Parental stress a factor in ADHD diagnosis
By Roman Bystrianyk

ADHD, or Attention Deficit Hyperactivity Disorder, is the most
frequently diagnosed behavioral disorder in children. The diagnosis
affects approximately 3 to 5% of school children or approximately 2 million children in the United States. A large number of children with ADHD, 40-60%, are also diagnosed with Oppositional Defiant Disorder (ODD) and/or Conduct Disorder (CD).

The DSM-IV, or Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States and internationally. The criteria and classification system of the DSM are based on the opinion of people who represent American mental health specialists. According to the DSM-IV the diagnosis for ADHD requires the symptoms to be pervasive and occur in two or more situations, such as
home and school.

However, the agreement between parent and teacher ratings of children’s behavior is low. In fact, recent research has shown substantial variation in the description of ADHD subtypes depending on the source – parent or teacher – of the diagnosis. A 2003 study showed that the hyperactivity ratings of parents contained a large “84%” of source variance. Unfortunately, studies examining the association between factors affecting parents and ADHD rating are scares. Key factors that are believed to have an effect on a parent’s perception of ADHD are depression and stress.

According to previous research some have theorized that, “the depressed mood of caregivers creates a negative bias in their descriptions of the child’s functioning.” Still other researchers have theorized that, “caregiver-child interactions might alter due to the caregiver’s depressed mood, causing behavior problems that might not have existed otherwise.

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According to the National Institute of Mental Health, “many other
factors such as parental stress or a changing family environment may influence the child's symptoms.”

A study in Behaviour Research and Therapy, examined 65 children (58 boys and 7 girls) that had been diagnosed with ADHD. Of the 65 children, 34 were determined to have ODD as well. The study was to examine the agreement of parents and teachers in ADHD symptoms and examine the association between parenting stress and depressed mood on these symptoms.

The authors found that, “our analyses showed that, consistent with
previous studies, parents and teachers do not fully agree. Especially for hyperactive/impulsive symptoms, agreement between parents and teachers was low.” They also found that parenting stress and not depressed mood, “to be systematically and significantly associated between agreement raters of inattentive, hyperactive/impulsive and oppositional behavior.”

The study noted that teachers are just as susceptible as parents to
depression and stress. Therefore, teacher ADHD ratings are subject to the “same sort of bias” as parents.

The authors conclude that, “our data suggest that for the assessment of ADHD and ODD symptoms it is important to also assess the emotional well-being of the informant, as this significantly and systematically is related to their ratings. More important than assessing depressed mood, it seems important to assess caregivers’ parenting stress levels because parenting stress is more strongly related to informant agreement. It may
be argued from the present results that parenting stress measures should be added to standard diagnostic procedures with behaviorally disordered children.”

SOURCE: Behaviour Research and Therapy, Article in Press