The influence of exposure to parental psychopathology and conflict on functioning and comorbidity in 140 children with ADHD and 120 normal controls was studied at the Pediatric Psychopharmacology Unit in Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston. Increased levels of environmental adversity were found among ADHD compared with control probands for all adversity variables and especially for parental conflict, diminished family cohesion, number of parents with psychiatric illness, and time exposed to maternal psychopathology (p<.01). Superior IQ protected ADHD subjects from negative influences of parental psychopathology. The risk of developing comorbidity (conduct disorder, depression, anxiety) in ADHD subjects was not influenced by environmental adversity. 
COMMENT. Adverse family environments, including chronic family conflict, decreased family cohesion, and exposure to maternal psychopathology, are risk factors in children with ADHD. Early recognition of these environmental factors should lead to intervention and improved outcome. The investigation of children with ADHD is multimodal and requires cooperation between various specialties involved. Parents will usually not accept from a neurologist the reality of their own behavior as a factor in the child’s disorder. The expertise of a psychologist or psychiatrist is required when parental conflict is suspected.