Abstract
Introduction
Attention deficit/hyperactivity disorder (ADHD) is a disorder that is characterized by inattention, hyperactivity, or impulsivity that results in difficulties performing in social, school, and work environments (American Psychiatric Association, 2013). The criteria for ADHD are split into two categories: inattention, and hyperactivity and impulsivity. For children to be diagnosed, they must show at least six symptoms from either category for the criteria Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). ADHD is among the most common mental health disorders in childhood with national prevalence estimates ranging from 8.4% of children in the United States (Danielson et al., 2018) to 10.2% (Xu et al., 2018), about a 67% increase since the late 1990s (Xu et al., 2018). Children with ADHD are more likely to have conflicts in the family with parents or siblings (Pei-Chen Chang & Shur-fen Gau, 2017), and have worse long-term academic outcomes (Arnold et al., 2020) and social functioning (Harpin et al., 2016), than children without ADHD. ADHD is also associated with worse employment outcomes, increased likelihood of substance abuse, and criminality (Erskine et al., 2016). Fortunately, there is also evidence that appropriate treatment ameliorates some of these outcomes (Langberg & Becker, 2012; Loe & Feldman, 2007; Shaw et al., 2012).
Parental Involvement in Children’s Learning
In U.S. educational law, parental involvement is defined as “the participation of parents in regular, two-way, and meaningful communication, involving student learning and other school activities” (USCS 7801 (32)). Recent meta-analyses have shown a strong, positive association between parental involvement and child’s academic outcomes in early childhood (Ma et al., 2016), urban elementary education (Jeynes, 2005), urban secondary education (Jeynes, 2007), as well as for selected subpopulations (Jeynes, 2016). In general, meta-analytic effect sizes typically have ranged from the mid 0.2s to the high 0.3s (Cohen’s d metric) depending on the specific outcome measured, the methodological quality of the study, and the population studied. Thus, there can be little doubt that parental involvement in education is associated with positive academic outcomes for the child.
Studies of parental involvement that are nationally representative are very scarce. Using the 2012 National Household Education Surveys (NHES) Program (Oswald et al., 2018), Oswald and his colleagues studied the determinants of an overall measure of parental involvement for the United States, but did not look at specific subgroups of parents. More common are nationally representative studies that use parental involvement as either a predictor or mediator on student achievement (Galindo & Sheldon, 2011; Xu et al., 2010). In discussing parents of children with special needs, they hypothesized that their involvement could be larger than other parents because of the need to coordinate complex services, while also acknowledging that the child’s special needs could make parental involvement in other activities more difficult.
Parental Involvement in the Education of Children With ADHD
Little is known about parental involvement for parents of children with ADHD. Parents of children with ADHD reported feeling less involved or welcomed in their child’s education, had lower self-efficacy, and reported having less time and energy for parental involvement in a seminal study based on a community sample in Canada (Rogers et al., 2009). A more recent study found evidence that parenting support and involvement, including educational involvement, helped ameliorate impairments in the transition to adulthood (Howard et al., 2016). A systematic review of qualitative research found that parent–teacher relationships among these groups of parents are often poor, with mothers reporting feeling criticized and silenced (Gwernan-Jones et al., 2015). Other studies have investigated the parental involvement of parents of children with special needs in general and have corroborated that parental time and energy was associated with school-based parental involvement (Fishman & Nickerson, 2015). We were unable to find any nationally representative studies of parental involvement of parents of children with ADHD.
Objectives of the Present Study
The purpose of the current study is to provide a nationally representative U.S. profile of parental involvement in education for parents of children with ADHD using the 2016 National Household Education Survey—Parent and Family Involvement (NHES-PFI). The study also determines whether univariate differences in parental involvement subsist after controlling for standard demographic covariates. Our initial hypothesis, based on the literature, was that having a child with ADHD will reduce parental involvement across all indicators due to time and energy constraints (Walker et al., 2005).
Method
Participants and Procedures
The NHES 2016 is a self-administered, cross-sectional, U.S. nationally representative mail survey administered by the U.S. Census Bureau on behalf of the National Center for Education Statistics, an agency of the Institute of Education Sciences in the U.S. Department of Education. The NHES program started in 1991 and contains three surveys: the Early Childhood Program Participation Survey (ECPP), the Parent and Family Involvement in Education (PFI) Survey, and the Adult Training and Education Survey (ATES). The PFI survey targets children (20 years or younger) enrolled in kindergarten to 12th grade at a public school, private school, or homeschool. In 2016, 13,523 parents whose children were enrolled in public or private school completed the PFI. The NHES conducted a screener (overall response rate of 66.4%) to identify suitable households and then conducted the PFI questionnaire (response rate 74.3%). Interested readers are referred to the Data File User’s Manual for additional detailed information on design, sampling, adjustments for nonresponse bias, and consent procedures. The analytic sample of the NHES-PFI 2016 public file was restricted to parents whose children were enrolled in public or private school because parents of homeschooled students were not asked some of the parental involvement questions used in the analyses. St. John Fisher College Institutional Review Board (IRB) board approved the study.
Measures
ADHD
Parents were asked the following yes/no question: “Has a health or education professional told you that this child has any of the following conditions?” with the condition being “Attention Deficit Disorder, ADD or ADHD.”
Parental involvement
One question was general (received “newsletters, memos, emails, or notices addressed to all parents”) and six questions asked about child-specific communication from teachers or administrators. Two of these questions were yes/no questions asking whether parents had received “notes or emails specifically about this child,” and “phone calls specifically about this child.” The remaining four questions asked, how many times have any of this child’s teachers or school staff contacted your household about (A) behavior problems this child is having in school, (B) problems this child is having with schoolwork, (C) very good behavior and (D) very good school work.
Parents were asked to enter the number of times these four events had happened since the beginning of the school year. These answers were severely skewed, and the variables were dichotomized (contact vs. no contact).
There were eight yes/no questions that asked whether “any adult in the household” had been involved in the school by attending class or school events (e.g., sports event, science fair, dance, play), general school meetings (e.g., open house), parent–teacher organization meetings, regularly scheduled parent–teacher conferences, serving as a volunteer in the child’s classroom or school, or participating in a school committee. Parents were also asked whether anyone in the household participated in fundraising for the school or met with “a guidance counselor in person.”
Meeting frequency was measured by a question that asked, “During this school year, how many times has any adult in the household gone to meeting or participated in activities at this child’s school?” Answers were categorized in three groups: none, one to five meetings, and six or more meetings.
There were two questions related to parental involvement regarding homework assignments: “How often does any adult in your household check to see that this child’s homework is done?” rated on a 4-point Likert-type scale (never, rarely, sometimes, and always), and “During this school year, about how many days in an average week does anyone in your household help this child with his or her homework?” rated on a 5-point frequency scale (less than once a week, 1–2 days, 3–4 days, 5 or more days, and never). The variables were dichotomized due to low frequencies in some of the categories. Checking homework was dichotomized as checks always or sometimes, versus rarely and never. Helping with homework was dichotomized as 3 or more days, versus 1 to 2 days or fewer, including never. Family activities were measured by two clusters of questions. The first cluster of seven yes/no questions asked whether “in the past week,” anyone in the family had told the child stories; done “activities like arts and crafts, coloring, painting, pasting, or using clay” with the child; played board games or did puzzles together; worked on a building; making or fixing something type of project; played sports together; discussed with the child “how to manage time”; or talked to the child about his or her ethnic heritage or family history. The second cluster of seven yes/no questions asked parents to identify if “in the past month” a family member had taken the child to the library, bookstore, play, concerts, or live shows, art galleries, museum or historical sites, zoo or aquariums, sports event that were not school related and where the child was not a player, or an event sponsored by a “community, religious, or ethnic group.”
Covariates
Covariates were chosen to control for the child’s demographics and family background and they included the child’s age, gender, race/ethnicity (White, Black, Asian, Hispanic), household income, divided into three similarly sized groups: Low (<US$50,000), Medium (US$50,000–US$100,000), and High (>US$100,000); variable was top coded at US$150,000, parental education (at least one parent college educated vs. not), two-parent household, English spoken at home as primary language, and census region (Northeast, South, Midwest, West). The NHES also collects information on public assistance program participation including Temporary Assistance to Needy Families (TANF), State welfare program, Food Stamps, Medicaid, Section 8 Housing, Special Supplemental Nutrition Program for Women, Infants and Children (WIC), and Children’s Health Insurance Program (CHIP).
Analysis
All statistical analyses were appropriately weighted to account for the complex survey design using R and Stata 14 (Stata Corp, College Station, Texas) appropriate commands. Cross tabulations used design-corrected F tests. Cohen’s h was estimated as the appropriate effect size metric for difference of proportions. Logistic regression was used to estimate the multivariate models, with the exception of meeting frequency that because of its three categories required a multinomial logit model. P values were set at the .05 level.
Results
Prevalence and Division Into Groups
Table 1 displays the demographic characteristics of the sample. Children with ADHD were disproportionately males (ADHD 69% vs. no ADHD 50%, p < .001, Cohen’s h = 0.41), of White (76% vs. 69%, h = 0.14) or Black Ethnicity (22% vs. 16%, h = 0.14). Children with ADHD were underrepresented in the Asian (2% vs. 9%, h = −0.30) and Hispanic (15% vs. 25%, h = −0.25) communities. Regarding household characteristics, children with ADHD lived in households that were more likely to speak English in the home (h = 0.33), with college-educated parents (h = −0.21), in two-parent households (h = −0.26) that were low-income households (h ranged from −0.22 to 0.21). The households that had a child with ADHD were also more likely to receive some forms of public assistance, TANF (h = 0.22), State welfare (h = 0.32), Food stamps (h = 0.29), Medicaid (h = 0.40), and Section 8 housing (h = 0.23), but not for WIC (h = 0.08) and CHIP (h = 0.08). Children with ADHD were overrepresented in the Northeast (h = 0.06), South (h = 0.14), and Midwest states (h = 0.06) and underrepresented in Western states (h = −0.29).
Demographic Characteristics of the Sample.
Note. ns = not significant at p ≤ .05. HH = household; TANF = Temporary Assistance to Needy Families; WIC = Women, Infants and Children; CHIP = Children’s Health Insurance Program.
Univariate Comparisons of Parental Involvement
Table 2 shows differences in parental involvement and parent school communication by ADHD status of the child. Parents of children with ADHD were more likely to receive child-specific communications regarding behavior problems (h = 0.68) and school work problems (h = 0.68). We found no detectable differences in receiving child-specific information on their child’s good schoolwork (h = 0.04) or good behavior (h = 0.06) between the groups. These child-specific communications happened in phone calls (h = 0.61) and notes or emails (h = 0.31).
Univariate Comparisons of Parental Involvement.
Note. PTA = parent–teacher association. ns = not significant at p ≤ .05.
Regarding parent participation in events, parents of children with ADHD were less likely to participate in school/class events (h = −0.16), or fundraising activities (h = −0.13), and were more likely to attend parent–teacher conferences (h = 0.22) and meet with the guidance counselor (h = 0.56). They were just as likely to attend open house events (h = −0.01), parent–teacher association (PTA) meetings (h = 0.05), and school committee meetings (h = −0.04) as other parents.
At home, parents of children with ADHD were more likely to help with (h = 0.11) and check that (h = 0.11) the homework was done than other parents.
Finally, parents of children with ADHD were just as likely as other parents to engage in family activities with their children except that they were less likely to participate in sports together (h = −0.10) and more likely to discuss time management strategies with their children (h = 0.10). In terms of family outings, parents of children with ADHD were essentially just as likely as other parents to take their children to museums/galleries (h = −0.05), zoos/aquariums (h = −0.05), and community events (h = −0.08), but less likely to attend athletic events (h = −0.14), libraries (h = −0.12), bookstores (h = −0.10), and plays/concerts (h = −0.16).
Demographically Adjusted Comparisons of Parental Involvement
Table 3 shows the adjusted odds ratios (AORs) of having ADHD in multivariate logistic models that adjusted for child’s sex, race (White vs. other), Hispanic ethnicity, parental education, income group, and Medicaid status of the household. In general, the findings reported in the previous section hold with a few exceptions.
Results from Multivariate Logistic Models.
Note. ns = not significant at p < .05. AOR = odds ratio adjusted for child’s sex, race, Hispanic ethnicity, parental education, income group, and Medicaid status of household. Meeting frequency was excluded because it was not dichotomous. Multinomial logit on meeting frequency found no significant association with ADHD. CI = confidence interval.
Parents of children with ADHD were 3.8 times more likely than similar parents of children without ADHD to receive child-specific communications regarding behavior or schoolwork. As in the univariate results, there were no differences in child-specific communications regarding good school work or good behavior. They were also 3 times (AOR = 3.24) more likely to receive child-specific phone calls and twice as likely as other parents to receive child-specific notes (AOR = 2.06). These results mirror the univariate findings.
Compared with similar parents, parents of children with ADHD were 3 times (AOR = 3.13) more likely to meet with the guidance counselor and 77% more likely to attend parent–teacher conferences, whereas they were 29% less likely to attend school or class events (AOR = 0.77). The univariate findings regarding decreased participation in volunteer activities at school and fundraising were not supported in the multivariate analyses.
Regarding family activities, the multivariate analyses supported that parents of children with ADHD are 33% more likely to have conversations about time management with their children than other parents (AOR = 1.33), and about 25% less likely to attend sports where the child participates together (AOR = 0.79), attend general athletic events (AOR = 0.77), or visit the library (AOR = 0.80). The univariate findings regarding decreased participation in plays or concerts and visiting bookstores were not supported in multivariate analyses.
Regarding the covariates in the multivariate models, generally, higher income households had more parental involvement. Receiving Medicaid was not generally associated with parental involvement after adjusting for household income. Parental education was related only to some types of parental involvement. Parents tended to receive more negative communication from the school for boys than for girls.
Discussion
To our knowledge, this is the first population-based study of parental involvement for parents of children with ADHD in the United States. Our initial set of hypotheses, that parents of children with ADHD would have lower parental involvement due to time and energy constraints across a variety of indicators, proved too simplistic for reality. The data showed that parents of children with ADHD are similar and different from other parents in terms of parental involvement in education. They display increased levels of involvement in terms of negative child-specific communications both by phone and notes or emails regarding both their child’s behavior and schoolwork and increased parental involvement with guidance counselors and PTA teacher conferences. These behaviors are almost certainly examples of the increased need for coordination in the education of a child with ADHD thus supporting the coordination hypothesis (i.e., need for coordination increases parental involvement) advanced by Oswald et al. (2018). The size of the effects was large enough to be clinically meaningful, indicating that parents of children with ADHD have a different experience of parental involvement than other parents.
Typically, studies of parental involvement employ the well-established Bronfenbrenner’s model of human ecology, characterizing the interactions between family, school, and the child as part of the mesosystem (Bronfenbrenner, 1977). This framework, however, has to be supplemented by more detailed theoretical explanations of how parental involvement actually operates.
Because parental involvement in education is a multidimensional construct (Rogers et al., 2009), there has been a need for models to better understand the phenomenon. The two most common models of parental involvement in education are the Joyce Epstein’s Model of Parental Involvement (Epstein, 1986; Epstein et al., 2018) and the Hoover-Dempsey and Sandler’s Model of Parental Involvement (Green et al., 2007; Hoover-Dempsey & Sandler, 1997). Epstein’s model of Parental Involvement focused on what schools can do to foster parental involvement in education. Originally, Epstein’s Model was created with five categories and later augmented with a sixth category. The final model’s categories of parental involvement are as follows: Parenting (e.g., school helping with parenting skills), Communicating, Volunteering (e.g., assisting in school functions), Learning at Home (e.g., helping with homework), Decision-Making (e.g., serving in a school committee), and Collaborating with the Community (Epstein, 1986, 1995; Epstein et al., 2018). While this model is widely disseminated among school districts within the United States and elsewhere, it has been criticized by researchers as too simplistic (Jeynes, 2007; Mapp et al., 2008).
In contrast, Hoover-Dempsey and Sandler’s revised model explains parental involvement with several layers of complexity. The first and most relevant layer posits parental involvement as a result of three factors: parents’ motivational beliefs; their perceptions of the invitations to become involved in education by the school, teachers, or their children; and parents’ perceived life context. Life context is influenced by two types of parental resources: the level of skills and knowledge parents have (e.g., a parent with math knowledge may be more willing to help with math homework) and the time and energy the parent can make available for involvement (Green et al., 2007; Walker et al., 2005).
Consistent with Hoover-Dempsey and Sandler’s time and energy resource availability hypothesis (Walker et al., 2005), we found that parents of children with ADHD were less likely to participate in sports activities with their children, or attend school events, athletic events, or visit the library. There is research demonstrating that parents of children with ADHD are more likely to have more authoritarian parenting, more conflict with the child, use different emotion-regulation strategies with their children, and generally experience increased difficulty in maintaining a high-quality parent–child relationship compared with typically developing children and their parents (Edwards et al., 2001; Gau & Chang, 2013; Pei-Chen et al., 2017; Shenaar-Golan et al., 2017). Parents of children with ADHD are also more likely to be depressed (Chronis et al., 2003). Thus, parents of children with ADHD likely have fewer discretionary psychological and time resources (time and energy) to invest in parenting involvement.
An alternative explanation for lower parental involvement levels on some of these group activities may simply reflect that there were no suitable and effective accommodations provided so that a child with ADHD and his or her parents could participate meaningfully and with relatively low levels of stress. Synthesis from qualitative studies on parenting children with ADHD reveals parents of children with ADHD engage in “everyday battles” to assist their children to control their behavior and to advocate for needed accommodations and changes with schools (Laugesen & Groenkjaer, 2015). However, even these qualitative studies are not detailed enough to distinguish between the parental time and energy scarcity hypothesis and the lack of accommodations in activities hypothesis. Thus, further qualitative and quantitative research needs to explore which activities are influenced by lack of time or energy, and which ones are not attended because of lack of accommodations and other needed supports.
Another potential reason for the findings may stem from the heritability of ADHD and the school experiences that parents with ADHD may have had in their own schooling. Regardless of the reason, parents of children with ADHD are spending more time on Epstein’s Learning at Home category in the form of checking and helping with homework and teaching time management skills to their children.
In our study, there were also a large number of parental involvement activities in which we found no evidence of differences between parents of children with ADHD and other parents. While small, nondetected differences may well exist; it is likely that these differences in parental involvement are so small (Cohen’s h ≤ 0.08) that they likely have no clinical or educational practical implications. These behaviors included a variety of activities in the family and the community from playing board games and building projects, to attending plays and concerts and going to museums.
In conclusion, parents of children with ADHD have similarities and differences from other parents in terms of parental involvement in their children’s education. Like other researchers, we found that Epstein’s model is perhaps too school focused and simplistic to account for our results (Jeynes, 2007; Mapp et al., 2008). Clinicians need to keep in mind that parental involvement may be influenced by the presence of ADHD and explore the degree and type of parental involvement that a particular child may have, as well as explore the reasons for increased or decreased participation in various activities. This better understanding of the context for parental involvement may lead to a more accurate understanding of the parent–child relationship, and also how ADHD is impacting parental involvement in education.
Limitations of the Study
There were some potential limitations. We were limited by the wording of questions, particularly by the yes/no answers, in the NHES. Also, the survey only asked about the parent’s view of their educational involvement, which may be different from teachers’ view or children’s view of parental involvement. Neither Joyce’s nor Hoover-Dempsey and Sandler’s models were completely covered by the available questions. Similarly, the question about time management suggests that there may be a hidden set of other socioemotional or organizational skills that parents teach specifically children with ADHD which were not asked about in this survey. In addition, the study does not ask about shared reading activities and other parental involvement activities with their children which have been shown to be positively associated with achievement in meta-analyses. Another limitation are concerns regarding the accuracy of parent-reported diagnosis of ADHD that had no clinical confirmation, yet nationally representative survey studies using databases similar to the NHES are published frequently in medical journals to monitor diagnosis and treatment patterns of children with ADHD (Danielson et al., 2018), and thus parent-reported ADHD has generally been found to be a reliable source of information. However, parent-reported ADHD diagnosis may include false positives, particularly for mild, never treated cases (Song et al., 2019).
Recommendations for Future Research
In terms of future research, there is a need to keep utilizing the expensive data collection processes of national surveys such as the NHES to study parental involvement in education via secondary analyses for a variety of subpopulations and conditions. In this regard, a more systematic definition of parental involvement in education and a corresponding broader set of questions regarding parental involvement would be of great assistance for future research. In addition to these secondary studies, the field also needs more in-depth qualitative and quantitative primary studies to better understand the types, effects, barriers, and motivations for parental involvement in education for parents of children with ADHD.
In sum, this first population-based study of parental involvement in the education of children with ADHD found a complex pattern of parental involvement in education that suggests that we need to be willing to abandon relatively simple models of parent involvement in favor of approaches that recognize the complexity of these choices.
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.
