Jan 13, 2016
Numerous studies have established that parents of children with ADHD experience more stress in their parenting role than other parents. Although it is reasonable to expect that this would also be true for parents of adolescents with ADHD, this issue has not been previously investigated. This is an important gap in the literature as documenting greater stress among parents whose teen has ADHD, and how this may differ for mothers and fathers, could inform the importance of attending to parents’ stress when treating teens with ADHD.
This issue was examined in the study Parenting stress of parents of adolescents with attention-deficit hyperactivity disorder, published in the Journal of Abnormal Child Psychology. Participants were 84 13-18 year-old teens (52 boys, 32 girls) and 54 typically developing teens (24 boys, 30 girls) and their parents. When available, both mothers and fathers participated.
Summary and implications
Results from this study highlight the importance of attending to parents’ stress in families where an adolescent has ADHD. Also highlighted is the important role of oppositional behavior in parents’ stress levels, irrespective of teens’ ADHD status, as well as differences in how mothers and fathers experience their relationship with their adolescent.
For mothers, raising a teen with ADHD is stressful in multiple domains. These moms experience greater stress related to their teens behavior, report more adverse consequences in other areas of their life, and feel more stress in their relationship with their teen. This is particularly true when teens display high rates of oppositional behavior as opposed to only the core ADHD symptoms of inattention and hyperactivity/impulsivity. This highlights the necessity of addressing oppositional behavior when treating teens with ADHD, something that may often be better addressed through behavioral interventions than by medication alone.
The situation with fathers appears to be different in important ways. In general, having a teen with ADHD was less likely to be associated with increased stress among fathers, and fathers reported less stress in the parent-teen relationship when their own ADHD symptoms were high. For dads, it was only high levels of teen oppositional behavior that was clearly linked to increased parenting stress. This again highlights the importance of attending to oppositional behavior specifically when treating adolescents with ADHD.
Although results from this study require replication – this is true for any study of a new issue – even these initial findings have important implications for parents and clinicians. First, mothers of teens with ADHD are likely to be experiencing elevated stress related to their parenting role and this should be carefully attended to. In many families, restricting treatment to a teens ADHD symptoms and associated behaviors may be too limited in that it fails to directly address the stress mothers may be experiencing. Clinicians should be attentive to this issue and may need to work with mothers to identify positive social supports and encourage them to pursue and prioritize appropriate self-care. Although similar stress levels may be less frequent among fathers, this is also an issue to be attentive to.
Moms whose parenting of a teen with ADHD is highly stressful should recognize that this is not an uncommon experience and hopefully feel comfortable about seeking help for their stressors. Fathers should feel comfortable seeking such help as well.
Differences in the typical experiences of mothers and fathers whose teen has ADHD also need to be considered. As noted above, these initial findings suggest that fathers are often less likely to report experiencing this as stressful and their own ADHD symptoms may actually decrease the stress they experience in their relationship with their teen. This difference in how parenting a teen with ADHD is experienced by mothers and fathers – regardless of how it comes about – may contribute to conflicts between parents that would also be important to assess for and address. Parents should be aware that differences in the experience of mothers and fathers is not uncommon, and recognize that their can be benefits in working to understand and respect their partner’s different perception, rather than this becoming another potential source of conflict.
The Study in Detail:
Stress Index for Parents of Adolescents – Parents completed this 90-item measure to assess their stress in 3 domains. The Adolescent domain measures parents’ stress in relation to the characteristics they perceive in their teen, e.g., moodiness, isolation, emotional reactivity, antisocial behavior. The Parent domain assesses parents’ perception of how parenting effects their other life roles, e.g., their relationships with friends and spouse, their feelings of competence). The Adolescent-Parent domain measures parents’ perception of their relationship with their teen, e.g., quality of communication, amount of affection).
Conners Adult ADHD Self-Report Scale – Parents reported on their own ADHD symptoms using the Conners Adult ADHD Self-Report Scale. This measure was administered so researchers could examine how parents’ own ADHD symptoms may relate to their experience of parenting stress.
Conners-3 Rating Scale – Parents completed this measure both to confirm the presence of ADHD symptoms in the teens and to assess the extent of oppositional/antisocial behavior that parents observed.
Results for mothers – Mothers of teens with ADHD reported more stress than mothers of comparison teens in the Adolescent, Parent, and Adolescent-Parent domains. These differences, however, were related to the amount of oppositional behavior that mothers perceived as well as to their own self-reported ADHD symptoms.
Regardless of whether or not mothers rated their teens’ oppositional behavior as clinically elevated, stress related to adolescents’ characteristics was still higher among moms whose teen had ADHD. However, moms’ reports of how parenting affected their other life roles, e.g., relationships with friends and spouse, feelings of competence, depended not only on whether the teen had ADHD, but also on whether moms’ rated the teens oppositional behavior as clinically elevated. Thus, when oppositional behavior was not elevated, stress in the Parent domain was not elevated for moms whose teen had ADHD. This was also true for mothers’ perception of their relationship with their teen, i.e., it was poorer for moms whose teen had ADHD and high levels of maternal-rated oppositional behavior but not among moms whose teen had ADHD without significant oppositional behavior.
Finally, moms’ reports of stress in the Parenting domain was also related to their self-reported ADHD symptoms, i.e., the more ADHD symptoms they reported the more stress they reported in the parenting domain.
Results for fathers – Results for fathers showed both similarities and differences from those obtained for mothers. As with mothers, fathers of teens with ADHD reported more stress related to their teen’s characteristics, although this was greatly influenced by whether they also reported their teen to show high rates of oppositional behavior.
Unlike for moms, however, fathers of teens with ADHD did not report more negative effects of parenting on other aspects of their lives than fathers of teens without ADHD; this was true even when teens had both ADHD and high rates of oppositional behavior.
Finally, an especially interesting result was obtained when examining fathers’ perception of their relationship with their teen. Here, teens’ ADHD status was not related to fathers’ reports of stress related to the relationship. However, the relationship was rated as more stressful when teens’ oppositional behavior was high.
Especially noteworthy, and surprising, was that the more ADHD symptoms that fathers reported the less stress they experienced in their relationship with their teen.
– Dr. David Rabiner is a child clinical psychologist and Director of Undergraduate Studies in the Department of Psychology and Neuroscience at Duke University. He publishes the Attention Research Update, an online newsletter that helps parents, professionals, and educators keep up with the latest research on ADHD.