What Are The Challenges of Families with ADHD Children? (page 2)
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.
Even though early family dysfunction is infrequently found in school-based samples of children, parental coping may become crystallized into a clear discipline style by the elementary school years (Woodward et al., 1998). That is, the child’s core symptoms of hyperactivity, impulsivity, and inattention, as well as frequent instances of children’s noncompliance, can contribute to negative expectations for these children and a parenting style that is control oriented.
Parents of elementary-level children with ADHD used more negative, reactive, and directive or controlling practices and less praise and fewer positive practices than did parents of children who were not ADHD (for reviews, see Hinshaw & McHale, 1991; Johnston & Mash, 2001; Johnston, Murray, Hinshaw, Pelham, & Hoza, 2002; Madan-Swain & Zentall, 1990). Aggressive discipline, parental feelings of anger and hostility, and poor parental coping were associated with hyperactivity even after controlling for conduct disorders and parents’ mental health (Woodward et al., 1998). Noncompliance is typically dealt with by adults who assert power, thereby intensifing parent–child conflict (Woodward et al., 1998).
At this age, conflicts around schoolwork and homework appear to be a major challenge for families (Bursuck et al., 1999). Difficulties with daily school and homework assignments and classroom conduct may lead parents to underestimate their children’s actual capabilities (Hartsough & Lambert, 1982). For example, parents of school-age children with hyperactivity had lower academic aspirations and less of a desire to participate in the learning activities of their children (Hartsough & Lambert, 1982).
Schoolwork and homework difficulties are made worse by difficulties with organization. For example, mothers and fathers of children with ADHD reported that their children organized their time and toys and planned important events more poorly than was reported by parents of typical children (Zentall, Harper, & Stormont-Spurgin, 1993).
In response to these organizational problems, fathers of students with ADHD (but not mothers) reported that they were more likely than comparison fathers to suggest that their child make lists for multiple jobs or tasks. In contrast, mothers of children with ADHD were (a) less likely to teach their child routines for placing objects, (b) more likely to get upset when their child was late for a planned meeting or activity, and (c) rated themselves as significantly less able than mothers of typical children to mentally organize tasks (Zentall et al., 1993). Similarly, in their interactions with their sons with ADHD, mothers used less effective scaffolding (instructional support appropriate to their child’s needs) (for a review, see Johnston, Murray, Hinshaw, Pelham, & Hoza, 2002).
Even parents of children with ADHD and giftedness found that enforcing rules was difficult, especially those rules related to morning and eating routines (Moon et al., 2001). One parent described eating as not very structured and that it wasn’t “uncommon to find food all over the house.”
As children develop into adolescents and demonstrate failing grades, noncompliance with family rules, and forgetfulness, it can be interpreted as irresponsibility and bring out additional conflicts with parents, especially when the teen has ADHD (Barkley, Edwards, Laneri, Fletcher, & Metevia, 2001). Parents report more conflicts with teens with ADHD, negative interactions, and intense anger during these conflicts than parents of comparison adolescents (Barkley et al., 1992). To indicate the specific contribution of ADHD symptomology to these family interactions, boys with ADHD (more than their brothers) had antisocial behavior and more self-reported illegal acts, specifically more crimes against persons (Loney, Whaley-Klahn, Kosier & Conboy, 1983). Conflicts are also at school, especially with secondary educators, who expect increased student independence (Bursuck et al., 1999).
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