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Study: Raising a teen with ADHD adds significant stress to parents–especially to mothers

MOTHER-TEENAGE-SONNumer­ous 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:

Measures

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

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.

Rabiner_David– 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.

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