Parenting Styles and Attention Deficit Hyperactivity Disorder in the South Asian Population: A Narrative Review

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder marked by persistent inattention, hyperactivity, and impulsivity that impair daily functioning across academic, social, and emotional domains, often persisting into adulthood if untreated. Although well-studied in Western contexts, research on ADHD within South Asian communities (e.g., Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, Sri Lanka) is scarce. Stigma toward mental illness, language barriers, limited culturally competent services, and low awareness contribute to underdiagnosis and undertreatment. Parenting styles—shaped by collectivist values, respect for authority, patriarchal structures, and emphasis on academic excellence—may influence ADHD symptom expression, recognition, and management. This review examines how South Asian cultural norms and family dynamics intersect with parenting styles to affect ADHD presentation, diagnosis, and care, identifying gaps and informing culturally tailored interventions.

The literature indicates parenting practices are associated with ADHD symptomatology, with differential maternal and paternal effects (e.g., inconsistent maternal discipline and paternal low involvement). Outside specifically South Asian samples, studies suggest authoritarian or harsh practices can relate to worse behavioral outcomes, whereas authoritative approaches may buffer difficulties. Within South Asian or Asian diaspora contexts, evidence points to culturally influenced parenting (collectivism, achievement orientation, hierarchical structures) with variability by host-country context and acculturation. Prevalence studies show lower reported ADHD diagnosis among Asian/South Asian youth compared to White peers, potentially reflecting underrecognition, access barriers, and stigma. Stigma studies within South Asian communities highlight negative attitudes toward mental health services, with gendered differences (e.g., more negative attitudes among males). Limited intervention work in South Asia (e.g., culturally contextualized parent skills training in India) shows promise for improving ADHD symptoms and academic/behavioral functioning, though implementation challenges exist. Overall, the literature underscores cultural moderation of parenting effects on child outcomes and potential underestimation of ADHD in South Asian populations due to systemic and cultural barriers.

Narrative review with systematic search elements. Databases: PubMed and Google Scholar. Search window: April 15, 2024–May 15, 2024. Inclusion: peer-reviewed, English-language articles (2000–2024) focusing on South Asian populations; ADHD or ADHD symptoms in relation to parenting styles; studies involving South Asian children, adolescents, or families. Exclusion: non–peer-reviewed items, opinion pieces/letters, studies unrelated to South Asians, ADHD, or parenting styles; non-standardized diagnostic measures or insufficient rigor; duplicates removed. Search strategy used Boolean operators and terms including “South Asian,” “Asian,” “South Asian children,” “ethnicity,” “mental illness/mental health,” “ADHD/Attention Deficit Hyperactivity Disorder,” “Parenting styles,” and “PCIT.” Initial retrieval totaled 133 articles (narrowed to 39 with mental health/ADHD terms). Iterative combinations targeting parenting styles and ADHD in South Asians led to a final set of 13 studies after eligibility screening. PRISMA guidelines were followed. PRISMA accounting in the article shows: records identified n=40; screened n=40; excluded n=27; assessed for eligibility n=13; included n=13. Study designs included among the final set: one systematic review and meta-analysis, one retrospective cohort study, nine cross-sectional studies, one randomized pre–post intervention study, and one case-control study. The timeframe was chosen to encompass DSM-IV to DSM-5 transitions and technological/societal changes affecting ADHD research and minority mental health care.

- Parenting practices and ADHD (Ellis & Nigg, 2009): Maternal inconsistent discipline associated with ADHD-Combined type (partial η²=0.14, p<0.001) independent of ODD/CD and parental ADHD; paternal low involvement associated with ADHD symptoms (partial η²=0.092, p<0.002; reduced to marginal p=0.051 after controlling paternal ADHD). Maternal inconsistent discipline correlated with inattention (r=-0.26), hyperactivity (r=-0.31), oppositionality (r=-0.32), conduct problems (r=-0.27), all p<0.001. Paternal involvement inversely related to inattention (r=-0.27, p<0.01). - Parenting styles in ADHD vs controls (Moghaddam et al., 2013, Iran): Parents of children with ADHD had lower permissive scores (M=27.4 vs 29.0, p=0.019) and higher authoritarian scores (M=23.5 vs 20.3, p<0.001); authoritative scores did not differ (p=0.646). - Parenting style and college adjustment with adult ADHD symptoms (Jones et al., 2015, USA undergrads): Academic adjustment negatively correlated with ADHD symptoms (r=-0.44, p<0.001); declines observed across varying levels of authoritarian and authoritative parenting when ADHD symptoms increased. - South Asian parenting patterns in diaspora (Yim, 2022, Hong Kong): In South Asians, adherence to Asian cultural values positively associated with authoritative parenting (R²=0.597); no significant links for authoritarian (R²=0.145) or permissive (R²=0.268). Suggests acculturation-linked emphasis on authoritative practices. - Cultural moderation of harshness and behavior (Ho et al., 2008, Canada): South Asian Canadian families reported less parental harshness than European Canadians (β=-0.147, p<0.05). Effects of harshness on child aggression varied by culture; South Asian children showed lower aggression in school even at higher harshness; parent-reported aggression lower among East Asian, South Asian, Caribbean vs European Canadian (β≈-0.014 to -0.027, all p<0.05). - Bangladesh adolescents (Stewart et al., 2000): Gendered effects of perceived parenting; higher dominating control linked to lower academic achievement for females but higher for males; supervision benefited females’ academics; warmth related to better relationship harmony (notably for males); self-derogatory ideation mediated links for females (22% variance, p=0.002). - Pakistan university students (Saleem et al., 2021): Parental overprotection and rejection associated with lower distress tolerance and higher psychological distress; emotional warmth buffered negative effects of rejection (interaction B≈-0.42 to -0.45, p<0.001). - ADHD diagnosis and treatment disparities (Adams et al., 2024, US claims): Asians had lower ADHD diagnosis at ages 12–14 (3.1% vs 10.6% in Caucasians; PR=0.29, 95% CI 0.28–0.30) and slightly lower treatment once diagnosed (80.8% vs 86.1%; PR=0.94). - Community sample self-/parent-reported diagnoses (Dissanayake et al., 2024, Canada): South Asians had 88% lower odds of self-reporting ADHD diagnosis vs Caucasians; recruitment context and self-report limit inference. - South Asia ADHD prevalence (Ranjan et al., 2024, meta-analysis of 61 studies): Pooled prevalence 61.9/1,000 (6.19%; 95% CI 4.78–7.76), higher in males (82.6/1,000) vs females (48.3/1,000); higher in urban (72.2/1,000) vs rural (42.9/1,000) settings; barriers (access, stigma, education) likely contribute to underrecognition. - Culturally contextualized parent skills training, India (Shah et al., 2021): Significant improvements in inattention (p<0.001), hyperactivity (p=0.007), conduct problems (p<0.002), academic performance (p<0.001), classroom behavior (p=0.001) post-intervention; high perceived helpfulness, but sustainability and family-wide adoption were challenges. - Stigma and help-seeking (Arora et al., 2016, US South Asian students): More negative attitudes toward seeking professional psychological help (p<0.001), with males holding more negative attitudes (p<0.05); perceived stigma by others not significantly linked (p=0.156). - Indian mothers’ knowledge/attitudes (Cadet et al., 2019): Only 35% had ADHD knowledge; factors associated with ≥6 ADHD-like behaviors included child gender (p=0.014), mother’s state of upbringing (p=0.035), parental behavior-management knowledge (p=0.008), ADHD knowledge (p=0.000), willingness to seek help (p=0.032). Common behaviors: hyperactivity (75%), distractibility (74%), fidgeting (70%), inattentiveness (69%).

Findings across diverse contexts suggest parenting practices influence ADHD-related outcomes, with inconsistent discipline and low parental involvement linked to greater symptom burden. In South Asian contexts, culturally shaped parenting—emphasizing achievement, respect for authority, and family cohesion—can manifest as more controlling/dominant practices, which may inadvertently exacerbate ADHD-related inattention or oppositional behaviors. However, diaspora studies also show variability: some South Asian families adopt more authoritative approaches through acculturation, which may buffer adverse outcomes. The consistently lower rates of ADHD diagnosis and treatment among Asian/South Asian youth likely reflect stigma, limited culturally competent services, language barriers, and access constraints, rather than truly lower disorder prevalence. Intervention evidence from India demonstrates that culturally tailored parent training can improve core symptoms and functional outcomes, though sustained implementation and broader family engagement are challenging. Together, these findings support the review’s premise that cultural norms and parenting styles shape ADHD presentation and management in South Asians and highlight the need for culturally informed screening, psychoeducation, and family-based interventions to reduce disparities.

Research on ADHD and parenting styles specific to South Asians is limited but points to critical gaps in diagnosis, treatment, and culturally appropriate care. Authoritarian or controlling parenting practices may add pressure and risk exacerbating ADHD symptoms, while authoritative practices and culturally contextualized parent training show promise for improving outcomes. To reduce disparities, future work should: (1) conduct larger, culturally disaggregated studies across South Asian subgroups and host countries; (2) develop and evaluate culturally tailored, scalable parenting interventions; (3) address stigma via community engagement and education; and (4) expand access to culturally competent services and inclusive research participation. Integrating cultural understanding into clinical practice and policy is essential for equitable ADHD care for South Asian families.

Review-level limitations include: (1) a small evidence base specifically linking South Asian parenting styles to ADHD; (2) English-language, peer-reviewed publication restriction (2000–2024), potentially omitting relevant non-English or gray literature; and (3) heterogeneity and predominance of cross-sectional, self-report designs among included studies, limiting causal inference and generalizability. The limited number of South Asian-specific studies and aggregation of diverse South Asian subgroups further constrain conclusions, underscoring the need for more rigorous, culturally specific research, including work in adults over 18 years.