Stress Experience of Mothers of Children with ADHD: Influence of the ADHD Presentation and Parental Psychopathology

Parents of children with attention deficit hyperactivity disorder (ADHD) report a high level of psychological stress associated with the child's symptoms, but this can also be attributed to the frequently comorbid oppositional defiant disorder (ODD). In addition, parents often have their own psychopathological symptoms, which contributes to the stress experience. The study involved 207 children (M = 9.00 years; SD = 1.52; 65.2% mate). The aim of the study was first to analyze whether the maternal stress differs depending on ADHD presentation and whether there is a comorbid symptomatology of ODD. The children with ADHD symptoms (n = 138) were divided into groups depending on ADHD presentation and signs of ODD (DSM-5; ADHS-KJ; Petermann & Petermann, 2019) and were examined in terms of maternal stress experience (EBI, Eltern-Belastungs-Inventar; Troster, 2011). Group differences were analyzed using a multivariate variance analysis. Furthermore, it was investigated, which symptoms and control variables best explain maternal stress in children (ADHD and ODD) and parents (depression; EBI and ADHD; Schmidt & Petermann. 2013), which was calculated with a stepwise multiple regression (n = 157). The results show a significant main effect between the different ADHD presentations on the scales of Mood and Adaptability. In addition, a significant interaction effect of ADHD presentation, sex, and ADHD-specific drug use was demonstrated on the EBI scale of Acceptability. Sidak post-hoc tests showed the highest maternal stress for children with ADHD+ODD (independent of ADHD presentation); medium-to-large effect sizes were found (d = .69 to 1.50). Furthermore, maternal depression proved to be the most important predictor of maternal stress (beta = 0.45). Combined presentation with ODD (beta = 0.37), inattentive presentation with ODD (beta = 0.16), the impulse control/disinhibition of mothers (beta = 0.15), the number of children living in the household (beta = 0.11), and the attention control of mothers (beta = 0.11) were able to clarify further variance, resulting in an overall model of R-korr(2) = 0.60. In the clinical context, mothers of children with ADHD should be specifically examined for depressive symptoms, and questionnaire procedures for parental symptoms should be collected. In the case of indications of the presence of their own symptoms, clinical diagnostic or therapy recommendations should be made, as otherwise the therapy goals would be at risk (e.g., owing to lack of support in practicing the therapy contents). The parental ADHD should be clarified because of the high heredity, since this can intensify the symptoms of the child. Additionally, behavioral therapeutic measures should be carried out that are adapted to the ADHD presentation of the child in order to guarantee a targeted stress reduction in mothers.