Attention Research Update

August 2011

"Helping parents, professionals and educators stay informed about new research on ADHD"

David Rabiner, Ph.D.  Associate Research Professor, Duke University

How Children's ADHD Symptoms Affect Parents' Feelings and Behavior


ADHD in children puts stress on parents.  In fact, parents of children with ADHD report greater parenting stress, less satisfaction in their parenting role, and more depressive symptoms than other parents.  They also report more negative interactions with their child.  This is certainly not true in all families where a child has ADHD but instead reflects average differences that have been found.

How do ADHD symptoms in children affect parents' feelings about parenting and their behavior toward their child?  And, does this differ for boys and girls?  These questions were the focus of a study recently published online in the Journal of Abnormal Child Psychology [Glatz et al., (2011). Parents' reactions to youths' hyperactive, impulsivity and attention problems. Journal of Abnormal Child Psychology.  Published online July 13, 2011.]

Participants were 706 children (376 boys and 330) and their parents from a mid-sized town in Sweden.  They were drawn from a 5-year longitudinal study which included nearly all youth from 4th thru 12th grade in this town.  Youth were between 10 and 12 at the start of the study and well into adolescence by the conclusion.  This was not a sample of youth diagnosed with ADHD but a regular community sample.

Three waves of data were collected from parents (over 70% mothers) with roughly 2 years between each wave.  Measures collected during each wave included the following:


Child ADHD symptoms - Parents rated their child's ADHD symptoms using a standardized rating scale.

Youth defiance - Ratings of children's oppositional behavior .

Unresponsiveness to Parental Correction - This scale measured how parents' felt their child normally responded to parental attempts to influence his or her behavior.  High scores reflect parents' feelings that their child was unresponsive to such efforts.

Parents' Feelings of Powerlessness - This scale measured parents' perceptions of their inability to change their youth's problematic behavior.  High scores reflected a parent's feeling that he/she was relatively powerless to change problematic behavior in their child.  A sample item from this scale is "Have you ever felt on the border of giving up - felt that there was nothing you could do about the problems you had with the youth?"

In addition to collecting the above data from parents, children also completed scales that measures their perception of their parents' warmth, coldness and rejection towards them.  These scales were collected during waves 2 and 3. 


Study Hypotheses

Because data was collected over a 5-year period, the researchers could test whether ADHD symptoms predicted parents' perception of child unresponsiveness and their own sense of powerless several years later. The specific predictions tested were that: 1) child ADHD symptoms lead parents to perceive their child as unresponsive to correction; and, 2) feeling that one's child is unresponsive to correction leads to increases in a parent's feelings of powerlessness.

The longitudinal design also allowed the researchers to test how parents' feelings of powerlessness may influence their behavior towards their child.  They hypothesized that parents who felt more powerless would be perceived by their child to display less warmth and more coldness and rejection towards them over time.


Results

Results from this study were largely consistent with the above hypotheses.  Parents' report of child ADHD symptoms at time 1 predicted increased feelings that their child was unresponsive to correction 2 years later. In turn, parents' reports of child unresponsiveness to correction at time 2 predicted increased feelings of powerless 2 years later.

The authors next tested whether parents' feelings of powerlessness predicted youths' perception of how their parents behaved towards them.  Parents who reported more powerlessness at time 1 had children who reported more cold and rejecting parental behavior and reduced parental warmth 2 years later. 

The above results were largely consistent across boys and girls.  In addition, these results remained largely unchanged even when taking children's level of defiance into account, suggesting that ADHD symptoms have a direct effect on the processes studied.


Summary and Implications

The adverse impact of children's ADHD symptoms on parents' stress levels, satisfaction in the parenting role, and even depressive symptoms have been known for some time.  Results from this study suggest that it is not ADHD symptoms themselves that affect parents in these ways, but rather, it is parents' perception that their child is largely unresponsive to correction that is most challenging. 

Behaviors associated with ADHD appear to influence parents negatively because they are perceived to be largely outside parents' control, which contributes to growing feelings of powerlessness.  Feelings of powerlessness, in turn, can lead parents to behave towards their child in ways that children increasingly view as colder, more rejecting, and less warm.  This cycle was largely similar for boys and girls and would be expected to have growing negative affects on children and parents over time.

What is somewhat ironic about these findings is that in children with ADHD, behaviors that reflect inattention, hyperactivity, and impulsivity are believed to have strong biological underpinnings and are legitimately difficult for parents and children to control.  Thus, it is not surprising that many parents experience children displaying high levels of these behaviors as unresponsive to correction, and these feelings are not necessarily inaccurate.  What makes these feelings problematic, however, is that they contribute to growing feelings of powerlessness in parents, perhaps because the understandable difficulty parents have 'correcting' behaviors that reflect core symptoms of ADHD can lead them to feel less confident about influencing their child in other important domains.

An example may make this clearer.  If I have a child with ADHD who is severely hyperactive, getting my child to significantly alter their activity level is going to be extremely difficult using the typical strategies parents might engage.  It is easy to imagine how if I continue to focus on this, I will increasingly feel that my child is unresponsive to correction and develop a growing sense of powerlessness.  Over time, this might contribute to my being less willing to try and exert influence in important areas where I am more likely to be successful, e.g., helping my child develop a particular skill or talent or helping him learn the importance of developing reasonable saving and spending habits.

This argues for the importance of helping parents recognize that although children may be 'unresponsive to correction' when it comes to the core symptoms of ADHD that have important biological underpinnings, this does not need to generalize to other aspects of a child's life where parents are eager to have an important positive influence.  Clearly understanding that getting children to change core ADHD symptoms is difficult - many would argue that this is where carefully monitored medication treatment can play a useful role - may protect parents from feeling increasingly powerless about exerting positive influence on their child and help them remain engaged with their child in ways that children experience as warm, nurturing and supportive. 



Information presented in Attention Research Update is for informational purposes only, and is not a substitute for professional medical advice.  Although newsletter sponsors offer products and services that I believe will be of interest to subscribers, sponsorship of Attention Research Update does not constitute a specific endorsement or guarantee of any company's product or services.

(c) 2011 David Rabiner, Ph.D.