Public Release: 

Persistent ADHD associated with overly critical parents

High levels of criticism over time related to continuation of symptoms, study says

American Psychological Association

WASHINGTON -- For many children with attention deficit hyperactivity disorder, symptoms appear to decrease as they age, but for some they do not and one reason may be persistent parental criticism, according to research published by the American Psychological Association.

"Why ADHD symptoms decline in some children as they reach adolescence and not for others is an important phenomenon to be better understood. The finding here is that children with ADHD whose parents regularly expressed high levels of criticism over time were less likely to experience this decline in symptoms," said Erica Musser, PhD, assistant professor of psychology at Florida International University and lead author of the study. It was published in the Journal of Abnormal Psychology.

Musser and her colleagues studied a sample of 388 children with ADHD and 127 without, as well as their families, over three years. Of the children with ADHD, 69 percent were male, 79 percent were white and 75 percent came from two-parent households. The researchers measured change in ADHD symptoms over that period and measured the parents' levels of criticism and emotional involvement.

Parents were asked to talk about their relationship with their child uninterrupted for five minutes. Audio recordings of these sessions were then rated by experts for levels of criticism (harsh, negative statements about the child, rather than the child's behavior) and emotional over-involvement (overprotective feelings toward the child). Measurements were taken on two occasions one year apart.

Only sustained parental criticism (high levels at both measurements, not just one) was associated with the continuance of ADHD symptoms in the children who had been diagnosed with ADHD.

"The novel finding here is that children with ADHD whose families continued to express high levels of criticism over time failed to experience the usual decline in symptoms with age and instead maintained persistent, high levels of ADHD symptoms," said Musser.

While the findings indicate an association between sustained parental criticism and ADHD symptoms over time, this doesn't mean one thing causes the other, said Musser.

"We cannot say, from our data, that criticism is the cause of the sustained symptoms," she said. "Interventions to reduce parental criticism could lead to a reduction in ADHD symptoms, but other efforts to improve the severe symptoms of children with ADHD could also lead to a reduction in parental criticism, creating greater well-being in the family over time."


Article: "Attention-Deficit/Hyperactivity Disorder Developmental Trajectories Related to Parental Expressed Emotion," by Erica Musser, PhD, Florida International University; Sara Karalunas, PhD, Nathan Dieckmann, PhD, and Joel Nigg, PhD, Oregon Health and Science University; and Tara Peris, PhD, University of California, Los Angeles, Journal of Abnormal Psychology, published Feb. 8, 2016.

Full text of the article is available from the APA Public Affairs Office and at

Contact: Erica Musser at or (305) 348-1034.

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States. APA's membership includes more than 122,500 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives.

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