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).