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August 1, 2005
Stress and Coping In Parents of Children with
ADHD |
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Although parenting can be stressful at times for most everyone, parents of
children with ADHD may experience greater
stress because of the additional parenting
challenges they face. In fact, prior studies
have shown that mothers of ADHD children experience
more parenting-related stress than other mothers
and often feel less competent as a parent.
These findings certainly do not mean that
parents of children with ADHD do not derive
enormous pleasure and satisfaction in their
parenting role. They may indicate, however,
that parenting a child with ADHD presents
parents with additional challenges that can
increase stress and lead parents to question
their own competence.
Our knowledge of stress, parental satisfaction,
and coping in parents of children with ADHD
is limited in several significant ways. First,
in studies examining parenting stress in families
with an ADHD child, attributes other than
the core symptoms of ADHD -- i.e. inattention
and hyperactivity-impulsivity -- have often
been neglected. For example, it is well established
that many ADHD children have co-occurring
problems with oppositional/disruptive behavior.
It is quite possible that these co-occurring
behavior problems -- and not a child's core
ADHD symptoms -- are the reasons for increased
stress in parents of children with ADHD. Prior
research does not permit a clear answer to
this question, however, because these other
behavior problems typically have been ignored.
Second, prior research has not considered
which aspects of ADHD -- inattention or hyperactivity
impulsivity -- is most closely linked to parents'
stress. Because these different symptoms are
most closely linked to different types of
impairment (i.e. inattention tending to be
more closely linked with academic problems
and hyperactivity-impulsivity with behavioral
problems), it is possible that they are also
differentially linked to parental stress.
This interesting issue has not been studied.
Third, prior investigations of stress in parents
of ADHD children have focused almost exclusively
on mothers. As a result, virtually nothing
is known about the impact on fathers of having
a child with ADHD. This is another significant
gap in the current literature.
Finally, relatively little is known about
the strategies that parents of children with
ADHD use to cope with the unique challenges
they face and whether particular strategies
are associated with reduced stress levels.
In the study discussed below, the authors
were particularly interested in whether "positive
reframing" would be associated with lower
levels of parental dissatisfaction and stress.
(Positive reframing is a coping strategy in
which stressful experiences are redefined
in order to make them more manageable. For
example, rather than feeling angry and frustrated
about having to remind their child each night
to organize what they need for school the
next morning, a parent might "reframe"
this as providing their child with necessary
practice that will help them to eventually
develop an important skill.)
The above issues were examined in a published
study (Pololski, C.L., & Nigg, J.T.
(2001). Parent stress and coping in relation
to child ADHD severity of associated child
disruptive behavior problems. Journal of Clinical
Child Psychology, 30, 503-513). Participants
in this study were mothers and fathers of
66 seven to eleven year-old children, including
15 children with the inattentive type of ADHD,
22 children with the combined type of ADHD
(i.e. children with the combined subtype have
both inattentive and hyperactive-impulsive
symptoms), and 22 parents of children without
ADHD. Parents of both boys and girls were
included.
In order to examine these issues, several
types of data were obtained from parents.
First, mothers and fathers rated their child
on each of the 18 DSM-IV symptoms of ADHD
using a four-point scale of increasing severity.
Ratings of children's oppositional/defiant
behavior were also obtained.
Next, the researchers measured the parents'
level of satisfaction with their own parenting
performance. This involved having parents
indicate how strongly they agreed with such
statements as:
"I wish I did not become impatient so
quickly with my child."
"I wish I were a better parent and could
do a better job of parenting."
Parents also completed a shortened version
of the Parenting Stress Index to evaluate
the amount of stress they experienced in their
parental role.
Finally, parents were asked a series of questions
about the coping strategies they used to deal
with challenges presented by their child.
RESULTS
Parents of children with both the inattentive
and combined subtypes of ADHD reported more
stress and less satisfaction as parents than
parents of children in the control group.
However, this resulted from the greater level
of oppositional/defiant behavior parents of
ADHD children reported, rather than from the
direct impact of their child's inattentive
and hyperactive-impulsive symptoms.
Separate analyses conducted for mothers and
fathers also yielded interesting results.
For mothers, feelings of satisfaction as a
parent were predicted by children's oppositional-defiant
behavior and inattentive symptoms. For fathers,
in contrast, only children's oppositional-defiant
behavior was associated with their level of
parental satisfaction. Children's level of
hyperactive-impulsive symptoms did not predict
feelings of dissatisfaction or stress for
either mothers or fathers.
Results pertaining to parents' coping strategies
also were interesting. Mothers and fathers
who reported frequent use of positive reframing
as a coping strategy also reported more satisfaction
as parents and less stress associated with
parenting. The use of positive reframing also
was associated with lower levels of child
behavior problems as reported by parents.
SUMMARY
AND IMPLICATIONS
The results of this study have several interesting
implications. First, it is noteworthy that,
in general, the distress experienced by mothers
and fathers of children with ADHD was more
closely linked to their child's oppositional/defiant
behavior than to core ADHD symptoms. This
suggests that, in many circumstances, ADHD
symptoms may only be associated with greater
parental stress when accompanied by excessive
oppositional behavior. Directly targeting
such behavior in treatment may thus be critically
important to decreasing parents' stress and
increasing their feelings of competence, since
addressing core ADHD symptoms alone may not
necessarily accomplish this.
For many mothers, however, children's levels
of inattention and disorganization may also
be uniquely associated with heightened stress.
It is interesting to speculate on why mothers
are affected by these aspects of their child's
ADHD to a greater extent than fathers. One
plausible explanation is that, on the whole,
mothers tend to have primary parenting responsibility
in domains where inattention and disorganization
are likely to create problems -- i.e., getting
homework completed and turned in, keeping
one's room clean, remembering to complete
chores, etc. In the case of fathers who tend
to be less involved in these aspects of their
child's life, they would not have to contend
as often with the problems caused by inattention
and disorganization. (Though this explanation
is quite speculative, it implies that when
fathers play a significant role in these aspects
of parenting -- as many fathers certainly
do -- they would be just as likely as mothers
to be adversely affected by their child's
struggles with attention.) In any case, providing
parents with effective strategies to handle
these aspects of their child's ADHD would
seem to be quite important.
Finally, results pertaining to the benefits
associated with positive reframing appear
to have important clinical implications. Recall
that parents who reported greater use of positive
reframing as a coping strategy experienced
less stress and reported fewer behavior problems
in their child. This suggests the way in which
parents interpret the challenges they encounter
with their child has a significant impact
on the satisfaction and stress they experience
as parents. By learning to redefine stressful
events in realistic and positive terms (i.e.
as challenges to overcome rather than unsolvable
problems), parents may find themselves feeling
less stressed and more satisfied with their
parenting. Of course, simply reframing one's
situation without taking appropriate steps
to actually improve things is unlikely to
result in any long-term positive change. It
may, however, be an important part of the
process. |
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