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JAD17110.1177/1087054711427562Ste

Articles

Psychopathology and Personality in Parents


of Children With ADHD

Journal of Attention Disorders


17(1) 3846
2013 SAGE Publications
Reprints and permission:
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DOI: 10.1177/1087054711427562
http://jad.sagepub.com

Hans-Christoph Steinhausen1,2,3, Julia Gllner2, Daniel Brandeis1,4,


Ueli C. Mller1,5, Lilian Valko1, and Renate Drechsler1

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

Manual of Mental Disorders (4th ed.; DSM-IV; American


Psychiatric Association, 1994) criteria developed for children,
interview schedules aiming at the categorical ADHD diagnosis, and various sorts of dimensional self-reports assessing
ADHD and other psychopathology. Only a few studies have
also incorporated the assessment of personality dimensions
(e.g., Nigg et al., 2002; Robin, Tzelepsis, & Bedway, 2008)
Within the Multilevel Family Assessment of ADHD
project (MFAA) which includes behavioral, neuropsychological, neurophysiological, and genetic assessments in
ADHD children plus one of their siblings and their parents,
we have been following the dimensional approach of behavioral assessment in the various family members (Steinhausen
et al., 2010), along with quantitative neuropsychological
and neurophysiological assessments (Valko et al., 2009) in
search of potential endophenotypes that might have an
1

University of Zurich, Switzerland


University of Basel, Switzerland
3
Aarhus University Hospital, Aalborg, Denmark
4
University of Heidelberg, Mannheim, Germany
5
Hochschule fr Heilpaedagogik, Zurich, Switzerland
2

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

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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

as a first step the German versions of the Conners Parent


Rating Scale (CPRS; Conners, Sitarenios, Parker, & Epstein,
1998a) and the Conners Teacher rating Scale (CTRS;
Conners, Sitarenios, Parker, & Epstein, 1998b). Parents and
teachers were asked to rate the behavior of the child when
off medication. The Parental Account of Childrens
Symptoms (PACS; Taylor, Schachar, Thorley, & Wieselberg,
1986), a semistructured, standardized, investigator-based
interview was administered to children suspected having
ADHD. Children along with their families were included if
at least one child met criteria of the DSM-IV combined type,
as resulting from the PACS and the CTRS. For control children, CPRS and CTRS were completed, and nonclinical
scores were required for inclusion.
Diagnosis of ADHD in the parents included the following instruments. Current ADHD was assessed by use of the
German ADHD-Self-Rating Scale (ADHD-SR) for adults
and the German version of the WenderReimherr Interview
(WRI). The ADHD-SR is based on the modified 18 DSM-IV
criteria for ADHD with each item scored on a 0 to 3 scale
leading to a total score. According to the suggestions of
Rsler et al., (2004), a cutoff of 15 on the total score was
used for diagnosis. In addition, each parent was interviewed
by use of the German version of the structured WRI consisting of 28 items each rated on a 0 to 2 scale (Rsler et al.,
2008). Following empirically based recommendations by
Rsler et al. (2008), a cutoff of 30 on the total score was
used for diagnosis. Furthermore, ADHD during childhood
and adolescence was assessed retrospectively by use of the
German version of the short form of the Wender Utah
Rating Scale (WURS-s) containing a total of 21 items each
rated on 0 to 5 scale. A cutoff of 27 on the total score was
used for diagnosis according to the empirically based suggestions by Retz-Junginger et al. (2003). Control parents
had to score below the cutoff scores of the ADHD-SR and
the WURS-s.
To qualify for the diagnosis of persistent ADHD-L, parents had to be positive on either all three ADHD instruments
or on either the ADHD-SR or the WRI and the WURS-s.
Current ADHD was designated to parents who were positive on either the ADHD-SR or the WRI but negative on the
WURS-s. Remitted ADHD was diagnosed when parents
fulfilled only the WURS-s criterion.
All parents responded to three questionnaires measuring
psychopathology and personality. The German version of the
Symptom Checklist 90Revised (SCL-90-R; Derogatis, 1986)
contains 90 items with 83 covering the following dimensions:
somatization, obsessive-compulsive, interpersonal sensitivity,
depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. In addition, a global severity index
(GSI), a positive symptom distress index (PSDI), and a positive symptom total (PST) may be calculated. The German
version of the SCL-90-R is based on a representative sample

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40

Journal of Attention Disorders 17(1)

and provides standardized T-scores for the nine scales and


the three global scores (Franke, 2002). The second instrument assessing psychopathology consisted of the German
version of the Patient Health Questionnaire (PHQ; Spitzer,
Kroenke, & Williams, 1999). This questionnaire covers all
major mental disorders according to DSM-IV criteria.
Following suggestions by Lwe, Spitzer, Zipfel, and Herzog
(2002), the authors of the German version, three dimensional
scores measuring depression, somatic symptoms, and stress
were calculated in the present examination. Finally, the NEO
Five Factors Inventory (NEO-FFI; Costa & McCrae, 1992)
was used for personality assessment. This questionnaire covers the so-called big five personality dimensions, namely,
neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness. In the present study, the
German version of the questionnaire (Borkenau & Ostendorf,
1993) was used and raw scores of the five dimensions were
computed.

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

easier inspection, these findings are represented also


graphically in Figure 1. There is a highly significant group
factor in the two MANOVAs based on the nine primary
scales and the three global indices, respectively. Post hoc
tests based on comparisons of pairs of groups indicate that
on all scales, ADHD-L scores significantly higher than do
ADHD-NP and CG and in the majority of scales higher
than ADHD-R. Furthermore, except for the scales measuring somatization, interpersonal sensitivity, and paranoid
ideation, the scores of ADHD-C do not differ significantly
from ADHD-L and in most instances also not from the CG.
The overall picture of the SCL-90-R findings indicates
clearly abnormal profiles for ADHD-L and ADHD-C with
little differentiation among each other on one hand and very
similar profiles for ADHD-NP, ADHD-R, and ADHD-C on
the other hand.
The analogous findings based on the PHQ are shown in
Table 2 and Figure 2. The MANCOVA findings indicate a
highly significant sex effect with higher scores for females
and a highly significant effect for groups. Post hoc comparisons show that on the depression scale, ADHD-L scores
significantly higher than ADHD-NP, ADHD-R, and the CG
and that ADHD-C scores higher than ADHD-NP and the
CG. On the somatic symptoms scale, there is less differentiation with only ADHD-L scoring higher than ADHD-NP
and the CG. Comparisons on the stress scale indicate that
ADHD-L scores higher than all other groups.
Finally, results of comparisons based on the NEO-FFI are
shown in Table 3 and Figure 3. Again, there is a highly significant effect for sex with females scoring higher than males
and a highly significant group effect in the MANCOVA.
Post hoc comparisons of groups indicate that there is a clear
differentiation on two of the five dimensions. On the neuroticism scale, ADHD-L scores higher than ADHD-NP and
CG whereas ADHD-C scores higher than ADHD-NP only.
Both ADHD-L and ADHD-C score lower than ADHD-NP
and the CG on the conscientiousness scale.

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

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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

Figure 1. Symptom Checklist 90Revised (SCL-90-R) profiles in five groups

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

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42

Journal of Attention Disorders 17(1)

Table 2. Comparison of Patient Health Questionnaire (PHQ) Findings in Five Groups

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

Figure 2. Patient Health Questionnaire (PHQ) profiles in five groups


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

remitted ADHD or without ADHD are not different from


parents with children having no ADHD.
The present study had a particular focus on the parents
of children with ADHD. They were shown to have a broad
range of increased psychopathology covering somatization, obsessive-compulsive, social insecurity, depression,
anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism, neuroticism, and stress. Overall, the present
findings add to a growing body of literature indicating that
adults with ADHD suffer from an additional load of other
psychopathology and personality dysfunctioning interfering with the organization of their daily life (Barkley et al.,
2008; Biederman et al., 1993, 2006; Kashdan et al., 2004;
Kessler et al., 2006; Murphy & Barkley, 1996; Murray &

Johnston, 2006; Satterfield et al., 2007; Weiss & Hechtman,


1993).
Furthermore, and in line with Barkley et al. (2008) and
Faraone et al. (2006), the present findings provide additional
evidence that the differentiation between lifelong persistent
and current ADHD in adulthood does not lead to much differentiation in other domains so that the validity of these
potential subtypes may be questioned. Particularly the
differentiating age criterion of onset of the disorder before
age 7 is difficult to assess reliably in retrospective history
taking and may not be reinstalled in the upcoming DSM-V
revisions after some criticism has been raised repeatedly
(Applegate et al., 1997; Barkley & Biederman, 1997; Kessler,
Berglund, Demler, Jin, & Walters, 2005). However, it should
not be overlooked that on the dimension of stress as measured by the PHQ, there was a single and clear differentiation
indicating that persistent lifelong ADHD in a parent may
have a different impact than does current ADHD only.
In general, the present findings also add to the notion
that remitting ADHD with only a previous history of ADHD
in childhood leads to normal adult functioning. In the
majority of scales, the remitted ADHD parent group was
clearly significantly less abnormal than the persistent
ADHD group and, at the same time, not distinguishable
from both parent groups without ADHD and a child with
ADHD or a normal child, respectively. These findings tend
to replicate those of the follow-up study of ADHD children
and adolescents by Barkley et al. (2008). Due to the different sample structure, the latter study had a much higher rate
of remitting ADHD participants than the present study so
that the differentiation between persistent and remitting
ADHD based on the SCL-90-R was even stronger.
In the present study, the consideration of a subgroup of
parents with an ADHD child but without having ADHD
themselves allowed to test whether it is the ADHD in the
parent or in the child that has a major impact on parental
functioning. The present findings revealed that parents with

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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

Figure 3. NEO Five Factors Inventory (NEO-FFI) profiles in five


groups
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 < .05; ***p < .001

an ADHD child but without having ADHD themselves


showed identical and normal profiles like the CG of parents
without an ADHD child. Furthermore, the profiles of these
parents were clearly distinct from those of parents with
either persistent or current ADHD. Thus, there is clear evidence that it is mainly the ADHD in the parents themselves
rather than the ADHD in the child that has an impact on
parental functioning in other domains of psychopathology
and personality. This conclusion is very much in concordance with findings from a few other studies (Minde et al.,
2003; Murray & Johnston, 2006; Sonuga-Barke et al., 2002)
and reviews (Barkley et al., 2008; Deault, 2010; Johnston &
Mash, 2001).

Finally, the methods used in the present study deserve a


brief comment. The various indicators of psychopathology
and personality were selected to cover a broad range of
mental phenomena that potentially might serve in the identification of endophenotypes in association with future
analyses of potential genotypes. All three measures, the
SCL-90-R, the PHQ, and (perhaps a little less well)
the NEO-FFI, served these purposes well by differentiating
the various groups under study. The SCL-90-R findings
have been used repeatedly in previous studies and findings
across studies are congruent by showing the high load of
psychopathology in adults with ADHD (Barkley et al.,
2008; Murphy & Barkley, 1996; Murphy, Barkley, & Bush,
2002; Weiss & Hechtman, 1993).
To our knowledge, the PHQ has not been used before in
other adult ADHD studies. In the present contribution, we
have abstained from presenting other outcome variables of
the PHQ, that is, the various indications of DSM-IV disorders. Our reluctance to present this information is due to the
screening type of this self-report which provides only an
indication of a disorder that requires more intensive clinical
interviewing to establish reliable diagnoses. However, the
three presented quantitative scores of depression, somatic
symptoms, and stress represent reliable and valid dimensions of psychosocial dysfunction and potential endophenotypes for further analysis. So far, the NEO-FFI had served
better in two other studies by differentiating adult ADHD
from controls in all five dimensions (Nigg et al., 2002;
Robin et al., 2008).
Limitations of the present study include a disproportionate
number of female participants. There were more mothers
than fathers in the ADHD-L group (m:f ratio = 0.76:1), the
ADHD-C group (0.43:1), and the ADHD-R group (0.8:1).
This is, however, in line with some other studies on adult
ADHD, where female patients are overrepresented (Almeida
Montes, Hernandez Garcia, & Ricardo-Garcell, 2007;

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Journal of Attention Disorders 17(1)

DuPaul et al., 2001) or where the gender ratio is at least


balanced (see the meta-analysis by Simon, Czobor, Blint,
Mszros, & Bitter, 2009). The recruitment of whole families with an index child with ADHD as the defining criterion and a greater willingness of ADHD mothers than
ADHD fathers to participate may have contributed to this
different sex distribution in the adult sample. Sex was controlled in all analyses as a covariate which clearly indicated
a higher symptom load in the mothers as compared with
the fathers. This finding may reflect valid sex differences
and a greater honesty of the mothers to admit their symptoms. Furthermore, the sample sizes of the various adult
samples were relatively small so that replications of the
present findings with larger samples may be warranted.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.

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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Journal of Attention Disorders 17(1)

Ueli C. Mller is lecturer at the Hochschule fr Heilpaedagogik,


Zurich, Switzerland. He graduated with a MAS in Cognitive
Behavioral Therapy (2004) and with a PhD in Psychology (2009).
His main research interests include evaluation of psychotherapy
and neuropsychology of ADHD.
Lilian Valko graduated with a PhD in Psychology (2009) on neurophysiological and neuropsychological aspects of time processing in ADHD. Currently she specializes in clinical child and
adolescent psychology.

Renate Drechsler, PhD, is research associate at the Department


of Child and Adolescent Psychiatry, University of Zurich,
Switzerland. She graduated in Linguistics and Psychology and
specialized in clinical neuropsychology. Her current research
interests include neuropsychological aspects of ADHD, interventions for children with ADHD, executive functions, emotion processing, and neuropsychological assessment.

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