Parental Emotional Symptoms as a Statistical Mediator Between ADHD Symptoms and Behavior Problems: A Cross-Sectional Study in China

Background: Children with Attention Deficit Hyperactivity Disorder (ADHD) often face behavioral challenges, which may be exacerbated through bidirectional parent–child interactions. Sex differences and cultural context may further shape this pathway. This study aims to examine these relationships among children’s ADHD symptoms, behavioral problems, and parental emotions (anxiety and depression) within China, testing whether parental emotions serve as a mediator and exploring potential differences across child sex. Methods: A path analysis was conducted among children’s ADHD symptoms, children’s behavioral problems, and parental emotional symptoms. Children’s ADHD symptoms were measured using the Swanson, Nolan, and Pelham version IV scale-parent form (SNAP-IV), while the Strengths and Difficulties Questionnaire (SDQ) assessed behavioral problems. Parental emotional symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales. All questionnaires are in Chinese. Results: The direct, indirect, and total associations of children’s ADHD symptoms on behavioral problems were significant in all models. In the full model, the indirect association, defined through parental emotional symptoms, was estimated at 0.206 (95% CI: 0.157–0.262). The indirect pathway constituted 27.3% of the total association. Conclusions: Parental emotional symptoms are associated with both children’s ADHD symptoms and their behavioral problems, indicating a potential pathway warranting further investigation. Child sex does not play a significant moderating role in the path, but an indirect association from ADHD symptoms to peer problems is observed in boys, not girls.