td>[0.068, 0.185]</td><td><.001</td></tr><tr><td>PS1→EA2→ PCRS-N2→CI2</td><td>.046</td><td>0.020</td><td>2.284</td><td>[0.006, 0.085]</td><td>.022</td></tr><tr><td>PS1→EA1→ PCRS-N2→CI2</td><td>.076</td><td>0.026</td><td>2.904</td><td>[0.025, 0.127]</td><td>.004</td></tr><tr><td>PS1→EA1→ PCRS-N1→CI2</td><td>.075</td><td>0.027</td><td>2.783</td><td>[0.022, 0.128]</td><td>.005</td></tr></tbody></table> </ephtml> </p> <ulist> <item>4 <emph>Note</emph>. β = standardized regression coefficient; SE = standard error; CI = confidence interval; PS = parental stress; EA = experiential avoidance; PCRS-N = negative parent-child relationship; CI = child irritability.</item> <item>5 Numbers indicate that Time Series.</item> </ulist> <hd id="AN0191330933-14">Discussion</hd> <p>The present study aimed to extend previous research on how parental stress contributes to child externalizing behaviors in ADHD by illuminating the mediating roles of parenting processes, with an emphasis on experiential avoidance and negative parent–child relationship. Findings from the longitudinal path analysis revealed that experiential avoidance and negative parent–child relationship mediated the relationship between parental stress and child irritability at both T1 and T2. The explanatory power of the model increased from T1 to T2, indicating that the relationships among the variables became more pronounced over time, and the model better predicted these relationships. The high model fit indices observed in the longitudinal serial path analysis (e.g., CFI = 0.970, TLI = 0.944) further underscore the robustness of the proposed model in capturing dynamic, sequential processes within a short-term framework. The findings indicate that experiential avoidance and parent-child relationship may represent mechanisms through which parental stress drives child irritability. Again, consistent with hypotheses, T1 variables influenced T2 variables. Specifically, parental stress at T1 predicted experiential avoidance at T2; experiential avoidance at T1 predicted negative parent–child relationships at T2; and finally, negative parent–child relationships at T1 predicted child irritability at T2. These findings provide evidence for longitudinal mediation effects, suggesting that the indirect effect of parental stress on child irritability through experiential avoidance and negative parent–child relationships is not limited to the same time point but rather extends over time, meaning that it persists. Furthermore, this study provides a novel contribution by applying a serial multiple mediator model, where experiential avoidance and parent–child relationship sequentially transmit the effect of parental stress on child irritability, an approach rarely employed in ADHD literature. Given the novelty of this temporal pattern, it is essential to contextualize our results within the existing literature documenting the direct effects of parental stress on child externalizing symptoms in children with ADHD, and then discuss how experiential avoidance and parent–child relationship may serve as potential mediators within this short-term sequence of effects.</p> <p>Previous research has largely shown support on the bidirectional relationship between parental stress and externalizing behavior in ADHD, often emphasizing how children's externalizing symptoms contribute to elevated parental stress. For instance, [<reflink idref="bib40" id="ref64">40</reflink>] and [<reflink idref="bib23" id="ref65">23</reflink>] documented that parental stress was linked to more negative parenting practices and higher behavioral problems, while [<reflink idref="bib35" id="ref66">35</reflink>] observed that parental stress predicted greater externalizing behavior in children with and without ODD. However, these studies relied on cross-sectional data, limiting the ability to assess directionality or temporal effects. More recent longitudinal research, such as [<reflink idref="bib16" id="ref67">16</reflink>], extended this by showing that maternal stress in infancy predicted ADHD symptoms in adolescence, but without addressing intermediate processes or specific emotional markers like irritability. Similarly, [<reflink idref="bib22" id="ref68">22</reflink>], examined long-term effects of parental stress on adolescent outcomes in a 5-year follow-up of girls with ADHD, but their use of broad behavioral indices and single-gender sampling limits generalizability. In contrast, the present study employed a two-wave design within a developmentally diverse ADHD sample, focusing on irritability as a specific outcome and modeling short-term parent-to-child dynamics. Because our design included only two measurement waves, we were not able to reliably test fully bidirectional pathways, which typically require three or more waves ([<reflink idref="bib9" id="ref69">9</reflink>]). While prior research often focused on overt externalizing behaviors such as aggression, our study focused on irritability, a subtler yet clinically disruptive emotional state, as a key outcome. Importantly, by focusing on a shorter temporal window than prior studies that assessed effects over several months or years ([<reflink idref="bib16" id="ref70">16</reflink>]; [<reflink idref="bib22" id="ref71">22</reflink>]), our design captures more immediate, dynamic patterns that may be obscured in longer-term models ([<reflink idref="bib37" id="ref72">37</reflink>]). Our findings demonstrated that higher levels of parental stress at T1 significantly predicted child irritability at T2. Moreover, a temporal cascade was observed in which T1 parental stress led to elevated experiential avoidance, which subsequently predicted negative parent–child relationship and greater irritability in children. Grounded in Patterson's coercive family process theory ([<reflink idref="bib46" id="ref73">46</reflink>]), the findings suggest that unresolved parental stress may initiate coercive emotional cycles, propelling child dysregulation over time. The progressive increase in explained variance across two waves in our study—42.5% for experiential avoidance, 45.4% for negative parent–child relationship, and 41.1% for child irritability at T2—highlights the cumulative and reinforcing nature of these psychological processes over short period of time. Importantly, these relationships are not only theoretically grounded but statistically robust, as evidenced by the substantial variance explained in each construct at T2. Furthermore, the temporal structure of our model supports the interpretation that these constructs are dynamic and are best understood through their interactions across time, rather than as isolated or static influences.</p> <p>Building on this framework, our findings delineate a sequential mechanism by which parental stress contributes to child irritability through increased experiential avoidance and subsequent deterioration in parent–child relationship. This pathway is supported by [<reflink idref="bib26" id="ref74">26</reflink>], who showed that behavioral problems in children elicit fatigue and ineffective, emotion-driven coping responses in mothers, often rooted in experiential avoidance. Likewise, [<reflink idref="bib10" id="ref75">10</reflink>] emphasized that experiential avoidance undermines caregivers' emotional responsiveness, straining the parent–child interaction. [<reflink idref="bib6" id="ref76">6</reflink>] identified links between parental experiential avoidance and child behavior problems but examined these constructs in parallel, using cross-sectional data and treating experiential avoidance and parenting practices as separate entities. In contrast, our study modeled these constructs sequentially within a short-term longitudinal framework, capturing their interactive and temporal nature. The strong correlation between parental stress and experiential avoidance at T1 (β =.626, <emph>p</emph> <.001) is consistent with theoretical models proposing that stress and experimental avoidance are closely related processes ([<reflink idref="bib17" id="ref77">17</reflink>]; [<reflink idref="bib24" id="ref78">24</reflink>]); however, the correlational nature of our data does not permit causal conclusions. Similarly, [<reflink idref="bib28" id="ref79">28</reflink>] found that negative mother–child relationship predicted ODD symptoms 2 years later in a Chinese sample using dyadic modeling; however, their study focused solely on relational factors and did not include experiential avoidance as an explanatory mechanism. By contrast, our model integrates both parenting processes—experiential avoidance and parent-child relationship—providing a more comprehensive account of how stress in parents is translated into child irritability over time. These findings are consistent with coercive family process theory ([<reflink idref="bib46" id="ref80">46</reflink>]) and underscore the relevance of short-term dynamic patterns in ADHD populations.</p> <p>The present findings underscore meaningful directional associations among parental stress, experiential avoidance, parent–child relationship, and child irritability, suggesting a temporally sequenced cascade of psychological and relational mechanisms. Crucially, these associations retained their significance across both time points, providing empirical support for robust longitudinal mediation effects. The progressive increase in explained variance from T1 to T2 emphasizes the cumulative and self-reinforcing nature of these interconnected processes. While further research is warranted to validate these findings across more heterogeneous samples and extended time frames, the current study contributes meaningfully to the field by elucidating how elevated parental stress may set in motion a pattern of parenting process that, in turn, perpetuate child irritability within the ADHD context.</p> <p>The results suggest that experiential avoidance and parent-child relationship form a bridge between parental stress and child irritability and highlight that these parenting processes may be an important step for intervention, warrant continued research. Given that experiential avoidance mediated the effect of parental stress on both parent-child relationship and child outcomes, targeting this mechanism—rather than child behavior directly—may offer a more sustainable path to change. Prior work has shown that lower experiential avoidance is associated with reduced parental stress and improved parent-child relationship ([<reflink idref="bib39" id="ref81">39</reflink>]; [<reflink idref="bib48" id="ref82">48</reflink>]), supporting the need for interventions to reduce experiential avoidance in parents.</p> <p>Our study's strengths lie in its novelty, as it is the first to employ path analysis to longitudinally examine the relationship between parental stress and child irritability through both experiential avoidance and negative parent–child interaction within an ADHD sample. The two-wave design over 1-month interval enabled the detection of both concurrent and longitudinal mediation effects, offering temporal clarity often missing in prior research. Additionally, the use of a narrow age range (6–12 years) and validated, reliable measures increased the developmental specificity and methodological rigor of the study. Furthermore, the model exhibited strong fit indices and accounted for a substantial proportion of variance in all key outcomes at T2 reflecting the robustness and explanatory power of the proposed pathway.</p> <hd id="AN0191330933-15">Limitations</hd> <p>Despite the strengths of the current study, several limitations should be noted. First, the sample consisted predominantly of mothers, and all data were collected via self-report, which may have led to shared-rater variance and biased perceptions of child behavior under stress, particularly reflecting mothers' subjective experiences ([<reflink idref="bib11" id="ref83">11</reflink>]). Although this gender imbalance is common in ADHD research and may reflect caregiving realities ([<reflink idref="bib29" id="ref84">29</reflink>]; [<reflink idref="bib31" id="ref85">31</reflink>]), it limits generalizability to other parent–child dyads. In future studies—to improve upon this weakness—researchers may incorporate multi-informant or observational approaches; however, these additional procedures may suffer from ecological limitations. Second, the child sample included a disproportionately high number of males (81.4%), which may have restricted the ability to identify gender-specific effects. Prior research indicates that ODD symptoms are more prevalent in boys and may elicit greater parental stress due to behavioral expectations and differential parental tolerance ([<reflink idref="bib12" id="ref86">12</reflink>]; [<reflink idref="bib55" id="ref87">55</reflink>]). Accordingly, the generalizability of our findings to girls may be limited. Third, although the current study modeled parent-to-child effects, existing evidence suggests that reciprocal influences are likely. Future research with three or more waves will be necessary to adequately test such bidirectional dynamics. Fourth, although socioeconomic status (SES) was not measured in the present study, prior work has shown that SES may influence both parental stress and child outcomes ([<reflink idref="bib45" id="ref88">45</reflink>]). Fifth, because the sample consisted of treatment-seeking families who primarily received stimulant medication or other psychopharmacological treatment options, the applicability of the findings to non-treatment-seeking populations is limited. Non-treatment-seeking families may show different stress levels and parenting behaviors. Lastly, we could not assess distinct facets of experiential avoidance due to reliance on the unidimensional AAQ-II. 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Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology, 26(4), 397–408.</bibtext> </blist> </ref> <ref id="AN0191330933-17"> <title> Footnotes </title> <blist> <bibtext> Armagan Aral</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0001-5098-3664 Gizem Gerdan</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0001-6066-7059 Yılmaz Orhun Gürlük</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0002-1134-3776</bibtext> </blist> <blist> <bibtext> The City Hospital of Izmır Ethical Committee regarding non-interventional clinical research reviewed and approved the study on May15, 2024 (No: 2024/36).</bibtext> </blist> <blist> <bibtext> Written informed consent to participate was obtained from all parents, and verbal assent was provided by the children prior to data collection. Participants provided written informed consent after being informed of the study's purpose. Confidentiality was maintained, and access to personal information was restricted to the research team.</bibtext> </blist> <blist> <bibtext> Not applicable. The manuscript does not contain any identifiable personal data, images, or videos of individual participants.</bibtext> </blist> <blist> <bibtext> The authors received no financial support for the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The data that support the findings of this study are not publicly available due to ethical restrictions and the sensitive nature of clinical information. However, de-identified data may be made available from the corresponding author upon reasonable request.</bibtext> </blist> </ref> <aug> <p>By Armagan Aral; Gizem Gerdan and Yılmaz Orhun Gürlük</p> <p>Reported by Author; Author; Author</p> <p></p> <p>Armagan Aral, MD PhD is a Child and Adolescent Psychiatrist at the City Hospital of İzmir, Turkey. His primary research interests focus on neurodevelopmental disorders, particularly ADHD, and the psychosocial mechanisms that influence emotional and behavioral regulation in children. Dr. Aral has published and collaborated on studies exploring parental stress, emotion regulation, and family-based interventions in child psychiatry.</p> <p>Gizem Gerdan, PhD is an Assistant Professor of Psychology at İzmir Democracy University, with a strong publication record in clinical and developmental psychology. Her research includes studies on experiential avoidance, transdiagnostic processes in psychological symptoms, neuropsychological functioning, and psychometric evaluations, as seen in her co-authored article on experiential avoidance and psychological symptoms in clinical samples and numerous other peer-reviewed contributions.</p> <p>Yılmaz Orhun Gürlük, PhD is an Assistant Professor at İzmir Democracy University with expertise in psychometrics, measurement theory, and statistical methods in psychological research. His peer-reviewed work includes studies on interrater reliability, latent class analysis for agreement patterns, and assessment scale development, reflecting his methodological focus in research design and measurement.</p> </aug> <nolink nlid="nl1" bibid="bib41" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib47" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib34" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib49" firstref="ref9"></nolink> <nolink nlid="nl5" bibid="bib16" firstref="ref10"></nolink> <nolink nlid="nl6" bibid="bib45" firstref="ref11"></nolink> <nolink nlid="nl7" bibid="bib38" firstref="ref13"></nolink> <nolink nlid="nl8" bibid="bib13" firstref="ref14"></nolink> <nolink nlid="nl9" bibid="bib22" firstref="ref15"></nolink> <nolink nlid="nl10" bibid="bib36" firstref="ref19"></nolink> <nolink nlid="nl11" bibid="bib15" firstref="ref20"></nolink> <nolink nlid="nl12" bibid="bib43" firstref="ref21"></nolink> <nolink nlid="nl13" bibid="bib14" firstref="ref22"></nolink> <nolink nlid="nl14" bibid="bib53" firstref="ref23"></nolink> <nolink nlid="nl15" bibid="bib30" firstref="ref25"></nolink> <nolink nlid="nl16" bibid="bib17" firstref="ref27"></nolink> <nolink nlid="nl17" bibid="bib24" firstref="ref28"></nolink> <nolink nlid="nl18" bibid="bib50" firstref="ref29"></nolink> <nolink nlid="nl19" bibid="bib52" firstref="ref31"></nolink> <nolink nlid="nl20" bibid="bib39" firstref="ref32"></nolink> <nolink nlid="nl21" bibid="bib48" firstref="ref33"></nolink> <nolink nlid="nl22" bibid="bib18" firstref="ref34"></nolink> <nolink nlid="nl23" bibid="bib42" firstref="ref36"></nolink> <nolink nlid="nl24" bibid="bib21" firstref="ref37"></nolink> <nolink nlid="nl25" bibid="bib54" firstref="ref38"></nolink> <nolink nlid="nl26" bibid="bib44" firstref="ref39"></nolink> <nolink nlid="nl27" bibid="bib104" firstref="ref41"></nolink> <nolink nlid="nl28" bibid="bib25" firstref="ref43"></nolink> <nolink nlid="nl29" bibid="bib56" firstref="ref47"></nolink> <nolink nlid="nl30" bibid="bib51" firstref="ref50"></nolink> <nolink nlid="nl31" bibid="bib33" firstref="ref51"></nolink> <nolink nlid="nl32" bibid="bib32" firstref="ref56"></nolink> <nolink nlid="nl33" bibid="bib139" firstref="ref57"></nolink> <nolink nlid="nl34" bibid="bib27" firstref="ref62"></nolink> <nolink nlid="nl35" bibid="bib40" firstref="ref64"></nolink> <nolink nlid="nl36" bibid="bib23" firstref="ref65"></nolink> <nolink nlid="nl37" bibid="bib35" firstref="ref66"></nolink> <nolink nlid="nl38" bibid="bib37" firstref="ref72"></nolink> <nolink nlid="nl39" bibid="bib46" firstref="ref73"></nolink> <nolink nlid="nl40" bibid="bib26" firstref="ref74"></nolink> <nolink nlid="nl41" bibid="bib10" firstref="ref75"></nolink> <nolink nlid="nl42" bibid="bib28" firstref="ref79"></nolink> <nolink nlid="nl43" bibid="bib11" firstref="ref83"></nolink> <nolink nlid="nl44" bibid="bib29" firstref="ref84"></nolink> <nolink nlid="nl45" bibid="bib31" firstref="ref85"></nolink> <nolink nlid="nl46" bibid="bib12" firstref="ref86"></nolink> <nolink nlid="nl47" bibid="bib55" firstref="ref87"></nolink> <nolink nlid="nl48" bibid="bib20" firstref="ref89"></nolink> <nolink nlid="nl49" bibid="bib19" firstref="ref90"></nolink>
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Parental Stress and Child Irritability in ADHD: A Two-Wave Longitudinal Serial Mediation Model via Experiential Avoidance and Negative Parent-Child Relationship
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  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Armagan+Aral%22">Armagan Aral</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-5098-3664">0000-0001-5098-3664</externalLink>)<br /><searchLink fieldCode="AR" term="%22Gizem+Gerdan%22">Gizem Gerdan</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-6066-7059">0000-0001-6066-7059</externalLink>)<br /><searchLink fieldCode="AR" term="%22Yilmaz+Orhun+Gürlük%22">Yilmaz Orhun Gürlük</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-1134-3776">0000-0002-1134-3776</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Attention+Disorders%22"><i>Journal of Attention Disorders</i></searchLink>. 2026 30(3):342-353.
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  Label: Availability
  Group: Avail
  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 12
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2026
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Attention+Deficit+Hyperactivity+Disorder%22">Attention Deficit Hyperactivity Disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Rearing%22">Child Rearing</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Variables%22">Stress Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Symptoms+%28Individual+Disorders%29%22">Symptoms (Individual Disorders)</searchLink><br /><searchLink fieldCode="DE" term="%22Parenting+Styles%22">Parenting Styles</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Child+Relationship%22">Parent Child Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Preadolescents%22">Preadolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Predictor+Variables%22">Predictor Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Psychological+Patterns%22">Psychological Patterns</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Influence%22">Parent Influence</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Turkey%22">Turkey</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/10870547251407731
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1087-0547<br />1557-1246
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: ADHD is complex neurodevelopmental disorder that causes considerable individual and social difficulties, creating significant parental stress. This study aimed to examine the indirect associations between parental stress and child irritability through two sequential parenting mechanisms: experiential avoidance and negative parent-child relationship, within a sample of school-aged children with ADHD (ages 6-12). Using a two-wave longitudinal serial path analysis based on parent-reported data collected at two time points 1-month apart (Time 1 and Time 2), the study investigated whether early parental stress predicted subsequent child irritability via its influence on experiential avoidance and the quality of the parent-child relationship. Findings supported the hypothesized model. More precisely, higher parental stress was associated with greater experiential avoidance, which in turn predicted more negative parent-child relationship, ultimately resulting in elevated child irritability. Longitudinal serial mediation effects confirmed that all Time 1 variables significantly predicted corresponding Time 2 outcomes across the proposed sequential pathway. Notably, the model explained 41.1% of the variance in child irritability at Time 2, underscoring how stress-related disruptions in experiential avoidance and parent-child relationship can affect child irritability even over a short period of time. Taken together, these findings provide empirical support for a stress-driven sequence of parental mechanisms through which parental stress may contribute to child irritability in ADHD. In this context, interventions targeting parental experiential avoidance and improving the quality of parent-child relationship may help mitigate the early development of irritability in children with ADHD. Clinical implications are discussed.
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  Data: As Provided
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  Label: Entry Date
  Group: Date
  Data: 2026
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1496445
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1496445
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/10870547251407731
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 12
        StartPage: 342
    Subjects:
      – SubjectFull: Attention Deficit Hyperactivity Disorder
        Type: general
      – SubjectFull: Child Rearing
        Type: general
      – SubjectFull: Stress Variables
        Type: general
      – SubjectFull: Symptoms (Individual Disorders)
        Type: general
      – SubjectFull: Parenting Styles
        Type: general
      – SubjectFull: Parent Child Relationship
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Preadolescents
        Type: general
      – SubjectFull: Predictor Variables
        Type: general
      – SubjectFull: Psychological Patterns
        Type: general
      – SubjectFull: Parent Influence
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Turkey
        Type: general
    Titles:
      – TitleFull: Parental Stress and Child Irritability in ADHD: A Two-Wave Longitudinal Serial Mediation Model via Experiential Avoidance and Negative Parent-Child Relationship
        Type: main
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      – PersonEntity:
          Name:
            NameFull: Armagan Aral
      – PersonEntity:
          Name:
            NameFull: Gizem Gerdan
      – PersonEntity:
          Name:
            NameFull: Yilmaz Orhun Gürlük
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 03
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-print
              Value: 1087-0547
            – Type: issn-electronic
              Value: 1557-1246
          Numbering:
            – Type: volume
              Value: 30
            – Type: issue
              Value: 3
          Titles:
            – TitleFull: Journal of Attention Disorders
              Type: main
ResultId 1