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JAD17110.1177/1087054711427562Ste
Articles
Abstract
Objective: To compare psychopathology and personality in parents of children with ADHD and control parents. Method:
A total of 140 parents were subdivided according to presence and duration of ADHD. Assessment was based on various
ADHD self-rating scales, the revised Symptom Checklist (SCL-90-R), the Patient Health Questionnaire (PHQ), and the
revised NEO Five Factors Inventory (NEO-FFI). Results: Parents with lifelong persistent ADHD were most abnormal on
all dimensions of ADHD psychopathology, the SCL-90-R, the PHQ, and the neuroticism and conscientiousness dimensions
of the NEO-FFI. The scores of parents with current ADHD approached those of parents with persistent ADHD on most
dimensions, and both groups scored higher than did parents with either remitted ADHD or no ADHD, or controls. The
scores of the latter three groups were not significantly different from each other. Conclusion: Among parents of children
with ADHD, parents with lifelong persistent or current ADHD show highest scores of psychopathology. (J. of Att. Dis. 2013;
17(1) 38-46)
Keywords
adult ADHD, parents, personality, psychopathology
Following the increasing awareness that ADHD is a lifelong condition in many afflicted individuals, there has been
a strong interest in the psychopathology, personality, and
everyday life functioning of adults with ADHD. Typically,
the samples for these studies have been recruited from
long-term follow-up studies of former child or adolescent
patients or among newly diagnosed adult patients (e.g.,
Barkley, Murphy, & Fischer, 2008; Biederman et al., 1993;
Deault, 2010; Johnston & Mash, 2001; Kashdan et al.,
2004; Kessler et al., 2006; Murphy & Barkley, 1996;
Ninowiski, Marh, & Benzies, 2007; Satterfield et al., 2007;
Weiss & Hechtman, 1993).
In a smaller number of studies, there has been a specific
focus on parents of children with ADHD due to the observation that ADHD runs in families. Using this recruiting
strategy, parents of children with ADHD came into the
focus of research on parenting stress (Minde et al., 2003;
Murray & Johnston, 2006; Sonuga-Barke, Daley, &
Thompson, 2002; Tzang, Chan & Liu, 2009). So far, both
strategies of research have led to rather similar findings,
namely, that ADHD in adults including parents is associated with a high load of other-than-ADHD psychopathology and psychosocial dysfunctioning.
Research strategies have used different sorts of assessments for adults with ADHD, including symptom checklists
based on and modified from the Diagnostic and Statistical
Corresponding Author:
Hans-Christoph Steinhausen, Department of Child and Adolescent Psychiatry,
University of Zurich, Neptunstrasse 60, CH-8032 Zurich, Switzerland
Email: hc.steinhausen@kjpd.uzh.ch
39
Steinhausen et al.
association with certain genotypes. The present contribution had the aim of studying the impact of ADHD in parents
on other psychopathology and major personality dimensions by differentiating various manifestations of ADHD in
these parents, namely, lifelong persistent ADHD, current
ADHD, and remitted ADHD. In addition, it was intended to
control for the impact of ADHD in the child rather than the
parent by including a subgroup of parents with an ADHD
child but without parental ADHD and a normal control
group (CG) of parents.
Method
Samples
The recruitment of children with ADHD included referred
and nonreferred participants. The referred children came
from a public child and adolescent psychiatric service and
from local pediatricians and child and adolescent psychiatrists in private practice. Further participants came from a
large national ADHD self-help group or responded to various campaigns in the media providing information on the
project.
The 70 participating ADHD families consisted of biological parents and two children aged 8 to 16 years, with at
least one sibling meeting criteria for DSM-IV combined
type. Based on specific ADHD assessment procedures (see
the following sections), there were 70 ADHD index children (M age = 11.4, SD = 2.0 years; male:female (m:f) ratio
3:1; M IQ = 115.9, SD = 16.5). The 34 control children (M
age = 11.1, SD = 2.1 years; m:f ratio 1.25:1; M IQ = 119.5,
SD = 16.5) were recruited from regional elementary schools,
friends, or local sport clubs. The 140 parents of children
with ADHD included 70 fathers (M age = 44.3, SD =
4.6 years) and 70 mothers (M age = 41.9, SD = 4.4 years).
In addition, there were 17 fathers (M age = 45.6, SD =
6.1 years) and 17 mothers (M age = 43.8, SD = 4.7 years) in
the CG. Age did not differ significantly between these two
groups, t(172) = 1.67, p = n.s.
Based on diagnostic assessments (see the following sections), the 140 parents of children with ADHD were classified into the following four groups: (a) parents with a
lifelong history of persistent ADHD (ADHD-L, n =
30, m:f = 0.76:1), (b) parents with current ADHD (ADHD-C,
n = 20, m:f = 0.43:1), (c) parents with remitted ADHD
(ADHD-R, n = 9, m:f = 0.8:1), and (d) parents with ADHD
not present (ADHD-NP, n = 81, m:f = 1.4:1).
Assessments
Rating scales used to quantify ADHD symptoms in children
have been described in detail in a recent companion article
(Steinhausen et al., 2010). In brief, the procedure included
40
Statistical analyses
Two parallel statistical procedures were performed when
comparing the findings in the four samples. To control for
unequal sample sizes, normal distribution of variables (analyzed with the KolmogorovSmirnov test), homogeneity of
variances (Levene test), and homogeneity of variance
covariance matrices (Boxs M test) were checked first. With
a few exceptions, in most of the variables, there was a violation of these prerequisites of the analysis of variance model.
As a consequence, the nonparametric KruskalWallis test
was performed as a first strategy of data analysis.
In a second approach, group comparisons were performed by use of MANCOVA controlling for age and sex
and followed by post hoc comparisons based on Bonferroni
corrections. If these analyses did not explain more variance
than MANOVA without these covariables, the latter were
followed by Hochberg post hoc tests (in the case of equal
variances) or GamesHowell post hoc tests (in the case of
unequal variances). Finally, if there were no differences in
the level of significance between the nonparametric and the
parametric approach, the MANOVA model was preferred
because of a better control of chance findings.
After controlling for the potential impact of the covariables and after comparing both statistical approaches, the
final data to be reported here are based only on MANOVA
and MANCOVA models. All analyses were performed with
the help of the Statistical Program for Social Sciences
(SPSS, version 16.0).
Results
Findings based on a comparison of the SCL-90-R scores of
the five groups are presented in Table 1. For the sake of
Discussion
The first main finding of the present study is a remarkable
abnormality of the group of parents with a lifelong history
of persistent ADHD on all scales measuring psychopathology and in the personality domains of high neuroticism and
low conscientiousness. Second, there is strong evidence
that parents with current ADHD without clear indication of
a lifelong history of the disorder have a very similar profile
of abnormality like the ADHD-L group with no real
significant differentiation. Third, these two groups differ
significantly from the other two groups containing parents
with remitted ADHD and parents without ADHD but both
having children with ADHD. Finally, in terms of psychopathology and personality, these two groups of parents with
41
Steinhausen et al.
Table 1. Comparison of Symptom Checklist 90Revised (SCL-90-R) Findings in Five Groups
ADHD
lifelong
(ADHD-L)
Somatization
Obsessivecompulsive
Interpersonal
sensitivity
Depression
Anxiety
Hostility
Phobic
anxiety
Paranoid
ideation
Psychoticism
GSI
PST
PSDI
ADHD
current
(ADHD-C)
ADHD
remitted
(ADHD-R)
ADHD
not
present
(ADHDNP)
Control
group
(CG)
Post hoc comparisons
SD
SD
SD
SD
SD
52.8
60.4
9.5
7.4
51.0
58.7
6.9
8.7
47.0
52.1
8.0
7.4
45.7
50.1
8.8
8.1
44.3
48.6
6.5
8.9
6.09
13.39
<.001
<.001
59.7
9.6
54.4
11.0
50.3
8.2
49.0
7.5
47.8
7.2
11.44
<.001
60.6
57.4
59.7
54.9
9.9
6.8
8.0
9.5
56.0
56.3
55.9
54.2
9.4
7.7
9.1
7.7
49.6
48.6
49.3
50.4
9.0
9.3
4.6
9.4
48.8
47.9
49.5
49.0
8.9
7.8
8.5
6.6
48.9
47.7
49.9
46.9
8.7
6.8
7.5
4.4
11.14
13.02
10.51
7.25
<.001
<.001
<.001
<.001
L > R, NP, CG
L > R, NP, CG
a
L > R, NP, CG
b
L > NP, CG
C > NP
C > NP, CG
C > NP
C > CG
58.7
9.3
53.5
8.8
49
11.0
49.2
6.9
46.9
7.2
11.12
<.001
54.7
59.6
58.0
8.8
7.7
6.9
54.2
55.6
56.0
8.9
8.9
6.9
50.7
48.9
49.0
7.9
9.3
8.5
48.0
48.1
48.5
7.0
8.2
8.0
48.8
47.1
47.8
6.1
7.9
8.1
6.16
14.23
11.93
<.001
<.001
<.001
L > NP, CG
L > R, NP, CG
a
L > R, NP, CG
C > NP
C > NP, CG
C > NP, CG
58.1
7.2
54.0
8.8
47.4
7.8
47.2
8.0
45.8
6.1
15.22
<.001
C > NP, CG
L > NP, CG
L > NP, CG
L > R, NP, CG
L > NP, CG
L > R, NP, CG
C > NP, CG
Note: GSI = global severity index; PST = positive symptom total; PSDI = positive symptom distress index. Multivariate group of the scales first order:
Wilkss lambda = .605, F = 2.29; df = 36, 601; p <.001. Multivariate group effect of the scales second order (GSI, PST, PSDI): Wilkss lambda = .679; F = 5.76;
df = 12, 439; p < .001.
a
Hochbergs post hoc tests.
b
GamesHowell post hoc tests.
65
T-Scores
60
ADHD-L
ADHD-C
55
ADHD-R
50
ADHD-NP
CG
45
40
SCL-90-R Scales
Note: ADHD-L = parents with a lifelong history of persistent ADHD; ADHD-C = parents with current ADHD; ADHD-R = parents with remitted
ADHD; ADHD-NP = parents with ADHD not present; CG = control group.
***p < .001
42
ADHD
lifelong
(ADHD-L)
ADHD
current
(ADHD-C)
ADHD
remitted
(ADHD-R)
ADHD
not
present
(ADHDNP)
SD
SD
SD
SD
SD
Depression
Somatic
symptoms
Stress
8.7
7.2
4.6
3.8
6.3
6.4
3.4
4.5
4.1
4.0
2.8
9.0
3.1
4.3
2.9
3.3
3.1
3.5
2.4
2.6
18.9
6.09
<.001
<.001
C > NP, CG
L > R, NP, CG
L > NP, CG
7.1
3.9
5.5
3.0
4.7
3.5
3.4
3.2
3.3
2.5
7.77
<.001
C<L
L > C, R, NP, CG
Control
group
(CG)
a
Pairwise comparisons
Note: Multivariate effect of group: Wilkss lambda = .650, F = 6.43, df = 12, 437; p <.001. Multivariate effect of sex: Wilkss lambda = .886, F = 7.07,
df = 3, 165; p < .001.
a
Pairwise comparisons have been performed with a Bonferroni correction.
10
9
Raw scores
ADHD-L
ADHD-C
ADHD-R
ADHD-NP
CG
3
2
PHQ-D Scales
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Steinhausen et al.
Table 3. Comparison of NEO Five Factors Inventory (NEO-FFI) Findings in Five Groups
ADHD not
present
(ADHDNP)
ADHD
lifelong
(ADHD-L)
ADHD
current
(ADHD-C)
ADHD
remitted
(ADHD-R)
Control
group
(CG)
SD
SD
SD
SD
SD
Neuroticism
Extraversion
Openness to
experience
Agreeableness
Conscientiousness
2.2
2.2
2.3
0.8
0.7
0.5
2.1
2.2
2.5
0.7
0.7
0.6
1.7
2.4
2.5
0.8
0.3
0.4
1.4
2.3
2.4
0.6
0.5
0.6
1.5
2.4
2.4
0.6
0.5
0.4
8.14
0.87
0.29
2.5
2.4
0.5
0.6
2.5
2.3
0.6
0.8
2.7
2.7
0.5
0.6
2.7
3.0
0.4
0.5
2.6
2.9
0.4 2.47
0.5 11.38
Pairwise comparisons
<.001 C > NP
.483
.887
L > NP, CG
.047
<.001 C > NP, CG L > NP, CG
Note: Multivariate effect of group: Wilkss lambda = .693, F = 3.14, df = 20, 538; p < .001. Multivariate effect of sex: Wilkss lambda = .841, F = 6.12, df = 5,
162; p < .001. Multivariate effect of age: Wilkss lambda = .936, F = 2.21, df = 5, 162; p = .055.
a
Pairwise comparisons have been performed with a Bonferroni correction.
3.5
Raw scores
3
2.5
ADHD-L
ADHD-C
ADHD-R
ADHD-NP
CG
2
1.5
1
NEO-FFI Scales
44
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article: This
study was financially supported by a grant from the Swiss
National Science Foundation to the first author.
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Bios
Hans-Christoph Steinhausen is professor and chairman emeritus
at the Department of Child and Adolescent Psychiatry, University
of Zurich, Switzerland, Honorary Professor at the Institute of
Psychology, University of Basel, Switzerland, and Professor of
Child and Adolescent Psychiatry at Aalborg Psychiatric Hospital,
Aarhus University Hospital, Denmark. He graduated with an MD
in medicine (1970), a PhD in psychology (1975), and a postdoctoral dissertation in medicine (DMSc. 1976). His current major
research interests include developmental psychopathology and
various neuroscientific, genetic, and clinical issues in child and
adolescent psychopathology.
Julia Gllner graduated in 2010 with an MA in psychology. In
her master thesis, she worked on psychopathology and personality
issues in the parents of children with ADHD. Currently she specializes in clinical child and adolescent psychology.
Daniel Brandeis is professor at the Departments of Child and
Adolescent Psychiatry, University of Zurich, Switzerland, and the
Central Institute of Mental Health, Medical Faculty Mannheim/
Heidelberg University, Germany. He graduated with diploma and
doctorate in Biological Sciences (1979, 1986) and holds a MA in
Psychology (1981). His current main research interests include the
developmental neuroscience of ADHD and dyslexia and their treatments, using neurophysiological, multimodal imaging, and genetic
approaches.
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