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Journal of Abnormal Child Psychology, Vol. 29, No. 6, December 2001, pp. 557–572 (°
C 2001)

Parent–Adolescent Conflict in Teenagers

With ADHD and ODD1

Gwenyth Edwards,2,3 Russell A. Barkley,2,6 Margaret Laneri,2,4 Kenneth Fletcher,2

and Lori Metevia2,5

Received November 20, 2000; revision received March 14, 2001; accepted May 7, 2001

Eighty-seven male teens (ages 12–18 years) with ADHD/ODD and their parents were compared to
32 male teens and their parents in a community control (CC) group on mother, father, and teen ratings
of parent–teen conflict and communication quality, parental self-reports of psychological adjustment,
and direct observations of parent–teen problem-solving interactions during a neutral and conflict
discussion. Parents and teens in the ADHD/ODD group rated themselves as having significantly more
issues involving parent–teen conflict, more anger during these conflict discussions, and more negative
communication generally, and used more aggressive conflict tactics with each other than did parents
and teens in the CC group. During a neutral discussion, only the ADHD/ODD teens demonstrated
more negative behavior. During the conflict discussion, however, the mothers, fathers, and teens in the
ADHD/ODD group displayed more negative behavior, and the mothers and teens showed less positive
behavior than did participants in the CC group. Differences in conflicts related to sex of parent were
evident on only a few measures. Both mother and father self-rated hostility contributed to the level of
mother–teen conflict whereas father self-rated hostility and anxiety contributed to father–teen conflict
beyond the contribution made by level of teen ODD and ADHD symptoms. Results replicated past
studies of mother–child interactions in ADHD/ODD children, extended these results to teens with
these disorders, showed that greater conflict also occurs in father–teen interactions, and found that
degree of parental hostility, but not ADHD symptoms, further contributed to levels of parent–teen
conflict beyond the contribution made by severity of teen ADHD and ODD symptoms.

KEY WORDS: ADHD – attention deficit hyperactivity disorder; ODD – oppositional defiant disorder; family
conflict; adolescents.

Children with attention deficit hyperactivity disorder
(ADHD) manifest developmentally inappropriate degrees
of inattention and/or hyperactive–impulsive behavior that
arise in childhood, are relatively persistent, and result in
1 This project was supported by grant MH41583 from the National Insti-
tute of Mental Health to the second author. The contents of this paper,
however, are solely the responsibility of the authors and do not neces-
sarily represent the official views of this institute.
2 Department of Psychiatry, University of Massachusetts Medical School,
Worcester, Massachusetts.
3 Now in private practice in Sudbury, Massachusetts.
4 Present address: Youth Opportunities Unlimited, Worcester,
Massachusetts.
5 Now a homemaker in Westborough, Massachusetts.
6 Address all correspondence to Russell A. Barkley, Department of Psy-
chiatry, University of Massachusetts Medical School, 55 Lake Avenue
North, Worcester, Massachusetts 01655; e-mail: barkleyr@ummhc.org.
cross-situational impairment (American Psychiatric As-
sociation [APA], 1994). Such behavior frequently brings
the child with ADHD into conflict with others, whether
parents (Campbell, 1975; Cunningham & Barkley, 1979),
teachers (Whalen, Henker, & Dotemoto, 1980), or peers
(Campbell & Paulauskas, 1979; Cunningham & Siegel,
1987). And that conflict often results in greater hostil-
ity, censure, rejection, and punishment directed at ADHD
children, as well as withdrawal from them, than is true
of behavior directed at normal children (Cunningham,
Benness, & Siegel, 1988; Danforth, Barkley, & Stokes,
1991; Pelham & Milich, 1984).
Extensive research on the parent–child interactions
of children with hyperactivity, or ADHD, in particular
(see Danforth et al., 1991, for a review) finds that hyper-
active children are more negative, less compliant, less able

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C 2001 Plenum Publishing Corporation
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558
to sustain their compliance, and make more requests for
assistance from their mothers than do control children.
Mothers of the hyperactive children are less rewarding,
more directive, provide more physical assistance, and ex-
press more disapproval than do mothers of the control
children. Although the direction of influence in such re-
ciprocal interactions can be difficult to discern, studies
employing stimulant medication with hyperactive chil-
dren routinely find that reducing the child’s ADHD symp-
toms and improving their compliance via medication of-
ten results in significant declines in maternal control and
negativity (Barkley, Karlsson, Pollard, & Murphy, 1985;
Humphries, Kinsbourne, & Swanson, 1978). Such results
imply that the larger influence in determining the nega-
tivity of these interactions is from child to parent rather
than vice versa, although parental behavior is not en-
tirely without influence (Pollard, Ward, & Barkley, 1984).
Subsequent research on the mother–child interactions of
hyperactive or ADHD children suggests that greater de-
grees of mother–child conflict may occur in that subset
of ADHD children manifesting more symptoms of oppo-
sitional defiant disorder (ODD; Gomez & Sanson, 1994;
Johnston, 1996). Indeed, level of ODD may contribute
more to maternal reports of mother–child conflict and
parenting stress than does ADHD alone (Anastopoulos,
Guevremont, Shelton, & DuPaul, 1992; Fischer, 1990;
Stormshak, Bierman, McMahon, & Lengua, 2000).
The vast majority of research on ADHD generally,
and parent–child relations specifically, has focused on
children, primarily boys, between 5 and 12 years of age.
Little research exists on teens with ADHD, most of which
comes from follow-up studies of hyperactive children
into adolescence (e.g., Barkley, Fischer, Edelbrock, &
Smallish, 1990; Gittelman, Mannuzza, Shenker, &
Bonagura, 1985; Weiss & Hechtman, 1993). Far less re-
search exists on clinic-referred adolescents with the dis-
order. This is particularly so for research on parent–teen
relations. Yet the extent of parent–teen conflict has been
shown to be a significant determinant of concurrent and
later adolescent psychological adjustment (Shek, 1998).
Only two studies have examined the nature of mother–teen
interaction patterns in the families of adolescents having
ADHD; these studies suggest that conflict is substantially
greater than in control groups and is particularly evident in
the subset having comorbid ODD (Barkley, Anastopoulos,
Guevremont, & Flecther, 1992; Barkley, Fischer, et al.,
1991; Fletcher, Fischer, Barkley, & Smallish, 1996). In
view of the dearth of information on clinic-referred teens
having ADHD, and particularly on their parent–teen inter-
actions, the present study sought to investigate further the
nature of these interactions in ADHD teens having comor-
bid ODD. Specifically, this study attempted to determine
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Edwards, Barkley, Laneri, Fletcher, and Metevia
whether previous findings on mother–child and mother–
teen interactions in comorbid ADHD/ODD samples could
be extended to father–teen interactions. Only three pre-
vious studies have examined father–child interactions in
ADHD children (Burhmester, Camparo, Christensen,
Gonzalez, & Hinshaw, 1992; Johnston, 1996; Tallmadge
& Barkley, 1983), and none have studied father–teen in-
teractions. The previous studies using children found few
differences in the father–child interactions of children with
ADHD relative to normal children but did find greater
conflict in the mother–child than in the father–child in-
teractions (Buhrmester et al., 1992; Tallmadge & Barkley,
1983). Once again, the presence of ODD appeared to mag-
nify the reports of family conflict in the ADHD compared
to the control families (Johnston, 1996).
Mothers of ADHD children and adolescents have
been shown to manifest significantly greater parenting
stress, marital dissatisfaction, and psychological malad-
justment (particularly anxiety, depression, and hostility)
than mothers of control children (Befera & Barkley, 1983;
Breen & Barkley, 1988; Cunningham, Benness, & Siegel,
1988; Mash & Johnston, 1983). This seems to be partic-
ularly so for mothers of ADHD children and teens hav-
ing comorbid ODD (Anastopoulos et al., 1992; Barkley,
Anastopoulos, et al., 1992; Barkley, Fischer, et al., 1991).
Research suggests that it is the mother’s level of hostil-
ity, rather than depression, anxiety, or marital discord,
that makes a significant contribution to the degree of con-
flict experienced in these mother–teen interactions beyond
that contribution made by teen ADHD/ODD symptoms
(Barkley, Anastopoulos, et al., 1992). This makes sense
from the standpoint of the family coercion theory of child-
hood social aggression (Patterson, 1982; Patterson, Reid,
& Dishion, 1992) in which coercive (hostile) interaction
patterns typify other members of the aggressive child’s
family rather than just that child alone. Once again, how-
ever, no research has examined whether fathers of teens
having ADHD also manifest greater marital dissatisfaction
or anxiety, depression, and hostility than fathers of control
teens. Nor has any research examined the degree to which
such psychological difficulties contribute to the level of
father–teen or mother–teen conflict in these families be-
yond that resulting from teen disruptive behavior alone.
One previous study of fathers of ADHD children, however
did find them to have more depression, but not hostility,
than control fathers, and even this difference was only in
those ADHD children having ODD (Johnston, 1996). No
prior studies have examined the contribution of parental
ADHD symptoms, however, to the extent of parent–teen
conflict. This study, therefore, examined the psychologi-
cal adjustment (depression, anxiety, hostility, and ADHD)
of both fathers and mothers of ADHD/ODD teens and its
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Family Conflict and ADHD/ODD
contribution to parent–teen conflict. It specifically tested
the following hypotheses:
• There will be greater interaction conflicts between
teens with ADHD/ODD and their mothers than in
control families;
• There will also be greater conflicts in the interac-
tions of ADHD/ODD teens with their fathers in
comparison to control families;
• There will be greater conflict in mother–teen than
in the father–teen interactions in families having
ADHD/ODD teens;
• Parents and teens in families with ADHD/ODD
teens will employ more aggressive conflict tactics
than will control families;
• Both mothers and fathers of ADHD/ODD teens
will show higher levels of hostility, anxiety, de-
pression, and ADHD than will parents of control
teens; and
• Parental hostility will contribute to the degree of
parent–teen conflict beyond that contribution made
by the level of teen disruptive behavioral problems
(ADHD and ODD symptoms).
METHOD
Participants
This study involved a total of 87 male teens with
ADHD/ODD and 32 community control male teens re-
cruited over a 3-year period. The teens with ADHD/ODD
and their parents were subsequently assigned to one of two
behavioral family therapies for the treatment of parent–
teen conflict. The results of that treatment study are re-
ported in a separate paper (Barkley, Edwards, Laneri,
Fletcher, & Metevia, in press-b). All teens enrolled in this
study had to be between the ages of 12 and 18 years of
age, be the biological child of at least one of the parents
living in the home or have been adopted at birth, and have
an IQ greater than 80 on the Kaufman Brief Intelligence
Test (Kaufman & Kaufman, 1990). Teens were excluded
if they had the following conditions: deafness, blindness,
severe language delay, cerebral palsy, epilepsy, autism, or
psychosis, as established through parental and adolescent
interview and history. The teens and parents signed state-
ments of informed consent. The project and consent forms
received approval from the institutional review board for
research on human subjects.
To be considered eligible for the ADHD/ODD group,
the adolescent had to meet the following seven criteria:
(1) parent and/or teacher complaints of inattention, poor
impulse control, and overactivity as established through
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559
the screening telephone interview; (2) have at least 12
of the 18 symptoms of ADHD from the DSM-IV criteria
as established through the ADHD screening scale (symp-
toms rated “Often” or higher) or a T score of 65 or higher
on the Inattention scale of the Child Behavior Checklist
(Achenbach, 1991); (3) have at least four of the eight
symptoms of ODD in the DSM-IV as established through
ODD screening scale or have a T score greater than 65
on the aggression scale of the Child Behavior Checklist
(CBCL; Achenbach, 1991); (4) meet DSM-IV criteria for
both ADHD and ODD or conduct disorder (CD) during
the structured clinical interview; (5) either not currently
receiving psychoactive medication or, if receiving medica-
tion, able to remain at a stable dose through the 18 sessions
of behavioral family therapy; (6) not seek any other form of
psychiatric or psychological treatment during their partic-
ipation in this project, and (7) not have any immediately
ongoing legal proceedings against them for criminal or
status offenses by the local juvenile court authorities that
would result in their removal from their family during the
active treatment phase of the study. All the ADHD/ODD
teens selected were of the Combined Type. More than half
of these teens were already receiving treatment, particu-
larly medication, from various mental health specialists
for their psychiatric disorders (see Results later).
Families with teens having ADHD/ODD were re-
cruited from one of two sources: A clinic specializing in
ADHD at a New England medical school and advertise-
ments run periodically in the local city newspaper. This
report focuses on the families of the 87 males having
ADHD/ODD who completed the entire screening, eligi-
bility, and evaluation procedures. The community con-
trol (CC) teens were recruited through advertising in the
same community newspaper as above. These teens were
screened using the parent report form of the Child Behav-
ior Checklist (completed by mothers). They had to have
T scores on all scales below 65 to serve in this control
group. Teens also had to have fewer than three symptoms
(answers of “Often” or greater) of inattention and three
symptoms of hyperactive–impulsive behavior from the
DSM-IV symptom list as assessed by the ADHD screening
scale (see Selection Measures later). This report focuses
on the 32 males who completed the entire screening, eligi-
bility, and evaluation procedures. More detailed informa-
tion on the flow of participants in both groups throughout
the recruitment, screening, and evaluation process appears
in the reports by Barkley, Edwards, Laneri, Fletcher, &
Metevia (in press-a) and Barkley et al. (in press-b).
To summarize, there were 32 male teens in the CC
group and 87 male teens in the ADHD/ODD group. Con-
cerning minority composition, 86% of all of the teens
were Caucasian, 9% were Hispanic, 2% were African
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560
American, and 3% were Asian. The groups did not differ
significantly in their ethnic composition. This composi-
tion reflects that generally found in referrals to the clinic
from which these families were drawn as well as the city in
which this medical school is located. As for parental par-
ticipation, all 32 mothers of CC teens and 83 of 87 mothers
(95%) in the ADHD/ODD group participated in this study.
There were 22 fathers in the CC group (69%) who par-
ticipated and 70 fathers in the ADHD/ODD group (80%).
The groups did not differ significantly in the proportion
of fathers participating in the study. Information on the
neuropsychological status of the two groups is provided
in the paper by Barkley et al. (in press-a).
Procedures
After passing the telephone and rating scale screen-
ings, all ADHD/ODD teens received an initial evaluation
by a PhD level child clinical psychologist before entering
the study. This evaluation served to establish the diagnos-
tic status of these participants and that all other eligibility
criteria had been met. A second, more senior child clini-
cal psychologist reviewed all chart material from the initial
evaluation to ensure that teens met diagnostic criteria for
ADHD and ODD or CD, as earlier, before entering the next
phase of the study when the dependent measures were col-
lected. Where this second clinician disagreed with the first
on diagnostic status, they met to determine if a consensus
could be reached. Where a disagreement continued to ex-
ist, the family was removed from consideration for this
project. Such disagreement occurred for 9.6% of the teens
undergoing this initial evaluation. Thus, all ADHD/ODD
teens participating in this project met diagnostic criteria,
reflected in 100% agreement between the two clinicians
in this stepwise diagnostic/review process.
Teens and parents who met eligibility requirements
for the study during this initial evaluation were then sched-
uled within 1–2 weeks for their direct observation of fam-
ily interactions using the dependent measures (see later).
They were provided with the rating scales of family con-
flict to complete at home prior to this next observation
session. In this second session, the rating scales of family
conflict and parental psychological adjustment (see later)
were collected at which time the observation of parent–
teen interactions occurred. In four cases in the CC group
(18%), fathers completed and returned their rating scales
of parent–teen conflict and parental adjustment but chose
not to attend this direct observation session. This occurred
in five cases for mothers of the CC group (18%). In the
ADHD/ODD, this occurred for 14 fathers (20%) and just
one of the mothers (1%). During this observation session,
parents and teens participated in the neutral discussion
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Edwards, Barkley, Laneri, Fletcher, and Metevia
period, followed by the conflict discussion period, and
concluding with the positive discussion period. This same
order of the assessment methods was followed for all par-
ticipants. Participants were paid $50 for participating in
this assessment.
Selection Measures
Parental Interview
A structured psychiatric interview created for this
project was used with the parents to assess the presence of
DSM-IV diagnostic criteria for ADHD, ODD, and conduct
disorder in the teens. One part of the interview consisted
of questions pertaining to the current status of the family,
demographic data, and the academic, social, medical, and
mental health histories of the teenagers. A second section
collected information on the DSM-IV criteria for ADHD,
ODD, and CD (APA, 1994). Parents were instructed that,
if their teen was receiving psychiatric medication, their
responses should be based on the teen’s behavior while off-
medication. No information is available on the interjudge
agreement for this particular structured interview for the
disruptive behavior disorders. However, as noted earlier,
to be in this study, two clinicians had to agree on the
diagnosis of ADHD and ODD or CD.
Child Behavior Checklist – Parent Form (CBCL;
Achenbach, 1991)
The 1991 version of this scale provided T scores for
specific narrow band scales. The inattention and aggres-
sion scales were employed in determining eligibility crite-
ria for the project, as noted earlier. If the teen was receiv-
ing medication, the answers were to be based upon how
the teen functioned while off-medication. The scale has
been used extensively in research on various childhood
psychopathologies.
Ratings of ADHD/ODD Symptoms
Parents completed two rating scales, one containing
the items from the DSM-IV for ADHD and the other the
symptoms for ODD. Each item on each scale was rated
on a 4-point scale (0–3), using the response format of Not
at all, Sometimes, Often, and Very often. The scales were
used at the initial screening to insure that teens met eligi-
bility criteria for the number of ADHD and ODD symp-
toms, as described earlier. Once more, if the teen was
receiving medication, the answers were to be based upon
how the teen functioned while off-medication. Evidence
of reliability comes from prior research showing internal
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Family Conflict and ADHD/ODD
consistency (coefficient α) for the ADHD items as .92 and
1-month test-retest reliability as being .85. Validity has
been established through correlations of the ADHD items
with other scales assessing hyperactive–impulsive behav-
ior ranging from .61 to .80 for parent ratings. Significant
differences have also been found between ADHD and con-
trol groups (DuPaul, Power, Anastopoulos, & Reid, 1998).
The ODD items were added to this scale and do not have
prior information on their reliability or validity when used
in this format.
Kaufmann Brief Intelligence Test (KBIT; Kaufman &
Kaufman, 1990)
All teens were given this 20-min well-standardized
brief intelligence test containing subtests for vocabulary
and matrix reasoning. Teens needed a total IQ score of 80
or higher to be eligible for this study. Split-half reliability
is .94 and test-retest reliability is .93 for the age span of
10–19 years (Kaufman & Kaufman, 1990). Validity has
been established through significant correlations between
this test and other lengthier intelligence tests (see Kaufman
& Kaufman, 1990, for research review).
Dependent Measures
All of the measures collected below that pertained to
the teenager’s behavior were completed based upon the
teen’s current functioning, regardless of whether or not
the teen was receiving psychiatric medication.
Parental Adjustment
Beck Depression Inventory (BDI; Beck, Steer, &
Garbin, 1988). This self-report scale, used extensively in
research on depression in adults, consists of 21 symp-
toms. Each item is rated on a 4-point Likert scale (0–3)
in terms of the intensity with which that item has been
experienced. Internal consistency of the items averages
0.86 (coefficient α) for psychiatric patients and 0.81 for
nonpsychiatric control participants. Test-retest stability of
the scale ranges from .62 to .90 (1 week to 4 months),
varying with the population studied and the duration be-
tween testings. Validity of the scale has been established
through its correlation with clinical ratings of depression
(r = .72) and with the Hamilton Rating Scale for Depres-
sion (r = .73) for psychiatric patients. The scale signifi-
cantly differentiates between depressed and nondepressed
patients and between depression and anxiety (Beck et al.,
1988). The single raw score from the scale was employed
here to assess depression in parents.
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561
Symptom Checklist 90 – Revised (SCL-90-R;
Derogatis, 1992). This self-report scale has been used
extensively in research on adult psychopathology. It as-
sesses 90 symptoms of various forms of adult psycho-
logical maladjustment. T scores are produced for scales
assessing anxiety, depression, hostility, phobic anxiety,
interpersonal sensitivity, etc. Only the T scores for the
anxiety and hostility scales were employed here in the re-
gression analyses (see Results later) as these were the only
scales to significantly distinguish parents of ADHD and
normal children, as discussed earlier. When available, both
parents completed this scale about themselves. Informa-
tion on reliability and validity is satisfactory and available
in the scale manual (Derogatis, 1992).
Locke–Wallace Marital Adjustment Test (LW-MAT;
Locke & Wallace, 1959). This widely used rating scale
evaluates marital satisfaction. The scale was used here to
evaluate the quality of the relationship between the cur-
rently cohabiting adult partners, whether married or not.
Numerous studies attest to its validity and utility in distin-
guishing distressed from nondistressed couples (O’Leary
& Arias, 1988). The single raw score was employed here
to assess relationship satisfaction in the parents and their
cohabiting partners.
Adult ADHD Rating Scale (Barkley & Murphy,
1998). Each parent, when available, completed two ver-
sions of this 18 item rating scale that contained the DSM-IV
symptoms for ADHD. Each item was rated on a 4-point
scale (0–3; Not at all, Sometimes, Often, and Very often).
One version assesses current symptoms (past 6 months)
and the second assesses recall of childhood symptoms be-
tween 5–12 years of age. A total summary score was calcu-
lated for the ADHD items for each version. The reliability
(coefficient αs) obtained in a recently completed study of
young adults with ADHD by Barkley is .92 for the inat-
tention items and .91 for the hyperactive–impulsive items.
Evidence for validity comes from studies showing that
ratings of current symptoms are significantly correlated
(r = .76) with concurrent ratings provided by spouses, par-
ents, and cohabiting partners about the subjects (Murphy
& Barkley, 1996). Validity of the childhood recall ver-
sion of the scale comes from evidence that self-reports
of childhood are correlated significantly (r = .74) with
parental ratings of their recall of the adult subject as a
child 5–12 years of age.
Ratings of Parent–Teen Conflict
Conflict Behavior Questionnaire (CBQ; Prinz, Foster,
Kent, & O’Leary, 1979). The scale contains 20 true/false
items assessing the quality of communication and level
of conflict in parent–adolescent relationships during the
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past 2 weeks (e.g., “My mother (dad, teen) doesn’t un-
derstand me,” “My mom (dad, teen) screams a lot,” etc.).
Both parents completed this scale about the teen and the
teen completed a separate scale about each parent. Each
informant’s scale provided a single score that was the total
number of items answered in a negative direction. Internal
consistency has been found to be .90 (coefficient α; Robin
& Foster, 1989). Test-retest reliability over 6–8 weeks for
clinically referred, distressed families ranged from .37 for
teens’ appraisals of their relations with their mothers, to
.84 for teens’ appraisals of relationships with fathers. Re-
liability was .57 for mothers’ appraisal of their relation-
ships with their teens, and .82 for fathers’ appraisals of
their relationship with their teens. Validity evidence comes
from studies showing that distressed families report sig-
nificantly poorer scores on this scale than nondistressed
families do (Robin & Foster, 1989).
Issues Checklist (Prinz et al., 1979). This scale cov-
ers 44 topics on which parents and teens may have dis-
agreements (e.g., homework, friends, dress, leisure time,
use of phone, etc.). It provided a measure of the diversity of
family conflicts as well as the intensity of disagreements.
Each topic required three answers. One was if the parent
and teen discussed the topic at all in the past 2 weeks.
If so, then they had to answer approximately how many
times they discussed it. Finally, they rated how “hot” the
discussions were, with 1 indicating being calm and 5 indi-
cating being very angry. The parents each completed this
scale about their teen and the teen completed two scales
separately, one for the mother and one for the father. Two
scores were obtained from each informant’s version of
the scale: the Number of Conflicts and the Mean Anger
Intensity. Reliability has been demonstrated through sig-
nificant 1–2-week test-retest correlations (.63–.70 for
mothers ratings; .73–.80 for father ratings; .47–.49 for
teen ratings of mothers; and .60–.72 for teen ratings of
fathers). Validity has been established in studies show-
ing agreement averaging 67.5% between parent and teen
as to whether a conflict issue had been discussed in the
prior 2 weeks. Significant correlations have been obtained
between scores on the scale and direct observations of
parent–teen interaction conflicts (.44–.52) and scales as-
sessing dissatisfaction in child rearing (.45–.55) (Robin &
Foster, 1989).
Conflict Tactics Scale – Parent–Teen Version (CTS-
PT). This 18-item scale was adapted from the Conflict
Tactics Scale (Straus, 1990) used in marital violence re-
search. The items were arranged in order of increasing
anger and hostility toward the other person such that Item 1
referred to “Discussed an issue calmly,” whereas Item 9
was “Threatened to hit or throw something at the other
person,” and Item 18 was “Used a knife or fired a gun.”
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Edwards, Barkley, Laneri, Fletcher, and Metevia
The first 10 items referred to verbal forms of conflict
(insulting, sulking, threatening, etc.) whereas the final 8
referred to physical forms of conflict (throwing something
at another, pushing, slapping, hitting, threatening with a
weapon, etc.). For each item, respondents were asked to
indicate if the tactic was used during the past year and,
if so, with what frequency. The scale contained two sec-
tions, one providing a report by the parent about behavior
toward their teen and the second about the teen’s behavior
toward them. The teens completed this same scale but did
so twice, once with regard to their interactions with their
mother and the second with regard to their interactions
with their father. The section in the scale referring to the
teen included all 18 items. For the section of the scale
referring to the parent, only the first 12 items were used
here with the highest item referring to “Pushed, grabbed,
or shoved the teen.” The reason for not including the re-
maining six more violent items is that we did not wish
to elicit answers that could be construed as possibly con-
stituting child abuse because state reporting requirements
would have mandated that we initiate such a report. The
only score used here was the Worst Tactic, representing
the highest item (most hostile action) that had been used
by the parent toward the teen or teen toward that parent
in the previous year. To our knowledge, the scale has not
been previously employed in studies of parent–teen con-
flict but has been used extensively in research on marital
conflict and more recently in studies of dating violence
among teenagers (Foshee, 1996). Evidence of reliability
comes from past studies of maritally violent couples us-
ing the CTS in which coefficient alphas ranged from .80
(men) to .86 (women) (Dunford, 2000). Evidence of va-
lidity comes from studies employing the scale in national
studies of marital violence (Straus & Gelles, 1986). Corre-
sponding agreement between husbands and wives on the
wives’ violent behavior were 88% for clinical dyads and
95% for community dyads (Jouriles & O’Leary, 1985).
Higher scores on the scale also are significantly predic-
tive of marital dissolutions over a 4-year follow-up period
(Rogge & Bradbury, 1999).
Direction Behavioral Observations of Parent–Teen
Interactions. Conflict Rating System (CRS; Christensen
& Heavey, 1990; Christensen & Shenk, 1991; Heavey,
Layne, & Christensen, 1993) has been used in previous
studies of dyadic conflict during marital interactions. It
is an expanded version of the observational form used by
Christensen and Heavey (1990) to characterize the behav-
ior of couples during problem-solving discussions. To our
knowledge, it has not been used to study problem solv-
ing in parent–teen discussions. The CRS is composed of
15 behavioral dimensions along which each participant
in the interaction is rated by an observer using a 9-point
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Journal of Abnormal Child Psychology pp275-jacp-346560 October 3, 2001
Family Conflict and ADHD/ODD
scale. There are 10 dimensions reflecting negative com-
munication (e.g., blames, accuses, criticizes the other per-
son, pressures the other to change, withdraws from the
interaction, avoids discussing the problem, interrupts the
other person, dominates the discussion) and 5 reflecting
positive communication (e.g., suggests possible solutions,
expresses self clearly, shows positive affect, expresses un-
derstanding and acceptance of partner’s feelings). Reports
of coefficient alphas of .80–.83 (positive) and .66 (neg-
ative) come from studies of marital interaction conflict
(Heavey et al., 1993; Berns, Jacobson, & Gottman, 1999).
Interobserver agreement (intraclass correlations) in these
same studies was .84–.89 (positive) and .84–.85 (nega-
tive). Separate positive and negative communication scale
scores were computed here by summing the ratings across
the respective items for each scale. In this study, coefficient
alphas were .84–.86 (negative) and .87–.89 (positive) for
mothers across the neutral and conflict discussion periods
(see later), .76–.80 (negative) and .89–.91 (positive) for fa-
thers across these same discussions, and .89–.90 (negative)
and .94–.95 (positive) for teens in these same discussions.
Parents and teens were seated in a clinic room with
a one-way observation mirror and intercom and asked to
engage in three types of discussions. All discussions were
videotaped. The first discussion lasted 15 min and involved
planning a vacation given unlimited funds and was called
the Neutral Discussion. The next discussion, called the
Conflict Discussion, required the parents and adolescent
to discuss and attempt to resolve the five angriest conflicts
the mother reported on her version of the Issues Checklist,
described earlier. This situation lasted 15 min. Following
the Conflict Discussion, participants engaged in a brief
Positive Discussion period so as to reduce the level of
hostility among family members elicited by the Conflict
Discussion before permitting them to depart the clinic.
Each person had to list approximately five positive char-
acteristics they noticed in the other person and then de-
scribe these to each other, giving examples that illustrated
each positive feature. This session lasted 10 min. For this
study, only scores from the Neutral and Conflict Discus-
sions were used. At the end of this discussion period, each
participant was asked to rate on a scale of 0 (not at all) to 9
(very similar) just how similar this discussion was to those
taking place at home on these problem topics. These dis-
cussions involved at least one of the parents and the teen in
all instances. Where the second parent was available, they
also participated in these same discussions with the other
parent and the teen. Approximately 68% of the control
group and 60% of the ADHD/ODD group involved such
triadic as opposed to dyadic discussions with the teens.
This difference was not significant (χ 2 = 0.50, df = 1,
p = .48).
16:25 Style file version July 26, 1999
563
The videotapes of the two discussions were coded us-
ing the CRS described earlier. The observer was required
to watch the entire videotape of the discussion period and
then complete the CRS for each participant in the discus-
sion separately. The observers were trained by the first
author in the use of this coding system based on instruc-
tions developed by Christensen and Heavey (1990) and
provided by Heavey to this project. The observer was blind
to group membership of the families. Interobserver relia-
bility was conducted on 20% of the videotapes by using a
second observer also trained in this system who was also
blind to group membership. Agreement was examined us-
ing intraclass correlations on the scores from the two ob-
servers for mothers, fathers, and teens (collapsed) across
both discussions (collapsed). Results were .82 (negative
scale) and .64 (positive scale).
RESULTS
Initial Subject Characteristics
Initial demographic characteristics as well as the
measures employed as selection criteria for each group
are reported in Table I. The two groups did not differ in
age or grade levels, or in the ages or education of the
mothers and fathers. The ADHD/ODD group, however,
had a significantly lower IQ than did the control group.
As expected from the use of these measures as selection
criteria, the ADHD/ODD group had a significantly more
DSM-IV symptoms of both ADHD and ODD and signifi-
cantly higher CBCL attention and aggression scores than
did the CC group. The proportion of each group meeting
DSM-IV criteria for ODD was 93% for the ADHD/ODD
group and 12% for the control group (χ 2 = 74.60, df = 1,
p < .001). Of the four CC teens with ODD, three had
just the bare minimum of four symptoms and one had six
symptoms. The proportion of each group having CD (with
or without ODD) was 62% for the ADHD/ODD group and
9% for the control group (χ 2 = 26.03, df = 1, p < .001).
The three CC teens having CD had the bare minimum
number of symptoms of three.
A total of 67.7% of the control group and 68.7% of the
ADHD/ODD group had parents who were currently mar-
ried (χ 2 = 1.80, df = 3, p = .61). Approximately 97%
of the mothers of control teens and 92% of the mothers
of the ADHD/ODD group were the biological mothers
(χ 2 = 1.35, df = 3, p = .72). Ninety-one percent of the
CC group and 82% of the ADHD/ODD group were the
biological fathers (χ 2 = 2.28, df = 3, p = .52). Compar-
isons on the measures listed in Table I between teens
whose fathers did and did not participate found no sig-
nificant differences within the ADHD group and just one
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564 Edwards, Barkley, Laneri, Fletcher, and Metevia

Table I. Participant Selection Characteristics for Each Group

Control ADHD/ODD
Measures Mean SD Mean SD t p<

Adolescent age (years) 14.9 1.5 14.8 1.5 0.57 —

Adolescent IQ (KBIT) 113.5 9.2 103.7 10.0 4.72 .001
Adolescent school grade 9.4 1.6 8.9 1.7 1.59 —
Mother age (years) 42.1 3.8 42.7 6.0 −0.53 —
Mother education (years) 14.0 2.3 14.7 2.1 −1.43 —
Father age (years) 44.6 4.9 45.1 6.3 −0.36 —
Father education (years) 14.8 3.4 14.5 2.9 0.39 —
# ADHD symptoms – Teen 0.6 1.4 13.2 5.6 −18.87 .001
# ODD symptoms – Teen 0.6 1.4 5.9 2.0 −15.38 .001
Teen CBCL attention 51.0 2.1 72.9 9.2 −20.07 .001
Teen CBCL aggression 51.8 4.2 71.3 10.8 −13.61 .001

Note. ADHD – attention deficit hyperactivity disorder; SD – standard deviation; t – results of

the t test; p – probability value for the t test if significant ( p < .05); KBIT – Kaufman Brief
Intelligence Test; CBCL – Child Behavior Checklist T score (parent version—mother report);
ODD – oppositional defiant disorder.

in the control group: teens whose fathers did not partic-
ipate had mothers with less years of education than did
teens whose fathers did participate.
In the ADHD/ODD group, 58.6% were taking psy-
chiatric medication. No one in the control group was on
medication. The medicated and nonmedicated ADHD/
ODD participants were compared on all dependent mea-
sures pertaining to the teen (e.g., age, IQ, CBCL, ADHD,
and ODD ratings by parents and teens, teen and parent re-
ports of parent–teen conflict, etc.), of which there were 52
such measures. Given the large number of t tests, signifi-
cance was set at p < .01. The groups did not differ signif-
icantly on any measures. Therefore, these two subgroups
of ADHD/ODD youth were considered to be comparable
and collapsed for purposes of this study.
Because the ADHD/ODD group differed signifi-
cantly from the CC group in IQ, it was necessary to de-
termine if IQ needed to be covaried in any subsequent
group comparisons. Pearson correlations were computed
between the teen IQ scores and all of the dependent mea-
sures, using the entire sample. Only three of the 32 correla-
tions were significant ( p < .05). This is nearly the number
that might be expected to be significant by chance alone
(2). Nevertheless, to err on the conservative side, IQ was
used as a covariate in the analyses of these three dependent
measures (indicated by a in Table II).
Parental and Teen Reports of Parent–Teen
Conflict (Table II)
Five measures were collected separately from moth-
ers and fathers about the extent of conflict in their rela-
tionships with their teen ( p < .01 set for each measure).
Significant group differences were found on all measures.
The ADHD/ODD group manifested significantly more is-
sues of conflict, more anger intensity during those con-
flicts, poorer parent–teen communication (CBQ), and
more aggressive conflict tactics as reported by both par-
ents than did the control group.
Teens completed these same five measures separa-
tely about their mothers and fathers ( p set at <.01). The
ADHD/ODD group reported significantly higher levels of
anger during the mother–teen conflicts and poorer mother–
teen communication than did teens in the CC group. The
ADHD/ODD group also reported more anger intensity
during their conflicts with their fathers, poorer father–teen
communication, and use of more aggressive conflict tac-
tics by their father toward them than did teens in the CC
group.
Observations of Parent–Teen Interactions
Mothers, fathers, and teens rated the similarity of
the neutral and conflict discussion periods to those that
occurred at home concerning a neutral or conflict topic
( p set at <.017). For the neutral discussion, both mothers
(Mean = 5.8; SD = 2.4) and teens (Mean = 4.6; SD =
2.8) in the ADHD/ODD group rated these discussions as
being significantly less similar to discussions of neutral
topics that occur at home than did mothers (Mean = 7.0;
SD = 1.5) and teens (Mean = 6.1, SD = 2.0) in the
CC group (Mothers: t = 3.03, df = 68.3 [unequal vari-
ances], p = .003; Teens: t = 3.09, df = 56.8 [unequal
variances], p = .003). The groups did not differ on any
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Family Conflict and ADHD/ODD 565

Table II. Ratings of Parent–Teen Conflict

Control ADHD/ODD

Measures Mean SD N Mean SD N F p<

Mother ratings
IC: No. of issues 15.8 6.8 32 22.1 7.4 83 17.46 .001
IC: Anger intensitya 1.6 0.6 30 2.3 0.6 83 21.54 .001
CBQ ratinga 3.9 4.4 30 13.9 4.1 83 108.29 .001
CTS: M worst tactic 6.7 3.7 32 10.6 2.1 83 51.13 .001
CTS: T worst tactic 7.8 3.1 31 11.4 3.0 83 32.21 .001
Father ratings
IC: No. of issues 14.5 6.8 22 19.9 7.8 69 8.36 .005
IC: Anger intensity 1.4 0.4 22 2.0 0.6 69 16.37 .001
CBQ ratinga 4.1 3.6 20 12.0 5.4 70 29.70 .001
CTS: F worst tactic 6.9 3.8 22 10.5 2.6 69 24.87 .001
CTS: T worst tactic 7.7 3.6 22 10.7 2.8 70 16.14 .001
Teen on mother
IC: No. of issues 12.1 6.4 32 13.9 5.7 84 2.08 ns
IC: Anger intensity 1.5 0.6 32 2.2 0.7 84 22.64 .001
CBQ rating 4.0 4.1 32 7.9 5.1 84 4.65 .001
CTS: M worst tactic 6.5 3.7 31 8.4 3.4 84 6.30 ns
CTS: T worst tactic 8.7 3.2 32 10.0 3.0 84 3.91 ns
Teen on father
IC: No. of issues 9.0 6.3 24 12.5 6.3 75 5.50 ns
IC: Anger intensity 1.2 0.6 24 2.2 0.9 75 23.56 .001
CBQ rating 1.4 2.2 25 7.8 6.1 75 25.67 .001
CTS: F worst tactic 5.1 3.8 25 8.3 4.0 76 12.63 .001
CTS: T worst tactic 7.1 3.9 26 9.3 3.7 76 6.10 ns

Note. ADHD – attention deficit hyperactivity disorder; SD – standard deviation; F – results

of the F test; p – probability value for the F test if significant ( p < .01); ODD – oppositional
defiant disorder; IC – Issues Checklist; CBQ – Conflict Behavior Questionnaire; CTS – Conflict
Tactics Scale; M – mother; T – teen; F – father.
a Indicates that IQ served as a covariate in the analysis of this measure.

of the conflict discussion ratings, with both groups rating
these discussions as reasonably similar to conflict discus-
sions occurring at home (Mean ratings between 6.0 and
7.2 for the ADHD/ODD and CC groups out of a possible
9 maximum score).
Positive and negative interaction scores were coded
for each participant in each discussion using the CRS sys-
tem, thus yielding six measures for each discussion period
( p set at <.008). These measures are shown in Table III.
Results indicated that teens in the ADHD/ODD group
were observed to be significantly more negative during
the neutral discussion than were teens in the CC group.
No other comparisons reached significance. However, in
the conflict discussion period, mothers and teens in the
ADHD/ODD group displayed significantly less positive
behavior whereas mothers, fathers, and teens in this group
demonstrated significantly more negative behavior than
did those in the comparison group.
Because some of these direct observations were
dyadic (mothers and teens) whereas most others were tri-
adic (mothers, fathers, and teens), a subsequent analysis
was done to determine if the group differences noted ear-
lier for mother and teen behavior were affected by the
father’s participating in these discussions. The foregoing
analyses for mother and teen measures were re-computed
using family composition (dyadic vs. triadic) as a sepa-
rate factor in the analyses along with that of teen grouping
(ADHD/ODD vs. CC). Because of the very small sample
sizes for the dyadic family composition factor in some
cells, significance was set at p < .05 to maximize power.
For the neutral discussion period, the family composition
factor was not significant on any measure nor was its inter-
action with the grouping factor. For the conflict discussion
period, no main effect for family composition was noted
on either the mothers’ or teens’ positive or negative be-
havior. However, a significant interaction of composition
with teen grouping was noted on teen negative behav-
ior (F = 4.44, df = 1/95, p = .038). Pair-wise contrasts
indicated that within the CC group, teens demonstrated
significantly less negative behavior when the father was
present (Mean = 34.7, SD = 17.9) than when absent
from this discussion (Mean = 23.1, SD = 8.9). In the
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566 Edwards, Barkley, Laneri, Fletcher, and Metevia

Table III. Direct Observations (CRS) From Neutral and Conflict Discussion Periods

Control ADHD/ODD
Measures Mean SD N Mean SD N F p<

Neutral discussion
Mother positive 38.1 5.2 27 36.3 7.7 81 1.20 ns
Father positive 34.8 9.0 18 34.4 8.0 56 0.02 ns
Teen positive 34.0 8.5 28 28.5 11.6 86 5.43 ns
Mother negative 17.3 8.8 26 18.9 9.7 82 0.56 ns
Father negative 18.3 9.2 18 20.7 8.0 56 1.13 ns
Teen negative 18.6 7.5 26 31.6 16.5 86 15.12 .001
Conflict discussion
Mother positive 37.5 5.4 27 31.9 7.8 82 12.02 .001
Father positive 34.7 10.3 18 30.5 8.6 56 2.88 ns
Teen positive 33.9 9.1 28 21.1 10.5 85 33.11 .001
Mother negative 23.8 9.1 27 33.5 10.8 82 17.22 .001
Father negative 25.0 10.2 18 35.8 11.1 54 13.30 .001
Teen negative 26.5 13.3 28 47.1 18.3 84 30.14 .001

Note. ADHD – attention deficit hyperactivity disorder; ODD – oppositional defiant disorder;
SD – standard deviation; F – results of the F test; p – probability value for the F test if
significant ( p < .01).

ADHD/ODD group, this difference was not significant
(Means = 43.3 vs. 49.1, SDs = 18.8 vs. 17.9, respectively).
CC and ADHD/ODD teens in the dyadic interactions were
not significantly different in their level of negative be-
havior. However, ADHD/ODD teens in the triadic inter-
actions were significantly more negative than were CC
teens. Thus, the presence of the father during mother–teen
conflict discussions may help to suppress teen negativity
in the CC group but not in the ADHD/ODD group. This
same interaction was also marginally significant for moth-
ers’ negative behavior (F = 3.77, df = 1/92, p = .055) and
showed much the same pattern in pair-wise comparisons.
Comparison of Mother–Teen Versus
Father–Teen Conflicts
One purpose of this study was to determine if the
severity of parent–teen interaction conflicts varied as a
function of sex of the parent. To evaluate this issue, the
ratings collected from mothers on the five measures as-
sessing such conflict (IC, CBQ, and CTS) were compared
to those collected from fathers using that subset of par-
ticipants within each group on which data were available
from both mothers and fathers (N s: ADHD/ODD = 65,
Control = 22). For each measure, a 2 (groups) × 2 (par-
ents) ANOVA was computed with repeated measures on
the last factor ( p set at <.01). The main effects for group
were ignored in these analyses as they have already been
reported earlier. Of interest here was any main effect for
sex of the parent or any interaction of it with the grouping
factor. Only one main effect for parent was significant, and
this indicated that mothers reported higher levels of anger
intensity (Mean = 2.10, SD = 0.70) in conflict discussions
with their teens than did fathers (Mean = 1.77, SD = 0.57;
F = 6.77, df = 1/85, p = .01). No other main effects or
interaction terms reached this level of significance.
These analyses were then repeated using the teens’
ratings of their mothers and fathers on these same five mea-
sures for that subset of participants from whom teen rat-
ings were available for both parents (N s: ADHD/ODD =
75; Control = 25; p set at <.01). The main effect for the
teens’ worst tactic used toward their parents was signif-
icant, with teens reporting that they employed a signifi-
cantly more hostile tactic toward their mothers (Mean =
9.75, SD = 3.2) than toward their fathers (Mean = 8.60,
SD = 3.80; F = 13.37, df = 1/97, p < .001). No other
main effects for sex of parent or interactions of this factor
with the grouping factor were significant.
Finally, these analyses were conducted on the par-
ents’ positive and negative interactive behavior scores
from the CRS for both the neutral and the conflict dis-
cussion periods where both parents had participated in
these discussions (N s: ADHD/ODD = 44; Control = 19;
p set at <.012). There were no significant main effects for
sex of parent or any interaction of sex with group.
Parental Psychological Adjustment
Significance for the mothers’ and fathers’ self-reports
on the BDI, the two SCL-90 scales, the LW-MAT score,
and for the ADHD symptoms, both current and childhood
was set at <.008 for each set of measures. Mothers in the
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Family Conflict and ADHD/ODD 567

ADHD/ODD group reported significantly higher levels of
hostility (SCL-90; t = 3.23, df = 113, p = .002) and
depression (BDI; t = 4.82, df = 113, p < .001) than
did mothers in the CC group. No other differences were
significant. Fathers of the ADHD/ODD group reported
significantly higher levels of childhood ADHD than did
fathers in the CC group (t = 3.22, df = 89, p = .002). No
other comparisons reached this level of significance.
Contribution of Parental Self-Rated Maladjustment
to Parental Ratings of Parent–Teen Conflict
The final aim of this study was to examine the ex-
tent to which parental anxiety, depression, hostility, and
ADHD may have contributed to parent–teen conflict be-
yond that contribution made by the severity of teen ADHD
and ODD symptoms. Multiple regression was used to ad-
dress this issue. First, however, the five ratings collected
from mothers (IC, CBQ, and CTS) were reduced through
principal components factor analysis using varimax ro-
tation (SPSS version 9.0). This indicated that these five
measures formed a single significant component having
an Eigenvalue of 2.94 and accounting for 58.9% of the
variance. No other components received Eigenvalues of
greater than 1.00. The range of factor loadings was .641–
.840. A single factor score (Mother–Teen Conflict) there-
fore was created using factor loadings for these mater-
nal ratings. Next, the same analysis was applied to the
same five father ratings, yielding the same result. The
single factor solution gave an Eigenvalue of 2.52, ac-
counting for 50.4% of the variance. Factor loadings here
ranged from .60 to .778. Consequently, a single factor
score (Father–Teen Conflict) was created for the father
ratings as well.
The contribution of parental psychological malad-
justment to the Mother–Teen Conflict scores was then
examined using stepwise multiple regression. The entire
sample was used in this analysis. Independent variables
were entered in three blocks, corresponding to teen,
mother, and father characteristics, respectively. Block 1
comprised the mothers’ ratings of the teens’ severity of
ADHD and ODD, using raw scores derived from the
ADHD/ODD Rating Scale and the teens’ KBIT IQ score.
Block 2 consisted of the mothers’ ratings of their own de-
pression (BDI), anxiety (SCL-90), hostility (SCL-90), and
current ADHD symptoms (Adult ADHD Rating Scale).
Block 3 consisted of these same scores from the fathers’
self-ratings. The results are displayed in Table IV. Al-
though teen ratings of ODD accounted for a substantial
portion of the variance in the Mother–Teen Conflict score
(41%), and teen ADHD made an additional significant
contribution (3%), two parental characteristics also con-
tributed significantly to mother–teen conflicts. These were
the mothers’ and fathers’ own self-ratings of hostility,
which accounted for 3.4 and 1.8% of the variance, re-
spectively, in the Mother–Teen Conflict factor scores.
The same approach was employed to study the con-
tribution of these three blocks of variables to the Father–
Teen Conflict factor scores. Except in this case, the
fathers’ ratings of the teens ADHD and ODD symptoms
were employed in the first block, the fathers’ self-ratings
were entered in the second block, and the mothers’ self-
ratings were entered last. These results also appear in
Table IV. Once again, the teens’ ODD and ADHD symp-
toms made significant contributions to the Father–Teen
Conflict scores (40 and 6% of the variance, respectively).
Beyond these, however, two father self-ratings also made a
significant contribution: father hostility (6%) and anxiety
(2%) scores from the SCL-90. In short, some aspects of

Table IV. Regression Analyses Showing the Contribution of Parent Maladjustment to Mother and Father
Ratings of Parent–Teen Conflict (After Controlling for Teen ADHD, ODD, and IQ)

Dependent measure R R2 R 2 change Betaa F change df p

Mother–teen conflict factor

Teen ODD (mother rated) .644 .415 .415 .411 83.02 1/117 <.001
Teen ADHD (mother rated) .667 .445 .030 .207 6.17 1/116 .014
Mother hostility (SCL-90) .692 .478 .034 .165 7.47 1/115 .007
Father hostility (SCL-90) .705 .496 .018 .140 4.06 1/114 .046
Father–Teen conflict factor
Teen ODD (father rated) .630 .396 .396 .382 76.80 1/117 <.001
Teen ADHD (father rated) .676 .457 .061 .272 13.05 1/116 <.001
Father hostility (SCL-90) .722 .521 .063 .353 15.21 1/115 <.001
Father anxiety (SCL-90) .736 .541 .020 −.169 5.05 1/114 .026

Note. ADHD – attention deficit hyperactivity disorder rating scale score; ODD – oppositional defiant disorder
rating scale score; SCL-90 – Symptom Checklist 90 T -score.
a Beta coefficients are standardized.
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568
parental psychological adjustment make significant con-
tributions to parent–teen conflict besides the important
contribution made by teen levels of disruptive behavior
(ADHD/ODD).
DISCUSSION
The findings serve to both replicate and extend the
results of earlier research on the parent–child and parent–
teen interactions of children and teens with ADHD and
ODD. As in earlier studies, the present one found a sub-
stantial degree of conflict between the teens with ADHD/
ODD and their mothers. The mothers of the teens with co-
morbid ADHD and ODD had more issues on which they
had conflicts with their teens, more anger in these conflicts,
used more aggressive tactics, and reported poorer commu-
nication with their teens than did CC mothers. These ma-
ternal reports were largely corroborated by the teens’ own
reports. As in our earlier studies of ADHD teens (Barkley,
Anastopoulos, et al., 1992; Barkley, Fischer, et al., 1991),
increased conflict between mothers and teens was directly
observed during problem-solving discussions. The level
of ODD symptoms more than the ADHD symptoms con-
tributed most to mother–teen conflict; a result found in
earlier studies of ADHD children (Anastopoulos et al.,
1992; Gomez & Sanson, 1994; Johnston, 1996).
This study also extended these findings on mother–
teen relations to the interactions of fathers with ADHD/
ODD teens. Like mothers, fathers of the ADHD/ODD
group also reported more conflict issues, more anger, more
aggressive conflict tactics, and poorer communication than
did CC fathers. Again, teen reports largely corroborated
these results. However, the teens did not see themselves
as using more aggressive conflict tactics with either their
fathers or their mothers than did the teens in the CC group,
in contrast to both mothers and fathers reports of teen
tactics. Thus, teens with ADHD/ODD may be underre-
porting severity of conflict more than CC teens. Once
more, the teens in the ADHD/ODD group were observed
to use more negative and less positive forms of interaction
with their fathers, and fathers used more negative inter-
actions toward their teens than was the case with the CC
group. Furthermore, although the presence of the father
during conflict discussions appeared to reduce the level of
teen negative behavior in CC teens, this was not the case in
ADHD/ODD teens. There, negativity actually increased,
albeit not significantly, during father presence. A similar,
though marginally significant, pattern between the groups
was evident in the effect of father presence on mothers’
negative behavior as well during these conflict discus-
sions. Buhrmester et al. (1992) found similar suppress-
ing effects of father presence on mother–child conflict
Style file version July 26, 1999
Edwards, Barkley, Laneri, Fletcher, and Metevia
in ADHD children and speculated that it may stem from
paternal rescuing of mothers from their children’s coercive
behavior by the father’s involvement in the interaction.
Just as in some earlier research on father–child
interactions in hyperactive children (Johnston, 1996;
Tallmadge & Barkley, 1983), this study did not find differ-
ences in parent–teen interactions as a function of sex of the
parent on most of the measures. Mothers and fathers both
reported comparable numbers of conflicts and compara-
ble degrees of aggressiveness and extent of parent–teen
positive communication in their interactions, even though
mothers and fathers of ADHD/ODD teens reported sig-
nificantly more such problems than was the case in the
CC group. However, this study did find that mothers, re-
gardless of group, reported higher levels of anger in their
conflict discussions with their teen than was reported by
fathers during their own interactions with the teens. The
teens, again regardless of group, also reported having used
a more aggressive or hostile tactic toward their mothers
than was the case with fathers. This is reminiscent of ear-
lier findings by Burhmester et al. (1992) on parent–child
interactions where boys were found to direct more neg-
ative behavior toward their mothers than fathers. Apart
from these few differences, the conflicts that mothers have
with their teens are largely comparable to those of fathers
within each of these groups. The patterns of interaction
conflict for both parents in families of ADHD/ODD teens
are in keeping with family coercion theory (Patterson et al.,
1992) where greater family conflict would be most evi-
dent in that subset of ADHD teens having comorbid social
aggression (ODD).
One purpose of this study was to examine the worst
level of violence that occurred in the parent–teen relations
of ADHD/ODD teens. According to family coercion the-
ory, family members ought to demonstrate more extreme
aggressive tactics toward each other over time as the use
of coercive tactics escalates via a process of negative re-
inforcement for progressively more aggressive behavior
toward each other. Consistent with this theory, mothers
in the ADHD/ODD group reported that, on average, the
worst tactics they used involved “throwing, hitting, smash-
ing, or kicking something” or actually throwing something
at their teenager during conflict discussions. Mothers of
CC teens, in contrast, reported that their worst tactics aver-
aged between “stomped out of the room or house or yard”
or “cried.” Mothers in the ADHD/ODD group further
reported that their teens worst tactics averaged between
“throwing something” at them and “pushed, grabbed, or
shoved” them, whereas mothers in the CC group reported
their teens’ worst tactics, on average, ranged between cry-
ing and doing something to spite the other person. Inter-
estingly, the groups did not differ in the teens’ reports of
P1: FYJ/GOQ P2: GCR
Journal of Abnormal Child Psychology pp275-jacp-346560 October 3, 2001
Family Conflict and ADHD/ODD
the worst tactics they used toward their mothers or that
the mothers used toward them. This was largely owing
to the ADHD/ODD group reporting a lower level of ag-
gressive tactic relative to their mothers’ reports than was
the case with the teens in the CC group, whose reports
were similar to those of their mothers. Similar findings
held true with respect to severity of father–teen violence
during conflicts. Fathers of the ADHD/ODD group re-
ported their worst tactics and that of their teens as being at
levels similar to that reported by the mothers of these teens
(threw, smashed, hit or kicked something, or threw some-
thing at the other person) whereas fathers of the CC teens
reported lower levels of aggression that were again com-
parable to those reported by the mothers. Higher levels of
violence, then, may be more typical of parent–teen conflict
interactions in families with an ADHD/ODD teen than is
the case in families of CC teens. The former families are
locked into coercive spirals of ever-escalating aggressive
behavior toward each other whereas the latter families are
less prone to such interaction spirals (Fletcher et al., 1996).
It is conceivable that the worst levels of violence during
conflicts in the ADHD/ODD group may be even higher,
on average, than those reported here due to the intentional
truncation of the parents’ version of the Conflict Tactics
Scale to levels just short of physical violence. This was
done so as to preclude triggering state mandated reports
of potential abuse.
In keeping with past studies of ADHD children and
teens (Barkley, Anastopoulos, et al., 1992; Befera &
Barkley, 1985; Cunningham et al., 1988; Johnston, 1996),
particularly those having comorbid ODD, this study docu-
mented significantly greater levels of depression and hos-
tility in the mothers of teens with ADHD/ODD relative
to mothers in the CC group. However, this study did not
find lower levels of marital satisfaction in the mothers of
teens with ADHD/ODD as previous studies had reported.
Nor did mothers of the ADHD/ODD group report having
more symptoms of ADHD, either currently or in child-
hood, than did mothers of the CC group. Such a finding
seems inconsistent with the substantial evidence for the
high heritability of ADHD (average h2 = .80+; Faraone,
2000; Thapar et al., 1999) and with the increased risk of the
disorder among the biological relatives of child probands
having ADHD (Biederman et al., 1992). However, fathers
of the ADHD/ODD group did report having had a higher
level of ADHD symptoms, at least as children, than did
CC group fathers. The disparity between this study and
prior research on the familial aggregation of ADHD may
be due to at least two factors. This study used only rating
scales of ADHD symptoms rather than direct personal in-
terviews to assess DSM criteria for parental ADHD. And
up to 10% of the parents participating in this study were
16:25 Style file version July 26, 1999
569
not the biological parents of these teens. There may also
exist a referral bias among these families in that higher
functioning families having less parental ADHD may be
more likely to seek treatment services for their teens.
The final aim of this study was to determine the ex-
tent to which parental hostility, depression, anxiety, and
ADHD contributed to parent–teen conflicts beyond the
contribution made by the teens’ level of disruptive behav-
ior problems (ADHD/ODD). Once more, in keeping with
family coercion theory and past research, this study found
severity of teen ODD symptoms made the greatest contri-
bution to severity of parent–teen conflict, with symptoms
of ADHD contributing less so. The parents’ level of self-
rated hostility also contributed significantly to the level of
parent–teen conflict in both sexes of parent. Moreover, for
mother–teen conflict, not only did the mothers’ level of
hostility contribute to such conflict, so did that reported
by their male partners (mostly husbands). The reverse was
not true for father–teen conflict. Prior research on dis-
ruptive males suggests that this effect of father hostility
on mother–son interactions may stem from an indirect
pathway of influence, in this case modeling (Lavigueur,
Tremblay, & Saucier, 1995). Father’s hostility toward
mothers is significantly correlated with mother–son con-
flict perhaps because sons are imitating the father’s in-
teraction style toward the mother. Unexpectedly, fathers’
self-rated level of anxiety contributed inversely to the level
of father–teen conflict beyond the contribution made by
the teens’ ADHD/ODD symptoms and fathers’ self-rated
hostility. This implies that higher levels of anxiety may
serve to diminish fathers’ propensities for engaging in co-
ercive, conflictual exchanges with more disruptive teens.
The results of this study must be viewed in the con-
text of its limitations. One was that the vast majority of
ADHD/ODD teens and their parents volunteered because
of their desire to participate in the subsequent study of
family therapies for parent–teen conflict associated with
this project (Barkley et al., in press-b). It is possible that
these families may not be representative of all clinic re-
ferred ADHD/ODD teens but only those with conflicts
that are sufficiently extreme to compel them to seek these
treatments. Also noteworthy was the limitation introduced
by the high percentage of teens in the ADHD/ODD group
that were on medication at the time of their evaluation.
Although the screening measures used to select partici-
pants were collected based on parental reports of the teens’
adjustment off-medication, the dependent measures were
based upon current functioning regardless of medication
status. Fortunately, the medicated ADHD/ODD partici-
pants did not differ significantly from the nonmedicated
ADHD/ODD ones on any of the dependent measures. It is
still possible that the presence of so many medicated teens
P1: FYJ/GOQ P2: GCR
Journal of Abnormal Child Psychology pp275-jacp-346560 October 3, 2001 16:25
570
in the ADHD/ODD group may have reduced the represen-
tativeness of that group relative to the larger population
of teens with ADHD/ODD. Nevertheless, any such bias
would have acted conservatively to reduce ADHD/ODD
versus CC group differences given that those medications
(mainly stimulants) have been shown to have a beneficial
impact on parent–child interactions in studies of children
with ADHD (Danforth et al., 1991). A further limitation
was the relatively small sample of control teens and their
parents, particularly for the number of fathers participating
in that group. This may have limited the statistical power
of this study to detect additional group differences beyond
those reported here. Even so, group differences for father
ratings of parent–teen conflict were significant despite this
limitation in sample size, suggesting that such elevated
conflict in father–teen relations in the ADHD/ODD group
is probably reliable and rather robust.
In summary, this study found that parents and teens
in families having adolescents clinically diagnosed with
comorbid ADHD and ODD reported having substantially
more issues of conflict, expressing higher levels of anger
intensity during such conflicts, and using more aggres-
sive conflict tactics toward each other than did a com-
munity control group of teens and parents. Greater levels
of negative interactive behavior and lower levels of pos-
itive interactive behavior were also documented through
direct observations of parents and teens during conflict dis-
cussions in a clinical setting, though not during a neutral
discussion period. The results also indicated that parental
self-reports of hostility made additional contributions to
the level of parent–teen conflict beyond that contributed
by teen ADHD and ODD. Such findings are quite consis-
tent with coercion theory and past research on aggressive
children where increased intrafamilial conflict serves as a
training ground for social aggression.
These findings have implications for interventions
for reducing parent–teen conflict. Although treatment may
need to focus on parent–teen problem-solving and com-
munication skills, as was done in the subsequent treat-
ment study with these teens (Barkley et al., in press-a, in
press-b), this may not be sufficient, as was also evident
in the outcome of that treatment study. The substantial
contribution of both ODD and ADHD symptoms to fam-
ily conflict suggest that other therapies, such as stimu-
lant medication, must be added that directly reduce both
symptom domains if greater therapeutic efficacy is to be
attained. The contribution of parental hostility to parent–
teen conflict generally and the possible indirect modeling
effects of paternal hostility in particular further suggests
that both anger control training and marital therapy with
parents may also be necessary to further increase treat-
ment success beyond the relatively mixed results obtained
Style file version July 26, 1999
Edwards, Barkley, Laneri, Fletcher, and Metevia
by teen-focused family therapies to date for this clinical
population (Barkley et al., in press-a, in press-b; Barkley,
Guevremont, Anastopoulos, & Fletcher, 1992).
ACKNOWLEDGMENTS
Appreciation is expressed to Trisha Chaplin for as-
sistance with data entry, to Denise Kwasnik and Susan
Barrett for assistance with the viewing and coding of the
videotapes of family interactions, and to Laura Montville
for administrative assistance.
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