Attention Deficit Hyperactivity Disorder: Psychological Factors - Article Example

ATTENTION DEFICIT HYPERACTIVITY DISORDER: PSYCHOSOCIAL FACTORS IN CAUSATION AND DEVELOPMENT, IMPLICATIONS IN HEALTH CARE ATTENTION DEFICITHYPERACTIVITY DISORDER: PSYCHOSOCIAL FACTORS IN CAUSATION AND DEVELOPMENT, IMPLICATIONS IN HEALTH CARE Abstract Attention Deficit Hyperactivity Disorder is a developmental disorder with mental health problems and is found to affect 3 to5% of all children. Many researches have been done on the causes of this disorder but true explanations span over biological, psychological and sociological realms. A good understanding of the psychosocial factors influencing ADHD is needed to understand this disorder and then to implement health care practices. A discussion of these factors is presented in this essay and the need for knowledge of these aspects for effective health care is assessed in the paper. ATTENTION DEFICIT HYPERACTIVITY DISORDER: PSYCHOSOCIAL FACTORS IN CAUSATION AND DEVELOPMENT, IMPLICATIONS IN HEALTH CARE Definition of ADHD: Attention Deficit Hyperactivity Disorder is a common developmental and behavioral disorder characterized by poor concentration, distractibility, hyperactivity and impulsiveness inappropriate for the child's age. They are easily disoriented by sights and sounds in the environment, cannot concentrate for a long period of time, are restless and impulsive or have a tendency to daydream and be slow to complete tasks. (Web MD Medical Reference, 2005) Effects of ADHD on the child: ADHD affects on an average 3 to 5% of children and is the most common mental health problem among young children in the U.S. Hyperactivity is manifested in the child always seeming to be in a hurry or constantly in motion. Impulsivity is common and the children seem unable to curb their immediate actions or thought processes. Inattention or and easy distraction from the work at hand is a common symptom. The affects of having an ADHD child on the family is a debatable matter since the nursing and care of the child is a considerable responsibility of the other members of the family. Both parents and the children need special help to develop techniques and methods to manage the patterns of behavior. (ADHD, NIMH review, 2003) A National Longitudinal survey of Youth in USA and Canadian National Longitudinal survey of children and youth studies were done on 4-14 year old children focusing on symptoms of ADHD and educational outcomes. The possibility that some children who belong to low income households may be more prone to ADHD and also have worse outcomes was stressed on in these studies. The authors found out that children with more symptoms of ADHD have significantly lower math and reading scores on standardized tests even several years later. The authors also found that boys and girls with moderate symptoms are similarly affected but boys with severe symptoms are more likely to have worse outcome than girls. In general boys are 2 to 3 times more likely to suffer from ADHD. They found that children from high income, high class families are not more likely to receive treatment than those from lower class families. This is due to the stigma associated with ADHD preventing the high income families from acknowledging the problem of their child. (The effect of ADHD on Educational outcomes, 2005)Thus social class does seem to have an influence on ADHD occurrence and social stigma involved, nursing care and educational help needed are viewed differently by different classes. Causes of ADHD: Evidences point to biological causes to be more likely than other factors. Environmental agents, brain injury, food additives, sugar and genetic causes have been implicated. Recent studies on the causes of ADHD have shown that these children had 3 to 4% smaller brain volumes in regions of the frontal lobes, temporal gray matter, caudate nucleus and cerebellum which are parts of the brain. Environmental agents like lead exposure, cigarette or alcohol use during pregnancy could cause a predilection towards ADHD. Sugar as a cause of ADHD does not have much credibility from research analysis. Genetic factors have a role since ADHD runs in families. Hence a possible genetic cause can be held responsible. Studies showed that nearly 25% of close relatives in families of ADHD children also have it themselves. (Attention Deficit Hyperactivity Disorder, NIMH review, 2003) Biological causes: Functional causes in the brain in the dopaminergic system have been researched into. Brain Imaging studies have reported changes like increased Dopa Decarboxylase activity in midbrains of children and decreased activity in the prefrontal regions of adults. Biochemical pathways in the brain are likely to be complicated by other factors and dopamine deficit and excess individually or in combination may contribute to ADHD. Noradrenergic and Serotonergic neurotransmitter systems are also implicated in causation. ( A.Kirley et all, 2002) Poor Parenting: It can lead to bad behavior in a child but is not a direct cause. It can worsen the outcome of an ADHD child but is not the sole cause. The media and other resources which blame parents when a child is diagnosed with ADHD mislead the public and this leads to further mental trauma for the parents who are already under the stress of dealing with the child. Parents of ADHD children are likely to give less positive attention to their child and more negative commands which may be due to the disobedience and noncompliance of the child. No studies have supported poor parenting practices as the sole cause of ADHD. (Causes of ADHD, 2005) A study on how parents of an ADHD child feel about things in the family showed that these parents reported significantly higher levels of dissatisfaction about family life. This could be the direct result of having a disabled child and could also reflect the fact that parents of ADHD children are likely to have ADHD themselves. This study appeared in the Journal of Attention Disorders. There can thus be frustrations about parenting a child with ADHD which can spill over to create difficulties for the entire family as well as relationship with the child. (Rabiner, David, 2000). According to a study conducted online by the University of Sydney, on the Stress and Coping Practices for parents with ADHD children, 40% of participants thought that their child with ADHD was the major source of stress in their lives and more than 50% said that they were overwhelmed with the task of parenting their ADHD child and have as a result too few choices and little control over their own lives. The study also showed that the more irritable the parents were the worse was the child's behavior. More than 97% of participants felt that community resources to help them manage their ADHD child was needed and would help to improve the quality of their life by reducing stress. (Dr. Campbell, Andrew, Dr. Sithanthan, Gomathi, Amon, Krestina, 2005). The implications of having an ADHD child in the family are considerable. Life would seem challenging for the family. The common misconception that poor parenting or neglect have led to this behavioral disorder further causes stress for the parents and the family. Lack of knowledge in the general public regarding the causes of ADHD makes the society look down on the family with an ADHD child. The parents of that child have to cope up with the stress of parenting as well as with the social stigma that is attached to ADHD. The societal outlook in this regard makes the parents neglect the child whom they perceive as the sole cause of their stress. A chaotic home environment can cause worsening of the child's behavior but is not the cause for ADHD according to studies conducted. The parents should not waste their emotional energy or time on self-blame and instead should develop a positive outlook. Gaining good knowledge about ADHD, becoming an effective manager of the child's affairs, joining a support group, seeking professional help, learning behavior management strategies and learning parental training are some of the things that parents of an ADHD child are advised to do. (Parenting a child with ADHD, 2004). Psychological factors: Attachment Developmental factors that influence ADHD, mainly social cognition, attachment, parental interaction styles and temperament suggest a bi-directionality of influence in behavior patterns i.e. those behavior patterns that characterize ADHD thought to be a result of biological mechanisms, environmental, interactional and relational variables may determine the extent of the adaptive outcomes they face. The quality of the attachment relationship between parents/caregivers and children has far reaching implications for development, particularly in children's socio-emotional and adaptive behaviors. Positive attachment enhances neurological maturation and development. Poor attachment may cause an increase in hyper-vigilant behavior and increased non-compliance. Attachment theory indicates that children form multiple attachments throughout childhood. The quality of attachments formed has implications for social as well as academic outcomes particularly for the ADHD child. The behavior of ADHD children makes relationship building difficult. (Ongan, Talay, Ayshe, Macquarie University at Sydney). Attachment between parents and their ADHD child is not only difficult to form but also to sustain. The quality of this relationship thus has profound effects on the development of the child. ADHD children need supportive care and perseverance at teaching from the parents' side. Psychological, social and cultural factors may not be the direct causes of ADHD but have an overbearing influence on the development of the child who has been diagnosed with ADHD. Parent-Child relationship Strong research evidence supports the fact that parenting methods have a marked effect on a child's potential for developing behavioral problems. Coercive styles such as intrusive, harsh and rejecting parenting appears to correlate with non-compliant, hyperactive and other negative externalizing behaviors more so in boys. The style of socialization of the parents influences the self-control in children. Maternal anger and inducing guilt in the child have a negative effect on the child and more on boys. (Ongan, Talay, Ayshe, Macquarie University of Sydney). It is not only the parent-child relationship but also the social and cultural practices in the family, the dynamics of the family and family structure which have an influence on the outcome of the ADHD child in terms of behavior, social, emotional factors and academics. The type of family and the routine either bring out the symptoms of ADHD or even sometimes mask the condition. For example a family that is very activity oriented and fast paced may not notice the hyperactive behavior of the child which is masked. Thus parents and teachers contribute to the total well-being of the child. Parents sometimes do end up feeling inadequate in their nursing of the child and self-blame and guilt is experienced. Social Factors: Acceptance, Labeling - The ADHD children remain an enigma to western societies which are struggling to accept the notion that their children may have a developmental disorder of chiefly biological origin when nothing is apparently wrong outwardly or in physical appearance. A research conducted on the stages of acceptance of a learning disability and the impact of labeling showed that there is a strong influence of the positioning of those with learning disability within the larger society including social class membership on these individuals. It is already traumatic to have a behavioral disorder and to cope with it knowing that their behavioral range is different from social expectations and a society in which this difference is used for degradation further compounds the problem and is worse than the first. A proactive attitude of tolerance and impartiality towards the ADHD children is needed. Inappropriately labeling a person should be condemned and recognizing and combating the negative valuation by others is warranted. The ADHD children are vulnerable to developing negative self-images and non-acceptances by the society peer groups worsens the situation. (Higgins, Raskind, Goldberg, Herman, 2002). The various social factors discussed as explanations of ADHD in this essay have contributed to the increase in the numbers of diagnosed cases of ADHD. Parents of ADHD children do have increased stress compared to those of non-ADHD children. Although most research has been done on mother and children, little difference was found in stress levels experienced by mothers and fathers of ADHD children. (Baker, 1994). Child behavior, socio-economic status and years married contributed to stress levels more than the gender of the patient. Mothers of ADHD children manifest significantly greater parenting stress, marital dissatisfaction and psychological maladjustments than mothers of normal children. Mothers' level of hostility also increases. Research shows that it is the mothers' level of hostility rather than depression, anxiety or marital discord that makes a significant contribution to the degree of conflict in the mother-child interactions. One study of fathers of ADHD children found them to have more depression but not hostility as compared to control fathers of normal children. In a study conducted to assess parent-adolescent conflict in teenagers with ADHD and ODD, like mothers, fathers also reported more conflict issues, more anger, more aggressive conflict tactics and poorer communication than the control fathers. Fathers used more negative interactions and negativity was thus increased during father presence. Mother and father both reported comparable number of conflicts but mother had higher levels of anger in conflict discussions with the teen than the father. (Edwards, Barkley, Laveri, Fletcher, Metevia, 2001). Labeling theory: Scheffs (1966) sociological theory attributes violations of explicit rules to the actions of criminals and delinquents and refers to psychopathology or aberrant behaviors which violate rules as primary deviance. Labeling theory states that if this primary deviance leads an individual to acquire a diagnostic label, society members' reactions to this produce secondary deviance, additional pathology or further behavioral disturbance which can exacerbate the mental illness. Sociologists believe that specific labels do have negative effects. Some sociologists agree that the role of this secondary deviance is overestimated. (Ruscio, 2004). The stigma associated with ADHD is pervasive and could be damaging to the child's development. However, it is not really clear as to how much influence this would really have. It can be argued that primary deviance is more damaging than secondary deviance or attitudes of society. An ADHD child does seem to experience further withdrawal if societal and parent's attitudes are negative. We cannot really assume that this would have the same effect on every labeled child. Normalization in an ADHD child can occur to a certain extent and psychological and sociological factors play a role in this process and attitudes of parents, society and healthcare professionals should be positive. A study conducted to assess normalized functioning in youths with persistent ADHD showed that children with ADHD have variable emotional, educational and social adjustment despite syndromatic persistence. (Biederman, Mick, Faraone, 1998). From this study it can thus be argued that normalization of functioning and syndrome persistence of ADHD may be independent of each other. Medicalisation of ADHD seems to have reduced the psychological burden or blame on parents and society. It can be argued that medicalisation, though necessary is not the only intervention needed. Support from the sociological and psychological professionals in the community along with parental training are needed. Reduced competence in the social services regarding children and cutbacks on pupil welfare in schools may also have contributed to increased medicalisation of problems that are fundamentally social. (Janson, Staffan, 2001). A link between disability and social deviance that functionalists make influences healthcare and research and supports the continued dominance of professionally controlled health and welfare services for disabled people. Functionalists like Parson emphasize medicine's role to cure and to maintain normal functioning of individuals and of society. The 'sick role' in Parson's functionalist theory of sick role involves the patient being compliant and wanting to get well. Implicit and explicit social theories coupled with disabled people's insistence that they be heard, have begun to change understandings of the nature of impairment and disability. This understanding poses key questions for healthcare research and the aspects of healthcare for these ADHD children are influenced by psychological views of the community at large. (Oliver, 1998). ADHD places a substantial economic burden on patients, families and the society. The poor academic performance implies increasing burden on the school systems. Also, the lack of value of the lives of the disabled attributed by the society and the family further compounds the problem. A new theory, the Social Role Valorization theory, described by Wolfensberger in 1998, is a high order concept for addressing the plight of socially devalued people and for structuring human services. This theory addresses the conceptual and emotional aspects of the devaluation process through the entire society. The failure of Marxism in conceiving solution leaves us with the problem of how to assist the many devalued, socially marginalized groups of society. SRV theory propounds that oppression of the marginalized people occurs due to individual, social, psychological, historical and cultural issues which need to be addressed. (Oak, ADHD and Social Role Valorization theory). Piaget says, "Child psychology is a branch equally of sociology and psychology, since the social environment is an integral component of development." (Piaget, 1950 cited by Burman, 1995-6). Those making decisions about child welfare have to thus be aware of psychosocial factors that can influence the policies regarding treatment. Health care professionals need to understand the implications that psychological and sociological factors play in causation of ADHD and further development of the child for effective health care practice. Specialists like the clinical psychologists, psychiatrists and pediatricians, the health care providers, have to understand the importance of psychosocial factors and have to incorporate the principles learned from this knowledge to health care practice. Justification of application of knowledge of psychosocial factors in health care practice: In the field of child and adolescent mental health, treatment will be meaningless if it is devoid of the application of knowledge of psychosocial backgrounds pf the disorders and developmental stages of the child. In fact, mental illness cannot even be defined without knowledge of psychological and sociological interactions between the child and his family and the society in which they live. Health care of ADHD children and in general children's mental health services are scattered around many service organizations and systems, schools, child welfare agencies, pediatric health care settings and juvenile correction facilities. The system of care model developed by Stroul and Friedman includes a series of values and principles centered on maintaining children in their communities, coordinating services, involving families centrally in delivery and planning of treatments and services. Family focused treatments, integrated community based treatments, school based interventions are needed for the management of an ADHD child. Effective health care practice of ADHD children involves good knowledge of their psychosocial backgrounds which have a role to play not only in the causation of mental illness but also in the future development of the child. Psychopharmacology is only one aspect of the treatment interventions in ADHD. (Hoagwood, Burns, Kiser, Ringeisen, Schoenwald, 2001). Thus a good understanding of psychological and sociological research evaluating their influence on an ADHD diagnosis is needed for effective health care of these children. References A.Kirley et all, 2002,Dopaminergic system genes in ADHD: Towards a biological hypothesis, Neuropsychopharmacology, Vol 27, No.4, Published by Elsevier Science Inc, Retrieved, 28 Dec 2005, http://www.nature.com/cgi-taf/dynapage.taffile=/npp/journal/V27/n4/full/1395905a.html&filetype=pdf Attention Deficit Hyperactivity Disorder, 2003, review, NIH publication No. 3572, 9-2-05, Retrieved, 28 Dec 2005, http://www.nimh.nih.gov/publicat/adhd.cfm Biederman, J, Mick, E, Faraone, S.V., 1998, Normalized functioning in youths with persistent attention deficit hyperactivity disorder, Journal of Pediatrics, 1998, October, 133(4): pages 544-551 Causes of ADHD, 2004, Retrieved, 28 Dec 2005, http://www.myadhd.com/causesofadhd.html Dr.Campbell, Andrew, Dr.Sitharthan, Gomathi, Amon,Krestina, 2005, An exploration of parental stress and coping mechanisms and the self perceived effects on their children with ADHD, Online study, Retrieved, 28 Dec 2005, http://www2.fhs.usyd.edy.au/arow/adhd/news.htm#Results Dr.Rabiner, David, 2000, The impact that having a child with ADHD has on Parents satisfaction with family life, ADHD and Family Life, Retrieved , 28 Dec 2005, http://www.focusas.com/ADHD-FamilyLife.html Edwards, Gwenyth, Barkley, A.Russel, Laveri, Margaret, Fletcher, Kenneth, Metevia, Lori, Dec 2001, Parent-Adolescent conflict in Teenagers with ADHD and ODD-1, Statistical DATA INCLUDED, Retrieved, 28 Dec 2005, http://findarticles.com/p/articles/mi_m0902/is_6_29/ai_80897778/pg_11 Higgins,L. Eleanor, Raskind, H.Marshall, Goldberg, J.Roberta, Herman,L.Kenneth, 2002, Disability:The Impact of Labeling, Learning disability Quaterly, Volume 25, Winter 2002, Retrieved, 28 Dec 2005, http://www.ldsuccess.org/pdf/LDQWinter2002.pdf Janson, Staffon, 2001, Chapter4, Childrens and Young Peoples Health, Scand Journal of Public Health; Suppl58:103-116, Retrieved, 28 Dec 2005, http://journalsonline.tandf.co.uk/media/9a0qb3fuqq3knm87vbft/contributions/n/y/j/k/nyjk875hfqq1h9m7.pdf Hoagwood, Kimberly, Burns, J.Barbara, Kiser, Laurel, Ringeison, Heather, Schoenwald,K.Sonja, 2001, Evidence based Practice in Child and Adolescent Mental Health Services, Psychiatric Services, September 2001, Vol 52 No.9, Retrieved, 28 Dec 2005, http://ps.psychiatryonline.org/cgi/reprint/52/9/1179/pdf Oak, Eileen, What's in a name, ADHD and Social Valorization Theory: its relevance for developing emancipatory practice, International Journal of Disability, Community and Rehabilitation, Volume 3,No.1, SRV Edition, Retrieved, 28 Dec 2005, http://www.ijdcr.ca/VOL03-01-CAN/articles/oak.shtml Oliver, Michael, 1998, Theories of disability in Health practice and Research, BMJ, 1998, 317:pages 1446 to 1449, Retrieved, 28 Dec 2005, http://bmj.bmjjournals.com/cgi/content/full/317/7170/1446 Organ, Talay, Ayshe, Developmental and Transactional Factors aided in the early years, Macquarie University at Sydney, Retrieved, 28 Dec 2005, http://www.aare.edu.au/04pap/tal04130.pdf Parenting a child with ADHD, 2004, Living with ADHD, National Resource Center on ADHD, Retrieved, 28 Dec 2005, http://www.help4adhd.org/en/living/parenting/WWK2 Ruscio, John,2004, A Cultural evaluation of Labeling Theory of mental Illness, The Scientific Review of mental Health Practice, Volume 3, No.1, Spring-Summer 2004, Retrieved, 28 Dec 2005, http://www.srmhp.org/0301/labels.html Stroul, B. & Friedman, R. (1986). A system of care for children and youth with severe emotional disturbances (rev. ed.). Washington, DC: Georgetown University Child Development Center, National Technical Assistance Center for Children's Mental Health. The Effects of ADHD on Educational outcomes, NBER website, Retrieved, 28 Dec 2005, http://www.nber.org/aginghealth/summer04/w10435.html Read More