A study of self-perception in hyperactive children

Attention deficit hyperactivity disorder, self-esteem and the impact of treatments

OBJECTIVES

Children with attention deficit hyperactivity disorder (ADHD) experience repetitive failures in their school and social life and often receive negative feedback from their environment, endangering the development of their self-esteem. Self-esteem is a forecasting factor for social, psychological, professional and familial well-being. Poor self-esteem is a risk factor for the development of depression, anxiety disorder, and personality disorder. The aim of this article is to evaluate the child's self-esteem at the initial time of ADHD diagnosis, describe self-esteem evolution after diagnosis and identify clinical and therapeutic factors associated with improved self-esteem.

METHODS

In a longitudinal descriptive study, 6-12-year-old patients with ADHD underwent a multidisciplinary evaluation including a diagnostic interview (Kiddie Schedule for Affective Disorders and Schizophrenia Present/Lifetime version: K-SADS), a symptoms severity assessment with parent questionnaires (Attention Deficit Hyperactivity Disorder Rating Scale: ADHD-RS), a neurocognitive testing of attention and IQ, and a self-esteem interview (Self-Esteem Inventory of Coopersmith: SEI). The follow-up assessment included a K-SADS-PL, ADHD-RS and SEI assessments and recorded treatment history. We compared the score of self-esteem between these two assessments.

RESULTS

Among the 108 screened patients, we obtained complete data from 55 patients at the second assessment. At first evaluation, two-thirds of children with ADHD had low self-esteem scores. At the second evaluation, our results indicate a significant improvement of global, personal, and social self-esteem score (SEI) and symptoms severity score (K-SADS-PL and ADHD-RS).

CONCLUSIONS

Self-esteem improved in patients with ADHD after specific treatments.

Perceived Family Climate and Self-Esteem in Adolescents With ADHD: A Study With a Control Group

Objective: In this study, our objective is to assess the perception of family environments by adolescents with ADHD based on perceived expressed emotion (EE) and the self-esteem of the adolescents. Method: Uludag University Medical Faculty Hospital completed this study with 41 adolescents with ADHD and 35 control group participants who were matched based on age and gender. Results: The total scores of perceived EE, described as a lack of emotional support, irritability, and intrusiveness, were significantly higher in ADHD group than in the control group. The group with ADHD also showed significantly lower self-esteem. There was a negative correlation between self-esteem scores and total perceived EE scores in the ADHD group and the control group. Conclusion: This study showed that the adolescents with ADHD perceive less emotional support and higher levels of intrusiveness, with patients also describing their families as more irritating. Other results in this study show that adolescents with less emotional support possess lower self-esteem, as do adolescents with more irritable parents.

The STARS Program: Social Empowerment Training for Preadolescents with Attention Deficit Hyperactivity Disorder (ADHD)

According to the National Institutes of Health (NIH), there has been a dramatic increase in the number of children being diagnosed with attention deficit hyperactivity disorder (ADHD) in the last several years. School nursing interventions need to be developed, implemented, and evaluated to address complexities experienced by this population. The STARS curriculum (Social Empowerment Training and Responsibilities for Students with ADHD) is a nursing intervention designed to improve perceptions of scholastic competence, social acceptance, and behavioral conduct in preadolescents diagnosed with ADHD. It consists of eight sessions with the theme of social empowerment training woven throughout the curriculum. The support group concept, with children helping children, initiated dynamic conversation as the participants creatively problem-solved and developed solutions to their difficulties.

Patterns of Sensory Processing in Children with Attention Deficit Hyperactivity Disorder

The researchers conducted this study to compare the sensory responses of children whose primary diagnosis was Attention Deficit Hyperactivity Disorder (ADHD) and children without disabilities on the Sensory Profile, a parent-reporting measure of children's sensory responses in daily life (Dunn, 1999). Parents of 70 children 3 to 15 years old with a primary diagnosis of ADHD and parents of children without disabilities matched by age and gender completed the Sensory Profile. Researchers completed a series of Multivariate Analyses of Variance (MANOVA) with post hoc testing to compare the performance of the two groups of children. Children with ADHD differed significantly from children without disabilities in their sensory responsiveness based on Sensory Profile results. The Sensory Profile can contribute to diagnostic and program planning processes and increase understanding of the nature of the disorder of ADHD.

Attention-Deficit/Hyperactivity Disorder is Related to Decreased Weight in the Preschool Period and to Increased Rate of Overweight in School-Age Boys

OBJECTIVE

Previous studies have associated attention-deficit/hyperactivity disorder (ADHD) with growth deviations and obesity. However, available data regarding the growth of children with ADHD in their early childhood are insufficient. Therefore, we aimed to examine whether there are differences in body size between preschool boys with and without ADHD.

METHODS

The study used cross-sectional and retrospective longitudinal data concerning 112 boys with ADHD and a community-based sample of 308 boys without ADHD. The groups were homogeneous in terms of socioeconomic status, place of residence, term of birth, and birth weight. The average age of diagnosis was 8.3 years, and none of boys had been treated with stimulants before they were 7 years of age. Comparisons were made at the ages of 2, 4, and 6 years, for World Health Organization (WHO)-norm-standardized height, weight, body mass index (BMI), prevalence of underweight, overweight, and obesity. Separate analysis were made for the cross-sectional measurements of current body size.

RESULTS

Boys with ADHD at the age of 2 had significantly lower z scores for weight (t=-1.98, p=0.04) and BMI (t=-2.09, p=0.04), and at the age of 4 for weight (t=-2.05, p=0.04) than the boys from the control group. A significantly lower percentage of overweight/obesity was observed in boys with ADHD at the age of 2 in comparison with the control group. At the age of 6, boys with ADHD were underweight more often. Cross-sectional analysis of current body size showed that boys with ADHD had lower z scores for height (t=-3.08, p=0.002) and higher z scores (t=3.13, p=0.002) for BMI. Overweight was more frequent in this group.

CONCLUSIONS

Preschool boys with ADHD (age of 2-6 years) have a tendency toward lower body weight than their peers. But in subsequent phases of development, they are shorter and more frequently overweight than boys without ADHD, when place of residence, socioeconomic status, term of birth, birth weight, comorbid conditions, and treatment are controlled.

Academic buoyancy and academic outcomes: towards a further understanding of students with attention-deficit/hyperactivity disorder (ADHD), students without ADHD, and academic buoyancy itself

BACKGROUND

Academic buoyancy is students' capacity to successfully overcome setback and challenge that is typical of the ordinary course of everyday academic life. It may represent an important factor on the psycho-educational landscape assisting students who experience difficulties in school and schoolwork.

AIMS

This study investigated the role of academic buoyancy in the achievement and cognitive, affective and behavioural engagement of (1) students with attention-deficit/hyperactivity disorder (ADHD) and (2) 'regular' (or 'general') students residing in the same classrooms and schools. The study also sought to extend prior research into academic buoyancy by including previously neglected and potentially influential factors such as personality and socio-economic status.

SAMPLE

Participants were n = 87 high school students with ADHD, n = 3374 non-ADHD peers, and n = 87 randomly drawn non-ADHD students.

METHOD

Survey-based data were analysed using multigroup (ADHD, non-ADHD, randomly weighted non-ADHD) multivariate (multiple independent/covariate and dependent variables) path analysis.

RESULTS

The findings revealed a significant and positive association between academic buoyancy and outcomes for students with ADHD that generalized to non-ADHD groups. On occasion where academic buoyancy effects differed between the groups, effects favoured students with ADHD. Furthermore, academic buoyancy explained significant variance in outcomes for both groups of students after covariates (age, gender, parent education, language background, socio-economic status, personality) were entered.

CONCLUSION

It is concluded that there is merit in widely promoting and fostering academic buoyancy among ADHD and non-ADHD students alike - and that academic buoyancy explains variance in outcomes beyond major intrapersonal factors such as personality, socio-economic status, ethnicity, and the like.

Parenting of children with ADHD in South Korea: the role of socio-emotional development of children with ADHD

AIMS AND OBJECTIVES

The aim was to investigate the factors affecting the self-esteem and social competence of children with attention deficit hyperactivity disorder.

BACKGROUND

Many studies have reported parenting variables such as parenting attitude and sense of competence have been suggested as significant determinants of socio-emotional development of children with attention deficit hyperactivity disorder. In South Korean society, the traditional culture of Confucianism is a strong influence on parenting practices and children's behaviour. However, there have been few studies that examined the relative significance of the parenting and other associated factors for self-esteem and social competence in children with attention deficit hyperactivity disorder in Korea living in a strict parenting environment.

DESIGN

This study was designed as a cross-sectional and descriptive survey.

METHOD

The subjects were 124 pairs of mothers and their children with attention deficit hyperactivity disorder, recruited from local paediatric psychiatric clinics in South Korea. Data collection was conducted through the use of questionnaires.

RESULTS

Affectionate parenting attitude and co-morbid condition of the child were the most important predictors of self-esteem. Rejecting parenting attitude was the most important predictor of social competence.

CONCLUSION

Higher levels of affectionate parenting attitude of mothers and non-co-morbid status of children both contributed unique variance to the overall prediction of higher self-esteem of children. Higher levels of rejecting parenting attitude of mothers contributed unique variance to the overall prediction of lower social competence in children with attention deficit hyperactivity disorder.

RELEVANCE TO CLINICAL PRACTICE

Parenting attitude is the most important factor to contribute to the healthy socio-emotional development in children with attention deficit hyperactivity disorder. Health care providers need to develop and apply a parenting skills improvement program to improve positive parenting attitudes, which will benefit self-esteem and social competence in children with attention deficit hyperactivity disorder.

Intensity of ADHD Symptoms and Subjective Feelings of Competence in School Age Children

The aim of this investigation was to assess how different levels of intensity of ADHD symptoms influence the development of the subjective feeling of competence in school age children. The sample was comprised of 62 children age 11 to13. For the purpose of estimation of the subjective feeling of competence, The Feeling of Competence Questionnaire was created. Level of ADHD symptoms intensity was estimated with the use of The Symptoms of ADHD Questionnaire, created on the basis of diagnostic criteria for ADHD included in DSM-IV and ICD-10. Cluster analysis distinguished two groups of children: a group with a lower level of ADHD symptoms intensity (Group 1) and a group with a higher level of ADHD symptoms intensity (Group 2). Group 2 revealed a significantly lower level of global feelings of competence and lower scores on the subscales: adaptive properties, knowledge and skills, acknowledgement, emotional factor and belief in success. There was no significant difference in the level of the feeling of co-operation skills and social adjustment. The results suggest that children with symptoms of ADHD are likely to have a low level of feelings of competence, which may well be a risk factor leading to later social disorders.

The self-concept of children and adolescents with neurofibromatosis type 1

BACKGROUND

Neurofibromatosis type 1 (NF1) is a genetic disorder associated with cognitive deficits, learning problems, medical complications and cosmetic disfigurement. Despite the wide-ranging impact of NF1, very few studies have examined the psychosocial adjustment of individuals with NF1, and in particular, self-concept. The aims of this study were threefold: (i) to examine the self-concept of children and adolescents with NF1; (ii) to compare the self-concept of children with NF1 (NF1 only), children with NF1 and learning difficulties [NF1 + LA (low achievement)], and children with NF1 and attention deficit hyperactivity disorder (ADHD) (NF1 + ADHD); and (iii) to examine the academic self-concept of these three groups relative to objective criteria - academic achievement and teacher ratings of academic competence.

METHODS

Measures of self-concept, academic achievement and intelligence were administered to 49 children and 26 adolescents with NF1. Parents and teachers completed behavioural rating scales.

RESULTS

The majority of children and adolescents with NF1 reported positive global self-concept, with some exceptions on specific domains. Children and adolescents with NF1 reported significantly poorer self-concept for physical abilities. Adolescents also reported significantly poorer self-concept for mathematics and general self when compared with normative mean values. Clinical severity of NF1 was not a significant predictor of self-concept for physical appearance or physical abilities. Despite a significant difference between NF1 only, NF1 + LA and NF1 + ADHD groups on measures of academic achievement and teacher ratings of academic competence, there was no significant difference between the groups for academic domains of self-concept, or any other domain of self-concept. All three groups reported inflated academic self-perceptions relative to objective criteria.

CONCLUSION

Children and adolescents with NF1 are most likely to develop negative self-concepts about their physical and sporting abilities. Inflated academic self-perceptions are discussed in light of the positive illusory bias, which may serve as an adaptive or protective function.

Quantitative regional cerebral blood flow MRI of animal model of attention-deficit/hyperactivity disorder

The spontaneously hypertensive rat (SHR) has been widely used as an animal model for attention-deficit/hyperactivity disorder (AD/HD), a developmental disorder that affects 3-5% of school-age children. Quantitative high-resolution (180 x 180 x 1500 microm) perfusion magnetic resonance imaging was performed to evaluate regional CBF in AD/HD rats (SHR, n=7) and control Wistar Kyoto rats (WKY, n=9) in the frontal cortex, motor cortex, sensory cortex, corpus callosum, hippocampus, thalamus, globus pallidus, caudoputamen and whole brain. The accuracy of repeated cerebral blood flow (CBF) measurements within animals in these brain regions ranged from 3% to 10% (7 repeated measures) and across animals ranged from 15% to 18% (n=7 rats), respectively, indicating highly accurate and reproducible CBF measurements. Regional CBF of the SHR were statistically different from those of the WKY rats in all structures analyzed (P<0.05) except for the caudate putamen (P=0.09) and the globus pallidus (P=0.12). Whole brain CBF of the SHR (1.5+/-0.2 ml/g/min, mean+/-S.D.) was approximately 25% higher than that of the WKY rats (1.2+/-0.2 ml/g/min), likely due to the hypertensive nature of the AD/HD rat model. Following normalization to eliminate global CBF differences, CBF in the medial prefrontal cortex, a structure thought to be the equivalent of the human dorsolateral prefrontal cortex and widely implicated in AD/HD, was found to be higher in SHR compared to WKY rats (P<0.05). The only other structure that was found to be statistically different after normalization is the corpus callosum (P<0.05). Since resting cerebral blood flow is intricately coupled to resting neural activity, these results suggest that there was abnormal resting neural activity in the medial prefrontal cortex and the corpus callosum between the control and AD/HD animals, consistent with the hyperactivity, impulsivity, inattention, and other AD/HD-like behaviors in this animal model.

Attention deficit hyperactivity disorder: the current debate and neglected dimensions

The aim of this article is to identify and highlight the issues facing children, young people and families experiencing Attention Deficit Hyperactivity Disorder (ADHD) in an United Kingdom context. In presenting these issues it is hoped that wider discussion and awareness of the challenges of this condition may have an effect on the planning and delivery of services within the UK. We seek to highlight that an overreliance on a medical perspective has the effect of neglecting the wider context of the rights of the child and the needs of the family. We advocate for an approach that recognizes the importance of the contributions of other professionals and the implementation of locally-agreed guidelines that incorporate the perspectives of families and the rights of the child.

Self-perception in children with attention deficit/hyperactivity disorder

The purpose of this study was to compare self-perceptions of children diagnosed with attention deficit/hyperactivity disorder (ADHD) with those of children not diagnosed with ADHD. Seventy-seven children aged 8-12 years composed the two groups-38 participants with ADHD and 39 control participants without ADHD. The children completed the Self-Perception Profile for Children Questionnaire designed to measure self-perceptions in school-aged children. t Tests compared differences in mean scores between the groups. The ADHD group had a significantly lower overall score and a lower score on the behavioral conduct subscale compared with children without ADHD. Findings suggest a difference in the way school-aged children with ADHD perceive themselves as compared with their peers. The cumulative effect of years of low self-esteem and negative self-perception may have significant life consequences. Attention should be focused on fostering self-esteem and positive self-perception in children with ADHD through support groups and behavioral training.

Comportamento social na escola: diferenças entre gêneros e séries

O objetivo deste estudo foi avaliar o comportamento social em um grupo de escolares, e verificar as diferenças entre os mesmos tendo em vista aspectos como sintomas emocionais, problemas de conduta, hiperatividade, problemas de relacionamento com colegas e comportamento prósocial, contemplados no instrumento SDQ (Strengths Difficulties Questionnaire) que avalia desordens psiquiátricas relacionadas ao comportamento social. Participaram da pesquisa crianças com idade média de 9 anos e 6 meses, cursando a 3a e 4a séries do ensino fundamental de uma escola da rede particular de ensino, sendo 24 do gênero feminino e 17 do gênero masculino. Os resultados demonstraram que para comportamento pró-social não foram observadas diferenças quanto ao gênero. Com relação às médias obtidas em dificuldades sociais de acordo com a série, foram encontradas diferenças em problemas de conduta, problema de relacionamento com colegas e total de dificuldades. Para comportamento pró-social, foram observadas diferenças com relação à série, sendo que os escolares da 3a série se auto-avaliaram como mais “hábeis socialmente”, com relação aos estudantes da 4a série.

Increasing perceptions of self-worth in preadolescents diagnosed with ADHD

PURPOSE

To test the effectiveness of a school-based, nurse-facilitated support group in increasing perceptions of scholastic competence, social acceptance, behavioral conduct, perceived athletic competence, perceived physical appearance, and perceived global self-worth in preadolescents diagnosed with attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD).

DESIGN

A quasi-experimental design with 65 preadolescents diagnosed with ADD or ADHD in an upper-middle class community in the United States.

METHODS

Participants randomly assigned to either the control or experimental group completed Harter's Self-Perception Profile for Children instrument at the beginning of the study and 4 weeks later. Students in the experimental condition participated in a school-nurse facilitated support group which met twice weekly for 4 weeks.

FINDINGS

Participants in the support group had increased scores on each of the six subscales, with significant increases on four of the subscales, including perceived social acceptance, perceived athletic competence, perceived physical appearance, and perceived global self-worth.

CONCLUSION

Participation in a school-based, nurse-led support group was positively associated with perception of self-worth in preadolescents diagnosed with ADD or ADHD.

Ten-year review of rating scales. III: scales assessing suicidality, cognitive style, and self-esteem

OBJECTIVE

This is the third article in a series of 10-year reviews of rating scales. Here, the authors review scales that are useful in tapping the affective disturbances experienced with various psychiatric disorders, including suicidality, cognitive style, and self-esteem.

METHOD

The authors sampled articles incorporating these constructs over the past 25 years and selected scales with established uses or new development. Those presented here have adequate psychometric properties and high utility for efficiently elucidating youths' functioning, plus either wide literature citations or a special niche.

RESULTS

These scales were developed bimodally. Many were developed in the 1980s when internalizing disorders were elucidated, but there has been a resurgence of interest in these constructs. Scales assessing suicidality have clear constructs, whereas scales of cognitive style demonstrate deficits in developmental relevance, and scales of self-esteem suffer from lax constructs.

CONCLUSIONS

The constructs underlying these scales tap core symptoms of internalizing disorders, mediate the expression of affective disturbances associated with various disorders, and depict the impairments resulting from these disorders. Overall, the psychometrics of these scales are adequate. These scales provide a broader representation of youths' functioning than that conveyed with diagnostic scales alone.