The Impact That Having A Child with ADHD Has on Parents' Satisfaction with Family Life

During my years of working with children who have ADHD and their parents, the level of stress that many families seemed to experience was striking. I have seen many parents who felt incredibly burned out by the daily struggles around behavior, homework, etc., and this was often compounded by frustrations associated with trying to make certain that their child's needs were getting adequately addressed at school. In many instances, I felt like one of the most helpful services I—or any other mental health professional could provide—was simply giving parents the opportunity to discuss their struggles and frustrations. In the process, we were sometimes able to help identify ways to manage these frustrations more effectively, although this was not always an easy task.

There is a very nice study that appeared in the November 98 issue of the Journal of Attention Disorders that looks explicitly at how parents who have a child with ADHD feel that things are going in their family (Kaplan, B.J., Crawford, S.G., Fisher, G.C., & Dewey, D.M. (1998). Family dysfunction is more strongly associated with ADHD than with general school problems. Journal of Attention Disorders, Vol. 2(4), 209-216).

The authors of this study start with the premise that having a child who is struggling in school is likely to create stress for parents, and perhaps lead to problems with how parents feel that things are going in the family. They wondered, however, whether this differed depending on what the reason for the child's school difficulties were. Specifically, they wanted to learn whether having a child with ADHD poses an additional challenge above and beyond the stresses and difficulties encountered due to general school problems.

In order to evaluate this, the authors obtained information on family functioning from parents whose children were having difficulties at school for different reasons. These included 49 parents whose child had a primary diagnosis of ADHD, 59 parents of children with a primary reading disability, 50 children who had both ADHD and a reading disability, and 90 control children who had neither type of difficulty.

Parents of these children completed a 12-item questionnaire that had been derived from the McMaster Family Assessment Device. Each item was rated on a 4-point scale from "Strongly Agree" to "Strongly Disagree". Examples of some of the items that parents were asked to respond to are shown below.

1. There are lots of bad feelings in the family.
2. We don't get along well together.
3. We are not able to make decisions on how to solve problems.

As can be gleaned from the examples above, parents reporting high levels of agreement with these items were acknowledging higher levels of dissatisfaction with how things were going in their family. For all four groups of children, the parent who responded to the questionnaire items was almost always the mother. (This was not something the authors chose to do deliberately but is simply how things worked out.)

The results of this study indicated that parents of children with ADHD reported significantly higher levels of dissatisfaction about family life than did mothers of children with a primary reading disability. What I found particularly interesting was that even after the authors reanalyzed the data after removing the children in the ADHD sample who also had been diagnosed Oppositional Defiant Disorder, the results did not change. In other words, even for parents whose child with ADHD did not have a serious co-occurring behavior disorder, significantly greater dissatisfaction with how things were going in the family was still reported.

There is no way of knowing with any certainly from this data what the reasons for this higher level of dissatisfaction actually was. The authors note that although it could be a direct result of having a child with ADHD, it could also reflect the fact that parents of children with ADHD are more likely to have ADHD themselves. Thus, the mothers completed these forms could have been expressing frustration they experienced as a result of having a husband with ADHD in addition to frustrations brought about by difficulties with their child.

From my own clinical experience, I believe that many different explanations for this finding are possible and that no single explanation is correct in all instances. One thing I will say—although let me be clear that this is based on clinical experience and not on research data—is that with the parents I have worked with, there often seemed to be real disagreement about the best way to handle their child's difficulties.

For reasons that I won't even begin to speculate on, in many couples it seemed that fathers were not willing or prepared to accept a diagnosis of ADHD in their child, and were unwilling to get involved in their child's treatment in a supportive way. In an unfortunate number of instances, they were not even willing to allow treatment of any sort to proceed. (Please understand that I have no intention of offending anyone here and there are many couples who clearly work together to help their child in a cooperative and supportive manner. I sincerely hope that has been your experience.)

In contrast to this situation, I almost never saw this level of disagreement in a child who had a reading disability. In such situations, parents seemed to invariably accept and understand the nature of their child's difficulties, and were in agreement about the help that needed to be obtained. It is possible that this experience was idiosyncratic to my own practice, but from many conversations that I have had with colleagues, I don't believe this is likely to have been the case.

Certainly, this type of disagreement could be one important factor contributing to dissatisfaction with family life more generally. Regardless of the reasons for this, however, I think the important implication of this study is the need to recognize that their can be unique frustrations about parenting a child with ADHD that can spill over to create difficulties for an entire family. I found that parents I worked with were often reluctant to bring these issues up, perhaps because they were so focused on trying to attend first and foremost to the problems experienced by their child.

My experience has also been, however, that providing parents with an opportunity to discuss the frustrations associated with their child, and how this was affecting the entire family, were often experienced as enormously helpful. Thus, if you have found yourself experiencing some of what the parents in this study reported, I hope that it is helpful to recognize that yours is by no means an isolated experience. Perhaps developing a way to address some of these issues may prove to be useful to you as well, and that finding a good person to discuss these issues with could be something to consider.

Dr. David Rabiner is a child psychologist and Senior Research Scientist at Duke University.and produces a monthly online newsletter, Attention Research Update, that helps parents, professionals, and educators keep informed about new research on ADHD. To sign up for a free subscription, please visit http://www.helpforadd.com.

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