Parenting Adolescents with Attention Deficit Hyperactivity Disorder: Analysis of the Literature for Social Work Practice
McCleary, Lynn, Health and Social Work
Attention deficit hyperactivity disorder (ADHD) and disruptive behavior disorders are among the most common reasons for referrals of adolescents to mental health services (Kazdin, Siegel, & Bass, 1990). ADHD is associated with significant morbidity I terms of social functioning and adjustment of both adolescents and their parents (Anastopoulos, Guevremont, Shelton, & DuPaul, 1992; Biederman et al., 1996; Breen & Barkley, 1988; Faigel, Sznajderman, Tishby, Turel, & Pinus, 1995). Social workers serving adolescents in any setting are likely to encounter clients with ADHD and provide some form of psychosocial treatment for these adolescents and their families. However, practice with this population has not been well-addressed in the social work literature. The question addressed in this article is: How do theories and research on parenting stress inform social work practice with parents of adolescents with ADHD?
ADHD is one of the disruptive behavior disorders of childhood and adolescence listed in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association [APA], 1994). Adolescent prevalence is 3.4 percent among girls and 7.3 percent among boys (Szatmari, Offord, & Boyle, 1989b). Comorbidity, the co-occurrence of ADHD with learning disabilities or mental health problems, is common (Biederman et al., 1996; Szatrnari, Offord, & Boyle, 1989a).
The essential features of ADHD are persistent, frequent, and severe inattention; hyperactivity; and impulsivity (APA, 1994). Children with ADHD are easily distracted by extraneous stimuli and have difficulty organizing their activities. They have difficulty sustaining attention in tasks and play activities such that tasks like schoolwork and homework, which require sustained mental effort, are unpleasant experiences for them. Teachers may comment that the child could do better in school if he or she would just try harder. If inattention is a more prominent feature than hyperactivity, the ADHD may not be identified until adolescence, when the disorder interferes with the increasingly demanding attention and organizational requirements for academic success (Faigel et al., 1995). Impulsivity in ADHD is characterized by impatience, difficulty delaying responses, and social intrusiveness. These problems interfere with social relationships. Impulsivity may result in accidents and the adolescent's engaging in poten tially dangerous activities without thinking about the consequences.
ADHD-associated impairments affect children at home, with friends, at school, and in the community. The disorder persists into adolescence for a majority of individuals. Although ADHD symptoms generally are resolved by adulthood, there are significant risks of psychosocial impairments, such as poor academic or occupational adjustment and antisocial behavior (Hechtman, 1996).
The goals of ADHD treatment are reduced morbidity; improved functioning, and prevention of negative sequelae. Treatments include psychopharmacologic treatment with stimulants or other medications; social skills and relationship training for the child or adolescent; individual counseling or cognitive therapy for the adolescent; family therapy; parent counseling and education; and modification of the school environment. It is generally acknowledged that no single treatment may be sufficient, and multimodal treatments are recommended (Barkley, 1990; Faigel et al., 1995).
STRESS AND PARENTING
A number of theorists and researchers have postulated a relationship between parenting and the course and outcome of ADHD. Some have investigated parental psychopathology and dysfunctional parenting as risk factors for childhood ADHD and negative sequelae. Others have proposed more complex reciprocal and interactive relationships among parenting, expression of ADHD, and ADHD problem behaviors as sources of parenting stress. …