Parents of Children With ADHD May Have ADHD Themselves

Laurie Barclay, MD

Jan. 9, 2004 — Parents of children with attention deficit–hyperactivity disorder (ADHD) are likely to have the disorder themselves and may benefit from treatment, according to the results of a comparison study published in the December 2003 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

"The evidence is dramatic and the message clear: we need to treat the whole family, not just the child," lead author Andrea M. Chronis, PhD, from the University of Maryland in College Park, says in a news release. "Too often the answer is just to give the children drugs. But our study suggests that when there are problems in the family, you need to address those too."

From 1995 to 1996, 98 three- to seven-year-old children with ADHD as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), including 68 children with ADHD and comorbid oppositional defiant or conduct disorder (ADHD+ODD/CD) were recruited during the first wave of a longitudinal study and compared with 116 children without ADHD.

Based on interviews with the biological mothers, the investigators concluded that ADHD in the children was associated with a 24-fold increase in rates of maternal and paternal childhood ADHD compared with rates in parents of control children. ADHD+ODD/CD was associated with maternal mood disorders, anxiety disorders, and dependence on stimulants or cocaine, as well as childhood disruptive behavior disorders and alcohol problems in the biological fathers.

Study limitations include reliance on maternal reporting, use of DSM-III rather than DSM-IV criteria in the parents, and limited power to detect differences between pure ADHD and control patients and between diagnostic subtypes.

Because treatments for children with ADHD rely heavily on parental support, mental health problems in the parents can interfere with the child's treatment and recovery, the authors note. Young children with ADHD, especially those with comorbid ODD/CD, require comprehensive services to address both their ADHD and the mental health needs of their parents.

"We hope to identify meaningful early predictors of how these kids will do as they grow up," Dr. Chronis said, noting that this study is the fourth in a 10-year project following the long-term progress of approximately 200 children recruited at the Universities of Chicago and Pittsburgh.

The National Institutes of Mental Health helped support this study.

J Am Acad Child Adolesc Psychiatry. 2003;42:1424-1432Reviewed by Gary D. Vogin, MD

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