Parenting Stress of Parents of Adolescents with …...parents of children with ADHD who experience high levels of parenting stress have poorer psychological well-being (Crnic & Greenberg,
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
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
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.
iv
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
v
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
vi
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
vii
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.
ix
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
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
References
Abidin, R.R. (1986). The parenting stress index (2nd ed.). Charlottesville, VA: Pediatric Psychology Press.
Abidin, R. R. (1995). The Parenting Stress Index (3rd ed.). Odessa, FL: Psychological Abidin, R.R. (1990). Introduction to the special issue: The stresses of parenting. Journal of
Abidin, R. R. (1992). The determinants of parenting behaviour. Journal of Clinical Child Psychology, 21, 407-412. doi: 10.1207/s15374424jccp2104_12
Anastopoulos, A. D., Guevremont, D. C., Shelton, T. L., & DuPaul, G. J. (1992). Parenting
stress among families of children with attention deficit hyperactivity disorder. Journal of Abnormal Child Psychology, 20, 503-520. doi: 10.1007/BF00916812
Anderson, L.S. (2008). Predictors of parenting stress in a diverse sample of parents of early adolescents in high-risk communities. Nursing Research, 57 (5), 340 -350. doi:10.1097/01.NNR.0000313502.92227.87
Bagwell, C., Molina, B. S. G., Pelham, W. E., & Hoza, B. (2001). Attention-deficit hyperactivity
disorder and problems in peer relations: Predictions from childhood to adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1285–1292. doi: 10.1097/00004583-200111000-00008
Barkley, R. A., Anastopoulos, A. D., Guevremont, D. C., & Fletcher, K. E. (1992). Adolescents
with attention deficit hyperactivity disorder: Mother adolescent interactions, family beliefs and conflicts, and maternal psychopathology. Journal of Abnormal Child Psychology, 20, 263– 288. doi: 10.1007/BF00916692 Barkley, R.A., Fischer, M., Edelbrock, C., & Smallish, L. (1990). The adolescent outcome of
hyperactive children diagnosed by research criteria: An 8-year prospective follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 546-557. doi: 10.1097/00004583-199007000-00007
Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2004). Young adult follow-up of
hyperactive children: antisocial activities and drug use. Journal of Child Psychology and Psychiatry, 45, 195–211. doi:10.1111/j.1469-7610.2004.00214.x
Barkley, R. A., Karlsson, J., & Pollard, S. (1985). Effects of age on the mother child
interactions of ADD-H and normal boys. Journal of Abnormal Child Psychology, 13, 631–637. doi: 10.1007/BF00923146
40
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173-1182. doi:10.1037/0022-3514.51.6.1173
Biederman, J., Faraone, S. V., Mick, E., Spencer, T., Wilens, T., Kiley, K., et al. (1995). High
risk for attention deficit disorder among children of parents with child childhood onset of the disorder: A pilot study. American Journal of Psychiatry, 152, 431-435.
Bianchi, S. M., & Raley, S.B. (2005). Time allocation in families. In Work, family, health, and
well-being, eds. S. M. Bianchi, L. M. Casper, and R. B. King, pp. 21–42. Mahwah, NJ: Erlbaum.
Breen, M. J., & Barkley, R. A. (1988). Child psychopathology and parenting stress in girls and boys having attention deficit disorder with hyperactivity. Journal of Pediatric Psychology, 13, 265-280. doi: 10.1093/jpepsy/13.2.265
Bronte-Tinkew, J., Horowitz, A. & Carrano, J (2010). Aggravation and stress in parenting:
Associations with coparenting and father engagement among resident fathers. Journal of Family Issues, 31, 525-555. doi: 10.1177/0192513X09340147.
Brunk, M. A,, & Henggeler, S. W. (1984). Child influences on adult controls: An experimental
Collins, W.A., Madsen, S.D., & Susman-Stillman, A. (2002). Parenting during middle
childhood. In M.H. Bornstein (Ed.), Handbook of parenting: Children and parenting (2nd ed., Vol.1, pp. 73-101). Mahwah, NJ: Erlbaum.
Coltrane, S. 2000. Research on household labor: Modeling and measuring the social
embeddedness of routine family work. Journal of Marriage & Family 62:1208–33.doi 10.1111/j.1741-3737.2000.01208.x
Conners, C.K. (2008). Conners-3 (3rd ed.). Toronto, ON: Multi-Health Systems Inc.
Conners, C. K., Erhardt, D., & Sparrow, E. (1999). Conners’ adult ADHD rating scales (CAARS) technical manual. Toronto, Canada: Multi-Health Systems.
Crnic, K., & Greenberg, M. (1990). Minor parenting stress with young children. Child Development, 54, 209-217. doi: 10.2307/1130770
Danforth, J. S., Harvey, E., Ulaszek, W. R., & McKee, T. E. (2006). The outcome of group
parent training for families of children with attention-deficit hyperactivity disorder and defiant/aggressive behavior. Journal of Behavior Therapy and Experimental Psychiatry, 37, 188–205. doi:10.1016/j.jbtep.2005.05.009
41
Deater-Deckard, K. (2004). Parenting stress and child adjustment: Some old hypotheses and new questions. Clinical Psychology: Science and Practice, 5, 314-332. Dishion, T.J.,Nelson, S.E. & Kavanagh, K. (2003) The family check-up with high-risk young adolescents: Preventing early-onset substance use by parent monitoring. Behaviour Therapy, 4(4), 553–571.doi 10.1016/S0005-7894(03)80035-7
DuPaul, G. J., McGoey, K. E., Eckert, T., & VanBrakle, J. (2001). Preschool children with
attention-deficit/hyperactivity disorder: Impairments in behavioural, social, and school functioning. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 508-515.doi: 10.1097/00004583-200105000-00009
Duncan, S.C., Duncan, T.E. & Strycker, L.A (2000). Risk and protective factors influencing adolescent problem behavior: A multivariate latent growth curve analysis. Annals of Behavioral Medicine, 22, 103-109. doi:10.1007/BF02895772 Edwards,G.,Barkley,R.A.,Laneri,M.,Fletcher,K.,&Metevia,L.(2001). Parent–adolescent conflict in teenagers with ADHD and ODD. Journal of Abnormal Child Psychology, 29(6), 557- 572. doi: 10.1023/A:1012285326937
Erhardt, D., Epstein, J. N., Conners, C. K., Parker, J. D. A., & Sitarenios, G. (1999). Self- ratings
of ADHD symptoms in adults II. Reliability, validity, and diagnostic sensitivity. Journal of Attention Disorders, 3, 153–158.
Fabiano, G. A., Chacko, A., Pelham, W. E., Jr., Robb, J., Walker, K., Wymbs, F., Sastry, A. L.,
Flammer, L., Keenan, J. K., Visweswaraiah, H., Shulman, S., Herbst, L., & Pirvics, L. (2009). A comparison of behavioral parent training programs for fathers of children with attention-deficit/hyperactivity disorder. Behavior Therapy, 40(2), 190-204. doi: 10.1016/j.beth.2008.05.002
Fagan, J., Barnett, M., Bernd, E., & Whiteman, V. (2003). Prenatal involvement of
adolescent unmarried fathers. Fathering, 1(3), 283-301. doi: 10.3149/fth.0103.283 Fischer, M. (1990). Parenting stress and the child with attention deficit hyperactivity
disorder. Journal of Clinical Child Psychology. Special Issue: The Stresses of Parenting, 19, 337- 346. doi:10.1207/s15374424jccp1904_5
Furstenberg, F.F (1999). Managing to make it: Urban families and adolescent success. Chicago:
University of Chicago Press. Greenwald, R. L. (1989). Abusive parenting: A discipline mediated model. Unpublished
doctoral dissertation, Department of Psychology, University of Oregon, Eugene.
42
Harrison, C. & Sofronoff, K. (2002). ADHD and parental psychological distress: Role of demographics, child behavioral characteristics, and parental cognitions. Journal of the American Academy of Child and Adolescent Psychiatry, 41 (6), 703-711. doi:10.1097/00004583-200206000-00010 Henderson, C.E., Rowe, C.L., Dakof, G.A., Hawes, S.W. & Liddle, H.A. (2009). Parenting practices as mediators of treatment effects in an early-intervention trial of multidimensional family therapy. American Journal of Drug and Alcohol Abuse, 35, 220- 226. doi:10.1080/00952990903005890
Hinshaw, S.P. (1992). Externalizing behaviour problems and academic underachievement in
childhood and adolescence: Causal relationships and underlying mechanisms. Psychological Bulletin, 111(1), 127-155. doi:10.1037//0033-2909.111.1.127
Hinshaw S. P., & Melnick S. M. (1995). Peer relationships in boys with attention-deficit
hyperactivity disorder with and without comorbid ag- gression. Development and Psychopathology, 7, 627–647. doi:10.1017/S0954579400006751
Hofferth, S. L., Cabrera, N., Carlson, M., Coley, R. L., Day, R., & Schindler, H. (2007). Resident
father involvement and social fathering. In S. L. Hofferth & L. M. Casper (Eds.), Handbook of measurement issues in family research (pp. 335–374). Mahwah, NJ: Erlbaum.
Hofferth, S. L., Stueve, J. L., Pleck, J., Bianchi, S., & Sayer, L. (2002). The demography of
fathers: What fathers do. In C. S. Tamis-LeMonda & N. Cabrera (Eds.), Handbook of father involvement: Multidisciplinary perspectives (pp. 63–90). Mahwah, NJ: Lawrence Erlbaum Associates.
Hosley, C. A., & Montemayor, R. (1997). Fathers and adolescents. In M. E. Lamb (Ed.), The
role of the father in child development (3rd ed., pp. 163–178). New York: Wiley. Johnston, C. & Mash, E. (2001). Families of children with Attention-Deficit/Hyperactivity
Disorder: Review and Recommendations for Future Research. Clinical Child and Family Psychology Review, 4, 183-207.doi: 10.1023/A:1017592030434
for child behaviour using open-ended questions. Journal of Clinical Child Psychology, 27, 87-97. doi: 10.1207/s15374424jccp2701_10
Kazdin, A.E. (1995). Child, parent and family dysfunction as predictors of outcomes in
cognitive-behavioral treatment of antisocial children. Behaviour Research and Therapy, 33(3), 271-281. doi:10.1016/0005-7967(94)00053-M
Kazdin, A.E. & Nock, M.K. (2003) Delineating mechanisms of change in child and adolescent therapy: Methodological issues and research recommendations. Journal of Child Psychology and Psychiatry, 44:1116–1129. doi:10.1111/1469-7610.00195
43
Kazdin, A. E., & Whitley, M. K. (2003). Treatment of parental stress to enhance therapeutic change among children referred for aggressive and antisocial behavior. Journal of Consulting and Clinical Psychology, 71, 504-515. doi:10.1037/0022-006X.71.3.504 Lange, G., Sheerin, D., Carr, A., Dooley, B., Barton, V., Marshall, D.,... Doyle, M. (2005). Family factors associated with attention deficit hyperactivity disorder and emotional disorders in children. Journal of Family Therapy, 27, 79-96. doi: 10.1111/j.1467- 6427.2005.00300.x
Larson, R.W. & Verna, S. (1999). How children and adolescents spend time across the world:
Lazarus, R.S. & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer. Lewis, C., & Lamb, M. E. (2003). Fathers’ influences on children’s development: The evidence
from two-parent families. European Journal of Psychology of Education, 18, 211–228. doi:10.1007/BF03173485
Lo Coco, A., Ingoglia, S., Zappulla, C., & Pace, U. (2001). Condizioni di stress genitoriale,
autonomia emotive e adattamento psicologico durante l’adolescenze [Parental stress, emotional autonomy and psychological adjustment during adolescence]. Eta Evolutiva, 69, 88-94.
substance use: An examination of deviant peer group affiliation as a risk factor. Psychology of addictive behaviors, 17, 293-302. doi:10.1037/0893-164X.17.4.293
Mash, E.J., & Johnston, C. (1983). Parental perceptions of child behavior problems,
parenting self-esteem, and mothers’ reported stress in younger and older hyperactive and normal children. Journal of Consulting and Clinical Psychology, 51, 86-99. doi:10.1037/0022-006X.51.1.86
Mash, E. J., & Johnston, C. (1990). Determinants of parenting stress: Illustrations from
families of hyperactive children and families of physically abused children. Journal of Clinical Child Psychology, Special Issue: The Stresses of Parenting, 19, 313-328. doi:10.1207/s15374424jccp1904_3
McCleary, L. (2002). Parenting adolescents with attention deficit hyperactivity disorder:
Analysis of the literature for social work practice. Health & Social Work, 27, 285- 292. McCleary, L. & Ridley, T. (1999). Parenting adolescents with ADHD: Evaluation of a
psychoeducation group. Patient Education and Counseling, 38, 3-10. doi:10.1016/S0738- 3991(98)00110-4
44
McClellan, J. M., & Werry, J. S. (2003). Evidence-based treatments in child and adolescent psychiatry: An inventory. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1388-1400.
McKee,T.E., Harvey, E., Danforth, J.S., Ulaszek, W.R. & Freidman, J.L. (2004). The relation
between parental coping styles and parent-child interactions before and after treatment for children with ADHD and oppositional disorder. Journal of Clinical Child and Adolescent Psychology, 33, 158-168. doi:10.1207/S15374424JCCP3301_15
Miller, S.A. (1988). Parents’ beliefs about children’s cognitive development. Child
Development. 59, 259-285. doi:10.2307/1130311 Minde, K., Eakin, L., Hechtman, L., Ochs, E., Bouffard, R., Greenfield, B., et al. (2003). The
psychosocial functioning of children and spouses of adults with ADHD. Journal of Child Psychology and Psychiatry, 44, 637-646. doi:10.1111/1469-7610.00150
Mokrova,I., O’Brien, M., Calkins, S. & Keane, S. (2010). Parental ADHD symptomology
and ineffective parenting: The connecting link of home chaos. Parenting, 10 (2), 119- 135. doi:10.1080/15295190903212844
Morgan, J., Robinson, D. & Aldridge, J. (2002). Parenting stress and externalizing child
behaviour. Child and Family Social Work, 7, 219-225. doi 10.1046/j.1365- 2206.2002.00242.x
Murphy, K. & Barkley, R.A. (1996). Attention-deficit/hyperactivity disorder in adults:
Comorbidities and adaptive impairment. Comprehensive Psychiatry, 37, 393-401. doi:10.1016/S0010-440X(96)90022-X
Murray, C. & Johnston, C. (2006). Parenting in mothers with and without attention-
deficit/hyperactivity disorder. Journal of Abnormal Psychology, 115, 52-61. doi:10.1037/0021-843X.115.1.52
O’Connor, B. P., & Dvorak, T. (2001). Conditional associations between parental behavior and adolescent problems: A search for personality-environment interactions. Journal of Research in Personality, 35, 1–26. doi:10.1006/jrpe.2000.2295
Ostberg, M., & Hagekull, B. (2000). A structural modeling approach to understanding parenting stress. Journal of Clinical Child Psychology, 29(4), 615-625. doi:10.1207/S15374424JCCP2904_13
Parke, R. D. (2000). Father involvement: A developmental psychological perspective. Marriage
and Family Review, 29, 43–58. doi:10.1300/J002v29n02_04 Parke, R. D., McDowell, D. J., Kim, M., Killian, C., Dennis, J., Flyr, M. L., & Wild, M. N. (2002). Fathers’ contributions to children’s peer relationships. In C. S. Tamis-LeMonda & N. Cabrera (Eds.), Handbook of father involvement: Multidisciplinary perspectives (pp. 141–167). Mahwah, NJ: Lawrence Erlbaum Associates.
45
Pasley, K. & Gecas, V. (1984). Stresses and satisfaction of the parental role. The Personnel and Guidance Journal, 62, 400-404.
Patterson, G.R., Dishion, T.J. & Yoerger, K. (2000). Adolescent growth in new forms of problem
Patterson, G. R., & Forgatch, M. S. (1990). Initiation and maintenance of process disrupting
single-mother families. In G. R. Patterson (Ed.), Depression and aggression in family interaction (pp. 209-245). Hillsdale, NJ: Erlbaum.
Patterson, G.R., Reid, J.B. & Dishion, T.J (1992). Antisocial boys, Eugene, OR: Castalia. Phares, V., Fields, S. & Kamboukos, D. (2009). Fathers’ and mothers’ involvement with their
adolescents. Journal of child and family studies, 18, 1-9. doi:10.1007/s10826-008-9200-7 Pisterman, S., Firestone, P., McGrath, P., Goodman, J.T., Webster, I., Mallory, R. & Coffin, B.
(1992). The effects of parent training on parenting stress and sense of competence. Canadian Journal of Behavioural Science, 24(1), 41-58. doi:10.1037/h0078699
(2010). Stability, continuity, and similarity of parenting stress in European American mothers and fathers across their child’s transition into adolescence. Parenting, 10 (1), 60- 77. DOI: 10.1080/15295190903014638.
Robin, A. L. (1990). Training families of ADHD adolescents. In R. A. Barkley (Ed.), Attention
deficit hyperactivity disorder: A handbook for diagnosis and treatment (pp. 462-497). New York: Guilford Press.
Scarr, S., Philips, D. & McCartney, K. (1990). Facts, fantasies, and the future of child care
in the United States. Psycholgical Science, 1, 26-35. doi:10.1111/j.14679280.1990.tb00061.x Sheras, P. L., Abidin, R. R., & Konold, T. R. (1998). Stress Index for Parents of Adolescents.
Psychological Assessment Resources, Odessa, FL. Small, S.A., Eastman, G. & Cornelius, S. (1988). Adolescent autonomy and parental stress.
Journal of Youth and Adolescence, 17, 377-391. doi:10.1007/BF01537880
Sobel M.E., Asymptotic confidence intervals for indirect effects in structural equation models. In: Leinhardt, S., editor. Sociological Methodology 1982.Washington, DC: American Sociological Association; 1982. p. 290-312.
Stice, E., Ragan, J., & Randall, P. (2004). Prospective relations between social support and
depression: Differential direction of effects for parent and peer support. Journal of Abnormal Psychology, 113 (1), 155-159. doi:10.1037/0021-843X.113.1.155
46
Stormshak, E.A., Bierman, K.L., McMahon, R.J. & Lengua, L.J. (2000). Parentin practices and child disruptive behavior problems in early elementary school. Journal of Clinical Child Psychology, 29, 17-29. doi:10.1207/S15374424jccp2901_3
Stright, A. D., & Bales, S. S. (2003). Coparenting quality: Contributions of child and parent
characteristics. Family Relations, 52, 232-240. doi:10.1111/j.1741-3729.2003.00232.x
Taylor, E., Dopfner, M., Sergeant, J., Asherson, P., Banaschewski, T., Buitelaar, J., et al. (2004). European clinical guidelines for hyperkinetic disorder—First upgrade. European Child & Adolescent Psychiatry, 13, I7-30. doi:10.1007/s00787-004-1002-x
Thoits, P.A (1992) Identity structures and psychological well-being: Gender and marital status
comparisons. Social Psychology Quarterly, 55, 236-256. doi:10.2307/2786794 Theule, J., Wiener, J., Jenkins, J. & Tannock, R. (in press). Parenting stress in families of
children with ADHD: A meta-analysis. Journal of Emotional and Behavioral Disorders.
van der Oord, S., Prins, P.J.M., Oosterlaan, J., & Emmelkamp, P.M.G. (2006). The association between parenting stress, depressed mood, and informant agreement in ADHD and ODD. Behaviour Research and Therapy, 44, 1585-1595. doi:10.1016/j.brat.2005.11.011
Webster-Stratton, C. (1990). Stress: A potential disruptor of parent perceptions and family interactions. Journal of Clinical Child Psychology, 19, 302-312. doi:10.1207/s15374424jccp1904_2
Webster-Stratton, C. & Hammond, M. (1988). Maternal depression and its relationship to life
stress, perceptions of child behavior problems, parenting behaviors, and child conduct problems. Journal of Abnormal Child Psychology, 16, 299-315. doi:10.1007/BF00913802
Wechsler, D. (1999). Manual for the Wechsler Abbreviated Scale of Intelligence (WASI). San
Antonio, TX: Psychological Corporation. Weiss, M., Hechtman, L., & Weiss, G. (2000). ADHD in parents. Journal of the American
Academy of Child and Adolescent Psychiatry, 39, 1059-1061. doi: 10.1097/00004583-200008000-00023
spectrum and everyday life: Experience sampling of adolescent moods, activities, smoking and drinking. Society for Research in Child Development, 73, 209-227. doi:10.1111/1467-8624.00401
Whalen, C.K. & Henker, B. (1992). The social profile of attention-deficit hyperactivity disorder:
Five fundamental facets. Child and Adolescent Psychiatric Clinics of North America, 1, 395-410.
47
Wilens, T.E., Martleton, M., Joshi, G., Bateman, C., Fried, R., Petty, C. & Biederman, J. (2010). Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 543-553. doi:10.1016/j.jaac.2011.01.021
48
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
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.
51
52
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.
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
55
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
56
Appendices
Appendix A: Adolescent and Parent Assent and Consent Forms and Letters
57
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.
58
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.
59
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
60
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
61
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.
62
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?
63
“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
64
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.
65
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.
66
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
67
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
68
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
69
Appendix C: ANOVA Summary for Maternal Stress by ADHD Status and Gender