Abstract
Background and Objectives
Household chores have long been considered an important element of childrearing, in that they are an integral part of household routines that promote family cohesion (Humphrey & Wakeford, 2006). Participation in household tasks is associated with lower levels of depression and anxiety (Pennick, 2013) and greater self-regulatory capacity in children (Bridley & Jordan, 2012; Oaten & Cheng, 2006). In addition, longitudinal studies suggest that the benefits associated with chores continue to have a positive impact throughout an individual’s lifetime; engagement in household tasks at a young age strongly predicts positive relationships with family and friends, lower rates of drug use, and professional success in adulthood (Rossmann, 2002).
Children and adolescents with ADHD often exhibit deficits in occupational functioning, leading them to struggle with tasks such as household chores (American Psychiatric Association [APA], 2013). Clinically significant distractibility may result in difficulty completing tasks. Moreover, comorbidities such as oppositional defiant disorder (ODD) and motor issues can pose additional challenges for children with ADHD attempting to complete chores (Mendes et al., 2016).
There is limited research to date on this topic. In a study comparing 22 children with ADHD and 22 neurotypical children of ages 9 to 11 years, there were no differences in parent ratings of the importance of household chores (Dunn, Coster, Orsmond, & Cohn, 2009). However, children with ADHD were reported as significantly less independent in completing household tasks than children without ADHD (Dunn, Coster, Orsmond, & Cohn, 2009). Specifically, children with ADHD required substantially more assistance with self-care (SC) chores, such as making their bed and cleaning their bedroom, and family-care (FC) chores, such as setting the table or taking out the garbage (Dunn, Coster, Orsmond, & Cohn, 2009). Of note, parents who reported providing more assistance to their children with chores also reported more parenting stress (Dunn, Coster, Cohn, & Orsmond, 2009). However, this study focused on a small, local convenience sample that was ethnically homogeneous and had a very narrow age-range. There were also significant differences in parent education between the two groups, with a greater proportion of the parents of the non-ADHD children having an undergraduate degree or higher. Moreover, this study did not examine disparities in parental expectations regarding chore completion with respect to ADHD diagnosis.
The only other study examining chore performance in children with ADHD was conducted by researchers in a child psychiatry clinic in Brazil that serves low-to-middle socioeconomic class families (Mendes et al., 2016). The study examined 67 patients with ADHD of ages 6 to 14 years. Parental assistance in performing SC chores and FC chores was found to be directly associated with severity of hyperactivity symptoms, but not with severity of inattention symptoms. It is unclear how many of the school-age children in this cohort had ADHD, combined type (ADHD, CT) versus ADHD, inattentive type (ADHD, IA). Oppositional symptoms in this cohort were associated with parental assistance for SC and FC chores. This study was similarly limited by a small, demographically skewed convenience sample.
Given the paucity of chore-focused research and issues with sample size of prior studies, the goal of this study was to investigate the relationship between ADHD and household chore performance in a large, diverse national sample of youth with ADHD. In addition to looking at ADHD sub-type and the impact of comorbid ODD on chore performance, study objectives included examining parent expectations regarding chore performance, parent perceptions regarding the ability of children with ADHD to complete chores satisfactorily and independently, and the extent to which children with ADHD need reminders and/or assistance compared with non-ADHD peers.
Methods
A 72-question voluntary, anonymous online questionnaire was developed in Qualtrics to collect information about demographic and clinical variables, as well as parent assessment of performance of SC and FC chores. The questionnaire focused on two SC chores (“making bed” and “cleaning bedroom”) and six FC chores (“setting or clearing the table,” “washing or drying dishes,” “housecleaning,” “taking out garbage,” “laundry,” and “assisting with family meals or snack preparations”). In addition to parent ratings regarding each of the two SC chores and six FC chores, the questionnaire solicited general ratings by chore category (SC, FC). Chore ratings focused on parent expectations regarding chore performance, parent perceptions regarding the ability of their child with ADHD to complete chores satisfactorily and independently, and the extent to which parents believe their child needs reminders and/or assistance compared with their non-ADHD peers.
Participants were recruited with the assistance of CHADD (Children and Adults with Attention-deficit/Hyperactivity Disorder), a national nonprofit organization that provides education, advocacy, and support for individuals with ADHD. CHADD disseminated information about this study to its membership via e-mail and social media (Facebook). In addition, study information was included in CHADD’s electronic newsletter, as well as in a separate newsletter disseminated by its National Resource Center for ADHD, a Centers for Disease Control and Prevention (CDC) supported public information center.
Study participation was limited to parents of children 6 to 18 years of age who live at home during the school year. Families were excluded if they did not live in the United States or if their child with ADHD had autism spectrum disorder, intellectual disability, or a serious physical disability or medical condition that significantly compromised their child’s ability to do chores (e.g., cerebral palsy, arthrogryposis). In addition to descriptive statistics summarizing response data, several analyses were performed using SPSS Statistics 24. Spearman correlation was used to assess the relationship between parent-reported ability of children to do household chores independently/satisfactorily and parental belief that ADHD impacts chore performance. Chi-square tests were used to examine if the extent to which chore involvement is expected in the household is independent of children meeting or exceeding these expectations. Differences in parent ratings of chore performance between ADHD and non-ADHD children were assessed using a weighted kappa analysis. Finally, chi-square tests were used to examine the roles of ADHD subtype and ODD diagnosis status in chore performance. This protocol was approved by the Institutional Review Board of the Feinstein Institutes for Medical Research at Northwell Health.
Results
The sample consists of responses from 797 primary caregivers of children with ADHD. Demographic and clinical characteristics of the sample are listed in Table 1. Parent responses regarding the extent to which their child “completes chores independently (once they are started)” and “does chores satisfactorily” are summarized in Table 2. Less than one third of parents reported their child with ADHD was often or very often able to complete SC and FC chores independently (31.2% and 30.2%, respectively), and approximately one-quarter of parents reported their child with ADHD was often or very often able to do SC and FC chores satisfactorily (24.5% and 25.3%, respectively).
Participant/Household/Child Demographics, Online Survey of Parent/Guardians of Children with ADHD (n = 797).
Note. ODD = oppositional defiant disorder.
Parent Ratings of Their Child’s Ability to Complete Chores Independently and Satisfactorily and of the Impact of ADHD on Their Child’s Performance of Chores (n = 797).
ADHD impact score: 0 = not at all, 1 = mildly, 2 = moderately, 3 = severely.
Parents were also asked “to what extent does ADHD affect their child’s ability” to complete chores independently once started and to do chores satisfactorily (Table 2). In terms of chore completion, 93.5% and 92.1% of parents believed that ADHD to some extent affected their child’s ability to independently complete SC and FC chores, respectively. A total of 42% and 35% of parents believed that ADHD had a severe impact on the ability to independently complete SC and FC chores, respectively. The vast majority of parents (92.4% and 92.2%, respectively) believed that ADHD limited their child’s ability to do SC and FC chores satisfactorily, and 35% and 31.4% of parents, respectively, believed that the impact of ADHD on their child’s ability to do SC and FC chores satisfactorily was severe.
An inverse relationship was noted between parent ratings of a child’s ability to do chores independently and the likelihood that they believed ADHD affected chore performance. Parents who reported that their child was less frequently able to do chores independently were more likely to indicate that ADHD affected their child’s chore performance. This was true for SC chores in general (r = −.423, p < .001) and also for FC chores in general (r = −.486, p < .001). As with chore independence, an inverse relationship was noted between parent ratings of a child’s ability to do chores satisfactorily and the likelihood that they believed ADHD affected chore performance. Parents who reported that their child was less frequently able to do chores satisfactorily were more likely to indicate that ADHD affected their child’s chore performance. This was true for SC chores in general (r = −.477, p < .001) and for FC chores in general (r = −.439, p < .001).
Table 3 illustrates parents’ expectations of their children to complete specific SC and FC chores, and the proportion of children who met/exceeded parental expectations. There was considerable variation in frequency with respect to how often children were expected to do each of the SC and FC chores, with up to 25% of households not expecting a given task to be done. Whereas the majority of families expected their children to do SC chores at least sometimes, less than a third of children met/exceeded expectations with respect to making their bed and less than one quarter of children with ADHD actually met/exceeded expectations for cleaning their bedroom. Even in households where children were rarely expected to complete these SC tasks, a similarly low percentage of children met/exceeded parental expectations.
Frequency With Which Household Chores Were Completed Relative to Parental Expectations (n = 797).
With the exception of two FC tasks (setting/clearing the table and taking out the garbage), less than half of children met/exceeded expectations for FC chores regardless of how often parents expected that chore to be performed. As with SC chores, children with ADHD were more likely to meet or exceed expectations when each FC chore was expected very often versus sometimes. When the child was expected to make the bed very often, they were more likely to meet/exceed expectations than when the chore was only expected sometimes (Table 3).
In terms of comparison to peers, parents were asked to indicate how frequently their child and a peer without ADHD each need reminders to complete chores (Table 4). Weighted kappa (κw) analysis established that there was a significant difference between parent rating of frequency of reminders needed to do chores for their child with ADHD compared with a non-ADHD peer; this was true for both SC chores (κw = .030, p < .001) and FC chores (κw = .024, p = .001). For SC and FC chores, 86.5% and 84.3% of all parents, respectively, thought their child needed reminders more frequently than did their child’s non-ADHD peers. For SC and FC chores, of parents who reported their child needed reminders only rarely/sometimes, 36% and 18.3%, respectively, indicated that their children needed more reminders than same-age peers. By contrast, of parents who reported their child needed reminders often/very often, 94% and 92%, respectively, indicated their children needed reminders more often than their peers.
Report by Parents of Children With ADHD of How Often Their Child and a Peer Without ADHD Need Reminders or Assistance for Household Chores (n = 797).
Overall, 65.2% and 67.5% of all parents thought their child needed assistance more frequently for SC and FC chores, respectively, than did their non-ADHD peers. As with reminders, there was poor agreement between parent rating of the frequency that assistance with chores was needed for their child with ADHD and a non-ADHD peer; this was true for both SC chores (κw = .177, p < .001) and FC chores (κw = .162, p < .001). For SC and FC chores, of parents who reported their child needed assistance only rarely/sometimes, 50% and 45.6%, respectively, indicated that their children needed more assistance than same-age peers. By contrast, of parents who reported their child needed assistance often/very often, 95.3% and 94.5%, respectively, indicated their child needed assistance more often than their peers for SC and FC chores.
To assess potential clinical predictors, chore performance was examined with respect to ADHD subtype. For these analyses, children with ODD were excluded—resulting in 168 children with ADHD, IA and 419 children with ADHD, CT. Table 5 summarizes chore performance for these two subgroups. A small but significant between-group difference was noted in age (12.7 years vs. 11.1 years, p < .001). No difference was noted in gender or ADHD severity. No between-group differences were noted with respect to meeting/exceeding parent expectations for the two SC chores or five of the six FC chores examined. Children with ADHD, IA were more likely than ADHD, CT to meet/exceed expectations for setting/clearing the table (χ2=5.95, p = .015). No differences were noted in the extent to which ADHD, IA or ADHD, CT children needed reminders or parental assistance for SC or FC chores.
Sample Demographics and Chore Performance of Children With ADHD and No Oppositional Defiant Disorder (n = 587) and Comparison of Boys, Ages 8 to 13, Combined Types With and Without ODD (n = 265).
Note. IA = inattentive type; CT = combined type; ODD = oppositional defiant disorder; SC = self-care; FC = family-care.
To similarly assess whether ODD is an important covariate with respect to chore performance, separate analyses were conducted comparing children with and without ODD. Given that ODD is more common among boys than girls and more common in ADHD, CT than ADHD, IA, these analyses were limited to boys of ages 8 to 13 years with ADHD, CT. In total, 265 boys with ADHD met these selection criteria: 198 boys with ADHD, CT without ODD and 67 boys with ADHD, CT and comorbid ODD (Table 5). Although there was no between-group difference in age, boys with ADHD and comorbid ODD were rated by parents as having more severe ADHD (χ2=25.4, p < .001). No differences were noted with respect to meeting/exceeding parent expectations for the two SC or six FC chores examined. No between-group differences were noted in the extent to which children with ADHD, CT with or without ODD needed reminders or parental assistance for SC or FC chores.
Discussion
In this study, we aimed not only to examine household chore performance and independence in children with ADHD, but also to assess the relationships between these variables and measures such as parental expectations of chore frequency, parental beliefs about the effects of ADHD on chore performance, ADHD subtype, and presence of ODD.
This study identifies several important findings related to ADHD and household chores. Of note, most parents of children with ADHD indicated that their children did not regularly complete chores independently or satisfactorily. In addition, they overwhelmingly indicated that ADHD affected their child’s chore performance. Most parents noted their children failed to meet or exceed expectations for the completion of all SC and most FC chores, and the majority also believed their child with ADHD required more reminders and assistance than non-ADHD peers.
This study’s findings suggest that engagement with household chores is lower for children with ADHD than for typical children. Previous studies have demonstrated that routines—including household chores—have a powerful role in improving child outcomes at almost all stages of development (Sytsma et al., 2001). Importantly, routines are essential for developing a typical child’s “sense of predictability, stability, and feelings of security” (Sytsma et al., 2001), and adherence to them may help to control impulsivity and develop self-regulation (Bater & Jordan, 2017). Moreover, routine engagement with FC chores in children of ages 9 to 14 is positively correlated with concern for others in the family (Grusec et al., 1996). Among youth with ADHD, household chores have also been associated with less internalizing and externalizing symptoms (Harris et al., 2014). Among typically developing teens, it has been shown that routines involving chores improve parent–child interactions and reduce parental nagging (Sytsma et al., 2001). Chore performance also has long-term impacts on children, as household responsibilities are strongly predictive of general and work self-efficacy later in life (Riggio et al., 2010). To the extent that children and adolescents with ADHD have greater issues with impulsivity and self-regulation, they likely stand to gain the most from increased engagement with household tasks. This study’s findings regarding household chore engagement among children and adolescents with ADHD suggest that these youth are at risk of not being able to do these tasks independently or satisfactorily, potentially precluding them from receiving much needed developmental benefits from household task engagement. Multimodal interventions (such as training in time-processing ability) and the use of time-assistive devices (Wennberg et al., 2018) may have the potential to encourage children with ADHD to engage in regular routines and reap the key benefits that these routines provide (Abikoff et al., 2013).
Interestingly, in this study, parental expectations regarding chore frequency were positively associated with the likelihood of a child meeting or exceeding these expectations. In other words, children with ADHD were more likely to meet or exceed expectations when parents expected the chore more frequently. Given that children with ADHD have considerable difficulty with chore performance (i.e., initiation, completion, and quality) and given that parents overwhelmingly believed that these difficulties were in large part a consequence of the child’s ADHD, it is likely that parents may encounter difficulties when setting expectations relating to chores for a child with ADHD relative to other children in the home.
Our findings indicate that parents have unequal expectations for children with ADHD compared with other children of a similar age. This could pose a significant parenting challenge with respect to expectations regarding chores if there are similarly aged siblings without ADHD in the same household. If parents lower their expectations or provide more support for the child with ADHD, this may lead to a range of problems, including sibling concerns of parental fairness and resentment between siblings. Research suggests that differential parental treatment is one key factor in explaining the impact of non-shared environment on child (Wamboldt & Wamboldt, 2000). Studies have shown that adolescents that were the target of more parental negativity relative to other siblings are more likely to develop depressive and antisocial tendencies (Pike et al., 1996; Reiss et al., 1995). In addition to these considerations, there is the additional concern that children with ADHD may not derive the same long-term developmental benefits associated with performance of household chores if parents either exempt them from this responsibility or significantly lower their expectations. This has not been examined to date, and longitudinal studies investigating the validity of this concern would be of value.
The difficulties that children with ADHD have with chore performance may not only have adverse consequences for these children and their siblings but also for their parents. Our findings indicate that children with ADHD struggle to independently do household chores and require more reminders and assistance than their typically developing peers. This may necessitate greater parental involvement around chores, which has been shown to be associated with higher rates of parenting stress (Dunn, Coster, Cohn, & Orsmond, 2009).
Apart from setting/clearing the table, no differences were identified between children with ADHD, IA and those with ADHD, CT in terms of meeting/exceeding parental expectations and needing reminders or parental assistance. Similarly, no between-group differences were noted between boys who had ADHD, CT and comorbid ODD and those who only had ADHD, CT. This is somewhat surprising in that children with ODD are typically oppositional in the home setting, and research has shown that, among children with ADHD, children with higher scores on an ODD factor score based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; APA, 1994) criteria had greater difficulties with homework (Langberg et al., 2010). It is possible that there is no difference in chore performance with respect to ODD among children with ADHD, and that difficulties with homework reported among children with ODD may be due to the greater amount of time required to do homework and/or the presence of co-morbid learning disorders among some children with ADHD and ODD. To the extent that our analysis of ODD was limited to boys with ADHD, CT to avoid confounding due to gender and ADHD sub-type, more than half of the sample’s children with ADHD and ODD were excluded from our analyses, likely limiting the generalizability of our findings.
This study has several strengths. Whereas previous studies focusing on performance of chores by children with ADHD have typically had small samples (Mendes et al., 2016) and did not include older adolescents (Dunn, Coster, Orsmond, & Cohn, 2009), this study examines the largest and most diverse sample to date. Moreover, the robust sample size enabled analysis of the impact of ADHD subtype and co-morbid ODD on chore expectations and performance.
In terms of study limitations, although the sample is considerably larger and more diverse than previous studies, it is not nationally representative. For example, parents in the study are somewhat older (27% of parents were more than 50 years old) and more educated (39% of parents had a graduate degree) than the overall U.S. parent population (U.S. Census Bureau, 2016). Disproportionately, more participants also reported a higher annual income than did the average U.S. parent, and the majority (88%) were White—a racial distribution that varies considerably from that of the overall U.S. population (U.S. Census Bureau, 2016). These sample characteristics may limit the generalizability of this study’s findings to the U.S. population as a whole. In addition, the findings in this study are based on parent report, which may be subject to observer bias or expectancy bias and may not represent the objective or standardized competence of a given child.
Future research examining chore performance would be enhanced with verification of clinical diagnoses (i.e., ADHD subtype, ODD), inclusion of a comparison group of children without ADHD, and prospective collection of data by parents using a chore log. In addition, investigations into the associations between children’s own perceptions of their competence and parental perceptions of their children’s competence would help frame this study’s findings. It would also be of value to compare chore performance of children with ADHD with that of other populations of chronically ill children.
Conclusion
The overwhelming majority of parents of children with ADHD reported challenges in getting their children to complete SC and FC chores independently or satisfactorily and attributed these difficulties to the child’s ADHD. Given that household routines, including chores, play an important role in children’s development and psychosocial adjustment, pediatricians and other professionals must be sensitive to the adverse impact that ADHD may have in this regard. Future studies should investigate clinical strategies to reduce parental frustration and allow children to be more successful with respect to performance of household chores.
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.
