Maternal ADHD Symptoms and Parenting Stress: The Roles of Parenting Self-Efficacy Beliefs and Neuroticism

Abstract

Objective: ADHD symptoms in adults are consistently related to stress in a variety of domains, although whether the link between ADHD symptoms and stress is direct, or accounted for or moderated by other variables, is little studied. We used a cross-sectional design to examine whether parenting self-efficacy accounts for the relation between maternal ADHD symptoms and parenting stress, and whether levels of maternal neuroticism moderate this relation. Method: A nonclinical sample of mothers of 120, six- to 12-year-old children completed surveys online. Results: Maternal ADHD symptoms were associated with parenting stress, but this relation was accounted for by parenting self-efficacy beliefs. Neuroticism did not moderate the relations among these variables. Covariate analyses indicated that although parenting self-efficacy beliefs remain a robust predictor of parenting stress, the relation between maternal ADHD symptoms and parenting stress can be better accounted for by other variables. Conclusion: The results highlight the importance of self-efficacy beliefs and demonstrate that ADHD symptoms are not sufficient to understand the experience of parenting.

Keywords

parent ADHD parenting self-efficacy beliefs parenting stress

Parenting, although a rewarding and worthwhile endeavor, is often difficult and stressful. In a prospective study, adults who had children reported lower self-efficacy, more daily strains, and lower psychological well-being compared with those who remained childless, with women being particularly affected by the move to parental status (Nomaguchi & Milkie, 2003). Parenting is likely even more stressful when a parent’s own capacity to cope with stress is diminished by personal or life circumstances.

High levels of ADHD symptoms are present in approximately 2% to 4% of the adult population (Bitter, Simon, Bálint, Mészáros, & Czobor, 2010; Kessler et al., 2006). The problems with planning, organization, memory, and restlessness characteristic of ADHD are associated with impairment in domains, including academic achievement, vocational and social functioning, and parenting (e.g., Das, Cherbuin, Butterworth, Anstey, & Easteal, 2012; Johnston, Mash, Miller, & Ninowski, 2012). As adult ADHD symptoms are associated with both parenting difficulties (e.g., Wymbs, Wymbs, & Dawson, 2015) and stressful life events (e.g., Friedrichs, Igl, Larsson, & Larsson, 2012), it is likely that they also are associated with parenting stress, similar to other maternal mental health difficulties such as depression (Thomason et al., 2014), anxiety (Skreden et al., 2012), or hostility (Delvecchio et al., 2014).

Maternal ADHD Symptoms, Stress, and Parenting Stress

Parenting stress is conceptualized as the negative internal experience that is the consequence of parenting-related stressors, combined with the mother’s capacity to cope with challenging parenting situations (Abidin, 1995), and is associated with a number of negative outcomes in the parenting domain (e.g., Kazdin, 1995; Morgan, Robinson, & Alridge, 2002). Although several studies have demonstrated associations between adult ADHD symptoms and general stress (e.g., Das et al., 2012; Friedrichs et al., 2012), to date, only one study has examined the association between stress in the parenting domain and maternal ADHD symptoms. Wietecha and colleagues (2012) found that parents with higher levels of ADHD symptoms who received medication experienced significantly less stress and fewer symptoms than those who received a placebo. Although the design of the study prohibits a direct test of the association of ADHD symptoms and parenting stress, the similarity in the response of both ADHD symptoms and parenting stress to medication would be consistent with such an association. However, further tests of this relation are clearly needed. The first aim of this study is to test whether mothers with higher levels of ADHD symptoms experience more stress in their parenting role than mothers with lower levels of ADHD symptoms.

The Role of Parenting Self-Efficacy Beliefs

Going beyond the prediction of a significant bivariate association between maternal ADHD symptoms and parenting stress, we explore factors that may account for this relation and conditions under which it is stronger or weaker. Two possible pathways are proposed to underlie the association of maternal ADHD symptoms and parenting stress. The first pathway reflects a direct link such that parenting situations that result from a mother’s ADHD symptoms are inherently stressful. For example, a mother’s disorganization may cause her child to be repeatedly late for school and she might experience increased stress in her parenting role due to the social and practical consequences of the child’s habitual tardiness.

Alternatively, in a second pathway, maternal ADHD symptoms may increase parenting stress indirectly via a third variable. We propose parenting self-efficacy as such variable. We know that ADHD symptoms in adults are related to a variety of maladaptive beliefs (Torrente et al., 2014), that other psychological problems in mothers are linked to lower parenting self-efficacy beliefs (Kohlhoff & Barnett, 2013; Porter & Hsu, 2003), and that mothers with ADHD symptoms have lower levels of perceived efficacy in a variety of domains (Jiang & Johnston, 2012). Therefore, we suggest it is likely that mothers with higher levels of ADHD symptoms will perceive themselves as less competent as parents than mothers with lower levels of symptoms. In addition, low levels of parenting self-efficacy have been repeatedly associated with increased parenting stress (Harper et al., 2013; Ngai & Chan, 2011). In this pathway, a mother’s ADHD symptoms and the associated parenting difficulties are expected, over time, to result in a diminished sense of efficacy as a parent, and a negative consequence of this low parenting self-efficacy is increased parenting stress (e.g., Bandura, Caprara, Barbaranelli, Regalia, & Scabini, 2011). Importantly, demonstrating that perceptions of one’s ability are distinct from actual skill, the unique importance of self-efficacy beliefs has been demonstrated in studies finding that people with greater self-efficacy perform better in a variety of domains compared with people of the same level of actual ability but who have lower self-efficacy beliefs, and it is probable that the same effect will be observed in the parenting domain (Bandura, 1997; Paunonen & Hong, 2010).

In summary, two possible pathways are proposed to explain the association between maternal ADHD symptoms and parenting stress. The first is a direct pathway in which maternal ADHD symptoms directly generate an experience of stress in the parenting role. The other possibility is that the relation between maternal ADHD symptoms and parenting stress is partially or wholly accounted for by the mother’s sense of efficacy as a parent. That is, mothers with higher levels of ADHD symptoms are proposed to feel less efficacious as mothers (perhaps due to a history of negative parenting experiences associated with their ADHD symptoms) and it is that lower sense of parenting self-efficacy that is most strongly related to parenting stress. Given the current state of the literature, both proposed pathways between maternal ADHD symptoms and parenting stress are defensible. It is the second aim of this study to investigate whether one or both of these possible pathways accurately describe the relation between maternal ADHD symptoms and parenting stress.

Maternal Neuroticism

It is possible that the strength of parenting self-efficacy beliefs in accounting for the relation between maternal ADHD symptoms and parenting stress may depend on personality characteristics, as personality factors are predictive of a variety of outcomes, including stress (Casalin, Tang, Vliegen, & Luyten, 2014). Nigg, Goldsmith, and Sachek (2004) proposed that there are different groups of people with equivalently high levels of ADHD symptoms, differentiated by distinct underlying temperamental and personality characteristics which predict different developmental pathways, and these differing trajectories explain some of the heterogeneity that is observed in the clinical presentations of adults with ADHD symptoms. Neuroticism is the most theoretically plausible personality characteristic that may distinguish the hypothesized pathways between maternal ADHD symptoms and parenting stress in this study.

Neuroticism is the personality factor most consistently related to ADHD (Di Nicola et al., 2014; Jacob et al., 2007; Polner, Aichert, Macare, Costa, & Ettinger, 2015), and a recent meta-analysis confirmed that this is a strong association (Gomez & Corr, 2014). Gomez and Corr suggest that neuroticism dictates how individuals with ADHD react to emotional events, including stressful events. Confirming this empirically, Robin and colleagues (2008) demonstrated two clusters of adults with ADHD who were distinguished by the presence of negative expectations, maladaptive interpersonal behaviors, and a tendency to be reactive to negative life events—personality features highly analogous to the construct of neuroticism.

Given that people with higher levels of neuroticism are, by definition, prone to self-criticism and self-doubt, it seems likely that neurotic personality characteristics are related to parenting self-efficacy beliefs such that a tendency toward pessimism and negative emotions (i.e., neuroticism) makes mothers more likely to doubt their competence as a parent. Research supports relations between neuroticism and both parenting stress and perceived self-efficacy. For example, Casalin and colleagues (2014) found that self-criticism and dependency—aspects of neuroticism—were associated with concurrent parenting stress and that parenting stress when the child was an infant was predictive of parental self-criticism 1 year later. In addition, a recent longitudinal study of parent personality and parenting stress found levels of neuroticism at age 33 positively predicted parenting stress 9 years later, even after controlling for initial stress (Rantanen, Tillemann, Metsäpelto, Kokko, & Pulkinnen, 2015).

In addition, a meta-analysis confirms neuroticism as the strongest and most consistent predictor of general self-efficacy beliefs based on 37 studies and 6,730 participants (average r = −.29; Judge & Ilies, 2002).

In sum, research demonstrates that neuroticism, maternal ADHD symptoms, parenting stress, and parenting self-efficacy beliefs are all linked and may have important relations that warrant investigation within a single model. Specifically, it may be only when mothers are more reactive to negative emotions (high neuroticism) that their parenting self-efficacy beliefs are affected by ADHD-related parenting failures and account for the link between ADHD symptoms and parenting stress. In contrast, mothers who are low in neuroticism, despite higher levels of ADHD symptoms and parenting stress, may have a sense of parenting self-efficacy that is relatively unscathed and do not serve as a link between their symptoms and parenting stress. Therefore, the third aim of this study is to investigate whether neuroticism moderates the strength of the indirect effect of parenting self-efficacy beliefs on the association between maternal ADHD symptoms and parenting stress.

Covariates and Exploratory Analyses

It is critical to test the contributions of a variety of other maternal characteristics and circumstances to ensure that it is ADHD symptoms and not these other difficulties that are associated with self-efficacy beliefs and parenting stress. Parenting stress is, of course, strongly influenced by child characteristics (Pardini, 2008), and the heritable nature of ADHD (Larsson, Chang, D’Onofrio, & Lichtenstein, 2014) makes examination of the role of child problems in the relation between maternal ADHD symptoms and parenting stress particularly important. We also include measures of maternal psychopathology and parenting behavior as these variables are each related to ADHD symptoms, parenting self-efficacy, and/or parenting stress (e.g., Benson, 2016; Chau & Giallo, 2015; Delvecchio et al., 2014). Including these variables not only controls for their associations with the primary variables but may expand our understanding of other factors beyond ADHD symptoms that are related to mothers’ experience of parenting stress and parenting self-efficacy beliefs. Finally, we examined the role of various demographic characteristics in accounting for the hypothesized relations.

Current Study

In sum, although existing research suggests links among maternal ADHD symptoms, parenting stress, parenting self-efficacy beliefs, and neuroticism, these important relations have not been examined within a single model. In an effort to minimize single-rater bias, two important variables—maternal ADHD symptoms and maternal neuroticism—are measured by collateral informants. We predict that mothers’ ADHD symptoms are related to parenting stress, that this association is at least partially accounted for by parenting self-efficacy, and that the role of self-efficacy is stronger at higher levels of neuroticism. We also examine the role of other maternal and child characteristics within this model. Better understanding of mothers’ experience of parenting stress is intrinsically valuable, and knowing the degree to which this stress is directly related to ADHD symptoms as compared with a diminished sense of parenting self-efficacy may have clinical implications. Furthermore, the critical inclusion of covariates will begin to disentangle the extent to which to the relations among ADHD symptoms, parenting self-efficacy beliefs, and parenting stress are specific to ADHD symptoms, or remain significant among mothers with a variety of challenges. Importantly, we acknowledge that although this model is tested with mediational analyses, the design of the study is cross-sectional. This is a conceptual, rather than statistical, distinction that nevertheless has important implications for the interpretation of the results. We take great care to not go beyond the limits of what can be learned from a cross-sectional study conducted in a nonclinically referred sample.

Method

Recruitment

Participants for this study were recruited from Amazon’s Mechanical Turk (MTurk). MTurk is an online marketplace where employers or researchers post Human Intelligence Tasks (HITs) for users to complete in exchange for compensation from the requester, in this case the researcher. Typical tasks include transcription, comparing images, and responding to questionnaires. MTurk has the advantage of providing access to a large sample of adults including from traditionally difficult-to-reach populations. The average MTurk user is a female in her mid 30s (Paolacci, Chandler, & Ipeirotis, 2010). When the attentiveness of respondents on MTurk is not confirmed, the reliability of their data has been shown to be worse than for participants recruited through more conventional methods (Rouse, 2015). However, MTurk users who consistently receive positive reviews from requesters rarely fail attention check questions (Peer, Vosgerau, & Acquisti, 2014), and the reliability of the data collected from such users appears no different than data gathered by more traditional means (Eriksson & Simpson, 2010; Gardner, Brown, & Boice, 2012). In this study, we included validity questions to assess participants’ attention when completing measures and to confirm parenthood. In addition, participants were required to have an approval rating of 95% or higher by previous requesters on MTurk, as suggested by Peer et al. (2014). Less than 5% of participants were excluded as a result of validity concerns. Although MTurk users may reside in a variety of countries, the majority of users are in the United States. To avoid potential cultural differences in parenting, all participants in this study were located in the United States.

Participants

To enhance the comparability of our study to much of the previous work on parenting stress, we recruited mothers. The sample included 120 mothers of 6- to 12-year-old children. These mothers passed all validity checks (see “Procedure” section). Demographic information can be found in Table 1. The variables found in Table 1 were all considered for potential inclusion in the main analyses, but none showed significant relations to main study variables that would warrant such inclusion. Mothers who had more than one child between the ages of 6 and 12 were asked to think of the child they have the most difficulty parenting when reporting on parenting variables and child behavior.

Table 1.

Demographic Characteristics.

	M	SD	Range
Mother age	33.88	5.95	24.00-52.00
Child age	7.83	1.71	6-12
Number of other children	1.45	1.07	0-5
Percentage of time child spends with mother	81.22	20.64	13-100
	Percentage of sample
Child gender (boys)	57
Mother employed	67
Education
High school graduate	11
College or university training	77
Graduate training	12
Ethnicity
Caucasian	74
African American	10
Asian American	5
Mixed race	3
Other	8
Household income per year
<US$20,000	14
US$20,000-US$74,999	65
>US$75,000	21
Marital status
Single	17
Divorced or separated	13
Married or common-law	71

To avoid exclusive reliance on mothers’ ratings for all variables, collateral informants were recruited to provide ratings of mothers’ ADHD symptoms and neuroticism. These informants needed to be adults who had a current personal relationship with the mother, including weekly contact (in person, by telephone, or via Internet) for at least 1 year. Informants were typically spouses (38%) or friends (35%), but close family members such as siblings (11%), parents (10%), and others (6%) also participated.

Procedure

The study was advertised on MTurk as about beliefs about parenting and how parents’ personalities are related to parenting experiences. Once a mother began the study, she provided informed consent and answered preliminary screening questions to determine that she was the mother of a child aged 6 to 12 years. Mothers who met screening criteria were directed to the remainder of the survey where they provided demographic information (see Table 1) and completed questionnaires. The first two questionnaires (assessing parenting self-efficacy beliefs and parenting stress) were fully counterbalanced across mothers, and the remaining questionnaires (assessing covariates) were administered in a second set, again fully counterbalanced across mothers.¹

Between measures, mothers answered attention and validity questions (e.g., “Paraphrase one of the questions that was asked on the previous page,” “What is your child’s date of birth?”). This procedure served four purposes: first, to ensure that mothers were paying adequate attention and not providing random responses; second, to ensure that mothers’ mastery of English was sufficient that they are able to read and comprehend the questions being asked; third, to identify computer programs, or “bots,” posing as mothers; and fourth, to check for mothers who may have falsified their responses to the screening items to qualify for the study. In this case, it was assumed that such people would put in a date of birth for their child in the screening item, but be unlikely to remember this date later (in contrast to actual mothers who would have no such difficulty in repeatedly providing their child’s date of birth). In addition to these validity checks, we note that prior to the screening questions, there was no reason for a participant to believe that she would not be allowed to participate if not a female parent. Furthermore, the screening questions were phrased in such a way as to not suggest the “correct” answers that allowed participation in the study. Thus, we are confident of the parenthood status of participants.

Mothers identified their collateral informants and had these informants contact the researcher who provided them with a link to a web-based survey where they provided informed consent and completed questionnaires describing the mother (assessing maternal ADHD symptoms and maternal neuroticism) in counterbalanced order. Collateral informants were administered attention questions similar to those used with mothers.

Once data from the mother and collateral informant were received, each received a code that they input into MTurk to signify completion. Mothers received US$9 and collateral informants received US$3 for completing the measures. Participants who began the study but did not meet screening criteria received US$0.10. Level of compensation was determined based on the recommendations for fair pay provided by MTurk participants (Guidelines for Academic Requesters - Fair Payment, 2015).

Measures

Maternal ADHD symptoms

Each collateral informant completed the Barkley Adult ADHD Rating Scale–IV (BAARS-IV; Barkley, 2011), which is a screening measure for ADHD symptoms in adults. The BAARS-IV assesses ADHD symptoms, as per Diagnostic and Statistical Manual of Mental Disorders (DSM), on a 4-point Likert-type scale (1 = never or rarely to 4 = very often), and a total score was calculated. Collateral reports on the BAARS-IV (or its earlier version) are strongly correlated with self-reports of symptoms (r = ~.70) and a variety of other measures (e.g., occupational functioning, marital satisfaction; Barkley, 2011). Furthermore, self-reports on the BAARS-IV have consistently exhibited good psychometric properties (Barkley & Murphy, 2010). In this study, the internal consistency for informant reports of mothers’ ADHD symptoms was .93.

Parenting stress

Mothers self-reported on the short form of the Parenting Stress Index (PSI-SF; Abidin, 1995). The PSI-SF is a 36-item measure with statements related to parenting rated on a 5-point Likert-type scale from strongly disagree to strongly agree. The PSI-SF has been shown to be reliable and valid across gender and race (McKelvey et al., 2009) and has shown good construct validity in a variety of contexts (e.g., Wietecha et al., 2012). Internal consistency has been reported as above .80 (Abidin, 1995), and in this study, the internal consistency of the mothers’ PSI-SF total score was .94.

To supplement the PSI-SF, items from two additional scales from the Parental Stress Scale (PSS; Berry & Jones, 1995) were administered. These scales have good reliability (Cronbach’s alphas ranging from .80 to .84), are correlated with child problems, and reliably distinguish between parents of children with and without mental health problems (Huang, Chang, Chi, & Lai, 2014). Scores were totaled across PSS items and demonstrated an alpha of .91.

In addition, mothers were presented with seven vignettes describing child inattentive, oppositional, and positive behavior that were drawn from the Written Analogue Questionnaire (WAQ; Johnston & Freeman, 1997). Mothers imagined their child in each vignette and indicated how much stress they would experience as the mother in each situation (i.e., “This behavior causes me to feel a great deal of stress as a parent”). Across the seven vignettes, mothers’ ratings of parenting stress showed an internal consistency of .78.

To maximize coverage of the construct of parenting stress, and because measures of parenting stress were all significantly intercorrelated, mothers’ scores from the three measures of parenting stress were standardized and combined into a single parenting stress composite.

Parenting self-efficacy beliefs

Mothers completed the Parenting Sense of Efficacy Instrument (P-SEMI; Harty, 2009) as a measure of their perceived level of parenting self-efficacy. The P-SEMI is a 40-item, task-specific measure of mothers’ perceived self-efficacy. Mothers used a 6-point Likert-type scale, ranging from 1 (never) to 6 (always), to rate how often they believe they are able to successfully complete parenting tasks. The P-SEMI assesses six subdomains of parenting: showing affection and empathy, engaging in play, facilitating routines, establishing discipline strategies, providing appropriate activities for learning and development, and promoting communication interaction. The P-SEMI has excellent face and content validity, strong internal consistency (α = .80-.91 for the six subdomains), and construct and convergent validity (correlations with the other measuring of parenting self-efficacy beliefs between .55 and .69 for the six subdomain scores and the P-SEMI total score), and better discriminates between mothers of children with mental health problems and mothers of typically developing children than other widely used measure of self-efficacy beliefs (Harty, 2009). The P-SEMI subscales were averaged for a total score, with an internal consistency of .97. Although other measures of parenting self-efficacy beliefs are more widely used (e.g., the Parenting Sense of Competence Scale; Johnston & Mash, 1989), the P-SEMI is the only measure of parenting self-efficacy beliefs that satisfies Bandura’s (1997) criteria for assessing self-efficacy beliefs: The P-SEMI portrays items in terms of parenting task demands, phrases items in a “can do” manner, consistently asks mothers to rate the strength of their belief in their ability to carry out parenting tasks, and comprehensively assesses parenting efficacy beliefs in relation to a variety of specific parenting skills.

Neuroticism

Collateral informants reported on mothers’ neuroticism on the International Personality Item Pool–120 Item (IPIP-120; Maples, Guan, Carter, & Miller, 2014), a freely accessible 120-item measure assessing five personality dimensions (24 items each): Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. The IPIP-120 has strong psychometric properties, and is comparable with the NEO Personality Inventory - Revised (NEO-PI-R; Costa & McCrae, 1992) with correlations between the Neuroticism subscales of the two measures ranging between .65 and .89 (Maples et al., 2014). Collateral informant reports on the IPIP show good psychometric properties (Witt, Donnellan, & Blonigen, 2009). Only the Neuroticism subscale was used in this study and informant reports of mothers on this subscale indicated an internal consistency of .92.

Covariates

Measures related to ADHD symptoms, parenting stress, neuroticism, and/or parenting self-efficacy beliefs were included as covariates. Mothers completed the Depression, Anxiety, and Hostility subscales of the Brief Symptom Inventory (BSI; Derogatis, 1993), and scores were totaled to measure psychological problems. For positive parenting behavior, the Positive Parenting and Involvement scales from the Alabama Parenting Questionnaire (APQ; Shelton, Frick, & Wootton, 1996) were averaged. To measure negative parenting, scores from the Inconsistent Discipline scale from the APQ and the Overreactivity and Laxness scales of the Parenting Scale (PS; Arnold, O’Leary, Wolff, & Acker, 1993) were standardized and averaged. The Parental Care and Tenderness questionnaire (PCAT; Buckels et al., 2015) measured feelings of caring and warmth toward children, and the total problems score from the Strengths and Difficulties Questionnaire (SDQ; Goodman, 2001) indexed behavior problems in the mothers’ children.

Data Analytic Plan

We calculated bivariate correlations between all study variables. The stats, boot, and lmtest packages in R Version 3.2.2 were used to conduct all analyses. The primary analysis tested the mediational model linking ADHD symptoms to parenting stress through associations with parenting self-efficacy and the conditional indirect effect of these links by neuroticism. To test the conditional indirect effect, Path a was the relation between the interaction of maternal ADHD symptoms and neuroticism as linked to maternal self-efficacy beliefs, and Path b was the interaction of maternal self-efficacy beliefs and neuroticism as linked to parenting stress. The product of these two paths tested for whether neuroticism moderated the strength of the mediation, particularly the strength of Paths a and b together in the original simple mediation model (equivalent to Model 5 in Preacher, Rucker, & Hayes, 2007). Again, we note that although we are conducting analyses that are statistically identical to mediation analyses, we are careful to observe the constraints imposed by our cross-sectional design.

Results

Preliminary Analyses

The mean, standard deviation, and range for all variables can be found in Table 2. As reported by informants (and compared with norms developed from self-reported symptoms, as norms for collateral informants are not available), mothers in this study, on average, had higher levels of ADHD symptoms than would be expected from a the general population (the average mother’s ADHD symptoms were at the 77th percentile based on the norms for self-reported symptoms provided by Barkley, 2011), but only 5% met the clinical cutoff for ADHD symptoms, which is consistent with prevalence estimates of ADHD in adults (Kessler et al., 2006). On the measure of parenting self-efficacy, the P-SEMI, the average mother reported that she “often” or “almost always” feels efficacious in her role as a parent (although norms that would help aid interpretation of this measure are not available). Based on the only measure of parenting stress for which norms are available (the PSI-SF), mothers’ average score was at the 65th percentile. Collateral informants reported a normal distribution of maternal neuroticism that was centered around the middle of the scale.

Table 2.

Means, Standard Deviations, and Ranges for Study Variables.

	M	SD	Range
Maternal ADHD symptoms (BAARS-IV)^a	1.64	0.58	1-3.89
Parenting self-efficacy beliefs (P-SEMI)	4.85	0.78	3-6
Parenting stress
PSI-SF	3.53	0.69	1.92-4.94
PSS	3.39	0.95	1.17-5
Stress vignette rating	3.17	0.80	1-5
Maternal neuroticism (IPIP-120)^a	2.75	0.63	1.46-4.17
Maternal psychological symptoms (BSI)	1.80	0.75	1-4.56
Positive parenting behavior (APQ)	4.70	0.67	2.68-6.05
Negative parenting behavior
APQ negative parenting total	2.50	1.06	1.08-6.55
PS total	2.75	0.86	1.02-5.46
Maternal affection for children (PCAT)	4.37	0.49	2.6-5.17
Child problems (SDQ)	1.63	0.24	1.25-2.25

Note. BAARS-IV = Barkley Adult ADHD Rating Scale–IV; P-SEMI = Parenting Self-Efficacy Measuring Instrument; PSI-SF = Parenting Stress Index–Short Form; PSS = Parental Stress Scale; IPIP-120 = International Personality Item Pool–120 Item; BSI = Brief Symptom Inventory; APQ = Alabama Parenting Questionnaire; PS = Parenting Scale; PCAT = Parental Care and Tenderness questionnaire; SDQ = Strengths and Difficulties Questionnaire.

Measures completed by collateral informants.

Bivariate Correlations

See Table 3 for correlations among the variables included in the mediational and conditional indirect effect analysis, all of which were significant and consistent with predictions, as well as correlations between potential covariates and the four primary variables. Maternal psychological symptoms, negative parenting practices, and the problems exhibited by the mother’s own child were each significantly related to maternal ADHD symptoms, parenting stress, parenting self-efficacy beliefs, and neuroticism in the expected directions. In addition, higher levels of parental caring and tenderness were related to stronger parenting self-efficacy beliefs and lower levels of parenting stress.

Table 3.

Bivariate Correlations Between Variables Involved in the Mediational and Conditional Indirect Effect Analyses and Covariates.

	Maternal ADHD symptoms	Parenting self-efficacy beliefs	Parenting stress	Maternal neuroticism (IPIP-120)^a
Maternal ADHD symptoms (BAARS-IV)^a	—	−.21**	.27***	.55***
Parenting self-efficacy beliefs (P-SEMI)		—	−.61***	−.43***
Parenting stress (composite)			—	−.43***
Maternal psychological symptoms (BSI)	.30***	−.37***	.52***	.53***
Positive parenting behavior (APQ)	−.07	.49***	−.41***	−.19*
Negative parenting behavior (composite)	.25**	−.48***	.50***	.44***
Child problems (SDQ)	.30***	−.38***	.46***	.33***
Maternal affection for children (PCAT)	−.04	.46***	−.39***	−.09

Note. IPIP-120 = International Personality Item Pool–120 Item; BAARS-IV = Barkley Adult ADHD Rating Scale–IV; P-SEMI = Parenting Self-Efficacy Measuring Instrument; BSI = Brief Symptom Inventory; APQ = Alabama Parenting Questionnaire; SDQ = Strengths and Difficulties Questionnaire; PCAT = Parental Care and Tenderness questionnaire.

Measures completed by collateral informants.

p < .05. **p < .01. ***p < .001.

Mediation Analysis

Mediation analysis: The role parenting self-efficacy beliefs

Before conducting the mediation analysis, possible issues with normality, linearity, homoscedasticity, and outliers were examined, and none were found. As shown in Figure 1, Path c was examined by regressing the maternal parenting stress variable on maternal ADHD symptoms. As predicted, maternal ADHD symptoms were significantly related to parenting stress. Path a was examined by regressing parenting self-efficacy beliefs on maternal ADHD symptoms. Again as predicted, a significant negative relation was found. To investigate Path b, parenting stress was regressed on self-efficacy beliefs, controlling for the effect of maternal ADHD symptoms. Confirming predictions, the relation between parenting self-efficacy beliefs and parenting stress was significant even after controlling for ADHD symptoms. The indirect effect was bootstrapped with 6,000 resamples and found to be significant. Consistent with our hypothesis, a significant proportion of the variance in the relation between maternal ADHD symptoms and parenting stress can be accounted for by parenting self-efficacy beliefs. To investigate the extent to which the relation between maternal ADHD symptoms and parenting stress was accounted for by self-efficacy beliefs, Path c was recalculated with self-efficacy beliefs in the model (Path c′). When this was done, maternal ADHD symptoms were no longer significantly related to parenting stress suggesting the possibility of full mediation.

Figure 1.

Model of indirect effect of parenting self-efficacy beliefs on the relationship between maternal ADHD symptoms and parenting stress.

Conditional indirect effect analysis: The role of neuroticism

Maternal neuroticism was tested as a moderator of one or both of Paths a and b in the model. To examine this, the mediation model was run with maternal neuroticism entered and allowed to interact with both maternal ADHD symptoms and self-efficacy beliefs. Although neuroticism was related to all three of the other variables in the expected directions, contrary to prediction, it did not significantly moderate the indirect effect, β(116) = .03, p = .61. Relations between ADHD symptoms, parenting self-efficacy beliefs, and parenting stress did not vary depending on the mothers’ level of neuroticism.

Covariate Analysis

In anticipation of the possibility that other variables better accounted for the observed mediation and based on the recommendations for best practices in the analysis of covariates in mediation (Kenny, 2015; MacKinnon, Fairchild, & Fritz, 2007), covariates were included in the analysis if they were significantly bivariately related to at least two of the four variables in the conditional indirect effects analysis. The variables which met this criterion were other maternal psychological symptoms (BSI), positive parenting (APQ), the composite negative parenting behavior scale, child problems (SDQ), and parental care and tenderness toward children (PCAT; see Table 3). As already noted, no demographic variable met these criteria. As there was no conceptual reason to expect that any one, or any particular combination of covariates, was more likely than others to alter the pattern of results found in the original analysis, all covariates were simultaneously added to each path.

When the covariates were added to Path c (the relation between maternal ADHD symptoms and parenting stress), BSI, APQ positive parenting, negative parenting, SDQ child problems, and the PCAT all significantly predicted parenting stress above and beyond maternal ADHD symptoms and all other covariates. For Path a (the relation between maternal ADHD symptoms and parenting self-efficacy beliefs), APQ positive parenting, negative parenting, SDQ child problems, and PCAT all significantly predicted parenting self-efficacy beliefs. Suggesting the importance of these covariates, for both of these pathways, maternal ADHD symptoms were no longer a significant predictor of self-efficacy or parenting stress when the covariates were included.

When Path b (the relation between parenting self-efficacy beliefs and parenting stress controlling for maternal ADHD symptoms) was analyzed with covariates included, BSI and APQ positive parenting and negative parenting were all significant predictors of parenting stress. However, self-efficacy beliefs remained a significant predictor of parenting stress. When all covariates were included in each path, the indirect effect of maternal ADHD symptoms on parenting stress through parenting self-efficacy beliefs was no longer significant (β = −.008, 95% confidence interval [CI] = [−.05, .02]).

The results of the covariate analysis suggest that much of the original mediation model can be explained by the inclusion of other variables. Specifically, other mother-centered characteristics (psychological symptoms, parenting behavior, and attitudes) as well as child problems accounted for significant variance in at least one of the meditational pathways, above and beyond the effects of all other variables in the model. In the case of Paths a and c, the covariates accounted for enough variance that maternal ADHD symptoms were no longer uniquely predictive of parenting self-efficacy beliefs and parenting stress. However, even with all covariates included, parenting self-efficacy beliefs remained a robust and unique predictor of parenting stress.

Discussion

This study addressed three main questions: first, whether a relation exists between maternal ADHD symptoms and parenting stress; second, whether the relation between maternal ADHD symptoms and parenting stress could be indirectly accounted for by parenting self-efficacy beliefs; and finally, whether the indirect effect of maternal ADHD symptoms on parenting stress through parenting self-efficacy beliefs was conditional on maternal neuroticism. Consistent with our hypotheses, maternal ADHD symptoms were positively related to parenting stress, and parenting self-efficacy beliefs significantly mediated this relation. However, contrary to expectations, this mediation was not conditional on levels of maternal neuroticism.

Maternal ADHD symptoms were moderately related to parenting stress at levels that are consistent with what has been found in previous research investigating the relationship between adult ADHD symptoms and general stress (β = .30; Das et al., 2012). This is not surprising, as ADHD symptoms are highly impairing and likely to interfere with effectively managing parenting situations so as to minimize stress, and this impairment may be particularly strong for women (Williamson & Johnston, 2015). The moderate relation between maternal ADHD symptoms and parenting stress is notable because few mothers in the sample had significantly elevated levels of symptoms. Although the average level of ADHD symptoms was consistent with previous prevalence estimates (Bitter et al., 2010; Kessler et al., 2006), it is possible that in a sample of mothers with more normally distributed or severe ADHD symptoms, the relation between ADHD symptoms and parenting stress would be even stronger.

The relation between maternal ADHD symptoms and parenting stress was significantly mediated by parenting self-efficacy beliefs. Although causal relationships are not testable with our cross-sectional design, our results are consistent with the interpretation that the association between maternal ADHD symptoms and parenting stress is attributable to maternal ADHD symptoms having a negative impact on parenting self-efficacy beliefs, and it is these beliefs that lead mothers to experience greater parenting stress. Path c′ was not significant when parenting self-efficacy beliefs were included in the model, suggesting that the relation between maternal ADHD symptoms and parenting stress is wholly explained by the indirect effect of maternal ADHD symptoms on parenting stress through parenting self-efficacy beliefs. This finding is consistent with previous research showing that mothers with ADHD symptoms have lower levels of perceived efficacy in a variety of domains (Jiang & Johnston, 2012) and that parents with other psychological problems have lower parenting self-efficacy beliefs (Kohlhoff & Barnett, 2013; Porter & Hsu, 2003). However, although these results are consistent with full mediation, caution should be taken when interpreting these results as suggesting that there is no direct relation between maternal ADHD symptoms and parenting stress. Although Path c′ in this study was not significantly different from zero, it was still nontrivial (β = .14, p = .11), and it is possible that a larger sample size, the recruitment of a clinical sample, or other methods of assessment of both ADHD symptoms and parenting stress might find different results. Furthermore, existing research supports the prediction of a direct effect, as ADHD symptoms in adults are related to other maladaptive beliefs (Torrente et al., 2014).

We hypothesized that maternal neuroticism would differentiate mothers such that the indirect effect of parenting self-efficacy beliefs would be stronger for mothers with higher levels of neuroticism. Specifically, we predicted that mothers with increased neuroticism would be more prone to interpreting their ADHD behaviors as reflecting poorly on their ability to effectively parent their child. However, levels of neuroticism did not moderate any of the models that were tested. We return to this null finding later in the discussion.

Parenting Self-Efficacy Beliefs

Transactional relations

It is important to acknowledge the likely transactional relations between parenting self-efficacy beliefs and other variables. Our use of mediation analysis in a cross-sectional design cannot exclude the possibility that the causal direction of each pathway flows in either or both directions. Although our discussion of causal direction has suggested maternal ADHD symptoms as the cause of parenting self-efficacy beliefs (as, conceptually, the reverse cannot be true given the proposed genetic/biological etiology of ADHD symptoms), it is probable that for all the other significant mediational relations that were found, the causal arrow between parenting self-efficacy beliefs and other variables points in both directions. For instance, it is likely that mothers who experience parenting stress are less successful in managing child behavior and, therefore, feel less efficacious in their role as parents. However, it also is likely that feelings of low parenting self-efficacy are themselves stressful. Thus, in a transactional manner, a mother who is unsuccessful in disciplining her child may feel as though she is not an effective disciplinarian, and these feelings of parenting uncertainty may increase levels of parenting stress, driving adoption of harsher, more negative parenting strategies, which are even more likely to fail, further eroding her sense of parenting self-efficacy.

Furthermore, an analysis of reverse causal effects in this study (not presented, contact the first author for more details) found that parenting stress could mediate the relation between maternal ADHD symptoms and parenting self-efficacy beliefs, lending even more complexity to the interpretation of causality among these variables that cannot be disentangled without the use of longitudinal or cross-lagged designs. This finding suggests both that low maternal self-efficacy beliefs may cause parenting stress and that experiencing parenting stress may result in decreased parenting self-efficacy beliefs. A mother who feels that she is not effectively parenting her child is likely to feel stress over not meeting her own parenting expectations, and this stress may further compromise her ability to effectively manage or organize her parenting, continuing the negative cycle of effects. The transactional nature of mothers’ cognitions, affects, and behaviors has been well established (Bandura, 1986; Johnston & Chronis-Tuscano, 2015; Rantanen et al., 2015). Longitudinal, treatment (e.g., targeting self-efficacy beliefs and/or ADHD symptoms), and experimental (e.g., inducing parenting self-efficacy beliefs) research would be helpful to determine more fully the nature of the transactional relationships present in the mediation found in this study.

Covariates

Notably, contrary to expectations, the inclusion of covariates in the proposed model eliminated the indirect effect of maternal self-efficacy beliefs on the relation between maternal ADHD symptoms and parenting stress. In addition, when covariates were included, the relations between maternal ADHD symptoms and both parenting stress and parenting self-efficacy beliefs also were eliminated. The only mediational pathway that survived inclusion of covariates was the relation between parenting self-efficacy beliefs and parenting stress. These results suggest that much—or all—of the indirect effect of maternal ADHD symptoms on parenting stress through parenting self-efficacy beliefs can be better explained by other variables.

Interestingly, other maternal psychological symptoms (i.e., depression, anxiety, and hostility) were related to parenting self-efficacy beliefs and parenting stress in much the same way as were maternal ADHD symptoms. Specifically, although there were bivariate relations among maternal psychological symptoms, parenting stress, and parenting self-efficacy beliefs, when covariates such as parenting behavior and maternal feelings of warmth were included in the model, no unique effect of other maternal psychological symptoms remained. The important conclusion to be drawn is that, although at the bivariate level (and in a mediational analysis without covariates in the case of maternal ADHD symptoms), a variety of maternal psychological symptoms, including ADHD symptoms, are related to parenting self-efficacy beliefs and parenting stress, when other variables are considered, the more accurate picture is of relations between parenting behavior, child problems, and maternal feelings of warmth toward children with parenting stress and parenting self-efficacy beliefs. This suggests that although maternal psychological symptoms are related to maternal impairment, they are not uniquely related, nor are they the aspect of maternal functioning most closely related to the experience of parenting stress.

Absence of a Conditional Indirect Effect of Neuroticism

Neuroticism did not affect the outcome of the mediation analysis, and the observed conditional effect was approximately zero. The failure to find an effect of neuroticism occurred despite good internal consistency of the measure of neuroticism and strong bivariate relations between neuroticism and other variables that were consistent with our hypotheses and previous research (Rantanen et al., 2015; Robin et al., 2008), suggesting that neuroticism was measured correctly. It is possible that the study was underpowered to detect a conditional effect of neuroticism. It has been suggested that conditional indirect effect models may require very large sample sizes, although the calculation of these requirements is usually not feasible (Beaujean, 2008). However, a too-small sample size seems unlikely as the explanation for the lack of an effect of neurotic personality features as the effect of neuroticism was small (β = .07), suggesting that even if there is an indirect effect, it is likely to be too small to be clinically meaningful. In sum, it seems that the hypothesized conditional indirect effect of neuroticism does not exist based on the results of this study.

Strengths, Limitations, and Future Directions

This study had many strengths including a representative sample acquired with online recruitment methods and the use of collateral informants in measuring key study variables. This conservative approach to measurement allowed for more objective assessment of maternal ADHD symptoms and neuroticism compared with self-reports. Measurement of adult externalizing symptoms in general, and ADHD symptoms in particular, is known to vary widely depending on the rater and method of assessment (Chronis-Tuscano et al., 2008; Jiang & Johnston, 2012), and the use of collateral informants in this manner enhances our confidence that the results presented here are valid. However, limitations of this study should also be noted. Although throughout this article, the term mediation has been used to describe the model under analysis, we acknowledge that the design of this study did not meet criteria for mediation in a classic sense. First, simultaneous measurement of all study variables makes it impossible to statistically disentangle causal effects. A conceptual analysis of the issue of causality in this study was presented above, but a longitudinal or experimental study, in which the specific causal effects of ADHD symptoms, maternal self-efficacy beliefs, and parenting stress could be determined, would be ideal for more fully understanding this model.

Gender differences in adults with ADHD have been demonstrated in a number of domains (Williamson & Johnston, 2015). Parent gender would be a valuable moderator to investigate in future research of the relation between parent ADHD symptoms and parenting stress.

Although we controlled for a variety of child problems with the use of the SDQ, we did not administer a targeted measure of child ADHD symptoms. Our study would have been strengthened to the extent that child ADHD symptoms were measured more thoroughly, as ADHD symptoms are highly heritable (heritability coefficient = .72; Larsson et al., 2014). The bidirectionality of the relation between ADHD symptoms in mother and child in relation to parenting cognitions may not have been fully captured by our measure of child problems.

Although the use of online methods for recruitment was a strength of this study, as it facilitated reaching a sample of mothers that might otherwise have been difficult to recruit, there are limitations inherent to online recruitment methods. First, even though methods were in place to detect falsified responses, there was no way to definitively verify that participants were, in fact, mothers of a child between the ages of 6 and 12. Second, time limits were in place to prevent mothers from taking an extended period of time to complete the study, but there was not any way to determine whether mothers took breaks for shorter periods of time or were distracted by their children or other environmental stimuli while completing the measures. Third, although previous research suggests that samples recruited via MTurk are as representative of the general population—or more—as samples recruited with more traditional techniques (Casler, Bickel, & Hackett, 2013), it is possible that mothers who participate in online studies do not accurately represent the larger population of mothers. Future research should replicate these results with mothers recruited from other sources such as clinically referred sample to ensure that the results found here remain accurate even at very high levels of maternal ADHD symptoms. Doing so will reveal the extent to which our findings remain meaningful in a clinical setting.

Conclusion

This article investigated whether maternal self-efficacy beliefs mediated the relation between ADHD symptoms and parenting stress, and tested whether neuroticism moderated these relations. Hypothesized moderating influences of maternal neuroticism were not found; however, the mediation of maternal ADHD symptoms and parenting stress by parenting self-efficacy beliefs was established. These results strongly suggest that clinicians and researchers pay greater attention to the subjective experiences of mothers. This study contributes to existing literature indicating that parenting self-efficacy beliefs are central to a wide variety of factors that, together, could greatly improve the functioning of families. By focusing our resources on improving not only maternal parenting skill but also mothers’ belief in their ability to effectively implement the skills they have, we allow mothers to improve not only their own well-being but the well-being of their children and families.

Footnotes

Acknowledgements

The authors thank the participants who devoted time to participating in this research.

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) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research was funded by a grant from the Canadian Institutes of Health Research to the second author (CIHR 2010 MOP 106586).

Notes

Author Biographies

David Williamson is a graduate student pursuing a PhD in psychology at the University of British Columbia.

Charlotte Johnston is a professor in clinical psychology at the University of British Columbia. Her research focuses on adult and child ADHD.

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