When Parent and Child Both Have ADHD

It’s a story we hear regularly: A child is diagnosed with ADHD and one of his parents, recognizing the symptoms, realizes that he (or she) has the disorder, too.

It’s often a surprise to the mom or dad, but to clinicians it’s not surprising. “We know ADHD is highly familial,” explains Mark Stein, a clinical psychologist and director of the ADHD and Related Disorders Program (PEARL Clinic) at Seattle Children’s Hospital. “That means 25 percent of the parents of kids we diagnose are going to have it.”

It also comes as no surprise to Dr. Stein that many parents who meet the criteria for ADHD don’t know it, and haven’t been diagnosed. There’s still a good deal of stigma and lack of understanding surrounding adults with ADHD.

Moms and dads with undiagnosed ADHD often find themselves overwhelmed by the demands of parenting and struggling to meet their children’s needs. Lacking organizational skills, they may find keeping up with their kids’ schedules and managing their behavior very stressful. But in the case of moms, they are more likely to be treated for depression than ADHD, notes Dr. Stein, who is also a professor of psychiatry and behavioral science at the University of Washington.

This oversight is unfortunate, Dr. Stein adds, because treating the ADHD that’s underlying their problems would benefit both them and their children.

Studies show that intervention for kids with ADHD tends to be less effective when a caregiving parent has ADHD, too. Medication treatment requires a lot of parental organization to make appointments, deal with insurance, fill prescriptions, make sure kids take their meds and monitor side effects, and the child’s treatment is less effective if compliance with the treatment regimen isn’t consistent.

Behavioral treatment for kids with ADHD is also less effective when parents have ADHD. “There are a number of studies that look at behavioral parent training,” notes Dr. Stein, “and the biggest predictor of not responding is if a parent has ADHD.”

It is especially common for mothers to discover that they have ADHD that was not diagnosed when they were children. That’s because ADHD presents in the two genders differently. Women tend to have the inattentive type of ADHD, rather than the hyperactive/impulsive or combined types. These women may have been chronically disorganized and underachieving back in school, but since they’re not as likely to be disruptive, they were more often overlooked.

“When we see moms who are seriously stressed out, being pulled between all kinds of things in their work and their family life, we tend to think of anxiety or depression,” adds David Anderson, a clinical psychologist, and director of the ADHD and Behavior Disorders Center at the Child Mind Institute. “That’s because we associate depression and anxiety more with their gender, rather than seeing the underlying deficit, the ADHD, that’s making it so it’s difficult to manage all of those things.”

“We hear parents all the time say that they feel like a failure because they know what they have to do, but then carrying it out is so difficult,” notes Dr. Anderson. “Managing the logistics, remembering everything — they’re feeling really bad about themselves.”

For a parent who has ADHD, getting a diagnosis itself can help reduce guilt and alleviate stress. “A lot of adults with ADHD don’t realize they have ADHD,” says Dr. Stein. “They don’t know why they’ve struggled in school, and perhaps at work and maybe in their marriage, and raising their kids. They’re demoralized and frustrated.” With a diagnosis, he adds,” rather than blaming themselves and thinking that it’s a moral failing, they understand they have this genetic disorder, like their child does.”

Getting treatment for a parent with ADHD can improve that person’s parenting skills and reduce stress on the whole family, Dr. Stein notes. Treatment for ADHD often involves stimulant medication, but might also include behavioral therapy. “You’re able to be better organized and give kids more focused attention,” explains Dr. Stein. “Patients report that they all of a sudden feel less overwhelmed, and they can be more relaxed and comfortable with their children.”

When his team works with families in which both a parent and a child have ADHD, Dr. Anderson explains, the team does an inventory with the parent, to talk about strengths and weaknesses. “We want to be allies with them from the get-go, to figure out how to support both them and their child.” Parents assessing their own capabilities helps the team craft strategies to help them succeed.

One of the challenges of parenting children with ADHD is that these kids often have serious behavior problems. They have low frustration tolerance and are prone to tantrums and outbursts when things don’t go their way. Responding effectively to this kind of behavior is difficult for all parents, but more so for someone with ADHD.

Managing a child’s behavior successfully requires parents to be consistent and calm, and keep their own emotions out of the equation. Parents need to pay close attention to and respond positively to behaviors they want to encourage. And they need to avoid reacting emotionally to behaviors that are problematic. None of these things is easy if you have ADHD.

But when parents get treatment for their own ADHD, research shows that their behavior management skills improve, leading to an increase in positive parent-child interactions and more effective direction for their children. Hence treating the caregiver’s ADHD may be a vitally important part of helping the child overcome behavior problems.

Dr. Stein sees a shortage of professionals who are comfortable diagnosing and treating adults with ADHD. “I think ADHD is where depression was 15 years ago, where it used to be something that only psychiatrists treated. Then it became primary care, and now primary care doctors routinely screen for it. ADHD is very common, but seldom screened for in adults.”

Dr. Stein notes that physicians get much more training in diagnosing depression and prescribing antidepressants than they do diagnosing and treating ADHD. On top of that, they may be uncomfortable prescribing stimulant medications because they worry about potential abuse.

And organizations that treat children with ADHD are leery about including parents in their coverage. “Family medicine should be a place that should work for it,” Dr. Stein argues, “but, again, there’s this discomfort with using stimulants, and so they’re more likely to be tried with an antidepressant.”

This gap in the medical system, he adds, demonstrates why, for lifelong developmental disorders like autism and ADHD, “we need lifespan clinics.”