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As
awareness that ADHD frequently persists into adulthood has grown -
as recently as the late 1980s, ADHD was still regarded as almost
exclusively a disorder of childhood - increasing attention has been
given to how ADHD impacts the lives of adults. Surprisingly,
however, research on how ADHD may impact parenting behavior has been
extremely limited.
In the extensive liter ature on how parenting behavior influences
children's development, 3 aspects of parenting - parental monitoring,
inconsistent discipline, and parental problem solving - have emerged as
particularly important.
Parental monitoring involves tracking where a child is, what he or she
is doing, and whom he or she is with. Poor parental monitoring
has consistently been found to be strongly associated with poor child
outcomes, particularly antisocial outcomes. It is also clear that
monitoring becomes increasingly important as children make the
transition to adolescence.
Inconsistent discipline refers to variability in parents' responses to
child noncompliance - with parents sometimes punishing and sometimes
reinforcing noncompliance by "giving in" to the child's demands. This
inconsistent responding to negative child behavior has been shown to
predict increases in oppositional and defiant behavior in children.
Finally, parental problem solving reflects the ability to generate
multiple solutions for addressing child behavior problems, to
accurately evaluate the likely effectiveness of different solutions,
and to skillfully implement the chosen strategy. Less effective
parental problem solving has been linked to negative child outcomes in
a number of studies.
Although there are many other dimensions of parenting are important
influences on children's development - a parent's warmth and affection
towards the child is certainly one - the parenting dimensions described
above have been widely studied and are frequent targets for change in
parenting interventions. In fact, when parents improve their
skills in these areas children's behavior problems decrease.
There is good reason to expect that parents with ADHD would have
difficulty in these 3 aspects of parenting. Parents who have
difficulty listening and attending may miss out on information that is
important for carefully monitoring their child's activities and
whereabouts.
Enforcing household rules consistently may be a struggle for a parent
who acts impulsively or who becomes so absorbed in an activity that he
or she does not notice a child's failure to comply.
Finally, effective problem solving requires the ability to refrain from
acting impulsively with the first idea that pops into one's mind, and
to instead systematically generate and evaluate different
possibilities.
A recently published study in the Journal
of Abnormal Psychology provides the first data on how parents
with ADHD perform on these key parenting tasks (Murray & Johnston,
2006. Parenting in mothers with and without
Attention-Deficit/Hyperactivity Disorder. JAP, 115, 52-61).
Participants were 60 mothers between the ages of 31 and 50. These
mothers were recruited via notices in community centers, schools,
libraries, newspapers, and local support groups for ADHD. Thirty
of these mothers were diagnosed with ADHD based on a comprehensive and
rigorous evaluation. The remaining mothers did not have ADHD and
served as the comparison group. All of the mothers had at least
one child between the ages of 8 and 14 who had been diagnosed with
ADHD. This is important because it helps guard against the
possibility that any group differences in parenting that were found
could be attributed to the fact that moms with ADHD were more likely to
be dealing with the challenges of parenting a child with ADHD.
Measures
Participants completed a variety of measures to assess their own
functioning as well as their parenting. First, a structured
clinical interview was administered to assess for psychiatric
difficulties. Next, children's level of oppositional and
antisocial behavior was assessed by having the moms complete a
standardized behavior rating scale.
Well-established measures were administered to assess the key aspects
of parenting - monitoring, consistency, and problem solving - noted
above.
Monitoring - The Poor Monitoring Scale is a 10-item measure
designed to assess a parents' knowledge of their child's friends,
knowing where the child is after school, and the variety of activities
that a child engages in. Sample items include:
"You ask your child about his or her
day in school." "You ask your child what his/her plans are for
the coming day." "Your child is out with friends you don't know."
Moms rated how often they engaged in these kinds of behaviors on a 1
"never" to 5 "always" scales so that high scores on this scale are
indicative of a parent who is well informed about their child's
whereabouts, activities and companions. .
In addition to this measure of monitoring, each mother and child were
asked a series of identical and specific questions about the child's
social, academic, and leisure activities during the prior 24
hours. Moms and children were interviewed separately to insure
that their answers were independent, and the number of nonmatching
responses were used to compute an index of poor monitoring.
Inconsistency
- Several validated parenting scales were used to assess moms'
consistency in disciplining their child. Examples of items
include:
"You threaten to punish your child and then do not actually punish
him/her." "Your child talks you out of being punished after
he/she has done something wrong."
Moms rated how often they engaged in these kinds of behaviors on the
same 1 to 5 scale noted above. High scores thus reflect more
inconsistent discipline.
Problem solving
- Parental problem solving was assessed by presenting mothers with 3
common child management problems, e.g., getting the child to comply
with a request that he/she did not want to follow such as cleaning
their room. Mothers were asked to discuss how they would solve
the problem and their response was coded for the number of solutions
they offered, the likely effectiveness of these solutions, and the
level of planning indicated by the solutions. Response coding was
done by research assistants who were blind to the study hypotheses as
well as to mothers' diagnostic status.
Positive parenting
- The final parenting measure administered was included to evaluate
whether moms with and without ADHD differed in their positive parenting
behaviors, e.g., affection, praise, etc. Sample items from this
scale include:
"You compliment your child when
he/she is doing something well." "You hug or kiss your child when
he/she has done something well."
Parents rated how often they engaged in each positive behavior on a 1
to 5 scale with high scores reflecting more positive parenting.
Results
In
considering the results of this study that are summarized below, it is
important to emphasize that not all parents with ADHD will struggle in
the ways suggested. It would also be erroneous and
unfortunate to interpret these results as suggesting that individuals
with ADHD cannot be warm, supportive, and effective parents. This
is not the case nor would the authors of this study wish to convey that.
Demographics, Psychiatric Problems, and Child Problems
Mothers with ADHD were more likely to be single parents and had lower
levels of formal education. In addition, 70% of moms with ADHD
had a mood or anxiety disorder compared to only 23% of the comparison
moms. Interestingly, of the 16 moms with ADHD taking psychiatric
medication, 15 were on antidepressant or antianxiety medication and
only 1 was taking stimulant medication for ADHD. This is
important in that it suggests that adults with ADHD may often fail to
receive medication that specifically targets ADHD symptoms.
Mothers with ADHD also reported greater impairment in multiple domains
of functioning and that their children had higher rates of oppositional
and antisocial behavior.
Parenting Behavior
Monitoring
- As predicted, moms with ADHD reported monitoring their children less
carefully than moms without ADHD and the magnitude of the difference on
the Poor Monitoring Scale would be considered to reflect a large
effect. In addition, on the interview of children's activities during
the prior 24 hours, moms with ADHD provided substantilly more answers
that did not match their child, indicating less awareness of their
child's activities.
Inconsistency
- As predicted, moms with ADHD reported that they were significantly
less consistent in their discipline behavior and the group difference
was again large. Interestingly, the children of moms with and without
ADHD did not report any differences in their mother's consistency.
Problem Solving
- Although mothers with ADHD did not provide fewer solutions to the
problem solving scenarios than other mothers, their solutions were
judged to be lower in quality and to reflect lower levels of
planning. Group differences were again large.
Positive Parenting
- Based on both mother report and child report, there were no
statistically significant differences between groups for the number of
positive parenting techniques used.
Secondary Analyses
As noted above, moms with ADHD were more likely to have a mood or
anxiety disorder, and also reported that their children displayed
higher rates of antisocial behavior. Thus, it is possible that
the differences found in parenting behavior reflect these differences
rather than the presence or absence of ADHD. In other words,
perhaps the poorer monitoring in moms with ADHD was not related to ADHD
per se, but to anxiety and depression that interfered with their
ability to monitor their child.
To rule out this explanation, supplementary analyses were conducted
controlling for group differences in other psychiatric problems, in
single parent status, and in child behavior problems. Even with
these controls in place, parenting differences between mothers with and
without ADHD remained evident.
The authors also examined whether parenting behavior in moms with ADHD
varied as a function of ADHD subtype, i.e., inattentive ADHD vs.
combined ADHD. Interestingly, mothers with the inattentive
subtype of ADHD monitored their children less well than mothers with
the combined type, and also reported that they were less consistent in
their discipline practices.
SUMMARY AND IMPLICATIONS
Results from this study document the parenting difficulties experienced
by mothers with ADHD. Compared to other mothers, moms with ADHD
were less knowledgeable about their child's whereabouts, friends, and
activities, were less consistent in their discipline strategies, and
generated less effective solutions to child management problems.
In most cases, the parenting differences between mothers with and
without ADHD were large in addition to being statistically significant,
with most effect sizes greater than 1. Despite these difficulties,
however, they were no less positive than other moms in how they related
to their child, and provided their child with similar levels of
positive feedback and support.
The parenting differences found cannot be explained by the fact that
moms with ADHD were more likely to be have mood and/or anxiety
disorders, to be single parents, to have less formal education, and to
have children with higher rates of disruptive behavior. This is
because even when these factors were controlled for, parenting
differences between the groups remained evident. Thus, while this
study does not prove that ADHD "causes" the parenting difficulties
reported, the results suggest that ADHD plays a central role in these
difficulties.
It is interesting to note that mothers with the inattentive type of
ADHD, i.e., those with inattentive symptoms but not
hyperactive-impulsive symptoms, appeared to have greater difficulty
with monitoring and consistency than moms with ADHD, Combined
Type. Although these results are preliminary, the authors suggest
that in mothers with inattentive and hyperactive symptoms, high levels
of activity and energy may partially compensate for their attention
difficulties and allow them to be more involved in their child's life,
and thus better at monitoring their child.
The authors note several limitations to their study that are important
to recognize. First, as already discussed, the design of this
study does not allow clear conclusions to be made about whether ADHD is
the specific cause of the parenting difficulties that were
reported.
Second, parenting was assessed primarily by mothers' self-report and
future studies should incorporate other ways to assess parenting
behavior. For example, observations of mother-child interactions
could allow a more objective assessment of maternal consistency.
In cases of two-parent families, having spouses report on their
partner's monitoring behavior would also be an enhancement.
Finally, it would be very helpful to conduct a similar study in fathers
with ADHD. One cannot assume that the results obtained with
mothers would also be found with fathers, and an understanding of how
paternal ADHD may impact parenting and children's development is thus
an important topic for future research.
Despite these limitations, this study extends our knowledge of ADHD in
adults by clearly indicating that it is associated with difficulties in
key parenting tasks for mothers. Because it has been estimated that
between 40-60% of children with ADHD have at least one parent with
ADHD, these results highlight the importance of taking this into
consideration when implementing treatment for children with ADHD.
Moms with ADHD, because they are less likely to supervise their child's
activities or to have regular routines, may have difficulty
administering medication consistently. They may also face
particular challenges in traditional parent training programs, that
emphasize the important of consistency, monitoring, and effective
problem solving. Thus, effectively treating children for ADHD may
frequently necessitate treatment of ADHD symptoms in parents as well.
While
the results of this study represent an initial step in understanding
how ADHD can impact parenting behavior, it is important - as noted
above - to recognize that not all parents with ADHD struggle in the
ways suggested here. It is also important to recognize that even
in this sample, moms with ADHD were as positive and supportive as other
moms. Thus, it is very important that one does not conclude from
this study that moms with ADHD cannot be warm, supportive, and
effective parents to their child.
Instead, an important contribution of this study is that by increasing
awareness of the parenting difficulties that ADHD contributes to, it
may facilitate more parents with ADHD obtaining effective treatment for
the disorder. Such treatment would be expected to help address
the parenting difficulties reported here, and thus contribute to more
positive outcomes for children as well as parents. That would
certainly be a wonderful outcome for this type of research.