PARENTS AND ADHD Stress Caregivers for a child with ADHD are burdened with the ongoing challenges of the child’s inability to follow rules and his or her continual struggles with academics and peer relationships.29 These hardships stress parents’ patience, often resulting in parental impulsive reactivity (eg, physical punishment of the child).
In addition, social isolation for both children and parents is common because of the judgmental scrutiny of other parents whose children are not affected by ADHD.30 Parents’ career and social activities may be interrupted, adding to the sense of guilt, blame, burnout, and depression often associated with parenting a child with ADHD.29
While some parenting stress is expected, those who are unable to cope with everyday events are more likely to experience conflict and anger, further increasing the child’s anxiety and emotional state.31 This dysfunctional environment prohibits the adoption of positive parenting techniques and ultimately contributes to more psychologic distress and harm to the parent-child relationship.31
Support Once a child is diagnosed with ADHD, parents require adequate education to bolster their understanding of how to manage their child’s symptoms.29 Establishing effective support systems—whether a spouse, family member, friend, or another parent whose child has ADHD—is imperative to enable parents to cope with the stress and to promote positive parenting, which has been shown to decrease symptomatic behavior.32
Furthermore, understanding the individual child’s traits will help the parents channel his or her energy into personal areas of interest, such as sports or creative outlets (art, dance, theater).32
Training Parenting styles may play a role in the management of a child’s ADHD.9,11 Encouraging parents to learn how to change their responses to their child’s behavior through evidence-based behavioral training can be one of the most effective interventions for both parents and children.33 Parents who participate in this training gain greater behavioral understanding and treatment satisfaction, and their children experience significant improvement in conduct and other symptoms.23
TREATMENT OPTIONS Choice of treatment depends on patient age, the severity of functional impairment, and the individual needs of the child. Treatment may include behavioral therapy, medication administration, or a combination of the two.23
Behavioral therapy Behavioral therapists can provide parents and teachers with evidence-based training to understand and manage ADHD conduct.34 Parents and teachers are taught to recognize the effects of environmental factors on behavior and then to modify environments and daily schedules and set appropriate limits. They learn how to reinforce positive behavior, identify triggers, and decrease inappropriate behavior, using calm disciplinary approaches that lead to positive parent-child and teacher-student relationships.23,34
Collaborative efforts between parents and teachers are crucial to the child’s treatment plan, and individualized educational plans should be implemented to enhance academic performance, social skills, and self-esteem. For example, teachers can send home daily report cards to assist parents with monitoring core symptoms and treatment efficacy.35
Behavioral therapy classes for both parent and child, or for parents only, usually meet weekly for eight to 20 weeks. Parents learn how to build positive relationships, set limits, and respond consistently with rewards or punishments (eg, consequences, time-outs). Less effective outcomes were noted when such interventions were tried by parents without adequate training.14,24,33
Medications have been found to be more effective to treat ADHD symptoms than behavioral therapy alone, and parents and teachers report higher satisfaction with treatment plans that combine behavior modification with pharmacologic therapy.23
