Prospective study on the impact of parental anxiety on academic performance in children with attention deficit

Attention deficit hyperactivity disorder (ADHD) affects approximately 5% of children worldwide and is associated with significant academic impairment. Parents of children with ADHD experience elevated stress and anxiety levels, which may further affect their children's educational outcomes. This prospective study examined the relationship between parental anxiety and academic performance of children with ADHD over a 6-year period.

To investigate the longitudinal impact of parental anxiety on academic performance in children with ADHD and explore the mediating and moderating factors over a 6-year follow-up period.

A longitudinal cohort study was conducted from 2018 to 2024, enrolling 118 children with ADHD (aged 6-12 years) and their parents from three specialized educational centers. Parental anxiety was assessed using the Parenting Stress Index-4 (PSI-4) and Parental Anxiety Scale. Children's academic performance was measured using the Academic Performance Questionnaire and standardized achievement tests. Assessments were conducted at baseline and every 6 months for 3 years.

Higher parental anxiety scores were significantly associated with poorer academic performance in children with ADHD (β = -0.42, P < 0.001). Children of parents with clinically significant anxiety (PSI-4 scores > 85^th percentile) showed 1.2 standard deviations lower academic achievement than children of parents with normal anxiety levels. The relationship was partially mediated by parent-child interaction quality (indirect effect = -0.18, 95%CI: -0.26 to -0.10) and homework supervision practices (indirect effect = -0.15, 95%CI: -0.22 to -0.08).

Parental anxiety could significantly affect the academic outcomes of children with ADHD via multiple pathways. Interventions targeting parental mental health may improve the educational outcomes of children with ADHD.