Virtual Medical Centre

The Family Impact of Attention Deficit Hyperactivity Disorder (ADHD)

• Introduction to ADHD
• Impact of ADHD on education
• ADHD and families
  • Siblings

Introduction to ADHD 

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Attention deficit hyperactivity disorder (ADHD) is currently the most frequently diagnosed behavioural disorder in children. It affects 3–5% of school aged children. ADHD is characterised by inattention, hyperactivity and impulsivity. The impact of this disorder can be widespread, affecting not only schooling and academic performance but also home life, peer relationships and social-emotional development.

Impact of ADHD on education

School-based problems are common with ADHD, and in many cases are the signs that bring the child to the doctor's attention. The educational problems faced by children with ADHD include various impairments, limitations and restrictions that affect their academic performance. They may have problems with sequencing complex movements, may be limited in their reading, writing and calculating skills, or may have troubles with general tasks, self care and interpersonal interactions and relationships.

Attention-Deficit/Hyperactivity Disorder (ADHD) Evaluation Tool

Does your child have problems paying attention?
Do they fidget, talk a lot, or run around with seemingly endless energy?
Do they have trouble waiting their turn, and 'butt into' games or conversations?

If the answer to any of these is yes, you might want to find out whether your child is exhibiting symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD). All children at some time or another will tend to be inattentive, hyperactive or impulsive. However some children will exhibit these qualities most of the time, and more than their peers.

Please complete the survey below to find out if you need to consult your GP about these symptoms. It is important to keep in mind that symptoms of ADHD are often common in many energetic children; therefore it might help to compare your child to other children in the same age group.

Scientific studies that have followed children with ADHD over time have shown that the academic and educational problems they face are long-standing. Although the initial symptoms of inattention, hyperactivity, impulsivity and frequently aggression tend to become less severe, they remain high compared to children who do not have ADHD. These studies have also shown that, as these children approach adulthood, they commonly fall into one of three major groups:

• Most have continued functional impairment, limitations in learning and applying knowledge, and restricted social participation; 
• Around 25% eventually function comparably to those without ADHD; and
• < 25% develop significant problems.

It is unclear what factors determine the long-term outcomes of ADHD.

ADHD and families

The families of children with ADHD have to contend with a greater number of behavioural, developmental and educational disturbances. This often requires that more time, logistics and energy be spent. It is not surprising that these increased demands are frequently associated with more stress in marital and family functioning. The financial burden of treating ADHD and its associated psychiatric disorders can add to these difficulties.

When family environments are chronically stressful, both the adults and children are at greater risk of physical and mental health problems. In families affected by ADHD, marital conflict is common, and has been consistently linked with poorer health and mental outcomes. Some believe that marital conflict can negatively impact a child by:

• Reducing the child's sense of safety and security in their home environment;
• Upsetting parent-child relationships;
• Adding to inconsistent discipline;
• Decreasing parental monitoring of potentially dangerous behaviours; or
• More directly acting as a platform for aggressive behaviours.

Siblings 

ADHD has a significant impact on the siblings of children who have the condition. One study found that 10 of the 13 siblings (brothers and sisters) interviewed thought they were "severely and negatively" affected by living with a sibling who had ADHD. This study found the most significant problem identified by siblings was the disruption caused by the behaviour of the child with the condition. Examples of this disruptive behaviour included physical and verbal aggression, out-of-control hyperactivity, emotional and social immaturity, academic underachievement and learning problems, family conflicts, poor peer relationships, and difficult relationships with extended family.

Siblings described their family life as "chaotic", "exhausting", and "focused on their sibling". Siblings described "never knowing what to expect next" and that they did not expect an end point to the impact of ADHD on their lives.

Siblings of children with ADHD experienced the disruptive effects of the condition in three ways: victimisation, caretaking and feelings of sorrow and loss. Siblings reported feeling victimised through physical violence, verbal aggression and manipulative and controlling behaviour. Many siblings felt unprotected by their parents who were perceived as too exhausted or overwhelmed to intervene.

Disruption for siblings also arose due to expectations that they act as caretakers for their brother or sister with ADHD. Older and younger siblings reported that their parents expected them to play with and supervise the child with ADHD. Other caretaking activities included giving medication, helping with homework, intervening with teachers and other children on behalf of the child with ADHD, keeping that child "out of trouble" and keeping the child occupied when the parents were exhausted. While some siblings reported pride at being able to carry out this role, the majority reported that they found it difficult, particularly when they felt victimised by their sibling. Some reported that they provided relief for their parents, but did not feel they received relief themselves.

Feelings of sorrow and loss were common among siblings of children with ADHD. These children wished for "peace and quiet", and a "normal" family life. They experienced worry that their sibling with ADHD would get hurt or get into trouble. Siblings felt their parents expected them to not require much attention. These children often felt ignored or overlooked because their needs seemed less significant than those of their sibling with ADHD. They reported that they tried not to be a further burden to their parents.

Some of the siblings of children with ADHD felt frustrated due to the degree to which the child with the condition "controlled" family life. Parents of children with ADHD rate their families as lower in achievement and organisation, and higher in conflict than families not affected by ADHD. Siblings reported concern about the child with ADHD "ruining" potentially enjoyable activities due to their behaviour, which reduced their anticipation for these events. Siblings commonly expressed feelings of powerlessness, and saw themselves as unworthy of attention, love and care from their parents.

It has been shown that parenting stress can be reduced and family relationships improved if parent training is included in the management of ADHD.