Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Perspectives on parental support of attention deficit hyperactivity disorder self-management at the transition to adulthood

Nature Mental Health volume 2, pages 489–495 (2024)Cite this article

Subjects

Abstract

Attention deficit hyperactivity disorder (ADHD) is a chronic mental health condition that often persists into adulthood. Here we highlight challenges and potential opportunities for research and intervention for individuals with ADHD transitioning to adulthood and present intervention targets involving parents that are less well studied. Unique elements of intervention for transition-aged youth include targeting self-efficacy, motivation, environmental fit and independence. Parents may be at a loss for how to support transition-aged youth, however, equipping parents with motivational interviewing strategies, considering changes to an individual’s environment to enhance fit as well as balancing independence and support are all areas that may be incorporated into interventions for this age group. Importantly, cultural and socioeconomic context need to be considered.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Life transitions approach to ADHD.
Fig. 2: Future directions.

Similar content being viewed by others

References

  1. Faraone, S. V. et al. The world federation of ADHD international consensus statement: 208 evidence-based conclusions about the disorder. Neurosci. Biobehav. Rev. 128, 789–818 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  2. Fayyad, J. et al. The descriptive epidemiology of DSM-IV adult ADHD in the world health organization world mental health surveys. Atten. Defic. Hyperact. Disord. 9, 47–65 (2017).

    Article  PubMed  Google Scholar 

  3. Faraone, S. V., Biederman, J. & Mick, E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol. Med. 36, 159–165 (2006).

    Article  PubMed  Google Scholar 

  4. Chronis-Tuscano, A. et al. Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Arch. Gen. Psychiatry 67, 1044–1051 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  5. Barkley, R. A. & Fischer, M. Hyperactive child syndrome and estimated life expectancy at young adult follow-up: the role of ADHD persistence and other potential predictors. J. Atten. Disord. 23, 907–923 (2019).

    Article  PubMed  Google Scholar 

  6. Mechler, K., Banaschewski, T., Hohmann, S. & Häge, A. Evidence-based pharmacological treatment options for ADHD in children and adolescents. Pharmacol. Ther. 230, 107940 (2022).

    Article  PubMed  Google Scholar 

  7. The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Arch. Gen. Psychiatry 56, 1073–1086 (1999).

  8. Fiks, A. G., Mayne, S., DeBartolo, E., Power, T. J. & Guevara, J. P. Parental preferences and goals regarding ADHD treatment. Pediatrics 132, 692–702 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Schatz, N. K. et al. Systematic review of patients’ and parents’ preferences for ADHD treatment options and processes of care. Patient 8, 483–497 (2015).

    Article  PubMed  Google Scholar 

  10. FDA announces shortage of Adderall. US Food And Drug Administration https://www.fda.gov/drugs/drug-safety-and-availability/fda-announces-shortage-adderall (1 August 2023).

  11. Rios-Davis, A., Sibley, M. H., Delgado, A. & Zulauf-McCurdy, C. Identifying common and unique elements of evidence-based treatments for adolescent ADHD. J. Child Fam. Stud. 32, 466–480 (2023).

    Article  Google Scholar 

  12. Mikami, A. Y., Smit, S. & Khalis, A. Social skills training and ADHD—What works? Curr. Psychiatry Rep. 19, 93 (2017).

    Article  PubMed  Google Scholar 

  13. Molina, B. S. G. et al. The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. J. Am. Acad. Child Adolesc. Psychiatry 48, 484–500 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Arnett, J. J., Žukauskienė, R. & Sugimura, K. The new life stage of emerging adulthood at ages 18–29 years: Implications for mental health. Lancet Psychiatry 1, 569–576 (2014).

    Article  PubMed  Google Scholar 

  15. Altszuler, A. R. et al. Financial dependence of young adults with childhood ADHD. J. Abnorm. Child Psychol. 44, 1217–1229 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  16. Doshi, J. A. et al. Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States. J. Am. Acad. Child Adolesc. Psychiatry 51, 990–1002 (2012).

    Article  PubMed  Google Scholar 

  17. Anastopoulos, A. D., Langberg, J. M., Eddy, L. D., Silvia, P. J. & Labban, J. D. A randomized controlled trial examining CBT for college students with ADHD. J. Consult. Clin. Psychol. 89, 21–33 (2021).

    Article  PubMed  Google Scholar 

  18. DuPaul, G. J., Evans, S. W., Mautone, J. A., Owens, J. S. & Power, T. J. Future directions for psychosocial interventions for children and adolescents with ADHD. J. Clin. Child Adolesc. Psychol. 49, 134–145 (2020).

    Article  PubMed  Google Scholar 

  19. LaCount, P. A., Hartung, C. M., Canu, W. H. & Knouse, L. E. Interventions for transitioning adolescents with ADHD to emerging adulthood: developmental context and empirically-supported treatment principles. Evid. Based Pract. Child Adolesc. Ment. Health 4, 170–186 (2019).

    Article  Google Scholar 

  20. McCarthy, C. J., Moller, N. P. & Fouladi, R. T. Continued attachment to parents: its relationship to affect regulation and perceived stress among college students. Meas. Eval. Couns. Dev. 33, 198–213 (2001).

    Article  Google Scholar 

  21. Stevens, A. E., Lefler, E. K., Serrano, J. W. & Hartung, C. M. Transitioning to college with ADHD: a qualitative examination of parental support and the renegotiation of the parent-child relationship. Curr. Psychol. 43, 3134–3149 (2023).

    Article  Google Scholar 

  22. Lindell, A. K. & Campione-Barr, N. Continuity and change in the family system across the transition from adolescence to emerging adulthood. Marriage Fam. Rev. 53, 388–416 (2017).

    Article  Google Scholar 

  23. Knouse, L. E. & Fleming, A. P. Applying cognitive-behavioral therapy for ADHD to emerging adults. Cogn. Behav. Pract. 23, 300–315 (2016).

    Article  Google Scholar 

  24. Evans, S. W., Owens, J. S., Mautone, J. A., DuPaul, G. J. & Power, T. J. in Handbook of School Mental Health: Research, Training, Practice, and Policy (eds Weist, M. D. et al.) 413–426 (Springer, 2014).

  25. Turgay, A. et al. Lifespan persistence of ADHD: the life transition model and its application. J. Clin. Psychiatry 73, 10337 (2012).

    Article  Google Scholar 

  26. Kuriyan, A. B. et al. Young adult educational and vocational outcomes of children diagnosed with ADHD. J. Abnorm. Child Psychology 41, 27–41 (2013).

    Article  Google Scholar 

  27. Barkley, R. A., Fischer, M., Smallish, L. & Fletcher, K. Young adult outcome of hyperactive children: adaptive functioning in major life activities. J. Am. Acad. Child Adolesc. Psychiatry 45, 192–202 (2006).

    Article  PubMed  Google Scholar 

  28. Schaefer, M. R. et al. Parent perceptions of their college students’ self-management of attention-deficit/hyperactivity disorder. J. Adolesc. Health 63, 636–642 (2018).

    Article  PubMed  Google Scholar 

  29. Stevens, A. E., Canu, W. H., Lefler, E. K. & Hartung, C. M. Maternal parenting style and internalizing and ADHD symptoms in college students. J. Child Fam. Stud. 28, 260–272 (2019).

    Article  Google Scholar 

  30. Humphreys, K. L. et al. The association of ADHD and depression: mediation by peer problems and parent–child difficulties in two complementary samples. J. Abnorm. Psychol. 122, 854–867 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  31. Meinzer, M. C., Hill, R. M., Pettit, J. W. & Nichols-Lopez, K. A. Parental support partially accounts for the covariation between ADHD and depressive symptoms in college students. J. Psychopathol. Behav. Assess. 37, 247–255 (2015).

    Article  Google Scholar 

  32. Johnston, C. & Chronis-Tuscano, A. in Attention-Deficit/Hyperactivity Disorder: a Handbook for Diagnosis and Treatment 4th edn (ed. Barkley, R. A.) 191–209 (Guilford Press, 2014).

  33. Vasko, J. M., Oddo, L. E., Meinzer, M. C., Garner, A. & Chronis-Tuscano, A. Psychosocial interventions for college students with ADHD: current status and future directions. ADHD Rep. 28, 5–12 (2020).

    Article  Google Scholar 

  34. Rollnick, S. & Miller, W. R. What is motivational interviewing? Behav. Cogn. Psychother. 23, 325–334 (1995).

    Article  Google Scholar 

  35. Sibley, M. H., Graziano, P. A., Coxe, S. J., Bickman, L. & Martin, P. Effectiveness of motivational interviewing-enhanced behavior therapy for adolescents with attention-deficit/hyperactivity disorder: a randomized community-based trial. J. Am. Acad. Child Adolesc. Psychiatry 60, 745–746 (2020).

  36. Meinzer, M. C. et al. Motivational interviewing plus behavioral activation for alcohol misuse in college students with ADHD. Psychol. Addict. Behav. 35, 803–816 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  37. Smeerdijk, M. et al. Motivational interviewing and interaction skills training for parents of young adults with recent-onset schizophrenia and co-occurring cannabis use: 15-month follow-up. Psychol. Med. 45, 2839–2848 (2015).

    Article  PubMed  Google Scholar 

  38. Kline, E. R. et al. Motivational interviewing for loved ones in early psychosis: development and pilot feasibility trial of a brief psychoeducational intervention for caregivers. Front. Psychiatry 12, 659568 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  39. Anastopoulos, A. D. & King, K. A. A cognitive-behavior therapy and mentoring program for college students with ADHD. Cogn. Behav. Pract. 22, 141–151 (2015).

    Article  Google Scholar 

  40. Oguchi, M., Takahashi, T., Nitta, Y. & Kumano, H. The moderating effect of attention-deficit hyperactivity disorder symptoms on the relationship between procrastination and internalizing symptoms in the general adult population. Front. Psychol. 12, 708579 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  41. Knouse, L. E. & Safren, S. A. in ADHD in Adults: A Practical Guide to Evaluation and Management (ed. Surman, C. B. H.) 119–136 (Humana, 2012).

  42. Mazursky-Horowitz, H. et al. Maternal emotion regulation mediates the association between adult attention-deficit/hyperactivity disorder symptoms and parenting. J. Abnorm. Child Psychol. 43, 121–131 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  43. Johnston, C. & Mash, E. J. Families of children with attention-deficit/hyperactivity disorder: review and recommendations for future research. Clin. Child Fam. Psychol. Rev. 4, 183–207 (2001).

    Article  PubMed  Google Scholar 

  44. Psychogiou, L., Daley, D., Thompson, M. & Sonuga‐Barke, E. Testing the interactive effect of parent and child ADHD on parenting in mothers and fathers: a further test of the similarity‐fit hypothesis. Br. J. Dev. Psychol. 25, 419–433 (2007).

    Article  Google Scholar 

  45. Riesch, S. K., Jackson, N. M. & Chanchong, W. Communication approaches to parent-child conflict: young adolescence to young adult. J. Pediatr. Nurs. 18, 244–256 (2003).

    Article  PubMed  Google Scholar 

  46. Elias, R. & White, S. W. Autism goes to college: understanding the needs of a student population on the rise. J. Autism Dev. Disord. 48, 732–746 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  47. Francis, G. L., Stride, A. & Reed, S. Transition strategies and recommendations: perspectives of parents of young adults with disabilities. Br. J. Spec. Educ. 45, 277–301 (2018).

    Article  Google Scholar 

  48. Sibley, M. H. & Carlos, E. Y. ‘Managing ADHD at the post-secondary transition: a qualitative study of parent and young adult perspectives’. School Mental Health 10, 352–371 (2018).

    Article  Google Scholar 

  49. Cui, M., Hong, P. & Jiao, C. Overparenting and emerging adult development: a systematic review. Emerg. Adulthood 10, 1076–1094 (2022).

    Article  Google Scholar 

  50. Nelson, L. J., Padilla-Walker, L. M. & Nielson, M. G. Is hovering smothering or loving? An examination of parental warmth as a moderator of relations between helicopter parenting and emerging adults’ indices of adjustment. Emerg. Adulthood 3, 282–285 (2015).

    Article  Google Scholar 

  51. Wood, J. J., McLeod, B. D., Sigman, M., Hwang, W. C. & Chu, B. C. Parenting and childhood anxiety: theory, empirical findings, and future directions. J. Child Psychol. Psychiatry 44, 134–151 (2003).

    Article  PubMed  Google Scholar 

  52. Kristof-Brown, A. L. & Guay, R. P. in APA Handbook Of Industrial And Organizational Psychology (ed. Zedeck, S.) 3–50 (American Psychological Association, 2011).

  53. Pfeiffer, B., Brusilovskiy, E., Davidson, A. & Persch, A. Impact of person-environment fit on job satisfaction for working adults with autism spectrum disorders. J. Vocat. Rehabil. 48, 49–57 (2018).

    Article  Google Scholar 

  54. Lasky, A. K. et al. ADHD in context: young adults’ reports of the impact of occupational environment on the manifestation of ADHD. Social Sci. Med. 161, 160–168 (2016).

    Article  Google Scholar 

  55. Weiss, M. D. & Weiss, J. R. A guide to the treatment of adults with ADHD. J. Clin. Psychiatry 65, 27–37 (2004).

    PubMed  Google Scholar 

  56. Chronis-Tuscano, A., Wang, C. H., Woods, K. E., Strickland, J. & Stein, M. A. Parent ADHD and evidence-based treatment for their children: review and directions for future research. J. Abnorm. Child Psychol. 45, 501–517 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  57. Stevenson, C. S., Whitmont, S., Bornholt, L., Livesey, D. & Stevenson, R. J. A cognitive remediation programme for adults with attention deficit hyperactivity disorder. Aust. N. Z. J. Psychiatry 36, 610–616 (2002).

    Article  PubMed  Google Scholar 

  58. Schulenberg, J. E. & Zarrett, N. R. in Emerging Adults in America: Coming of Age in the 21st Century (eds Arnett, J. J. & Tanner, J. L.) 135–172 (American Psychological Association, 2006).

  59. Barkley, R. A. Taking Charge of Adult ADHD: Proven Strategies to Succeed at Work, at Home, and in Relationships (Guilford Publications, 2021).

  60. Paidipati, C. P., Brawner, B., Eiraldi, R. & Deatrick, J. A. Parent and family processes related to ADHD management in ethnically diverse youth. J. Am. Psychiatric Nurses Assoc. 23, 90–112 (2017).

    Article  Google Scholar 

  61. Slobodin, O. & Masalha, R. Challenges in ADHD care for ethnic minority children: a review of the current literature. Transcult. Psychiatry 57, 468–483 (2020).

    Article  PubMed  Google Scholar 

  62. Self, K. J. et al. Cultural adaptations of motivational interviewing: a systematic review. Psychol. Serv. 20, 7–18 (2023).

    Article  PubMed  Google Scholar 

  63. Coker, T. R. et al. Racial and ethnic disparities in ADHD diagnosis and treatment. Pediatrics 138, e20160407 (2016).

    Article  PubMed  Google Scholar 

  64. Becker, C. B., Stice, E., Shaw, H. & Woda, S. Use of empirically supported interventions for psychopathology: can the participatory approach move us beyond the research-to-practice gap? Behav. Res. Ther. 47, 265–274 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  65. Thompson, A. E., Morgan, C. & Urquhart, I. Children with ADHD transferring to secondary schools: potential difficulties and solutions. Clin. Child Psychol. Psychiatry 8, 91–103 (2003).

    Article  Google Scholar 

  66. Schmidt, S. & Petermann, F. Developmental psychopathology: attention deficit hyperactivity disorder (ADHD). BMC Psychiatry 9, 1–10 (2009).

    Article  Google Scholar 

Download references

Author information

Author notes

  1. These authors contributed equally: Hong N. T. Bui, Nicholas P. Marsh.

Authors and Affiliations

  1. University of Maryland, College Park, MD, USA

    Hong N. T. Bui, Nicholas P. Marsh & Andrea Chronis-Tuscano

Authors
  1. Hong N. T. Bui
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicholas P. Marsh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea Chronis-Tuscano
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

H.N.T.B. and N.P.M. were responsible for conceptualization and preparing the original draft. A.C.-T. contributed to conceptualization, writing and editing.

Corresponding author

Correspondence to Hong N. T. Bui.

Ethics declarations

Competing interests

A.C.-T. has received research funding from National Institutes of Health and royalties from Oxford University Press.

Peer review

Peer review information

Nature Mental Health thanks Richard Gallagher, Mary Solanto and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bui, H.N.T., Marsh, N.P. & Chronis-Tuscano, A. Perspectives on parental support of attention deficit hyperactivity disorder self-management at the transition to adulthood. Nat. Mental Health 2, 489–495 (2024). https://doi.org/10.1038/s44220-024-00234-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s44220-024-00234-0

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing