A Look at Parental Stress in Families of Children with ADHD

A Look at Parental Stress in Families of Children with ADHD

Parenting a child who has been diagnosed with ADHD has certainly had many challenges for myself and my husband. As I began to notice that my son seemed to be struggling more with his behavior and inability to focus more that other children, I began to realize that I was more stressed than other parents with children who were my son's age that did not have ADHD. Research on this topic of parental stress in families of children with ADHD has begun to expand(Kendall, Leo, Perrin & Hatton, 2005). Throughout my research, I found two  that approached this topic differently, but that both ultimately open up dialogue on how to best support families of children with ADHD.

Below is a video that gives a brief vignette into a family where the parents are exhibiting distress in parenting a child with ADHD:

“Modeling ADHD Child and Family Relationships”

Kendall, Leo, Perrin and Hatton(2005) specifically examined the relationship between the child's behavior, family conflict and the mother's distress within the family. The researchers provide previous research that gives light to the presence of more interpersonal conflict in families who have a child that is diagnosed with ADHD. This interpersonal conflict appears to have a correlation with other family dynamics, particularly conflict within the marriage, increased maternal distress and less experiences within the family context that are positive. Of particular interest in this research was the focus on maternal distress, rather than looking at stress of the parents as a whole unit. Kendall, Leo, Perrin and Hatton's(2005) literature review suggested that mothers who have children with ADHD can be more susceptible to their mental health being affected, particularly being at risk for depression and anxiety. Additionally, mothers also seem to carry more of the responsibility of the issues or struggles that come in parenting a child with ADHD and also experience less connection to other family members for support.

While the study examined multiple correlations between the variables of child behavior, maternal distress and family conflict, the factor of most interest within this study was the importance of the maternal role within families of children with ADHD. The sample for the study involved 157 families. Ethnicity was recorded , with 31% being African-American, 36% Hispanic American, and 33% Caucasian. The mothers in the sample ranged from 21-79 years of age, with the children in the sample ranging from 6-18 years old, with a mean of 10.8 years. Fifty-one percent of the sample identified as single parent families. Socioeconomic status was also recorded for the families, which produced some significant results, which will be discussed(Kendall, Leo, Perrin & Hatton, 2005).

Results indicated a relationship between an increase in behavior problems of the child with the mother's distress. Additionally, mothers who reported distress had increased conflict within their families. Another relationship of interest found that African-American families reported lower levels of child behavior issues than Caucasian families. Families with a higher socioeconomic status also reported less issues with their child's behavior than families with lower income(Kendall, Leo, Perrin, & Hatton, 2005). Given these relationships, the researchers concluded that “ the pattern of these results suggests that the degree of mother's distress may mediate the relationship between child behavior problems and family conflict, indicating the pivotal nature of the role of mothers play in these families” (p. 512).

Kendall,Leo,Perrin and Hatton(2005) conclude that this maternal distress is a residual effect of the expectation that is placed on mothers in general, especially being in the role of caregiver. When this role is combined with parenting a child with ADHD, it is most often left to the mother to “carry the responsibility for the exceedingly difficult work of caring for a behaviorally disordered child while simultaneously organizing home and family life, being the family ADHD expert, and acting as the child's advocate and liason within the school, health care system, extended family, and neighborhood”(p.512). The researchers ultimately conclude that because maternal distress is a mediating factor between child behavior and family conflict, more support and resources should be provided to the mother in order to play out their role as caregiver.

“Predicting Parenting Stress in Families of Children with ADHD: Parent and Contextual Factors”

Theule,Wiener, Rogers and Marton(2011) focused on identifying how ADHD symptomology in parents and contextual factors of parenting stress, such as level of education, amount of social support and marital status may be a function of child ADHD symptoms. While the variables of contextual factors are important in understanding parental stress, of particular importance in this study was the relationship between adult ADHD in parents and parental stress. The research ultimately determined that parents who had more severe ADHD symptomology and less social supports had a higher level of parental stress. Additionally, while the research indicated that parents with ADHD had a higher level of stress, there was no significant finding that the presence of ADHD symptoms in their child provided a causal effect. The discussion of this finding offered ways in which parenting in general can be stressful for a parent with ADHD, but that additional factors to consider in parenting a child with ADHD may increase the level of stress, such as attending school meetings, medication monitoring and being consistent in parenting practives(Theule, Wiener, Rogers & Marton, 2011).

Given the importance that parent ADHD symptomology plays in the level of stress experienced, especially in parenting a child with ADHD, the authors propose a closer look into examining mental illness within the parents , and how symptomology of diagnoses may have more of an effect on parenting stress than child behavior factors. Theule, Wiener, Rogers and Marton(2011), briefly make this connection with past studies that identified levels of parental stress within mothers who were diagnosed with depression. Given this information, the researchers ultimately suggest the importance of connection to parent support groups and programs, such as parent management training being available to parents who are diagnosed with ADHD in order to reduce stress.

Closing Thoughts

The first article that was summarized was a clear indication that more efforts need to be taken within support systems to engage the whole family unit in parenting a child with ADHD. The role of primary caregiver for children is often left to the mother, as the maternal role is seen as nurturing and able to provide emotional support for their children and sometimes the whole family. This view in itself can have the ability to create higher levels of stress within mothers, as they often feel pressured to be “supermom”. When parenting a child with behavior, inattention and hyperactiviity issues, this pressure to hold the family unit together can be overwhelming. Being a mother to a son with ADHD, I have definitely experienced times where I have felt that the struggle of navigating systems to help my son succeed independently. This is not because my husband was being a passive member within my family, but rather it is the continued notion that whenever an issue would arise with my son, especially at school, I was always the first parent called to handle the situation, even though my husband was listed as a contact as well. While the researchers in the first article make a valid point that mothers do need more support in order to alleviate stress in their roles, it is also important to consider how systems, whether it be school, therapy environments or the community should be making efforts to involve both parents to communicate about the child's needs.

This notion of support for the whole family can also be extended to the second article, especially in families who have parents and children with ADHD. Creating programs or areas for conversation such as support groups about stress within these families is crucial to improve symptomology and relationships within the family unit. Within my own process, I have found that while my son's school had been very supportive in working with me, it only happened because I had the knowledge and ability to advocate for my son and myself. The ability to advocate for one's children may not always be an option for some parents, whether it be lack of knowledge or fear of stigma. Creating an open space for conversation to occur within schools will ultimately help to strengthen parent-teacher connections and may also open doors to other resources that parents can access in order to reach a healthy place within their family. My final blog will discuss the importance of parent involvement in schools and how utilization of stress-reduction techniques, such as mindfulness, can be beneficial to family unit as a whole.

References:

Kendall, J., Leo, M.C., Perrin, N. & Hatton,D. (2005). Modeling ADHD child and family relationships. Western Journal of Nursing Research, 27(4), 500-518.

Theule, J., Wiener, J., Rogers, M. A., & Marton, I. (2010). Predicting parenting stress in families of children with ADHD: Parent and contextual factors. Journal of Child and Family Studies J Child Fam Stud, 20(5), 640-647.

Parenting a Child with ADHD

Parenting a Child with ADHD

In the past, when I have been asked in my academic career to choose a topic to research, I have often found myself going to where my passion lies, or a topic in which I feel a sense of comfort in discussing as it is familiar. Upon being asked to write this blog, however; I chose a topic, that while I live the experience on a daily basis, I have been reluctant to immerse myself further into the topic as I have been scared of the research I might find, especially research that could indicate poor outcomes. Additionally, I have lived with the shame that I may be doing something wrong for this to happen within my family. As I researched my topic, however, I realized that I am not the only mother that feels this way and that my efforts to create structure and stability within my family have been crucial to the improvements that I have seen over the past year. This blog series will explore the dynamics of parenting a child with attention deficit hyperactivity disorder, or ADHD. I will specifically address topics that affect families who have children with ADHD: family structure and environment, parent perception of family functioning, parental stress, parental involvement in the child’s education and effective strategies or interventions for the family unit as a whole to utilize. This blog is dedicated to my son Sebastian, who is an incredible child that continues to show me daily that he is not his diagnosis.

                 

Prevalence of Childhood ADHD and Signs/Symptoms

According to Moen, Hedelin and Hall-Lord (2015), “attention deficit hyperactivity disorder (ADHD) is one of the most common developmental disorders in childhood, with a prevalence of approximately 5% of school-aged children” (p. 10).  Additionally, a diagnosis of ADHD is known to be more prevalent in males, with a ratio of 2:1, as reported by the American Psychiatric Association (Conlon, Strassle, Vinh & Trout, 2008).

The following video highlights signs and symptoms of childhood ADHD. It is important to note, however, that proper assessment by a licensed professional should be completed before a diagnosis of ADHD is determined.

Effects of Environment and Functioning Within Families Who Have a Child Diagnosed with ADHD

 
 Shroeder and Kelley(2009) conducted a research study on attempting to identify links between family environment, ways of parenting and level of executive functioning of children who are diagnosed with ADHD, compared to those children who do not have ADHD. This study took a different approach on looking at the structure of the family environment in that the goal was to identify “how aspects of the family environment and parent-child relationships were related to executive functioning of children with ADHD as compared to children without ADHD” (p. 227). Shroeder and Kelley(2009) note that past studies have certainly focused on the effects of family environment and parenting styles, but have not explored how children’s executive functioning(which includes a behavioral regulation component and metacognition abilities)may be affected as a result. 

 Shroeder and Kelley’s(2009) study in particular gathered 134 parents and/or legal guadians of children who had or did not have ADHD. Ages of children ranged from 6-12 years of age, where 29 had a diagnosis of ADHD, and the remaining 105 child participants did not have ADHD. The sample was 45.5% girls and 54.5% boys, with the distribution of grade level as follows: 9% in kindergarten, 12.7% in first grade, 15.7% in second grade, 14.9% in third grade,17.2% in fourth grade, 12.7% in fifth grade and 14.9% in sixth grade. The study utilized three measures ( Behavior Rating Inventory of Executive Function-Parent Form, Parent-Child Relationship Inventory and Family Environment Scale) to determine if there was a correlation between family environment, ways of parenting and a child’s executive functioning.  The study ultimately concluded that families of children with ADHD identified with more variables that indicated a presence of a higher level of family conflict and less organization as compared to families with children who did not have ADHD. Within the measure results it was additionally identified that children who have ADHD do have more difficulty in executive functioning processes (Shroeder & Kelley, 2009). While parents reported that their child with ADHD had more difficulty in executive functioning, the study ultimately concluded that no significant correlation existed between family environment, ways of parenting and a child’s difficulty in executive functioning.

 
 In addition to researching possible impacts that family environment may have on a child with ADHD in regards to their executive functioning, I also briefly examined  a research study completed by Moen, Hedelin and Hall-Lord(2015) that focused on the parent’s perspective on living with a child who has ADHD when support is involved. The study also focused on other factors such as the child’s behavior, ability for the family to function and a sense of togetherness via the parent’s perspective. The study measured these variables by not only including questions about each family member and perspectives from other support services, but a series of scales were used as well. These scales included the Family Assessment Device (FAD), the Strengths and Difficulties Questionnaire (SDQ), Sense of Coherence(SOC) and Social Cohesion and Support Index(SCS). The results indicated that parents who had children that were medicated for ADHD had reported that they were “satisfied with social support (SCS), rated their children’s behavior as less problematic and reported better family functioning” (p. 10). Additionally, the research concluded that the following factors were important to consider when looking to provide families with support: a strong sense of togetherness within the family unit, social support and formal support from community partners or agencies.

Next time…

               

 The brief research I have presented suggests that there are many facets to consider in a family when a child within the unit is diagnosed with ADHD. While some of the research has indicated that a child diagnosed with ADHD has a greater chance of living within a family that is lower functioning, has more marital conflict, less of a sense of togetherness and less parental involvement with the child’s education, there is more to be discovered within the family dynamic as to why these factors may be arising (Conlon, Strassle, Vinh & Trout, 2008). One significant component is the reality of the amount of stress that this diagnosis can place on each member of the family, and how this can have the potential to cause issues such as marital conflict or lack of support from others within and outside the family unit. The next blog will focus specifically on parental stress within families that have a child who is diagnosed with ADHD and how this component is also crucial to address in addition to treating the actual ADHD diagnosis. Additionally, the final blog will explore the importance of parental involvement, particularly in the child’s education in order to improve the child’s symptoms and ultimately to create an environment where the child is supported in each realm of their lives. Lastly, I also plan to offer my own perspective on what myself and my husband have learned in this journey with our son and provide positive ways to promote family connectedness.

References

Conlon, K. E., Strassle, C. G., Vinh, D., & Trout, G. (2008). Family management styles and ADHD: Utility and treatment implications. Journal of Family Nursing, 14(2), 181-200.

Moen, O. L., Hedelin, B., & Hall-Lord, M. L. (2015). Parental perception of family functioning in everyday life with a child with ADHD. Scandinavian Journal of Public Health, 43(1), 10-17.

Schroeder, V. M., & Kelley, M. L. (2009). Associations between family environment, parenting practices, and executive functioning of children with and without ADHD. Journal of Child and Family Studies J Child Fam Stud, 18(2), 227-235.