What Are The Challenges of Families with ADHD Children?

Preschoolers:

One of the major tasks of families of preschool children is the establishment of a climate within which children can express emotions and negotiate conflict. Angry and distressed families are less likely to support feelings (Dunn & Brown, 1994). Regulating emotions and negotiating conflict are difficult in a negative family climate, especially for preschool children who appear to be particularly vulnerable to the effects of adverse parenting (Keown & Woodward, 2002). At this early developmental stage, the child’s nature interacts with family practices to facilitate or discourage the learning of oppositionality (oppositional defiant disorder) (Johnston & Mash, 2001).

Parental conflict and a retaliatory style of management were more characteristic of families with preschoolers with hyperactivity plus aggression than for families of preschoolers with pure hyperactivity (Stormont-Spurgin & Zentall, 1995). Mothers in these families reported giving more physical aggression to their partners (threatening, attempting, or actually hitting, pushing, shoving, grabbing, or throwing something at her partner or throwing things or smashing objects) and receiving more verbal aggression (arguing, yelling, insulting, or sulking) from partners during conflict than mothers of preschoolers with only ADHD (Stormont-Spurgin & Zentall, 1995). In fact, in longitudinal studies, family fights were most frequently cited as a contributing factor to child difficulties (for a review, see Cunningham, Benness, & Siegel, 1988).

Fathers of children with ADHD plus aggression differed from fathers of children with only ADHD in their greater restrictiveness with preschoolers and greater indulgence and permissiveness with their older children (Stormont-Spurgin & Zentall, 1995, 1996). It is possible that fathers’ early control strategies failed to produce intended results, so they disengaged from the disciplinary process. Although disengagement avoids feelings of failure, it can also have long-term negative consequences, including failure to monitor children, which appears to protect them from learning aggression (Johnston & Mash, 2001). Disengagement has also been reported for parents in other disability groups (for a review, see Stormont-Spurgin & Zentall, 1996).

Mothers used more lax parenting with their preschoolers (Keown & Woodward, 2002) but more punishment (time-outs or taking away privileges) with their elementary-age children than did comparison mothers (Stormont-Spurgin & Zentall, 1996). Disengagement for mothers was seen in decreased interactions during play, especially when mothers were experiencing stress (Mash, 1983). The statements of mothers of children with ADHD can indicate their reactions to some parenting tasks. For example, when asked what were the rules in their family, one mother replied, “Keep their rooms clean, which they don’t; do the dishes, which they don’t; take care of these pets, which they don’t.” In contrast, when mothers were confident in their parenting skills and knowledge, they were more likely to be active in their task interactions with their children (Mash, 1983).

Parents and support personnel have little control over many family factors that predict later aggression (i.e., initial child manageability, maternal depression, and low income [Stormont-Spurgin & Zentall, 1995, 1996]). However, parents’ feelings of not being supported or helped by others (Cunningham et al., 1988; Woodward, Taylor, & Dowdney, 1998) is modifiable and becomes increasingly important over time. That is, parents of older children with ADHD reported lower parenting self-esteem and parenting satisfaction than did parents of younger children with ADHD (Mash & Johnson, 1983). In addition, lower self-esteem, more guilt, and a greater sense of isolation are often reported by mothers and fathers of children with ADHD (Cunningham et al., 1988).

Because of the importance of supporting families at this young age, Congress decided to increase families’ abilities to meet the special needs of infants and toddlers with handicaps. To help the whole family, an individualized family service plan (IFSP) was developed to guide early intervention services. Parents and professionals work together as partners in writing the IFSP, which typically includes both family and child goals. The emphasis in the IFSP is on enabling the family to support the child.