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. Author manuscript; available in PMC: 2023 Jul 1.
Published in final edited form as: J Atten Disord. 2021 Dec 23;26(9):1257–1268. doi: 10.1177/10870547211066488

Parent ADHD is Associated with Greater Parenting Distress in the First Year Postpartum

Heather M Joseph a, Susheel K Khetarpal b, Michelle A Wilson c, Brooke SG Molina a
PMCID: PMC9098664  NIHMSID: NIHMS1786360  PMID: 34937412

Abstract

Objective:

Little is known about the experience of parenting infants when a mother or father has Attention-Deficit/Hyperactivity Disorder (ADHD). This study examined cross-sectional predictors of parenting distress experienced by parents with and without ADHD who also have infants.

Methods:

Participants were 73 mother-father pairs (N=146) of infants 6-10 months old. Half of the families included a parent with ADHD. Psychosocial predictors were tested using multilevel modeling.

Results:

Parent or partner ADHD, lower parent sleep quality, fewer social supports, and less infant surgency and effortful control were associated with greater parental distress. Infant negative affect and sleep were not associated.

Conclusions:

Parents with ADHD and their partners experience greater parenting distress in the first year of their child’s life than parents without ADHD. Addressing parent ADHD symptoms and co-occurring difficulties, including sleep disturbances, are potential targets for early interventions to maximize both parent and infant mental health outcomes.

INTRODUCTION

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, impulsivity, and hyperactivity with increasing recognition that many individuals with ADHD also have difficulty with emotion regulation (Association, 2013; Beheshti et al., 2020). Although most often identified in childhood, ADHD can persist into adulthood and impairment is often present even if symptoms desist (Faraone et al., 2006). The overall prevalence of ADHD among adults is estimated to be 4% in the United States and 2.5% worldwide (Faraone et al., 2021; Kessler et al., 2006). Individuals with ADHD have multiple impairments spanning social, occupational, and health-related domains (Barkley, 2014; Doshi et al., 2012). A growing focus of research is on the impact of adult ADHD on the experience of parenting.

There is much known about parenting in families affected by ADHD, but these studies tend to be about parenting behaviors and experiences when the child has ADHD (e.g., Hinshaw et al. 2000 and Theule, Wiener, Tannock, & Jenkins, 2013). Much less is known about the impact of parental ADHD on the experience of parenting (Johnston et al., 2012). Despite high heritability of ADHD, studies have found that, after accounting for familial risk for ADHD, parent-controlled environments (e.g., early cognitive enrichment or level of home chaos) predict later development of ADHD (Einziger et al., 2019; Larsson et al., 2014). Thus, improving the parenting experience may improve parents’ capacity to regulate and enhance their child’s environment. This is particularly important in the first year of life when parents most heavily influence their child’s environment and a period of time when the human brain is rapidly developing (Gao et al., 2016).

High parenting stress, the perception of excess demands relative to one’s resources due to parenthood, has been linked to numerous negative outcomes for parents and children, including worse physical and mental health for the parent, less optimal parenting (e.g., harsher parenting), and greater child problem behaviors over time (Eisenhower et al., 2009; McQuillan & Bates, 2017; Neece et al., 2012). Parenting stress is commonly endorsed in the general population; a large national survey found that 13% of parents report high levels of parenting stress (Raphael et al., 2010). Inability to cope or maladaptive adjustment to parenting-associated stressors can significantly increase parental stress. Given the unique challenges faced by adults with ADHD, including disorganization, difficulty with time management, poor working memory, and emotional dysregulation, families with parental ADHD should be at increased risk for experiencing parenting stress but there are few data on this association and particularly in the first year of parenting. This is a significant gap in the literature given that parenting behaviors known to be affected by stress (e.g., warmth and support, positive communication) also influence brain development at this time (Crnic et al., 1983; Spinelli et al., 2013).

In addition to understanding the magnitude of stress experienced in the first year of parenting in relation to adult ADHD, identifying factors that contribute to this stress is important for prevention efforts. The Parent-Child-Relationship Stress theory is a widely referenced conceptual model of parenting stress (Deater-Deckard, 2004). Although typically examined in the context of parental depression or among families of children with chronic illnesses and disabilities, this theory emphasizes the importance of considering both parent and child factors associated with parental distress. One factor that is especially pertinent in this developmental window is sleep. New parents experience frequent sleep disruptions due to nighttime care for their infant. Sleep changes across the first postpartum year can have a negative impact on mood, relationships, and quality of life (Da Costa et al., 2021; Medina et al., 2009; Simard et al., 2021). Studies of parents of infants and toddlers have also identified that the quality of the child’s sleep predicts parent’s sleep quality (Meltzer & Mindell, 2007; Sinai & Tikotzky, 2012). Moreover, both the parent’s and their child’s sleep are related to parenting stress such that worse sleep quality is associated with greater parenting distress (Atzaba-Poria et al., 2010; Hoffman et al., 2008; McQuillan & Bates, 2017; Meltzer & Mindell, 2007; Sinai & Tikotzky, 2012). Given that adults with ADHD report significantly worse sleep than adults without ADHD, it is likely that parents with ADHD, compared to parents without ADHD, experience greater sleep disruption in the postpartum period (Díaz-Román et al., 2018). Additionally, infants at familial risk for ADHD have been found to have poorer sleep than infants without a family history of ADHD (Keating et al., 2020). Together this suggests that sleep of the parent and of the infant might be worse in the presence of parental ADHD and may increase parenting-related distress. This association has yet to be tested.

Another parent-level factor that should affect the parenting experience is social support. Having a robust social support system can provide resources, including emotional support and access to childcare. In fact, a vast literature, primarily focused on parents of children with disabilities, supports this notion with numerous studies finding a negative association between social supports and parental stress (See review by Boyd, 2002; Shin et al. 2006; Zeng, Hu, Zhao, & Stone-MacDonald, 2020; Guralnick, Hammond, Neville, & Connor, 2008). Deater-Deckard (1998) emphasizes the importance of the link between social supports and parenting stress for high-risk families. Different risk groups have been found to vary in the types of social support deficits (e.g., high- vs. low-educated mothers) although the relation between social supports and parent stress remains the same across groups (Parkes et al., 2015). Parents affected by ADHD should be at especially elevated risk for having fewer social supports given the many studies that have documented impairments in interpersonal functioning associated with ADHD (Barkley et al., 2010; Biederman et al., 2006; Molina et al., 2014).

Finally, just as infant sleep may be important for parent stress, infant temperament may also contribute in families where a parent has ADHD. Infant temperament has been examined in relation to parental stress for mothers with and without psychiatric disorders. Infants at familial risk for ADHD have been found to have more difficult temperament (e.g., more anger/irritability, greater activity levels, and less effortful control) compared to infants at low familial risk for ADHD (Auerbach et al., 2008; Sullivan et al., 2015). Mother’s perception of their infant as having a more difficult infant temperament was significantly associated with greater parental distress and easy temperaments were associated with less parental distress (Moe et al., 2018; Siqveland et al., 2013). Interestingly, mothers of infants born to fathers with elevated ADHD symptoms have been found to be less responsive than mothers of infants at low familial risk for ADHD (Landau et al., 2009; Landau et al., 2010). This could represent the effect of challenging infant temperament, commonly reported amongst children at high risk for developing childhood ADHD, on the parenting experience (Wolke, 2020, Einziger et al., 2018; Willoughby et al., 2017). Whether this translates to increased parenting stress is unknown.

While most studies of parental stress focus on a single parent, parenting stress among families with ADHD should examine both parents as increased stress among co-parents affected by ADHD is plausible. Problems with romantic partners is amongst the interpersonal difficulties experienced by adults with ADHD and may contribute to parenting stress. For example, more ADHD symptoms are associated with greater stress and maladaptive coping strategies in romantic relationships for young adults (Overbey et al., 2011). Adults with ADHD have also been found to have lower romantic partner satisfaction, higher rates of separation and divorce, and more unplanned pregnancies (Bruner et al., 2015; Minde et al., 2003; Murphy & Barkley, 1996). Likewise, partners of individuals with ADHD report significantly lower marital satisfaction than couples without ADHD (Ben-Naim et al., 2017). A robust literature finds a decrease in marital satisfaction across the transition to parenthood (e.g., see review by Kluwer, 2010). As couples enter parenting and co-parenting responsibilities, greater demands are placed on their relationships (e.g., communication around childcare, change in roles) with a resultant increase in frequency and intensity of disagreements (Huss & Pollmann-Schult, 2020). Therefore, new parents with ADHD and their co-parents may experience higher levels of parenting stress during the first year of parenthood compared to families without ADHD.

Together, these parent and infant factors are hypothesized to be associated with parental distress among families with and without ADHD. We hypothesized that poorer sleep quality and fewer social supports for the parent as well as more difficult temperaments (e.g., greater negative affect) and poorer infant sleep would each contribute to greater parental distress. Given impairments associated with ADHD in adulthood, including in interpersonal relationships, we also hypothesized that parent ADHD would contribute to parental distress for both the parent with ADHD and their co-parenting partner. Finally, as these factors were expected to be exacerbated amongst parents affected by ADHD (themselves or their partner), as well as being important for parental distress, we hypothesized that prediction from presence or absence of parental ADHD would lessen once these variables were included together in our statistical models.

METHODS

Participants

Biological parent pairs (N=146; 73 families) and their infants, 6-10 months old, were recruited from southwestern Pennsylvania for participation in the Pittsburgh ADHD Risk in Infancy Study (PARIS). This study enrolled families with infants at high and low familial risk for ADHD to longitudinally examine early predictors of childhood ADHD. High risk infants had at least one parent who met DSM-5 criteria for childhood ADHD with persistence into adulthood (n=37) and low risk infants had two parents without ADHD (n=36). Of the families with ADHD, 13 included a mother with ADHD, 28 included a father with ADHD, and 4 included two parents with ADHD. Both male and female infants were enrolled, and high- and low-risk offspring were group-matched on infant sex, race, and ethnicity. Families were excluded if the infant was born before 38 weeks of gestation, had a low birth weight (< 5lbs 8oz), or was exposed to perinatal substances as determined by both mother and father report. Participant characteristics are shown in Table 1.

Table 1:

Participant Demographics

High-Risk
(N=73) 		Low-Risk
(N=72)
M (SD) M (SD)
Parent Age (years) 32.9 (5.5) 32.7 (5.7)
Infant Age (months) 8.8 (2.1) 8.4 (1.6)
N (%) N (%)
Parent Race
  Asian 2 (2.7) 7 (9.7)
  Black or African American 11 (15.1) 13 (18.1)
  White or European American 58 (79.4) 51 (70.8)
  More than One Race 2 (2.7) 1 (1.4)
Parent Ethnicity
  Hispanic or Latinx 5 (6.8) 3 (4.2)
  Not Hispanic or Latinx 68 (93.2) 69 (95.8)
Parent Education
  Partial High School 2 (2.7) 0 (0.0)
  High School or GED 8 (11.0) 9 (12.5)
  Technical/Secretarial School 2 (2.7) 2 (2.8)
  Partial College (>1 year) 7 (9.6) 8 (11.1)
  Associate or 2-Year Degree 5 (6.8) 5 (6.9)
  College or University Graduate 23 (31.5) 23 (31.9)
  Graduate or Professional Training 26 (35.6) 25 (34.7)
Parent Relationship Status
  Single, Never Married 19 (26.0) 8 (11.1)
  Married 54 (74.0) 64 (88.9)
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Note: High-Risk indicates the parent or co-parent has an ADHD diagnosis

Procedures

All parents participated in a research visit, in-person, to determine ADHD status and co-morbid psychiatric disorders. Assessments were conducted by a masters or doctoral-level clinician, research-trained to evaluate symptoms and impairment of ADHD across the lifespan. Parents also completed questionnaires remotely using Qualtrics (Provo, UT) regarding their demographics, parenting stress, sleep, and their infant’s behavior. All participants provided informed consent prior to participation. All families were compensated for their time and the study protocol was approved by the University of Pittsburgh IRB.

Measures

Parent ADHD

The Conners’ Adult ADHD Diagnostic Interview (CAADID; Epstein, Johnson, & Conners, 2001) is a semi-structured interview to examine presence of ADHD in childhood and adulthood. Participants were identified as having ADHD (yes, no) if they met DSM-5 criteria for any presentation, 6+ symptoms in childhood and 5+ symptoms in adulthood with impairment across the lifespan.

Parenting Distress

The Parent Distress subscale of the Parenting Stress Index-Short Form (PSI-4-SF; Abidin, 2012) contains 12 items and assesses distress related to perceived parenting competence, social support, and conflicts between parenting and other roles. Parents rate each item on a scale from 1 (strongly disagree) to 5 (strongly agree). The PSI contains two additional domains of parent stress: Parent-Child Dysfunctional Interaction and Difficult Child. Cronbach’s alphas for all three scales in our sample were 0.89, 0.86, and 0.90, respectively. Raw scores from each scale can be converted into normed percentile scores, which can be used to determine if a parent’s stress scores are in the clinically significant range (90th percentile or greater). The measure also includes a check for defensive responding.

Parent Sleep

The General Sleep Disturbance Scale (GSDS; Lee, 1992) is a 21-item scale used to assess sleep problems. Parents rated the frequency of a number of different sleep problems on a scale from 0 (did not occur in the past week) to 7 (occurred every day in the past week). Responses to the 21 items are summed to yield a total score which generally range from 20-40 for good sleepers and in the 60s for shift workers (Lee, 1992); women typically score above 42 in the pregnancy and postpartum periods (Gay et al., 2004). Gay, Lee, and Lee reported internal consistencies of 0.77 for new mothers and 0.85 for new fathers. The Cronbach’s alphas for our sample were 0.88 for mothers and 0.88 for fathers. A 3-item sleep quality subscale mean can also be calculated; a score above 3 on the Sleep Quality subscale indicates poor sleep quality 3 nights per week or more.

Parent Depression

The Structured Clinical Interview for DSM-5 Research Version (SCID-5-RV; First, Williams, Karg, and Spitzer, 2015) is a semi-structured interview guide used by the study clinicians to determine the presence of a lifetime history of major depressive disorder (MDD) by DSM-5 symptom and impairment criteria, yes or no.

Social Support

The Maternal Social Support Index (MSSI, Pascoe, Loda, & Earp, 1981) is a 21-item questionnaire that asks about support with household chores and childrearing, frequency, and quality of contact with neighbors, family members, significant other, and friends, as well as involvement in organizations. Scores on the MSSI can range from 1-19. Although validated for use with mothers (Pascoe et al., 1981, Pascoe, Walsh-Clifford, & Earp, 1982), there were no significant differences in overall report of social supports by fathers and mothers in our sample (Mfathers=14.15, SD=2.53; Mmothers=14.22, SD=2.81).

Infant Sleep

The Brief Infant Sleep Questionnaire (BISQ; Sadeh, 2004) is a 10-item questionnaire completed by parents regarding their infant’s sleep. Two items (How much time does your child spend in sleep during the NIGHT between 7 in the evening and 7 in the morning, and Average number of awakenings per night), have been found to discriminate between infants presenting clinically with sleep concerns and controls. Nighttime sleep and number of nighttime awakenings accounted for 45% of the variance between groups (clinical vs. control) and assignment to the correct group occurred 85% of the time based on these two items (Sadeh, 2004).

Infant Temperament

The Infant Behavior Questionnaire – Revised Very Short Form (IBQ-R-VS; Putnam, Helbig, Gartstein, Rothbart, & Leerkes, 2014) is a 37-item questionnaire used to assess infant temperament. Parents rated how often their child exhibited a particular behavior in the past week on a 7-point scale (1=Never, 7=Always). The IBQ-R-VS has three subscales: 1) Surgency, which includes positive affect, activity level, and vocal reactivity; 2) Negative Affect, which includes sadness, distress to limitations, and fear; and 3) Effortful Control, which includes regulatory capacity, cuddliness, and soothability. Putnam reported alphas >0.65 for all subscales; Cronbach’s alphas in our sample were 0.79 for Surgency, 0.78 for Negative Affect, and 0.75 for Effortful Control.

Analytic Approach

Hypotheses were tested using a series of multilevel models clustered by family (both biological parents), with maximum likelihood estimation, to cross-sectionally examine predictors of parenting distress. All analyses were conducted in SPSS version 24 (IBM Corp, 2016). Covariates (parent sex and education) were first entered into the model followed by parental ADHD. Parent and infant predictors were tested in separate models. In a final model, all predictors p ≤ .2 were retained (Vittinghoff, Glidden, Shiboski, & McCulloh, 2012). Given the high comorbidity of adult ADHD and depression as well as the potential overlap between symptoms of depression and parental distress, we conducted additional analyses to determine if a history of depression explains a portion of the elevated risk for parental distress among families with ADHD.

RESULTS

Table 2 shows the bivariate correlations amongst the study variables. Statistically significant associations were observed among some of the predictors (e.g., Infant Surgency and Effortful Control), but none of the associations were over .4, supporting their distinctiveness as hypothesized predictors. Descriptive statistics for all study variables are reported in Table 3. Additionally, families with and without ADHD were compared on all study variables. Parents in families with ADHD had worse sleep quality, greater parental distress, and more frequent lifetime history of MDD. Children born to parents with ADHD had greater surgency and negative affect. Forty-two parents met criteria for MDD across their lifetime with 29 (40%) among the high-risk parents and 13 (18%) among the low-risk parents. Fourteen parents scored in the high or clinically significant range for the Parent Distress scale of the PSI-4-SF (7 high-risk parents and 7 low-risk parents; 5 fathers and 9 mothers).

Table 2:

Intercorrelations

1 2 3 4 5 6 7 8 9 10 11
1 Parent Education --
2 Parent Poor Sleep Quality −.073 --
3 Social Support .130 −.098 --
4 Infant Surgency .101 .076 −.036 --
5 Infant Negative Affect −.030 .268 ** −.012 .341 *** --
6 Infant Effortful Control .075 .042 .064 .375 *** .072 --
7 Infant Night Sleep .364 *** −.173 * .240 ** .130 .016 −.010 --
8 Infant Awakenings −.078 .036 −.064 −.040 .115 −.026 −.259 ** --
9 Parent Distress −.026 .341 *** −.274 ** −.150 .023 −.229 ** −.136 −.045 --
10 Parent/Partner ADHD −.010 .199 * −.133 .223 ** .171 * .110 −.150 .021 .201 * --
11 History of MDD −.001 .320 *** −.102 −.031 .048 .077 −.053 −.022 .168 * .247 ** --
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Note:

*

p < .05

**

p < .01

***

p < .001

Table 3:

Descriptive statistics and comparison between high and low-risk families

Mean SD Range High-Risk
M (SD) 		Low-Risk
M (SD) 		p
PSI-4-SF: Parental Distress Raw Score 25.6 9.0 12 - 60 27.4 (7.9) 23.8 (9.7) .015
PSI-4-SF: Parental Distress Percentile Score 47.5 27.6 3 - 99 54.4 (24.4) 40.5 (29.0) .002
GSDS: Parent Sleep Quality Subscale 3.6 2.0 0 - 7 4.0 (2.1) 3.2 (1.9) .016
Social Supports 14.2 2.7 7-19 13.8 (2.7) 14.5 (2.6) .111
IBQ-R-VS: Surgency Subscale 5.2 0.7 3.0 – 7.0 5.3 (0.8) 5.1 (0.7) .008
IBQ-R-VS: Negative Affect Subscale 4.2 1.0 1.8 - 7.0 4.3 (0.9) 4.0 (0.9) .044
IBQ-R-VS: Effortful Control Subscale 5.3 0.8 3.4 - 7.0 5.3 (0.8) 5.2 (0.8) .199
Infant Hours of Nighttime Sleep 9.2 2.1 1.5 – 12.0 8.9 (2.2) 9.5 (2.0) .115
Infant Number of Nighttime Awakenings 1.5 1.0 0-3 1.5 (1.00) 1.5 (1.0) .803
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Note: Higher GSDS Parenting Sleep Quality scores indicate lower quality sleep.

Parent ADHD in Relation to Parental Distress

Before testing associations with parent ADHD, an unconditional model was tested and found to have a significant (p=0.001) random intercept clustering by family with an intraclass correlation (ICC) of 0.42; this supported the use of multilevel modeling. The next model examined the relation between parent ADHD and parental distress adjusting for parent sex and education, Table 4. This initial model showed that having an ADHD diagnosis or a partner with an ADHD diagnosis significantly predicted more parent distress in the first year of their infant’s life (t=2.07; p=0.04; ES 0.40). Neither parent sex nor parent education were significantly associated with parental distress.

Table 4:

Multilevel models predicting parenting distress

Unconditional
Model		 ADHD Only
Model		 Parent Factors
Model		 Infant Factors
Model		 Full Model
B SE B SE B SE B SE B SE
Intercept .000 .099 .232 .149 .110 .152 .336* .158 .221 .148
Parent Education .052 .084 .087 .082 .118 .086 .117 .076
Parent Sex −.069 .125 .025 .119 −.156 .124 −.081 .108
Parent or Partner ADHD .400* .193 .231 .197 .491* .207 .355+ .194
Parent Poor Sleep Quality .309*** .075 .303*** .068
Social Support −.267*** .077 −.248*** .070
Infant Hrs of Nighttime Sleep −.091 .090
Infant Nighttime Awakenings −.080 .092
Infant Surgency −.209* .091 −.197* .078
Infant Negative Affect .054 .086
Infant Effortful Control −.221* .086 −.206** .077
 
Residual Variance .571*** .555*** .442*** .464*** .343***
Intercept Variance .421*** .401** .421*** .450*** .435***
Intraclass Correlation .424 .419 .488 .492 .559
Log Likelihood 395.9 391.0 340.8 348.0 332.1
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Note:

+

p < .10

*

p < .05

**

p < .01

***

p < .001

Parent Factors in Relation to Parental Distress

Parent sleep quality and social supports were added to the main effect model of parent ADHD predicting parent distress, Table 4. Both parent sleep quality and social supports were significant predictors of parent distress such that poorer sleep quality (t=3.87, p<0.001, ES 0.31) and fewer social supports (t= −3.48, p<0.001, ES 0.27) were associated with greater parent distress. In this model, family ADHD status was no longer significantly associated with parent distress.

Infant Factors in Relation to Parental Distress

In a separate model, infant factors (infant sleep and temperament) were added to the main effect model of parent ADHD predicting parent distress, Table 4. Greater infant surgency (t= −2.23, p=0.02, ES 0.21) and effortful control (t= −2.57, p=0.01, ES 0.22) predicted less parental distress. Family ADHD status remained a significant predictor of parental distress (t=2.38; p=0.02; ES 0.49). Negative affect and infant sleep were not significantly associated with parent distress.

Full Model Predicting Parental Distress

In a final model, all predictors of parental distress with p-values < .2 from the prior models were included and tested simultaneously. Parental ADHD was marginally significant (t= 1.83, p=0.07, ES 0.36) and each of the remaining predictors that were previously significant remained so, Table 4. The ICC was .56, estimating that 56% of the total variance in parenting distress is explained by parent or partner ADHD status, parent sleep quality, social supports, infant surgency and effortful control when clustering by family and adjusting for parent education and sex, up from 42% in the unconditional model.

Contribution of Lifetime Depression

Lifetime history of depression was a significant predictor of parental distress when examined with the covariates and parental ADHD only, t=2.48; p=0.02, and marginally significant in the full model, t=1.81; p=0.07, Table 5. Parental ADHD was no longer a significant predictor when lifetime history of depression was included in the model.

Table 5:

Multilevel models predicting parenting distress accounting for lifetime history of depression

ADHD Only
Model		 Full Model
B SE B SE
Intercept .522** .195 .397* .178
Parent Education .070 .088 .117 .075
Parent Sex −.024 .128 −.063 .105
Parent or Partner ADHD .325 .213 .303 .198
Lifetime history of MDD .458* .185 .288+ .159
Parent Poor Sleep Quality .273*** .069
Number of Social Supports −.248*** .069
Infant Surgency −.174* .078
Infant Effortful Control −.219** .076
 
Residual Variance .521*** .317***
Intercept Variance .487*** .467***
Intraclass Correlation .483 .596
Log Likelihood 361.7 317.5
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Note:

+

p < .10

*

p < .05

**

p < .01

***

p < .001

DISCUSSION

The current study examined the relation between parent ADHD and parental distress in the first year postpartum. This is one of the few studies of parents with ADHD and their infant offspring and it has several strengths including parents being well-characterized with ADHD and inclusion of both parents. The latter is particularly important as fathers have historically been under-represented in research on parenting (Lamb, 2000). Yet, research has demonstrated the importance of fathers and the co-parenting relationship on child development and behavior (Parkes et al., 2019; Sethna et al., 2017; Yogman & Garfield, 2016). In studying two groups of parents – one that included at least one parent with ADHD and the other excluding parents with ADHD, we found evidence (at least at the group mean level) of greater distress reported by those affected by ADHD. This study also revealed that several parent and infant factors, above and beyond demographic characteristics, may be important for the experience of parenting-related distress among parents with ADHD or partnered to a parent with ADHD. Given the link between parenting stress and poor behavioral health outcomes for both parents and offspring, families affected by parental ADHD with infants may benefit from early interventions and/or support that address these factors during the transition to parenthood.

Our finding of greater average level of distress among the parents in families with ADHD was consistent with our prediction and expands understanding of family dynamics in the context of ADHD. In particular, presence of ADHD in either parent of an infant may represent a variety of difficulties in the home that elevate parenting-related stress and should be considered when attempting to understand the transmission of ADHD across generations. Importantly, this group difference disappeared when accounting for parental history of depression and suggests that this well-known comorbidity (e.g., Riglin et al., 2021) may create the initial vulnerability responsible for the parenting distress. Another possible contributor to our group-level finding may be the absence of treatment experienced in this sample. Few parents reported currently receiving medications for ADHD (19%, 7/37). Untreated ADHD, either pharmacologic or cognitive/behavioral, could be contributing to parent and partner distress through a variety of mechanisms including greater home chaos and less cohesion in co-parenting. These impairments likely result in higher levels of stress in daily activities of parenting. Our finding of no group differences at clinically significant levels of distress was unexpected and may be a function of the advanced level of education in our sample; future research should expand sampling to include more parents without college degrees. In addition, although the magnitude of distress differences may be modest, cumulative effects of chronic parenting distress over time need to be investigated.

Lower quality parent sleep was found to be associated with greater parental distress in the first year postpartum. Importantly, this result was observed after adjusting for parental demographic characteristics, ADHD, and other parent and infant factors (including parental depression history). Moreover, the association between parent ADHD and parent distress fell to non-significance after including parent sleep in the regression model, suggesting that part of the effect of parental ADHD on parent distress is explained by poor sleep quality amongst parents with, or partnered to someone with, ADHD. ADHD is commonly comorbid with sleep disturbances which likely result from a combination of physiological (e.g., delayed melatonin onset ; Van Veen, 2010) and behavioral etiologies (e.g., nighttime media use and sleep hygiene; Martin et al., 2018). Sleep may worsen for adults with ADHD in early parenthood because of a heightened need for greater discipline around sleep routines and advanced planning for activities to be accomplished after infant bedtime – each of which should be more difficult for parents with versus without ADHD. Indeed, our results found that, when examined cross-sectionally, parent sleep quality is associated with parental ADHD such that parents with ADHD or a partner with ADHD reported significantly worse sleep quality.

Sleep as a predictor of distress is consistent with similar results in the literature outside of ADHD. Increasing attention has been given to the impact of postpartum sleep disruption on parental well-being and the parenting experience. Studies have found that mothers with poorer sleep at 6 months postpartum have lower quality parenting and greater symptoms of depression across the first year of their infant’s life (Bai et al., 2020; Saxbe et al., 2016). Saxbe and colleagues (2016) also found mother and father sleep quality to be correlated and, interestingly, that mothers’ sleep quality predicted paternal depressive symptoms. This suggests that sleep disruption of one parent may be a conduit for parental distress among both parents. The transmission of poor sleep among couples is particularly relevant among families affected by ADHD given the high rates of sleep disturbances reported among individuals with ADHD (Fadeuilhe et al. 2021).

Parent social supports was associated with parental distress. However, it was not associated with high or low risk status of the parents. These findings may also have been influenced by the high proportion of well-educated parents in this sample and may not be representative of the general population of adults with ADHD. As such, we speculate that the parents with ADHD may have had greater supports than is typical for this population which may have contributed to their academic successes despite their ADHD symptoms. The observed social support levels in the sample supports this conjecture. Additionally, nearly all participants were from intact families (married or living with the infants’ other parent) due to the study design requiring both parents to participate. Thus, it is possible that parents with ADHD may also benefit from the social network of the unaffected parent.

Support was found for the hypothesis that infant temperament would relate to parental distress, but our expectations about the associations between parental ADHD, infant temperament, and parental distress were not supported. Three infant temperament factors were studied, two were associated with parental ADHD (more surgency, more negative affect), but greater effortful control (regulatory capacity, cuddliness, and soothability) and surgency (activity level combined with positive affect and vocal reactivity) were each associated with less parental distress. These associations with distress were supported in the final model with all variables included as well as in the initial model excluding parent factors. The association between (more) effortful control and (less) parental distress was expected, but the inverse association between surgency and parenting distress was not expected, nor was the strengthening of the ADHD-parental distress association after including surgency in the model. Although speculative, infants in the high-risk families may be exhibiting a combination of temperament traits that include high activity levels and positive emotions. A recent literature review and meta-analysis found greater activity levels in infants to be associated with later development of childhood ADHD (Kostyrka-Allchorne et al., 2020) and other literature has supported early exuberance (happiness, positive emotions) to be associated with both inattentive and hyperactivity symptoms in childhood (e.g., Thorell et al., 2017). Lowered parental distress may stem from an increase in rewarding interactions experienced by parents of infants who frequently smile, coo, and wave their arms and legs with excitement. Replication of this finding is important to ensure that it is not idiosyncratic to this sample.

Our findings have some tentative clinical implications that would be strengthened by replication in larger samples. First and foremost, our finding that parental sleep related to both parental distress and parental risk group suggests that treating sleep disturbances, as well as the symptoms and impairments of ADHD that may interfere with sleep, may be beneficial for new parents with ADHD. ADHD symptoms may lead to poor sleep behaviors and result in poor sleep quality for both the parent with ADHD and their partners, as seen in this sample. Ultimately, such interventions may improve the overall physical and mental health of parents with ADHD, their partners, and infants at familial risk of developing ADHD.

Interestingly, our bivariate correlational analyses showed that families with greater social supports and higher parent education reported more nighttime hours of sleep for their infant. Research on postpartum sleep interventions has demonstrated that consultation with pediatric providers and behavioral-education can improve infant nighttime sleep including greater sleep duration and fewer awakenings (Hiscock & Wake, 2002; Stremler et al., 2006). Therefore, families with greater supports and education may more readily access resources (e.g., new parent support groups, infant sleep training books, social supports) for help with sleep training their infants. While infant hours of nighttime sleep was significantly associated with parent sleep quality in the bivariate correlations, the association was small in magnitude and infant sleep did not predict parent distress. Thus, sleep training for the infant alone may be insufficient for improving parent sleep quality and parenting distress. Additionally, infants’ hours of nighttime sleep did not differ between families with and without parental ADHD.

Certain limitations of our research must be acknowledged. First, the study was cross-sectional and therefore we were unable to directly test mediational pathways unfolding longitudinally or rule out prospectively the existence of confounding variables in place prenatally. Additionally, the absence of objective measurement of infant temperament and sleep leaves open the possibility that reporter effects are driving associations in this study. As mentioned earlier, the educational level of the participants is high with over half of families having a 4-year college degree or graduate degree (67%) and most (75%) identifying as White which may limit the generalizability of these findings to populations more distressed by fewer resources. Participants were primarily recruited through two mechanisms: (1) a university-hosted community research registry, and (2) postcards mailed to women on a university hospital birth registry. Enrollment of families from the birth registry was limited to women with stable housing given the time between delivery and mailing of the postcards (4-9 months). Both recruitment methods likely contributed to the higher SES sample. Additionally, requiring both biological parents to be able and willing to participate resulted in a sample of heterosexual, largely co-parenting, couples and eliminated most single-parent households that might be more prone to parenting distress (as well as same-sex couples). Lastly, the sample size prohibits separate examination of parents with ADHD and their partners as well as gender, sexual, racial, and ethnic identity differences that may be present. Our future work will examine longitudinal outcomes for these families and efforts are ongoing to recruit and retain more diverse participants.

Overall, the findings herein demonstrated that parents with ADHD and their partners experience greater mean-level parenting distress in the first year of their child’s life than families without parental ADHD. This association is modest but should be examined for cumulative, long-term effects. Poor parental sleep quality was significantly associated with parental distress. Sleep disturbance is common among individuals with ADHD, and in this sample parents with ADHD and their partners reported poorer sleep quality than families without ADHD. Thus, treating sleep disturbances, as well as the symptoms and impairments of ADHD that may be disrupting sleep, are potential targets for new parents with ADHD. Ultimately, such interventions may improve the overall physical and mental health of parents with ADHD, their partners, and infants at familial risk of developing ADHD.

References

  1. Abidin R (2012). Parenting stress index–fourth edition (PSI-4). Lutz, FL: Psychological Assessment Resources. [Google Scholar]
  2. Association AP (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub. [DOI] [PubMed] [Google Scholar]
  3. Atzaba-Poria N, Meiri G, Millikovsky M, Barkai A, Dunaevsky-Idan M, & Yerushalmi B (2010). Father–child and mother–child interaction in families with a child feeding disorder: The role of paternal involvement. Infant mental health journal, 31(6), 682–698. [DOI] [PubMed] [Google Scholar]
  4. Auerbach JG, Berger A, Atzaba-Poria N, Arbelle S, Cypin N, Friedman A, & Landau R (2008). Temperament at 7, 12, and 25 months in children at familial risk for ADHD. Infant and Child development, 17(4), 321–338. [Google Scholar]
  5. Bai L, Whitesell CJ, & Teti DM (2020). Maternal sleep patterns and parenting quality during infants’ first 6 months. Journal of Family Psychology, 34(3), 291. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Barkley RA (2014). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. Guilford Publications. [Google Scholar]
  7. Barkley RA, Murphy KR, & Fischer M (2010). ADHD in adults: What the science says. Guilford Press. [Google Scholar]
  8. Beheshti A, Chavanon M-L, & Christiansen H (2020). Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis. BMC Psychiatry, 20(1), 1–11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Ben-Naim S, Marom I, Krashin M, Gifter B, & Arad K (2017). Life with a partner with ADHD: The moderating role of intimacy. Journal of Child and Family Studies, 26(5), 1365–1373. [Google Scholar]
  10. Biederman J, Faraone S, Spencer T, Mick E, Monuteaux M, & Aleardi M (2006). Functional impairments in adults with self-reports of diagnosed ADHD. Journal of Clinical Psychiatry, 67(4), 524–540. [DOI] [PubMed] [Google Scholar]
  11. Boyd BA (2002). Examining the relationship between stress and lack of social support in mothers of children with autism. Focus on Autism and Other Developmental Disabilities, 17(4), 208–215. [Google Scholar]
  12. Bruner MR, Kuryluk AD, & Whitton SW (2015). Attention-deficit/hyperactivity disorder symptom levels and romantic relationship quality in college students. Journal of American College Health, 63(2), 98–108. [DOI] [PubMed] [Google Scholar]
  13. Crnic KA, Greenberg MT, Ragozin AS, Robinson NM, & Basham RB (1983). Effects of stress and social support on mothers and premature and full-term infants. Child Development, 209–217. [PubMed] [Google Scholar]
  14. Da Costa D, Lai JK, & Zelkowitz P (2021). A prospective study on the course of sleep disturbances in first-time fathers during the transition to parenthood. Infant mental health journal, 42(2), 222–232. [DOI] [PubMed] [Google Scholar]
  15. Deater-Deckard K (2004). Parenting Stress. Yale University Press. http://www.jstor.org/stable/j.ctt1nq6k2 [Google Scholar]
  16. Deater-Deckard K (1998). Parenting stress and child adjustment: Some old hypotheses and new questions. Clinical psychology: Science and practice, 5(3), 314–332. [Google Scholar]
  17. Díaz-Román A, Mitchell R, & Cortese S (2018). Sleep in adults with ADHD: systematic review and meta-analysis of subjective and objective studies. Neuroscience and Biobehavioral Reviews, 89, 61–71. [DOI] [PubMed] [Google Scholar]
  18. Doshi JA, Hodgkins P, Kahle J, Sikirica V, Cangelosi MJ, Setyawan J, Erder MH, & Neumann PJ (2012). Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States. Journal of the American Academy of Child and Adolescent Psychiatry, 51(10), 990–1002. e1002. [DOI] [PubMed] [Google Scholar]
  19. Einziger T, Zilberman-Hayun Y, Atzaba-Poria N, Auerbach JG, & Berger A (2019). How important is early home environment in the prediction of attention-deficit hyperactivity disorder in adolescence? The protective role of early cognitive stimulation. Infant and Child development, 28(5), e2138. [Google Scholar]
  20. Eisenhower AS, Baker BL, & Blacher J (2009). Children's delayed development and behavior problems: Impact on mothers' perceived physical health across early childhood. Social Science and Medicine, 68(1), 89–99. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Epstein J, Johnson DE, & Conners CK (2001). Conners' Adult ADHD Diagnostic Interview for DSM-IV™. [Google Scholar]
  22. Faraone SV, Banaschewski T, Coghill D, Zheng Y, Biederman J, Bellgrove MA, Newcorn JH, Gignac M, Al Saud NM, & Manor I (2021). The World Federation of ADHD International Consensus Statement: 208 Evidence-based Conclusions about the Disorder. Neuroscience and Biobehavioral Reviews. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Faraone SV, Biederman J, & Mick E (2006). The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychological Medicine, 36(2), 159. [DOI] [PubMed] [Google Scholar]
  24. Gao W, Lin W, Grewen K, & Gilmore JH (2016). Functional Connectivity of the Infant Human Brain Plastic and Modifiable. The Neuroscientist, 1073858416635986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Gay CL, Lee KA, & Lee S-Y (2004). Sleep patterns and fatigue in new mothers and fathers. Biological Research for Nursing, 5(4), 311–318. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Guralnick MJ, Hammond MA, Neville B, & Connor RT (2008). The relationship between sources and functions of social support and dimensions of child-and parent-related stress. Journal of Intellectual Disability Research, 52(12), 1138–1154. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Hinshaw SP, Owens EB, Wells KC, Kraemer HC, Abikoff HB, Arnold LE, Conners CK, Elliott G, Greenhill LL, & Hechtman L (2000). Family processes and treatment outcome in the MTA: Negative/ineffective parenting practices in relation to multimodal treatment. Journal of Abnormal Child Psychology, 28(6), 555–568. [DOI] [PubMed] [Google Scholar]
  28. Hiscock H, & Wake M (2002). Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood. BMJ, 324(7345), 1062. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Hoffman CD, Sweeney DP, Lopez-Wagner MC, Hodge D, Nam CY, & Botts BH (2008). Children with autism: Sleep problems and mothers' stress. Focus on Autism and Other Developmental Disabilities, 23(3), 155–165. [Google Scholar]
  30. Huss B, & Pollmann-Schult M (2020). Relationship satisfaction across the transition to parenthood: The impact of conflict behavior. Journal of family issues, 41(3), 383–411. [Google Scholar]
  31. Hvolby A (2015). Associations of sleep disturbance with ADHD: implications for treatment. ADHD Attention Deficit and Hyperactivity Disorders, 7(1), 1–18. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Johnston C, Mash EJ, Miller N, & Ninowski JE (2012). Parenting in adults with attention-deficit/hyperactivity disorder (ADHD). Clinical Psychology Review, 32(4), 215–228. 10.1016/j.cpr.2012.01.007 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Keating J, Bramham J, McNicholas F, Carr A, Hasshim N, & Downes M (2020). An Exploration of Sleep and Family Factors in Young Children at Familial Risk for ADHD. Behavioral Sleep Medicine, 1–15. [DOI] [PubMed] [Google Scholar]
  34. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, Faraone SV, Greenhill LL, Howes MJ, & Secnik K (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163(4), 716–723. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Lamb ME (2000). The history of research on father involvement: An overview. Marriage & family review, 29(2-3), 23–42. [Google Scholar]
  36. Landau R, Amiel-Laviad R, Berger A, Atzaba-Poria N, & Auerbach JG (2009). Parenting of 7-month-old infants at familial risk for ADHD during infant's free play, with restrictions on interaction. Infant Behavior & Development, 32(2), 173–182. 10.1016/j.infbeh.2008.12.007 [DOI] [PubMed] [Google Scholar]
  37. Landau R, Avital M, Berger A, Atzaba-Poria N, Arbelle S, Faroy M, & Auerbach JG (2010). Parenting of 7-month-old infants at familial risk for attention deficit/hyperactivity disorder. Infant mental health journal, 31(2), 141–158. [DOI] [PubMed] [Google Scholar]
  38. Larsson H, Chang Z, D'Onofrio BM, & Lichtenstein P (2014). The heritability of clinically diagnosed attention deficit hyperactivity disorder across the lifespan. Psychological Medicine, 44(10), 2223–2229. 10.1017/S0033291713002493 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Lee KA (1992). Self-reported sleep disturbances in employed women. Sleep, 15(6), 493–498. [DOI] [PubMed] [Google Scholar]
  40. McQuillan ME, & Bates JE (2017). Parental Stress and Child Temperament. In Deater-Deckard K & Panneton R (Eds.), Parental Stress and Early Child Development: Adaptive and Maladaptive Outcomes (pp. 75–106). Springer International Publishing. 10.1007/978-3-319-55376-4_4 [DOI] [Google Scholar]
  41. Medina AM, Lederhos CL, & Lillis TA (2009). Sleep disruption and decline in marital satisfaction across the transition to parenthood. Families, Systems, & Health, 27(2), 153. [DOI] [PubMed] [Google Scholar]
  42. Meltzer LJ, & Mindell JA (2007). Relationship between child sleep disturbances and maternal sleep, mood, and parenting stress: a pilot study. Journal of Family Psychology, 21(1), 67. [DOI] [PubMed] [Google Scholar]
  43. Minde K, Eakin L, Hechtman L, Ochs E, Bouffard R, Greenfield B, & Looper K (2003). The psychosocial functioning of children and spouses of adults with ADHD. Journal of Child Psychology and Psychiatry, 44(4), 637–646. [DOI] [PubMed] [Google Scholar]
  44. Moe V, Von Soest T, Fredriksen E, Olafsen KS, & Smith L (2018). The multiple determinants of maternal parenting stress 12 months after birth: the contribution of antenatal attachment style, adverse childhood experiences, and infant temperament. Frontiers in Psychology, 9, 1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Molina BS, Walther CA, Cheong J, Pedersen SL, Gnagy EM, & Pelham WE Jr (2014). Heavy alcohol use in early adulthood as a function of childhood ADHD: Developmentally specific mediation by social impairment and delinquency. Experimental and Clinical Psychopharmacology, 22(2), 110. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Murphy K, & Barkley RA (1996). Attention deficit hyperactivity disorder adults: comorbidities and adaptive impairments. Comprehensive Psychiatry, 37(6), 393–401. [DOI] [PubMed] [Google Scholar]
  47. Neece CL, Green SA, & Baker BL (2012). Parenting stress and child behavior problems: A transactional relationship across time. American journal on intellectual and developmental disabilities, 117(1), 48–66. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Overbey GA, Snell WE Jr, & Callis KE (2011). Subclinical ADHD, stress, and coping in romantic relationships of university students. Journal of Attention Disorders, 15(1), 67–78. [DOI] [PubMed] [Google Scholar]
  49. Parkes A, Green M, & Mitchell K (2019). Coparenting and parenting pathways from the couple relationship to children’s behavior problems. Journal of Family Psychology, 33(2), 215. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Parkes A, Sweeting H, & Wight D (2015). Parenting stress and parent support among mothers with high and low education. Journal of Family Psychology, 29(6), 907. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Putnam SP, Helbig AL, Gartstein MA, Rothbart MK, & Leerkes E (2014). Development and assessment of short and very short forms of the Infant Behavior Questionnaire–Revised. Journal of Personality Assessment, 96(4), 445–458. [DOI] [PubMed] [Google Scholar]
  52. Raphael JL, Zhang Y, Liu H, & Giardino A (2010). Parenting stress in US families: Implications for paediatric healthcare utilization. Child: Care, Health and Development, 36(2), 216–224. [DOI] [PubMed] [Google Scholar]
  53. Sadeh A (2004). A brief screening questionnaire for infant sleep problems: validation and findings for an Internet sample. Pediatrics, 113(6), e570–e577. [DOI] [PubMed] [Google Scholar]
  54. Saxbe DE, Schetter CD, Guardino CM, Ramey SL, Shalowitz MU, Thorp J, Vance M, Health, E. K. S. N. I. f. C., & Network, H. D. C. C. H. (2016). Sleep quality predicts persistence of parental postpartum depressive symptoms and transmission of depressive symptoms from mothers to fathers. Annals of Behavioral Medicine, 50(6), 862–875. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Sethna V, Perry E, Domoney J, Iles J, Psychogiou L, Rowbotham NE, Stein A, Murray L, & Ramchandani PG (2017). Father–child interactions at 3 months and 24 months: contributions to children's cognitive development at 24 months. Infant mental health journal, 38(3), 378–390. [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Shin J, Nhan N, Crittenden K, Hong H, Flory M, & Ladinsky J (2006). Parenting stress of mothers and fathers of young children with cognitive delays in Vietnam. Journal of Intellectual Disability Research, 50(10), 748–760. [DOI] [PubMed] [Google Scholar]
  57. Simard V, Pilon M, & Blouin MM (2021). Maternal lack of sleep in the first two years after childbirth: Perceived impacts and help-seeking behaviors. Infant mental health journal, 42(3), 346–361. [DOI] [PubMed] [Google Scholar]
  58. Sinai D, & Tikotzky L (2012). Infant sleep, parental sleep and parenting stress in families of mothers on maternity leave and in families of working mothers. Infant Behavior and Development, 35(2), 179–186. [DOI] [PubMed] [Google Scholar]
  59. Siqveland TS, Olafsen KS, & Moe V (2013). The influence of maternal optimality and infant temperament on parenting stress at 12 months among mothers with substance abuse and psychiatric problems. Scandinavian Journal of Psychology, 54(5), 353–362. [DOI] [PubMed] [Google Scholar]
  60. Spinelli M, Poehlmann J, & Bolt D (2013). Predictors of parenting stress trajectories in premature infant–mother dyads. Journal of Family Psychology, 27(6), 873. [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Statistics, I. (2016). IBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp. In [Google Scholar]
  62. Stremler R, Hodnett E, Lee K, MacMillan S, Mill C, Ongcangco L, & Willan A (2006). A behavioral-educational intervention to promote maternal and infant sleep: a pilot randomized, controlled trial. Sleep, 29(12), 1609–1615. [DOI] [PubMed] [Google Scholar]
  63. Sullivan EL, Holton KF, Nousen EK, Barling AN, Sullivan CA, Propper CB, & Nigg JT (2015). Early identification of ADHD risk via infant temperament and emotion regulation: a pilot study. Journal of Child Psychology and Psychiatry and Allied Disciplines, 56(9), 949–957. 10.1111/jcpp.12426 [DOI] [PubMed] [Google Scholar]
  64. Theule J, Wiener J, Tannock R, & Jenkins JM (2013). Parenting stress in families of children with ADHD: A meta-analysis. Journal of Emotional and Behavioral Disorders, 21(1), 3–17. [Google Scholar]
  65. Yogman M, & Garfield CF (2016). Committee on Psychosocial Aspects of Child Family Health, Fathers’ roles in the care and development of their children: the role of pediatricians. Pediatrics, 138(1). [DOI] [PubMed] [Google Scholar]
  66. Zeng S, Hu X, Zhao H, & Stone-MacDonald AK (2020). Examining the relationships of parental stress, family support and family quality of life: A structural equation modeling approach. Research in Developmental Disabilities, 96, 103523. [DOI] [PubMed] [Google Scholar]

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