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The Checkup

Health in the News -- And Your Life

Married, With ADHD

Relationships Suffer Under Stress of Raising Child With Disorder, Study Finds

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Washington Post Staff Writer
Tuesday, March 3, 2009; Page HE01

For many years, scientists have explored how parental conflicts and other marital problems can affect the well-being of children. Far less attention has been paid to the opposite question: How do children, especially difficult children, influence the quality of married life?

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Couples who have a child with attention deficit hyperactivity disorder are nearly twice as likely to divorce or separate as couples who do not have children with the psychiatric disorder, according to a definitive new study that is the first to explicitly explore the question. The reason appears simple: Having a child who is inattentive or hyperactive can be extremely stressful for caregivers and can exacerbate conflicts, tensions and arguments between parents.

The research topic is sensitive because it can be easily misinterpreted to mean that scientists are blaming kids for the marital woes of their parents; that may be one reason researchers have generally avoided the topic and limited their investigations to how parental conflicts affect children. But increasingly, the evidence suggests that the lines of influence run in both directions.

The study, led by psychologists Brian Wymbs and William Pelham and published last year in the Journal of Consulting and Clinical Psychology, longitudinally tracked a large number of families with and without children diagnosed with ADHD, a disorder characterized by inattention and hyperactivity and often accompanied by conduct problems and oppositional behavior.

While 12.6 percent of the parents of children without ADHD were divorced by the time the children were 8 years old, the figure was 22.7 percent for parents of kids with ADHD. Couples with ADHD kids also tended to reach the point of divorce or separation faster.

"We have known for a long time that kids can be stressful for their parents. What we show is they can be really stressful and can lead to marital dissatisfaction and divorce," said Pelham, who works at the State University of New York at Buffalo. "What it means is ADHD should not be treated without involving the parents in the treatment."

Pelham said his interest in the topic was piqued after he conducted a study that looked into how children's behavior influenced the propensity of their parents to consume alcohol. Pelham had a large number of parents interact with children who were not their own. Some of the kids were trained to act cooperatively, while others were trained to act as though they had ADHD. The parents were given a break midway through the session, when they could consume alcohol, and then sent back in for a second period with the same child.

The parents thought the experiment was measuring how parent-child interactions changed depending on alcohol use; in reality, Pelham wanted to know how dealing with easy and difficult children influenced the propensity of caregivers to drink. The psychologist found that parents randomly assigned to interact with the difficult children drank a whopping 40 percent more alcohol during the break than parents who were assigned manageable kids.

Several previous studies have hinted at connections between marital health and children's behavior.

"Parents of children with ADHD report less marital satisfaction, fight more often, and use fewer positive and more negative verbalizations during child-rearing discussions than do parents of children without ADHD especially if the child also has conduct or oppositional problems," Pelham and Wymbs noted in their paper.

Many other factors influence whether couples stay together. Communication problems, substance abuse, financial difficulties and mental health problems among partners all play a role in the health of intimate relationships. The difference between those other factors and the role that children play is that the other factors have been widely documented and discussed.

Wymbs said that in a separate study, he brought parents with and without ADHD kids into a laboratory. As before, he assigned them to interact with children who were not their own; some had been trained to act cooperatively, and others had been trained to act difficult. (The "difficult" kids in the study were nowhere as difficult as many kids with ADHD in real life; ethical guidelines forbade researchers from training child actors to hit or scream.)

Wymbs had the parents and kids perform four exercises: The first involved playing the game Jenga, which requires strategic thinking and planning. Kids trained to be helpful worked cooperatively with the parents; the kids trained to act difficult undermined the parents at every turn.

A second exercise called for parents to monitor the kids solving math problems while they themselves had to fill out a checkbook, the kind of parallel processing that induces stress. The easy kids attended to their homework; the difficult kids refused to do their homework, scribbling on their papers or erasing their answers and blowing the shavings on the parents.

In the third task, the kids directed play. The child actors always chose to play mini-bowling and mini-basketball. The cooperative children took turns and helped set up the games, and the difficult children played out of turn and were disruptive.

The fourth task involved cleanup where, as you might imagine, the children were trained to be either helpful or unhelpful.

Wymbs videotaped the interactions. What he was on the lookout for was not how the parents interacted with the children, but how the children's behavior affected the way the parents worked with each other. Regardless of whether they had children with ADHD, Wymbs found, the parents asked to work with difficult children were four times as likely to exchange negative criticism and questions, or to ignore each other and trade nonverbal barbs, than the parents in the other group.

And regardless of whether they were dealing with easy or difficult children, parents who had ADHD children at home were three times as likely to be negative toward each other as parents who did not. Put another way, the parents of children with ADHD simply had less ability to respond to challenges with equanimity; they appeared to be psychologically worn thin.

Pelham said that although medications are effective in addressing ADHD symptoms, they often prove unhelpful when it comes to parent-child interactions because ADHD drugs are stimulants, usually given to the kids in the morning before they head to school. The medication is wearing off by the time kids get home and have most of their interactions with their parents. It isn't advisable to give children more medication because it would keep them up at night.

Several researchers said parents need to develop behavioral techniques to improve coping skills.

"When you sit back, you can laugh at it, but in the moment it is phenomenally stressful for the family," said Charlotte Johnston, a psychology professor at the University of British Columbia, referring to the daily challenges that parents of kids with ADHD face. "Often the parents have different tolerances for tantrums. One wants to stand firm, but the other is willing to give in. Now the parents are set up to fight, [saying,] 'You let him do that?' or 'You are too strict with him!' "

Johnston teaches parents to get on the same page and follow three rules: The first is to pare down their expectations and to focus on only one or two problem behaviors in their ADHD child. The second rule is the familiar parental technique of rewarding all positive behavior and discouraging negative behavior, often by ignoring it. The third rule is to consistently stick with the technique long enough to see it work.

Other experts said it is also important to teach parents to take time to pamper themselves and put themselves back together psychologically.

"Many parents do not take care of themselves. We encourage them to do that even though they may feel they have no time because of all their commitments to their families," said Andrea Chronis-Tuscano, a psychologist who directs the University of Maryland's ADHD Program. "One of our mantras is, 'If you don't take care of yourself, you can't do your best as a parent.' "

Comments: vedantams@washpost.com.


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