Prospective study on the impact of parental anxiety on academic performance in children with attention deficit

doi:10.5498/wjp.v15.i12.111663

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Prospective Study

World J Psychiatry. Dec 19, 2025; 15(12): 111663
Published online Dec 19, 2025. doi: 10.5498/wjp.v15.i12.111663

Prospective study on the impact of parental anxiety on academic performance in children with attention deficit

Yan Jin, Yun-Shi Xiao, Ping Zhou

Yan Jin, Ping Zhou, Department of Child Healthcare, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, Hubei Province, China

Yun-Shi Xiao, Department of Pediatric Endocrinology, Genegrow Pediatric Clinic, Shanghai 200233, China

Co-first authors: Yan Jin and Yun-Shi Xiao.

Author contributions: Jin Y was responsible for the overall research design, participant recruitment, data analysis, and manuscript writing; Zhou P provided guidance on the overall direction of the study and contributed to data interpretation and manuscript revision; Xiao YS collected data, coordinated follow-up assessments, and assisted with the statistical analysis and interpretation of results; Jin Y and Xiao YS implemented psychological and academic performance evaluations; Xiao YS, as a co-first author, has made equal contributions; all the authors have reviewed and approved the final manuscript.

Institutional review board statement: This study has been reviewed and approved by the Ethics Committee of Maternal and Child Health Hospital of Hubei Province (approval No. 2018-045-07).

Clinical trial registration statement: This study is registered at the Clinical Registry: https://www.researchregistry.com (Researchregistry11504). Uploaded a separate file as the registration certificate.

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: The authors declare that there is no conflict of interests.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: No data available.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Ping Zhou, MD, Department of Child Healthcare, Maternal and Child Health Hospital of Hubei Province, No. 745 Wuluo Road, Hongshan District, Wuhan 430070, Hubei Province, China. qiu19277250365@163.com

Received: August 6, 2025
Revised: September 7, 2025
Accepted: September 18, 2025
Published online: December 19, 2025
Processing time: 113 Days and 1.4 Hours

Abstract

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) affects approximately 5% of children worldwide and is associated with significant academic impairment. Parents of children with ADHD experience elevated stress and anxiety levels, which may further affect their children's educational outcomes. This prospective study examined the relationship between parental anxiety and academic performance of children with ADHD over a 6-year period.

AIM

To investigate the longitudinal impact of parental anxiety on academic performance in children with ADHD and explore the mediating and moderating factors over a 6-year follow-up period.

METHODS

A longitudinal cohort study was conducted from 2018 to 2024, enrolling 118 children with ADHD (aged 6-12 years) and their parents from three specialized educational centers. Parental anxiety was assessed using the Parenting Stress Index-4 (PSI-4) and Parental Anxiety Scale. Children's academic performance was measured using the Academic Performance Questionnaire and standardized achievement tests. Assessments were conducted at baseline and every 6 months for 3 years.

RESULTS

Higher parental anxiety scores were significantly associated with poorer academic performance in children with ADHD (β = -0.42, P < 0.001). Children of parents with clinically significant anxiety (PSI-4 scores > 85^th percentile) showed 1.2 standard deviations lower academic achievement than children of parents with normal anxiety levels. The relationship was partially mediated by parent-child interaction quality (indirect effect = -0.18, 95%CI: -0.26 to -0.10) and homework supervision practices (indirect effect = -0.15, 95%CI: -0.22 to -0.08).

CONCLUSION

Parental anxiety could significantly affect the academic outcomes of children with ADHD via multiple pathways. Interventions targeting parental mental health may improve the educational outcomes of children with ADHD.

Keywords: Attention deficit hyperactivity disorder; Parental anxiety; Academic performance; Prospective study; Parent-child interaction

Core Tip: This 6-year prospective cohort study examined how parental anxiety affects academic performance in children with attention deficit hyperactivity disorder (ADHD). Higher parental anxiety was significantly associated with lower academic achievement, particularly for mathematics and homework. These effects were mediated by poor parent-child interactions and ineffective homework supervision. Younger age, male sex, ADHD severity, and comorbid anxiety further intensified this impact. These findings highlight the importance of addressing parental mental health in the treatment of ADHD. Interventions targeting parental anxiety may improve academic outcomes and reduce long-term educational disparities in vulnerable populations.