Hira Khan (URCAD)

Caregivers of children with mental disorders face significant challenges, yet caregiver strain is often underexplored, particularly for ADHD (attention-deficit-hyperactivity disorder) (an externalizing disorder) and anxiety (an internalizing disorder). This study compared caregiver strain between these groups, hypothesizing distinct strain levels based on disorder classification. Using the 2021 National Survey of Children’s Health (NSCH), we analyzed 5,309 children aged 6–17 years, including 2,994 with anxiety and 2,315 with ADHD. A Caregiver Strain Index was developed using four Likert-scale NSCH questions assessing anger, caregiving difficulty, overwhelming demands, and bother, with scores ranging from 4 to 19 (higher scores indicating greater strain). Descriptive statistics and a Wilcoxon Rank Sum test revealed a statistically significant difference in strain levels (p=0.0265). The ADHD group showed a higher rank sum (626,842) than expected (614,625), indicating greater strain, while the anxiety group had a lower rank sum (782,697) than expected (794,970). These findings suggest that caregivers of children with ADHD experience more strain than those of children with anxiety. The study’s large, nationally representative sample strengthens its conclusions. Future research should examine confounding factors affecting caregiver strain and develop targeted support strategies for families of children with externalizing disorders like ADHD.

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number T16MC29832 and title MCH LEAP Training Program. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.