471717

al of Attention DisordersWilliamson and Johnston

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Journal of Attention Disorders

Marital and Coparenting Relationships:

XX(X) 1­–11
© 2013 SAGE Publications
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DOI: 10.1177/1087054712471717
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Symptoms of ADHD

David Williamson1 and Charlotte Johnston1

Abstract
Objective: To examine relations between symptoms of ADHD and reports of marital and coparenting functioning.
Method: Parents of 8- to 12-year-old boys with (n = 26) and without (n =38) ADHD participated. Results: Although
mothers of children with ADHD had the highest levels of ADHD symptoms, their symptoms were typically not related
to measures of the couples’ functioning, particularly when controlling for family ADHD and comorbidities. Father ADHD
symptoms were related to their reports of couple functioning, and fathers’ ADHD symptoms were associated with their
negative attributions for their wives’ behavior, even with child and mother ADHD controlled. However, when fathers’
depression and hostility symptoms were controlled, these were more important predictors of the attributions than ADHD
symptoms. Conclusion: It is important to consider parental levels of ADHD symptoms in the context of other family
members’ symptoms as well as other forms of psychopathology. (J. of Att. Dis. 2012; XX(X) 1-XX)

Keywords
ADHD, family, marital, coparenting

ADHD is highly heritable and persistent across the life span
(Bidwell et al., 2011) and is associated with impairments in
numerous domains of life functioning (Barkley & Murphy,
2011), including interpersonal relations (Overbey, Snell, &
Callis, 2011). Although previous studies have reported lower
marital satisfaction among adults with ADHD symptoms
(Eakin et al., 2004), the mechanisms that might underlie this
marital dissatisfaction, such as relationship attributions,
have not been examined. Similarly, although a recent review
(Johnston, Mash, Miller, & Ninowski, 2012) highlighted
links between adult ADHD symptoms and parenting diffi-
culties, most previous research has focused on parenting at
the individual level. Less is known about how ADHD symp-
toms in adults may be related to mothers’ and fathers’ abili-
ties to cooperate as a couple. In this study, we examine
ADHD symptoms in mothers and fathers in relation to the
couples’ marital satisfaction, attributions for each other’s
behavior, and their reports of coparenting. We also examine
these relations within the context of child ADHD symptoms
and both parent and child comorbidities.
ADHD symptoms have been associated with difficulties
in interpersonal relationships in adults (Babinski et al.,
2011; Das, Cherbuin, Butterworth, Anstey, & Easteal, 2012;
Overbey et al., 2011). Regarding marital relationships, stud-
ies have reported that adults with ADHD symptoms experi-
ence less marital satisfaction and elevated rates of marital
dissolution (Barkley, Murphy, & Fischer, 2008; Eakin et al.,
2004; Minde et al., 2003). In some reports, the association
between adult ADHD symptoms and marital dissatisfaction
appears to be independent of comorbidities (Eakin et al.,
2004); however, these are not always controlled.
In addition to the possible contributions of comorbidities
to the association between adult ADHD and marital func-
tioning, the influence of child ADHD also sometimes
remains uncontrolled. This omission raises concerns
because we know that ADHD often affects both parents and
children within a family (Biederman, Faraone, Mick, &
Spencer, 1995), and child ADHD behavior is a risk factor
for marital dissolution (Wymbs et al., 2008). In addition,
there is considerable evidence supporting the transactional
nature of the relationship between marital functioning and
child problems including both ADHD and oppositional
behavior (Jenkins, Simpson, Dunn, Rasbash, & O’Connor,
2005; Wymbs & Pelham, 2010). Thus, it is important to
assess the extent to which adult ADHD symptoms are
related to marital satisfaction independent of the impact of
1
University of British Columbia,Vancouver, Canada
Corresponding Author:
David Williamson, Department of Psychology, University of British
Columbia, 2136 West Mall,Vancouver, British Columbia,V6T 1Z4, Canada
Email: dkwilliamson@psych.ubc.ca

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2 Journal of Attention Disorders XX(X)
child ADHD symptoms. Similarly, it is important to control
for child oppositional behavior, given its relations to both
marital satisfaction and child ADHD. Finally, given the
contextual nature of each partner’s experience of marital
functioning, we argue it is also important to account for the
partner’s level of ADHD symptoms when examining cor-
relations between adult ADHD symptoms and measures of
marital functioning.
Most existing studies of adult ADHD symptoms and mari-
tal distress have focused on adults with extreme or diagnostic
levels of ADHD symptoms (e.g., Eakin et al., 2004).
However, given the recognized limitations to the diagnostic
criteria for adult ADHD (Barkley et al., 2008; Kessler et al.,
2010), it is possible that impairments in social functioning
may also appear at subdiagnostic levels of symptoms. We
examine marital satisfaction as it relates to a dimensional
measure of ADHD symptoms reported by mothers and
fathers of children with varying levels of ADHD symptoms
and oppositional behavior. We predicted that higher levels of
ADHD symptoms in either parent would be related to less
marital satisfaction as reported by both parents, even account-
ing for child ADHD. We also predicted that this relationship
would survive control for child oppositional behavior.
Moving beyond marital satisfaction, we know less about
the aspects of marital functioning that are linked to ADHD
symptoms. Studies of marital functioning consistently dem-
onstrate that attributions of blame or intent for negative
spouse behavior predict lower and less stable levels of satis-
faction in the marriage (Bradbury, Fincham, & Beach, 2000).
Although various types of psychopathology within each
spouse are associated with both attributions and marital sat-
isfaction (Fincham & Bradbury, 2004), possible relations
between ADHD symptoms and marital satisfaction and attri-
butions have not been examined. ADHD symptoms can be
hypothesized to influence marital attributions in at least two
ways. First, ADHD symptoms may lead partners to give less
attention to situational influences on behavior, to expend
less effort when considering alternate causes of negative
events, and/or to have more impulsive reactions to the part-
ner’s negative behavior (Knouse et al., 2008), such that there
is a positive relationship between the perceiver’s ADHD
symptoms and negative attributions for the spouse.
Alternately, it is also possible that ADHD symptoms in a
spouse result in more negative attributions for his or her
behavior by the partner (Canu, Newman, Morrow, & Pope,
2008). For example, partners with ADHD symptoms may
act in ways that have negative consequences for their spouse,
and such behaviors may be interpreted as intentional. Thus,
we predicted that ADHD symptoms in mothers and fathers
would be related to more negative attributions, both for their
partners and as made by their partners about them.
As noted above, marital functioning and attributions are
related to child ADHD and oppositional behavior, and to
other adult psychopathologies. In addition, adults with high
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levels of ADHD symptoms have higher rates of comorbid
internalizing (e.g., anxiety, depression) and externalizing
(e.g., substance use, antisocial behavior) problems (Miller,
Nigg, & Faraone, 2007). Therefore, we tested whether the
associations between parents’ ADHD symptoms and mari-
tal functioning and marital attributions were specific to
ADHD symptoms or might be better accounted for by
comorbid symptoms of depression or hostility.
In families, couples function not only as marital partners
but also as parents of offspring and must coordinate their
parenting efforts. This ability to coparent is related to marital
functioning and child behavior problems (Teubert &
Pinquart, 2010). Parenting alliance, one aspect of coparent-
ing, reflects each parent’s views of the cooperation and feel-
ings of mutual respect in the parenting team (Konold &
Abidin, 2001). To extend our understanding of how adult
ADHD symptoms may be related to functioning within cou-
ples, we included assessment of the coparenting alliance.
Although couples’ childrearing disagreements have been
linked to child problems in families of children with ADHD
(Johnston & Behrenz, 1993), the relation of coparenting to
adult ADHD, to our knowledge, has not been examined.
Given that adult ADHD is associated with reduced marital
satisfaction and interpersonal communication deficits
(Barkley, Fischer, Smallish, & Fletcher, 2006), we expected
that adult ADHD symptoms would be negatively associated
with coparenting alliance. As with the marital measures, we
hypothesized that parenting alliance would be related to both
self and partner ADHD symptoms, and that these relations
would survive control for comorbid conditions.
In summary, we examined marital satisfaction, marital
attributions, and parenting alliance as reported by both
mothers and fathers of children with and without ADHD,
and predicted associations between these variables and the
level of ADHD symptoms in each parent and their partner.
We also examined whether these associations were unique
to ADHD symptoms or were accounted for by comorbid
family problems.
Method
Participants
Mothers and fathers of 64 boys aged 8 to 12 years with
(41%) and without (59%) ADHD participated in this study.
Participants were recruited from both community and clini-
cal sources. All mothers, and 81% of fathers, were the bio-
logical parents of their child. Demographic information can
be found in Table 1. Child ADHD symptoms were assessed
with mother and other informant reports on the ADHD
Rating Scale–IV (ADHD-IV; DuPaul, Power, Anastopoulos,
& Reid, 1998). Other informants were the children’s teach-
ers (78%), coaches, day care workers, or relatives. The
ADHD-IV is an 18-item scale that reflects Diagnostic and
Williamson and Johnston 3
Table 1. Family, Child, and Parent Characteristics
Child has ADHD (n = 26)
Variable % %
Maternal ethnicity
  Euro North American 65
 Asian 19
 Other 12
 Missing 4 3
  M (SD)
Family SES 2.01 (0.77)
Number of years married 11.16 (9.59)
Child age in months 117.23 (14.38)
Comorbidities
  Child ODD 1.37 (.57)
  Mother
a
Depressive symptoms 0.60 (0.63)
Hostility symptomsa 0.92 (0.48)
Note: SES = socioeconomic status; ODD = oppositional defiant disorder.
a
Brief Symptom Inventory: High scores indicate greater symptom endorsement.
Statistical Manual of Mental Disorders (4th ed.; DSM-IV;
American Psychiatric Association, 1994) criteria for inatten-
tive and hyperactive-impulsive symptoms on a 4-point rat-
ing scale from 0 (never or rarely) to 3 (very often). The
ADHD-IV has demonstrated good psychometric properties
including a replicable factor structure, interrater reliability,
and convergent validity (DuPaul et al., 1998). In this study,
the internal consistency on the Inattention and Hyperactive-
Impulsive subscales were, respectively, .80 and .87 for
mothers, and .91 and .91 for other informants.
Children were considered to have ADHD if they had
been diagnosed by a health professional, symptoms were
present prior to age 7, and either the mother or the infor-
mant rated the child as 2 or 3 for at least six inattentive or
hyperactive/impulsive symptoms. In addition, either the
mother or teacher must have rated the child as impaired by
his symptoms. Of the 26 boys with ADHD, 16 (62%) were
taking medication at the time of the study. Parents were
asked to complete all measures of child behavior, thinking
of the child as off medication.
The Total Problems Score of the Strengths and Difficulties
Questionnaire (SDQ; Goodman, 2001) was used to ensure
that the control children did not have high levels of behavior
problems. The SDQ has good psychometric properties
(Goodman, 2001), and in this study, α = .89 for mothers and
α = .85 for fathers. All children in the control group scored
below the 90th percentile on the Total Problems Score
(youthinmind, 2004). Children with pervasive developmen-
tal disorders were excluded from both groups.
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Control child (n = 38)
55
37
5
M (SD)
1.82 (0.72)
13.21 (5.71)
114.74 (11.98)
0.69 (0.40)
Father Mother Father
0.50 (0.68) 0.34 (0.42) 0.47 (0.50)
0.81 (0.60) 0.58 (0.42) 0.53 (0.45)
Parent Measures
Parent ADHD symptoms. Mothers and fathers each com-
pleted the Current Symptoms Scale (CSS; Barkley & Mur-
phy, 2006), an 18-item measure assessing adult ADHD
symptoms on a scale ranging from 0 (never or rarely) to 3
(very often). The CSS has shown good reliability (Gomez,
2011; Ladner, Schulenberg, Smith, & Dunaway, 2011), con-
struct validity (Gomez, 2011; Murphy & Barkley, 1996),
and convergent validity (Ladner et al., 2011). Parent ADHD
symptoms were calculated as the average level of endorse-
ment across all items. Internal consistencies were .93 and
.89 for mothers and fathers, respectively.
Relationship quality. The short form of the Dyadic Adjust-
ment Scale (DAS-7; Hunsley, Best, Lefebvre, & Vito, 2001;
Spanier, 1976) was administered to each parent to measure
marital satisfaction. The DAS-7 has seven items, and the
total score averaged across items rated from 0 to 5 or 6 was
used. The DAS-7 total score has shown good criterion
validity, convergent validity, and consistently high internal
consistency (Hunsley et al., 2001). In this study, mothers’
ratings of marital adjustment were internally consistent, α =
.83, as were fathers’ α = .81.
Spousal attributions. The Relationship Attribution Mea-
sure (RAM; Fincham & Bradbury, 1992) was administered
to mothers and fathers to assess attributions spouses make
for their partner’s behavior. The RAM has six scenarios, four
of which are negative and two of which are positive. For
each scenario, participants use a 6-point scale (1 = strongly
4 Journal of Attention Disorders XX(X)
agree to 6 = strongly disagree) to rate the cause of the behav-
ior on six items that correspond to the attributional dimen-
sions of locus, stability, globality, intentionality, selfish
motivation, and whether the behavior is blameworthy. Only
the four negative questions are utilized in scoring. The RAM
has shown adequate test–retest reliability, as well as good
internal consistency (Tonizzo, Howells, Day, Reidpath, &
Froyland, 2000) and convergent and criterion validity
(Fincham & Bradbury, 1992). In this study, RAM scores
were averaged within and across scenarios. Internal consis-
tency was α = .94 for mothers and α = .91 for fathers.
Although higher ratings indicate less negative attributions,
for ease of interpretation, inversed scores were used such that
higher RAM scores indicate more negative attributions.
Parenting alliance. Each parent completed the Parenting
Alliance Measure (PAM; Abidin & Konold, 1999) reporting
their cohesiveness as a parenting team. The PAM has
20-items rated on a 5-point scale from strongly agree to
strongly disagree. The PAM has high internal consistency,
test–retest reliability, concurrent validity, criterion validity
(Abidin & Konold, 1999), and construct validity (Abidin &
Konold, 1999; Hughes, Gordon, & Gaertner, 2004). In addi-
tion, the factor structure of the PAM indicates that it is a
valid measure for use with both mothers and fathers (Konold
& Abidin, 2001). In this study, the internal consistency was
α = .95 for maternal and α = .94 for paternal parenting alli-
ance. PAM scores were calculated by averaging across the
items on the scale, and higher scores indicate greater
alliance.
Parental comorbidity. Both parents completed the Hostil-
ity and Depression subscales of the Brief Symptom Inven-
tory (BSI; Derogatis, 1993). The BSI is a self-report
measure of psychological symptoms rated on a 5-point
scale (0 = not at all to 4 = extremely). The Depression sub-
scale consists of six items, and the Hostility subscale has
five items. The BSI has demonstrated good psychometric
properties (Boulet & Boss, 1991; Derogatis & Melisaratos,
1983), including validity when used in families of children
with ADHD (Seipp & Johnston, 2005). Scores were calcu-
lated by averaging items on each subscale. Internal consis-
tencies for mothers’ ratings were α = .71 for hostility and
α = .87 for depression. For fathers, α = .76 for hostility and
α = .87 for depression.
Child comorbidity. Child oppositional behavior was
assessed on the Oppositional Defiant Disorder Rating Scale
(ODDRS; Hommersen, Murray, Ohan, & Johnston, 2006).
The ODDRS is an eight-item scale keyed to DSM-IV criteria
with items ranged from 0 (not at all) to 3 (very much). The
ODDRS has demonstrated high internal consistency and
interrater reliability as well as good test–retest reliability and
convergent validity (Hommersen et al., 2006). The internal
consistencies for mother and father ratings on the scale were
both .91. Scores for each child were calculated as averages
across items, and across mother and father ratings.
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Procedure
This study was conducted in a research lab at the University
of British Columbia and was approved by our university’s
ethics board. After families indicated interest in participat-
ing, the study was described and informed consents were
obtained. Mothers and fathers completed questionnaires
separately, with mothers completing the measures during a
lab visit with their son, and fathers completing the mea-
sures at home and returning them by mail.1 Parents received
an honorarium, and each child received a t-shirt.
Results
A total of 65 two-parent families completed all questionnaires
required to be included for analysis. During preliminary data
analysis, an outlier was discovered. This mother responded
inconsistently across and within questionnaires. In addition,
she rated herself very low on acculturation to Canadian cul-
ture. This family’s data were omitted from analysis, resulting
in 64 families. As a subset of participants had missing data on
one or more variables, we used multiple imputation in all
analyses. A total of 20 imputations were conducted for each
analysis, and each data set was analyzed separately; the
results were then combined using the procedures outlined in
Barnard and Rubin (1999). This procedure allows the full use
of all available data without limiting inferences to those par-
ticipants with complete data. In addition, due to several
assumption violations, all reported statistics were boot-
strapped, and bias-corrected and accelerated (BCa) boot-
strapped confidence intervals were calculated via resampling.
Correlations Among Variables
Bivariate correlations among variables can be found in
Table 2. As expected, DAS and PAM scores correlated
positively with each other, and RAM scores generally cor-
related negatively with DAS and PAM scores. In addition,
the comorbidities correlated with DAS, PAM, and RAM
scores in the expected directions. Looking specifically at
parental ADHD symptoms, for mothers, there was one mar-
ginal association of ADHD symptoms with lower PAM
scores. For fathers, their ADHD symptoms were associated
with less marital satisfaction (a marginal association with
mother reports and a significant association with father
reports), and with lower PAM and higher RAM scores.
Families of Children With and
Without ADHD
Comparing families of children with and without ADHD
on demographic variables and child comorbidities, only
child oppositional symptoms differed significantly, with
parents of children with ADHD rating their children
Williamson and Johnston 5

Table 2. Correlations Between Predictor and Criterion and Between Covariate and Criterion Variables

Child Mother Father

  ODD DAS PAM RAM Depression Hostility DAS PAM RAM Depression Hostility
Mother
 DAS −.15 1.00 −.24+ −.12 .40* .29* −.09 −.28* −.26*
 PAM −.40* .74* 1.00 −.29* −.15 .43* .53* .02 −.24* −.32*
 RAM .07 −.51* −.45* 1.00 .31* .09 −.28* −.24* −.10 .16 .16
 ADHD .22+ −.02 −.24+ .16 .24+ .41* −.16 −.17 −.01 .18 .28*
Father
 DAS −.30* .40* .43* −.28* −.09 −.02 1.00 −.31* −.32*
 PAM −.33* .29* .53* −.24* −.19 −.08 .70* 1.00 −.40* −.37*
 RAM .14 −.09 .02 −.10 −.22 −.10 −.42* −.30* 1.00 .40* .27*
 ADHD .08 −.23+ −.20 .11 .03 .09 −.25* −.30* .34* .64* .52*
Note: ODD = oppositional defiant disorder; DAS = Dyadic Adjustment Scale; PAM = Parenting Alliance Measure; RAM = Relationship Attribution Measure.
+
.05 < p < .10. *p < .05.

Table 3. Parental ADHD Symptoms and Relationship Variables as a Function of Child ADHD

Child has ADHD (n = 26) Control child (n = 38)

  M (SD) M (SD)

Variable Mother Father Mother Father

ADHD symptoms 0.98 (0.64) 0.63 (0.52) 0.42 (0.30) 0.48 (0.36)
Marital adjustmenta 3.28 (0.78) 3.03 (1.18) 3.58 (0.84) 3.42 (0.71)
Parenting allianceb 3.88 (0.65) 4.04 (0.94) 4.37 (0.55) 4.22 (0.59)
Spousal attributionsc 3.48 (0.77) 3.79 (1.59) 3.35 (0.90) 3.37 (0.76)
a
Dyadic Adjustment Scale: Higher scores indicate greater marital adjustment.
b
Parenting Alliance Measure: Higher scores indicate greater coparenting alliance.
c
Relationship Attribution Measure: Higher scores indicate more negative relationship attributions.

higher, t(62) = 5.58, p < .001, 95% confidence interval =
[.44, .93], d = 1.38 (see Table 1).Within-between ANOVA
compared parental depressive and hostility symptoms across
families of children with and without ADHD and across
mothers and fathers within families. Hostility symptoms
were significantly higher in parents of boys with ADHD,
F(1, 62) = 12.81, p < .001, η2 = .09 (see Table 1), and this
effect remained significant even when child ODD symptoms
were covaried (p = .011). No other effects were significant.
To test whether parent and child ADHD symptoms were
associated, an ANOVA was conducted comparing parental
ADHD symptoms across families of children with and
without ADHD and within mothers and fathers (see Table 3).
Consistent with our hypotheses, parents of sons with
ADHD were significantly more likely to report ADHD
symptoms of their own. This main effect was qualified by
a significant interaction between child ADHD status and
parent sex, F(1, 62) = 11.55, p = .001, η2 = .07. Post hoc
analyses indicated that mothers of children with ADHD
self-reported significantly more ADHD symptoms than
mothers of children without ADHD. Fathers of children with
ADHD did not differ significantly from fathers of children
without ADHD in their reports of ADHD symptoms. In
addition, among parents of children with ADHD, mothers
self-reported significantly more ADHD symptoms than
fathers. However, among parents of children without ADHD,
mothers and fathers did not significantly differ in their self-
reports of ADHD symptoms (see Table 3). The interaction
between child ADHD status and parent sex remained signifi-
cant even when child ODD symptoms, parental depression,
and parental hostility were covaried (p < .001).
Finally, ANOVAs were conducted comparing the rela-
tionship variables across families of children with and with-
out ADHD and within mothers and fathers (see Table 3).
Although we expected parents of children with ADHD to
differ on all of these measures, the only significant differ-
ence was on the PAM; parents of sons with ADHD reported
lower parenting alliance than parents of control children,
F(1, 62) = 9.71, p = .003, η2 = .10. When child ODD was
covaried, this difference was no longer significant (p = .102).

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6 Journal of Attention Disorders XX(X)

Table 4. ADHD Symptoms Predicting Marital and Coparenting Variables in Mothers and Fathers

RAM PAM

  Mothers Fathers Mothers Fathers

  β t p 95% CI β t p 95% CI β t p 95% CI β t p 95% CI

Child ADHD −.01 0.07 .945 [−.24, .29] .14 −0.88 .385 [−.34, .14] −.34 −2.21 .031 [.03, .64] −.24 −1.55 .127 [−.06, .55]
Mother ADHD .14 1.14 .259 [−.08, .42] −.14 −0.96 .340 [−.36, .15] −.04 −0.21 .835 [−.42, .30] .003 0.02 .986 [−.31, .31]
Father ADHD .09 0.66 .515 [−.18, .34] .36 3.05 .003 [.10, .45] −.15 −1.17 .245 [−.40, .11] −.27 −1.81 .075 [−.56, .04]
Note: RAM = Relationship Attribution Measure; PAM = Parenting Alliance Measure; CI = confidence interval.
Child ADHD: 0 = control child, 1 = child with ADHD.

Table 5. Psychopathology Predicting Negative Relationship Attributions and Parenting Alliance in Mothers and Fathers
RAM PAM

  Mother Father Mother Father

  β t p 95% CI β t p 95% CI β t p 95% CI β t p 95% CI

Child ODD .07 0.44 .659 [−.23, .42] .13 0.75 .459 [−.18, .53] −.30 −1.94 .056 [−.59, .003] −.30 −1.61 .112 [−.63, .09]
Mother depression .32 2.51 .015 [.10, .62] −.26 −1.98 .052 [−.53, −.004] −.24 −1.50 .140 [−.62, .04] −.16 −1.27 .207 [−.46, .05]
Mother hostility −.02 −0.10 .918 [−.35, .27] −.01 −0.03 .973 [−.31, .31] .04 0.29 .772 [−.25, .34] .03 0.29 .777 [−.23, .26]
Father depression .09 0.44 .661 [−.29, .52] .37 2.32 .023 [.04, .64] −.18 −1.09 .279 [−.51, .13] −.35 −1.76 .082 [−.72, .05]
Father hostility .12 0.65 .521 [−.26, .47] −.06 −0.36 .717 [−.42, .21] −.15 −0.89 .375 [−.47, .19] −.12 −0.63 .534 [−.51, .27]
Child ADHD −.11 0.61 .545 [−.23, .48] .14 −0.92 .362 [−.44, .17] −.12 0.68 .497 [−.24, .48] −.05 0.24 .808 [−.32, .42]
Mother ADHD .08 0.56 .581 [−.23, .37] −.12 −0.75 .459 [−.46, .18] −.01 −0.04 .968 [−.44, .35] .04 0.24 .812 [−.27, .37]
Father ADHD −.02 −0.11 .909 [−.42, .39] .14 0.83 .411 [−.22, .45] .04 0.25 .805 [−.29, .31] .01 0.08 .933 [−.29, .42]

Note: RAM = Relationship Attribution Measure; PAM = Parenting Alliance Measure; CI = confidence interval; ODD = oppositional defiant disorder.

Parent and Child ADHD Symptoms
as Predictors of Marital Adjustment,
Relationship Attributions, and Coparenting
Regressions were conducted to assess the relationships
between parent ADHD symptoms and measures of marital
functioning and coparenting. Analyses were conducted
separately for mothers’ and fathers’ DAS, RAM, and PAM
scores as dependent variables. At Step 1, mother and father
ADHD symptoms and child ADHD status were entered,
and at Step 2, an interaction term between mother and
father ADHD symptoms was added. This interaction term
was not significant in any model and is not discussed fur-
ther. Models that significantly predicted marital and copar-
enting variables were reanalyzed: covarying child ODD
symptoms, parental depression, and parental hostility. For
marital adjustment, contrary to our expectations of a nega-
tive relationship between dyadic adjustment and parent
ADHD symptoms, the overall models were not significant
for mothers, R2adj = .04, F(3, 61) = 1.95, p = .132, or fathers,
R2adj = .03, F(3, 61) = 1.72, p = .173.
For the RAM, parent and child ADHD symptoms did
not significantly predict maternal negative relationship
attributions either individually or together, despite our
expectation of positive associations, R2adj = −.02, F(3, 61) =
.65, p = .585 (see Table 4). However, as expected, paternal
negative relationship attributions were significantly pre-
dicted by the full model, R2adj = .10, F(3, 61) = 3.21, p =
.029, as well as by paternal ADHD symptoms in particular
(see Table 4). When other parent and child psychological
symptoms were included in the regression, the overall
model remained significant, R2adj = .17, F(8, 55) = 2.57, p =
.019, but now both maternal and paternal depression sig-
nificantly predicted paternal relationship attributions, and
paternal ADHD symptoms were no longer significant. This
suggests that depressive symptoms account for much of the
relationship between paternal ADHD symptoms and nega-
tive relationship attributions (see Table 5).
Similar regressions were calculated with family ADHD
symptoms predicting parenting alliance. The model was
significant for maternal reports of parenting alliance, R2adj =
.13, F(3, 61) = 4.09, p = .010, with child ADHD status as
the only significant predictor (see Table 4). This model
remained significant when other parent and child psycho-
logical symptoms were included, R2adj = .21, F(8, 55) =
3.14, p = .005. However, child ADHD status was no longer

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Williamson and Johnston 7
a significant predictor, and child ODD symptoms became
marginally significant (see Table 5), suggesting that ODD
symptoms are largely responsible for the relationship
between child ADHD and parenting alliance. Contrary to
predictions, parents’ own ADHD symptoms did not signifi-
cantly predict mothers’ reports of parenting alliance in the
regression analysis. However, consistent with our predic-
tion, the results for fathers’ reports of parenting alliance
were significant, R2adj = .10, F(3, 61) = 3.36, p = .024, and
father ADHD symptoms were marginally predictive of
paternal parenting alliance (see Table 4). When other family
psychological symptoms were included into the equation,
the overall model remained significant, R2adj = .21, F(8, 55)
= 3.16, p = .005. But again, paternal ADHD symptoms were
no longer a predictor, and paternal depressive symptoms
instead became marginally significant (see Table 5), sug-
gesting that parental psychological symptoms, and paternal
depression in particular, are largely driving the relationship
between paternal ADHD and paternal parenting alliance.
Discussion
Contrary to expectations, our results indicated that adult
ADHD symptoms were rarely related to measures of family
functioning. For the relations that did exist, including
ADHD or comorbid psychological symptoms of child or
parents, reduced the associations between parental ADHD
and family functioning. The reasons why our primary
hypotheses were not fully supported are difficult to deter-
mine. Perhaps the parents with high levels of ADHD symp-
toms in our sample had developed compensatory strategies
that reduced the impact of their symptoms, or had strategi-
cally selected partners who were tolerant of ADHD symp-
toms, or the influence of child ADHD symptoms in other
family members affected the impact of each parent’s symp-
toms. Although our results regarding adult ADHD symp-
toms and family functioning are unexpected and null when
examined in the context of family members’ psychological
symptoms, the intercorrelations among measures of family
functioning and the bivariate associations between parent
ADHD symptoms and functioning were often consistent
with our expectations. In particular, intercorrelations
between mother and father reports of marital adjustment,
relationship attributions, and parenting alliance were gener-
ally significant in the expected directions.
With regard to the links between adult ADHD symptoms
and family functioning, previous research has found that
spousal and self-reports of dyadic adjustment are lower in
adults with ADHD compared with control adults (Eakin
et al., 2004), even with child ADHD status controlled
(Minde et al., 2003). In contrast to these results, we found
that maternal ADHD symptoms were not related to self- or
partner reports of dyadic adjustment. There were small cor-
relations of father ADHD symptoms with both father and
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mother DAS reports, but these relations were reduced when
placed in the context of mother and child ADHD symptoms,
suggesting that the relationship between a father’s ADHD
symptoms and marital satisfaction may be explained by
ADHD symptoms in other members of the family. The dif-
ferences between our results and previous findings may be
due to our control of other family ADHD symptoms, as well
as due to our focus on mothers and fathers separately.
Consistent with the results for marital satisfaction, mother
ADHD symptoms did not significantly predict mother-
reported relationship attributions, nor the attributions her
partner made for her. Father ADHD symptoms did predict
his own negative relationship attributions about his wife,
and this effect survived the inclusion of other family mem-
bers’ ADHD symptoms but not other comorbidities. For the
coparenting relationship, both mother and father ADHD
symptoms related to their own reports of difficulties in this
alliance, but these relationships disappeared in the context
of other family members’ ADHD symptoms, particularly
child ADHD status. These results are consistent with previ-
ous findings that child ADHD symptoms contribute to
interparental conflict (Wymbs & Pelham, 2010).
Consistent with previous research, ADHD symptoms
were associated with both depression and hostility for
mothers and fathers, and child ADHD was significantly
associated with ODD symptoms (Johnston et al., 2012;
Maughan, Rowe, Messer, Goodman, & Meltzer, 2004).
These comorbid conditions in both parents and children
were correlated with family functioning in the directions
that would be expected, and when entered into the regres-
sion equations, it was often these comorbid conditions that
accounted for the relationships that had previously been
attributed to ADHD symptoms. For example, the effect of
child ADHD status on maternal parenting alliance became
nonsignificant when child ODD symptoms were included
and depressive symptoms seemed to be driving the rela-
tionships between parent ADHD symptoms and negative
marital attributions. Together, these results suggest that
ADHD-specific behaviors may not be the most strongly
predictive of impairments in marital and parental function-
ing, but, instead, that comorbid parental and child psycho-
pathologies are most important.
Several important sex differences were observed in our
study. Among parents of children with ADHD, mothers
reported, on average, higher levels of ADHD symptoms
than fathers, although there were more significant correla-
tions between father ADHD symptoms and measures of
family functioning. Using norms for adult ADHD symp-
toms provided by Barkley (2011), no more than 16% of
parents in control families and fathers in ADHD families
scored above the 90th percentile. However, 38% of moth-
ers in the ADHD group reported symptoms above the 90th
percentile. In short, although mothers reported more
ADHD symptoms than fathers, fathers appeared to be more
8 Journal of Attention Disorders XX(X)
affected by their ADHD symptoms. Eakin and colleagues
(2004) speculated that husbands may be more upset by
their wives’ ADHD symptoms than the reverse; however,
this is contrary to our findings, which generally do not sup-
port links between adult ADHD symptoms and spousal
reports of family functioning. However, looking at other
psychological symptoms, we did find some cross-partner
effects. For example, although mothers’ depression was
related to their own but not their husbands’, perceptions of
family functioning, fathers’ depression, and hostility were
related to their own and their wives’ reports. These rela-
tions are generally consistent with previous results show-
ing that depression and anxiety are associated with both
self- and spousal reports of marital adjustment (Whisman,
Uebelacker, & Weinstock, 2004). Sex differences were
also found in the relations within measures of family func-
tioning. Wives’ negative attributions about husbands were
related to the husbands’ reports of dyadic adjustment and
parenting alliance, but husbands’ attributions about their
wives were not related to any of the wives’ reports of fam-
ily functioning. This is consistent with previous research
finding that wives’ attributions are more related to marital
satisfaction than husbands’ attributions (Bradbury, Beach,
Fincham, & Nelson, 1996; Sanford, 2005). Our results sug-
gest that, compared with men, women’s experiences of
their families are more strongly related to their partner’s
views and to psychological symptoms.
In interpreting our findings, it is important to consider
the nature of the sample. Although not referred for clinical
services, the families in our study are representative of fam-
ilies who seek treatment. All children in the ADHD group
had been diagnosed by a mental health professional, and
most had sought clinical services. For example, 63% of
children with ADHD were taking medication, and more
than half of their parents reported using specialized parent-
ing techniques such as reward system charts. However, the
sample is restricted to two-parent families where both par-
ents were willing and able to participate in research. Such
families may be better functioning than many families with
a child with ADHD, including single-parent families.
Furthermore, it is possible that families’ treatment experi-
ence may have limited our ability to find significant effects
between groups. This concern was alleviated somewhat by
the fact that rerunning the analyses controlling for child
medication status and use of behavior therapy did not alter
our pattern of results. However, further research would be
necessary to examine the possible influence of parental
treatments. Our instruction to parents to imagine their child
off of medication when completing questionnaires also
introduces the possibility of recall bias. However, more
than 80% of our families with children with ADHD consis-
tently interacted with their child when he or she was not
medicated. Neither excluding families whose children were
never off of medication nor controlling for the presence of
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these long-acting medications altered our pattern of results,
suggesting that the influence of recall bias is minimal.
Although we do not have measures of current or past
treatment for marital difficulties, scores for the families in
our sample were often below clinical cutoffs on measures of
family functioning. For example, the DAS scores were con-
sistent with those from previous studies of adults with
ADHD (Eakin et al., 2004), but predictably higher than
what has been found in samples of adults with more severe
psychological difficulties (Hunsley et al., 2001). Scores on
the RAM in our sample were similar to scores from typical
couples in previous studies (e.g., McNulty, O’Hara, &
Karney, 2008). Similarly, 20% of mothers and 44% of
fathers of children with ADHD scored below the 20th per-
centile on the measure of parenting alliance in comparison
with 5% of mothers and 18% of fathers of control children
(Abidin & Konold, 1999). Overall, although the families in
our sample likely overestimate the level of functioning in
many families of children with ADHD, perhaps due to cur-
rent and past treatment, they were still significantly more
impaired than controls in parenting alliance, and although
not significantly different, mean levels on the DAS and
RAM also suggested greater difficulty in families with
ADHD compared with controls.
Limitations
Our study is limited by several factors. First, the relatively
small sample size limits our power to detect relationships
among the variables. This is evidenced by a number of
bivariate correlations and betas that are in the expected
direction, but they fail to reach traditional levels of signifi-
cance. Our study was powered to determine medium to
large effects, and although it is true that smaller effects may
be obscured by our sample size, effects of such a size are
unlikely to be clinically significant. Nevertheless, our con-
clusions are tentative and require replication and elabora-
tion. In addition, although one outlier was removed as there
was an identifiable reason for the abnormal responses, two
other outliers were maintained in the analysis as there were
no apparent reasons for their extreme responses. However,
we note that our use of bootstrapping and multiple imputa-
tion would minimize the effect of these outliers and that
results remained the same even under the constraints of
robust regression. Nevertheless, a larger data set would
reduce the impact of such outliers and add confidence to the
obtained results.
Our study is also limited by the uncertainty associated
with the measurement of ADHD symptoms in adults.
DSM-IV criteria were written for children, and it is currently
unknown the extent to which these criteria are applicable to
adults (Barkley et al., 2008). In this study, we relied on a
dimensional approach to measuring adult ADHD; however, it
is possible that different results might be obtained with a
Williamson and Johnston 9
diagnostic approach. Similarly, it is possible that ADHD
symptoms as currently written function differently in adult
men compared with adult women. Finally, in this sample,
parents’ scores on the Inattention and Hyperactivity/
Impulsivity subscales of the CSS were highly correlated,
r(62) = .74 and r(62) = .60 for mothers and fathers, respec-
tively, and so were collapsed into a total score in our analyses
to avoid difficulties in interpretation of highly colinear pre-
dictors and to minimize the number of variables considered
in the regressions. It will be important for future research to
consider the role that the two symptom dimensions may play
in family functioning. Among the children with ADHD, 77%
were rated highly on both inattentive and hyperactive symp-
toms by either their mother or another informant; the remain-
ing children were split equally between predominantly
inattentive and predominantly hyperactive/impulsive symp-
tom endorsement. Although this distribution of child ADHD
suggests that the effect of child subtype would be minor, future
studies are needed to more fully examine this question.
It is likely that genetic effects are contributing to our
results. In particular, our finding that parents of children
with ADHD are more likely to have ADHD symptoms is
likely reflective of a genetic relationship. Specifically, our
results suggest that mothers’ ADHD symptoms might have
a stronger relationship to their child’s ADHD than fathers’
ADHD symptoms, although the presence of more nonbio-
logical fathers than mothers in this sample limits the
strength of this interpretation. In addition, the specificity of
any genetic effects is difficult to determine due to the sig-
nificant relations among comorbid conditions and family
functioning. Future research using genetically informed
designs would be useful in sorting out how genetic and
environmental factors work together within families with
members with ADHD.
Clinical Implications
It is important to consider both parent and child ADHD
symptoms in the context of other psychological difficulties.
We found that when ADHD symptoms appear to be related
to important domains of family functioning, other psycho-
logical difficulties often contribute to or were wholly
responsible for the relation with ADHD. Furthermore, any
one family member’s ADHD symptoms need to be under-
stood in the context of other family members’ ADHD and
comorbid psychological symptoms. Parents’ perceptions of
family functioning are often meaningfully affected by the
symptoms of other family members, and what appears to be
the effect of one person’s ADHD may actually reflect a
combination of their own and other family members’ ADHD
and comorbid symptoms. As a result, in a clinical setting, it
is important to not assume that the presence of ADHD
symptoms in a parent necessarily implies difficulties in
marital or family relationships, and if such difficulties are
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present, the clinician should consider treating comorbid
psychological symptoms instead of or in addition to the
ADHD symptoms. Our results suggest that comorbid
depressive and hostility symptoms are related to coparent-
ing, marital attributions, and marital satisfaction, and it
would be beneficial for future research to explore how
other kinds of psychopathology (e.g., parental anxiety)
may be related to measures of family functioning.
Conclusion
This is the first study to investigate marital attributions and
coparenting as they relate to ADHD symptoms in adults in
a larger context that included child ADHD and family
comorbidities. Results highlighted the importance of con-
sidering ADHD symptoms in the broader family milieu, as
well as the value of including both mothers and fathers
when investigating how ADHD is related to family mem-
bers’ perceptions of one another.
Acknowledgment
We thank the families who generously gave their time and our lab
colleagues who offered comments.
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 sup-
port for the research, authorship, and/or publication of this
article: This research was supported by a grant from the Social
Sciences and Humanities Research Council of Canada to the
second author.
Note
1.  The data used for this study are a subset of a larger study of
parent and child relationship attributions.
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Bios
David Williamson is a graduate student pursuing an MA in psy-
chology 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.