Marlene Busko

Medscape Medical News 2008. © 2008 Medscape

October 31, 2008 — Attention-deficit/hyperactivity disorder (ADHD) in children not only poses significant challenges for the children themselves, but new research shows that it can also exact a significant toll on their families.

Two new studies report that having a child with ADHD doubles the likelihood of divorce, and ADHD has a significant negative impact on family routines and relationships.

In the first study to compare the durability of marriages of parents of children with or without ADHD and to identify divorce risk factors in this group, investigators at University at Buffalo, in New York, found that by the time children with ADHD are 8 years old, their parents are twice as likely to be divorced as parents of other children.

"This work highlights the importance of considering the whole family when you are treating a child with ADHD and not just treating the child and the symptoms," senior author William E. Pelham, Jr., PhD, told Medscape Psychiatry.

Parents need tools to learn how to cope with the stresses of having a child with ADHD, he added. In addition to treating the child, clinicians must ensure that parents get any needed behavioural parent training.

The study was published in the October issue of the Journal of Consulting and Clinical Psychology.

Antisocial Father, Poorly Educated Mother

Previous research has not consistently shown that childhood ADHD is linked to a greater risk for divorce, but these studies only looked at a single point in time, said Dr. Pelham.

To examine the rates and predictors of parental divorce among children with or without ADHD, the investigators analysed longitudinal data from parents of adolescents and young adults who participated in the Pittsburgh ADHD Longitudinal Study (PALS).

Children diagnosed with ADHD (n = 282) were compared with a control group of children without ADHD (n = 206). At study entry, subjects were 5 to 12 years old. Marital data were obtained from parents at 8-year follow-up. All parents had been married at some point during the study period.

Parents of children with ADHD were more likely than other parents to divorce when their child was between the ages of 1 and 8 years. By the time the children were 8 years old, 22.7% of the parents of children with ADHD were divorced, compared with 12.6% in the control parents. After age 8, the gap in the divorce rate did not widen between the 2 groups.

Risk for divorce was greatest if the father had a lifetime history of antisocial/criminal behaviour, and was also increased if the mother had substantially less education than the father.

In future studies, the group will investigate different ADHD treatments in children and their potential affect on parental divorce, said Dr. Pelham.

Strained Family Relationships

In a second study, David Coghill, MD, from the Centre for Child Health, in Dundee, Scotland, and colleagues also found that ADHD placed a significant strain on family relationships.

Based on responses to an online survey, almost three quarters of the parents of children with ADHD reported that the disorder had a negative impact on their relationship with the child, and just over 50% reported problems with relationships between the child with ADHD and his or her siblings or peers.

In contrast, fewer parents of children without ADHD reported problems in the relationships with their child (43%), or between their child and siblings (29%) or other children (12%).

The study was published online October 28 in Child and Adolescent Psychiatry and Mental Health.

To explore the impact of ADHD on children's everyday activities, behaviour, and relationships, as assessed by the parents, the group analysed data from a household survey of 910 parents of children with ADHD and 955 parents of children without ADHD living in 10 European countries.

The households included those with a child aged 6 to 18 years with a confirmed diagnosis of ADHD and those with a child with no ADHD. Most of the children with ADHD (62%) were not receiving medication at the time of the study. Children who were receiving the nonstimulant medication atomoxetine (Strattera, Eli Lilly) or who were receiving only 1 dose of an immediate-release stimulant were excluded from the study.

Parents of children with ADHD were much more likely than other parents to report that their children consistently exhibited demanding, noisy, disruptive, disorganized, and impulsive behaviour.

This type of behaviour had the most significant impact on homework, family routines, and playing with other children.

"Results from this parental survey demonstrate the breadth of problems experienced by children with ADHD [and also alert] physicians to a range of factors that should be considered in the management of children with ADHD," the authors write.

The study by Pelham et al was funded by grants from the National Institute of Mental Health, the National Centre for Education Research, the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute of Environmental Health Sciences. The authors of that study have disclosed no relevant financial relationships.