Skip to main content
Log in

Examining the influence of irritability and ADHD on domains of parenting stress

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Parents of children with ADHD typically report higher levels of parenting stress than parents of typically developing children. Children with ADHD display developmentally inappropriate levels of hyperactivity, impulsivity, and inattention. Some children with ADHD are also prone to particularly high levels of tonic irritability that may explain some of the impairments typically found in ADHD. The present study sought to determine the unique impact of ADHD and tonic irritability on child-related parenting stress domains (e.g., difficult child, parent–child dysfunctional interactions). 145 mothers of children with and without ADHD aged 7–12 years participated in the current study. Mothers completed self-report measures of parenting stress as well as a diagnostic structured interview. Ecological momentary assessment (EMA) was used to assess tonic irritability in an ecological environment. Indirect effects models were specified using PROCESS Model 4. For the parent–child dysfunctional interaction domain, the data were best fit by a model specifying a significant total effect of ADHD that was fully accounted for by an indirect effect through irritability. For the difficult child domain, model testing indicated a significant total effect of ADHD that was partially accounted for by an indirect effect through irritability. The current study adds support to the growing body of literature acknowledging the role of tonic irritability in children with ADHD. Furthermore, the results provide novel insight in the complex relation of irritability, child ADHD, and domains of parenting stress.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+
from $39.99 /Month
  • Starting from 10 chapters or articles per month
  • Access and download chapters and articles from more than 300k books and 2,500 journals
  • Cancel anytime
View plans

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

Availability of data and material

Data and material available upon request.

Code availability

Not applicable.

References

  1. A. American Psychological Association (2013) Diagnostic and statistical manual of mental disorders, 5th ed. American Psychiatric Publishing, Arlington

  2. Danielson ML, Bitsko RH, Ghandour RM, Holbrook JR, Kogan MD, Blumberg SJ (2018) Prevalence of parent-reported ADHD diagnosis and associated treatment among US Children and adolescents, 2016. J Clin Child Adolesc Psychol 47(2):199–212

    Article  PubMed  PubMed Central  Google Scholar 

  3. Barkley RA (2015) Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment, 4th edn. The Guilford Press, New York

    Google Scholar 

  4. Danckaerts M et al (2010) The quality of life of children with attention deficit/hyperactivity disorder: a systematic review. Eur Child Adolesc Psychiatry 19(2):83–105

    Article  PubMed  Google Scholar 

  5. Deault LC (2010) A systematic review of parenting in relation to the development of comorbidities and functional impairments in children with attention-deficit/hyperactivity disorder (ADHD). Child Psychiatry Hum Dev 41(2):168–192

    Article  PubMed  Google Scholar 

  6. Theule J, Wiener J, Tannock R, Jenkins JM (2013) Parenting stress in families of children with ADHD: a meta-analysis. J Emot Behav Disord 21(1):3–17

    Article  Google Scholar 

  7. Karalunas SL, Fair D, Musser ED, Aykes K, Iyer SP, Nigg JT (2018) ‘Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria’: retraction and replacement. JAMA Psychiat 75(4):408–409

    Article  Google Scholar 

  8. Karalunas SL, Gustafsson HC, Fair D, Musser ED, Nigg JT (2019) Do we need an irritable subtype of ADHD? Replication and extension of a promising temperament profile approach to ADHD subtyping. Psychol Assess 31(2):236–247

    Article  PubMed  Google Scholar 

  9. Shaw P, Stringaris A, Nigg J, Leibenluft E (2014) Emotion dysregulation in attention deficit hyperactivity disorder. Am J Psychiatry 171(3):276–293

    Article  PubMed  PubMed Central  Google Scholar 

  10. Stringaris A, Goodman R (2009) Longitudinal outcome of youth oppositionality: Irritable, headstrong, and hurtful behaviors have distinctive predictions. J Am Acad Child Adolesc Psychiatry 48(4):404–412

    Article  PubMed  Google Scholar 

  11. Stringaris A, Taylor E (2015) Disruptive mood: irritability in children and adolescents. Oxford University Press, New York

    Book  Google Scholar 

  12. Vidal-Ribas P, Brotman MA, Valdivieso I, Leibenluft E, Stringaris A (2016) The status of irritability in psychiatry: a conceptual and quantitative review. J Am Acad Child Adolesc Psychiatry 55(7):556–570

    Article  PubMed  PubMed Central  Google Scholar 

  13. Evans SC et al (2017) Irritability in child and adolescent psychopathology: an integrative review for ICD-11. Clin Psychol Rev 53:29–45

    Article  PubMed  Google Scholar 

  14. Martorell GA, Bugental DB (2006) Maternal variations in stress reactivity: implications for harsh parenting practices with very young children. J Fam Psychol 20(4):641–647

    Article  PubMed  Google Scholar 

  15. Simpson AE, Stevenson-Hinde J (1985) No title. J Child Psychol Psychiatry Allied Discip 26(1):43–53

    Article  CAS  Google Scholar 

  16. Abidin RR (1992) The determinants of parenting behavior. J Clin Child Psychol 21(4):407–412

    Article  Google Scholar 

  17. Abidin RR (1990) Parenting stress index : (PSI) LK. https://uofl.on.worldcat.org/oclc/314484123, 3 ed. VA SE—test: Pediatric Psychology Press, Charlottesville

  18. Abidin RR (1995) Parenting stress index: professional manual. Psychological Assessment Resources, Odessa

  19. Anderson LS (2008) Predictors of parenting stress in a diverse sample of parents of early adolescents in high-risk communities. Nurs Res 57(5):340–350

    Article  PubMed  PubMed Central  Google Scholar 

  20. Raikes HA, Thompson RA (2005) Efficacy and social support as predictors of parenting stress among families in poverty. Infant Ment Health J 26(3):177–190

    Article  PubMed  Google Scholar 

  21. Williford AP, Calkins SD, Keane SP (2007) Predicting change in parenting stress across early childhood: child and maternal factors. J Abnorm Child Psychol 35(2):251–263

    Article  PubMed  Google Scholar 

  22. Deater-Deckard K (1998) Parenting stress and child adjustment: Some old hypotheses and new questions. Clin Psychol Sci Pract 5(3):314–332

    Article  Google Scholar 

  23. Bloomfield L, Kendall S (2012) Parenting self-efficacy, parenting stress and child behaviour before and after a parenting programme. Prim Heal Care Res Dev 13(4):364–372

    Article  Google Scholar 

  24. Crnic KA, Gaze C, Hoffman C (2005) Cumulative parenting stress across the preschool period: relations to maternal parenting and child behaviour at age 5. Infant Child Dev 14(2):117–132

    Article  Google Scholar 

  25. McKay JM, Pickens J, Stewart AL (1996) Inventoried and observed stress in parent–child interactions. Curr Psychol A J Divers Perspect Divers Psychol Issues 15(3):223–234

    Google Scholar 

  26. Creasey GL, Jarvis PA (1994) Relationships between parenting stress and developmental functioning among 2-year-olds. Infant Behav Dev 17(4):423–429

    Article  Google Scholar 

  27. Melis-Yavuz H, Selcuk B, Corapci F, Aksan N (2017) Role of temperament, parenting behaviors, and stress on turkish preschoolers’ internalizing symptoms. Soc Dev 26(1):109–128

    Article  Google Scholar 

  28. Tan T, Wang Y, Ruggerio AD (2017) Childhood adversity and children’s academic functioning: roles of parenting stress and neighborhood support. J Child Fam Stud 26(10):2742–2752

    Article  Google Scholar 

  29. Deater-Deckard K (2004) Parenting stress. Yale University Press, New Haven

    Book  Google Scholar 

  30. McBride BA, Mills G (1993) A comparison of mother and father involvement with their preschool age children. Early Child Res Q 8(4):457–477

    Article  Google Scholar 

  31. Chang L, Schwartz D, Dodge KA, McBride-Chang C (2003) Harsh parenting in relation to child emotion regulation and aggression. J Fam Psychol 17(4):598–606

    Article  PubMed  PubMed Central  Google Scholar 

  32. Neece CL, Green SA, Baker BL (2012) Parenting stress and child behavior problems: a transactional relationship across time. Am J Intellect Dev Disabil 117(1):48–66

    Article  PubMed  PubMed Central  Google Scholar 

  33. Barroso NE, Mendez L, Graziano PA, Bagner DM (2018) Parenting stress through the lens of different clinical groups: a systematic review & meta-analysis. J Abnorm Child Psychol 46(3):449–461

    Article  PubMed  PubMed Central  Google Scholar 

  34. Morgan J, Robinson D, Aldridge J (2002) Parenting stress and externalizing child behaviour. Child Fam Soc Work 7(3):219–225

    Article  Google Scholar 

  35. Solem M, Christophersen K, Martinussen M (2011) Predicting parenting stress: children’s behavioural problems and parents’ coping. Infant Child Dev 20(2):162–180

    Article  Google Scholar 

  36. Vaughan EL, Feinn R, Bernard S, Brereton M, Kaufman JS (2013) Relationships between child emotional and behavioral symptoms and caregiver strain and parenting stress. J Fam Issues 34(4):534–556

    Article  PubMed  Google Scholar 

  37. Barron AP, Earls F (1984) The relation of temperament and social factors to behavior problems in three-year-old children. Child Psychol Psychiatry Allied Discip 25(1):23–33

    Article  CAS  Google Scholar 

  38. Patterson GR, Reid JB, Dishion TJ (1992) Antisocial boys. Castalia Pub. Co., Eugene

    Google Scholar 

  39. Webster-Stratton C, Eyberg SM (1982) Child temperament: Relationship with child behavior problems and parent–child interactions. J Clin Child Psychol 11(2):123–129

    Google Scholar 

  40. Johnston C, Mash EJ (2001) Families of children with attention-deficit/hyperactivity disorder: review and recommendations for future research. Clin Child Fam Psychol Rev 4(3):183–207

    Article  CAS  PubMed  Google Scholar 

  41. Rogers MA, Wiener J, Marton I, Tannock R (2009) Parental involvement in children’s learning: comparing parents of children with and without attention-deficit/hyperactivity disorder (ADHD). J Sch Psychol 47(3):167–185

    Article  PubMed  Google Scholar 

  42. Cunningham CE, Barkley RA (1979) The interactions of normal and hyperactive children with their mothers in free play and structured tasks. Child Dev 50(1):217–224

    Article  CAS  PubMed  Google Scholar 

  43. DeWolfe NA, Byrne JM, Bawden HN (2000) ADHD in preschool children: parent-rated psychosocial correlates. Dev Med Child Neurol 42(12):825–830

    Article  CAS  PubMed  Google Scholar 

  44. Pressman LJ et al (2006) Relationship of family environment and parental psychiatric diagnosis to impairment in ADHD. J Am Acad Child Adolesc Psychiatry 45(3):346–354

    Article  PubMed  Google Scholar 

  45. Lange G et al (2005) Family factors associated with attention deficit hyperactivity disorder and emotional disorders in children. J Fam Ther 27(1):76–96

    Article  Google Scholar 

  46. Berryhill MB, Durtschi JA (2017) Understanding single mothers’ parenting stress trajectories. Marriage Fam Rev 53(3):227–245

    Article  Google Scholar 

  47. Chang Y, Fine MA, Ispa J, Thornburg KR, Sharp E, Wolfenstein M (2004) Understanding parenting stress among young, low-income, African-American, first-time mothers. Early Educ Dev 15(3):265–282

    Article  Google Scholar 

  48. Ostberg M, Hagekull B (2000) A structural modeling approach to understanding parenting stress. J Clin Child Psychol 29(4):615

    Article  CAS  PubMed  Google Scholar 

  49. Abidin RR (1990) Parenting stress index : manual (PSI). Pediatric Psychology Press, Charlottesville

    Google Scholar 

  50. Peters K, Jackson D (2009) Mothers’ experiences of parenting a child with attention deficit hyperactivity disorder. J Adv Nurs 65(1):62–71

    Article  PubMed  Google Scholar 

  51. Carson JL, Parke RD (1996) Reciprocal negative affect in parent–child interactions and children’s peer competency. Child Dev 67(5):2217–2226

    Article  CAS  PubMed  Google Scholar 

  52. Shaffer A, Suveg C, Thomassin K, Bradbury L (2012) Emotion socialization in the context of family risks: links to child emotion regulation. J Child Fam Stud 21(6):917–924

    Article  Google Scholar 

  53. Calkins SD (2002) Does aversive behavior during toddlerhood matter? The effects of difficult temperament on maternal perceptions and behavior. Infant Ment Health J 23(4):381–402

    Article  Google Scholar 

  54. Davidov M, Grusec JE (2006) Untangling the links of parental responsiveness to distress and warmth to child outcomes. Child Dev 77(1):44–58

    Article  PubMed  Google Scholar 

  55. Eisenberg N, Fabes RA, Shepard SA, Guthrie IK, Murphy BC, Reiser M (1999) Parental reactions to children’s negative emotions: longitudinal relations to quality of children’s social functioning. Child Dev 70(2):513–534

    Article  CAS  PubMed  Google Scholar 

  56. Lengua LJ, Kovacs EA (2005) Bidirectional associations between temperament and parenting and the prediction of adjustment problems in middle childhood. J Appl Dev Psychol 26(1):21–38

    Article  Google Scholar 

  57. Lerner JV, Galambos NL (1985) Mother role satisfaction, mother–child interaction, and child temperament: a process model. Dev Psychol 21(6):1157–1164

    Article  Google Scholar 

  58. Nigg JT et al (2020) Evaluating chronic emotional dysregulation and irritability in relation to ADHD and depression genetic risk in children with ADHD. J Child Psychol Psychiatry 61(2):205–214

    Article  PubMed  Google Scholar 

  59. Maire J, Galera C, Bioulac S, Bouvard M, Michel G (2020) Emotional lability and irritability have specific associations with symptomatology in children with attention deficit hyperactivity disorder. Psychiatry Res 285:5

    Article  Google Scholar 

  60. Leibenluft E (2017) Irritability in children: what we know and what we need to learn. World Psychiatry 16(1):100–101

    Article  PubMed  PubMed Central  Google Scholar 

  61. Climie EA, Mitchell K (2017) Parent-child relationship and behavior problems in children with ADHD. Int J Dev Disabil 63(1):27–35

    Article  Google Scholar 

  62. Derella OJ, Burke JD, Stepp SD, Hipwell AE (2019) Reciprocity in undesirable parent–child behavior? Verbal aggression, corporal punishment, and girls’ oppositional defiant symptoms. J Clin Child Adolesc Psychol 2019:5

    Google Scholar 

  63. Gerdes AC, Hoza B, Pelham WE (2003) Attention-deficit/hyperactivity disordered boys’ relationships with their mothers and fathers: child, mother, and father perceptions. Dev Psychopathol 15(2):363–382

    Article  PubMed  Google Scholar 

  64. Stone AA, Shiffman S (1994) Ecological momentary assessment (EMA) in behavorial medicine. Ann Behav Med 16(3):199–202

    Article  Google Scholar 

  65. Shiffman S, Stone AA, Hufford MR (2008) Ecological momentary assessment. Annu Rev Clin Psychol 4:1–32

    Article  PubMed  Google Scholar 

  66. Ebner-Priemer UW, Trull TJ (2009) Ecological momentary assessment of mood disorders and mood dysregulation. Psychol Assess 21(4):463–475

    Article  PubMed  Google Scholar 

  67. de la Cruz LF, Simonoff E, McGough JJ, Halperin JM, Arnold LE, Stringaris A (2015) Treatment of children with attention-deficit/hyperactivity disorder (ADHD) and irritability: results from the multimodal treatment study of children with ADHD (MTA). J Am Acad Child Adolesc Psychiatry 54(1):62–70

    Article  Google Scholar 

  68. Rosen PJ, Factor PI (2015) Emotional impulsivity and emotional and behavioral difficulties among children with ADHD: an ecological momentary assessment study. J Atten Disord 19(9):779–793

    Article  PubMed  Google Scholar 

  69. Walerius DM, Fogleman ND, Rosen PJ (2016) The role of ADHD and negative emotional lability in predicting changes in parenting daily hassles. J Child Fam Stud 25(7):2279–2291

    Article  Google Scholar 

  70. Whalen CK et al (2009) ADHD and anger contexts: electronic diary mood reports from mothers and children. J Pediatr Psychol 34(9):940–953

    Article  PubMed  Google Scholar 

  71. Shaffer D, Fisher P, Lucas CP, Dulcan MK, Schwab-Stone ME (2000) NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. J Am Acad Child Adolesc Psychiatry 39(1):28–38

    Article  CAS  PubMed  Google Scholar 

  72. Ramtekkar UP, Reiersen AM, Todorov AA, Todd RD (2010) Sex and age differences in attention-deficit/hyperactivity disorder symptoms and diagnoses: implications for DSM-V and ICD-11. J Am Acad Child Adolesc Psychiatry 49(3):217–228

    PubMed  PubMed Central  Google Scholar 

  73. United States Census Bureau (2010) Population and Housing Units Count, 2010

  74. Phillips BM, Lonigan CJ, Driscoll K, Hooe ES (2002) Positive and negative affectivity in children: a multitrait-multimethod investigation. J Clin Child Adolesc Psychol 31(4):465

    Article  PubMed  Google Scholar 

  75. Rosen PJ, Epstein JN, Van Orden G (2013) I know it when I quantify it: ecological momentary assessment and recurrence quantification analysis of emotion dysregulation in children with ADHD. Atten Defic Hyperact Disord 5(3):283–294

    Article  PubMed  PubMed Central  Google Scholar 

  76. A. P. Association (1994) Diagnostic and statistical manual of mental disorders, 4th ed

  77. Barroso NE, Hungerford GM, Garcia D, Graziano PA, Bagner DM (2016) Psychometric properties of the Parenting Stress Index-Short Form (PSI-SF) in a high-risk sample of mothers and their infants. Psychol Assess 28(10):1331–1335

    Article  PubMed  Google Scholar 

  78. Lee SJ, Gopalan G, Harrington D (2016) Validation of the parenting stress index-short form with minority caregivers. Res Soc Work Pract 26(4):429–440

    Article  PubMed  Google Scholar 

  79. Thompson ER (2007) Development and validation of an internationally reliable short-form of the positive and negative affect schedule (PANAS). J Cross Cult Psychol 38(2):227–242

    Article  Google Scholar 

  80. Musser ED, Galloway-Long HS, Frick PJ, Nigg JT (2013) Emotion regulation and heterogeneity in attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 52(2):163–171

    Article  PubMed  PubMed Central  Google Scholar 

  81. Galera C et al (2020) Developmental profiles of childhood attention-deficit/hyperactivity disorder and irritability: association with adolescent mental health, functional impairment, and suicidal outcomes. J Child Psychol Psychiatry 2020:5

    Google Scholar 

  82. Levy T, Kronenberg S, Crosbie J, Schachar RJ (2020) Attention-deficit/hyperactivity disorder (ADHD) symptoms and suicidality in children: the mediating role of depression, irritability and anxiety symptoms. J Affect Disord 265:200–206

    Article  PubMed  Google Scholar 

  83. Carlson GA (2007) Who are the children with severe mood dysregulation, aka ‘rages’? Am J Psychiatry 164(8):1140–1142

    Article  PubMed  Google Scholar 

  84. Rosen PJ et al (2019) Managing Frustration for Children (MFC) group intervention for ADHD: an open trial of a novel group intervention for deficient emotion regulation. Cogn Behav Pract 26(3):522–534

    Article  Google Scholar 

  85. Kochanska G, Friesenborg AE, Lange LA, Martel MM (2004) Parents’ personality and infants’ temperament as contributors to their emerging relationship. J Pers Soc Psychol 86(5):744–759

    Article  PubMed  Google Scholar 

  86. Luby JL, Sullivan J, Belden A, Stalets M, Blankenship S, Spitznagel E (2006) An observational analysis of behavior in depressed preschoolers: further validation of early-onset depression. J Am Acad Child Adolesc Psychiatry 45(2):203–212

    Article  PubMed  Google Scholar 

  87. Low SM, Stocker C (2005) Family functioning and children’s adjustment: associations among parents’ depressed mood, marital hostility, parent-child hostility, and children’s adjustment. J Fam Psychol 19(3):394–403

    Article  PubMed  Google Scholar 

  88. Morrison EF, Rimm-Kauffman S, Pianta RC (2003) A longitudinal study of mother–child interactions at school entry and social and academic outcomes in middle school. J Sch Psychol 41(3):185

    Article  Google Scholar 

  89. Modesto-Lowe V, Danforth JS, Brooks D (2008) ADHD: does parenting style matter? Clin Pediatr (Phila) 47(9):865–872

    Article  PubMed  Google Scholar 

  90. Woolfson L, Grant E (2006) Authoritative parenting and parental stress in parents of pre-school and older children with developmental disabilities. Child Care Health Dev 32(2):177–184

    Article  CAS  PubMed  Google Scholar 

  91. Patterson GR (2002) The early development of coercive family process. In: Reid JB, Patterson GR, Snyder J (eds) Antisocial behavior in children and adolescents: a developmental analysis and model for intervention. American Psychological Association, Washington, DC, pp 25–44

  92. Wiener J, Biondic D, Grimbos T, Herbert M (2016) Parenting stress of parents of adolescents with attention-deficit hyperactivity disorder. J Abnorm Child Psychol 44(3):561–574

    Article  PubMed  Google Scholar 

  93. Mandy W, Roughan L, Skuse D (2014) Three dimensions of oppositionality in autism spectrum disorder. J Abnorm Child Psychol 42(2):291–300

    Article  PubMed  Google Scholar 

  94. Treacy L, Tripp G, Baird A (2005) Parent stress management training for attention-deficit/hyperactivity disorder. Behav Ther 36(3):223–233

    Article  Google Scholar 

  95. Theule J, Cheung K, Aberdeen K (2018) Children’s ADHD interventions and parenting stress: a meta-analysis. J Child Fam Stud 27(9):2744–2756

    Article  Google Scholar 

  96. Bianchi SM, Sayer LC, Milkie MA, Robinson JP (2012) Housework: who did, does or will do it, and how much does it matter? Soc Forces 91(1):55–63

    Article  PubMed  PubMed Central  Google Scholar 

  97. Maume DJ (2008) Gender differences in providing urgent childcare among dual-earner parents. Soc Forces 87(1):273–297

    Article  Google Scholar 

Download references

Funding

The authors have no funding sources to report.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Meaghan M. Flynn.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee. Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Flynn, M.M., Rosen, P.J., Reese, J.S. et al. Examining the influence of irritability and ADHD on domains of parenting stress. Eur Child Adolesc Psychiatry 32, 353–366 (2023). https://doi.org/10.1007/s00787-021-01868-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1007/s00787-021-01868-6

Keywords

Profiles

  1. Helena F. Alacha