Mother and adolescent reports of interparental discord among parents of adolescents with and without attention-deficit/hyperactivity disorder.(Disease/Disorder overview)

Evidence is scarce regarding the prevalence of interparental discord in families of adolescents with attention-deficit/hyperactivity disorder (ADHD). Using data collected from adolescents with childhood ADHD and comorbid oppositional defiant disorder (ODD; n = 46) or conduct disorder (CD; n = 23), with childhood ADHD only (n = 26), and without ADHD (n = 88) and their mothers, maternal and adolescent reports of interparental discord were compared. Adolescents with ADHD + CD reported witnessing more frequent and unresolved interparental conflict than adolescents without ADHD and with ADHD only. Adolescents with ADHD + CD also indicated more frequent conflict than adolescents with ADHD + ODD. However, differences in conflict resolution were nonsignificant when household income was covaried, and maternal ratings of interparental discord did not differ across groups. Findings highlight the potential utility of adolescents with ADHD as informants of interparental relationship quality.

Keywords: ADHD; attention deficit; families or parent(s) of children or youth with EBD ODD; CD; interparental conflict

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Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent chronic health conditions among children, with an estimated 4% to 12% of school-age children exhibiting developmentally inappropriate levels of inattention, hyperactivity, and impulsivity (American Academy of Pediatrics, 2000). ADHD tends to co-occur with oppositional defiant disorder (ODD) or conduct disorder (CD) (MTA Cooperative Group, 1999; Pelham, Gnagy, Greenslade, & Milich, 1992), academic difficulties (DuPaul & Stoner, 2003), and impaired social relationships with peers (Mrug, Hoza, & Gerdes, 2001). Not surprisingly, research suggests that parental functioning appears to be adversely affected in these families. Relative to parents of children without ADHD, parents of children with ADHD experience elevated levels of distress (Fischer, 1990) and are more likely to react negatively in response to child misbehavior (Whalen & Henker, 1999). Of note, parents of children with ADHD are also at risk for experiencing interparental discord (Johnston & Mash, 2001). Studies have shown that parents of children with ADHD, especially those with comorbid ODD or CD, report lower marital satisfaction, engage in more frequent acts of overt interparental conflict, and use more negative verbalizations during child-rearing discussions than parents of children without ADHD (e.g., Befera & Barkley, 1985; Johnston & Behrenz, 1993; Lindahl, 1998).

Curiously, very few studies have assessed the level of discord between parents of adolescents with ADHD. This gap in the literature is worth exploring for several reasons. First, researchers have shown that negative parent-adolescent interactions mediate the relationship between interparental conflict and adolescent externalizing behavior (e.g., Fauber, Forehand, Thomas, & Wierson, 1990; Harold, Fincham, Osborne, & Conger, 1997). Although this relationship has been established already in studies with preadolescents and their parents (e.g., Gonzales, Pitts, Hill, & Roosa, 2000; Mann & MacKenzie, 1996), it is of more concern in families of adolescents, considering that adolescents have better developed social--cognitive skills and are more rebellious with their parents than preadolescents (Dishion & Kavanagh, 2003; Robin, 1998; Robin & Foster, 1989). Given the heightened challenge of parenting cognitively adept, willful teenagers, parents of adolescents are at greater risk for discord than parents of preadolescents. Furthermore, because adolescents with ADHD, especially those with comorbid ODD or CD, engage in more frequent conflictual interactions with their parents than adolescents without ADHD (e.g., Barkley, Anastopoulos, Guevremont, & Fletcher, 1992; Barkley, Fischer, Edelbrock, & Smallish, 1990), parents of adolescents with ADHD appear more likely to experience discord than parents of adolescents without ADHD. Second, adolescents are more likely than preadolescents to involve themselves in interparental discord (Cummings, Ballard, & El-Sheikh, 1991; see also Cummings & Davies, 1994). This is worrisome for discordant parents because adolescents with histories of witnessing intense and unresolved interparental conflict respond to recurring discord with heightened emotional and disruptive behavior (Davies & Windle, 2001). Moreover, since aggressive youth exhibit more emotional and behavioral distress in response to recurring interparental conflict than those without conduct problems (Cummings, Ianotti, & Zahn-Waxler, 1985; Klaczynski & Cummings, 1989), adolescents with ADHD are likely to exhibit more severe disruptive behavior with discordant parents and may require more intensive treatment as a result than adolescents with ADHD whose parents have harmonious relationships. Taken together, for the reasons listed above, research is clearly needed to flesh out the prevalence of discord between parents of adolescents with ADHD.

Interparental Discord Among Parents of Adolescents With ADHD

Only two studies have compared the quality of interparental relations in families of adolescents with and without ADHD. Barkley, Fischer, Edelbrock, and Smallish (1991) found that mothers of adolescents with ADHD, both with and without comorbid ODD, reported lower marital satisfaction than mothers of adolescents without ADHD. Somewhat differently, Barkley and colleagues (1992) indicated that only mothers of adolescents with ADHD and comorbid ODD, not mothers of adolescents with ADHD only, experienced lower marital satisfaction than mothers of adolescents without ADHD. Thus, although research highlights how dissatisfying marital relationships are in families of adolescents with ADHD and comorbid ODD, evidence remains mixed regarding whether parents of adolescents with ADHD only are at any greater risk for experiencing interparental discord than parents of adolescents without ADHD. Studies are needed to clarify the degree to which ADHD alone portends risk for interparental relationship quality. Furthermore, no studies have evaluated whether parents of adolescents with ADHD and either comorbid ODD or CD differ in level of discord. In view of the fact that oppositional behavior is somewhat developmentally appropriate throughout adolescence, it appears worthwhile to examine whether parents of adolescents with ADHD and more severe conduct problems (i.e., CD) report greater conflict than parents of adolescents with ADHD and less severe conduct problems (i.e., ODD).

Of note, despite substantial evidence highlighting the utility of assessing properties (i.e., frequency, intensity, degree of resolution) of interparental conflict relative to assessing marital satisfaction (Grych & Fincham, 1990), very few studies have compared interparental conflict properties among families of preadolescents with and without ADHD (e.g., Johnston & Behrenz, 1993; Lindahl, 1998), and no studies have compared conflict properties reported by parents of adolescents with and without ADHD. This gap in the literature is conspicuous for three reasons. First, interparental conflict properties are more strongly and reliably linked with child and adolescent behavior problems than marital satisfaction (Grych & Fincham, 1990). Unlike acts of interparental conflict, according to Grych and Fincham (1990), marital satisfaction is, at best, indirectly linked with youth behavior problems. Second, while convincing evidence highlights how children and adolescents witnessing frequent, intense, and unresolved interadult conflict respond immediately with elevated externalizing and internalizing behavior problems (Cummings & Davies, 1994), no data indicate that marital dissatisfaction exacerbates youth behavior problems. Third, given research highlighting the potential utility of adding behavioral couples-therapy components (e.g., problem-solving skills; Jacobson & Margolin, 1979) to enhance the outcome of treatments for ADHD (e.g., behavioral parent training [BPT]; Chronis, Chacko, Fabiano, Wymbs, & Pelham, 2004), it seems logical to measure properties of interparental conflict targeted by marital therapy (e.g., resolution of conflict) in this population. In sum, studies are needed to characterize the quality of interparental conflict, not just the level of relationship satisfaction, in families of adolescents with ADHD.

Youth Reports of Interparental Conflict

Studies investigating the link between interparental conflict and youth behavior problems often rely solely on maternal reports of both conflict and behavior problems (Emery, Joyce, & Fincham, 1987). In order to control for potential single-reporter bias, researchers have instead utilized child and adolescent reports of interparental conflict. Impressive evidence suggests that reports of interparental conflict made by nonreferred youth account for more of the variance in parent-reported child and adolescent behavior problems than parents' own reports of marital satisfaction or conflict (Cummings, Davies, & Simpson, 1994; Emery & O'Leary, 1982; Grych, Seid, & Fincham, 1992; Wierson, Forehand, & McCombs, 1988).

To our knowledge, only one study has utilized clinic-referred children as informants of the level of discord between their parents. Counts, Nigg, Stawicki, Rappley, and Von Eye (2005) found that children with ADHD Combined type reported greater interparental conflict than children with ADHD Primarily Inattentive type and children without ADHD. J. T. Nigg (personal communication, September 14, 2005) specified that children with ADHD Combined type in their study reported witnessing significantly more frequent, intense, and less frequently resolved interparental conflict than children with ADHD Inattentive type or without ADHD. These intriguing data highlight the opportunity for clinicians and researchers assessing interparental relationship quality in families of children with ADHD to control for single-reporter bias by using child reports of conflict. Additional investigations are needed to extend Counts et al.'s work by evaluating (a) the utility of youth with ADHD as informants of interparental discord, (b) whether adolescents with ADHD report more interparental conflict than adolescents without ADHD, and (c) whether youth with ADHD and comorbid ODD or CD indicate different levels of interparental conflict than youth with ADHD only or without ADHD. Given the dearth of studies assessing conflict between parents of adolescents with ADHD, reports of interparental discord made by adolescents in these families is an intriguing research direction for the field.

One possible issue with using adolescents with ADHD as informants of conflict between their parents is that youth with ADHD are poor evaluators of their own functional impairment (e.g., Hope et al., 1999; Smith, Pelham, Gnagy, Molina, & Evans, 2000), likely due to a "positive illusory" bias (e.g., Hoza, Pelham, Dobbs, Owens, & Pillow, 2002; Owens & Hoza, 2003). Research suggests that children with ADHD are more likely than comparison children to inflate self-competencies (i.e., exhibit positive illusions) across domains (e.g., peer relations, academic performance), especially in areas of greatest deficit, according to parents and teacher reports (Hoza et al., 2004). Interestingly, Gerdes, Hoza, and Pelham (2003) revealed that children with ADHD also have positive illusions regarding the quality of relations they have with their parents. In sum, youth with ADHD tend to be inaccurate reporters of their own behavior and relations with their parents and peers. However, it is unclear whether these biases extend to reports about the behavior of others. Thus, there may be merit in examining youth reports of interparental discord in this population.

In an effort to address gaps in the extant literature discussed above, this study sought to investigate whether parent reports of interparental relationship satisfaction and aggressive behavior during …