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The Relationship Between ADHD Symptoms in Parents and Their Parenting Behavior
Although researchers and clinicians have noted difficulty that adults with ADHD are likely to experience in their interpersonal relationships, little attention has been paid to how the disorder might affect their behavior as parents.
Some researchers have suggested that ADHD symptoms may place a parent at risk for engaging in parenting practices that could contribute to the development of behavior difficulties in their child. For example, parents who are impulsive may have difficulty inhibiting the strong expression of anger and other negative emotions when disciplining their child. Impulsivity may also contribute to a parent being overly permissive by increasing likelihood that the parent will "give in" to a child's coercive behavior because this can provide an immediate "reward" (i.e. reducing/eliminating a child's whining), even though this typically creates more problems in the long-term.
The inattentive symptoms of ADHD may also create difficulties in parenting. For example, parents who are highly inattentive may have trouble engaging in consistent monitoring of a child's behavior. Being consistent and enforcing rules requires attending to what the child is doing and remembering what the consequences are for different behaviors. This may be more difficult for parents who are highly inattentive themselves.
It has been found in prior research that as many as 25-30% of parents who have a child with ADHD have ADHD themselves. In many cases, ADHD in parents has never been diagnosed, and some parents do not become aware that they have ADHD until it becomes apparent when having their child evaluated.
Because ADHD is so common in parents of children with ADHD, and may contribute to difficulties in parenting, it is important to learn how ADHD in parents may impact their parenting. It is also important to study whether ADHD symptoms in parents affects the benefit they derive from parent training programs designed to teach parenting skills and strategies that are helpful for a child who has ADHD. This knowledge could potentially contribute to the development of more effective parenting programs for parents who have ADHD themselves.
Despite the importance of this issue, there has been only one prior study in which ADHD symptoms in parents were related to the effectiveness of parent training. In this study mothers with high levels of ADHD symptoms had children who showed no improvement following parent training, while mothers with few ADHD symptoms had children who benefited strongly from the intervention. Participants in this study were limited to parents of preschool children, however, and no fathers were included.
A recent issue of the Journal of Attention Disorders - www.mhs.com/jad - includes an interesting study on the association between ADHD symptoms in parents and their parenting behavior (Harvey, E.J., et al [2003]. Parenting of children with ADHD: The role of parental ADHD Symptomatology. Journal of Attention Disorders, 7, 31-43). In this study, the authors examined the relation between parents' self-reported ADHD symptoms and their parenting behavior both before and after participating in a behavioral parent-training program. The authors predicted that parents who reported more ADHD symptoms would demonstrate less effective parenting strategies before parent training and would show less improvement in their parenting skills after parent training.
Participants
Participants in the study were 46 mothers and 26 fathers who were recruited through advertisements in local newspapers and schools. All were parents of a child (age range 4-12) with ADHD, the vast majority of whom were boys. The age of mothers and fathers in the study ranged from the mid-20s to the late 50s, with an average age of approximately 37.
Study Procedure
Prior to participating in the parent training intervention, parents completed a number of measures intended to assess their level of ADHD symptoms and their parenting practices. Parents' ADHD symptoms were assessed via their self-report on the Adult Attention Deficit Disorder Evaluation Scale. As would be expected in a sample of parents of children with ADHD, parents reported more ADHD symptoms than is typical for the general adult population. Interestingly, mothers tended to report slightly higher levels of ADHD symptoms than fathers.
Parenting behavior was assessed in several ways. Parents completed a 30-item Parenting Scale in which they rated their tendency to employ a variety of specific disciplinary strategies. Responses to individual items were used to compute a summary score for each parent that indicated their tendency to be overly reactive/punitive in their disciplinary style and overly lax/permissive. Parents also completed a second measure designed to assess their general level of nurturance and restrictiveness with their child.
Finally, parents were asked to audio tape their interactions with their child for 3 hours over the course of a week during times when they typically had difficulty with discipline (e.g. getting ready for school in the morning, getting chores completed, etc.). These audio tapes were subsequently evaluated to determine the frequency of the following parent behaviors: 1) using negative tone towards child; 2) repeating a command/directive in an effort to get the child to comply; 3) arguing with the child to get the child to do something or to stop doing something; and, 4) praising the child or verbalizing some other form of affection.
Child behaviors during the audio taped interactions were coded as: 1) non compliant - used when child did not comply with their parent's request; 2) ignore - used when the child did not respond to parent or produced a response unrelated to their parent's statement; 3) verbal misbehavior - used when the child talked back, argued, swore, or nagged; and 4) compliance - used when the child complied with a request made by the parent.
The parent-training program consisted of 8-weekly sessions that lasted for 75 minutes. The program provided parents with instruction on giving effective commands, and how to use praise, reprimands, and time outs. Parents were also provided with strategies to use when when their child refused to comply with the time-out procedure. Modeling and role-playing of effective and ineffective parenting practices were used as teaching techniques and parents were encouraged to practice what they learned between sessions.
After completing the parenting program, parents completed the parenting measures for a second time, including audio taping interactions with their child. This enabled the researchers to examine whether any changes in parenting behavior had occurred.
Results
Is There A Relationship Between Parents' ADHD Symptoms And Their Self-reported Parenting Practices?
For mothers, higher levels of inattentive symptoms were associated with a more lax parenting style (i.e. being more permissive) both before and after parent training. This is problematic because overly permissive parenting tends to be associated with higher levels of child behavior problems. After parent training, higher levels of impulsivity were also related to greater maternal laxness. There was no indication that mothers' ADHD symptoms were related to their general level of nurturance.
For fathers, associations between self-reported ADHD symptoms and self-reported parenting style were stronger. Fathers who reported high impulsivity and high inattentiveness were more lax in their parenting and also reported being more emotionally reactive with their child. These relationships were found both before and after parent training. The combination of high reactivity and high permissiveness may be especially problematic, as it suggests a parenting style in which one frequently loses one's temper but fails to follow through on enforcing consequences. As with mothers, there was no indication that fathers' ADHD symptoms were related to their general level of nurturance.
Is There A Relationship Between Parents' ADHD Symptoms And Their Interactions With Their Child?
Before parent training, maternal reports of impulsive and inattentive symptoms were not associated with their own or their child's behavior. After parent training, however, mothers who were more impulsive and more inattentive showed more repetition of commands and higher levels of arguing. Their children were more non compliant, engaged in more verbal misbehavior, and were more likely to ignore their mothers' commands.
These results appeared to reflect the fact that highly inattentive mothers were helped least by the parent training - i.e., parent training produced little if any change in their parenting behavior. Mothers who reported lower levels of ADHD symptoms, in contrast, showed significant change in their parenting behavior after training.
For fathers, higher levels of impulsivity and inattentiveness were associated with more arguing with their child prior to parent training. After parent training, none of the relationships between fathers' ADHD symptoms, fathers' behavior, or child behavior were significant. There was also no indication that fathers with high levels of ADHD symptoms failed to benefit from parent training.
Was The Parent Training Program Effective?
Although the central focus of the study was to examine the association between parents' ADHD symptoms and their parenting behavior, it is also interesting to examine the impact of the parent training program on parent and child behavior overall.
Analysis of the audio taped interactions indicated that mothers reduced their use of a negative tone with their child, reduced their use of repetition, and also reduced the frequency of arguing. As noted above, however, these changes were substantially greater among mothers without high levels of inattentive symptoms. Among children, noncompliance, verbal misbehavior, and ignoring parental commands were reduced.
Among fathers, reductions in the use of negative tone and arguing were found. Significant changes in child behavior, however, were not evident.
Summary And Implications
Results from this study are consistent with the hypothesis that ADHD symptoms in parents tend to be associated with less effective parenting practices.
Fathers' who reported more symptoms of inattention and impulsivity were more permissive and reactive with their child before and after parent training. Fathers' impulsivity was also associated with more arguing with their child before parent training.
For mothers, inattention was associated with lax parenting before and after parent training, and with more problematic child behavior after parent training. In addition, mothers with clinically elevated levels of inattentive symptoms benefited less from the parent-training program. This is consistent with a prior finding that mothers with high levels of ADHD symptoms showed the least response to parent training.
Results from this study have several important implications. First, they highlight the potential value of assessing ADHD symptoms in parents when their child is being evaluated for ADHD. ADHD is known to be more common in parents who have a child with ADHD and may not have previously been diagnosed. This study indicates that in such situations, parents' ADHD symptoms can undermine the effectiveness of their parenting and the benefit they derive from working on their parenting skills. Treating ADHD symptoms in parents may thus be an important component of effectively managing ADHD in children, not to mention the benefits such treatment may have for parents independent of their parenting role.
Second, for mothers in particular, high levels of ADHD symptoms appear to limit the benefits they derive from participating in parent training programs. This suggests that research on how parent-training programs can be modified to provide greater benefit to mothers with ADHD would be important to pursue.
This study has several limitations that the authors acknowledge. First, the sample size, particularly of fathers, was relatively small. Replicating the study with a larger sample would thus be important.
Second, it is problematic that parental ADHD symptoms were assessed only via self-report, rather than by conducting more extensive diagnostic assessments with parents.
Third, this study does not enable one to determine whether parents' ADHD symptoms caused the parenting behavior that was observed. Thus, the parenting behavior that characterized parents with high levels of ADHD symptoms may be related to other factors beside their ADHD symptoms.
Despite these limitations, results from this from this study highlight:
- 1) The adverse impact that ADHD symptoms in parents may have on their parenting behavior;
- 2) The value of assessing parents for ADHD when evaluating their child, or, when parents have persistent difficulty implementing parenting suggestions that are offered as part of their child's treatment; and,
- 3) The potential benefits to children's treatment of providing effective treatment for ADHD to parents who have ADHD themselves.
- 4) The need to consider how parent training programs can be modified so that they may be more effective for parents who may have ADHD themselves.
The authors have done the field a service by initiating work in this important area. Hopefully, additional research on this topic will soon become available.
Note: This article originally appeared in Attention Research Update, an online newsletter written by Dr. David Rabiner, a Duke University psychologist and former member of CHADD's Professional Advisory Board. You can learn more about Attention Research Update and sign up for a free subscription at www.helpforadd.com.