Beyond Symptoms: The Impact of Stigma in Families of Children With ADHD

This article reviews how stigma affects families of children with attention-deficit/hyperactivity disorder (ADHD)—undermining help‑seeking, adherence, and well‑being—and offers clinician strategies to counter it, including destigmatizing language, brief caregiver screening, family psychoeducation, and school partnerships.

ADHD is a common neurodevelopmental disorder, with a global prevalence ranging from 2% to 7%.¹ Historically, ADHD research has prioritized symptom control as the primary goal of treatment.² More recently, emphasis has shifted toward understanding the broader impact of ADHD, including how the condition affects family dynamics² and how those dynamics, in turn, influence the patient's daily functioning.^1,3  

The Interplay of Caregiver Stress and Stigma in ADHD 

Caring for a child with ADHD is consistently associated with elevated caregiver stress, often exacerbated by stigma and feelings of shame. Studies in the United States, Canada, and Australia consistently show that parents of children with ADHD experience higher parenting stress than controls, and a meta-analysis of 44 studies confirmed this pattern.¹ Qualitative studies indicate that stigma-related stress can impair parents’ ability to manage behaviors, maintain family relationships, and preserve self-confidence.¹ 

Caregivers of individuals with mental health conditions often internalize societal stigma—a process referred to as affiliate stigma.³ Affiliate stigma may manifest at cognitive (agreement with public stigma), emotional (shame, embarrassment, distress), and behavioral (withdrawal from social interaction or even emotional distancing from the affected child) levels. These patterns have been well documented among caregivers of individuals with serious mental illness, including ADHD, where shame and stigma may result in social avoidance, reluctance to follow medical advice, or, in extreme cases, withdrawal from caregiving responsibilities—each of which may harm the child’s well-being.^3,4  

Parenting stress can be conceptualized in three domains: parental distress (PD), parent–child dysfunctional interaction (PCDI), and difficult child (DC).¹ These domains reflect caregivers’ emotional burden, challenges in parent–child relationships, family conflict, and perceptions of the child’s difficulty with self-regulation—all of which may be intensified by internalized shame and public stigma.¹ 

These stressors stem from a complex interplay between child- and parent-related factors.¹ Parent-related contributors include caregiver depression, maternal anxiety, and parental ADHD symptoms; affiliate stigma is strongly associated with all three of these stress domains, independent of child symptoms.¹ It is also associated with higher levels of caregiver depression and anxiety, lower life satisfaction, more negative parenting behaviors, and delays in seeking treatment—demonstrating how stigma can permeate the family system.¹  

Child-Related Contributors to Caregiver Stress 

Child-related factors contributing to parenting stress include ADHD severity, symptoms of oppositional defiant disorder (ODD), conduct issues, aggression, emotional dysregulation, and executive functioning impairments.¹ ODD is particularly impactful: mothers of children with both ADHD and ODD report greater stress than mothers of children with ADHD or ODD alone, and elevated ODD symptoms appear to magnify the influence of affiliate stigma on caregiver stress.¹ Higher ODD symptoms amplify the impact of affiliate stigma on parenting stress.¹ Collectively, these findings suggest a cyclical process in which stigma and internalized shame interact with child-specific factors (especially ODD) and caregiver mental health, compounding parenting stress and negatively affecting care. 

The Overlooked Role of Stigma in ADHD Interventions 

These insights highlight the need for interventions that address both parenting stress and stigma. Psychoeducation aimed at improving public awareness of ADHD may help reduce both stigma and internalized shame.¹ Interventions that equip caregivers with coping skills, strengthen parent management training, offer social support, and reduce ADHD symptoms may alleviate stress.¹ However, the role of stigma and shame in ADHD care remains underexplored. For example, when parents and children receive psychoeducation together, the programs typically emphasize ADHD information, treatment, and developmental course but focus less on self-image, self-esteem, and stigma—highlighting a need to develop interventions that more directly address the shame and stigma.⁵ Given the significant impact of ODD on family functioning, early diagnosis and tailored intervention may reduce symptom severity and help mitigate the amplifying effects of stigma on caregiver stress and child outcomes.¹  

References

1. Lin PY, Chou WJ, Hsiao RC, Liu TL, Yen CF. Association of affiliate stigma with parenting stress and its moderators among caregivers of children with attention-deficit/hyperactivity disorder. Int J Environ Res Public Health. 2023;20(4):3192. doi:10.3390/ijerph20043192 
2. French B, Nalbant G, Wright H, et al. The impacts associated with having ADHD: an umbrella review. Front Psychiatry. 2024;15:1343314. doi:10.3389/fpsyt.2024.1343314 
3. Chen YL, Chang CC, Chen YM, et al. Association between affiliate stigma and depression and its moderator in caregivers of children with attention deficit/hyperactivity disorder. J Affect Disord. 2021;279:59-65. doi:10.1016/j.jad.2020.09.121 
4. Schoeman R, Voges T. Attention-deficit hyperactivity disorder stigma: the silent barrier to care. S Afr J Psychiatry. 2022;28:1865. doi:10.4102/sajpsychiatry.v28i0.1865 
5. Morris D, Agha SS, Cooper M, Langley K. Content of attention-deficit hyperactivity disorder psychoeducation packages: scoping review. BJPsych Bull. Published online August 12, 2025:1-12. doi:10.1192/bjb.2025.10121