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When Parents Disagree

Categories: 2012, April

I’m Right, You’re Wrong…


When parents disagree on how to manage their child's ADHD


by Julie Mayfield, LCSW

ImageI HAVE WORKED WITH PARENTS OF CHILDREN newly diagnosed with ADHD for twenty-five years, helping them navigate the resource maze. I am always humbled and impressed with their stories, struggles, and strength. ADHD impacts the entire family and puts significant stress on marriages. The diagnosis changes a couple’s routines and their parenting vision. They suddenly need to understand all that is involved in raising a child diagnosed with ADHD. Couples easily become flooded with information and overwhelmed with treatment and medication decisions for their child. This often creates frustration and feelings of inadequacy, leading to different points of view and disagreements.

According to a study conducted by psychologists William Pelham and Brian Wymbs, “couples raising children with ADHD are about twice as likely to divorce by the time their children reach eight years of age as couples whose children don't have the condition. Parents of children with ADHD report less marital satisfaction, fight more often, and use fewer positive and more negative verbalizations during child-rearing discussions than do parents of children without ADHD especially if the child also has conduct or oppositional problems.”

Everyone in the family needs to be considered when developing an effective treatment plan for a child with ADHD. I often tell parents, “This is not only your child’s issue, this is a family problem, and everyone needs to take some responsibility for the way they manage difficulties at home.” Families in my practice have a greater satisfaction in family relationships when parents make a concerted effort to change dysfunctional patterns at home, co-parent with their spouse consistently, and begin to support and nurture their marriage.

Developing a treatment plan

Parents need to be well-informed and knowledgeable about their child’s diagnosis. The first step in developing a treatment plan is a complete understanding of ADHD and how it impacts their child. It is important for both parents to be involved when meeting with professionals, allowing each parent to ask questions, express concerns, and later discuss or clarify information. They are then more equipped to come up with common goals and move the family toward appropriate treatment options on which they agree. The perspectives of both parents are also helpful for professionals in understanding family dynamics and planning treatment options.

Common questions parents ask me when we first meet after their child is newly diagnosed include: “Where do we start? What are the treatment options? How do we handle discipline problems? How can we get help with school issues?” Once we start exploring treatment options and implementing strategies, marital problems often surface. The work in therapy shifts focus to include stressors in the marriage, inconsistent parenting styles, and resentment toward each other for lack of emotional support. Parents, particularly mothers, have told me that they often feel trapped, with no way out, due to the time and energy it takes to manage and care for their child. They view their lives as a never-ending cycle of managing a child’s behavior. They find that is draining, overwhelming, and not at all what they anticipated or expected when they started their family. Morning routines, bedtime, and compliance with homework seem most challenging.

As studies have indicated, behavior therapy is effective in treating children with ADHD. In addition, marital or parenting counseling is helpful in restructuring the household routine and encouraging consistent parenting. At times family therapy is needed to address the needs of the entire family or to include other children in the household.

Parenting counseling

Once I begin working with a family, after gathering information and history, I carefully listen to the issues that are most difficult for the family. Typically, parents are frustrated, feeling helpless in resolving ongoing problems in the household routine. Their different parenting styles and upbringings often create tension, a lack of support, and understanding.

Within the first or second meeting, I give the parents a worksheet to complete, asking them to make a list of no more than ten specific household rules. I instruct them to do this task together at home prior to our next meeting. We then look at two or three of the rules that are violated most often or cause the most upset in the family. Working with both parents, we develop a behavioral plan to resolve the issues presented.

Usually, this is the first time they have engaged in this type of discussion calmly. They are asked to be solution-oriented, no longer avoiding the child’s inappropriate behaviors at home or deciding how to deal with issues as they are occurring. The couple begins to feel united and empowered, and the cycle of blaming each other lessens. Therapy is helpful in allowing them an opportunity to understand their patterns of communication and to recognize each other’s strengths and weaknesses in parenting. As they work together with the therapist, the process allows an opportunity for productive communication and problem solving.

Once the parents have agreed on a set of rules, we establish a list of consequences for violation of the rules and rewards for compliance of the rules. This starts a process of the parents being a united front, working together, and supporting each other. They begin to feel they have direction in controlling behavior at home and see more consistency in themselves and with their spouse. The communication between them is more proactive, rather than argumentative or blaming. They are also less likely to implement consequences out of anger or without first consulting the other parent.

When communication has improved and the couple is able to implement a structure in the household that works, they are more likely to work together productively regarding issues occurring at school. A similar process can be used when making school decisions. The first step is gathering information and being well informed. Writing up questions and concerns together before school meetings can be beneficial, since there is usually a time limit at these meetings. Both parents should meet with the teaching or educational staff to address questions and present concerns. When both parents understand the problems that are occurring at school, they are more likely to discuss the situation rationally. Together, once again as a united front, they are better equipped to advocate for appropriate accommodations to help their child. Therapists and educational consultants are also resources available to parents in helping the educational process proceed productively.

Medication

Medication is a complicated and difficult decision for most parents. One parent thinks medication is the answer to helping the child with self-control, while the other parent worries about side effects and long-term consequences of medication use. This is particularly difficult when one parent feels strongly that medication is necessary and the other is ambivalent about trying medication. One parent may worry that time is slipping away and see their child’s self-esteem declining, friendships deteriorating, and grades slipping. The other parent is concerned about dependence on medication and how it will impact their child’s development.

Parents need to be well-informed and meet together with a qualified medical doctor to have questions and concerns addressed. A trial of medication often means tolerating different medications and dosages until a therapeutic level is reached and progress is seen. Too often, I have seen parents prematurely decide against continuing the use of medication due to having difficulty finding something that is well tolerated by the child. When this decision involves an older child or teen, it’s important to include them in the decision process, carefully listening to their perspective and attitude about taking medication on a routine basis.

Couples need to spend time listening to each other’s concerns, communicate clearly and calmly to each other, and try to understand the other’s point of view. They need to have accurate information and realize that there is no magic pill. Research has shown that although medication is very effective in the treatment of ADHD, therapy combined with medication is most effective.

Nurturing the marriage

Raising a child with ADHD takes tremendous energy, patience, and time. Parents often feel depleted emotionally and marriages become neglected. Intimacy and spending quality time together away from children occurs less frequently, becoming lower on the priority list. Parents comment that they have little or no time to take care of themselves and have nothing left to give to the marriage.

Finding time for yourself and time with your partner is essential in restoring a satisfying relationship. Couples who have a strong and supportive marriage tend to have a more satisfying family life. Feeling secure and happy with your spouse contributes to raising secure children.

Make your marriage a priority and have regular date nights without children to rekindle your romance. Engage in activities that you both enjoy, and schedule time together to rediscover and nurture each other without talking about family problems. Discuss activities that you enjoyed as a couple prior to having children, and reconnect with feelings that attracted you to your mate when you were dating and first married.

Finding the right balance of time together as a couple and time for yourself is critical. It is very difficult to take care of others and nurture your marriage if your needs are consistently unmet. Find time to be selfish and take care of yourself physically and emotionally. Encourage your spouse to take care of his or her individual needs. Take a class, go out with friends, start a new hobby, or exercise. Work together with your partner, taking turns to watch the kids while the other has time on his or her own.

Marriage is fragile and takes effort. It is important to look at your contribution and what you can do to enhance the marriage, rather than complain about what you are not getting. “Think about what you want in your marriage not what’s missing. I've grown increasingly convinced that most marriages are worth saving simply because most problems are solvable," says family therapist Michelle Warner-Davis, MSW, author of Divorce Busting (Fireside, 1993).

Marriage is challenging when you are raising a child with ADHD. Even in strong marriages, there are times when couples argue and have difficulty agreeing on treatment for their child. Partners in successful relationships choose their battles carefully, listen and understand their partner’s point of view, and work toward finding a solution or a compromise to the problem. When couples reach an impasse and become stuck, parent support groups, parenting classes (such as CHADD’s Parent to Parent training program), or a trained marriage counselor are often beneficial resources in helping them get back on track, creating stability within the family.


In the heat of the argument 

 
Here are some tips for de-escalation when you and your spouse disagree over some aspect of your child’s treatment or diagnosis.

   Image  When arguments escalate, agree to a cool-off time and discuss the issue at a later time when both of you have de-stressed and had time to think.
   Image  Remind yourself that a compromise is the best outcome and if someone wins the argument you both end up losing.
   Image  Do not yell, scream, or threaten your spouse.
   Image  Listen carefully to what your partner is saying and try to understand their point of view. Don’t interrupt. Ask for clarification by saying “What I hear you saying is…?”
   Image  Use I-statements rather than You-statements.
   Image  Pay attention to your feelings and ask yourself, “Am I over-reacting? Is something else going on in my life that is bothering me and am I taking it out on my partner or this issue?” If so, call a time-out to calm down.
   Image  If the argument continues after utilizing time-outs, try writing down your thoughts. Do not use this as a source of blame or to intimidate your spouse. The objective of writing down your perspective is to help you feel understood. Allow your spouse to read what you have written and try to discuss the issue again.
   Image  Forgive. Take responsibility for your role in the escalation and say “I’m sorry.”

 



A licensed clinical social worker, Julie Mayfield provides individual, group, and family psychotherapy to children, adolescents, and adults. Her areas of expertise include ADHD, Asperger syndrome, anxiety, and childhood depression. She has worked with children and families in a variety of clinical settings, such as inpatient psychiatric hospitals, day treatment centers, residential school settings, and a multidisciplinary group practice. She coordinates and implements social skills groups for children having difficulty with peer relationships and supervises graduate level clinicians. 

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