Testing the Similarity Fit/Misfit Hypothesis in Adolescents and Parents With ADHD

Abstract

Objective: Higher rates of conflict are observed between adolescents with ADHD and their parents due to cognitive, academic, social, and behavioral difficulties. Conflict should be even more pronounced when parents have ADHD themselves; however, some research suggests that parents with ADHD may have increased tolerance toward children who share similar challenges (i.e., similarity-fit hypothesis). Method: We tested the similarity-fit model and its converse, the similarity-misfit model, in a sample of 93 ADHD adolescents, 63 comparison adolescents, and their parents with varying levels of ADHD. Quantity and intensity of conflict were examined in mothers and fathers separately. Results: We found evidence for the similarity-fit process in fathers, and similarity misfit in mothers, particularly regarding quantity of conflict between parent and adolescent. Conclusion: Results indicate the importance of differential parental roles in mothers and fathers, and have implications for involving parents in treatment for ADHD in adolescents.

Keywords

parental ADHD adolescent ADHD conduct problems parent–child interactions similarity-fit similarity-misfit

Introduction

Research has shown that ADHD youth and their parents engage in higher rates of conflict (Barkley, Anastopoulos, Guevremont, & Fletcher, 1992; Markel & Wiener, 2014), more intense conflict (Barkley, Fischer, Edelbrock, & Smallish, 1991), and more mutually negative behaviors (e.g., controlling behaviors; Edwards, Barkley, Laneri, Fletcher, & Metevia, 2001; Fletcher, Fischer, Barkley, & Smallish, 1996), compared with typically developing adolescents and their parents. This parent–adolescent conflict is proposed to arise from academic, cognitive (e.g., inattention, self-regulation), and social problems evident in youth with ADHD, as well as other behaviors such as lying, defiance, and noncompliance (Barkley et al., 1992; Markel & Wiener, 2014). Importantly, child and adolescent externalizing problems, often comorbid with ADHD (Barkley et al., 1991), are also strongly associated with conflict between parents and their children (Ingoldsby et al., 2006; Patterson, Reid, & Dishion, 1992). In fact, many of the aforementioned studies comparing ADHD families versus comparison families also identified that comorbid oppositional defiant disorder (ODD) symptoms either accounted for most of the variance or magnified the rate and intensity of conflict between parents and adolescents with ADHD (Barkley et al., 1991; Edwards et al., 2001).

Conflict can be exacerbated by the reactions of parents to adolescent negative behaviors, particularly evident in parents who struggle with psychopathology themselves (Edwards et al., 2001; Fletcher et al., 1996). Parents with ADHD may have most difficulty in coping and managing their youth’s general behavior as well their behavior during conflict, thus amplifying the rate and intensity of conflict. Edwards and colleagues (2001) examined the role of maternal and paternal psychopathology (e.g., hostility, anxiety, depression, and ADHD) on conflict with adolescents and found that maternal and paternal hostility contributed to more conflict above and beyond adolescent ADHD and ODD; paternal anxiety was related to less conflict with their teenager. Although parental ADHD did not affect conflict in this study, this study highlighted that type of parental psychopathology affects conflict with adolescents in different ways and may be different in fathers and mothers. Babinski et al. (2012) reported that mothers with ADHD who also had an adolescent with ADHD had the highest conflict, compared with mothers without ADHD who had an adolescent with ADHD and with non-ADHD (i.e., control) dyads.

Parents with ADHD also show challenges in many aspects of parenting (Chen & Johnston, 2007; Chronis-Tuscano et al., 2008; Murray & Johnston, 2006), which may contribute to more conflict with their adolescents. Deficits in parenting are considered to be due to executive functioning deficits in ADHD (e.g., working memory, planning and inattention difficulties; Johnston, Mash, Miller, & Ninowski, 2012). However, parenting does not appear to be equally affected by parental ADHD (Johnston et al., 2012). In their review, Johnston and colleagues (2012) highlighted some research reporting that parents with ADHD struggle with parenting behaviors intended to direct or protect their child, such as more negative disciplinary practices (e.g., inconsistent discipline, lax parenting, overreactive parenting, physical punishment), less structured and chaotic family environments, and more criticism toward their children (Chen & Johnston, 2007; Chronis-Tuscano et al., 2008; Harvey, Danforth, Eberhardt McKee, Ulaszek, & Friedman, 2003; Mokrova, O’Brien, Calkins, & Keane, 2010; Murray & Johnston, 2006), whereas other studies that examined more affective parenting processes showed no significant association between parental ADHD and warmth, sensitivity, positivity, and emotional responsivity toward their children (Chen & Johnston, 2007; Ellis & Nigg, 2009; Mokrova et al., 2010; Murray & Johnston, 2006). Notably, many of these studies were based on community samples and so rates of ADHD were generally low. Other research found that mothers with higher levels of ADHD symptoms were more praising and positive during play with their ADHD children (Chronis-Tuscano et al., 2008) and were more likely to positively reinforce their ADHD children (Williamson, 2013).

To explain the null and positive effects for positive and responsive parenting, parents of adolescents with ADHD may have greater tolerance for aversive behaviors. This may especially so for parents with ADHD themselves as they may develop a better understanding, tolerance, and simpatico for their children who share similar attributes (i.e., similarity-fit hypothesis; Psychogiou, Daley, Thompson, & Sonuga-Barke, 2007, 2008). This may also be the reason why null effects were observed for some of the positive parenting studies that mostly investigated community (i.e., non-ADHD) samples. Thus, it seems important to consider how parental ADHD interacts with child ADHD symptoms.

Among the small number of studies that have analyzed how parental ADHD moderates child ADHD, there is some preliminary evidence indicating that parental ADHD actually ameliorates the negative effects of child ADHD on parenting (Biederman, Faraone, & Monuteaux, 2002; Griggs & Mikami, 2011; Psychogiou et al., 2007, 2008). The similarity-fit hypothesis, an extension of the goodness-of-fit concept (Thomas & Chess, 1977), was posited by Psychogiou and her colleagues (2007, 2008) to explain this effect. Based on results from some of their studies, Psychogiou et al. suggested that parents with ADHD may be more understanding, empathic, tolerant, and less frustrated with their children with ADHD who share similar traits and attributes. Furthermore, similarities with respect to motivations for behavior and “cognitive tempo” result in less conflict between parent and child. Studies have found that mothers with elevated levels of ADHD reported more positive involvement and showed more positivity and affection (Psychogiou et al., 2007, 2008) and were less irritable and less corrective (Griggs & Mikami, 2011) toward their children with higher levels of ADHD. In addition, mothers with higher levels of ADHD reported more negative parenting (e.g., inconsistent discipline, physical punishment, poor monitoring) toward children with fewer ADHD symptoms (Psychogiou et al., 2007, 2008). Notably, the similarity-fit hypothesis proposes less conflict when parents and adolescents both have ADHD; however, no studies have directly investigated this particular outcome.

However, the similarity-misfit hypothesis proposes that parental ADHD exacerbates the negative impact of child ADHD on parenting (Babinski et al., 2012; Fischer, 1990; Psychogiou et al., 2007). The limited research suggests thus far that this phenomenon may occur in fathers with ADHD (Psychogiou et al., 2007). Fathers with higher levels of ADHD reported more negative parenting toward their children who also had more ADHD symptoms (Psychogiou et al., 2007). The authors speculated that fathers may be more frustrated and overwhelmed by their child’s ADHD behaviors whereas mothers are more likely to be empathic toward them. Although they did not examine a statistical interaction between child and paternal ADHD, Arnold, O’Leary, and Edwards (1997) found that when involved fathers reported high levels of ADHD symptoms, they were more likely to show negative parenting behaviors in response to their ADHD child’s misbehavior. These findings are consistent with evidence that fathers have a more distorted and negative view of their child’s symptoms than mothers, and that they are more likely to attribute ADHD symptoms to internal causes that are controllable and changeable by the child (Chen, Seipp, & Johnston, 2008). Thus, similarity-fit/misfit models might look different in mothers and fathers, warranting an investigation of parental gender. Therefore, another objective of this study is to examine maternal and paternal ADHD separately to determine whether the models look different depending on parental gender.

The aim of the current study was to explore quantity and intensity of conflict between adolescents and parents with ADHD, specifically to test the similarity-fit and similarity-misfit models, separately in mothers and fathers. If the similarity-fit model were supported, parental ADHD symptoms would moderate the effect of adolescent ADHD symptoms on parent–adolescent quantity and intensity of conflict; conflict between parents and adolescents would be reduced when both have high levels of ADHD symptoms. If the similarity-misfit model were supported, moderation would also occur, but in this case, conflict between adolescents and parents would be increased when both have high levels of ADHD symptoms. We studied conflict because adolescence is a critical period for youth and their parents, with increased conflict and stress within families during this time, especially for ADHD youth (Barkley et al., 1992; Barkley et al., 1991; Markel & Wiener, 2014). Adolescent–parent conflict may thus be a salient and relevant process to study in this population. Conflict is also a key outcome to examine as it directly and indirectly taps into the very processes proposed to be at play in the similarity-fit hypothesis (e.g., less conflict, higher tolerance, patience, and understanding).

Method

Participants

The sample comprised 156 thirteen- to eighteen-year-old adolescents (93 with ADHD, 63 without ADHD) and their parents from Toronto, Canada. We recruited the participants with ADHD through flyers sent to physicians and children’s mental health centers, by posting on ADHD organization websites, and we contacted individuals who participated in previous studies. Typically developing adolescents in the comparison sample were recruited through community advertisements. All adolescents had average intellectual ability (IQ ≥ 85).

Adolescents with ADHD were diagnosed with ADHD by a physician or psychologist at least 1 year prior to participating in the current study. Ongoing ADHD symptoms were confirmed using the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) scales of the Conners-3 (Conners, 2008). Participants were deemed to have ADHD when at least one rater (i.e., parent or teacher) reported that the adolescents’ inattentive or hyperactive/impulsive symptoms were within the clinical range (T ≥ 70) on the Conners-3, and the second rater (i.e., parent or teacher) indicated that the adolescents’ inattentive or hyperactive/impulsive symptoms were within the borderline or clinical range (T ≥ 65). When teacher ratings were not available (n = 20), parent ratings were required to be within the clinical range and the adolescents’ self-report in the borderline or clinical range. For participants in the comparison group, parent and teacher scores on the Conners-3 needed to fall within the average range (T < 65). If teacher ratings were not available (n = 11), adolescent self-report scores were required to be in the average range. Participants were excluded from the sample if they were diagnosed or suspected of having any of the following disorders: autism spectrum disorders, bipolar disorder, and Tourette’s disorder. Due to high comorbidity rates, we included participants with co-occurring learning disabilities, conduct disorder (CD), ODD, anxiety, or depression.

Table 1 shows demographic and clinical differences between adolescents with and without ADHD. There was a trend toward a larger proportion of males in the ADHD group compared with the comparison group. ADHD adolescents were more likely than comparison adolescents to have received a comorbid diagnosis. In addition, ADHD adolescents demonstrated lower IQs, as measured by the Wechsler Abbreviated Scale of Intelligence (WASI; Wechsler, 1999), and their mothers were less educated than mothers of comparison adolescents. Finally, adolescent externalizing behavior and maternal inattention were higher in adolescents with ADHD compared with typically developing adolescents. There were no differences between ADHD and comparison adolescents with regard to age (M age = 15.25 years), parental marital status (72% of the total sample were married or common-law), father’s education, number of people living in their household, and siblings with ADHD. Concerning parental ADHD symptoms, maternal hyperactivity and paternal inattention and hyperactivity did not differ between the two adolescent subgroups; however, maternal inattention was higher in the ADHD adolescent group. In addition, total ADHD symptoms were higher in mothers and fathers of adolescents with ADHD. Among ADHD adolescents, 23% of mothers and 36% of fathers had above average (i.e., T > 60) levels of ADHD symptoms; whereas in the comparison group, 4% of mothers and 23% of fathers had above average levels of ADHD. Significantly more mothers in the ADHD adolescent group had above average ADHD symptoms, compared with mothers in the comparison group, χ²(1, N = 151) = 11.77, p = .00.

Table 1.

Comparison Between ADHD and Comparison Adolescents in Demographic and Clinical Factors.

Demographic variable	ADHD (n = 93)	Comparison (n = 63)	F statistic
Adolescent age	15.19 (1.68)	15.33 (1.65)	0.26, ns
Adolescent IQ	103.10 (12.78)	110.10 (9.80)	13.01**
Mother’s education	8.19 (1.45)	9.06 (1.33)	11.05**
Father’s education	8.07 (1.99)	8.57 (1.60)	2.05
Number of people in household	3.95 (1.12)	4.14 (1.23)	1.07
	ADHD	Comparison	χ²
Adolescent gender			4.06^†
Male	58 (62)	29 (46)
Female	35 (38)	34 (54)
Parental marital status			1.98
Single	10 (11)	3 (5)
Married or common-law	65 (70)	48 (76)
Separated or divorced	17 (19)	11 (18)
Widowed	1 (1)	1 (2)
Clinical variable	ADHD	Comparison	F statistic
Adolescent externalizing (teacher)	176.99 (44.35)	152.83 (30.32)	11.44***
Maternal inattention	54.14 (15.15)	44.64 (11.94)	15.27***
Maternal hyperactivity	45.10 (10.34)	42.43 (7.45)	2.67
Maternal ADHD total symptoms	49.55 (12.65)	42.88 (9.68)	13.15***
Paternal inattention	52.72 (14.95)	48.76 (14.65)	1.76
Paternal hyperactivity	56.38 (13.91)	52.50 (11.05)	2.31
Paternal ADHD total symptoms	56.77 (12.62)	51.95 (12.17)	4.38*
Adolescent–parent conflict—Quantity	16.84 (7.17)	19.49 (10.14)	2.86^†
Adolescent–parent conflict—Intensity	1.96 (0.70)	1.72 (0.59)	4.45*
	ADHD	Comparison	χ²
Comorbid diagnosis—Any	66 (71)	1 (2)	58.58***
Learning disability diagnosis	57 (61)	7 (11)	39.09***
Anxiety or depression diagnosis	14 (15)	1 (2)	7.84*
Conduct or oppositional diagnosis	3 (3)	1 (2)	0.39
ADHD medication	66 (71)	0 (0)	41.43***
Sibling with ADHD diagnosis	27 (29)	14 (23)	0.62

Note. F statistic, means, and standard deviations (in parentheses) presented for continuous variables; chi-square statistic, ns, and percentages (in parentheses) presented for categorical variables (ns and percentages are within adolescent ADHD status subgroup). Parental education is measured on an 11-point scale: 1 = no schooling, 5 = completed secondary school, 6 = some college, 7 = completed college, 8 = some university, 9 = completed undergraduate degree, 10-11 = postgraduate education.

†

p < .09. *p < .05. ***p < .001.

In terms of parental participation in the current study, 65% (n = 102) of the 156 adolescent participants had parental ADHD symptom ratings provided from both parents, 29% (n = 45) had only mother ratings, and 7% (n = 11) had only father ratings.

Measures

The Conners Adult ADHD Rating Scales–Self-Report: Screening Version (CAARS-S:SV; Conners, Erhardt, & Sparrow, 1999) is a 30-item self-report measure that screens for inattention, hyperactivity, and impulsivity in adults. The instrument has three subscales: DSM-IV Inattentive Symptoms, DSM-IV Hyperactive/Impulsive Symptoms, DSM-IV Total ADHD Symptoms, as well as an ADHD Index. Each item is rated on a 4-point Likert-type scale, ranging from 0 (not at all true/never) to 3 (very much/very frequently). Good psychometric properties have been reported; for example, the CAARS-S:SV produces an overall correct classification rate of 85% for adults with ADHD and strongly correlates with other adult clinical measures (Erhardt, Epstein, Conners, Parker, & Sitarenios, 1999). In addition, internal consistency of subscales were reported to be .80 or higher for men and women (Conners et al., 1999).

The Conners-3 rating scales (Conners, 2008; Parent, Teacher, and Self-Report long forms) were used to measure ADHD and externalizing symptomatology and behaviors in adolescents. Behaviors are rated on a 4-point scale ranging from 0 (not at all/seldom, never) to 3 (very much true/very often, very frequent). The two DSM-IV ADHD subscales (Inattention and Hyperactivity/Impulsivity) and the ODD, CD, and Aggression subscales demonstrate high internal consistency; for example, Cronbach’s alphas for adolescents range from .84 to .93 (parent ratings) and .70 to .95 (teacher ratings). Cronbach’s alphas for the self-report DSM-IV ADHD subscales range from .83 to .89. In terms of reliability, the mean test–retest correlation for the Conners-3 is .83, averaged across scales and rater types. The interrater reliability coefficient was estimated at .78, averaged across parent and teacher raters (Sparrow, 2010). Finally, the Conners-3 has strong convergent, discriminant, and construct validity (Conners, 2008).

The Issues Checklist Abridged (IC; Prinz, Foster, Kent, & O’Leary, 1979) contains a list of 44 issues/conflicts typically experienced between parents and adolescents. One item about computer/Internet use (“Have you discussed Internet/computer use?”) was added to this list as an updated (i.e., current) conflict and resulting in 45 total items (Markel & Wiener, 2014). Participants were asked to circle yes or no for issues they have or have not discussed with their parents during the last 4 weeks. Example items include “Have you discussed smoking tobacco?” and “Have you discussed messing up the house?” For each issue marked yes, the participant uses a 5-point Likert-type scale to indicate how angry they were during the discussion, ranging from 1 (calm) to 5 (very angry). Participant adolescents completed one measure for both parents. The IC produces two composite scores. The first is the frequency of conflicts, which is the number of conflicts/issues endorsed over the past 4 weeks. The second is an intensity score, assessing how angry the adolescent felt during the conflict discussions. This instrument has demonstrated good reliability (Edwards et al., 2001) and has successfully discriminated between distressed and nondistressed families (Robin & Foster, 1989).

Procedure

The study was approved by the university’s Research Ethics Board. Parental and adolescent consent was obtained, and parents (primarily mothers) completed the Conners-3 Parent Rating Scale (Conners, 2008). Parents of adolescents who met inclusion criteria based on the Conners-3 Parent Rating Scale were then asked to complete a number of questionnaires for other studies online. Parents were also asked to give the Conners-3 Teacher Rating Scale to a teacher whom the adolescents and parents believed could accurately comment on the adolescent’s behaviors. Raters of the Conners-3 were asked to consider the adolescents’ behaviors when they were not on medication. Adolescents and parents then came to the laboratory for a testing session. At this session, parents and adolescents completed a battery of questionnaires (including a demographic questionnaire), and adolescents underwent cognitive testing with a trained graduate student in clinical psychology.

Data Analysis

Prior to performing analyses, data were checked for outliers by examining descriptive statistics and creating boxplots of the variables of interest. There were no outliers evident. Bivariate correlations were conducted to examine the intercorrelations among the key variables of interest. This was done for mother and fathers separately. To test for similarity-fit/misfit, hierarchical multiple regression analysis was performed separately for mothers and fathers. Hierarchical regression examined the independent contribution of adolescent and parental ADHD symptoms and their interaction on the dependent variables: adolescent–parent issues/conflict (frequency and intensity). In each regression model, youth externalizing problems was entered into Step 1 as a control variable. A composite of externalizing problems was created by adding the T-scores for Conners-3 parent and teacher ratings of aggression, CD, and ODD (correlations between these variables ranged from .68 to .90). In Step 2, adolescent ADHD status and parental ADHD symptoms were entered into the model. In Step 3, the Adolescent ADHD Status × Parental ADHD Interaction term was entered. Variables in interactions were centered to reduce multicollinearity with other variables (Aiken & West, 1991). Four combinations of interactions between adolescent and parental ADHD were examined across models, resulting in eight models for mothers and eight for fathers. Combinations were as follows: adolescent inattention, based on self- and parent report, by parental inattention (inattention models), and adolescent hyperactivity/impulsivity, based on self- and parent report, by parental hyperactivity/impulsivity (hyperactivity models). For each model, components of the interaction were examined as main effects; for example, when the model included the interaction for Adolescent Inattention (self-report) × Maternal Inattention, main effects were also examined for each of these two variables separately. Significant interactions were probed using a technique described by Aiken and West (1991) whereby conditional effects of the main predictor (adolescent ADHD) were plotted at low, medium, and high levels of the moderating variable (parental ADHD).

Results

Bivariate Correlations

Table 2 presents correlations among key variables. The quantity of adolescent–parent conflicts was significantly associated with both adolescent inattention and hyperactivity, based on self-report. Quantity of conflicts was not related to maternal or paternal ADHD symptoms. Intensity of conflict was significantly correlated with adolescent externalizing problems, as well as adolescent inattention and hyperactivity symptoms, across raters. Intensity of adolescent–parent conflicts was also significantly related to maternal inattention.

Table 2.

Correlations Among Key Variables.

Variable	1	2	3	4	5	6	7	8	9	10	11
1. Conflict (quantity)	—	.23**	.10	.16^†	.21**	.12	.22*	.06	.04	.01	.05
2. Conflict (intensity)		—	.28**	.21*	.32**	.20*	.35**	.35**	.04	.10	.11
3. Adolescent externalizing (teacher)			—	.27**	.26**	.29**	.31**	−.13	−.04	.26*	.12
4. Adolescent inattention (parent)				—	.42**	.77**	.42**	.29**	.12	.11	.12
5. Adolescent inattention (self)					—	.44**	.72**	.30**	.03	.15	.19*
6. Adolescent hyperactivity (parent)						—	.46**	.30**	.18*	.11	.17^†
7. Adolescent hyperactivity (self)							—	.34**	.12	.13	.13
8. Maternal inattention								—	.46**	.04	.20^†
9. Maternal hyperactivity									—	.08	.14
10. Paternal inattention										—	.77**
11. Paternal hyperactivity											—

†

p < .09. *p < .05. **p < .01.

Adolescent and Maternal ADHD Symptoms as Predictors of Adolescent–Parent Conflict

Table 3 shows hierarchical regression results with adolescent–parent conflict, including quantity and intensity of conflict, as the dependent variables. Regarding main effects, adolescent inattention (self-report) was the only main effect found to predict quantity of conflict. For conflict intensity, adolescent externalizing behavior was a significant predictor of conflict intensity between adolescents and mothers when parent ratings of adolescent ADHD symptoms were entered in models. Significant main effects were also observed for adolescent inattention and adolescent hyperactivity (self-reports). Regarding maternal ADHD symptoms, maternal inattention significantly predicted conflict intensity in the parent reported inattention model.

Table 3.

Hierarchical Multiple Regression Results for Parent–Adolescent Conflict (Mothers).

	Conflict—Quantity						Conflict—Intensity
	R ²	ΔR²	B	SE (B)	β	p value	R ²	ΔR²	B	SE (B)	β	p value
(Step 1): Adolescent externalizing	.01	.01	.02	.02	.09	.38	.07	.07*	.00	.00	.25	.01*
(Step 2): Adolescent externalizing	.07	.06^†	.01	.02	.05	.65	.14	.07*	.00	.00	.25	.02*
Adolescent inattention (parent report)			.08	.06	.16	.16			.00	.00	.07	.50
Maternal inattention			.09	.07	.15	.18			.01	.01	.24	.02*
(Step 3): Adolescent externalizing	.11	.05*	.02	.02	.07	.50	.14	.00	.01	.00	.25	.02*
Adolescent inattention (parent report)			.11	.06	.21	.06^†			.00	.00	.09	.45
Maternal inattention			.08	.07	.13	.23			.01	.01	.24	.02*
Adolescent Inattention × Maternal Inattention			.01	.00	.23	.03*			.00	.00	.04	.69

(Step 1): Adolescent externalizing	.01	.01	.02	.02	.09	.38	.07	.07*	.00	.00	.25	.01
(Step 2): Adolescent externalizing	.10	.09*	.01	.02	.04	.73	.23	.17***	.00	.00	.18	.07^†
Adolescent inattention (self-report)			.17	.07	.25	.03*			.02	.01	.34	.00***
Maternal inattention			.07	.07	.11	.30			.01	.01	.16	.10
(Step 3): Adolescent externalizing	.12	.02	.01	.02	.04	.69	.23	.00	.00	.00	.18	.07^†
Adolescent inattention (self-report)			.17	.07	.25	.03*			.02	.01	.34	.00***
Maternal inattention			.03	.07	.05	.67			.02	.01	.17	.09^†
Adolescent Inattention × Maternal Inattention			.01	.01	.16	.13			.00	.00	−.02	.74

(Step 1): Adolescent externalizing	.01	.01	.02	.02	.09	.38	.07	.07*	.00	.00	.25	.01
(Step 2): Adolescent externalizing	.04	.03	.01	.02	.04	.74	.09	.03	.00	.00	.24	.03*
Adolescent hyperactivity (parent report)			.09	.06	.17	.13			.00	.00	.10	.36
Maternal hyperactivity			.03	.10	.04	.74			.01	.01	.12	.27
(Step 3): Adolescent externalizing	.04	.01	.01	.02	.04	.72	.11	.03	.00	.00	.24	.03*
Adolescent hyperactivity (parent report)			.09	.06	.17	.14			.00	.00	.10	.37
Maternal hyperactivity			.02	.10	.02	.87			.01	.01	.08	.47
Adolescent Hyperactivity × Maternal Hyperactivity			.00	.01	.07	.49			.00	.00	.17	.10

(Step 1): Adolescent externalizing	.01	.01	.02	.02	.09	.38	.07	.07*	.00	.00	.25	.01
(Step 2): Adolescent externalizing	.04	.04	.01	.02	.06	.58	.19	.13***	.00	.00	.19	.05*
Adolescent hyperactivity (self-report)			.13	.08	.18	.10			.02	.01	.34	.00***
Maternal hyperactivity			.05	.10	.05	.65			.01	.01	.09	.37
(Step 3): Adolescent externalizing	.04	.00	.01	.02	.06	.59	.19	.00	.00	.00	.19	.06^†
Adolescent hyperactivity (self-report)			.13	.08	.18	.10			.02	.01	.34	.00***
Maternal hyperactivity			.05	.10	.05	.63			.01	.01	.09	.38
Adolescent Hyperactivity × Maternal Hyperactivity			.00	.01	−.02	.89			.00	.00	.00	.99

Note. Adolescent externalizing is based on the Conners-3 (teacher report).

†

p < .09. *p < .05. ***p < .001.

Concerning interaction effects, when the inattention model included adolescent inattention based on parent report, a significant Adolescent Inattention × Maternal Inattention effect was found on quantity of conflict, β = .23; t(95) = 2.22; p = .03. Concerning this particular model, in Step 2, the effect of the independent variables predicted almost 7% of the variance in quantity of conflict, with the interaction effect predicting an additional 5% of the variance in Step 3: R² = .11, F(4, 95) = 2.91, p = .03. Figure 1 displays the plotted interaction effect between adolescent and maternal inattention on quantity of conflicts. Mothers with higher inattention experienced the greatest amount of conflict with adolescents who also showed higher inattention levels, compared with when adolescents had lower inattention. Mothers with the lowest levels of inattention showed less conflict with more inattentive adolescents. This plot suggests a similarity-misfit process because conflict is highest when both mothers and their adolescents exhibit higher levels of inattention. No significant interaction effects were found in hyperactivity models or when conflict intensity was the dependent variable.

Figure 1.

The interaction between adolescent and maternal inattention on conflict quantity.

Adolescent and Paternal ADHD Symptoms as Predictors of Adolescent–Parent Conflict

Table 4 displays hierarchical regression results for fathers and parent–adolescent conflict as the dependent variable. For fathers, adolescent externalizing behavior was no longer significantly related to conflict intensity when adolescent ADHD symptoms were entered into the models. Significant main effects were found for adolescent symptoms whereby adolescent inattention (based on parent and self-reports) and adolescent hyperactivity (self-report) predicted intensity of conflict. Adolescent hyperactivity based on parent report did not predict intensity of conflict.

Table 4.

Hierarchical Multiple Regression Results for Parent–Adolescent Conflict (Fathers).

	Conflict—Quantity						Conflict—Intensity
	R ²	ΔR²	B	SE (B)	β	p value	R ²	ΔR²	B	SE (B)	β	p value
(Step 1): Adolescent externalizing	.00	.00	.01	.03	.04	.73	.05	.05*	.00	.00	.23	.05*
(Step 2): Adolescent externalizing	.06	.06	−.01	.03	−.03	.79	.11	.06	.00	.00	.15	.21
Adolescent inattention (parent report)			.13	.06	.25	.05*			.01	.00	.25	.04*
Paternal inattention			−.01	.07	−.01	.92			.00	.00	−.01	.91
(Step 3): Adolescent externalizing	.13	.07*	−.01	.03	−.02	.84	.11	.01	.00	.00	.16	.21
Adolescent inattention (parent report)			.13	.06	.25	.04*			.01	.00	.25	.04*
Paternal inattention			−.02	.07	−.04	.75			−.00	.00	−.02	.87
Adolescent Inattention × Paternal Inattention			−.01	.00	−.26	.02*			.00	.00	−.07	.53

(Step 1): Adolescent externalizing	.00	.00	.01	.03	.04	.73	.05	.05*	.00	.00	.23	.05*
(Step 2): Adolescent externalizing	.05	.05	.01	.03	.00	.99	.19	.13*	.00	.00	.16	.15
Adolescent inattention (self-report)			.16	.08	.22	.06^†			.02	.01	.37	.00***
Paternal inattention			−.01	.07	−.02	.87			−.00	.00	−.03	.78
(Step 3): Adolescent externalizing	.09	.04^†	.01	.03	.02	.85	.20	.01	.00	.00	.17	.13
Adolescent inattention (self-report)			.15	.08	.21	.07^†			.02	.01	.37	.00***
Paternal inattention			−.07	.07	−.12	.35			−.00	.01	−.08	.50
Adolescent Inattention × Paternal Inattention			−.10	.01	−.23	.08^†			.00	.00	−.12	.33

(Step 1): Adolescent externalizing	.00	.00	.01	.03	.04	.73	.05	.05*	.00	.00	.23	.05*
(Step 2): Adolescent externalizing	.04	.04	−.01	.03	−.03	.81	.09	.04	.00	.00	.16	.19
Adolescent hyperactivity (parent report)			.10	.06	.20	.11			.01	.00	.19	.12
Paternal hyperactivity			.04	.08	.06	.63			.00	.01	.06	.64
(Step 3): Adolescent externalizing	.04	.00	−.01	.03	−.03	.81	.09	.00	.00	.00	.16	.19
Adolescent hyperactivity (parent report)			.10	.06	.20	.11			.01	.00	.19	.12
Paternal hyperactivity			.04	.08	.05	.67			.00	.01	.06	.62
Adolescent Hyperactivity × Paternal Hyperactivity			.00	.00	.01	.95			.00	.00	−.02	.85

(Step 1): Adolescent externalizing	.00	.00	.01	.03	.04	.73	.05	.05*	.00	.00	.23	.05*
(Step 2): Adolescent externalizing	.04	.04	−.01	.03	−.01	.93	.20	.15*	.00	.00	.14	.21
Adolescent hyperactivity (self-report)			.14	.08	.20	.11			.02	.01	.39	.00***
Paternal hyperactivity			.04	.08	.06	.61			.00	.01	.03	.78
(Step 3): Adolescent externalizing	.05	.01	.00	.03	−.01	.94	.21	.01	.00	.00	.14	.21
Adolescent hyperactivity (self-report)			.13	.09	.19	.13			.02	.01	.38	.00***
Paternal hyperactivity			.03	.09	.05	.70			.00	.01	.00	.99
Adolescent Hyperactivity × Paternal Hyperactivity			−.00	.01	−.02	.88			.00	.00	−.07	.59

Note. Adolescent externalizing is based on the Conners-3 (teacher report).

†

p < .09. *p < .05. ***p < .001.

Concerning interaction effects and quantity of conflict, adolescent inattention based on parent report emerged as a significant predictor of quantity of conflict, and there was a significant interaction between adolescent (parent report) and paternal inattention on the quantity of conflicts, β = −.26; t(74) = −2.34; p = .02. Concerning this particular model, in Step 2, the effect of the independent variables predicted 6% of the variance in quantity of conflict, with the interaction effect predicting an additional 7% of the variance in Step 3: R² = .13, F(4, 74) = 2.50, p = .05. Figure 2 displays the plotted interaction effect between adolescent and paternal inattention on quantity of conflicts. This plot demonstrates a general pattern whereby fathers with low and medium levels of inattention showed more conflict with inattentive adolescents, but an opposite pattern emerged where the most inattentive fathers showed the least amount of conflict with their highly inattentive adolescents, compared with less inattentive adolescents. This pattern of results is demonstrative of a similarity-fit process in fathers and adolescents with inattentive problems specifically. No significant interactions were found with conflict intensity in fathers.

Figure 2.

The interaction between adolescent and paternal inattention on conflict quantity.

Discussion

The current study identified some important differences between mothers and fathers with respect to the effects of adolescent externalizing behavior and adolescent and parental ADHD symptoms on the quantity and intensity of adolescent–parent conflict. For mothers, we found that teacher-rated adolescent externalizing problems predicted intensity of conflict when parent ratings of adolescent ADHD were also included in the models (adolescent externalizing was marginally predictive when self-reports of adolescent ADHD were used). For fathers, teacher-rated adolescent externalizing behavior predicted intensity of adolescent–parent conflict, but this was no longer significant when adolescent ADHD symptoms (across reporters) were included in the model. In sum, concerning the effects of adolescent symptoms on conflict, adolescent externalizing behavior and adolescent ADHD symptoms were important predictors of conflict intensity for mothers, whereas adolescent ADHD symptoms were important for fathers. In addition, for mothers, symptoms of maternal inattention predicted conflict intensity; maternal hyperactivity did not. Neither paternal inattention nor hyperactivity affected conflict intensity for fathers.

Our study also demonstrated support for the similarity-misfit model in mothers. Mothers with medium and high levels of inattention showed more conflict with their adolescents who also had higher levels of inattention; in fact, mothers with the highest levels of inattention showed the greatest amount of conflict with adolescents who also had the highest levels of inattention (i.e., exacerbative effect). Conversely, there was evidence supporting the similarity-fit model in fathers with inattention and quantity of adolescent–parent conflict. The greatest number of conflicts occurred between fathers with the lowest levels of inattention and adolescents with the most elevated inattentive symptoms. As fathers showed more elevated symptoms themselves, there was a shift in conflict quantity whereby fewer conflicts were experienced with adolescents with higher levels of inattentive symptoms compared with those with lower levels.

The robust impact of adolescent externalizing behavior on adolescent–mother conflict is indeed consistent with many other studies showing that adolescent externalizing behavior predicts rates and degree of conflict between mothers and adolescents with ADHD (Barkley et al., 1992; Barkley et al., 1991; Edwards et al., 2001; Fletcher et al., 1996). Many of these studies found that externalizing problems actually accounted for most of the variance in conflict; however, we found support that adolescent ADHD symptoms were also predictive of conflict intensity with mothers. Only one study (Edwards et al., 2001) specifically examined adolescent–father conflict in relation to the relative importance of adolescent ADHD and externalizing. This study demonstrated that ADHD adolescents with comorbid ODD showed higher rates and more intense conflict, compared with community controls. In our study, adolescent ADHD symptoms (but not externalizing behavior) was an important predictor of conflict intensity in fathers, consistent with other research showing parenting difficulties in fathers of children with ADHD (Harvey et al., 2003).

We also found that maternal inattention predicted conflict intensity above and beyond adolescent symptoms. This was not replicated in fathers, nor did we find support that hyperactivity symptoms (maternal or paternal) predicted conflict intensity. These results, consistent with other research on maternal inattention and parenting deficits (Chen & Johnston, 2007; Murray & Johnston, 2006), may best be explained by the fact that mothers play primary and more active roles in children’s day-to-day lives, compared with fathers. As such, mothers are typically more involved in activities such as getting their children out of bed and off to school in the morning, supervising homework, arranging pick-ups and play dates, making lunches and dinners, and so forth. These various responsibilities may be most difficult to execute when mothers struggle with inattention and related executive functioning deficits, leading to frustration and more intense conflict with their adolescents. The possible frustration experienced by mothers may be reflected in the finding that intensity (i.e., heatedness) of conflict was affected by maternal inattention, and not the sheer number of conflicts.

Adolescent problems, including externalizing and ADHD symptomatology, also predicted conflict between adolescents and mothers, indicating that the intensity of adolescent–mother conflict is driven by both adolescent and maternal symptomatology. This finding, along with our results supporting the similarity-misfit model in mothers, can also be interpreted in the context of parenting and gender roles. Given the primary role of mothers in families, they are typically more aware of what happens in the daily lives of their children and adolescents (Bianchi & Raley, 2005; Parke, 2000). Mothers also tend to invest more in family relationships and are generally more attuned to and concerned about interpersonal behaviors and relationships (Nolen-Hoeksema, 2012). As such, mothers may have a heightened awareness about how they affect their children and how their children affect them. Empirical evidence also suggests that females with ADHD are more likely to experience internalizing problems and have self-esteem issues (Biederman et al., 2010; Rucklidge & Kaplan, 1997). Taken together, these factors may explain our results in mothers, including the importance of mothers’ own inattentive symptoms and their children’s symptoms (e.g., externalizing and ADHD symptoms) on the intensity of conflict. Johnston et al. (2012) suggested that executive functioning deficits in adults with ADHD affects parenting by influencing both parental cognitions and behaviors. Regarding the impact on cognitions, involved mothers’ inattentive symptoms, especially in the face of adolescent impairment, may lead to mothers feeling overwhelmed and distressed regarding their child care responsibilities. Mothers may also feel guilty and to blame for their children’s difficulties, or they may believe they are ineffective parents. Feelings of frustration, guilt, and overburden may affect the way mothers behave with her adolescent, for example, engaging in more heated conflicts, yelling, and being generally less patient with their children. This process is reflected in our results suggesting the presence of the similarity-misfit process in mothers whereby adolescents and mothers engage in the most conflict when both maternal and adolescent inattentive symptoms are highest. Notably, these results are also consistent with findings from a study by Babinski et al. (2012) where mothers with ADHD reported the highest levels of conflict with adolescents with ADHD, compared with mothers who did not have ADHD. That we did not find evidence for a similarity-fit phenomenon in mothers may be a result of mothers feeling extremely stressed, guilty, and overwhelmed, especially during adolescence and with an adolescent who struggles with multiple impairments. These feelings of distress may actually overpower any feelings of sympathy or tolerance mothers may have toward their adolescents.

Fathers, however, may be more removed from the stressful daily lives of their adolescent children, possibly explaining why we found support for the similarity-fit model in fathers. Fathers may be freed from some of the burdens of stress and responsibility and can carry a more empathic perspective toward their children. Research has also shown that fathers are more likely to engage in recreational and leisure activities with their child (Hosley & Montemayor, 1997), thus potentially altering the nature of the relationship toward a more playful and less discordant one. Furthermore, fathers may not be as aware of their children’s various behaviors if they are involved less, and perhaps they may even tolerate certain behaviors more than mothers (e.g., aggression). In fact, this may help explain the findings that adolescent externalizing behavior was a more robust predictor of conflict intensity in mothers, but not so in fathers. Fathers may also be less insightful and thus less critical of their own cognitive impairments (and the impact on their adolescents), compared with mothers.

The results of the current study should be interpreted in light of several limitations. For one, we used a cross-sectional design and so causal relationships cannot be concluded. A longitudinal design would better speak to causal processes, and future research should consider this type of methodology. Relatedly, future research may consider investigating the intricacies of the similarity-fit/misfit processes in fathers and mothers, for example, the role of same parent and child gender, as well causal processes related to stress and conflict. Kendall, Leo, Perrin, and Hatton (2005) examined a sample of families with children and youth with ADHD and found that maternal distress mediated the link between child behavioral problems and family conflict (Kendall et al., 2005). This process should be further explored. In addition, adolescents provided ratings for conflict regarding both mothers and fathers at the same time. This was a limitation not only because of the single rater perspective but also because ratings were not provided for mothers and fathers separately. Also regarding raters, we acknowledge the potential bias in using self-report to assess ADHD symptoms in both parents and youth, for example, the positive illusory bias in which youth are overly positive in their self-perceptions. In addition, using the same reporter for adolescent and parent symptoms in the same analysis may have inflated some associations. Finally, approximately 22% (n = 34) of the sample had missing data on teacher ratings of adolescent behaviors on Conners-3. As a result, regression models, which included teacher-rated externalizing behaviors as covariate, had reduced statistical power, particularly for fathers (n = 95 for maternal regression models and n = 74 for paternal regression models). However, using teacher-rated externalizing as a covariate in the regression models enhanced our analyses because of the inclusion of multiple raters’ perspectives (e.g., parents, adolescents, and teachers).

This study is the first to investigate the similarity-fit/misfit process in adolescent families with ADHD, and one of few studies to look at conflict in parents of adolescents with ADHD. Our results demonstrated evidence that the similarity-misfit process may be active in ADHD mothers whereas similarity-fit may be more evident in ADHD fathers. Also, mothers’ own inattentive symptoms and adolescent externalizing and ADHD symptomatology independently contribute to greater intensity of conflict, suggesting that mothers may be so overwhelmed with the stress and burden of raising an adolescent with ADHD that there is little opportunity to experience empathy and tolerance toward their adolescents; fathers may have a different perspective based on their parental role.

Future research should build on the current study’s findings, looking specifically at differential parental roles and how that affects perceptions toward children and adolescents. Results also have implications for involving parents in treatments for ADHD in teenagers, and in teaching coping strategies for stress and conflict resolution in mothers particularly in relation to their own executive functioning deficits and possible concerns (i.e., self-blame) about the impact of their symptoms on their child. Involvement of fathers in treatment may include encouragement and teaching ways to assist with some of the child care responsibilities to alleviate stress and perhaps even increase time spent on recreational activities with adolescents. This may serve to reduce serious conflicts between mothers and their adolescents and within the family at large. In addition to reducing stressors for primary caregivers in families, our research results also point to the potential benefit of enhancing parents’ understanding and tolerance for adolescent behaviors. One way to accomplish this may be to emphasize similarities between adolescent and parental symptomatology to increase empathy.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Teresa Grimbos is a developmental psychology researcher who has published her work in several peer-reviewed journals and presented at many academic conferences in North America and Europe. Her research focuses on the development and treatment of child and youth psychopathology, relating to family processes and parental psychopathology. Teresa also conducts research in the area of forensic psychology and sexual behaviours. She is currently practicing as a clinician in Toronto, Canada, working with justice-involved youth.

Judith Wiener is a professor of school and clinical child psychology in the Department of Applied Psychology and Human Development at the University of Toronto (Ontario Institute for Studies in Education [OISE]). She is past president of the International Academy for Research in Learning Disabilities. Her current research is on the self-perceptions, family, and social relationships of children and adolescents with learning disabilities and ADHD. She has published more than 70 book chapters and articles in peer-reviewed journals.

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