Study reveals perceptual biases between mothers and fathers in ADHD assessments

Research from China uncovers significant differences in how mothers and fathers rate their children’s ADHD symptoms, highlighting the importance of understanding family dynamics in diagnosis and treatment.

A new study in Frontiers in Psychiatry suggests that differences between mothers and fathers in rating children with ADHD are common and may carry more meaning than simple reporting noise. In a sample of 460 Chinese children and adolescents aged 6 to 17, mothers consistently rated inattention, hyperactivity and impulsivity, and oppositional symptoms as more severe than fathers did. The gap was widest for inattention, which is often harder to observe than more outwardly visible behaviour.

The findings come from a single-centre clinical study at a tertiary hospital in south-west China, where parents independently completed the SNAP-IV questionnaire without seeing one another’s responses. The research team used intraclass correlation coefficients to measure agreement and found that parent concordance was modest overall, ranging from low to moderate depending on the symptom item and domain. Agreement was strongest for hyperactivity/impulsivity and oppositional symptoms and weakest for inattention.

What stood out most was that the direction of disagreement often tracked parental beliefs rather than symptom severity alone. Fathers’ belief that the child had ADHD was linked to lower mother-father discrepancy scores across all three domains, while mothers’ belief that the child had ADHD and each parent’s sense of parenting consensus were also associated with the direction of disagreement in different ways. The study found little evidence that overall symptom severity explained which parent gave the higher rating, although severity did appear to be linked more consistently with the size of the disagreement.

The authors argue that this matters because ADHD assessment usually depends on multi-informant reporting, and discrepancies are not necessarily a sign that one parent is wrong. Instead, they may reflect differences in what each parent sees, how they interpret the child’s behaviour and how family dynamics shape judgement. The paper also notes that inattention may be especially prone to disagreement because it is less directly observable in everyday life than restlessness, interrupting or defiance.

The study has limits. It was cross-sectional, so it cannot show cause and effect, and the models explained only a modest share of the variation in disagreement. The sample was also drawn from one hospital and excluded children with major psychiatric comorbidity, which may limit how far the results can be generalised to routine practice. Even so, the authors say the findings support a more nuanced approach to parental disagreement in ADHD, one that treats differences between mother and father reports as potentially useful clinical information rather than background noise.