Adults suffering from attention-deficit/hyperactivity-disorder (ADHD) often display high levels of inattention, hyperactivity and impulsivity. These symptoms might interfere with skills that are necessary for optimal parenting such as consequent and emotionally responsive behavior towards the child. Therefore, the present review aims at investigating how parental ADHD symptoms influence parenting, thereby including specific parental behaviors of both effective behavior control and emotional responsiveness. In order to identify eligible studies, a systematic search was conducted. Studies were included in this review if at least some of the investigated parents suffered from ADHD or heightened ADHD symptoms, and if the studies focused on specific parenting behaviors as outcome measures. 14 studies yielded the inclusion criteria. Across studies, parental ADHD symptoms were negatively associated with consistent discipline, parental involvement and positive parenting, and positively associated with lax and over-reactive parenting, intrusiveness and negative emotions. The core symptom of inattention had stronger negative effects on parenting than impulsivity and hyperactivity. Across studies, the gender of parents had inconsistent effects. All in all, the present review shows that parental ADHD is associated with serious impairments in parenting. Therefore, parents with ADHD should be specially addressed and trained in the context of children ADHD treatment.
The effects of attention-deficit/hyperactivity-disorder (ADHD) in adults on their parenting have long been neglected in psychological research [
One domain of functioning which is affected by ADHD symptoms is parenting behavior [
Johnston and colleagues reviewed a great number of studies investigating the effects of parental ADHD symptoms on parenting behavior [
However, the association between parental ADHD symptoms and emotional responsiveness appeared to be less consistent across studies. While some studies did not find any associations between ADHD symptoms and emotional responsiveness, other authors observed an impaired emotional responsiveness when ADHD symptoms were heightened. Despite, other studies showed that heightened ADHD symptoms led to parents being more emotionally responsive [
Beyond, previous studies had some methodical issues. First, they mostly focused on mothers and school-aged sons while not investigating fathers and daughters. Second, various studies relied on self-report measures of ADHD symptoms and parenting, which possibly impaired reliability. Third, the role of the gender of parent and child had not been systematically examined [
The present review focuses on parental ADHD symptoms affecting parenting behavior. More precisely, the present review examines how specific parenting behaviors of both effective behavioral control and emotional responsiveness are influenced by ADHD symptoms. We want to
・ investigate the effects of maternal as well as paternal ADHD symptoms,
・ examine the distinct role of the core deficits of ADHD and
・ examine the implemented methods of assessment besides self-report.
Cross-sectional or longitudinal studies were included in the present review, while case analyses were excluded. The participants investigated in eligible studies were parents and mostly their own children. A study met the inclusion criteria if at least some of the investigated parents either had an ADHD diagnosis or displayed a higher degree of ADHD symptoms. Furthermore, the age of the parents and their children was not restricted except for children being younger than 18 years. Children were not allowed to have any other disorder than attention-deficit/hyperactivity disorder or oppositional defiant disorder (ODD). The sample size was not restrained to a specific number of participants. Moreover, studies were included if they examined specific parenting behaviors, strategies or parenting styles. In order to receive some earlier as well as recent studies, the publication date was restricted from January, 2007, to April, 2017.
A systematic search of the databases PSYNDEX, PsycINFO, PsycARTICLES and MEDLINE was conducted from March 1, 2017, to May 2, 2017. The keywords “parenting ADHD OR maternal inattention OR parents ADHD children OR maternal ADHD OR parental ADHD OR paternal ADHD OR paternal inattention” were used. All searches were conducted in English.
Duplicate articles were removed prior to screening. Screening and data extraction were undertaken by two reviewers with the same keywords. First, titles and records were screened to identify eligible articles. Then the full-text articles were assessed and included within the review if they met all inclusion criteria mentioned above. Potential risk of bias of these full-text articles was estimated using the Cochrane Collaboration’s tool for assessing risk of bias [
The systematic search of the databases yielded 708 studies after removing duplicate articles. Fourteen of these met the inclusion criteria and were hence included within the review.
The demographic data, method, outcome measures and limitations of the included studies can be seen in
The included studies were clustered into four categories: Studies that examined general maternal ADHD symptoms, studies that differentiated between the core symptoms of maternal ADHD, studies that examined general parental ADHD symptoms and studies that differentiated between the core symptoms of parental ADHD.
Babinski and colleagues compared ADHD-affected mothers of ADHD-affected adolescents (MCA) to healthy mothers of ADHD-affected adolescents (CA) [
Furthermore, Banks, Ninowski, Mash and Semple assessed mothers ADHD symptoms and, based on these, divided them into a high and low ADHD group [
Chronis-Tuscano and colleagues [
In their three-year prospective longitudinal study, Mazursky-Horowitz and colleagues examined whether emotion regulation was a mediator between maternal ADHD symptoms and parenting [
Furthermore, Psychogiou, Daley, Thompson and Sonuga-Barke [
Finally, Watkins and Mash [
First, Chen and Johnston investigated the influence of the core symptoms (inattention, hyperactivity, impulsivity) of maternal ADHD on parenting separately [
Then, Semple, Mash, Ninowski and Benzies [
As mentioned above, some studies investigated the effects of both maternal and paternal ADHD symptoms on parenting. First, Mokrova, O’Brien, Calkins and Keane [
Psychogiou, Daley, Thompson and Sonuga-Barke [
Finally, Tung, Brammer, Li and Lee [
Some studies investigated the effects of parental ADHD symptoms on parenting separately for the core symptoms. Lui and colleagues [
Second, Williamson and colleagues [
Finally, Wymbs, Wymbs and Dawson [
Publications | Sequence generation | Allocation sequence concealed | Blinding of participants and personnel | Blinding of outcome assessment | Incomplete outcome data | Selective outcome reporting | Other bias |
---|---|---|---|---|---|---|---|
Studies with mothers | |||||||
12 | - | - | H | - | L | L | H |
13 | - | - | H | - | L | L | H |
14 | - | - | L | - | L | L | H |
15 | - | - | L | - | L | L | H |
16 | - | - | H | - | L | L | H |
22 | - | - | H | - | L | L | H |
17 | - | - | U | - | L | L | H |
18 | - | - | U | - | L | L | H |
19 | - | - | H | - | L | L | H |
Studies with both parents | |||||||
20 | - | - | L | - | L | L | H |
21 | - | - | H | - | L | L | H |
23 | - | - | L | - | L | L | H |
24 | - | - | U | - | L | L | H |
25 | - | - | H | - | L | L | H |
Note: - = does not apply to study; L = low risk of bias; H = high risk of bias; U = unclear/unknown risk of bias.
The systematic search of four databases yielded fourteen studies meeting the inclusion criteria. Out of these, eight studies investigated the effects of maternal ADHD symptoms on parenting, while six assessed the effects of both maternal and paternal ADHD symptoms. Across studies it was shown that maternal ADHD symptoms were negatively associated with consistent discipline, maternal involvement and positive parenting, and positively associated with lax and over-reactive parenting, intrusiveness and negative regard. Also, mothers with high ADHD symptoms displayed higher parenting dissatisfaction and expressed more negative emotions. Furthermore, studies investigating the core symptoms of ADHD separately demonstrated that especially a heightened inattention was positively associated with more parenting problems, whereas heightened impulsivity and hyperactivity were rarely or not at all associated with parenting problems.
It was also examined if parenting improves if both children and mothers/fathers suffered from severe ADHD symptoms (similarity-fit hypothesis) or if it impairs (similarity-misfit hypothesis). A parental gender difference was found: a similarity-fit existed for mothers, whereas a similarity-misfit existed for fathers.
Other studies investigating both maternal and paternal ADHD effects on parenting revealed similar results to those reported in studies which focused on maternal ADHD symptoms. Moreover, some of these studies revealed gender differences, while others did not. In those reporting gender differences, fathers’ parenting impairments were mostly associated with their own ADHD symptoms, whereas mothers reported that both their own, children’s and fathers’ ADHD symptoms were related to their negative parenting behaviors. It was also shown that mothers’ and fathers’ ADHD symptoms may exert an interactive effect on each parent’s parenting.
Not all the studies investigating the effects of parental ADHD symptoms on parenting behavior were included within the present review. This is partly because the period of publication was restricted to the last ten years (2007-2017). Moreover, some studies were not available in full text form and others did not mainly focus on parenting behaviors and were therefore excluded from the review. Furthermore, the search of studies was only conducted in English, possibly not taking studies of other languages into account.
The quality of evidence of the reported studies’ results can be estimated as low to moderate according to the GRADE approach [
The present review demonstrates that parental ADHD symptoms are related to various impairments in parents’ effective behavioral control such as family disorganization and less parental involvement which is in line with the review of Johnston and colleagues [
Another important result of the current review was the differentiation between the three ADHD core symptoms: While the core symptom of inattention was strongly associated with parenting behaviors, the other two core symptoms impulsivity and hyperactivity only had a small influence on negative parenting.
Chen and Johnston postulate that inattentive parents experience more stress in their daily lives, because they exhibit a higher level of disorganization and forgetfulness [
Reasons for the lack of an association between symptoms of parental hyperactivity/impulsivity and negative parenting are harder to find. Chen and Johnston [
All in all, the reasons for the different effects of parental ADHD core symptoms on parenting remain sparse. More research is needed to provide empirically sound argumentation.
Beyond, in the present review we aimed to encounter some methodical issues. First, it tried to examine the effects of both paternal as well as maternal ADHD symptoms on parenting. Although some studies regarding paternal ADHD were included, the heterogeneous results impair interpretation of the differences between mothers and fathers with ADHD. Recent studies used more observational methods to assess parenting behavior. The importance of the more objective methods of investigation is emphasized by the results of Lui und colleagues [
Given the severe parenting impairments revealed in the present review and the coincident occurrence of ADHD in both child and parents of one family [
Not all potentially relevant studies could be included within the review. General methodological flaws included social desirability of parental reports, the lack of causal designs and ethnic diversity, and the retrospective assessment of parental ADHD symptoms.
However, it was achieved to integrate the findings of both rather early and recent studies which relied on observational methods of measuring parenting. Also, a great range of children’s age was covered across the included studies. It was shown that parental ADHD symptoms affect the parenting of infants and school-aged children as well as that of adolescents.
Most studies revealed that maternal ADHD symptoms were consistently related to severe parenting impairments, whereby the core symptom of inattention led to more parenting difficulties than impulsivity/hyperactivity. Only six studies investigated the effects of fathers’ ADHD symptoms on their parenting, also revealing impairments but inconsistent gender differences compared to mothers. Therefore, the effects of paternal ADHD symptoms on parenting and the differences compared to maternal ADHD should be investigated more precisely in future studies. Furthermore, regarding the severe ADHD-induced parenting impairments revealed in the present review, and the negative effects of parenting impairments on ADHD-affected children reported by other authors, it is important to support ADHD-affected parents by offering parent trainings adjusted to their specific difficulties. In general, investigating which specific parenting behaviors are impaired by parental ADHD could encourage the development of parent trainings that meet the special needs of ADHD-affected parents. One possibility of better supporting parents to improve their negative parenting might be interventions that combine both cognitive behavioral therapy and parent training [
There is no conflict of interest.
We acknowledge support for the Article Processing Charge by the Deutsche Forschungsgemeinschaft and the Open Access Publication Fund of Bielefeld University.
Friedrich, A., Moning, J., Weiss, J. and Schlarb, A.A. (2017) The Effects of Parental ADHD Sym- ptoms on Parenting Behaviors. Health, 9, 1054-1074. https://doi.org/10.4236/health.2017.97077