parenting stress of parents of adolescents with …...parents of children with adhd who experience...
TRANSCRIPT
Parenting Stress of Parents of Adolescents with Attention-Deficit/Hyperactivity Disorder
by
Daniella Biondic
A thesis submitted in conformity with the requirements for the degree of Master of Arts
Graduate Department of Human Development and Applied Psychology Ontario Institute of Studies in Education
University of Toronto
© Copyright by Daniella Biondic (2011)
ii
Parenting Stress of Parents of Adolescents with
Attention-Deficit/Hyperactivity Disorder
Daniella Biondic
Masters of Art
Graduate Department of Human Development and Applied Psychology
University of Toronto
2011
This study examined parenting stress among parents of adolescents with ADHD. The sample
comprised 45 adolescents (26 ADHD; 19 Comparison) age 13 to 18 and their parents.
The Stress Index for Parents of Adolescents was completed by both mothers and fathers of
participating youth. Parents of adolescents with ADHD reported more stress than parents of
adolescents without ADHD. Mothers of adolescents with ADHD experience higher levels of
stress in all areas. Fathers of adolescents with ADHD experience more total stress and more
stress in the Adolescent and Adolescent-Parent Relationship domains. Maternal inattention and
adolescent externalizing behaviour mediated the relationship between ADHD status and maternal
parenting stress, and ADHD status and adolescent externalizing behaviour were found to predict
paternal parenting stress. The results of this study provide strong support for the need to provide
parents of adolescents with ADHD with interventions designed to reduce or help them cope with
parenting stress.
iii
Acknowledgments
To my loving and devoted parents: none of this would have been possible without your
unwavering support and sacrifice. You have always been and will always be my greatest
inspiration. Thank you for supporting me along this journey. To my sister: thank you for never
letting me lose sight of the goals and passions I hold dear. Thank you for all your encouragement
and advice. To my supervisor, Dr. Judy Wiener: thank you for your guidance and support from
the inception of this study to the final draft. I am so grateful for your enthusiasm and unwavering
commitment to each and every one of my endeavours over the last 7 years. Thank you for
guiding me every step of the way. To Dr. Jennifer Jenkins: thank you for your assistance and
support in the writing of this thesis. To the members of the ADHD lab: thank you for your
tireless effort and commitment to this research. I would especially like to thank Clarisa Markel,
Victoria Timmermanis, Angela Varma, Heather Prime, Ashley Brunsek, Jill Murray, Alan
Rokeach, Samantha Yammine, and Justin Mak for making this all possible. Finally, thank you to
all the participants in this study for your trust, honesty and openness. I offer you all my most
heartfelt thanks.
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Table of Contents
Acknowledgments......................................................................................................................... iii
Table of Contents .......................................................................................................................... iv
List of Tables ................................................................................................................................ vi
List of Figures............................................................................................................................... vii
List of Appendices ...................................................................................................................... viii
1. Introduction................................................................................................................................1 1.1 Theoretical Framework……………………...................................................................3 1.2 Literature Review………………………………………................................................6 1.3 Objectives of the Present Study…...……………………...............................................11 2. Manuscript ……………….……………...................................................................................13 2.1 Literature Review………………...................................................................................13 2.2 Objectives of the Present Study ………..………………...............................................18 Method ……………….........................................................................................................20 2.3 Participants.....................................................................................................................20 2.4 Measures.........................................................................................................................22 2.5 Procedure........................................................................................................................24 Results..................................................................................................................................24 2.6 Data Analyses.................................................................................................................24 2.7 Levels of Parenting Stress.…………………….............................................................26 2.8 Predictors of Parenting Stress…....................................................................................27 Discussion............................................................................................................................32 2.9 Levels of Parenting Stress…….……………….............................................................33
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2.10 Predictors of Parenting Stress......................................................................................35 2.11 Strengths and Limitations ………………………………...........................................37 2.12 Conclusions and Clinical Implications........................................................................38 References.....................................................................................................................................39 Tables............................................................................................................................................48 Figures...........................................................................................................................................55 Appendices....................................................................................................................................56
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List of Tables
Table 1. Adolescent and Parent Demographics. Table 2. Maternal Parenting Stress Levels. Table 3. Paternal Parenting Stress Levels. Table 4. Pearson-Product-Moment Correlations for Variables on the C3P and CAARS Correlated with Total Stress and Domains of Maternal Parenting Stress. Table 5. Pearson-Product-Moment Correlations for Variables on the C3P and CAARS Correlated with Total stress and Domains of Paternal Parenting Stress. Table 6. Hierarchical Multiple Regression Analyses Predicting Maternal Stress. Table 7. Hierarchical Multiple Regression Analyses Predicting Paternal Stress
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List of Figures
Figure 1. Mediation Models of Parenting Stress.
viii
List of Appendices
Appendix A. Adolescent and Parent Assent and Consent Forms and Letters. Appendix B. Descriptive Statistics of Maternal Stress by Adolescent Gender. Appendix C. ANOVA Summary for Maternal Stress by ADHD Status and Gender. Appendix D. Descriptive statistics of Paternal Stress by Adolescent Gender. Appendix E. ANOVA Summary for Paternal Stress by ADHD Status and Gender. Appendix F. Pearson-Product-Moment Correlations for Child Variables Correlated with Subscales and Domains of Maternal Parenting Stress.
Appendix G. Pearson-Product-Moment Correlations for Child Variables Correlated with Subscales and Domains of Paternal Parenting Stress.
Appendix H. Pearson-Product-Moment Correlations for Conners-3 Parent Ratings Correlated with Subscales and Domains of Maternal Parenting Stress. Appendix I. Pearson-Product-Moment Correlations for Conners-3 Parent Ratings Correlated with Subscales and Domains of Paternal Parenting Stress. Appendix J. Pearson-Product-Moment Correlations for Conners-3 Teacher Ratings Correlated with Subscales and Domains of Maternal Parenting Stress. Appendix K. Pearson-Product-Moment Correlations for Conners-3 Teacher Ratings Correlated with Subscales and Domains of Paternal Parenting Stress.
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Appendix L. Hierarchical Multiple Regression Predicting Maternal Stress using C3T Ratings of Adolescent Externalizing Behaviour Appendix M. Hierarchical Multiple Regression Predicting Paternal Stress Using C3T Ratings of Adolescent Externalizing Behaviour
1. Introduction
Parenthood, viewed by many parents as being their most important role, ranking ahead of
their careers and marriage (Thoits, 1992), demands a tremendous amount of time, energy, and
economic and emotional resources (Furstenberg, 1999). Most parents therefore experience
parenting stress (Crnic & Greenberg, 1990), which is defined as an aversive experience where
the demands of parenting are perceived to exceed the physical, economic, and emotional
resources available to manage or meet these demands (Deater-Deckard, 2004). Having some
parenting stress is normal and not maladaptive, but when parents experience high levels of
parenting stress, they are often less effective in their role as parents (e.g., Kazdin, 1995; Mash &
Johnston, 1990). The daily sacrifices and efforts that parents exert are exacerbated when children
exhibit problem behaviours (Stice, Ragan, & Randall, 2004). Consequently, parents of children
with Attention-Deficit/Hyperactivity Disorder (ADHD) report significantly more parenting stress
than parents of children without ADHD (see Johnston & Mash, 2001; Theule, Wiener, Jenkins,
& Tannock, in press for reviews).
Distressed mothers of children with ADHD report having lower tolerance for their
children’s misconduct (Johnston, Reynolds, Freeman & Geller, 1998), and often use over
reactive, coercive, inconsistent, and punitive disciplinary methods (Mash & Johnston, 1990;
Stormshak, Bierman, McMahon, Lengua, 2000). These maladaptive approaches to parenting
have been found to increase child misbehaviour (McKee, Harvey, Danforth, Ulaszek, &
Freidman, 2004) as children respond by being less compliant and more negative (Barkley,
Karlsson, & Pollard, 1985; DuPaul, McGoey, Eckert, & VanBrakle, 2001). These child
responses may increase parenting stress and perpetuate the use of over-reactive and punitive
discipline strategies.
1
2
According to Theule et al.’s (in press) recent meta-analysis, parents of children with
ADHD, ages 8 to 12, experience more parenting stress (d =1.80) than parents of children without
ADHD. Their parenting stress is associated with their children’s ADHD symptoms (both
inattention and hyperactivity-impulsivity), conduct problems, internalizing problems, their own
depressive symptoms and is negatively associated with the quality of their marriage.
Furthermore, Theule, Wiener, Rogers, and Marton (in press) found that self-reported parental
ADHD symptoms and low social support are predictors of their parenting stress.
Although there is considerable research on parenting stress among parents of children
with ADHD, it is unclear whether these findings can be extrapolated to parents of adolescents
with ADHD. To my knowledge, there are no previous published studies investigating whether
parents of adolescents with ADHD experience more stress than parents of typically developing
adolescents, whether mothers and fathers of adolescents with ADHD report comparable levels of
parenting stress, or the factors that might predict their parenting stress. Adolescents with ADHD,
however, are more likely than other adolescents to exhibit behaviours that tend to elicit parenting
stress including oppositional behaviours, conduct problems, low academic achievement,
substance abuse, and risk taking behaviours (Barkley, Fischer, Smallish, & Fletcher, 2004).
Consequently, the overall aim of this study was to investigate whether parents of
adolescents with ADHD experience elevated parenting stress and to begin to uncover the factors
predicting this stress. This empirical question is an important area of investigation because
parents of children with ADHD who experience high levels of parenting stress have poorer
psychological well-being (Crnic & Greenberg, 1990) and are less able to implement parenting
interventions (e.g., Kazdin, 1995). Furthermore, parent management training interventions are
more effective when the intervention initially focuses on reducing parenting stress (Kazdin &
Whitley, 2003).
3
This thesis comprises two chapters. This introductory chapter provides a theoretical
framework and reviews the literature on parenting stress experienced by parents of children with
ADHD. Chapter 2 describes a study that involves a comparison of levels of parenting stress
experienced by parents of adolescents with ADHD and explores whether adolescent
externalizing behaviour and parent ADHD symptoms are predictors of parenting stress in parents
of these adolescents. As chapter 2 is written in manuscript form, there is some redundancy; the
literature review section is repeated and elaborated on in chapter 1 of the thesis.
1.1. Theoretical Framework
Several models have been proposed to understand the determinants of parenting stress
and to understand the links between parenting stress, parenting behaviours and child outcomes
(e.g., Abidin, 1976, Mash & Johnston, 1990; McCleary, 2002; Webster-Stratton, 1990). Abidin’s
(1976; as cited by Abidin, 1995) model conceptualized parenting stress from an ecological
perspective. He proposed that negative child characteristics and dysfunctional parent-child
interactions were the major factors that contributed to the development of parenting stress, which
exacerbated the dysfunctional parent-child interactions and contributed to later behavioural
difficulties in children. This model outlined a pathway for conceptualizing how parenting stress
is linked with child outcomes; however, it did not include any additional contributing factors. As
an extension of this work, Abidin and Burke’s (cited in Abidin, 1990) model of parenting stress
posits that levels of parenting stress are determined by parent factors (i.e., health, sense of
competence, personality, and psychopathology), child factors (i.e., ability to adapt to and accept
environmental changes, degree of demandingness, mood, and hyperactivity), and social-
environmental factors (i.e., parent role restrictions, quality of spousal relationship, and social
support).
4
While Abidin and Burke’s (Abidin, 1990) ecological model of parenting stress includes a
number of contributing factors, it does not specify the mechanisms by which these factors lead to
parenting stress. Mash and Johnston (1990) proposed a four-component model to explain parent-
child interactive stress, which is the manifestation of many converging sources of stress
(Greenwald, 1989). High levels of negative and control-oriented exchanges between a parent and
a child characterize parent-child interactive stress. In this model, parent-child interactive stress is
determined by the characteristics of the child (e.g. temperament and behavioural problems), the
parent (e.g., cognitions, health status, affective states, behavioural repertories and personality
traits), and the environment (e.g. daily hassles and major life events). Each of these three
determinants has a direct effect on interactive stress. Mash and Johnston (1990), however, posit
that parent characteristics, specifically maternal cognitions such as perceptions of child
behaviour (Webster-Stratton, 1988) and expectations and standards for appropriate child
behaviour (Brunk & Henggeler, 1984; Miller, 1988) mediate the influences of child and
environmental characteristics. Certain parental cognitions may increase the level of interactive
stress and others may alleviate or reduce the impact of child and environmental stressors. This
model thus suggests that parents play a central role in controlling the degree to which they
experience stress.
Parental cognitions interface with various stressors to increase or alleviate the amount of
stress a parent experiences. Webster-Stratton (1990), however, argues that the impact of stressors
on parents is mediated by a parent’s ability to cope with the stressor. According to the Webster-
Stratton model, parents’ psychological well-being, their personal resources, and their appraisal of
the stressor all play a role in how well they are able to cope with the stress they experience and
this, in turn, impacts their parenting abilities. In this model, extrafamilial stressors (e.g.,
unemployment), interpersonal stressors (e.g., divorce) and child stressors (e.g., behaviour
5
problems) affect parenting. Parenting stress is created when there is a mismatch between the
demands or stresses of parenting and the parent’s resources (e.g., psychological well-being,
social support, cognitive appraisal of a stressor) to meet those demands.
Individually, these models address important ecological and cognitive factors that
contribute to parenting stress; however, none of these models provide a clear pathway illustrating
how ecological stressors and cognitive factors result in parenting stress. McCleary (2002)
proposed a theory to illustrate how parenting stress develops in parents of adolescents with
ADHD. Adopting Lazarus and Folkman’s (1984) theory of stress, appraisal and coping,
McCleary states that parenting stress results when parents judge their children’s problem
behaviour as exceeding the resources they have available to cope. This model is flexible in that
the situations or behaviours that are appraised as stressful differ between parents as they may
have different resources, coping strategies, cognitions, behavioural attributions, personal
characteristics, beliefs, values and access to social support. The duration and timing of the
stressor is also taken into account as some behaviours or events may be perceived as more or less
stressful depending on what other events are occurring. The manner in which a stressor is
appraised thus determines how a parent will react.
In sum, parenting stress may be caused by a number of factors at the child level (e.g.,
behavioural problems, personality), the parent level (e.g., health status, psychopathology, sense
of competence), or the social-environmental level (e.g., marital status, relationship with spouse,
social support). These factors interact such that parents feel stress in many domains, that is, stress
in relation to their child, their role as parents, and the quality of their interactions with their
children (i.e., parent-child interactive stress or stress associated with the parent-child
relationship). Although some of these factors may be difficult to control or avoid entirely, a
6
parents’ ability to cope with these stressors (i.e., appraisal of the stressor, financial resources,
access to social support) may mediate the degree to which they experience stress.
The first step in beginning to understand the stress that parents of adolescents with ADHD
experience is to measure the amount of stress they have and to identify the domains in which
they experience parenting stress. This study is mainly informed by Abidin’s (1986; 1990) model
of parenting stress as it is the most widely applied theory in the parenting stress literature. It
forms the basis of the Parenting Stress Index (Abidin, 1986) and the Stress Index for Parents of
Adolescents (Sheras, Abidin, & Konold, 1998), the most widely used measures of parenting
stress. Through the application of Abidin’s model of adolescent factors (externalizing behaviour)
and parent factors (parental ADHD symptoms) will be examined as potential predictors of
parenting stress.
1.2 Literature Review
The severity of inattentive and hyperactive/impulsive symptoms and conduct problems
among children with ADHD is strongly associated with increased parenting stress (Theule,
Wiener, Jenkins, & Tannock, in press). Nevertheless, parent management training that reduces
problem behaviours does not typically lead to reduced parenting stress (Pisterman et al., 1992). It
is therefore likely that there are other factors that contribute to the amount and pervasiveness of
the stress which parents experience. These factors are reviewed below.
Adolescent Factors
Child oppositionality and conduct problems have been linked with increased parenting
stress (Theule, Wiener, Jenkins, & Tannock, in press) among parents of children with ADHD.
The experience of parenting an adolescent, however, has been reported to be even more
challenging than parenting a young child (Pasley & Gecas, 1984). Adolescents typically strive to
7
assert their independence from their parents (Lo Coco, Ingoglia, Zappulla, & Pace, 2001) and
while this pursuit of autonomy is a normal part of adolescent development (Pasley & Gecas,
1984; Small, Eastman, & Corneius, 1988), the behaviours that adolescents with ADHD exhibit
often cross the boundary between pursuing autonomy and being oppositional (Barkley, Fischer,
Smallish, & Fletcher, 2004).
Adolescents with ADHD are more likely to exhibit oppositional behaviours, conduct
problems, low academic achievement, substance abuse, and risk taking behaviours than other
adolescents (Barkley, Fischer, Smallish, & Fletcher, 2004). In a 10-year follow-up study, Wilens
and colleagues (2010) found that adolescents with ADHD were 1.47 times more likely to
develop a substance use disorder compared to typically developing youth. Even when controlling
for conduct disorder and family history of substance abuse, ADHD continued to be associated
with an earlier onset and higher risk of substance use disorders across both males and females
with ADHD. Furthermore, using an experience sampling methodology, Whalen and colleagues
(2002) found that adolescents with ADHD reported more negative affectivity (i.e., elevated
levels of anger, anxiety, stress, sadness), spent more time participating in entertaining and non-
productive activities and less time performing challenging and beneficial tasks such as
completing homework or learning a new skill, and spent more time with friends. Although peer
interactions can offer opportunities to, for instance, develop skills in conflict resolution (Larson
& Verma, 1999), children and adolescents with ADHD are more likely to be affiliated with a
deviant peer group because their difficulties with behaviour and emotion regulation (Whalen &
Henker, 1992) cause them to be rejected by more prosocial peers (Hinshaw & Melnick, 1995).
Overall, children with ADHD are more likely to have friends their parents disapprove of
(Bagwell, Molina, Pelham, & Hoza, 2001) and it is this deviant peer group affiliation that is a
risk factor for substance use and abuse among children and adolescents with ADHD (Marshal,
8
Molina, & Pelham, 2003). Association with deviant peers also promotes rule breaking and
delinquent behaviour (Duncan, Duncan, & Strycker, 2000; Patterson, Dishion & Yoerger, 2000).
Although the link between externalizing behaviour (i.e., oppositionality, conduct
problems) and parenting stress among parents of adolescents with ADHD has yet to be
examined, Anderson (2008) found that social skills (i.e., cooperation, responsibility, self-control)
and problem behaviours (i.e., fighting, arguing, moodiness) explained most of the variability in
parenting stress in a high risk sample of youth between the ages of 10 and 18. Consequently, this
link warrants investigation among parents of adolescents with ADHD.
Parent Factors
Fischer (1990) and Anastopoulos and colleagues (1992) suggest that parental
psychopathology, which they found occurs more frequently in parents of children with ADHD
compared with comparison families, exacerbates parenting stress. Maternal psychopathology has
been shown to be related to higher levels of parenting stress, most likely because mental illness
and psychological difficulties may prevent a parent from accessing coping skills that are
necessary for decreasing stress levels (Webster-Stratton, 1990). Maternal depression in particular
has been linked with higher levels of parenting stress (Webster-Stratton & Hammond, 1988) and
this relationship has been widely reported among mothers of children with ADHD
(Anastopoulos, Guevremont, Shelton, & DuPaul, 1992; Harrison & Sofronoff, 2002; van der
Oord, Prins, Oosterlaan & Emmelkamp, 2006). Furthermore, child behaviour problems and
lower perceived parental control of child ADHD symptoms have been linked to both increased
parenting stress and higher levels of depression. The association between parental ADHD
symptoms and stress must also be considered because approximately 30 to 50 percent of children
with ADHD continue to show symptoms in adulthood (Murphy & Barkley, 1996), and 40 to 60
percent of parents with ADHD also have a child with ADHD (Biederman et al., 1995; Minde et
9
al., 2003). Given the prevalence of ADHD symptomatology in adulthood and among families of
children with ADHD, the impact of parental ADHD symptoms on parenting stress among
parents of adolescents both with and without ADHD warrants investigation.
Parental ADHD symptoms are positively associated with inconsistent discipline and
nonsupportive responses to the negative emotions and behaviours of children (Mokrova,
O’Brien, Calkins, & Keane, 2010). These symptoms make it difficult to parent effectively
because parenting requires inhibition of immediate reactions (e.g., inhibiting the urge to yell and
overreact to a situation) and the use of positive communication and throughful problem-solving.
Effective parenting also requires the ability to monitor the behaviour and whereabouts of
children and adolescents while simultaneously focusing on many other personal and family
responsibilities (e.g., Dishion, Nelson & Kavanagh, 2003; Henderson, Rowe, Dakof, Hawes, &
Liddle, 2009; Kazdin & Nock, 2003). Parents who have ADHD, however, tend to be inconsistent
in enforcing rules and placing limits on their children; this may be due to difficulties with
monitoring and following through with consistent consequences (Murray & Johnston, 2006).
Furthermore, mothers with ADHD have been found to be relatively unaware of their children’s
activities (Weiss, Hechtman & Weiss, 2000). During the transition into adolescence, parents also
tend to spend less time with children because of reduced child care needs and increased child
autonomy (Phares, Fields, & Kamboukos, 2009). Thus, as parents and adolescents spend more
time apart, it may require more effort and diligence for parents to monitor their child’s
behaviour.
Due to the parenting difficulties associated with parental symptoms of ADHD, it is
possible that these parents may feel less competent and effective in their parenting role. Parents
of children with ADHD have reported having a lower sense of competence and low parenting
self-efficacy (Breen & Barkley, 1988; Mash & Johnston, 1983). In addition, parents of
10
adolescents with ADHD have expressed feelings of failure and inadequacy in their parenting role
(McCleary & Ridley, 1999). These feelings of low self-efficacy, low sense of competence, and
feelings of failure may lead parents who also have high levels of ADHD symptoms themselves to
experience more parenting stress. Similarly, parents may experience increased parenting stress
when their partner has symptoms of ADHD because the partner may not be able to co-parent
effectively and share parenting or household reponsibilities which may lead to an increase in
adolescent problem behaviours and parenting stress. However, it is also possible that parents
with ADHD symptoms may experience less parenting stress. The similarity-fit hypothesis
(O’Connor & Dvorak, 2001) suggests that parents who share similar characteristics with their
children may be more tolerant of their children’s behaviour because they are more able to
empathize with them, having experienced and still continuing to experience similar challenges.
The division of childcare responsibilities may also interact with parental ADHD
symptomatology. Since mothers tend to take on more parenting responsibilities (Phares, Fields &
Kamboukos, 2009) and spend more time interacting with their children (Scarr, Philips &
McCartney, 1990) even within dual-income families (Blanchi & Raley, 2005; Coltrane, 2000),
the quality of their parenting may be more likely to be impacted by their ADHD symptoms.
Fathers with ADHD, however, may be less overwhelmed with or burdened by childcare
demands; consequently their ADHD symptoms may not significantly impact their ability to
parent effectively. Furthermore, it is possible that fathers may be better able to empathize with
their children and be less distressed by their problem behaviours if they have fewer parenting
responsibilities. Thus, parental ADHD symtomatology may differentially impact maternal and
paternal stress levels.
11
Parent-Adolescent Relationship
Parents of adolescents with ADHD rate their relationships with their adolescent as being
more conflictual than do parents of comparison adolescents (Robin, 1990). Parent-adolescent
relationships differ from parent-child relationships in that their interactions are less frequent, and
typically involve fewer expressions of affection and increased conflict as adolescents try to assert
power (Collins, Madsen, & Susman-Stillman, 2002). It is likely that these changes in the
interactions are associated with the transition into adolescence (Putnick, Bornstein, Hendricks,
Painter, Suwalsky, & Collins, 2010). The relationship between parent-adolescent interactions and
parenting stress is likely bi-directional. Parents experiencing high levels of parenting stress tend
to be irritable and consequently are more bothered by deviant or problematic behaviour
(Patterson & Fogatch, 1990). These parents also tend to use maladaptive parenting strategies
such as over reactive discipline and coercion when dealing with problem behaviour. As
discussed above, these discipline practices lead to increased child misbehaviour (McKee,
Harvey, Danforth, Ulaszek, & Freidman, 2004) as they may inadvertently reinforce problem
behaviour, leading to an escalation of negative parent-child interactions and retaliatory
aggressive and oppositional child behaviour (Patterson & Fogatch, 1990; Patterson, Reid, &
Dishion, 1992). These interactions may then result in an increase in parenting stress (Abidin,
1986; Mash & Johnston, 1990).
1.3 Objectives of the Present Study
This research is guided by two objectives: Objective 1 is to determine whether parents of
adolescents with ADHD experience more stress than parents of typically developing adolescents.
I will examine whether parents of adolescents with and without ADHD differ in their total
parenting stress and specific domains of parenting stress including stress pertaining to adolescent
12
characteristics, impact of parenting on other life roles, and quality of the adolescent-parent
relationship. Similar to findings with children with ADHD (Theule, Wiener, Jenkins, & Tannock,
in press), it is expected that parents of adolescents with ADHD will also report experiencing
more parenting stress than parents of comparison adolescents.
Objective 2 is to identify whether specific factors that are associated with parenting stress
of parents of children with ADHD are associated with higher levels of parenting stress in parents
of adolescents. Abidin’s (1976; 1990) model of parenting stress will be the framework to identify
these predictors. Abidin suggests that child characteristics, parent characteristics, and situational
factors are predictive of parenting stress. In this current study, I will examine whether the
severity of adolescent inattentive and hyperactive symptoms, oppositional behaviour and conduct
problems and parental ADHD symptoms predict parenting stress in parents of these adolescents.
It is expected that adolescent ADHD symptom severity will continue be associated with
increased parenting stress (Theule, 2011). Given that the manifestation of ADHD in adolescents
differs somewhat from younger children (i.e., reduction in hyperactivity) and because
adolescents with ADHD are more likely than other adolescents to exhibit behaviours that are
likely to elicit parenting stress (i.e., oppositional behaviours, conduct problems, and risk-taking
behaviours; Barkley, Fischer, Smallish, & Fletcher, 2004), it is possible that oppositional and
aggressive behaviours will be strong predictors of parenting stress among parents of adolescents.
Finally, given that parental ADHD symptoms are positively associated with ineffective parenting
(i.e., inconsistent discipline, non-supportive responses to behaviours of children; Mokrova,
O’Brien, Calkins, & Keane, 2010) and parents of children with ADHD report low parenting self-
efficacy and low sense of competence (Breen & Barkley, 1988; Mash & Johnston, 1983), it is
hypothesized that parents of adolescents with ADHD who have high levels of ADHD symptoms
themselves will experience more parenting stress.
13
2. Manuscript 2.1 Literature Review
Parenthood, viewed by many parents as being their most important role, ranking ahead of
their careers and marriage (Thoits, 1992), demands a tremendous amount of time, energy, and
economic and emotional resources (Furstenberg, 1999). Most parents therefore experience
parenting stress (Crnic & Greenberg, 1990), which is defined as an aversive experience where
the demands of parenting are perceived to exceeded the physical, economic, and emotional
resources available to manage or meet these demands (Deater-Deckard, 2004). Having some
parenting stress is normal and not maladaptive, but when parents experience high levels of
parenting stress, they are often less effective in their role as parents (e.g., Kazdin, 1995; Mash &
Johnston, 1990). The daily sacrifices and efforts that parents exert are exacerbated when children
exhibit problem behaviours (Stice, Ragan, & Randall, 2004). Consequently, parents of children
with Attention-Deficit/Hyperactivity Disorder (ADHD) report significantly more parenting stress
than parents of children without ADHD (see Johnston & Mash, 2001; Theule, Wiener, Jenkins,
& Tannock, in press for reviews).
Distressed mothers of children with ADHD report having lower tolerance for their
children’s misconduct (Johnston, Reynolds, Freeman & Geller, 1998), and often use over-
reactive, coercive, inconsistent, and punitive disciplinary methods (Mash & Johnston, 1990;
Stormshak, Bierman, McMahon, Lengua, 2000). These maladaptive approaches to parenting
have been found to increase child misbehaviour (McKee, Harvey, Danforth, Ulaszek, &
Freidman, 2004) as children respond by being less compliant and more negative (Barkley,
Karlsson, & Pollard, 1985; DuPaul, McGoey, Eckert, & VanBrakle, 2001). These child
14
responses may increase parenting stress and perpetuate the use of over-reactive and punitive
discipline strategies.
According to Theule et al’s (in press) recent meta-analysis, parents of children with
ADHD, ages 8 to 12, experience more parenting stress (d =1.80) than parents of children without
ADHD. Their parenting stress is associated with their children’s ADHD symptoms (both
inattention and hyperactivity-impulsivity), conduct problems, and internalizing problems. Their
parenting stress is associated with their own depressive symptoms and is negatively associated
with the quality of their marriage. Theule, Wiener, Rogers, and Marton (in press) also found that
self-reported parental ADHD symptoms and low social support are predictors of their parenting
stress.
Although there is considerable research on parenting stress among parents of children
with ADHD, it is unclear whether these findings can be extrapolated to parents of adolescents
with ADHD. To my knowledge, there are no previous published studies investigating whether
parents of adolescents with ADHD experience more stress than parents of typically developing
adolescents, whether mothers and fathers of adolescents with ADHD report comparable levels of
parenting stress, or the factors that might predict their parenting stress. Adolescents with ADHD,
however, are more likely than other adolescents to exhibit behaviours that tend to elicit parenting
stress including oppositional behaviours, conduct problems, low academic achievement,
substance abuse, and risk taking behaviours (Barkley, Fischer, Smallish, & Fletcher, 2004).
Consequently, the overall aim of this study is to investigate whether parents of
adolescents with ADHD experience elevated parenting stress and to begin to uncover the factors
predicting this stress. This empirical question is an important area of investigation because
parents of children with ADHD who experience high levels of parenting stress have poorer
psychological well being (Crnic & Greenberg, 1990), and are less able to implement parenting
15
interventions (e.g., Kazdin, 1995). Furthermore, parent management training interventions are
more effective when the intervention initially focuses on reducing parenting stress (Kazdin &
Whitley, 2003). In accordance with Abidin’s (1976; 1990) model of parenting stress, both child
factors (e.g., behavioural problems) and parent factors (e.g., psychopathology) predict parenting
stress. Abidin also claims that parenting stress consists of stress in the child, parent, and child-
parent relationship domains. In this study, adolescent externalizing behaviours and parental
ADHD symptoms are investigated as predictors of parenting stress over and above adolescent
ADHD status.
Adolescent Externalizing Behaviour
Child oppositionality and conduct problems have been linked with increased parenting
stress (Theule, Wiener, Jenkins, & Tannock, in press) among parents of children with ADHD.
The experience of parenting an adolescent, however, has been reported to be even more
challenging than parenting a young child (Pasley & Gecas, 1984). Adolescents typically strive to
assert their independence from their parents (Lo Coco, Ingoglia, Zappulla, & Pace, 2001) and
while this pursuit of autonomy is a normal part of adolescent development (Pasley & Gecas,
1984; Small, Eastman, & Corneius, 1988), the behaviours that adolescents with ADHD exhibit
often cross the boundary between pursuing autonomy and being oppositional (Barkley, Fischer,
Smallish, & Fletcher, 2004).
Adolescents with ADHD are more likely to exhibit oppositional behaviours, conduct
problems, low academic achievement, substance abuse, and risk taking behaviours than other
adolescents (Barkley, Fischer, Smallish, & Fletcher, 2004; Wilens et al., 2010). Adolescents with
ADHD report more negative affect (i.e., elevated levels of anger, anxiety, stress, sadness), spend
more time participating in entertaining and non-productive activities with friends and less time
performing challenging and beneficial tasks such as completing homework or learning a new
16
skill (Whalen et al., 2010). Although peer interactions can offer opportunities to, for instance,
develop skills in conflict resolution (Larson & Verma, 1999), children and adolescents with
ADHD are more likely to be affiliated with a deviant peer group because their difficulties with
behaviour and emotion regulation (Whalen & Henker, 1992) cause them to be rejected by more
prosocial peers (Hinshaw & Melnick, 1995). Overall, children with ADHD are more likely to
have friends their parents disapprove of (Bagwell, Molina, Pelham, & Hoza, 2001) and it is this
deviant peer group affiliation that is a risk factor for substance use and abuse among children and
adolescents with ADHD (Marshal, Molina, & Pelham, 2003). Association with deviant peers
also promotes rule breaking and delinquent behaviour (Duncan, Duncan , & Strycker, 2000;
Patterson, Dishion & Yoerger, 2000).
Although the link between externalizing behaviour (i.e., oppositionality, conduct
problems) and parenting stress among parents of adolescents with ADHD has yet to be
examined, Anderson (2008) found that social skills (i.e., cooperation, responsibility, self-control)
and problem behaviours (i.e., fighting, arguing, moodiness) explained most of the variability in
parenting stress in a high risk sample of youth between the ages of 10 and 18. Consequently, this
link warrants investigation among parents of adolescents with ADHD.
Parental ADHD Symptoms
Approximately 30 to 50 percent of children with ADHD continue to show symptoms in
adulthood (Murphy & Barkley, 1996), and 40 to 60 percent of parents with ADHD also have a
child with ADHD (Biederman et al., 1995; Minde et al., 2003). Given the prevalence of ADHD
symptomatology in adulthood and among families of children with ADHD, the impact of
parental ADHD symptoms on parenting stress among parents of adolescents with and without
ADHD warrants investigation.
17
Parental ADHD symptoms are positively associated with inconsistent discipline and
nonsupportive responses to the negative emotions and behaviours of children (Mokrova,
O’Brien, Calkins, & Keane, 2010). These symptoms make it difficult to parent effectively
because parenting requires inhibition of immediate reactions (e.g., inhibiting the urge to yell and
overreact to a situation) and the use of positive communication and thoughtful problem-solving.
Effective parenting requires the ability to monitor the behaviour and whereabouts of children and
adolescents while simultaneously focusing on many other personal and familial responsibilities
(e.g., Dishion, Nelson & Kavanagh, 2003; Henderson, Rowe, Dakof, Hawes, & Liddle, 2009;
Kazdin & Nock, 2003). Parents who have ADHD, however, tend to be inconsistent in enforcing
rules and placing limits on their children; this may be due to difficulties with monitoring and
following through with consistent consequences (Murray & Johnston, 2006). Furthermore,
mothers with ADHD have been found to be relatively unaware of their children’s activities
(Weiss, Hechtman & Weiss, 2000). During the transition into adolescence, parents also tend to
spend less time with children because of reduced child care needs and increased child autonomy
(Phares, Fields, & Kamboukos, 2009). Thus, as parents and adolescents spend more time apart, it
may require more effort and diligence for parents to monitor their child’s behaviour.
Due to the parenting difficulties associated with parental symptoms of ADHD, it is
possible that these parents may feel less competent and effective in their parenting role. Parents
of children with ADHD have reported having a lower sense of competence and low parenting
self-efficacy (Breen & Barkley, 1988; Mash & Johnston, 1983). In addition, parents of
adolescents with ADHD have expressed feelings of failure and inadequacy in their parenting role
(McCleary & Ridley, 1999). These feelings of low parenting self-efficacy, low sense of
competence, and feelings of failure may lead them to experience more parenting stress.
Similarly, parents may experience increased parenting stress when their partner has symptoms of
18
ADHD because the partner may not be able to co-parent effectively and share parenting or
household responsibilities which may lead to an increase in adolescent problem behaviours and
parenting stress. However, it is also possible that parents with ADHD symptoms may experience
less parenting stress. The similarity-fit hypothesis (O’Connor & Dvorak, 2001) suggests that
parents who share similar characteristics with their children may be more tolerant of their
behaviour because they are more able to empathize with them, having experienced and still
continuing to experience similar challenges.
The division of childcare responsibilities may also interact with parental ADHD
symptomatology. Since mothers tend to take on more parenting responsibilities (Phares, Fields &
Kamboukos, 2009) and spend more time interacting with their children (Scarr, Philips &
McCartney, 1990) even within dual-income families (Blanchi & Raley, 2005; Coltrane, 2000),
the quality of their parenting may be more likely to be impacted by their ADHD symptoms.
Fathers with ADHD, however, may be less overwhelmed with or burdened by childcare
demands; consequently their ADHD symptoms may not significantly impact their level of
parenting stress. They may also be better able to empathize with their children and be less
distressed by their problem behaviours if they have fewer parenting responsibilities. Thus,
parental ADHD symtomatology may differentially impact maternal and paternal stress levels.
2.2 Objectives of the Present Study
This research is guided by two objectives: Objective 1 is to determine whether parents of
adolescents with ADHD experience more stress than parents of typically developing adolescents.
I will examine whether parents of adolescents with and without ADHD differ in their total
parenting stress and specific domains of parenting stress including stress pertaining to adolescent
characteristics, impact of parenting on other life roles, and quality of the adolescent-parent
19
relationship. Similar to findings with children with ADHD (Theule, Wiener, Jenkins, & Tannock,
in press), it is expected that parents of adolescents with ADHD will also report experiencing
more parenting stress than parents of comparison adolescents.
Objective 2 is to identify whether specific factors that are associated with parenting stress
of parents of children with ADHD are associated with higher levels of parenting stress in parents
of adolescents. Abidin’s (1976; 1990) model of parenting stress will be the framework to identify
these predictors. Abidin suggests that child characteristics, parent characteristics, and situational
factors are predictive of parenting stress. In this current study, I will examine whether the
severity of adolescent inattentive and hyperactive symptoms, oppositional behaviour and conduct
problems and parental ADHD symptoms predict parenting stress in parents of these adolescents.
It is expected that adolescent ADHD symptom severity will continue be associated with
increased parenting stress (Theule, 2011). Given that the manifestation of ADHD in adolescents
differs somewhat from younger children (i.e., reduction in hyperactivity) and because
adolescents with ADHD are more likely than other adolescents to exhibit behaviours that are
likely to elicit parenting stress (i.e., oppositional behaviours, conduct problems, and risk-taking
behaviours; Barkley, Fischer, Smallish, & Fletcher, 2004), it is possible that oppositional and
aggressive behaviours will be strong predictors of parenting stress among parents of adolescents.
Finally, given that parental ADHD symptoms are positively associated with ineffective parenting
(i.e., inconsistent discipline, nonsupportive responses to behaviours of children; Mokrova,
O’Brien, Calkins, & Keane, 2010) and parents of children with ADHD report low parenting self-
efficacy and low sense of competence (Breen & Barkley, 1988; Mash & Johnston, 1983), it is
hypothesized that parents of adolescents with ADHD who have high levels of ADHD symptoms
themselves will experience more parenting stress.
20
Method
2.3 Participants The sample comprised 45 13 to 18-year old adolescents (26 with ADHD, 19 without
ADHD) and their parents. Participants with ADHD were recruited through flyers sent to
physicians and children’s mental health centres. Adolescents in the comparison sample were
recruited through advertisements placed in local newspapers, community centres and libraries.
Some participants from both samples who had agreed to be contacted for future studies in the
ADHD lab at the Ontario Institute for Studies in Education/University of Toronto also
participated. All adolescent participants had average intellectual ability (IQ ≥ 85). Participants
with ADHD received a diagnosis of ADHD at least one year prior to participating in the study.
The presence of ongoing ADHD symptoms was confirmed using a standardized diagnostic
questionnaire that is in accordance with DSM-IV criteria (Conners-3; Conners, 2008).
Participants were classified as having ADHD when at least one rater (i.e., parent or teacher)
reported that the adolescents’ inattentive or hyperactive-impulsive symptoms were within the
clinical range (T ≥ 70) and the second rater (i.e., parent or teacher) indicated that inattentive or
hyperactive-impulsive symptoms were within the borderline or clinical range (T ≥ 65).
Adolescents with certain comorbid diagnoses were not included in the study (i.e., Rett’s
Disorder, Autism Spectrum Disorders, Intellectual Disabilities, Psychotic Disorders, Genetic
Disorders, Bipolar Disorder, Tourette’s Disorder). However, due to high comorbity rates,
adolescents with ADHD who also had co-occurring learning disabilities, conduct disorder,
oppositional defiant disorder, anxiety, or depression were included.
Adolescents with and without ADHD did not differ in age (Table 1) or gender (ADHD:
16 boys, 10 girls; comparison: 9 boys, 11 girls; χ² (1, N = 46) = 1.25, p = .264). Parents reported
21
that 69.2% (n = 18) of adolescents with ADHD were taking medication to manage their ADHD
symptoms. Sixty-eight percent (n = 17) of adolescents with ADHD had one or more comorbid
diagnoses (i.e., learning disability (n = 15), anxiety (n = 4), depression (n = 1), oppositional
defiant disorder (n = 2)). Three adolescents without ADHD had a diagnosis of a learning
disability. As shown in Table 1, adolescents with ADHD had a lower IQ, as measured by the
Wechsler Abbreviated Scale of Intelligence (WASI; Wechsler, 1999), and higher scores on the
Conners-3 rating scales (Conners, 2008).
A total of 42 mothers and 34 fathers participated in the study. Of the 45 adolescent
participants, 68.9% (n = 31) had parenting stress and parental ADHD symptom ratings provided
from both parents, 24% (n = 11) had only mother ratings, and 6.7% (n = 3) had only father
ratings. One parent was recently widowed and others were single, separated, or divorced and
were unable to obtain consent for participation from their former partner or spouse. Father data
were missing for 6 adolescents with ADHD and 5 comparison adolescents. Mother data were
missing for 1 adolescent with ADHD and 2 comparison adolescents.
As shown in Table 1, parents of adolescents with and without ADHD did not differ in
age. Fathers of adolescents with and without ADHD did not differ in their highest education
level attained; however, comparison mothers had a higher level of education than mothers of
adolescents with ADHD. The majority of parents were married or in common-law relationships
(60% (n = 15) ADHD, 75% (n = 14) comparison) and a similar proportion of parents of
adolescents with and without ADHD were single, separated or divorced (40% (n = 10) ADHD,
21.1% (n = 4) comparison). These differences in marital status between groups were not
significant (χ2 (2, N = 44) = 1.44, p = .49). In this sample, 9.4% (n = 4) of families reported
speaking a language other than English at home (i.e., Chinese, Persian, or Spanish).
22
Both mothers (χ2 (1, N = 45) = 4.46, p = .035) and fathers (χ2 (1, N = 45) = 16.44, p =
.000) of adolescents with ADHD were more likely to be diagnosed with or suspect they have
ADHD (Mothers: 30.8%, n = 8; Fathers: 57.7%; n = 15) than parents of adolescents without
ADHD (Mothers: 5.3%, n = 1; Fathers 0%, n = 0). Parents of adolescents with ADHD reported
higher levels of ADHD symptoms than parents of adolescents without ADHD (Table 1).
2.4 Measures
The Stress Index for Parents of Adolescents (SIPA; Sheras, Abidin, & Konold, 1998)
assesses parenting stress across three domains: an Adolescent domain, a Parent domain, and an
Adolescent-Parent Relationship domain. The Adolescent domain measures parenting stress as a
function of the characteristics of the adolescent (e.g., mood, delinquency, motivation). The
Parent domain measures parenting stress as a function of the effect of parenting on parents’ other
life roles (e.g., their relationship with their friends and their spouse, their feelings of
competence). The Adolescent-Parent Relationship domain measures the perceived quality of the
relationship parents have with their children (e.g., degree of communication, amount of
affection). There are several subscales within the adolescent (i.e., moodiness/emotional lability,
social isolation/withdrawal, delinquency/antisocial, failure to achieve or persevere) and parent
domains (i.e., life restrictions, relationship with spouse/partner, social alienation,
incompetence/guilt). The SIPA is a reliable measure in terms of internal consistency (Cronbach
alpha for Toal Stress and the 3 domains > .90 and for the subscales range from .80 - .90) and
test-retest reliability (coefficients range from .74 - .93).
The Conners Adult ADHD Self-Report Rating Scale- Short Version (CAARS-S:SV;
Conners, Erhardt, Sparrow, 1998) was used to screen parents for the core symptoms of ADHD,
including symptoms of all three DSM-IV subtypes of ADHD. The CAARS-S:SV is a 30-item
23
measure that contains subscales that are most directly relevant to ADHD diagnosis: DSM-IV
inattentive symptoms, DSM-IV hyperactive-impulsive symptoms, DSM-IV Total ADHD
symptoms, and ADHD index. Each symptom of hyperactivity and inattention is rated on a 4-
point scale, ranging from 0 (Not at all true/Never) to 3 (Very Much/Very Frequently). All
subscales have been reported to have internal reliability of .80 or higher (Conners et al., 1999). In
terms of its validity, the CAARS-S: SV produces an overall correct classification rate of 85% for
adults with ADHD and strongly correlates with other measures of adult ADHD (Erhardt, Epstein,
Conners, Parker, & Sitarenios, 1999).
The long forms of the Conners-3 rating scales (Conners, 2008; Parent and Teacher
Report forms) were used to determine whether ADHD symptoms were current in the sampled
adolescents. Parents and teachers rated the youth on a 4-point scale ranging from 0 (Not at
all/Seldom, Never) to 3 (Very Much True/ Very Often, Very Frequent) to evaluate inattention,
hyperactivity, oppositional and aggressive behaviour, conduct problems and problems related to
peer relations. These ratings were used as indicators of the severity of the adolescents’ ADHD
symptoms across two settings (home and school). The two DSM-IV ADHD subscales that were
used to confirm the ADHD diagnosis and to measure the severity of ADHD symptomology
(DSM-IV Inattentive, DSM-IV Hyperactive- Impulsive) demonstrate high internal consistency
(Parent: .93, .92; Teacher: .94, .95) and adequate to high test-retest reliability (Parent: .84, .89;
Teacher: .85, .84).
The Vocabulary and Matrix Reasoning subscales of the Wechsler Abbreviated Scale of
Intelligence (WASI; Wechsler, 1999), a standardized abbreviated test of intelligence, was
administered to obtain an estimate of adolescents’ cognitive functioning. These tests have strong
internal consistency (.93) and test-retest reliability (ranging from .88 to .93). Parent
24
characteristics (i.e., age, education) and household characteristics (i.e., marital status) were
assessed by asking one parent to complete a demographic questionnaire at intake.
2.5 Procedure
This study was approved by the Research Ethics Board of the University of Toronto.
Trained graduate students in school and clinical child psychology tested the adolescent
participants for a period of approximately 5 hours (including administering measures for other
studies). Prior to the testing session, parental consent and adolescent consent/assent were
obtained (see Appendix A) and parents (primarily mothers) of adolescents completed the
Conners-3 parent scale (Conners, 2008). If adolescents met criteria for inclusion in the ADHD or
comparison group, parents were mailed a package containing the SIPA and CAARS-S:SV
questionnaires (one for each parent to complete) and the Conners-3 teacher rating scale. Parents
were asked to give the Conners-3 to a teacher whom they felt could best comment on their
child’s current level of ADHD symptoms. When rating adolescents who took medication to
manage their ADHD symptoms, parents and teachers were asked to think of the adolescents’
behaviours when they were not on medication.
Results
2.6 Data Analysis
Two-way analyses of variance with adolescent ADHD status and gender as independent
factors, were used to compare parents of adolescents with and without ADHD on Total stress and
stress in the Adolescent, Parent, and Adolescent-Parent Relationship domains. Multivariate
analyses of variance were used to compare parents of adolescents with and without ADHD on
the subscales within the Adolescent and Parent domains. T-tests were used to compare the levels
of stress of parents of medicated adolescents with ADHD with parents of unmedicated
25
adolescents with ADHD. All of the above analyses were done for mothers and fathers separately.
Two-way ANOVAs were used to compare mothers and fathers of adolescents with and without
ADHD in terms of their Total stress and stress in the three domains. Correlates of maternal and
paternal parenting stress domains were examined for the whole sample, the ADHD sample, and
the comparison sample (Tables 4 & 5). To reduce the number of variables included in the
regression analyses, a composite of the externalizing symptoms on the Conners-3 parent rating
scale was created by adding the T-scores for parent ratings of aggression, conduct problems and
oppositionality. The correlations between these variables ranged from .74 to .86.
Hierarchical multiple regression analyses were conducted to predict parenting stress by
entering ADHD status in step 1 and any correlated variables in step 2 (i.e., adolescent
externalizing behaviour and maternal inattention). Significant predictors of parenting stress were
explored through a mediation analysis using the procedures suggested by Baron and Kenny
(1986). In addition, the Sobel (1982) procedure was used to investigate the effect of the proposed
mediators on the relationship between ADHD status and parenting stress. Prior to conducting
these analyses the data was checked for outliers by examining descriptive statistics and creating
boxplots of the variables of interest. There were two outliers on the Adolescent-Parent
Relationship domain that were not adjusted because they did not significantly affect the variable
range.
Adolescents with ADHD had lower full-scale IQ scores than adolescents without ADHD
and IQ was negatively correlated with parenting stress in the Adolescent domain for mothers (r
= -.36, p = .021) and fathers (r = -.52, p = .002). Analysis of covariance comparing parents of
adolescents with and without ADHD in Adolescent domain parenting stress revealed that IQ was
not a significant covariate (Mothers: F (1, 38) = .306, p = .583, η2 = .008; Fathers: F (1, 30) =
26
.000, p = .983, η2 = .000) and the results were essentially the same as when analyses were
completed without covarying IQ. Therefore, IQ was not controlled for in any of the analyses
reported below.
2.7 Levels of Parenting Stress
The first objective of this study was to determine whether mothers and fathers of
adolescents with ADHD experience more stress than parents of adolescents without ADHD. As
shown in Table 2, mothers of adolescents with ADHD reported significantly more Total stress,
more stress in the Adolescent domain, the Parent domain, and the Adolescent-Parent
Relationship domain than comparison mothers. They also differed from comparison mothers on
the amount of stress they reported on the subscales which compose the Adolescent domain (F (4,
35) = 20.56, p = .000, ηp2 = .70) and the Parent domain (F (4, 31) = 2.94, p = .036, ηp
2 = .28).
Within the Adolescent domain, mothers of adolescents with ADHD reported more stress
associated with the youth’s moodiness/emotional lability, social isolation/withdrawal,
delinquency/antisocial behaviour, and achievement/failure to persevere. Within the Parent
domain, mothers of adolescents with ADHD reported more stress on all of the subscales. There
were no adolescent gender or ADHD status by gender interaction effects for any of the parenting
stress domains (see Appendix B & C). There were also no significant differences in Total
parenting stress (F (1, 21) = .038, p = .847, ηp2 = .00) or stress in the Adolescent domain (F (1,
24) = .019, p = .892, ηp2 = .00), Parent domain (F (1, 21) = .193, p = .665, ηp
2 = .01), and
Adolescent-Parent Relationship domain (F (1, 23) = 1.92, p = .179, ηp2 = .08), between parents
of medicated (n = 15) and unmedicated (n = 7) adolescents with ADHD.
As shown in Table 3, fathers of adolescents with ADHD reported significantly more
Total stress and more stress in the Adolescent and the Adolescent-Parent Relationship domains
27
than comparison fathers. No differences were found for the Parent domain. Fathers of
adolescents with ADHD differed from comparison fathers on the amount of stress they reported
on the subscales which compose the Adolescent domain (F (4, 27) = 7.78, p = .000, ηp2 = .54);
however, they did not differ on the amount of stress they reported on the subscales within the
Parent domain (F (4, 26) = 1.56, p = .214, ηp2 = .19). Fathers of adolescents with ADHD reported
more stress associated with the youth’s moodiness/emotional lability, delinquency/antisocial
behaviour and achievement/failure to persevere but did not report more stress associated with the
adolescent’s social isolation/withdrawal. There were no gender differences on ADHD status by
gender interaction effects (Appendix E). No significant differences were found in Total (F (1,
18) = .026, p = .873, ηp2 = .00) parenting stress or stress in the Adolescent (F (1, 18) = .034, p =
.855, ηp2 = .00), Parent (F (1, 18) = .030, p = .864, ηp
2 = .00), and Adolescent-Parent
Relationship (F (1, 18) = .001, p = .970, ηp2 = .00) domains between fathers of adolescents
currently on (n = 15) or off (n = 5) ADHD medication.
There were no significant parent gender effects (Total: F (1, 67) = 1.49, p = .226, ηp2
=
.02; Adolescent domain: F (1, 72) = .150, p = .699, ηp2 = .00; Parent domain: F (1, 67) = .436, p
= .511, ηp2
= .01; Adolescent-Parent Relationship domain: F (1, 72) = 2.91, p = .092, ηp2 = .04)
or ADHD by parent gender interaction effects (Total: F (1, 67) = .694, p = .408, ηp2
= .01;
Adolescent domain: F (1, 72) = .896, p = .347, ηp2 = .01; Parent domain: F (1, 67) = 2.25, p =
.139, ηp2 = .03; Adolescent-Parent Relationship domain: F (1, 72) = .035, p = .852, ηp
2 = .00).
2.8 Predictors of Parenting Stress
The second objective of the study is to determine whether adolescent externalizing
behaviours and parental ADHD symptoms, which are associated with parenting stress of parents
of children with ADHD (Theule, Wiener, Jenkins, & Tannock, in press), are also associated with
28
higher levels of parenting stress in parents of adolescents with the disorder. As shown in Table 4,
among the whole sample, maternal stress in the Adolescent domain was positively correlated
with maternal and paternal inattentive symptoms, and parent ratings of adolescent inattention,
hyperactive-impulsive behaviour and externalizing problems. Maternal inattention was positively
correlated with stress in the Parent, Adolescent-Parent Relationship, and Total stress domains.
Parent ratings of inattention, hyperactive/impulsive behaviour and externalizing problems were
positively correlated with Parent domain stress and Total stress. Parent ratings of inattention and
externalizing problems were positively correlated with stress in the Adolescent-Parent
Relationship domain.
The results of the regression analysis show that ADHD status, externalizing behaviour,
and maternal inattention are significant predictors of Total parenting stress (Table 6). ADHD
status alone predicted 32.6% of the variance in Total stress (R2 = .326, F (1, 35) = 16.94, p =
.000); however, the addition of the externalizing behaviour composite and maternal inattention
predicted an additional 21.8% of the variance (R2 change = .218, p = .002). Thus, the entire
model (ADHD status, externalizing behaviour composite, maternal inattention) predicted 54.4%
of the variance in Total stress (R2 = .544, F (3, 33) = 13.11, p = .000). Figure 1a illustrates that
the relationship between ADHD status and Total stress is fully mediated by adolescent
externalizing behaviour as the standardized regression coefficient between ADHD status and
Total stress decreased significantly when controlling for externalizing behaviour. The Sobel test
indicated that externalizing behaviour (z = 2.48, p = .01) was a significant mediator. As Figure
1b illustrates, the standardized regression coefficient between ADHD status and Total stress
decreased when controlling for maternal inattention, indicating that relationship between ADHD
status and Total stress is partially mediated by maternal inattention. However, the Sobel test
indicated that maternal inattention (z = 1.59, p = .11) was not a significant mediator of the
29
influence of ADHD status on Total stress. The other conditions of mediation were met in both
analyses: ADHD status was a significant predictor of Total stress, maternal inattention and
adolescent externalizing behaviour. When controlling for ADHD status, maternal inattention and
adolescent externalizing behaviour were significant predictors of Total stress.
ADHD status and externalizing behaviour are significant predictors of maternal
Adolescent domain stress. Maternal inattention was not a significant predictor of stress in the
Adolescent domain. ADHD status alone predicted 58.3% of the variance in Adolescent domain
stress (R2 = .583, F (1, 37) = 51.66, p = .000); however, the addition of the externalizing
behaviour composite and maternal inattention predicted an additional 14.2% of the variance (R2
change = .142, p = .001). Thus, the entire model (ADHD status, externalizing behaviour
composite, maternal inattention) predicted 72.5% of the variance in Adolescent domain stress (R2
= .725, F (3, 35) = 30.73, p = .000). As Figure 1c illustrates, the standardized regression
coefficient between ADHD status and Adolescent domain stress decreased when controlling for
externalizing behaviour, indicating that the relationship between ADHD status and Adolescent
domain stress is partially mediated by externalizing behaviour. The other conditions of mediation
were also met: ADHD status was a significant predictor of Adolescent domain stress and of
externalizing behaviour, and externalizing behaviour was a significant predictor of Adolescent
domain stress while controlling for ADHD status. The Sobel test indicated that externalizing
behaviour (z = 2.95, p = .003) was a significant mediator of the influence of ADHD status on
Adolescent domain stress.
ADHD status and maternal inattention are significant predictors of maternal stress in the
Parent domain. Externalizing behaviour was not a significant predictor of stress in the Parent
domain. ADHD status alone predicted 19.9% of the variance (R2 = .199, F (1, 35) = 8.68, p =
.006); however, the addition of maternal inattention and the externalizing behaviour composite
30
predicted an additional 25.4% of the variance (R2 change = .254, p = .002). Thus, the entire
model (ADHD status, maternal inattention, externalizing behaviour composite) predicted 45.2%
of the variance in Parent domain stress (R2 = .452, F (3, 33) = 9.09, p = .000). As Figure 1d
illustrates, the standardized regression coefficient between ADHD status and Parent domain
stress significantly decreased when controlling for maternal inattention, indicating that the
relationship between ADHD status and Parent domain stress was fully mediated by maternal
inattention. The other conditions of mediation were also met: ADHD status was a significant
predictor of Parent domain stress and of maternal inattention, and maternal inattention was a
significant predictor of Parent domain stress while controlling for ADHD status. The Sobel test
indicated that maternal inattention (z = 1.98, p = .05) was a significant mediator of the influence
of ADHD status on Parent domain stress.
Finally, ADHD status and maternal inattention were found to be significant predictors of
maternal stress in the Adolescent-Parent Relationship domain. ADHD status alone predicted
10.8% of the variance (R2 = .108, F (1, 37) = 4.48, p = .041); however, the addition of maternal
inattention predicted an additional 10.2% of the variance in Adolescent-Parent Relationship
domain stress (R2 change = .102, p = .038). Thus, the entire model (ADHD status, maternal
inattention) predicted 21.0% of the variance in Adolescent-Parent Relationship domain stress (R2
= .210, F (2, 36) = 4.77, p = .014). As Figure 1e illustrates, the standardized regression
coefficient between ADHD status and Adolescent-Parent Relationship domain stress
significantly decreased when controlling for maternal inattention, indicating that relationship
between ADHD status and Adolescent-Parent Relationship domain stress is fully mediated by
maternal inattention. The other conditions of mediation were also met: ADHD status was a
significant predictor of Adolescent-Parent Relationship domain stress and of maternal
inattention, and maternal inattention was a significant predictor of Adolescent-Parent
31
Relationship domain stress while controlling for ADHD status. The Sobel test indicated that
maternal inattention (z = 1.61, p = .110) was not a significant mediator of the influence of
ADHD status on Adolescent-Parent Relationship domain stress.
Results of Pearson product-moment correlations (Table 5) indicate that among the whole
sample, both Total paternal stress and stress in the Adolescent domain were positively correlated
with parent ratings of adolescent inattention, hyperactive/impulsive behaviour, and externalizing
problems. Parent ratings of adolescent inattention and externalizing problems were positively
correlated with stress in the Adolescent-Parent Relationship domain.
Only ADHD status was a significant predictor of Total parenting stress, predicting 30.5%
of the variance (R2 = .305, F (1, 31) = 13.58, p = .001). Although the addition of the externalizing
behaviour composite predicted an additional 4.2% of the variance in Total stress (R2 change =
.042, p = .173), the additional variance explained was not significant. Thus, the entire model
(ADHD status) predicted 30.5% of the variance in Total stress.
ADHD status and externalizing behaviour are significant predictors of paternal stress in
the Adolescent domain. ADHD status alone predicted 51.5% of the variance in Adolescent
domain stress (R2 = .515, F (1, 32) = 34.02, p = .000); however, the addition of the externalizing
behaviour composite predicted an additional 9.1% of the variance (R2 change = .091, p = .012).
Thus, the entire model (ADHD status, externalizing behaviour composite) predicted 60.6% of the
variance in Adolescent domain stress (R2 = .606, F (2, 31) = 23.88, p = .000). As Figure 1f
illustrates, the standardized regression coefficient between ADHD status and Adolescent domain
stress decreased when controlling for externalizing behaviour, indicating that the relationship
between ADHD status and Adolescent domain stress is partially mediated by externalizing
behaviour. The other conditions of mediation were also met: ADHD status was a significant
predictor of Adolescent domain stress and of maternal inattention, and externalizing behaviour
32
was a significant predictor of Adolescent domain stress while controlling for ADHD status. In
addition, the Sobel test indicated that externalizing behaviour (z = 2.42, p = .02) was a significant
mediator of the influence of ADHD status on Adolescent domain stress.
Finally, results indicate that ADHD status was a significant predictor of parenting stress
in the Adolescent-Parent Relationship domain while externalizing behaviour was not. ADHD
status alone predicted 11.5% of the variance (R2 = .115, F (1, 32) = 4.18, p = .049). Although the
addition of the externalizing behaviour composite predicted an additional 5.9% of the variance in
Adolescent-Parent Relationship domain stress (R2 change = .059, p = .146), the additional
variance explained was not significant. Thus, the entire model (ADHD status) predicted 11.5%
of the variance in Adolescent-Parent Relationship domain stress.
Discussion Mothers and fathers of adolescents with ADHD experience more parenting stress than
parents of adolescents without ADHD. They claim to be distressed by their sons’ and daughters’
challenging behaviours and by problems with their relationships with their teens. Parenting stress
was not associated with adolescent gender or whether adolescents with ADHD were medicated.
Mothers of adolescents with ADHD also report higher levels of stress than other parents in terms
of life restrictions, alienation from friends, and conflict with their spouse. Adolescent
externalizing behaviour (i.e., oppositionality, conduct problems, aggression) mediated the
influence of ADHD status on maternal Total stress and stress in the Adolescent domain and
maternal inattention mediated the relationship between adolescent ADHD status and maternal
stress in the Parent and the Adolescent-Parent Relationship domains. Adolescent externalizing
behaviour partially mediated the relationship between adolescent ADHD status and paternal
stress in the Adolescent domain. The results of this study showed that although mothers and
33
fathers of adolescents with ADHD report similar levels of parenting stress across all stress
domains, they differ in the factors that predict their levels of parenting stress.
2.9 Levels of parenting stress
The first objective of this study was to determine whether parents of adolescents with
ADHD experience more stress than parents of typically developing adolescents. Consistent with
the hypotheses and previous studies with children with ADHD (Theule, Wiener, Jenkins &
Tannock, in press), mothers of adolescents with ADHD experience significantly higher levels of
stress in all areas and these effect sizes were large. Fathers of adolescents with ADHD
experience more Total stress and more stress in the Adolescent and Adolescent-Parent
Relationship domains. Both mothers and fathers of adolescents with ADHD report more stress
associated with their child’s moodiness and emotional lability, social isolation and withdrawal,
delinquent and antisocial behaviour, and their failure to achieve and persevere. The presence of
these stressors is consistent with the findings that adolescents with ADHD report more negative
affect (i.e., elevated anger, anxiety, stress, sadness), spend more time participating in entertaining
and non-productive activities and less time completing homework or learning new skills
(Whalen, Jamner, Delfino, & Lozano, 2002). In addition, parents report higher levels of stress in
the Adolescent-Parent Relationship domain which is indicative of less expressed affection and
poor communication (Sheras, Abidin, & Konold, 1998). This is consistent with previous research
showing that adolescents with ADHD and their parents report higher levels of conflict (e.g.,
Barkley, Anastopoulos, Guevremont, & Fletcher, 1992; Edwards, Barkley, Laneri, Fletcher &
Metevia, 2001).
There are several possible reasons for the finding that mothers of adolescents with ADHD
experience more stress in the Parent domain than mothers of typically developing adolescents
34
whereas this difference was not evident for fathers. First, mothers typically take responsibility for
the majority of childcare duties in the household (e.g., discipline, daily needs, recreational
activities; Parke, 2000) and provide more direct involvement throughout infancy and early
childhood (Hoffereh et al., 2007). This imbalance in childcare duties continues into adolescence
(Hosley & Montemayor, 1997) and is evident within dual-income families (Blanchi & Raley,
2005; Coltrane, 2000). Fathers, on the other hand, tend to spend time participating in leisure
activities with their children and adolescents (Hosley & Montemayor, 1997; Lewis & Lamb,
2003). Thus parenting challenges may impact mothers more strongly than fathers. This was
evident in this sample as mothers of adolescents with ADHD reported more life restrictions,
feelings of incompetence and guilt, and social alienation due to less time spent with friends and
relatives than mothers of adolescents without ADHD. These feelings of social alienation may be
indicative of low levels of social support which would be consistent with previous findings that
families of children with ADHD have lower levels of social support than families of children
without ADHD (Lange et al., 2005). Furthermore, high levels of paternal stress are associated
with lower parental engagement and less support when co-parenting (Bronte-Tinkew, Horowitz,
& Carrano, 2009). These difficulties with co-parenting and reduced spousal support were
reflected in maternal stress ratings as mothers of adolescents with ADHD reported higher levels
of stress in their relationship with their spouse or partner.
No differences in parenting stress were found between parents of medicated and
unmedicated adolescents with ADHD. Although ADHD medication reduces inattentive and
hyperactive/impulsive symptoms (e.g., McClellan & Werry, 2003; Taylor et al., 2004), it is
possible that parents mainly interact with their adolescent children when the effects of the
medication have worn off at the end of the school day. ADHD symptoms and problem
behaviours may increase at this point and continue for the duration of the day.
35
2.10 Predictors of parenting stress
The second objective of this study was to determine whether adolescent externalizing
behaviours and parental ADHD symptoms, which are associated with parenting stress of parents
of children with ADHD (Theule, Wiener, Jenkins, & Tannock, in press), are also associated with
higher levels of parenting stress in parents of adolescents with the disorder.
Child oppositionality, conduct problems and aggression have been shown in previous
literature to be highly predictive of parenting stress among parents of children with ADHD
(Theule, Wiener, Jenkins, & Tannock, in press). The current study has shown that externalizing
behaviour continues to be predictive of parenting stress among parents of adolescents with
ADHD. Externalizing behaviour in the current study was assessed by a composite of the
aggression, conduct problems and oppositionality scales of the Conners-3 parent rating scale.
These scales rate behaviours that are likely to be stressful for anyone interacting frequently with
the individual displaying them (see Morgan, Robinson, & Aldridge, 2002 for review) including
bullying, threatening, and physically hurting others, arguing, telling lies, and actively refusing to
do what adults tell them to do. Adolescents displaying these types of behaviours typically have
low academic achievement, engage in substance abuse and other risk-taking behaviours
(Barkley, Fischer, Smallish, & Fletcher, 2004) and associate with deviant peer groups (Whalen &
Henker, 1992). The deviant peer group association of some adolescents with ADHD may result
from rejection by prosocial peers due to difficulties with emotion and behaviour regulation
(Hinshaw & Melnick, 1995).
It is important to note that adolescent externalizing behaviours fully mediated the
influence of ADHD status on maternal Total and Adolescent domain stress and partially
mediated the influence of ADHD status on paternal Adolescent domain stress. This mediation
36
may have occurred because ADHD symptoms and externalizing behaviour are highly correlated
(Inattention: r = .70, p = .000; Hyperactivity/Impulsivity: r = .65, p = .000). Furthermore, due to
the relative independence of adolescents compared to younger children, parents may not be
constantly exposed to their sons’ and daughters’ inattention, hyperactivity and impulsivity.
Although oppositional behaviours (e.g., swearing at a teacher), conduct problems (e.g., stealing),
and aggression are less frequent than inattention, hyperactivity and impulsivity, they may have a
larger impact on parent stress levels.
Previous research has reported that parents of children with ADHD with higher levels of
ADHD symptoms reported more Parent domain stress (Theule, Wiener, Jenkins, Tannock, in
press). The current study showed that maternal inattention fully mediated the relationship
between adolescent ADHD status and stress reported in the Parent and Adolescent-Parent
Relationship domains, suggesting that mothers with higher levels of inattention experience more
stress. Parental ADHD symptoms are positively associated with inconsistent discipline and
nonsupportive responses to the negative emotions and behaviours of children (Mokrova,
O’Brien, Calkins, & Keane, 2010). In addition, parents with ADHD tend to be inconsistent in
enforcing rules and placing limits on their children and this may be due to difficulties with
monitoring and following through with consistent consequences (Murray & Johnston, 2006).
Thus, when parents are unable to effectively manage their children’s behaviour, this may result
in increased problem behaviours and in turn, increased parenting stress. Given that mothers are
primarily responsible for childcare duties (Blanchi & Raley, 2005; Hosley & Montemayor, 1997;
Parke, 2000), parenting may become much more difficult when mothers have difficulty
sustaining attention and concentration. Mothers with ADHD, for example, are relatively unaware
of their children’s activities and are more sensitive to problem behaviours (Weiss, Hechtman, &
Weiss, 2000). Monitoring a child’s behaviour and whereabouts poses a greater challenge when
37
adolescents begin spending more time outside of the home and away from the family. Thus,
symptoms of inattention may make it difficult for mothers to parent effectively and contribute to
higher levels of Total stress and Parent Domain stress. Lower tolerance for problem behaviours
may also result in greater conflict which then leads to a strained adolescent-parent relationship.
Although maternal inattention was positively associated with increased parent domain stress for
mothers, this was not the case for fathers. It is possible that because mothers tend to take on more
parenting responsibilities (Phares, Fields & Kamboukos, 2009), fathers with high levels of
inattention may be less overwhelmed by the demands of parenting.
2.11 Strengths and limitations
This study was the first to explore parenting stress in parents of adolescents with ADHD.
One of the strengths of this study is that ratings of parenting stress were obtained from both
mothers and fathers. Furthermore, the measure of parenting stress used in this study has strong
psychometric properties and provides a broad picture of parenting stress by examining stress
levels in different domains. Despite the important findings of this investigation, this study is not
without its limitations. First, items on the SIPA (e.g. Since my child became a teenager, my
spouse/partner and I don’t spend as much time together as a couple as I had expected) could not
be adequately answered by parents who were divorced, separated, or single; this precluded the
calculation of a Parent domain stress score for those parents (n = 12). Second, the relatively
small sample size of this study may have affected the exploratory analysis of the effect of ADHD
medication status on parenting stress where no differences were found between parenting stress
levels for parents of adolescents on or off medication. Although this may have been due to the
small number of unmedicated adolescents with ADHD (n =7), the effect sizes were small.
38
2.12 Conclusions and Clinical implications
Parents of adolescents with ADHD experience significantly more stress than parents of
adolescents without ADHD. Maternal inattention and adolescent externalizing behaviour
emerged as significant mediators of maternal parenting stress and ADHD status and adolescent
externalizing behaviour were found to predict paternal parenting stress. This study obtained
partial eta squared values for differences in parenting stress levels between parents of adolescents
with and without ADHD ranging from .13- .59 for mothers and .12 - .52 for fathers, suggesting
that parenting stress among parents of adolescents with ADHD is a significant issue that warrants
continued investigation. Through obtaining a deeper understanding of the causes of parenting
stress in this population, clinicians may be better able to identify and target the specific issues
and challenges these parents experience and provide them with coping skills and strategies to
alleviate stress. This is particularly important for parents of adolescents because empirically
supported behavioural treatments for ADHD are geared to parents of children (e.g., Danforth,
Harvey, Ulaszek, & McKee, 2006; Fabiano et al., 2009). Furthermore, studies of parent
management programs have found that a reduction in problem behaviour in children was not
associated with reduced parenting stress (Pisterman, Firestone, McGrath, & Goodman, 1992).
The results of this study provide strong support for the need to provide parents of adolescents
with ADHD and externalizing behaviour problems and mothers with ADHD and symptoms of
inattention with interventions designed to reduce or help them cope with parenting stress.
39
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Tables
Table 1: Adolescent and Parent Demographics
ADHD Non
ADHD Variable n M SD n M SD df t p Adolescent Age 26 15.15 1.85 19 15.32 1.64 43 .31 .76 Full Scale IQ 26 99.88 5.8 19 109.32 10.64 43 3.50a .002** Conners-3 Parent
Hyper/Impulsivity 26 79.23 11.99 19 49.95 6.7 40 -10.43a .000*** Inattention 26 83.69 6.29 19 51.84 7.93 43 -15.02 .000*** Aggression 26 72.15 15.66 19 50.95 8.02 39 -5.92a .000*** Conduct Disorder 26 66.65 14.28 19 48.11 5.94 35 -5.95a .000*** Oppositional Defiant 26 71.31 10.96 19 50.79 6.69 43 -7.22 .000*** Peer Relations 26 69.58 16.13 19 48.37 6.72 43 -6.03 .000*** Conners-3 Teacher
Hyper/Impulsivity 23 66.09 16.47 19 47.39 4.23 25 -5.23a .000*** Inattention 23 71.26 12 19 46.78 6.8 36 -8.24a .000*** Aggression 23 64 16.4 19 48.17 8.9 35 -3.34a .001** Conduct Disorder 23 57.96 14.09 19 47.39 5.12 29 -3.18 a .002** Oppositional Defiant 23 64.22 17.37 19 48.39 9.32 35 -3.74a .001** Peer Relations 23 64.39 18.41 19 49.11 7.78 31 -3.59 a .001** Mother Age 25 45.56 6.74 17 49.06 3.96 40 -1.92 .06 Father Age 21 47.76 6.88 18 50.78 4.58 37 -1.58 .12 Mother Education 23 8.09 1.28 18 9.11 1.41 39 -2.44 .02* Father Education 21 7.24 2.23 19 8.47 1.65 38 -1.97 .06 Mother Inattention 22 54.73 19.18 17 42.24 10.63 34 2.58a .01* Mother H/I 22 45.18 11.64 17 41.76 9.27 37 .99 .33 Father Inattention 16 51.00 17.15 15 36.93 8.20 29 2.88 .007** Father H/I 16 52.69 15.53 15 45.07 8.36 23 1.71a .10 a Levene’s test of Equality of Variances was significant; equal variances not assumed *p < .05, **p < .01, ***p<.001
Note: Maternal and paternal levels of inattention and hyperactive/impulsive (H/I) symptoms are measured by
the Conners Adult ADHD Self-Report Rating Scale-Short Version.
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Table 2: Maternal Parenting Stress Levels
ADHD Non
ADHD Domain n M SD n M SD F p ηp
2 Total Stress 23 228.43 56.27 16 159.56 31.24 18.23 .000*** .35 Adolescent 26 116.73 21.32 17 68.29 16.13 60.00 .000*** .61 Moodiness/Emotional Lability 26 31.69 9.31 17 19.06 7.42 23.70 .000*** .38 Social Isolation/Withdrawal 26 24.04 7.11 17 16.24 5.06 19.56 .000*** .34
Delinquency/Antisocial 26 23.23 7.76 17 11.65 2.29 33.70 .000*** .47 Failure to Achieve/Persevere 26 38.73 6.21 17 21.35 8.68 65.85 .000*** .63 Parent 23 81.65 19.99 16 61.69 16.80 11.53 .002** .25 Life Restrictions 23 23.17 7.01 16 18.13 6.86 5.98 .020* .15 Relationship with spouse/partner 23 23.26 8.18 16 17.69 4.51 6.70 .014* .17 Social Alienation 23 14.30 4.70 16 10.38 2.42 8.33 .007** .20 Incompetence/Guilt 23 20.91 6.23 16 15.5 5.57 7.97 .008** .19 Adolescent-Parent Relationship 26 35.04 11.79 17 27.94 8.10 4.70 .036* .11 *p < .05, **p < .01, *** p <.001
Note: SIPA scores are raw scores.
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Table 3: Paternal Parenting Stress Levels
Note: SIPA scores are raw scores.
ADHD Non
ADHD Domain n M SD n M SD F p ηp
2
Total Stress 21 227.81 37.76 13 180.38 32.77 12.66 .001** .30 Adolescent 21 112.67 19.23 14 74.29 17.33 32.07 .000*** .52 Moodiness/Emotional Lability 21 31.29 8.43 14 20.79 6.85 13.99 .001** .32
Social Isolation/Withdrawal 21 22.95 5.81 14 18.07 5.03 6.64 .015** .18
Delinquency/Antisocial 21 22.62 8.33 14 12.86 4.26 15.11 .001** .34 Failure to Achieve/Persevere 21 35.81 6.57 14 23.21 8.01 22.48 .000*** .43 Parent 21 76.76 17.22 13 70.85 12.91 1.17 .288 .04 Life Restrictions 21 21.38 6.66 13 21.77 4.94 .01 .939 .00 Relationship with spouse/partner 21 22.52 6.59 13 18.92 5.75 2.49 .125 .08 Social Alienation 21 14.29 3.17 13 12.62 3.43 2.35 .136 .08 Incompetence/Guilt 20 18.6 4.6 13 17.54 4.12 .37 .547 .01 Adolescent-Parent Relationship 21 38.38 10.02 14 32.14 6.82 4.20 .049* .12 *p < .05, **p < .01, *** p < .001
Table 4: Pearson-Product-Moment Correlations for variables on the C3P and CAARS correlated with Total stress and domains of maternal parenting stress
C3P DSM
ADHD Inattention
C3P DSM
ADHD Hyper/Impulsive
Externalizing Composite
Mother Inattention
Mother Hyper/Impulsive
Father Inattention
Father Hyper/Impulsive
SIPA Domain Total Stress ADHD .06 -.38 .48* .35 .15 .00 -.56* Comparison .45 .49 .10 .36 -.27 .19 .55* Total .58** .39* .65** .48** .12 .27 -.09 Adolescent ADHD .13 -.37 .50* .28 .25 .00 -.52* Comparison .47 .50* .40 .24 .01 .45 .28 Total .76** .53** .76** .44** .23 .41* .03 Parent ADHD .13 -.37 .50* .28 .25 .00 -.52* Comparison .47 .50* .40 .24 .01 .45 .28 Total .76** .54** .76** .44** .23 .41* .03 Adolescent-Parent Relationship ADHD .00 -.45* .29 .32 .10 -.03 -.39 Comparison .57* .10 -.16 .42 -.22 .00 .57* Total .39* .08 .38* .42** .05 .13 -.02 *p < .05.**p < .01.
Note: Parent ratings of adolescent ADHD symptoms are obtained from the Conners-3 parent report form: DSM-IV-TR
inattentive and hyperactive/impulsive symptom scales. Maternal and paternal symptoms of inattention and hyperactive/impulsive symptoms are obtained from the Conners Adult ADHD Self-Report Rating Scale-Short Version.
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Table 5: Pearson-Product-Moment Correlations for variables on the C3P and CAARS correlated with Total stress and domains of paternal parenting stress
Note: Parent ratings of adolescent ADHD symptoms are obtained from the Conners-3 parent report form: DSM-IV-TR
inattentive and hyperactive/impulsive symptom scales. Maternal and paternal symptoms of inattention and hyperactive/impulsive symptoms are obtained from the Conners Adult ADHD Self-Report Rating Scale-Short Version.
C3P DSM
ADHD Inattention
C3P DSM ADHD
Hyper/Impulsive Externalizing
Composite Mother
Inattention Mother
Hyper/Impulsive Father
Inattention Father
Hyper/Impulsive SIPA Domain Total Stress ADHD .11 -.25 .20 -.13 -.43 -.47 -.36 Comparison .25 .38 .47 -.09 -.56 .13 -.11 Total .55** .38** .53** .05 -.32 -.01 -.11 Adolescent ADHD .10 -.25 .41 -.18 -.35 -.26 -.24 Comparison .28 .44 .58* -.23 -.57 .37 .00 Total .69** .53** .72** .05 -.21 .27 .08 Parent ADHD -.01 -.15 -.14 .05 -.24 -.50* -.31 Comparison .01 .29 .41 .10 -.49 -.07 .00 Total .18 .12 .11 .11 -.28 -.29 -.19 Adolescent-Parent Relationship ADHD .26 -.19 .21 -.26 -.52* -.42 -.35 Comparison .22 .34 .50 -.11 -.50 .12 .01 Total .41* .22 .41* -.13 -.44* -.10 -.16 *p < .05.**p < .01.
Table 6: Hierarchical Multiple Regression Analyses Predicting Maternal Parenting Stress
Predictors R2 ΔR2 B SEB β Total Stress .33 .33*** Step 1 ADHD Status 61.68 14.99 .57*** Step 2 .54 .22** ADHD Status 8.34 18.94 .08 Externalizing Behaviour 2.09 .67 .53** Maternal Inattention .95 .40 .30* Adolescent .58 .58*** Step 1 ADHD Status 45.75 6.37 .76*** Step 2 .73 .14** ADHD Status 19.75 8.14 .33* Externalizing Behaviour 1.07 .28 .50** Maternal Inattention .32 .17 .18 Parent .20 .20** Step 1 ADHD Status 18.46 6.27 .45** Step 2 .45 .25** ADHD Status 4.65 7.96 .11 Externalizing Behaviour .30 .28 .20 Maternal Inattention .63 .17 .52** Adolescent-Parent Relationship .11 .11* Step 1 ADHD Status 6.74 3.19 .33* Step 2 .21 .10* ADHD Status 4.15 3.27 .20 Maternal Inattention 0.21 0.1 .34* * p < .05, ** p < .01, *** p < .001
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Table 7: Hierarchical Multiple Regression Analyses Predicting Paternal Parenting Stress
Predictors R2 ΔR2 B SEB β Total Stress .31 .31** Step 1 ADHD Status 47.92 13.00 .55** Step 2 .35 .04 ADHD Status 31.00 17.64 .36 Externalizing Behaviour .90 .65 .28 Adolescent .52 .52*** Step 1 ADHD Status 38.16 6.54 .72*** Step 2 .61 .09* ADHD Status 22.30 8.42 .42* Externalizing Behaviour .82 .31 .42* Adolescent-Parent Relationship .12 .12* Step 1 ADHD Status 6.31 3.09 .34* Step 2 .18 .06 ADHD Status 1.84 4.26 .10 Externalizing Behaviour .23 .16 .34 * p < .05, ** p < .01, *** p < .001
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Figures
Figure 1: Mediation models of Parenting Stress
a. Total Stress – Mother
b. Total Stress - Mother
c. Adolescent Domain - Mother
d. Parent Domain – Mother
e. Adolescent Parent-Relationship - Mother
f. Adolescent Domain - Father
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Appendices
Appendix A: Adolescent and Parent Assent and Consent Forms and Letters
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ADOLESCENT CONSENT LETTER
Dear ___________: My name is Judith Wiener, and I am a professor at the Ontario Institute for Studies in Education of the University of Toronto (OISE/UT). My colleagues (Dr. Rosemary Tannock, Dr. Tom Humphries, Dr. Martinussen, and I are doing a research project on teenagers with Attention-Deficit Hyperactivity Disorder (ADHD). We are writing to ask you if you would like to take part in this research. For this, we need the participation of a group of teenagers who have been previously been diagnosed with ADHD and a group of teenagers without ADHD. We are asking you to take part in this research, because we believe that your feelings and opinions are valuable information. Purpose of the Research We want to learn more about the beliefs that teenagers have about ADHD and about behaviors that commonly occur with ADHD, their views about themselves, and their social relationships. So far, there is little research on these areas of study. We believe that knowing how teenagers think about their behaviors and about their ADHD is important, so that people like teachers, parents, and other professionals can consider their beliefs when they try to help them. This research has been funded by the Social Sciences and Humanities Research Council. Description of the Research If you take part in this research study, the testing session will take approximately 5 to 6 hours. The session will take place in a quiet room at OISE/UT. During the session, my research assistant will ask you to answer some questions about yourself, such as what you think about your behaviors, and about ADHD. He or she will read the questions to you if you wish. Sometimes he or she will write the answers down for you and sometimes you will have to check off or circle an item on a form or a questionnaire You will also fill out some rating scales that tell about how you view yourself, your behaviors, your self-esteem and your relationships with peers and others. You will also do some reading, writing, and math activities. We will ask you to look at some pictures with a teenager in them behaving in different ways and ask you to point out which of the pictures are like you. We will also interview you about your beliefs about your behaviour and ADHD. We will give you a few breaks, including a lunch break. We are also going to send a rating scale for your teacher to fill out in a teacher package. Benefits A benefit of this study is that it will help us learn more about adolescents with ADHD. We want to listen to what you say and think, and then use that information to help other teens with ADHD. Another benefit about this study is that your answers to the questions from the reading, writing, and math activities and the questionnaires will let us know what your strengths are and what areas you need to work on a little bit more. After about one month after you take part in the study, we will mail a report to you and your family about these different areas, and about some ways that might help you do better in school. Knowing these types of things is important, because they can help you, your parents and teachers understand how to help you do better in school and in life in general.
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Potential Harms and Withdrawal There are no harms associated with taking part in the study. The only thing that might happen is that you may feel a little uncomfortable talking about yourself and how you feel about some things. If you feel that you don’t want to answer some of the questions, you can tell the research assistant, and talk about it. You may also say that you want to stop, skip a question, or that you need a break and want to continue some other time. Also, if you say that you will take part in the study and then change your mind, that is okay. You can decide at any time to stop taking part in the study. Confidentiality Everything you tell me in the session will stay between you, the research assistant, and Dr. Wiener. No information that reveals your identity will be released without consent unless required by law. The information that we collect from you, your parents, and teacher will be analyzed and stored in locked files in a locked office. The data will be kept at OISE/UT in locked files for 10 years. The questionnaires will not have your name on them. A number code will be used in place of your name. We will analyze the information, talk about it at meetings, and write about it, so that parents, teachers, and doctors can learn from what we have found. The results of the questionnaires and activities described above will be used for research purposes only. We would need your permission and signed consent if you want to send these scores to another professional. Because we are working with many teenagers on this project, people hearing our presentations or reading what we write will not know which teenager said what. When we do this, or when we publish our research in academic journals/books, we will only present group information. We will not tell anyone your name or give any information that could help them know who you are. We will not be able to provide you with your responses on some of the questionnaires and interviews, because they were developed for the purpose of the research. We will not tell your parents the specific answers that you gave to the questions, but we will write a report about how you did and mail it to them. The only time that we would have to tell somebody something you have said is if you tell us that you will do serious harm to yourself or someone else, or someone is seriously harming you. In that case, as required by law, we would have to make sure you get help by contacting appropriate mental health, or law enforcement professionals. Otherwise, everything you tell me is kept confidential. Compensation Participation in research is voluntary. If you do decide to take part in the study, you can choose between getting $30.00 for your participation, or, (for teenagers in high school), the time you spend taking part in the study can be counted towards your community service hours, which we will provide a certificate for. Access to Results The results of this research will be shared in the form of a summary report upon completion of the study. We are in the process of developing a website on which we will place all relevant information and will contact you about this when it is ready.
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You may contact Dr. Judith Wiener, Daniella Biondic, or Heather Prime with any questions you may have about the study, and all of your inquiries will be addressed. Sincerely, __________________________ Daniella Biondic, B.Sc. M.A. Student (416) 978-1007 __________________________ Heather Prime Lab Manager (416) 978-1007 __________________________ Judith Wiener, Ph. D Professor School and Clinical Child Psychology (416) 978-0935 Department of Human Development and Applied Psychology Ontario Institute for Studies in Education of the University of Toronto (OISE/UT) Toronto, Ontario M5S 1A1
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ADOLESCENT CONSENT FORM
“I acknowledge that the research procedures described above have been explained to me and that any questions that I have asked have been answered to my satisfaction. As well, the potential harms and discomforts have been explained to me and I also understand the benefits of participating in the research study. I know that I may ask now, or in the future, any questions that I have about the study. I have been assured that no information will be released or printed that would disclose my identity without my permission, unless required by law. I understand that I will receive a copy of this signed consent. I understand that participation is voluntary and I can withdraw at any time.”
I hereby consent to take part in this research. ___________________________________ Name of Teenager ___________________________________ Signature ___________________________________ Date ___________________________________ Name of person who obtained consent ___________________________________ Signature
“I agree to be contacted in the future regarding other studies being conducted by the ADHD Laboratory at OISE/UT.” ___________________________________ Signature “I agree that the information collected about me in this study can be used for future data analysis provided that all identifying is removed and that I cannot be identified.” ___________________________________ Signature
The person who may be contacted about this research is: __________________________ who may be contacted at: (416) 978-1007
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ASSENT SCRIPT Why are we doing this study? My Professor and I are doing a research project on teenagers with ADHD. We are interested in finding out about how teenagers who have been given a previous diagnosis of ADHD think about their behaviours. We also want to know about their self-esteem and their social relationships. We want to learn more about the beliefs that teenagers have about ADHD and about some of their behaviours that commonly occur with ADHD. We believe that knowing how teenagers think about their behaviours and about their ADHD is important, so that people like teachers, parents, and other professionals can consider their beliefs when they try to help them. I am asking you to participate in this research, because I believe that your feelings and opinions are valuable information. What will happen during the study? If you take part in this study today, it will take approximately 5 to 6 hours. I will ask you to answer some questions about yourself, such as what you think about your behaviours, and about ADHD. I will read the questions to you if you want. Sometimes I will write the answers down for you and sometimes you will have to check off or circle an item on a form. Your answers to these questions will help me understand how you think about your behaviours and about ADHD. I will also ask you to look at some pictures with a teenager in them behaving in different ways and ask you to tell me which of the pictures are like you. I will ask you about your beliefs about those behaviours. We will also do some reading, writing, and math activities. Since you are here for a few hours, we will take a few breaks including a lunch break. Your mother/father filled out a rating scale before you came in. I am also going to send a rating scale for your teacher to fill out. Who will know about what I did in the study? Do you know what confidentiality is? It means that everything you tell me today will stay between you, myself, and Dr. Wiener, who is my Professor. My Professor and I will analyze it, talk about it at meetings, and write about it, so that parents, teachers, and doctors can learn from what we have found. The questionnaires will not have your name on them. A number code will be used in place of your name. Because I am working with many teenagers on this project, people hearing my presentations or reading what I write will not know which teenager said what. When I do this, I will not tell anyone your name or give any information that could help them know who you are. For the reading, writing, and math activities and the other questionnaires, I will not tell your parents the specific answers that you gave to the questions. But I will write a report about how you did and mail it to them. The only time that I would have to tell somebody something you have said is if you tell me that you will do serious harm to yourself or someone else, or someone is seriously harming you. In that case, I would have to tell your parents and make sure you get help. Otherwise, everything you tell me is kept confidential.
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Participation in this study is your choice. Before you came here, your mother/father signed a letter saying that she/he agrees for you to be in the study, but you don’t have to participate if you don’t want to. If you say you will take part and then change your mind, that is okay. You can decide at any time to stop taking part in the study. If you do decide to take part in the study, you can choose between getting $30.00 for your participation, or, (for participants in high school), the time you spend here can count towards your community service hours, which we will provide a certificate for. Are there good things and bad things about the study? There are no bad things about the study. The only thing that might happen is that you may feel uncomfortable talking about yourself and how you feel about some things. If you feel that you don’t want to answer some of the questions, you can tell me, and we will talk about it. You may also tell me that you want to stop, skip the question, or that you need a break and want to continue some other time. A good thing about this study is that it will help us learn more about adolescents with ADHD. We want to listen to what you say and think, and then use that information to help other teens with ADHD. Finally, your answers to the questions from the reading, writing, and math activities and the questionnaires will help me know what your strengths are and what areas you need to work on a little bit more. Knowing these types of things is important, because they can help your parents and teachers understand how to help you do better in school and will help you figure out what you can do for yourself. How do I find out the results of the study? If you want information about the results of this research when it is completed, you can check the website we are making for the research. We will let your parents know when it is ready. Your name will not be in the report, but it will give you an idea of how other teenagers think and feel about their behaviours and about ADHD. Do you have any questions? Do you agree to participate in this research?
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“I was present when ____________________________read this form and gave his/her verbal assent to participate in this study.” Name of person who obtained assent:
________________________________
________________________________ ________________________________ Signature Date
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PARENTAL CONSENT LETTER
Dear Parent: My name is Dr. Judith Wiener. I am a Professor in the Department of Human Development and Applied Psychology at the Ontario Institute for Studies in Education of the University of Toronto (OISE/UT). I am writing to ask your permission for your adolescent to participate in a research project that I am conducting with my colleagues (Dr. Rosemary Tannock, Dr. Tom Humphries, Dr. Molly Malone, and Dr. Martinussen) about adolescents with Attention Deficit/Hyperactivity Disorder (ADHD). For this, we need the participation of adolescents who have been previously been diagnosed with ADHD as well as normally functioning adolescents. Purpose of the Research The purpose of this research to enhance our understanding about the self-perceptions of adolescents’ with ADHD including their self-esteem and self-concept, their beliefs regarding ADHD and about behaviors that commonly occur with ADHD, and their perceptions of their social relationships. Currently, little research exists on these areas of study. We believe that gaining a better understanding of the self-perceptions of adolescents with ADHD will help mental health professionals provide better services and develop appropriate interventions for them. This study is funded by the Social Sciences and Humanities Research Council of Canada. Description of the Research If you agree to allow your son/daughter to participate, my research assistants, who are graduate students in school and clinical child psychology, will work with him/her for a period of 5 to 6 hours in a quiet room at OISE/UT. He or she will complete a standardized educational test (Woodcock Johnson-Third Edition) that is recognized as being a valid measure of achievement in reading, writing and mathematics, and a brief cognitive measure (Wechsler Abbreviated Scale of Intelligence). He or she will also fill out several questionnaires designed to assess self-esteem, self-concept, peer relationships, social support, and problem behaviors that commonly occur with ADHD. He or she will also be asked to look at pictures with a teenager in them engaging in various behaviors characteristics of teens with ADHD and asked whether they are like the teenager in the picture. This will be followed up with an interview about his/her beliefs about why this behaviour is a problem, how controllable it is, how often it occurs, and whether it bothers other people. A similar interview will then be conducted about his or her beliefs about ADHD. The results of these measures will be used for research purposes only in the context of this study. We would need your permission and signed consent should you need to send these test scores to another professional involved in your case. With your permission we will also send the teacher who knows your son/daughter well a rating scale to complete. This rating scale assesses for symptoms of ADHD and other disorders. The results of the educational and cognitive measures will be interpreted by a registered psychologist and be communicated to you in a written report. We will not be able to provide you with your adolescent’s responses on some of the questionnaires and interviews, because they were developed for the purpose of the research and we will not know what individual adolescent’s scores mean until the data are collected and analyzed from all of the participants.
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Benefits The direct benefit of this study is that you will receive a report on your son/daughter’s educational and social-emotional functioning with specific recommendations for intervention. We believe that the study may also indirectly benefit adolescents with ADHD. More specifically, enhanced knowledge about adolescents’ self-perceptions and beliefs about ADHD and ADHD-related behaviors may provide important information for parents, teachers, and clinicians working with them. Potential Harms and Withdrawal There are no known harms associated with participation in the study. The only potential risk is that your son/daughter may feel some discomfort when talking about his/her behavior. We will clearly inform him/her that he/she may decline to participate and that if he/she decides to participate, he/she may skip any questions, request a break, or withdraw from the study at any time. Following the session, if you find the discomfort to be more than minor, please contact us so that we can discuss how to provide support for him/her. In addition, should we feel, during or after the session that he/she would benefit from referral to a mental health professional, we would inform you of that recommendation and would provide an appropriate referral. Confidentiality Confidentiality will be respected and no information that discloses the identity of the participants will be released without consent unless required by law. For your information, all research files will be stored in locked files at OISE/UT. The results of the tests described above will be used for research purposes only. We would need your permission and signed consent should you need to send these scores to another professional. The data we collect will be analyzed and stored in locked files in a locked office. The data will be retained at OISE/UT in locked files for 10 years. Your name and that of your son/daughter will be deleted and replaced by a number when filed in order to assure anonymity. In these ways, the information provided by you, your son/daughter and his/her teacher will be kept confidential. The one exception to this is in the event that your adolescent indicates that he/she might do serious harm to him/herself or others, or that he/she is being harmed. If that were to happen, as required by law, we would inform you and appropriate mental health, child protection, or law enforcement professionals. When the results of this research are published in the form of scholarly presentation and/or academic journal/books, only group data will be presented, ensuring that it will be impossible for anyone to identify you or your son/daughter. Compensation Participation in research is voluntary. If your son/daughter chooses to participate in this study, he/she will receive $30 to defray expenses. If he/she is in high school, he/she may alternatively opt to count his/her participation in the study toward his/her community service hours; in this case, a certificate attesting to his/her participation would be provided. As mentioned above, you will also receive a report of your adolescent’s academic and social emotional competencies.
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Access to Results The results of this research will be shared in the form of a summary report upon completion of the study. We are in the process of developing a website on which we will place all relevant information and will contact you about this when it is ready. You may contact Dr. Judith Wiener, Daniella Biondic, or Heather Prime with any questions you may have about the study, and all of your inquiries will be addressed. Sincerely, __________________________ Daniella Biondic, B.Sc. M.A. Student (416) 978-1007 __________________________ Heather Prime Lab Manager (416) 978-1007 __________________________ Judith Wiener, Ph. D Professor (416) 978-0935 Department of Human Development and Applied Psychology Ontario Institute for Studies in Education of the University of Toronto (OISE/UT) Toronto, Ontario M5S 1A1
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PARENTAL CONSENT FORM
“I acknowledge that the research procedures described above have been explained to me and that any questions that I have asked have been answered to my satisfaction. As well, the potential harms and discomforts have been explained to me and I also understand the benefits of participating in the research study. I know that I may ask now, or in the future, any questions that I have about the study. I have been assured that no information will be released or printed that would disclose the personal identity of my son/daughter without my permission, unless required by law. I understand that I will receive a copy of this signed consent. I understand that participation is voluntary and I can withdraw my adolescent at any time.”
I hereby consent for my son/daughter to participate. ___________________________________ Name of Parent ___________________________________ Signature ___________________________________ Date ___________________________________ Name of person who obtained consent ___________________________________ Signature
“I agree to be contacted in the future regarding other studies being conducted by the ADHD Laboratory at OISE/UT.” ___________________________________ Signature of parent “I agree that the information collected on my adolescent in this study can be used for future data analysis provided that all identifying is removed and my adolescent cannot be identified.” ___________________________________ Signature of parent
The person who may be contacted about this research is: __________________________ who may be contacted at: (416) 978-1007
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Appendix B: Descriptive Statistics of Maternal Stress by Adolescent Gender
ADHD Non
ADHD Stress by Adolescent Gender M SD N M SD N Male Total Stress 213.58 43.34 12 168.14 40.06 7 Adolescent Domain 110.00 16.37 15 75.14 19.44 7 Parent Domain 72.33 22.29 12 62.71 19.02 7 Adolescent-Parent Relationship Domain 34.33 10.74 15 30.29 11.60 7 Female Total Stress 237.30 64.58 10 152.89 22.62 9 Adolescent Domain 122.40 26.33 10 63.50 12.20 10 Parent Domain 91.30 11.14 10 60.89 16.01 9 Adolescent-Parent Relationship Domain 36.20 11.74 10 26.30 4.42 10
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Appendix C: ANOVA Summary for Maternal Stress by ADHD Status and Gender
Total Stress Source SS df MS F ηp
2 ADHD Status 38557.91 1 38557.91 18.23** .35 Gender 163.77 1 163.77 .077 .00 Error 71920.76 34 2115.32 ** p < .01
Adolescent Domain Stress Source SS df MS F ηp
2 ADHD Status 21464.94 1 21464.94 60.00** .61 Gender 1.40 1 1.40 .004 .00 Error 13593.76 38 357.73 ** p < .01
Parent Domain Stress Source SS df MS F ηp
2 ADHD Status 3664.32 1 3664.32 11.53** .25 Gender 671.90 1 671.90 2.12 .06 Error 10803.08 34 317.74 ** p < .01
Adolescent-Parent Relationship Domain Stress Source SS df MS F ηp
2 ADHD Status 475.03 1 475.03 4.70* .11 Gender 10.97 1 10.97 .108 .00 Error 3840.46 38 101.07 * p < .05
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Appendix D: Descriptive statistics of Paternal Stress by Adolescent Gender
ADHD Non
ADHD Stress by Adolescent Gender M SD N M SD N Male Total Stress 226.00 37.09 13 186.33 30.26 6 Adolescent Domain 110.85 20.27 13 75.29 18.20 7 Parent Domain 77.46 14.45 13 72.17 12.38 6 Adolescent-Parent Relationship Domain 37.69 9.42 13 32.00 8.06 7 Female Total Stress 232.57 44.17 7 175.29 36.29 7 Adolescent Domain 115.43 19.80 7 73.29 17.80 7 Parent Domain 77.29 23.29 7 69.71 14.22 7 Adolescent-Parent Relationship Domain 39.86 11.70 7 32.29 5.96 7
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Appendix E: ANOVA Summary for Paternal Stress by ADHD Status and Gender
Total Stress Source SS df MS F ηp
2 ADHD Status 17758.72 1 17758.72 12.66** .30 Gender 37.85 1 37.85 .027 .00 Error 40692.48 29 1403.19 ** p < .01
Adolescent Domain Source SS df MS F ηp
2 ADHD Status 11944.35 1 11944.35 32.07** .96 Gender 13.19 1 13.19 .035 .00 Error 11172.26 30 372.41 ** p < .01
Parent Domain Stress Source SS df MS F ηp
2 ADHD Status 312.75 1 312.75 1.17 .04 Gender 13.05 1 13.05 .049 .00 Error 7740.92 29 266.93 Adolescent-Parent Relationship Domain Stress Source SS df MS F ηp
2 ADHD Status 348.03 1 348.03 4.20* .12 Gender 11.88 1 11.88 .143 .01 Error 2489.06 30 82.97 * p < .05
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Appendix F: Pearson-Product-Moment Correlations for Child Variables Correlated with Subscales and Domains of Maternal Parenting Stress
Gender Child Age
Medication Status
SIPA Domain/Subdomain Total Stress .00 -.03 .43** Adolescent .10 -.07 .56** Moodiness/Emotional Lability -.11 -.18 .47** Social Isolation/Withdrawal -.14 .14 .50** Delinquency/Antisocial .03 .03 .43** Failure to Achieve/Persevere .39* -.05 .52** Parent -.20 .05 .40* Life Restrictions -.18 .20 .35* Relationship with spouse/partner -.23 .07 .35* Social Alienation .00 .00 .30 Incompetence/Guilt .02 -.11 .33* Adolescent-Parent Relationship -.09 .21 -.28 *p < .05.**p < .01.
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Appendix G: Pearson-Product-Moment Correlations for Child Variables Correlated with Subscales and Domains of Paternal Parenting Stress
Gender Child Age
Medication Status
SIPA Domain/Subscale Total Stress .11 -.07 .42* Adolescent .08 -.16 .55** Moodiness/Emotional Lability -.02 -.30 .46** Social Isolation/Withdrawal -.05 -.05 .22 Delinquency/Antisocial -.01 -.01 .45** Failure to Achieve/Persevere .25 -.08 .52** Parent .07 .01 .17 Life Restrictions -.02 .26 -.16 Relationship with spouse/partner .13 -.12 .24 Social Alienation .01 .03 .28 Incompetence/Guilt .01 -.15 .31 Adolescent-Parent Relationship -.02 .14 .25 *p < .05.**p < .01.
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Appendix H: Pearson-Product-Moment Correlations for Conners-3 Parent Ratings Correlated with Subscales and Domains of Maternal Parenting Stress
Inattention Hyperactive /Impulsive Aggression
DSM ADHD
Inattentive
ADHD DSM Hyperactive/
Impulsive Peer
Relations
DSM CD
DSM ODD
Conners-3 Parent Ratings Total Stress .59** .44** .60** .58** .39* .44** .53** .71** Adolescent .77** .59** .67** .76** .53** .51** .65** .81** Moodiness/Emotional Lability .55** .43** .67** .54** .37* .38* .48** .77** Social Isolation/Withdrawal .51** .53** .42** .47** .50** .69** .39* .40**
Delinquency/Antisocial .65** .44** .60** .66** .40** .41** .67** .75** Failure to Achieve/Persevere .84** .59** .45** .84** .56** .38* .56** .65** Parent .49** .46** .42** .50** .41** .54** .30 .48** Life Restrictions .45** .37* .32* .44** .30 .37* .19 .37* Relationship with spouse/partner .37* .34* .38* .38* .31* .27 .22 .37* Social Alienation .44** .47** .32* .43** .42** .54** .28 .35* Incompetence/Guilt .43** .35* .32* .47** .30 .41** .22 .50** Adolescent-Parent Relationship .35* .13 .31* .39* .08 .18 .35* .30** *p < .05.**p < .01.
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Appendix I: Pearson-Product-Moment Correlations for Conners-3 Parent Ratings Correlated with Subscales and Domains of Paternal Parenting Stress
Inattention Hyperactive /Impulsive Aggression
DSM ADHD
Inattentive
ADHD DSM
Hyperactive/ Impulsive
Peer Relations
DSM CD
DSM ODD
Conners-3 Parent Ratings Total Stress .54** .38* .48** .55** .38* .20 .44* .58** Adolescent .67** .55** .65** .67** .53** .35* .62** .76** Moodiness/Emotional Lability .45** .44** .62** .44** .43** .31 .51** .67** Social Isolation/Withdrawal .32 .43* .35* .34* .43* .32 .29 .36*
Delinquency/Antisocial .55** .33 .64** .54** .32 .14 .68** .69** Failure to Achieve/Persevere .70** .51** .40* .76** .47** .34* .42* .60** Parent .19 .12 .11 .18 .12 .03 .02 .19 Life Restrictions .01 -.10 .06 -.02 -.07 -,03 .04 .03 Relationship with spouse/partner .27 .26 .16 .28 .25 .10 .08 .30 Social Alienation .29 .26 .23 .32 .25 .10 .20 .33 Incompetence/Guilt .09 .09 -.02 .07 .05 -.01 -.16 .06 Adolescent-Parent Relationship .39* .22 .36* .41* .22 .05 .39* .42* *p < .05. **p < .01.
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Appendix J: Pearson-Product-Moment Correlations for Conners-3 Teacher Ratings Correlated with Subscales and Domains of Maternal Parenting Stress
DSM
ADHD
Inattention Hyperactive /Impulsive Aggression
DSM ADHD
Inattentive Hyperactive/
Impulsive Peer
Relations
DSM CD
DSM ODD
Conners-3 Teacher Ratings Total Stress .48** .38* .35* .52** .35* .31 .33 .25 Adolescent .60** .44** .41** .60** .42** .35* .34* .34* Moodiness/Emotional Lability .34* .26 .24 .37* .23 .26 .20 .15 Social Isolation/Withdrawal .25 .27 .18 .26 .23 .38* .22 .16 Delinquency/Antisocial .54** .37* .41** .53** .38* .28 .37* .35 Failure to Achieve/Persevere .74** .45** .42** .71** .47** .31 .30 .40* Parent .33 .16 .15 .34* .12 .31 .27 .07 Life Restrictions .42* .17 .08 .43** .14 .16 .20 .02 Relationship with spouse/partner .13 -.05 -.03 .14 -.09 .09 .02 -.05 Social Alienation .31 .20 .25 .28 .16 .43** .33* .14 Incompetence/Guilt .37* .16 .19 .38* .16 .24 .27 .04 Adolescent-Parent Relationship .32* .07 .18 .34* .07 .09 .22 -.01 *p < .05, **p < .01
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Appendix K: Pearson-Product-Moment Correlations for Conners-3 Teacher Ratings Correlated with Subscales and Domains of Paternal Parenting Stress
DSM
ADHD
Inattention Hyperactive /Impulsive Aggression
DSM ADHD
Inattentive Hyperactive/
Impulsive Peer
Relations
DSM CD
DSM ODD
Conners-3 Teacher Ratings Total Stress .50** .30 .33 .47** .29 .37* .37* .26 Adolescent .59** .49** .50** .56** .47** .49** .50** .43* Moodiness/Emotional Lability .28 .31* .48** .29 .36* .52** .46** .44* Social Isolation/Withdrawal .12 .08 .06 .08 .04 .27 .17 .08 Delinquency/Antisocial .60** .57** .52** .57** .58** .27 .46** .41* Failure to Achieve/Persevere .71** .35* .37* .66** .38* .41* .40* .32 Parent .19 -.08 -.05 .16 -.10 .15 .02 -.10 Life Restrictions -.06 -.25 -.29 -.04 -.29 .02 -.10 -.33 Relationship with spouse/partner .26 -.02 .17 .21 -.02 .32 .19 .09 Social Alienation .27 .10 -.03 .23 .09 .08 .04 -.04 Incompetence/Guilt .24 .02 .00 .22 .02 .03 -.07 -.02 Adolescent-Parent Relationship .48** .30 .31 .46** .28 .10 .33 .25 *p < .05, **p < .01
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Appendix L: Hierarchical Multiple Regression Predicting Maternal Stress using C3T Ratings of
Adolescent Externalizing Behaviour
Predictors R2 ΔR2 B SEB β Total Stress .32 .32** Step 1 ADHD Status 59.88 15.5 .56** Step 2 .38 .07 ADHD Status 44.67 18.63 .42* Externalizing Behaviour .42 .62 .11 Maternal Inattention .86 .50 .26 Adolescent .58 .58*** Step 1 ADHD Status 45.85 6.71 .76*** Step 2 .61 .03 ADHD Status 40.36 8.18 .67*** Externalizing Behaviour .11 .28 .05 Maternal Inattention .36 .22 .19 Parent .22 .22** Step 1 ADHD Status 17.99 6.03 .48** Step 2 .41 .19* ADHD Status 12.71 6.63 .33 Externalizing Behaviour -.05 .22 -.03 Maternal Inattention .55 .18 .46** * p < .05, ** p < .01, *** p < .001
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Appendix M: Hierarchical Multiple Regression Predicting Paternal Stress Using C3T Ratings of Adolescent Externalizing Behaviour
Predictors R2 ΔR2 B SEB β Total Stress .29 .29** Step 1 ADHD Status 44.06 12.85 .54** Step 2 .30 .01 ADHD Status 40.06 14.84 .49* Externalizing Behaviour .30 .54 .10 Adolescent .52 .52*** Step 1 ADHD Status 36.71 6.47 .72*** Step 2 .55 .03 ADHD Status 31.80 7.34 .62*** Externalizing Behaviour .37 .27 .20 Adolescent-Parent Relationship .09 .09 Step 1 ADHD Status 5.36 3.09 0.3 Step 2 .13 .04 ADHD Status 3.46 3.54 .20 Externalizing Behaviour .14 .13 .22 * p < .05, ** p < .01, *** p < .001