New research shows that children with attention deficit/hyperactivity disorder (ADHD) (search) and their families face special challenges that reach far beyond the classroom. Kids with ADHD in the study had more emotional and mental problems than their non-ADHD peers and family relationships were more strained.

The impact on a child's quality of life and the quality of his or her family relationships was directly correlated with the extent of ADHD symptoms, researchers from Vancouver's Children's and Women's Health Center of British Columbia, Canada, reported. Kids with the most severe symptoms or with two or more other psychological conditions had the lowest quality-of-life scores, indicating overall physical, social, and psychological well-being.

"Quality of life is an important measure to consider in evaluating children with ADHD, but we are only just beginning to study it," researcher Anne F. Klassen, DPhil, tells WebMD. "ADHD is the most researched psychiatric disorder in kids, but most of the focus has been on measuring symptoms."

Lower Self-Esteem in ADHD Kids

It is estimated that between 3 percent and 5 percent of children have ADHD; boys are three times more likely to have it than girls. The impact of ADHD on classroom performance has been well studied, but less is known about its impact on overall health and relationships.

In the newly reported study, Klassen and colleagues surveyed 131 children with ADHD and their families using a standardized questionnaire designed to measure overall quality of life. They compared the responses with those of children without ADHD.

While the two groups were similar in terms of physical health, the ADHD kids had more emotional and mental health issues, including low self-esteem. The more ADHD symptoms a child exhibited the lower the quality-of-life score was likely to be. Symptom severity also predicted the likelihood of family stress. Parents of children with the most ADHD symptoms were most likely to report that their child's problems caused them emotional worry and limited the time they had to meet their own needs.

Defiant, Conduct Disorders

While having other psychological conditions had a direct impact on quality of life, some were more significant than others. Children with oppositional defiant disorder and/or conduct disorder — characterized by frequent conflict with parents or other authority figures — had the lowest quality-of-life scores. The research is published in the November issue of the journal Pediatrics.

Pediatrics professor Martin T. Stein, MD, agrees that quality of life measurement has been a neglected outcome in the research evaluating children with ADHD. Stein is director of developmental and behavioral pediatrics at the Children's Hospital San Diego, and is a spokesman for the American Academy of Pediatrics.

"I think clinicians have always included informal assessment of overall well-being in the evaluation and monitoring of children with ADHD," he says. "However, studies like this one help to emphasize the importance of including this measure when we study this disorder."

SOURCES: Klassen, A. Pediatrics, November 2004; vol 114: pp 541-547. Anne Klassen, DPhil, Children's and Women's Health Center of British Columbia, Vancouver, Canada. Martin T. Stein, MD, professor of pediatrics, University of California at San Diego; director, developmental and behavioral pediatrics, Children's Hospital of San Diego; spokesman,

By Salynn Boyles, reviewed by Brunilda Nazario, MD