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The Relationship Between Divorce and Children with AD/HD of Different

Subtypes and Comorbidity: Results from a Clinically Referred Sample
Leila D. Heckela; Adam R. Clarkea; Robert J. Barrya; Rory McCarthyb; Mark Selikowitzb
a
School of Psychology and Brain & Behaviour Research Institute, University of Wollongong,
Wollongong, New South Wales, Australia b Sydney Developmental Clinic, Sydney, New South Wales,
Australia

To cite this Article Heckel, Leila D. , Clarke, Adam R. , Barry, Robert J. , McCarthy, Rory and Selikowitz, Mark(2009) 'The
Relationship Between Divorce and Children with AD/HD of Different Subtypes and Comorbidity: Results from a
Clinically Referred Sample', Journal of Divorce & Remarriage, 50: 6, 427 443
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 Journal of Divorce & Remarriage, 50:427443, 2009
Copyright Taylor & Francis Group, LLC
ISSN: 1050-2556 print/1540-4811 online
DOI: 10.1080/10502550902766324

The Relationship Between Divorce and

1540-4811
1050-2556
WJDR
Journal of Divorce & Remarriage,
Remarriage Vol. 50, No. 6, June 2009: pp. 00

Children with AD/HD of Different

Subtypes and Comorbidity: Results
from a Clinically Referred Sample

LEILA D. HECKEL, ADAM R. CLARKE, and ROBERT J. BARRY

AD/HD
L. D. Heckel
and Divorce
et al.

School of Psychology and Brain & Behaviour Research Institute, University of Wollongong,
Wollongong, New South Wales, Australia
Downloaded By: [University Of Melbourne] At: 02:37 14 February 2011

RORY McCARTHY and MARK SELIKOWITZ

Sydney Developmental Clinic, Sydney, New South Wales, Australia

This study investigated the relationship between divorce and the

symptom profile of children with attention deficit/hyperactivity dis-
order (AD/HD). The files of 1,201 children from a pediatric prac-
tice in Sydney, Australia were used in this study. Children were
aged 6 to 18 years, and were diagnosed with either the inattentive
or combined type of AD/HD. Results show that 213 children had
parents who were divorced. Children with the combined type, and
especially boys with comorbid conduct disorder/oppositional defiant
disorder (CD/ODD) were more common in the divorced group,
and children of the inattentive type with comorbid learning dis-
abilities were overrepresented in nondivorced families. Results sug-
gest that divorce is associated with disruptive behavior patterns in
children with AD/HD. The importance of including marital status as
an important correlate in AD/HD treatment outcomes is discussed.

KEYWORDS AD/HD, subtype, gender, age, divorce, comorbidity

Attention deficit/hyperactivity disorder (AD/HD) has been recognized as the

most common behavioral disorder in childhood, characterized by symptoms

This article contains partial results of a PhD research program.

Address correspondence to Adam R. Clarke, School of Psychology and Brain & Behaviour
Research Institute, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522,
Australia. E-mail: aclarke@uow.edu.au

427
 428 L. D. Heckel et al.

of inattention, hyperactivity, and impulsivity (Barkley, 1981). The current Diag-

nostic and Statistical Manual of Mental Disorders (4th ed. [DSMIV]; American
Psychiatric Association, 1994) describes AD/HD as a two-dimensional disorder
with cognitive and behavioral symptoms and defines three subtypes: pre-
dominantly inattentive, predominantly hyperactive-impulsive, and combined
type. Prevalence of AD/HD in Australian children is estimated at 11% (Sawyer
et al., 2000). Children with AD/HD are frequently diagnosed with other
comorbid conditions, such as conduct disorder (CD) and oppositional defi-
ant disorder (ODD; Souza, Serra, Mattos, & Franco, 2001), and learning dis-
abilities (LD; Semrud-Clikeman et al., 1992). In clinic-based studies the
combined subtype has been consistently associated with externalizing disor-
ders (Faraone, Biederman, Weber, & Russell, 1998), whereas the inattentive
subtype has been reported to present with greater impairment in academic
achievement (Marshall, Hynd, Handwerk, & Hall, 1997). Further, disruptive
Downloaded By: [University Of Melbourne] At: 02:37 14 February 2011

disorders and poorer school performances have been more frequently

observed among boys than girls (Biederman, Mick, et al., 2002).
Recent research has focused on studying the etiology of AD/HD. Studies
have shown that the disorder is highly heritable and may be associated with
neurobiological deficits in the cortical and subcortical regions that control
attention and motor behavior (Levy, Hay, McStephen, Wood, & Waldman,
1997; Spencer, Biederman, Wilens, & Faraone, 2002). Further, molecular
genetic studies have implicated the role of various polymorphisms, and the
involvement of several genes in the pathogenesis of AD/HD (Faraone &
Doyle, 2001; Mill et al., 2006). Taylor and Warner-Rogers (2005) suggested
that the quality of caregiving could negatively influence attention, impulse
control, and self-regulation in children with AD/HD. However, to date the
etiology of this disorder is still unclear and research on environmental factors,
such as divorce, as possible risks to the well-being of children with AD/HD
is lacking. Authors such as Barkley (1997) argue that only biological and
genetic factors play an important part in AD/HD, and therefore rule out the
influence of environmental factors. This issue needs to be investigated, as a
belief about the nature of a disorder has a major impact on treatment, and it
is possible that present best practice treatment for AD/HD does not actually
focus on all the factors that contribute to the problem.
The impact of divorce on the mental health of children has been well
documented. Studies suggest that divorce results in poorer academic achieve-
ment and more externalizing behavior problems in children (Forman &
Davies, 2003; Jeynes, 1999). A review of the literature also indicates that the
effect of divorce seems to be more enduring for boys than for girls, with
boys showing more behavior difficulties and poorer academic achievement
than girls (Harold & Conger, 1997; Kinard & Reinherz, 1986).
The relationship between parental divorce and the well-being of chil-
dren with AD/HD has not been widely investigated. Research focused on
families of children with AD/HD has so far found that these families have
 AD/HD and Divorce 429

difficulties in interpersonal relationships and somewhat fewer intact mar-

riages (Barkley, Fischer, Edelbrock, & Smallish, 1990; Biederman, Faraone,
Keenan, Steingard, & Tsuang, 1991; Cohen, Adler, Kaplan, Pelcovitz, &
Mandel, 2002; Kasen, Cohen, Brook, & Hartmark, 1996). However, very few
studies investigated a possible relationship between divorce and AD/HD.
Some researchers have found that adolescents with AD/HD and comorbid
conditions, relative to those with AD/HD alone, were significantly more
common in nonintact families, suggesting that family characteristics are
associated with the presence of more attention problems, CD, ODD, mild
depression, and substance abuse in adolescents with AD/HD (Hurtig et al.,
2007; Hurtig, Taanila, Ebeling, Miettungen, & Moilanen, 2005). Others have
found that harsh and inconsistent parenting, as well as low marital satisfac-
tion and high levels of conflict among family members, correlated with the
occurrence of conduct problems in children with AD/HD (Drabick, Gadow,
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& Sprafkin, 2006). Further, there is evidence in the literature that poor parent-
ing, a chaotic home environment, and marital disharmony are associated
with symptoms of inattention and hyperactivity in children (Brandon, 1971;
Burt, Krueger, McGue, & Iacono, 2003; Rutter, Cox, Tupling, Berger, &
Yule, 1975; Tallmadge & Barkley, 1983; Warner-Rogers, Taylor, Taylor, &
Sandberg, 2000); and others have found that family conflict and low family
cohesion not only correlated with a higher risk for AD/HD, but also with
more problem behavior in domains of internalizing and externalizing and social
functioning in children with AD/HD (Biederman, Faraone, & Monuteaux,
2002). However, the majority of these studies were limited in their sample
size, included mostly boys with AD/HD, did not differentiate between AD/HD
subtypes, and investigated children within a very narrow age range.
The aim of this study is to extend the existing etiological knowledge of
AD/HD by investigating differences in the occurrence of behavioral prob-
lems and learning disabilities among children with AD/HD from divorced
and nondivorced families, and to determine whether divorce is associated
with the symptom profile of these children. Further, subtype, sex, and age
differences are examined.

METHOD
Participants
This study used file audit data from a pediatric practice in Sydney, Australia.
For inclusion in this study, all children had a primary diagnosis of AD/HD
according to DSMIV criteria (American Psychiatric Association, 1994). The
sample consisted of alphabetically consecutive files from the pool of current
patients. The complete case files provided information about the childs
diagnosis, the presence of comorbid psychiatric disorders such as LD and
CD/ODD, the present family situation (e.g., carers, marital status), and
 430 L. D. Heckel et al.

demographic data. The files of 1,201 children, aged 6 to 18 years, were ini-
tially reviewed. From this sample, two groups were selected: (a) children with
AD/HD whose parents were divorced, and (b) children with AD/HD whose
parents were not divorced. For the purposes of this study, divorce was
defined as physical separation or divorce of the childs biological parents. We
excluded children living with adopted or foster families or other carers (e.g.,
grandparents) not as a result of a divorce or separation of their biological par-
ents (e.g., both parents deceased). These files were further reduced to 1,000
individuals, as only one sibling within a family was included in the study.
Where multiple siblings were found, only data from the first file reviewed was
included for analysis. This was done to reduce the possible impact of a single
divorce on multiple children, which might have biased results.
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Procedure
Each participant received a comprehensive clinical assessment by both a
pediatrician and a psychologist, and the clinical records were also reviewed
by a member of the research team (Leila D. Heckel). For the diagnoses of
AD/HD and disruptive behavior problems such as CD/ODD, children had
to meet criteria according to the DSMIV (American Psychiatric Association,
1994). For diagnosis of these conditions, semistructured clinical interviews,
based on DSMIV criteria, were used with all parents. Assessment was fur-
ther based on a physical examination of the child, and diagnoses were also
aided by school reports and reports from other health professionals. Each
child also had a psychometric assessment consisting of the StanfordBinet
Intelligence Scale or different age-related versions of the Wechsler Intelli-
gence Scale. Further, to identify learning disabilities, different standardized,
age-related reading and spelling tests were administered to each child,
including the Neale Analysis of Reading Ability (Neale, 1999), the
Woodcock Reading Mastery TestRevised (Woodcock, 1998), the TORCH
(Mossensen, Hill, & Masters, 1987) or GAPADOL (McLeod, 1989), and the
South Australian Spelling Test (Westwood, 1999). Prior to data collection,
approval of the ethical review board at the University of Wollongong was
obtained for this research study.

Statistical Analysis
At first, an analysis to measure frequencies in the total sample was performed.
This identified the number of divorced and nondivorced cases, prevalence
rates in each sex and AD/HD subtype, and comorbidities in children with
AD/HD. For categorical comparisons, Pearsons chi-square test was used,
with 1 df, and all p values were two-tailed. Further, a comparison of the two
groups (divorced, nondivorced) was performed to find differences between
AD/HD subtypes, age, sex, and other comorbid conditions in participants.
 AD/HD and Divorce 431

RESULTS
Total Group Comparisons
DEMOGRAPHIC DATA

The total sample analyzed contained 1,000 children with AD/HD. Of these,
213 (21.3%) came from families in which the parents were divorced or sep-
arated, and 787 (78.7%) came from families in which the parents were not
divorced or separated. The age of children ranged from 72 to 216 months,
with the mean age of all participants being 120 months. A male to female
ratio of approximately 3:1 was found, with boys (77.7%) being more preva-
lent than girls (22.3%). Within this sample, children with the combined or
inattentive type of AD/HD were nearly equally represented, combined type
(51.0%), inattentive type (49.0%). A prevalence rate of approximately 41%
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was identified for the existence of comorbid psychiatric disorders among

participants with AD/HD. Of the children with AD/HD, 34.5% were also
diagnosed with LD, and 6.7% were diagnosed with disruptive disorders
(CD/ODD).

SUBTYPE DIFFERENCES

Gender differences and the presence of other comorbid conditions within

the subtypes are presented in Table 1. Results indicated that boys were
significantly more likely to be diagnosed with the combined type of AD/HD,
whereas girls were more commonly diagnosed with the inattentive type,
c2(1, N = 1,000) = 48.248, p < .001. The presence of LD was significantly
elevated in the children with inattentive type of AD/HD, but less com-
mon in the combined type, c2(1, N = 1,000) = 25.478, p < .001. In contrast,
CD/ODD was significantly more frequent in our children with the com-
bined type of AD/HD than in the inattentive type, c2(1, N = 1,000) = 46.035,
p < .001.

TABLE 1 Attention Deficit/Hyperactivity Disorder (AD/HD) Subtype Comparisons on

Comorbidities and Gender of Children with AD/HD

Total
sample LD CD/ODD Boys Girls

n % n % n % n % n %

Inattentive type 490 49 207** 42 6 1 355 68 155* 32

Combined type 510 51 138 27 61** 12 442** 87 68 13
Total 1000 100 345 35 67 7 777 78 223 22
Note. LD = learning disorder; CD/ODD = conduct disorder/oppositional defiant disorder.
*p < .001.
 432 L. D. Heckel et al.

Divorced and Nondivorced Group Comparisons

DIFFERENCES IN COMORBIDITY

Table 2 shows the comorbidity of our children with AD/HD, comparing

divorced and nondivorced families. The presence of CD/ODD in children
with AD/HD differed significantly and this was due to the higher occurrence
of CD/ODD in the divorced families, 2(1, N = 1,000) = 10.974, p < .001. No
significant results were found for learning disabilities.

AGE DIFFERENCES

Figure 1 shows the incidence of divorce in the families of children with AD/HD
as a function of age. A significant age-related difference was found in the
parents marital status. There was a linear trend with increasing number of
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divorces with increasing age of children with AD/HD, and a corresponding

TABLE 2 Comparison of Divorced and Nondivorced Families of Our Children with

AD/HD by Comorbidity

Total sample LD CD/ODD

n % n % n %

Divorced 213 21 67 32 25* 12

Nondivorced 787 79 278 35 42 5
Total 1,000 100 345 34 67 7
Note. AD/HD = attention deficit hyperactivity disorder; LD = learning disorder; CD/ODD = conduct
disorder/oppositional defiant disorder.
*p < .001.

90
Percentage with disorder

80
70
60
__ _ ND
50
_ __ D
40
30
20
10
0
6 8 10 12 14 16 18
Age

FIGURE 1 Age of children with AD/HD from divorced and nondivorced families.
 AD/HD and Divorce 433

TABLE 3 Comparison of Age Differences in Children with ADHD by Comorbid Conditions

in Divorced and Nondivorced Families

LD CD/ODD

Total
sample Total NDa Db Total NDa Db

Age group n % n % n % n % n % n % n %

1 (69 years) 514 51 164 32 136 33 28 29 32 6 23 5 9 9

2 (1012 years) 268 27 121 45 96 47 25 40 17 6 10 5 7 11
3 (1315 years) 163 16 50 31 38 31 12 29 13 8 6 5 7* 2
4 (1618 years) 55 6 10 18 8 20 2 14 5 9 3 7 2 14
Total 1,000 100 345 34 278 35 67 31 67 7 42 5 25 12
Note. AD/HD = attention deficit hyperactivity disorder; LD = learning disorder; CD/ODD = conduct
disorder/oppositional defiant disorder; ND = nondivorced; D = divorced.
a
n = 787. bn = 213.
Downloaded By: [University Of Melbourne] At: 02:37 14 February 2011

*p < .05.

trend of declining numbers of nondivorces with increasing age of children,

2(1, N = 1,000) = 4.206, p < .05.
When investigating differences in the occurrence of comorbid condi-
tions among various age groups, significant results were only found for chil-
dren in age Group 3 (1315 years; see Table 3). The presence of CD/ODD
in children with AD/HD was significantly higher in the divorced group than
expected, 2(1, N = 163) = 6.140, p < .01. No significant differences were
found for LD.

SUBTYPE DIFFERENCES

Table 4 presents the rates of LD and CD/ODD in children with AD/HD as a

function of divorce, for both the inattentive and combined types of AD/HD
separately. In children with the inattentive type, the presence of LD was
significantly lower in the divorced compared to the nondivorced group,
2(1, N = 490) = 5.590, p < .01. In children with the combined type of AD/HD,
CD/ODD was significantly higher in the divorced families, 2(1, N = 510) =
4.015, p < .05.
Figures 2 and 3 show the results for parents marital status as a function
of age of children with AD/HD for the subtypes separately. With children of
the combined subtype, a significant age-related difference was found in the
parents marital status. There was a linear trend with increasing numbers of
divorces with increasing age of children with the combined subtype, and a
corresponding trend of declining numbers of nondivorces with increasing
age of the children, 2(1, N = 510) = 4.006, p < .05. In contrast, with chil-
dren of the inattentive subtype, no significant age-related difference was
 434 L. D. Heckel et al.

TABLE 4 Comparison of AD/HD Subtypes by Comorbid Conditions in Divorced and

Nondivorced Families

LD CD/ODD

Total
sample Total NDa Db Total NDa Db

Type n % n % n % n % n % n % N %

Inattentive 490 49 207 42 179** 45 28 31 6 1 2 .5 4 4

Combined 510 51 138 27 99 26 39 32 61 12 40 10 21* 17
Total 1,000 100 345 34 278 35 67 31 67 7 42 5 25 12
Note. AD/HD = attention deficit hyperactivity disorder; LD = learning disorder; CD/ODD = conduct
disorder/oppositional defiant disorder; ND = nondivorced; D = divorced.
a
n = 787. bn = 213.
*p < .05. **p < .01.
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90
80
Percentage with disorder

70
60
50 ___ND
___D
40
30
20
10
0
6 8 10 12 14 16 18
Age

FIGURE 2 Number of children with AD/HD combined type from divorced and nondivorced
families as a function of age.

found in the parents marital status, but a tendency toward a similar signifi-
cant linear effect was noted, 2(1, N = 490) = 3.213, p = .07.
No significant subtype differences were found between the divorced
and nondivorced group in the comparison of the two sexes.

GENDER DIFFERENCES

Table 5 shows the incidence of LD and CD/ODD in children with AD/HD

as a function of divorce for the genders separately. Analysis of the preva-
lence of CD/ODD among girls was inconclusive due to the small sample
size. However, in boys the presence of CD/ODD was significantly increased
 AD/HD and Divorce 435

90
80

Percentage with disorder

70
60

50 ___ND

40 ___D

30
20
10
0
6 8 10 12 14 16 18
Age

FIGURE 3 Number of children with AD/HD inattentive type from divorced and nondivorced
families as a function of age.
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TABLE 5 Comparison of Gender Differences in Children with AD/HD by Comorbid

Conditions in Divorced and Nondivorced Families

LD CD/ODD

Total
sample Total NDa Db Total NDa Db

n % n % n % n % n % n % n %

Boys 777 78 262 34 209 34 53 31 55 7 36 6 19* 11

Girls 223 22 83 37 69 38 14 37 12 5 6 3 6 14
Total 1,000 100 345 34 278 35 67 31 67 7 42 5 25 7
Note. AD/HD = attention deficit hyperactivity disorder; LD = learning disorder; CD/ODD = conduct
disorder/oppositional defiant disorder; ND = nondivorced; D = divorced.
a
n = 787. bn = 213.
*p < .01.

in the divorced families compared to the nondivorced families, 2(1, N = 777) =

5.686, p < .01. No significant results were found for learning disabilities.

DISCUSSION

This study investigated the occurrence of comorbid behavioral problems

(CD/ODD) and LD among children with AD/HD from divorced and nondi-
vorced families. Boys were more common than girls (approximately 3:1)
within this clinical group, which is consistent with several other studies
(Hartung et al., 2002; Nolan, Volpe, Gadow, & Sprafkin, 1999). Within this
sample, children with the combined subtype were slightly more common
 436 L. D. Heckel et al.

than those with the inattentive subtype of AD/HD. This is in accordance

with some clinic-based studies (Morgan, Hynd, Riccio, & Hall, 1996) but not
with others (Counts, Nigg, Stawicki, Rappley, & Von Eye, 2005; Faraone et al.,
1998). Additionally, boys were more frequently diagnosed with the combined
than the inattentive subtype (6.5:1), suggesting that boys are more severely
impaired than girls, and therefore more likely to be referred for clinical
assessment. Comorbid LD in children with AD/HD was more common than
comorbid CD/ODD. In addition to prevalence rates of AD/HD subtypes,
comorbid conditions are important aspects of the validity of diagnostic cate-
gories. Our findings that CD/ODD was significantly more prevalent in chil-
dren diagnosed with the combined subtype are congruent with findings in
the literature (Faraone et al., 1998; Morgan et al., 1996). LD was significantly
more common in the inattentive subtype, which corresponds with findings
by others (Marshall et al., 1997; Morgan et al., 1996). In accord with the lit-
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erature (Hartung et al., 2002), our study found that a diagnosis of the com-
bined subtype was significantly more common among boys, whereas the
inattentive subtype of AD/HD was significantly more diagnosed among girls.
However, these results are in contrast to other studies (Morgan et al., 1996;
Nolan et al., 1999) that found no differences in boys or girls for the various
subtypes. No significant gender differences were found in this study in
regard to comorbid CD/ODD and LD. These results are in accordance with
previous clinic-based studies that did not find gender differences in children
with AD/HD for comorbid conditions (Gaub & Carlson, 1997; Hartung et al.,
2002).
The influence of environmental factors on children with AD/HD has
generally been disregarded in preference for neurologically based models
of the disorder, which have primarily been used as the basis for the use of
stimulant medications as a first line of treatment in the United States and
Australia (Castellanos et al., 1996; Levy, 1991). However, the literature on divorce
suggests that children from divorced families present with more behavioral
problems and academic underachievement than those of nondivorced fami-
lies (Harold & Conger, 1997; Kinard & Reinherz, 1986). Therefore this study
aimed to investigate the relationship between an environmental factor,
parental divorce, and the symptom profile of children with AD/HD.
This study found significant differences in the rates of comorbidities
between children from divorced and nondivorced families. Children with
AD/HD and comorbid CD/ODD were significantly more common in divorced
families. However, no significant differences where found for comorbid LD.
There are two possible explanations for these results. First, marital conflict
and the family changes related to parental divorce might have a negative
impact on the childs behavior and could lead to more disruptive behavior
patterns in children with AD/HD. A possible relationship between CD or ODD
symptoms in children with AD/HD and family adversity has been proposed
(Counts et al., 2005; Drabick et al., 2006; Hurtig et al., 2007; Hurtig et al.,
 AD/HD and Divorce 437

2005), and others have suggested that secondary environmental or social

factors are associated with ODD in children with AD/HD (Satterfiels &
Schell, 1984). Further, on the basis of a lack of electrophysiological differences
between children with AD/HD, with and without CD/ODD, it has been sug-
gested that social and environmental factors are largely responsible for the
behavioral problems in children with AD/HD (Clarke, Barry, McCarthy, &
Selikowitz, 2002). The results reported here, when taken in the context of
past research into CD/ODD, would suggest that marital conflict is associated
with the symptom profile of children with AD/HD, and that environmental
factors should be considered when assessing and planning treatment regimes
for these children. A second possible interpretation is that these children
contribute to the breakdown of their parents marriage. Considering the fact
that children with disruptive behavior patterns are more difficult to control,
which might cause additional stress, conflict, and argument among couples,
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it is possible that the childs behavior might contribute to stress within the
marriage. There is some suggestion in the literature that negative parenting
might be a response to the childs disruptive behavior rather than the cause of it
(Bell & Harper, 1977; Humphries, Kinsbourne, & Swanson, 1978; Maniadaki,
Sonuga-Barke, Kakouros, & Karaba, 2005). However, this factor needs further
investigation.
Within the AD/HD literature, Graetz, Sawyer, Hazell, Arney, and Baghurst
(2001) studied subtype differences in children aged 6 to 17 years, and found
that the problems associated with the combined subtype of AD/HD were
related to greater disruption of family activities and greater limitations on
the amount of time parents had for their own personal needs, compared
with the problems displayed by children of the inattentive or hyperactive-
impulsive subtype. These findings were confirmed in this study where the
combined subtype was found to be more common in the divorced group
than the inattentive subtype, indicating a ratio of approximately 1.5:1, whereas
in the nondivorced group a ratio of 1:1 was observed. This study also aimed
to extend the investigation of subtype differences in terms of comorbidity,
as no divorce studies of AD/HD had investigated the occurrence of comorbid
conditions among subtypes of children from divorced and intact families.
Significant differences in AD/HD subtypes were found between children
from divorced and nondivorced families in this study. Children with the
inattentive subtype of AD/HD with a comorbid diagnosis of LD were signif-
icantly less common in divorced families. In contrast, children with the com-
bined subtype of AD/HD with CD/ODD were significantly more common in
divorced families. Again, these findings point to the stronger relation between
marital problems and CD/ODD behaviors than academic problems in chil-
dren with AD/HD. Because the combined subtype of AD/HD is more prone
to disruptive behavior, those children with a codiagnosis of CD/ODD might
experience more problems at home than those with comorbid LD. Counts et al.
(2005) found comparable results, indicating that family adversity is related to
 438 L. D. Heckel et al.

ODD symptoms in children with the combined subtype of AD/HD. In addi-

tion, this study found significant age-related differences among the subtypes
between the two groups. There was a linear trend with increasing number
of divorces with increasing age of children with the combined subtype, and
a corresponding trend of declining numbers of nondivorces with increasing
age of these children. In contrast, no significant age-related differences were
found for children of the inattentive subtype; however a tendency toward a
similar linear effect was noted.
Within the divorce literature for AD/HD, very few studies have investi-
gated age differences in children with this disorder who experienced the
divorce of their biological parents. Hurtig et al. (2007) studied adolescents
with AD/HD, aged 16 to 18 years, and found that those who presented with
comorbid conditions, such as CD, ODD, mild depression, or substance
abuse, were more common in nonintact families relative to those with AD/HD
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alone. The problem with this study is the use of a very narrow age range
that focused on participants in late adolescence only. This limitation makes
it difficult to draw conclusions on age differences in children with AD/HD
from divorced families. This study found a linear trend of increasing num-
bers of divorces with increasing age of children with AD/HD. Further, sig-
nificant differences were found for the older children (1315 years), with a
higher occurrence of CD/ODD in the divorced group. However, no significant
differences were found for LD. These findings suggest that parents might
wait to divorce until their children get older. Further, divorce is associated
with the presence of disruptive disorders in older children with AD/HD, and
this result reflects findings in the literature, suggesting a higher occurrence of
conduct problems during adolescence in general (Hetherington, 1993) and
in teenagers from divorced families in particular (Cooney, Smyer, Hagestad, &
Klock, 1986).
Within the divorce literature of AD/HD, there are very limited studies
investigating differences in effects of parental divorce associated with gender.
Counts et al. (2005) found a relationship between family adversity and AD/HD
in girls, particularly in those of the combined subtype. This study expanded
on this limited foundation by examining the associations of parental divorce
and the psychological well-being of boys and girls with this disorder. Our
results show that boys with AD/HD and comorbid CD/ODD are signifi-
cantly more likely to live with divorced parents. Further, the fact that boys
with AD/HD and comorbid CD/ODD are more common in divorced families
whereas boys and girls with LD are more frequent in nondivorced families
suggests once more that disruptive behaviors in children with AD/HD are
associated with marital discord more than are academic problems in children
with AD/HD. These findings were expected, as previous research suggests a
neurological basis for LD, including a central nervous system processing
deficiency (Casey, Rourke, & DelDotto, 1996; Marshall et al., 1997), whereas
CD/ODD are considered to be behavioral disorders associated with lower
 AD/HD and Divorce 439

socioeconomic status and greater family dysfunctions (Cantwell, 1996; Frick

et al., 1992). Further Trzesniewski, Moffitt, Caspi, Taylor, and Maughan
(2006) implicated an overlap between LD and AD/HD due to shared genetic
influences but not environmental factors. Finally, others failed to find an
association between learning disabilities in children with AD/HD and family
conflict (Biederman, Faraone, et al., 2002). Thus, these results suggest that
parental divorce correlates with an increase in disruptive behavior in chil-
dren with AD/HD, but seems to be unrelated to learning difficulties.
This study extended the literature regarding a possible relationship
between environmental factors and comorbid conditions in children with
AD/HD. Findings of this study showed that rates of CD/ODD were signifi-
cantly increased in children with AD/HD from divorced families, with main
effects for those of the combined subtype, boys and adolescents, which
suggests that divorce is associated with the occurrence of externalizing dis-
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orders in these children. However, disruptive behaviors might increase marital

discord and thereby increase the divorce rate within these families. This study
cannot fully determine whether divorce can be seen as a possible cause or
an effect of cooccurring CD/ODD in children with AD/HD. Therefore this
issue will be investigated further in one of our subsequent studies. How-
ever, it appears that parental divorce might not be associated with LD in
children with AD/HD. This is possibly attributable to the neurological basis
of LD, which implies that LD is relatively unaffected by environmental factors.
Findings in this study thus suggest that appropriate interventions in treat-
ment programs might be critical to improve family functioning for children
with AD/HD and to minimize parental discord, especially in those families
with comorbid CD/ODD.

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