Entire Family May Suffer When Child Has ADHD

Beth Kaplanek, a nurse and immediate past president of Children and Adults With Attention Deficit/Hyperactivity Disorder (CHADD), is proud that her son Chris has made it through high school and is now a sophomore in college. Although he is very bright, he gets marginal grades and breaks school rules.

Kaplanek explains that Chris has the impulsive/hyperactive type of ADHD and oppositional defiant disorder (ODD). About 40 percent of children with ADHD have co-occurring ODD, the figure cited in a study in the December 1999 Archives of General Psychiatry.

ADHD affects the entire family, said Kaplanek at a workshop held in New York City last month on the impact of ADHD on families. The workshop was organized by the Center for the Advancement of Children’s Mental Health at Columbia University.

“Parents of children with ADHD are often in a crisis mode,” said Mark Wolraich, M.D., a behavioral pediatrician and expert on ADHD.

“Their child may be kicked out of class or held for detention, or he or she may run up a huge telephone bill. With each new situation, parents have to decide how they will respond: Do they let it go or turn it into a battle?,” said Wolraich, who directs the child study center at the University of Oklahoma Health Sciences Center.

“Chris certainly knew how to push my buttons,” said Kaplanek, “and I would get upset and yell. The biggest challenge for me was learning to pick my battles and reacting calmly when he was upset, so the situation didn’t escalate.”

Wolraich said parents often have a tough time breaking out of the cycle of reacting negatively to a child with ADHD, especially if that pattern has lasted for years.

He suggested taking parenting classes offered in the community to learn behavior modification and positive-reinforcement techniques. Kaplanek is developing a curriculum for parents of ADHD children in her community that will incorporate behavioral interventions she wished she had learned sooner.

Early Signs of Trouble

Kaplanek noticed that her son behaved differently from other children when he was in preschool. “He walked over bodies to get what he wanted, pulled, shoved, jumped from one item to another, became easily distracted or frustrated, and had trouble waiting turns. He flew into a rage over the slightest thing, and then everyone in his path was in trouble,” she recalled.

Kaplanek stopped taking Chris to public places, such as parks or pools, because he behaved liked “greased lightning”—darting everywhere and pulling away from her when she tried to stop him from hurting himself.

“I was constantly chasing him. I knew people were watching and judging me,” said Kaplanek, who decided to keep Chris inside their small gated community to play.

Wolraich said that especially before the diagnosis is made, parents of children with ADHD often believe the problem must be their poor parenting. That message is often reinforced by relatives, teachers, and other adults.

The demands of raising children with ADHD often strain marriages, especially if disagreements between the spouses already exist, said Wolraich. “My husband thought our different parenting styles were why we were having so many conflicts with Chris. He tended to blame me because I was the yeller,” said Kaplanek.

Despite the signs of ADHD in Chris in preschool, “it took another six years of family stress and inner turmoil before I became desperate enough to demand that our pediatrician put Chris on a trial of Ritalin,” said Kaplanek.

Once he was on medication, however, the change in Chris was dramatic. “He finished his homework, followed instructions, and responded to his name when called. When his symptoms improved, it changed our negative perception of him.”

They saw a psychologist who educated them about the dynamics of the disorder and suggested using behavior modification charts to reinforce positive behaviors, which helped, said Kaplanek.

She and her husband took on the role of “coach” by helping Chris get his homework completed and manage his time and reminding him to take his medications. Kaplanek advocated for accommodations at his school, which Chris got. These included longer test times, alternate methods of recording answers to tests, and ungraded spelling, because Chris was a “phonetic speller.”

Kaplanek joined a CHADD support group in her area, which she later ran. “In talking with other parents, we could relate to each other’s struggles and exchange information and tips.”

Impact on Siblings

A child with ADHD consumes a significant amount of the parents’ time and attention. So it is not uncommon for other siblings to feel neglected, said Wolraich.

Chris’s brother, Carey, has anxiety disorder and the mild inattentive subtype of ADHD, said his mother. Studies have shown that anxiety and mood disorders exist in about 38 percent of children with ADHD.

Carey, who is two years younger than Chris, confided to his parents recently that he felt they had paid far more attention to Chris than to him, said Kaplanek.

“Carey tried hard to avoid family conflicts growing up and not become his older brother’s punching bag,” said Kaplanek.

Wolraich said that children with ADHD often have trouble getting along with their siblings.

“They may borrow their siblings’ possessions repeatedly without asking or returning them, interrupt activities with friends, or take out their frustrations on them,” said Wolraich.

If an older child with ADHD has a reputation for causing trouble, the younger sibling may be viewed in the same mold. For example, Kaplanek said that Carey was expelled last year for one infraction from the same high school that Chris attended for six years. “It appears that school officials became less tolerant after Chris misbehaved frequently,” said Kaplanek. ▪