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Indirect effect of ADHD on parenting stress through increased child anxiety and decreased emotional regulatory coping

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Abstract

Parents of children with ADHD experience significantly more parenting stress in comparison to parents of typically developing children due to the emotional and behavioral difficulties related to ADHD. Additionally, approximately 30% of children with ADHD experience co-occurring anxiety. Parents of children with co-occurring anxiety and ADHD report increased stress due to role restriction and isolation compared to parents of children with ADHD alone. Poor emotional regulatory coping in children with ADHD has been linked to elevated negative affect and irritability, which also contributes to increased stress among parents. The present study examined the direct and indirect associations of child anxiety symptoms and emotional regulatory coping on elevated ADHD symptoms and parenting stress. Participants were 203 children aged 7–12-years-old and their parents. Parents completed a self-report measure of parenting stress and measures of their child’s ADHD symptoms, anxiety, and emotional regulatory coping. Additionally, children completed self-report measures of emotional regulatory coping. Model testing indicated that the overall model demonstrated excellent fit to the data. Parameter testing supported an indirect effect of child ADHD symptoms on parenting stress through child anxiety symptoms and an indirect effect of child ADHD symptoms on parenting stress through child emotional regulatory coping. These results suggest that child anxiety and emotion dysregulation in children with ADHD have a negative impact on parental stress. The current study adds to the understanding of the important roles emotional regulatory coping and anxiety play in children with ADHD to contribute to increased parenting stress.

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  1. University of Louisville, Louisville, KY, USA

    Anna R. Olczyk, Paul J. Rosen, Helena F. Alacha & Meaghan M. Flynn

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Contributions

AO wrote the main manuscript text and prepared all tables and figures. PR was supervising author who ran the SEM analyses and contributed to parts of the manuscript text. All authors reviewed the manuscript.

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Correspondence to Anna R. Olczyk.

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Appendix A: Tables

Appendix A: Tables

See Tables 1, 2, 3 and Figs. 1, 2.

Table 1 Participant demographic data in children with and without elevated ADHD symptoms
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Table 2 Results comparing children with and without elevated ADHD symptoms on study measures
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Table 3 Summary of bivariate correlations
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Fig. 1
Fig. 1
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Proposed theoretical model of ADHD, anxiety, emotional coping, and parenting stress

Fig. 2
Fig. 2
Full size image

Indirect effects model of ADHD, anxiety, emotional coping, and parenting stress domains with standarized beta weights. Note. *p < 0.001. VAPRS-I Vanderbilt ADHD Parent Rating Scale, Inattentive; VAPRS-H Vanderbilt ADHD Parent Rating Scale, Hyperactive; CBCL-A Child Behavior Checklist-Anxiety Subscale; PSI-PD Parenting Stress Index, Parental Distress; PSI-DC Parenting Stress Index, Difficult Child; PSI-PCDI Parenting Stress Index, Parent–Child Dysfunctional Interaction; pCEMS-W Children’s Emotion Regulation Coping, Worry, parent report; pCEMS-A Children’s Emotion Regulation Coping, Anger, parent report; pCEMS-S Children’s Emotion Regulation Coping, Sad, parent report; cCEMS-W Children’s Emotion Regulation Coping, Worry, child report; cCEMS-A Children’s Emotion Regulation Coping, Anger, child report. The subscale beta weights are standardized regression coefficients that represent the degree to which the indicators change based on change in the latent factors, simultaneously. Several indicators were freed to covary in the model. These are not depicted in the above figure for visual clarity. The following indicators were freed to covary (with standardized weights): pCEMS-W←→pCEMS-A = 0.22; -W←→pCEMS-S = 0.40; cCEMS-W←→cCEMS-A = 0.39; PSI-PD←→PSI_PCDI = 0.73

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Olczyk, A.R., Rosen, P.J., Alacha, H.F. et al. Indirect effect of ADHD on parenting stress through increased child anxiety and decreased emotional regulatory coping. Eur Child Adolesc Psychiatry 33, 1407–1417 (2024). https://doi.org/10.1007/s00787-023-02246-0

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