A Large-Scale Examination of Attention-Deficit/Hyperactivity Disorder Behaviors and Family Functioning Over Time...

The association between family environment factors, such as family conflict and parental monitoring, and attention-deficit/hyperactivity disorder (ADHD) behaviors is well established. However, it is unclear whether ADHD behaviors precede changes in familial functioning, whether certain family dynamics increase ADHD behaviors, or if the association is reciprocal.

Data from 7,425 children across 4 waves of the Adolescent Brain and Cognitive Development Study were analyzed. ADHD behaviors were evaluated using the Child Behavior Checklist. Family conflict and parental monitoring were assessed using the Family Environment Scale and the Parental Monitoring Survey, respectively. Random-intercept cross-lagged panel modeling was employed to explore potential within-subject temporal associations between ADHD behaviors and the family environment.

At the within-subject level, increases in ADHD behaviors were associated with subsequent increases in family conflict (B = .02, 95% CI [0.002, 0.04], p = .03, adjusted p = .04) and reductions in parental monitoring (B = -.006, 95% CI [-0.01, -0.0006], p = .03, adjusted p = .04). Similar findings emerged when restricting analyses to 1,315 participants meeting diagnostic criteria for ADHD. These findings were not moderated by sex, race/ethnicity, household income, or medication status. Among participants with ADHD, cross-lagged associations involving ADHD behaviors remained significant after controlling for time-varying externalizing and internalizing behaviors, which did not show significant cross-lagged associations with family conflict or parental monitoring.

These findings indicate that worsening ADHD behaviors can negatively impact the family environment. Despite small effect sizes, this study bolsters the case for early detection and treatment to help young people with ADHD, potentially mitigating impact on family dynamics.