parenting 2001 prent-adolescent conflict in teenagers with adhd and odd

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Journal of Abnormal Child Psychology pp275-jacp-346560 October 3, 2001 16:25 Style file version July 26, 1999

Journal of Abnormal Child Psychology, Vol. 29, No. 6, December 2001, pp. 557–572 (C© 2001)

Parent–Adolescent Conflict in TeenagersWith ADHD and ODD 1

Gwenyth Edwards,2,3 Russell A. Barkley,2,6 Margaret Laneri, 2,4 Kenneth Fletcher,2

and Lori Metevia2,5

Received November 20, 2000; revision received March 14, 2001; accepted May 7, 2001

Eighty-seven male teens (ages 12–18 years) with ADHD/ODD and their parents were compared to32 male teens and their parents in a community control (CC) group on mother, father, and teen ratingsof parent–teen conflict and communication quality, parental self-reports of psychological adjustment,and direct observations of parent–teen problem-solving interactions during a neutral and conflictdiscussion. Parents and teens in the ADHD/ODD group rated themselves as having significantly moreissues involving parent–teen conflict, more anger during these conflict discussions, and more negativecommunication generally, and used more aggressive conflict tactics with each other than did parentsand teens in the CC group. During a neutral discussion, only the ADHD/ODD teens demonstratedmore negative behavior. During the conflict discussion, however, the mothers, fathers, and teens in theADHD/ODD group displayed more negative behavior, and the mothers and teens showed less positivebehavior than did participants in the CC group. Differences in conflicts related to sex of parent wereevident on only a few measures. Both mother and father self-rated hostility contributed to the level ofmother–teen conflict whereas father self-rated hostility and anxiety contributed to father–teen conflictbeyond the contribution made by level of teen ODD and ADHD symptoms. Results replicated paststudies of mother–child interactions in ADHD/ODD children, extended these results to teens withthese disorders, showed that greater conflict also occurs in father–teen interactions, and found thatdegree of parental hostility, but not ADHD symptoms, further contributed to levels of parent–teenconflict beyond the contribution made by severity of teen ADHD and ODD symptoms.

KEY WORDS: ADHD – attention deficit hyperactivity disorder; ODD – oppositional defiant disorder; familyconflict; adolescents.

Children with attention deficit hyperactivity disorder(ADHD) manifest developmentally inappropriate degreesof inattention and/or hyperactive–impulsive behavior thatarise in childhood, are relatively persistent, and result in

1This project was supported by grant MH41583 from the National Insti-tute of Mental Health to the second author. The contents of this paper,however, are solely the responsibility of the authors and do not neces-sarily represent the official views of this institute.

2Department of Psychiatry, University of Massachusetts Medical School,Worcester, Massachusetts.

3Now in private practice in Sudbury, Massachusetts.4Present address: Youth Opportunities Unlimited, Worcester,Massachusetts.

5Now a homemaker in Westborough, Massachusetts.6Address all correspondence to Russell A. Barkley, Department of Psy-chiatry, University of Massachusetts Medical School, 55 Lake AvenueNorth, Worcester, Massachusetts 01655; e-mail: [email protected].

cross-situational impairment (American Psychiatric As-sociation [APA], 1994). Such behavior frequently bringsthe child with ADHD into conflict with others, whetherparents (Campbell, 1975; Cunningham & Barkley, 1979),teachers (Whalen, Henker, & Dotemoto, 1980), or peers(Campbell & Paulauskas, 1979; Cunningham & Siegel,1987). And that conflict often results in greater hostil-ity, censure, rejection, and punishment directed at ADHDchildren, as well as withdrawal from them, than is trueof behavior directed at normal children (Cunningham,Benness, & Siegel, 1988; Danforth, Barkley, & Stokes,1991; Pelham & Milich, 1984).

Extensive research on the parent–child interactionsof children with hyperactivity, or ADHD, in particular(see Danforth et al., 1991, for a review) finds that hyper-active children are more negative, less compliant, less able

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558 Edwards, Barkley, Laneri, Fletcher, and Metevia

to sustain their compliance, and make more requests forassistance from their mothers than do control children.Mothers of the hyperactive children are less rewarding,more directive, provide more physical assistance, and ex-press more disapproval than do mothers of the controlchildren. Although the direction of influence in such re-ciprocal interactions can be difficult to discern, studiesemploying stimulant medication with hyperactive chil-dren routinely find that reducing the child’s ADHD symp-toms and improving their compliance via medication of-ten results in significant declines in maternal control andnegativity (Barkley, Karlsson, Pollard, & Murphy, 1985;Humphries, Kinsbourne, & Swanson, 1978). Such resultsimply that the larger influence in determining the nega-tivity of these interactions is from child to parent ratherthan vice versa, although parental behavior is not en-tirely without influence (Pollard, Ward, & Barkley, 1984).Subsequent research on the mother–child interactions ofhyperactive or ADHD children suggests that greater de-grees of mother–child conflict may occur in that subsetof ADHD children manifesting more symptoms of oppo-sitional defiant disorder (ODD; Gomez & Sanson, 1994;Johnston, 1996). Indeed, level of ODD may contributemore to maternal reports of mother–child conflict andparenting stress than does ADHD alone (Anastopoulos,Guevremont, Shelton, & DuPaul, 1992; Fischer, 1990;Stormshak, Bierman, McMahon, & Lengua, 2000).

The vast majority of research on ADHD generally,and parent–child relations specifically, has focused onchildren, primarily boys, between 5 and 12 years of age.Little research exists on teens with ADHD, most of whichcomes from follow-up studies of hyperactive childreninto adolescence (e.g., Barkley, Fischer, Edelbrock, &Smallish, 1990; Gittelman, Mannuzza, Shenker, &Bonagura, 1985; Weiss & Hechtman, 1993). Far less re-search exists on clinic-referred adolescents with the dis-order. This is particularly so for research on parent–teenrelations. Yet the extent of parent–teen conflict has beenshown to be a significant determinant of concurrent andlater adolescent psychological adjustment (Shek, 1998).Only two studies have examined the nature of mother–teeninteraction patterns in the families of adolescents havingADHD; these studies suggest that conflict is substantiallygreater than in control groups and is particularly evident inthe subset having comorbid ODD (Barkley, Anastopoulos,Guevremont, & Flecther, 1992; Barkley, Fischer, et al.,1991; Fletcher, Fischer, Barkley, & Smallish, 1996). Inview of the dearth of information on clinic-referred teenshaving ADHD, and particularly on their parent–teen inter-actions, the present study sought to investigate further thenature of these interactions in ADHD teens having comor-bid ODD. Specifically, this study attempted to determine

whether previous findings on mother–child and mother–teen interactions in comorbid ADHD/ODD samples couldbe extended to father–teen interactions. Only three pre-vious studies have examined father–child interactions inADHD children (Burhmester, Camparo, Christensen,Gonzalez, & Hinshaw, 1992; Johnston, 1996; Tallmadge& Barkley, 1983), and none have studied father–teen in-teractions. The previous studies using children found fewdifferences in the father–child interactions of children withADHD relative to normal children but did find greaterconflict in the mother–child than in the father–child in-teractions (Buhrmester et al., 1992; Tallmadge & Barkley,1983). Once again, the presence of ODD appeared to mag-nify the reports of family conflict in the ADHD comparedto the control families (Johnston, 1996).

Mothers of ADHD children and adolescents havebeen shown to manifest significantly greater parentingstress, marital dissatisfaction, and psychological malad-justment (particularly anxiety, depression, and hostility)than mothers of control children (Befera & Barkley, 1983;Breen & Barkley, 1988; Cunningham, Benness, & Siegel,1988; Mash & Johnston, 1983). This seems to be partic-ularly so for mothers of ADHD children and teens hav-ing comorbid ODD (Anastopoulos et al., 1992; Barkley,Anastopoulos, et al., 1992; Barkley, Fischer, et al., 1991).Research suggests that it is the mother’s level of hostil-ity, rather than depression, anxiety, or marital discord,that makes a significant contribution to the degree of con-flict experienced in these mother–teen interactions beyondthat contribution made by teen ADHD/ODD symptoms(Barkley, Anastopoulos, et al., 1992). This makes sensefrom the standpoint of the family coercion theory of child-hood social aggression (Patterson, 1982; Patterson, Reid,& Dishion, 1992) in which coercive (hostile) interactionpatterns typify other members of the aggressive child’sfamily rather than just that child alone. Once again, how-ever, no research has examined whether fathers of teenshaving ADHD also manifest greater marital dissatisfactionor anxiety, depression, and hostility than fathers of controlteens. Nor has any research examined the degree to whichsuch psychological difficulties contribute to the level offather–teen or mother–teen conflict in these families be-yond that resulting from teen disruptive behavior alone.One previous study of fathers of ADHD children, howeverdid find them to have more depression, but not hostility,than control fathers, and even this difference was only inthose ADHD children having ODD (Johnston, 1996). Noprior studies have examined the contribution of parentalADHD symptoms, however, to the extent of parent–teenconflict. This study, therefore, examined the psychologi-cal adjustment (depression, anxiety, hostility, and ADHD)of both fathers and mothers of ADHD/ODD teens and its

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Family Conflict and ADHD/ODD 559

contribution to parent–teen conflict. It specifically testedthe following hypotheses:

• There will be greater interaction conflicts betweenteens with ADHD/ODD and their mothers than incontrol families;• There will also be greater conflicts in the interac-

tions of ADHD/ODD teens with their fathers incomparison to control families;• There will be greater conflict in mother–teen than

in the father–teen interactions in families havingADHD/ODD teens;• Parents and teens in families with ADHD/ODD

teens will employ more aggressive conflict tacticsthan will control families;• Both mothers and fathers of ADHD/ODD teens

will show higher levels of hostility, anxiety, de-pression, and ADHD than will parents of controlteens; and• Parental hostility will contribute to the degree of

parent–teen conflict beyond that contribution madeby the level of teen disruptive behavioral problems(ADHD and ODD symptoms).

METHOD

Participants

This study involved a total of 87 male teens withADHD/ODD and 32 community control male teens re-cruited over a 3-year period. The teens with ADHD/ODDand their parents were subsequently assigned to one of twobehavioral family therapies for the treatment of parent–teen conflict. The results of that treatment study are re-ported in a separate paper (Barkley, Edwards, Laneri,Fletcher, & Metevia, in press-b). All teens enrolled in thisstudy had to be between the ages of 12 and 18 years ofage, be the biological child of at least one of the parentsliving in the home or have been adopted at birth, and havean IQ greater than 80 on the Kaufman Brief IntelligenceTest (Kaufman & Kaufman, 1990). Teens were excludedif they had the following conditions: deafness, blindness,severe language delay, cerebral palsy, epilepsy, autism, orpsychosis, as established through parental and adolescentinterview and history. The teens and parents signed state-ments of informed consent. The project and consent formsreceived approval from the institutional review board forresearch on human subjects.

To be considered eligible for the ADHD/ODD group,the adolescent had to meet the following seven criteria:(1) parent and/or teacher complaints of inattention, poorimpulse control, and overactivity as established through

the screening telephone interview; (2) have at least 12of the 18 symptoms of ADHD from theDSM-IVcriteriaas established through the ADHD screening scale (symp-toms rated “Often” or higher) or aT score of 65 or higheron the Inattention scale of the Child Behavior Checklist(Achenbach, 1991); (3) have at least four of the eightsymptoms of ODD in theDSM-IVas established throughODD screening scale or have aT score greater than 65on the aggression scale of the Child Behavior Checklist(CBCL; Achenbach, 1991); (4) meetDSM-IVcriteria forboth ADHD and ODD or conduct disorder (CD) duringthe structured clinical interview; (5) either not currentlyreceiving psychoactive medication or, if receiving medica-tion, able to remain at a stable dose through the 18 sessionsof behavioral family therapy; (6) not seek any other form ofpsychiatric or psychological treatment during their partic-ipation in this project, and (7) not have any immediatelyongoing legal proceedings against them for criminal orstatus offenses by the local juvenile court authorities thatwould result in their removal from their family during theactive treatment phase of the study. All the ADHD/ODDteens selected were of the Combined Type. More than halfof these teens were already receiving treatment, particu-larly medication, from various mental health specialistsfor their psychiatric disorders (see Results later).

Families with teens having ADHD/ODD were re-cruited from one of two sources: A clinic specializing inADHD at a New England medical school and advertise-ments run periodically in the local city newspaper. Thisreport focuses on the families of the 87 males havingADHD/ODD who completed the entire screening, eligi-bility, and evaluation procedures. The community con-trol (CC) teens were recruited through advertising in thesame community newspaper as above. These teens werescreened using the parent report form of the Child Behav-ior Checklist (completed by mothers). They had to haveT scores on all scales below 65 to serve in this controlgroup. Teens also had to have fewer than three symptoms(answers of “Often” or greater) of inattention and threesymptoms of hyperactive–impulsive behavior from theDSM-IVsymptom list as assessed by the ADHD screeningscale (see Selection Measures later). This report focuseson the 32 males who completed the entire screening, eligi-bility, and evaluation procedures. More detailed informa-tion on the flow of participants in both groups throughoutthe recruitment, screening, and evaluation process appearsin the reports by Barkley, Edwards, Laneri, Fletcher, &Metevia (in press-a) and Barkley et al. (in press-b).

To summarize, there were 32 male teens in the CCgroup and 87 male teens in the ADHD/ODD group. Con-cerning minority composition, 86% of all of the teenswere Caucasian, 9% were Hispanic, 2% were African

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American, and 3% were Asian. The groups did not differsignificantly in their ethnic composition. This composi-tion reflects that generally found in referrals to the clinicfrom which these families were drawn as well as the city inwhich this medical school is located. As for parental par-ticipation, all 32 mothers of CC teens and 83 of 87 mothers(95%) in the ADHD/ODD group participated in this study.There were 22 fathers in the CC group (69%) who par-ticipated and 70 fathers in the ADHD/ODD group (80%).The groups did not differ significantly in the proportionof fathers participating in the study. Information on theneuropsychological status of the two groups is providedin the paper by Barkley et al. (in press-a).

Procedures

After passing the telephone and rating scale screen-ings, all ADHD/ODD teens received an initial evaluationby a PhD level child clinical psychologist before enteringthe study. This evaluation served to establish the diagnos-tic status of these participants and that all other eligibilitycriteria had been met. A second, more senior child clini-cal psychologist reviewed all chart material from the initialevaluation to ensure that teens met diagnostic criteria forADHD and ODD or CD, as earlier, before entering the nextphase of the study when the dependent measures were col-lected. Where this second clinician disagreed with the firston diagnostic status, they met to determine if a consensuscould be reached. Where a disagreement continued to ex-ist, the family was removed from consideration for thisproject. Such disagreement occurred for 9.6% of the teensundergoing this initial evaluation. Thus, all ADHD/ODDteens participating in this project met diagnostic criteria,reflected in 100% agreement between the two cliniciansin this stepwise diagnostic/review process.

Teens and parents who met eligibility requirementsfor the study during this initial evaluation were then sched-uled within 1–2 weeks for their direct observation of fam-ily interactions using the dependent measures (see later).They were provided with the rating scales of family con-flict to complete at home prior to this next observationsession. In this second session, the rating scales of familyconflict and parental psychological adjustment (see later)were collected at which time the observation of parent–teen interactions occurred. In four cases in the CC group(18%), fathers completed and returned their rating scalesof parent–teen conflict and parental adjustment but chosenot to attend this direct observation session. This occurredin five cases for mothers of the CC group (18%). In theADHD/ODD, this occurred for 14 fathers (20%) and justone of the mothers (1%). During this observation session,parents and teens participated in the neutral discussion

period, followed by the conflict discussion period, andconcluding with the positive discussion period. This sameorder of the assessment methods was followed for all par-ticipants. Participants were paid $50 for participating inthis assessment.

Selection Measures

Parental Interview

A structured psychiatric interview created for thisproject was used with the parents to assess the presence ofDSM-IVdiagnostic criteria for ADHD, ODD, and conductdisorder in the teens. One part of the interview consistedof questions pertaining to the current status of the family,demographic data, and the academic, social, medical, andmental health histories of the teenagers. A second sectioncollected information on theDSM-IVcriteria for ADHD,ODD, and CD (APA, 1994). Parents were instructed that,if their teen was receiving psychiatric medication, theirresponses should be based on the teen’s behavior while off-medication. No information is available on the interjudgeagreement for this particular structured interview for thedisruptive behavior disorders. However, as noted earlier,to be in this study, two clinicians had to agree on thediagnosis of ADHD and ODD or CD.

Child Behavior Checklist – Parent Form(CBCL;Achenbach, 1991)

The 1991 version of this scale providedT scores forspecific narrow band scales. The inattention and aggres-sion scales were employed in determining eligibility crite-ria for the project, as noted earlier. If the teen was receiv-ing medication, the answers were to be based upon howthe teen functioned while off-medication. The scale hasbeen used extensively in research on various childhoodpsychopathologies.

Ratings of ADHD/ODD Symptoms

Parents completed two rating scales, one containingthe items from theDSM-IV for ADHD and the other thesymptoms for ODD. Each item on each scale was ratedon a 4-point scale (0–3), using the response format ofNotat all, Sometimes, Often, andVery often.The scales wereused at the initial screening to insure that teens met eligi-bility criteria for the number of ADHD and ODD symp-toms, as described earlier. Once more, if the teen wasreceiving medication, the answers were to be based uponhow the teen functioned while off-medication. Evidenceof reliability comes from prior research showing internal

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consistency (coefficientα) for the ADHD items as .92 and1-month test-retest reliability as being .85. Validity hasbeen established through correlations of the ADHD itemswith other scales assessing hyperactive–impulsive behav-ior ranging from .61 to .80 for parent ratings. Significantdifferences have also been found between ADHD and con-trol groups (DuPaul, Power, Anastopoulos, & Reid, 1998).The ODD items were added to this scale and do not haveprior information on their reliability or validity when usedin this format.

Kaufmann Brief Intelligence Test(KBIT; Kaufman &Kaufman, 1990)

All teens were given this 20-min well-standardizedbrief intelligence test containing subtests for vocabularyand matrix reasoning. Teens needed a total IQ score of 80or higher to be eligible for this study. Split-half reliabilityis .94 and test-retest reliability is .93 for the age span of10–19 years (Kaufman & Kaufman, 1990). Validity hasbeen established through significant correlations betweenthis test and other lengthier intelligence tests (see Kaufman& Kaufman, 1990, for research review).

Dependent Measures

All of the measures collected below that pertained tothe teenager’s behavior were completed based upon theteen’s current functioning, regardless of whether or notthe teen was receiving psychiatric medication.

Parental Adjustment

Beck Depression Inventory(BDI; Beck, Steer, &Garbin, 1988). This self-report scale, used extensively inresearch on depression in adults, consists of 21 symp-toms. Each item is rated on a 4-point Likert scale (0–3)in terms of the intensity with which that item has beenexperienced. Internal consistency of the items averages0.86 (coefficientα) for psychiatric patients and 0.81 fornonpsychiatric control participants. Test-retest stability ofthe scale ranges from .62 to .90 (1 week to 4 months),varying with the population studied and the duration be-tween testings. Validity of the scale has been establishedthrough its correlation with clinical ratings of depression(r = .72) and with the Hamilton Rating Scale for Depres-sion (r = .73) for psychiatric patients. The scale signifi-cantly differentiates between depressed and nondepressedpatients and between depression and anxiety (Beck et al.,1988). The single raw score from the scale was employedhere to assess depression in parents.

Symptom Checklist 90 – Revised(SCL-90-R;Derogatis, 1992). This self-report scale has been usedextensively in research on adult psychopathology. It as-sesses 90 symptoms of various forms of adult psycho-logical maladjustment.T scores are produced for scalesassessing anxiety, depression, hostility, phobic anxiety,interpersonal sensitivity, etc. Only theT scores for theanxiety and hostility scales were employed here in the re-gression analyses (see Results later) as these were the onlyscales to significantly distinguish parents of ADHD andnormal children, as discussed earlier. When available, bothparents completed this scale about themselves. Informa-tion on reliability and validity is satisfactory and availablein the scale manual (Derogatis, 1992).

Locke–Wallace Marital Adjustment Test(LW-MAT;Locke & Wallace, 1959). This widely used rating scaleevaluates marital satisfaction. The scale was used here toevaluate the quality of the relationship between the cur-rently cohabiting adult partners, whether married or not.Numerous studies attest to its validity and utility in distin-guishing distressed from nondistressed couples (O’Leary& Arias, 1988). The single raw score was employed hereto assess relationship satisfaction in the parents and theircohabiting partners.

Adult ADHD Rating Scale(Barkley & Murphy,1998). Each parent, when available, completed two ver-sions of this 18 item rating scale that contained theDSM-IVsymptoms for ADHD. Each item was rated on a 4-pointscale (0–3;Not at all, Sometimes, Often, andVery often).One version assesses current symptoms (past 6 months)and the second assesses recall of childhood symptoms be-tween 5–12 years of age. A total summary score was calcu-lated for the ADHD items for each version. The reliability(coefficientαs) obtained in a recently completed study ofyoung adults with ADHD by Barkley is .92 for the inat-tention items and .91 for the hyperactive–impulsive items.Evidence for validity comes from studies showing thatratings of current symptoms are significantly correlated(r = .76) with concurrent ratings provided by spouses, par-ents, and cohabiting partners about the subjects (Murphy& Barkley, 1996). Validity of the childhood recall ver-sion of the scale comes from evidence that self-reportsof childhood are correlated significantly (r = .74) withparental ratings of their recall of the adult subject as achild 5–12 years of age.

Ratings of Parent–Teen Conflict

Conflict Behavior Questionnaire(CBQ; Prinz, Foster,Kent, & O’Leary, 1979). The scale contains 20 true/falseitems assessing the quality of communication and levelof conflict in parent–adolescent relationships during the

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past 2 weeks (e.g., “My mother (dad, teen) doesn’t un-derstand me,” “My mom (dad, teen) screams a lot,” etc.).Both parents completed this scale about the teen and theteen completed a separate scale about each parent. Eachinformant’s scale provided a single score that was the totalnumber of items answered in a negative direction. Internalconsistency has been found to be .90 (coefficientα; Robin& Foster, 1989). Test-retest reliability over 6–8 weeks forclinically referred, distressed families ranged from .37 forteens’ appraisals of their relations with their mothers, to.84 for teens’ appraisals of relationships with fathers. Re-liability was .57 for mothers’ appraisal of their relation-ships with their teens, and .82 for fathers’ appraisals oftheir relationship with their teens. Validity evidence comesfrom studies showing that distressed families report sig-nificantly poorer scores on this scale than nondistressedfamilies do (Robin & Foster, 1989).

Issues Checklist(Prinz et al., 1979). This scale cov-ers 44 topics on which parents and teens may have dis-agreements (e.g., homework, friends, dress, leisure time,use of phone, etc.). It provided a measure of the diversity offamily conflicts as well as the intensity of disagreements.Each topic required three answers. One was if the parentand teen discussed the topic at all in the past 2 weeks.If so, then they had to answer approximately how manytimes they discussed it. Finally, they rated how “hot” thediscussions were, with 1 indicating being calm and 5 indi-cating being very angry. The parents each completed thisscale about their teen and the teen completed two scalesseparately, one for the mother and one for the father. Twoscores were obtained from each informant’s version ofthe scale: the Number of Conflicts and the Mean AngerIntensity. Reliability has been demonstrated through sig-nificant 1–2-week test-retest correlations (.63–.70 formothers ratings; .73–.80 for father ratings; .47–.49 forteen ratings of mothers; and .60–.72 for teen ratings offathers). Validity has been established in studies show-ing agreement averaging 67.5% between parent and teenas to whether a conflict issue had been discussed in theprior 2 weeks. Significant correlations have been obtainedbetween scores on the scale and direct observations ofparent–teen interaction conflicts (.44–.52) and scales as-sessing dissatisfaction in child rearing (.45–.55) (Robin &Foster, 1989).

Conflict Tactics Scale – Parent–Teen Version (CTS-PT). This 18-item scale was adapted from the ConflictTactics Scale (Straus, 1990) used in marital violence re-search. The items were arranged in order of increasinganger and hostility toward the other person such that Item 1referred to “Discussed an issue calmly,” whereas Item 9was “Threatened to hit or throw something at the otherperson,” and Item 18 was “Used a knife or fired a gun.”

The first 10 items referred to verbal forms of conflict(insulting, sulking, threatening, etc.) whereas the final 8referred to physical forms of conflict (throwing somethingat another, pushing, slapping, hitting, threatening with aweapon, etc.). For each item, respondents were asked toindicate if the tactic was used during the past year and,if so, with what frequency. The scale contained two sec-tions, one providing a report by the parent about behaviortoward their teen and the second about the teen’s behaviortoward them. The teens completed this same scale but didso twice, once with regard to their interactions with theirmother and the second with regard to their interactionswith their father. The section in the scale referring to theteen included all 18 items. For the section of the scalereferring to the parent, only the first 12 items were usedhere with the highest item referring to “Pushed, grabbed,or shoved the teen.” The reason for not including the re-maining six more violent items is that we did not wishto elicit answers that could be construed as possibly con-stituting child abuse because state reporting requirementswould have mandated that we initiate such a report. Theonly score used here was theWorst Tactic, representingthe highest item (most hostile action) that had been usedby the parent toward the teen or teen toward that parentin the previous year. To our knowledge, the scale has notbeen previously employed in studies of parent–teen con-flict but has been used extensively in research on maritalconflict and more recently in studies of dating violenceamong teenagers (Foshee, 1996). Evidence of reliabilitycomes from past studies of maritally violent couples us-ing the CTS in which coefficient alphas ranged from .80(men) to .86 (women) (Dunford, 2000). Evidence of va-lidity comes from studies employing the scale in nationalstudies of marital violence (Straus & Gelles, 1986). Corre-sponding agreement between husbands and wives on thewives’ violent behavior were 88% for clinical dyads and95% for community dyads (Jouriles & O’Leary, 1985).Higher scores on the scale also are significantly predic-tive of marital dissolutions over a 4-year follow-up period(Rogge & Bradbury, 1999).

Direction Behavioral Observations of Parent–TeenInteractions.Conflict Rating System (CRS; Christensen& Heavey, 1990; Christensen & Shenk, 1991; Heavey,Layne, & Christensen, 1993) has been used in previousstudies of dyadic conflict during marital interactions. Itis an expanded version of the observational form used byChristensen and Heavey (1990) to characterize the behav-ior of couples during problem-solving discussions. To ourknowledge, it has not been used to study problem solv-ing in parent–teen discussions. The CRS is composed of15 behavioral dimensions along which each participantin the interaction is rated by an observer using a 9-point

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scale. There are 10 dimensions reflecting negative com-munication (e.g., blames, accuses, criticizes the other per-son, pressures the other to change, withdraws from theinteraction, avoids discussing the problem, interrupts theother person, dominates the discussion) and 5 reflectingpositive communication (e.g., suggests possible solutions,expresses self clearly, shows positive affect, expresses un-derstanding and acceptance of partner’s feelings). Reportsof coefficient alphas of .80–.83 (positive) and .66 (neg-ative) come from studies of marital interaction conflict(Heavey et al., 1993; Berns, Jacobson, & Gottman, 1999).Interobserver agreement (intraclass correlations) in thesesame studies was .84–.89 (positive) and .84–.85 (nega-tive). Separate positive and negative communication scalescores were computed here by summing the ratings acrossthe respective items for each scale. In this study, coefficientalphas were .84–.86 (negative) and .87–.89 (positive) formothers across the neutral and conflict discussion periods(see later), .76–.80 (negative) and .89–.91 (positive) for fa-thers across these same discussions, and .89–.90 (negative)and .94–.95 (positive) for teens in these same discussions.

Parents and teens were seated in a clinic room witha one-way observation mirror and intercom and asked toengage in three types of discussions. All discussions werevideotaped. The first discussion lasted 15 min and involvedplanning a vacation given unlimited funds and was calledthe Neutral Discussion. The next discussion, called theConflict Discussion, required the parents and adolescentto discuss and attempt to resolve the five angriest conflictsthe mother reported on her version of the Issues Checklist,described earlier. This situation lasted 15 min. Followingthe Conflict Discussion, participants engaged in a briefPositive Discussion period so as to reduce the level ofhostility among family members elicited by the ConflictDiscussion before permitting them to depart the clinic.Each person had to list approximately five positive char-acteristics they noticed in the other person and then de-scribe these to each other, giving examples that illustratedeach positive feature. This session lasted 10 min. For thisstudy, only scores from the Neutral and Conflict Discus-sions were used. At the end of this discussion period, eachparticipant was asked to rate on a scale of 0 (not at all) to 9(very similar) just how similar this discussion was to thosetaking place at home on these problem topics. These dis-cussions involved at least one of the parents and the teen inall instances. Where the second parent was available, theyalso participated in these same discussions with the otherparent and the teen. Approximately 68% of the controlgroup and 60% of the ADHD/ODD group involved suchtriadic as opposed to dyadic discussions with the teens.This difference was not significant (χ2 = 0.50, df= 1,p = .48).

The videotapes of the two discussions were coded us-ing the CRS described earlier. The observer was requiredto watch the entire videotape of the discussion period andthen complete the CRS for each participant in the discus-sion separately. The observers were trained by the firstauthor in the use of this coding system based on instruc-tions developed by Christensen and Heavey (1990) andprovided by Heavey to this project. The observer was blindto group membership of the families. Interobserver relia-bility was conducted on 20% of the videotapes by using asecond observer also trained in this system who was alsoblind to group membership. Agreement was examined us-ing intraclass correlations on the scores from the two ob-servers for mothers, fathers, and teens (collapsed) acrossboth discussions (collapsed). Results were .82 (negativescale) and .64 (positive scale).

RESULTS

Initial Subject Characteristics

Initial demographic characteristics as well as themeasures employed as selection criteria for each groupare reported in Table I. The two groups did not differ inage or grade levels, or in the ages or education of themothers and fathers. The ADHD/ODD group, however,had a significantly lower IQ than did the control group.As expected from the use of these measures as selectioncriteria, the ADHD/ODD group had a significantly moreDSM-IVsymptoms of both ADHD and ODD and signifi-cantly higher CBCL attention and aggression scores thandid the CC group. The proportion of each group meetingDSM-IVcriteria for ODD was 93% for the ADHD/ODDgroup and 12% for the control group (χ2 = 74.60, df= 1,p < .001). Of the four CC teens with ODD, three hadjust the bare minimum of four symptoms and one had sixsymptoms. The proportion of each group having CD (withor without ODD) was 62% for the ADHD/ODD group and9% for the control group (χ2 = 26.03, df= 1, p < .001).The three CC teens having CD had the bare minimumnumber of symptoms of three.

A total of 67.7% of the control group and 68.7% of theADHD/ODD group had parents who were currently mar-ried (χ2 = 1.80, df= 3, p = .61). Approximately 97%of the mothers of control teens and 92% of the mothersof the ADHD/ODD group were the biological mothers(χ2 = 1.35, df= 3, p = .72). Ninety-one percent of theCC group and 82% of the ADHD/ODD group were thebiological fathers (χ2 = 2.28, df= 3, p = .52). Compar-isons on the measures listed in Table I between teenswhose fathers did and did not participate found no sig-nificant differences within the ADHD group and just one

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Table I. Participant Selection Characteristics for Each Group

Control ADHD/ODD

Measures Mean SD Mean SD t p<

Adolescent age (years) 14.9 1.5 14.8 1.5 0.57 —Adolescent IQ (KBIT) 113.5 9.2 103.7 10.0 4.72 .001Adolescent school grade 9.4 1.6 8.9 1.7 1.59 —Mother age (years) 42.1 3.8 42.7 6.0 −0.53 —Mother education (years) 14.0 2.3 14.7 2.1 −1.43 —Father age (years) 44.6 4.9 45.1 6.3 −0.36 —Father education (years) 14.8 3.4 14.5 2.9 0.39 —# ADHD symptoms – Teen 0.6 1.4 13.2 5.6 −18.87 .001# ODD symptoms – Teen 0.6 1.4 5.9 2.0 −15.38 .001Teen CBCL attention 51.0 2.1 72.9 9.2 −20.07 .001Teen CBCL aggression 51.8 4.2 71.3 10.8 −13.61 .001

Note. ADHD – attention deficit hyperactivity disorder;SD – standard deviation;t – results ofthe t test; p – probability value for thet test if significant (p < .05); KBIT – Kaufman BriefIntelligence Test; CBCL – Child Behavior ChecklistT score (parent version—mother report);ODD – oppositional defiant disorder.

in the control group: teens whose fathers did not partic-ipate had mothers with less years of education than didteens whose fathers did participate.

In the ADHD/ODD group, 58.6% were taking psy-chiatric medication. No one in the control group was onmedication. The medicated and nonmedicated ADHD/ODD participants were compared on all dependent mea-sures pertaining to the teen (e.g., age, IQ, CBCL, ADHD,and ODD ratings by parents and teens, teen and parent re-ports of parent–teen conflict, etc.), of which there were 52such measures. Given the large number oft tests, signifi-cance was set atp< .01. The groups did not differ signif-icantly on any measures. Therefore, these two subgroupsof ADHD/ODD youth were considered to be comparableand collapsed for purposes of this study.

Because the ADHD/ODD group differed signifi-cantly from the CC group in IQ, it was necessary to de-termine if IQ needed to be covaried in any subsequentgroup comparisons. Pearson correlations were computedbetween the teen IQ scores and all of the dependent mea-sures, using the entire sample. Only three of the 32 correla-tions were significant (p< .05). This is nearly the numberthat might be expected to be significant by chance alone(2). Nevertheless, to err on the conservative side, IQ wasused as a covariate in the analyses of these three dependentmeasures (indicated bya in Table II).

Parental and Teen Reports of Parent–TeenConflict (Table II)

Five measures were collected separately from moth-ers and fathers about the extent of conflict in their rela-

tionships with their teen (p < .01 set for each measure).Significant group differences were found on all measures.The ADHD/ODD group manifested significantly more is-sues of conflict, more anger intensity during those con-flicts, poorer parent–teen communication (CBQ), andmore aggressive conflict tactics as reported by both par-ents than did the control group.

Teens completed these same five measures separa-tely about their mothers and fathers (p set at<.01). TheADHD/ODD group reported significantly higher levels ofanger during the mother–teen conflicts and poorer mother–teen communication than did teens in the CC group. TheADHD/ODD group also reported more anger intensityduring their conflicts with their fathers, poorer father–teencommunication, and use of more aggressive conflict tac-tics by their father toward them than did teens in the CCgroup.

Observations of Parent–Teen Interactions

Mothers, fathers, and teens rated the similarity ofthe neutral and conflict discussion periods to those thatoccurred at home concerning a neutral or conflict topic(p set at<.017). For the neutral discussion, both mothers(Mean= 5.8; SD= 2.4) and teens (Mean= 4.6; SD=2.8) in the ADHD/ODD group rated these discussions asbeing significantly less similar to discussions of neutraltopics that occur at home than did mothers (Mean= 7.0;SD = 1.5) and teens (Mean= 6.1, SD = 2.0) in theCC group (Mothers:t = 3.03,df = 68.3 [unequal vari-ances],p = .003; Teens:t = 3.09,df = 56.8 [unequalvariances],p = .003). The groups did not differ on any

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Table II. Ratings of Parent–Teen Conflict

Control ADHD/ODD

Measures Mean SD N Mean SD N F p<

Mother ratingsIC: No. of issues 15.8 6.8 32 22.1 7.4 83 17.46 .001IC: Anger intensitya 1.6 0.6 30 2.3 0.6 83 21.54 .001CBQ ratinga 3.9 4.4 30 13.9 4.1 83 108.29 .001CTS: M worst tactic 6.7 3.7 32 10.6 2.1 83 51.13 .001CTS: T worst tactic 7.8 3.1 31 11.4 3.0 83 32.21 .001

Father ratingsIC: No. of issues 14.5 6.8 22 19.9 7.8 69 8.36 .005IC: Anger intensity 1.4 0.4 22 2.0 0.6 69 16.37 .001CBQ ratinga 4.1 3.6 20 12.0 5.4 70 29.70 .001CTS: F worst tactic 6.9 3.8 22 10.5 2.6 69 24.87 .001CTS: T worst tactic 7.7 3.6 22 10.7 2.8 70 16.14 .001

Teen on motherIC: No. of issues 12.1 6.4 32 13.9 5.7 84 2.08 nsIC: Anger intensity 1.5 0.6 32 2.2 0.7 84 22.64 .001CBQ rating 4.0 4.1 32 7.9 5.1 84 4.65 .001CTS: M worst tactic 6.5 3.7 31 8.4 3.4 84 6.30 nsCTS: T worst tactic 8.7 3.2 32 10.0 3.0 84 3.91 ns

Teen on fatherIC: No. of issues 9.0 6.3 24 12.5 6.3 75 5.50 nsIC: Anger intensity 1.2 0.6 24 2.2 0.9 75 23.56 .001CBQ rating 1.4 2.2 25 7.8 6.1 75 25.67 .001CTS: F worst tactic 5.1 3.8 25 8.3 4.0 76 12.63 .001CTS: T worst tactic 7.1 3.9 26 9.3 3.7 76 6.10 ns

Note.ADHD – attention deficit hyperactivity disorder;SD– standard deviation;F – resultsof theF test;p – probability value for theF test if significant (p < .01); ODD – oppositionaldefiant disorder; IC – Issues Checklist; CBQ – Conflict Behavior Questionnaire; CTS – ConflictTactics Scale; M – mother; T – teen; F – father.aIndicates that IQ served as a covariate in the analysis of this measure.

of the conflict discussion ratings, with both groups ratingthese discussions as reasonably similar to conflict discus-sions occurring at home (Mean ratings between 6.0 and7.2 for the ADHD/ODD and CC groups out of a possible9 maximum score).

Positive and negative interaction scores were codedfor each participant in each discussion using the CRS sys-tem, thus yielding six measures for each discussion period(p set at<.008). These measures are shown in Table III.Results indicated that teens in the ADHD/ODD groupwere observed to be significantly more negative duringthe neutral discussion than were teens in the CC group.No other comparisons reached significance. However, inthe conflict discussion period, mothers and teens in theADHD/ODD group displayed significantly less positivebehavior whereas mothers, fathers, and teens in this groupdemonstrated significantly more negative behavior thandid those in the comparison group.

Because some of these direct observations weredyadic (mothers and teens) whereas most others were tri-adic (mothers, fathers, and teens), a subsequent analysis

was done to determine if the group differences noted ear-lier for mother and teen behavior were affected by thefather’s participating in these discussions. The foregoinganalyses for mother and teen measures were re-computedusing family composition (dyadic vs. triadic) as a sepa-rate factor in the analyses along with that of teen grouping(ADHD/ODD vs. CC). Because of the very small samplesizes for the dyadic family composition factor in somecells, significance was set atp< .05 to maximize power.For the neutral discussion period, the family compositionfactor was not significant on any measure nor was its inter-action with the grouping factor. For the conflict discussionperiod, no main effect for family composition was notedon either the mothers’ or teens’ positive or negative be-havior. However, a significant interaction of compositionwith teen grouping was noted on teen negative behav-ior (F = 4.44,df= 1/95, p = .038). Pair-wise contrastsindicated that within the CC group, teens demonstratedsignificantly less negative behavior when the father waspresent (Mean= 34.7, SD = 17.9) than when absentfrom this discussion (Mean= 23.1, SD= 8.9). In the

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Table III. Direct Observations (CRS) From Neutral and Conflict Discussion Periods

Control ADHD/ODD

Measures Mean SD N Mean SD N F p<

Neutral discussionMother positive 38.1 5.2 27 36.3 7.7 81 1.20 nsFather positive 34.8 9.0 18 34.4 8.0 56 0.02 nsTeen positive 34.0 8.5 28 28.5 11.6 86 5.43 nsMother negative 17.3 8.8 26 18.9 9.7 82 0.56 nsFather negative 18.3 9.2 18 20.7 8.0 56 1.13 nsTeen negative 18.6 7.5 26 31.6 16.5 86 15.12 .001

Conflict discussionMother positive 37.5 5.4 27 31.9 7.8 82 12.02 .001Father positive 34.7 10.3 18 30.5 8.6 56 2.88 nsTeen positive 33.9 9.1 28 21.1 10.5 85 33.11 .001Mother negative 23.8 9.1 27 33.5 10.8 82 17.22 .001Father negative 25.0 10.2 18 35.8 11.1 54 13.30 .001Teen negative 26.5 13.3 28 47.1 18.3 84 30.14 .001

Note.ADHD – attention deficit hyperactivity disorder; ODD – oppositional defiant disorder;SD– standard deviation;F – results of theF test; p – probability value for theF test ifsignificant (p < .01).

ADHD/ODD group, this difference was not significant(Means=43.3 vs. 49.1,SDs=18.8 vs. 17.9, respectively).CC and ADHD/ODD teens in the dyadic interactions werenot significantly different in their level of negative be-havior. However, ADHD/ODD teens in the triadic inter-actions were significantly more negative than were CCteens. Thus, the presence of the father during mother–teenconflict discussions may help to suppress teen negativityin the CC group but not in the ADHD/ODD group. Thissame interaction was also marginally significant for moth-ers’ negative behavior (F = 3.77,df= 1/92,p= .055) andshowed much the same pattern in pair-wise comparisons.

Comparison of Mother–Teen VersusFather–Teen Conflicts

One purpose of this study was to determine if theseverity of parent–teen interaction conflicts varied as afunction of sex of the parent. To evaluate this issue, theratings collected from mothers on the five measures as-sessing such conflict (IC, CBQ, and CTS) were comparedto those collected from fathers using that subset of par-ticipants within each group on which data were availablefrom both mothers and fathers (Ns: ADHD/ODD= 65,Control= 22). For each measure, a 2 (groups)× 2 (par-ents) ANOVA was computed with repeated measures onthe last factor (p set at<.01). The main effects for groupwere ignored in these analyses as they have already beenreported earlier. Of interest here was any main effect forsex of the parent or any interaction of it with the groupingfactor. Only one main effect for parent was significant, and

this indicated that mothers reported higher levels of angerintensity (Mean= 2.10,SD= 0.70) in conflict discussionswith their teens than did fathers (Mean= 1.77,SD= 0.57;F = 6.77,df= 1/85, p = .01). No other main effects orinteraction terms reached this level of significance.

These analyses were then repeated using the teens’ratings of their mothers and fathers on these same five mea-sures for that subset of participants from whom teen rat-ings were available for both parents (Ns: ADHD/ODD=75; Control= 25; p set at<.01). The main effect for theteens’ worst tactic used toward their parents was signif-icant, with teens reporting that they employed a signifi-cantly more hostile tactic toward their mothers (Mean=9.75,SD= 3.2) than toward their fathers (Mean= 8.60,SD= 3.80; F = 13.37,df = 1/97, p < .001). No othermain effects for sex of parent or interactions of this factorwith the grouping factor were significant.

Finally, these analyses were conducted on the par-ents’ positive and negative interactive behavior scoresfrom the CRS for both the neutral and the conflict dis-cussion periods where both parents had participated inthese discussions (Ns: ADHD/ODD= 44; Control= 19;p set at<.012). There were no significant main effects forsex of parent or any interaction of sex with group.

Parental Psychological Adjustment

Significance for the mothers’ and fathers’ self-reportson the BDI, the two SCL-90 scales, the LW-MAT score,and for the ADHD symptoms, both current and childhoodwas set at<.008 for each set of measures. Mothers in the

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ADHD/ODD group reported significantly higher levels ofhostility (SCL-90; t = 3.23, df = 113, p = .002) anddepression (BDI;t = 4.82, df = 113, p < .001) thandid mothers in the CC group. No other differences weresignificant. Fathers of the ADHD/ODD group reportedsignificantly higher levels of childhood ADHD than didfathers in the CC group (t = 3.22,df= 89, p= .002). Noother comparisons reached this level of significance.

Contribution of Parental Self-Rated Maladjustmentto Parental Ratings of Parent–Teen Conflict

The final aim of this study was to examine the ex-tent to which parental anxiety, depression, hostility, andADHD may have contributed to parent–teen conflict be-yond that contribution made by the severity of teen ADHDand ODD symptoms. Multiple regression was used to ad-dress this issue. First, however, the five ratings collectedfrom mothers (IC, CBQ, and CTS) were reduced throughprincipal components factor analysis using varimax ro-tation (SPSS version 9.0). This indicated that these fivemeasures formed a single significant component havingan Eigenvalue of 2.94 and accounting for 58.9% of thevariance. No other components received Eigenvalues ofgreater than 1.00. The range of factor loadings was .641–.840. A single factor score (Mother–Teen Conflict) there-fore was created using factor loadings for these mater-nal ratings. Next, the same analysis was applied to thesame five father ratings, yielding the same result. Thesingle factor solution gave an Eigenvalue of 2.52, ac-counting for 50.4% of the variance. Factor loadings hereranged from .60 to .778. Consequently, a single factorscore (Father–Teen Conflict) was created for the fatherratings as well.

Table IV. Regression Analyses Showing the Contribution of Parent Maladjustment to Mother and FatherRatings of Parent–Teen Conflict (After Controlling for Teen ADHD, ODD, and IQ)

Dependent measure R R2 R2 change Betaa F change df p

Mother–teen conflict factorTeen ODD (mother rated) .644 .415 .415 .411 83.02 1/117 <.001Teen ADHD (mother rated) .667 .445 .030 .207 6.17 1/116 .014Mother hostility (SCL-90) .692 .478 .034 .165 7.47 1/115 .007Father hostility (SCL-90) .705 .496 .018 .140 4.06 1/114 .046

Father–Teen conflict factorTeen ODD (father rated) .630 .396 .396 .382 76.80 1/117 <.001Teen ADHD (father rated) .676 .457 .061 .272 13.05 1/116 <.001Father hostility (SCL-90) .722 .521 .063 .353 15.21 1/115 <.001Father anxiety (SCL-90) .736 .541 .020 −.169 5.05 1/114 .026

Note.ADHD – attention deficit hyperactivity disorder rating scale score; ODD – oppositional defiant disorderrating scale score; SCL-90 – Symptom Checklist 90T-score.aBeta coefficients are standardized.

The contribution of parental psychological malad-justment to the Mother–Teen Conflict scores was thenexamined using stepwise multiple regression. The entiresample was used in this analysis. Independent variableswere entered in three blocks, corresponding to teen,mother, and father characteristics, respectively. Block 1comprised the mothers’ ratings of the teens’ severity ofADHD and ODD, using raw scores derived from theADHD/ODD Rating Scale and the teens’ KBIT IQ score.Block 2 consisted of the mothers’ ratings of their own de-pression (BDI), anxiety (SCL-90), hostility (SCL-90), andcurrent ADHD symptoms (Adult ADHD Rating Scale).Block 3 consisted of these same scores from the fathers’self-ratings. The results are displayed in Table IV. Al-though teen ratings of ODD accounted for a substantialportion of the variance in the Mother–Teen Conflict score(41%), and teen ADHD made an additional significantcontribution (3%), two parental characteristics also con-tributed significantly to mother–teen conflicts. These werethe mothers’ and fathers’ own self-ratings of hostility,which accounted for 3.4 and 1.8% of the variance, re-spectively, in the Mother–Teen Conflict factor scores.

The same approach was employed to study the con-tribution of these three blocks of variables to the Father–Teen Conflict factor scores. Except in this case, thefathers’ ratings of the teens ADHD and ODD symptomswere employed in the first block, the fathers’ self-ratingswere entered in the second block, and the mothers’ self-ratings were entered last. These results also appear inTable IV. Once again, the teens’ ODD and ADHD symp-toms made significant contributions to the Father–TeenConflict scores (40 and 6% of the variance, respectively).Beyond these, however, two father self-ratings also made asignificant contribution: father hostility (6%) and anxiety(2%) scores from the SCL-90. In short, some aspects of

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parental psychological adjustment make significant con-tributions to parent–teen conflict besides the importantcontribution made by teen levels of disruptive behavior(ADHD/ODD).

DISCUSSION

The findings serve to both replicate and extend theresults of earlier research on the parent–child and parent–teen interactions of children and teens with ADHD andODD. As in earlier studies, the present one found a sub-stantial degree of conflict between the teens with ADHD/ODD and their mothers. The mothers of the teens with co-morbid ADHD and ODD had more issues on which theyhad conflicts with their teens, more anger in these conflicts,used more aggressive tactics, and reported poorer commu-nication with their teens than did CC mothers. These ma-ternal reports were largely corroborated by the teens’ ownreports. As in our earlier studies of ADHD teens (Barkley,Anastopoulos, et al., 1992; Barkley, Fischer, et al., 1991),increased conflict between mothers and teens was directlyobserved during problem-solving discussions. The levelof ODD symptoms more than the ADHD symptoms con-tributed most to mother–teen conflict; a result found inearlier studies of ADHD children (Anastopoulos et al.,1992; Gomez & Sanson, 1994; Johnston, 1996).

This study also extended these findings on mother–teen relations to the interactions of fathers with ADHD/ODD teens. Like mothers, fathers of the ADHD/ODDgroup also reported more conflict issues, more anger, moreaggressive conflict tactics, and poorer communication thandid CC fathers. Again, teen reports largely corroboratedthese results. However, the teens did not see themselvesas using more aggressive conflict tactics with either theirfathers or their mothers than did the teens in the CC group,in contrast to both mothers and fathers reports of teentactics. Thus, teens with ADHD/ODD may be underre-porting severity of conflict more than CC teens. Oncemore, the teens in the ADHD/ODD group were observedto use more negative and less positive forms of interactionwith their fathers, and fathers used more negative inter-actions toward their teens than was the case with the CCgroup. Furthermore, although the presence of the fatherduring conflict discussions appeared to reduce the level ofteen negative behavior in CC teens, this was not the case inADHD/ODD teens. There, negativity actually increased,albeit not significantly, during father presence. A similar,though marginally significant, pattern between the groupswas evident in the effect of father presence on mothers’negative behavior as well during these conflict discus-sions. Buhrmester et al. (1992) found similar suppress-ing effects of father presence on mother–child conflict

in ADHD children and speculated that it may stem frompaternal rescuing of mothers from their children’s coercivebehavior by the father’s involvement in the interaction.

Just as in some earlier research on father–childinteractions in hyperactive children (Johnston, 1996;Tallmadge & Barkley, 1983), this study did not find differ-ences in parent–teen interactions as a function of sex of theparent on most of the measures. Mothers and fathers bothreported comparable numbers of conflicts and compara-ble degrees of aggressiveness and extent of parent–teenpositive communication in their interactions, even thoughmothers and fathers of ADHD/ODD teens reported sig-nificantly more such problems than was the case in theCC group. However, this study did find that mothers, re-gardless of group, reported higher levels of anger in theirconflict discussions with their teen than was reported byfathers during their own interactions with the teens. Theteens, again regardless of group, also reported having useda more aggressive or hostile tactic toward their mothersthan was the case with fathers. This is reminiscent of ear-lier findings by Burhmester et al. (1992) on parent–childinteractions where boys were found to direct more neg-ative behavior toward their mothers than fathers. Apartfrom these few differences, the conflicts that mothers havewith their teens are largely comparable to those of fatherswithin each of these groups. The patterns of interactionconflict for both parents in families of ADHD/ODD teensare in keeping with family coercion theory (Patterson et al.,1992) where greater family conflict would be most evi-dent in that subset of ADHD teens having comorbid socialaggression (ODD).

One purpose of this study was to examine the worstlevel of violence that occurred in the parent–teen relationsof ADHD/ODD teens. According to family coercion the-ory, family members ought to demonstrate more extremeaggressive tactics toward each other over time as the useof coercive tactics escalates via a process of negative re-inforcement for progressively more aggressive behaviortoward each other. Consistent with this theory, mothersin the ADHD/ODD group reported that, on average, theworst tactics they used involved “throwing, hitting, smash-ing, or kicking something” or actually throwing somethingat their teenager during conflict discussions. Mothers ofCC teens, in contrast, reported that their worst tactics aver-aged between “stomped out of the room or house or yard”or “cried.” Mothers in the ADHD/ODD group furtherreported that their teens worst tactics averaged between“throwing something” at them and “pushed, grabbed, orshoved” them, whereas mothers in the CC group reportedtheir teens’ worst tactics, on average, ranged between cry-ing and doing something to spite the other person. Inter-estingly, the groups did not differ in the teens’ reports of

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the worst tactics they used toward their mothers or thatthe mothers used toward them. This was largely owingto the ADHD/ODD group reporting a lower level of ag-gressive tactic relative to their mothers’ reports than wasthe case with the teens in the CC group, whose reportswere similar to those of their mothers. Similar findingsheld true with respect to severity of father–teen violenceduring conflicts. Fathers of the ADHD/ODD group re-ported their worst tactics and that of their teens as being atlevels similar to that reported by the mothers of these teens(threw, smashed, hit or kicked something, or threw some-thing at the other person) whereas fathers of the CC teensreported lower levels of aggression that were again com-parable to those reported by the mothers. Higher levels ofviolence, then, may be more typical of parent–teen conflictinteractions in families with an ADHD/ODD teen than isthe case in families of CC teens. The former families arelocked into coercive spirals of ever-escalating aggressivebehavior toward each other whereas the latter families areless prone to such interaction spirals (Fletcher et al., 1996).It is conceivable that the worst levels of violence duringconflicts in the ADHD/ODD group may be even higher,on average, than those reported here due to the intentionaltruncation of the parents’ version of the Conflict TacticsScale to levels just short of physical violence. This wasdone so as to preclude triggering state mandated reportsof potential abuse.

In keeping with past studies of ADHD children andteens (Barkley, Anastopoulos, et al., 1992; Befera &Barkley, 1985; Cunningham et al., 1988; Johnston, 1996),particularly those having comorbid ODD, this study docu-mented significantly greater levels of depression and hos-tility in the mothers of teens with ADHD/ODD relativeto mothers in the CC group. However, this study did notfind lower levels of marital satisfaction in the mothers ofteens with ADHD/ODD as previous studies had reported.Nor did mothers of the ADHD/ODD group report havingmore symptoms of ADHD, either currently or in child-hood, than did mothers of the CC group. Such a findingseems inconsistent with the substantial evidence for thehigh heritability of ADHD (averageh2= .80+; Faraone,2000; Thapar et al., 1999) and with the increased risk of thedisorder among the biological relatives of child probandshaving ADHD (Biederman et al., 1992). However, fathersof the ADHD/ODD group did report having had a higherlevel of ADHD symptoms, at least as children, than didCC group fathers. The disparity between this study andprior research on the familial aggregation of ADHD maybe due to at least two factors. This study used only ratingscales of ADHD symptoms rather than direct personal in-terviews to assessDSMcriteria for parental ADHD. Andup to 10% of the parents participating in this study were

not the biological parents of these teens. There may alsoexist a referral bias among these families in that higherfunctioning families having less parental ADHD may bemore likely to seek treatment services for their teens.

The final aim of this study was to determine the ex-tent to which parental hostility, depression, anxiety, andADHD contributed to parent–teen conflicts beyond thecontribution made by the teens’ level of disruptive behav-ior problems (ADHD/ODD). Once more, in keeping withfamily coercion theory and past research, this study foundseverity of teen ODD symptoms made the greatest contri-bution to severity of parent–teen conflict, with symptomsof ADHD contributing less so. The parents’ level of self-rated hostility also contributed significantly to the level ofparent–teen conflict in both sexes of parent. Moreover, formother–teen conflict, not only did the mothers’ level ofhostility contribute to such conflict, so did that reportedby their male partners (mostly husbands). The reverse wasnot true for father–teen conflict. Prior research on dis-ruptive males suggests that this effect of father hostilityon mother–son interactions may stem from an indirectpathway of influence, in this case modeling (Lavigueur,Tremblay, & Saucier, 1995). Father’s hostility towardmothers is significantly correlated with mother–son con-flict perhaps because sons are imitating the father’s in-teraction style toward the mother. Unexpectedly, fathers’self-rated level of anxiety contributed inversely to the levelof father–teen conflict beyond the contribution made bythe teens’ ADHD/ODD symptoms and fathers’ self-ratedhostility. This implies that higher levels of anxiety mayserve to diminish fathers’ propensities for engaging in co-ercive, conflictual exchanges with more disruptive teens.

The results of this study must be viewed in the con-text of its limitations. One was that the vast majority ofADHD/ODD teens and their parents volunteered becauseof their desire to participate in the subsequent study offamily therapies for parent–teen conflict associated withthis project (Barkley et al., in press-b). It is possible thatthese families may not be representative of all clinic re-ferred ADHD/ODD teens but only those with conflictsthat are sufficiently extreme to compel them to seek thesetreatments. Also noteworthy was the limitation introducedby the high percentage of teens in the ADHD/ODD groupthat were on medication at the time of their evaluation.Although the screening measures used to select partici-pants were collected based on parental reports of the teens’adjustment off-medication, the dependent measures werebased upon current functioning regardless of medicationstatus. Fortunately, the medicated ADHD/ODD partici-pants did not differ significantly from the nonmedicatedADHD/ODD ones on any of the dependent measures. It isstill possible that the presence of so many medicated teens

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in the ADHD/ODD group may have reduced the represen-tativeness of that group relative to the larger populationof teens with ADHD/ODD. Nevertheless, any such biaswould have acted conservatively to reduce ADHD/ODDversus CC group differences given that those medications(mainly stimulants) have been shown to have a beneficialimpact on parent–child interactions in studies of childrenwith ADHD (Danforth et al., 1991). A further limitationwas the relatively small sample of control teens and theirparents, particularly for the number of fathers participatingin that group. This may have limited the statistical powerof this study to detect additional group differences beyondthose reported here. Even so, group differences for fatherratings of parent–teen conflict were significant despite thislimitation in sample size, suggesting that such elevatedconflict in father–teen relations in the ADHD/ODD groupis probably reliable and rather robust.

In summary, this study found that parents and teensin families having adolescents clinically diagnosed withcomorbid ADHD and ODD reported having substantiallymore issues of conflict, expressing higher levels of angerintensity during such conflicts, and using more aggres-sive conflict tactics toward each other than did a com-munity control group of teens and parents. Greater levelsof negative interactive behavior and lower levels of pos-itive interactive behavior were also documented throughdirect observations of parents and teens during conflict dis-cussions in a clinical setting, though not during a neutraldiscussion period. The results also indicated that parentalself-reports of hostility made additional contributions tothe level of parent–teen conflict beyond that contributedby teen ADHD and ODD. Such findings are quite consis-tent with coercion theory and past research on aggressivechildren where increased intrafamilial conflict serves as atraining ground for social aggression.

These findings have implications for interventionsfor reducing parent–teen conflict. Although treatment mayneed to focus on parent–teen problem-solving and com-munication skills, as was done in the subsequent treat-ment study with these teens (Barkley et al., in press-a, inpress-b), this may not be sufficient, as was also evidentin the outcome of that treatment study. The substantialcontribution of both ODD and ADHD symptoms to fam-ily conflict suggest that other therapies, such as stimu-lant medication, must be added that directly reduce bothsymptom domains if greater therapeutic efficacy is to beattained. The contribution of parental hostility to parent–teen conflict generally and the possible indirect modelingeffects of paternal hostility in particular further suggeststhat both anger control training and marital therapy withparents may also be necessary to further increase treat-ment success beyond the relatively mixed results obtained

by teen-focused family therapies to date for this clinicalpopulation (Barkley et al., in press-a, in press-b; Barkley,Guevremont, Anastopoulos, & Fletcher, 1992).

ACKNOWLEDGMENTS

Appreciation is expressed to Trisha Chaplin for as-sistance with data entry, to Denise Kwasnik and SusanBarrett for assistance with the viewing and coding of thevideotapes of family interactions, and to Laura Montvillefor administrative assistance.

REFERENCES

Achenbach, T. M. (1991).Manual for the Child Behavior Checklist/4–18and 1991 Profile. Burlington, VT: Thomas Achenbach.

American Psychiatric Association. (1994).Diagnostic and statisticalmanual of mental disorders(4th ed.). Washington, DC: Author.

Anastopoulos, A. D., Guevremont, D. C., Shelton, T. L., & DuPaul, G. J.(1992). Parenting stress among families of children with attentiondeficit hyperactivity disorder.Journal of Abnormal Child Psychol-ogy, 20,503–520.

Barkley, R. A., Anastopoulos, A. D., Guevremont, D. G., & Fletcher,K. F. (1991). Adolescents with attention deficit hyperactivity disor-der: Patterns of behavioral adjustment, academic functioning, andtreatment utilization.Journal of the American Academy of Childand Adolescent Psychiatry, 30,752–761.

Barkley, R. A., Anastopoulos, A. D., Guevremont, D. G., & Fletcher, K. F.(1992). Adolescents with attention deficit hyperactivity disorder:Mother–adolescent interactions, family beliefs and conflicts, andmaternal psychopathology.Journal of Abnormal Child Psychology,20,263–288.

Barkley, R. A., Edwards, G., Laneri, M., Fletcher, K., & Metevia, L. (inpress-a). Executive functioning, temporal discounting, and senseof time in adolescents with attention deficit hyperactivity disorder(ADHD) and oppositional defiant disorder (ODD).Journal of Ab-normal Child Psychology, 29,541–556.

Barkley, R. A., Edwards, G., Laneri, M., Fletcher, K., & Metevia, L.(in press-b). The efficacy of problem-solving training alone, behav-ior management training alone, and their combination for parent–adolescent conflict in teenagers with ADHD and ODD.Journal ofConsulting and Clinical Psychology.

Barkley, R. A., Fischer, M., Edelbrock, C. S., & Smallish, L. (1990). Theadolescent outcome of hyperactive children diagnosed by researchcriteria: I. An 8 year prospective follow-up study.Journal of theAmerican Academy of Child and Adolescent Psychiatry, 29, 546–557.

Barkley, R. A., Fischer, M., Edelbrock, C. S., & Smallish, L. (1991). Theadolescent outcome of hyperactive children diagnosed by researchcriteria: III. Mother–child interactions, family conflicts, and mater-nal psychopathology.Journal of Child Psychology and Psychiatry,32,233–256.

Barkley, R. A., Guevremont, D. G., Anastopoulos, A. D., & Fletcher, K. F.(1992). A comparison of three family therapy programs for treatingfamily conflicts in adolescents with attention deficit hyperactivitydisorder.Journal of Consulting and Clinical Psychology, 60,450–462.

Barkley, R. A., Karlsson, J., Pollard, S., & Murphy, J. (1985). Devel-opmental changes in the mother–child interactions of hyperactiveboys: Effects of two doses of Ritalin.Journal of Child Psychologyand Psychiatry, 26,705–715.

Barkley, R. A., & Murphy, K. R. (1998).Attention deficit hyperactivitydisorder: A clinical workbook. New York: Guilford.

P1: FYJ/GOQ P2: GCR



Beck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric proper-ties of the Beck Depression Inventory: Twenty-five years of evalu-ation.Clinical Psychology Review, 8, 77–100.

Befera, M., & Barkley, R. A. (1985). Hyperactive and normal girls andboys: Mother–child interaction, parent psychiatric status, and childpsychopathology.Journal of Child Psychology and Psychiatry, 26,439–452.

Berns, S. B., Jacobson, N. S., & Gottman, J. M. (1999). Demand-withdraw interaction in couples with a violent husband.Journalof Consulting and Clinical Psychology, 67,666–674.

Biederman, J., Faraone, S. V., Keenan, K., Benjamin, J., Krifcher, B.,Moore, C., Sprich-Buckminster, S., Ugaglia, K., Jellinek, M. S.,Steingard, R., Spencer, T., Norman, D., Kolodny, R., Kraus, I.,Perrin, J., Keller, M. B., & Tsuang, M. T. (1992). Further evidencefor family-genetic risk factors in attention deficit hyperactivity dis-order; Patterns of comorbidity in probands and relatives in psychi-atrically and pediatrically referred samples.Archives of GeneralPsychiatry, 49,728–738.

Breen, M. J., & Barkley, R. A. (1988). Child psychopathology and par-enting stress in girls and boys having attention deficit disorder withhyperactivity.Journal of Pediatric Psychology, 13,265–280.

Buhrmester, D., Camparo, L., Christensen, A., Gonzalez, L., & Hinshaw,S. P. (1992). Mothers and fathers interacting in dyads and triadswith normal and hyperactive sons.Developmental Psychology, 28,500–509.

Campbell, S. B. (1975). Mother–child interactions: A comparison ofhyperactive, learning disabled, and normal boys.American Journalof Orthopsychiatry, 45,51–57.

Campbell, S. B., & Paulauskas, S. (1979). Peer relations in hyperactivechildren.Journal of Child Psychology and Psychiatry, 20, 233–246.

Christensen, A., & Heavey, C. L. (1990). Gender and social structurein the demand/withdraw pattern of marital interaction.Journal ofPersonality and Social Psychology, 59,73–81.

Christensen, A., & Shenk, J. L. (1991). Communication, conflict, andpsychological distance in nondistressed, clinic, and divorcing cou-ples.Journal of Consulting and Clinical Psychology, 59,458–463.

Cunningham, C. E., & Barkley, R. A. (1979). The interactions of hyper-active and normal children with their mothers during free play andstructured task.Child Development, 50,217–224.

Cunningham, C. E., Benness, B. B., & Siegel, L. S. (1988). Family func-tioning, time allocation, and parental depression in the families ofnormal and ADDH children.Journal of Clinical Child Psychology,17,169–177.

Cunningham, C. E., & Siegel, L. S. (1987). Peer interactions of nor-mal and attention-deficit disordered boys during free-play, cooper-ative task, and simulated classroom situations.Journal of AbnormalChild Psychology, 15,247–268.

Danforth, J. S., Barkley, R. A., & Stokes, T. F. (1991). Observationsof parent–child interactions with hyperactive children: Researchand clinical implications.Clinical Psychology Review, 11, 703–727.

Derogatis, L. (1992).Manual for the Symptom Checklist 90 – Revised(SCL-90-R). Baltimore, MD: Author.

Dunford, F. W. (2000). The San Deigo Navy experiment: An assess-ment of interventions for men who assault their wives.Journal ofConsulting and Clinical Psychology, 68,468–476.

DuPaul, G. J., Power, T. J., Anastopoulos, A. D., & Reid, R. (1998).TheADHD Rating Scale-IV: Checklists, norms, and clinical interpreta-tion. New York: Guilford.

Faraone, S. V. (2000). Genetics of childhood disorders: XX. ADHD:Part 4. Is ADHD genetically heterogeneous?Journal of theAmerican Acaemy of Child and Adolescent Psychiatry, 39, 1455–1457.

Fischer, M. (1990). Parenting stress and the child with attention deficithyperactivity disorder.Journal of Clinical Child Psychology, 19,337–346.

Fletcher, K., Fischer, M., Barkley, R. A., & Smallish, L. (1996). Se-quential analysis of mother–adolescent interactions of ADHD,

ADHD/ODD, and normal teenagers during neutral and conflict dis-cussions.Journal of Abnormal Child Psychology, 24,271–297.

Foshee, V. A. (1996). Gender differences in adolescent dating abuseprevalence, types, and injuries.Health Education Research: Theoryand Practice, 11,275–286.

Gittelman, R., Mannuzza, S., Shenker, R., & Bonagura, N. (1985). Hy-peractive boys almost grown up: I. Psychiatric status.Archives ofGeneral Psychiatry, 42,937–947.

Gomez, R., & Sanson, A. V. (1994). Mother–child interactions andnoncompliance in hyperactive boys with and without conductproblems.Journal of Child Psychology and Psychiatry, 35, 477–499.

Heavey, C. L., Layne, C., & Christensen, A. (1993). Gender and conflictstructure in marital interaction: A replication and extension.Journalof Consulting and Clinical Psychology, 61,16–27.

Humphries, T., Kinsbourne, M., & Swanson, J. (1978). Stimulant effectson cooperation and social interaction between hyperactive childrenand their mothers.Journal of Child Psychology and Psychiatry, 19,13–22.

Johnston, C. (1996). Parent characteristics and parent–child interactionsin families of nonproblem children and ADHD children with higherand lower levels of oppositional-defiant behavior.Journal of Abnor-mal Child Psychology, 24,85–104.

Jouriles, E., & O’Leary, K. D. (1985). Interspousal reliability of reportsof marital violence.Journal of Consulting and Clinical Psychology,53,419–421.

Kaufman, A., & Kaufman, N. (1990).Kaufman Brief Intelligence Test.Circle Pines, MN: American Guidance Service.

Lavigueur, S., Tremblay, R. E., & Saucier, J. F. (1995). Interactionalprocesses in families with disruptive boys: Patterns of direct andindirect influence.Journal of Abnormal Child Psychology, 23,359–378.

Locke, H. J., & Wallace, K. M. (1959). Short marital adjustment andprediction tests: Their reliability and validity.Journal of Marriageand Family Living, 21,251–255.

Mash, E. J., & Johnston, C. (1983). Parental perceptions of child behav-ior problems, parenting self-esteem, and mothers’ reported stressin younger and older hyperactive and normal children.Journal ofConsulting and Clinical Psychology, 51,86–99.

Murphy, K. R., & Barkley, R. A. (1996). Attention deficit hyperactivitydisorder in adults.Comprehensive Psychiatry, 37,393–401.

O’Leary, K. D., & Arias, I. (1988). Assessing agreement of reports ofspouse abuse. In G. T. Hotaling, D. Finkelhor, J. T. Kilpatrick, &M. A. Straus (Eds.),New directions in family violence research(pp. 218–227). Newbury Park, CA: Sage.

Patterson, G. R. (1982).Coercive family process. Eugene, OR: Castalia.Patterson, G. R., Reid, J. B., & Dishion, T. J. (1992).Antisocial boys.

Eugene, OR: Castalia.Pelham, W. E., & Milich, R. (1984). Peer relations in children with

hyperactivity/attention deficit disorder.Journal of Laerning Dis-abilities, 17,560–567.

Pollard, S., Ward, E., & Barkley, R. A. (1983). The effects of parenttraining and Ritalin on the parent–child interactions of hyperactiveboys.Child and Family Therapy, 5, 51–69.

Prinz, R. J., Foster, S. L., Kent, R. N., & O’Leary, K. D. (1979).Multivariate assessment of conflict in distressed and nondistressedmother–adolescent dyads.Journal of Applied Behavior Analysis,12,691–700.

Robin, A. L., & Foster, S. (1989).Negotiating parent–adolescent conflict.New York: Guilford.

Rogge, R. D., & Bradbury, T. N. (1999). Till violence does us part:The differing rolse of communication and aggression in predictingadverse marital outcomes.Journal of Consulting and Clinical Psy-chology, 67,340–351.

Shek, D. T. L. (1998). A longitudinal study of the relations betweenparent–adolescent conflict and adolescent well-being.The Journalof Genetic Psychology, 159,53–67.

Stormshak, E. A., Bierman, K. L., McMahon, R. J., & Lengua, L. J.(2000). Parenting practices and child disruptive behavior problems

P1: FYJ/GOQ P2: GCR



in early elementary school.Journal of Clinical Child Psychology,29,17–29.

Strauss, M. (1990). New scoring methods for violence and new normsfor the Conflict Tactics Scale. In M. A. Strauss & R. Gellis (Eds.),Physical violence in American families: Risk factors and adapta-tions to violence in 8,145 families(pp. 535–559). New Brunswick,NJ: Transaction.

Strauss, M., & Gelles, R. J. (1986). Societal change and changein family violence from 1975 to 1985 as revealed by two na-tional surveys.Journal of Marriage and the Family, 48, 465–479.

Tallmadge, J., & Barkley, R. A. (1983). The interactions of hyperactiveand normal boys with their mothers and fathers.Journal of Abnor-mal Child Psychology, 11,565–579.

Thapar, A., Holmes, J., Poulton, K., & Harrington, R. (1999). Geneticbasis of attention deficit and hyperactivity disorder.British Journalof Psychiatry, 174,105–111.

Weiss, G., & Hechtman, L. T. (1993).Hyperactive children grown up(2nd ed.). New York: Guilford.

Whalen, C. K., Henker, B., & Dotemoto, S. (1980). Methylphenidate andhyperactivity: Effects on teacher behaviors.Science, 208, 1280–1282.

parenting 2001 prent-adolescent conflict in teenagers with adhd and odd

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