Attention Deficit/Hyperactivity Disorder (ADHD): Examining Adaptation in Normative Family Processes

By Ryan Ward


Attention Deficit/Hyperactivity Disorder (ADHD) presents a unique component within processes of family life. The affects of the disorder have been studied by clinicians and researchers attempting to understand system outcomes present in the individual, family life, and external environments. ADHD has come to be considered a common disability. It is suggested that among children and adolescents an estimated range of 3-7% of the United States population exhibits significant features of ADHD (Firmin & Phillips, 2009). Research is still unclear whether symptomatic behaviors decrease with age, however findings point with certainty that ADHD does not simply disappear with age and maturation, it continues into adulthood affecting future employment stability and family life, including relationships (Pressman, et al., 2005).  


Because many adults and consequently many children go undiagnosed this data is not wholly reliable in ascertaining the breadth and scope of the affects to the individual and the family. Compound this information with the staggering statistic that ADHD has been shown to have >76% rate of heritability within ADHD families (Pressman, et al., 2005). These recent findings advocate a strong stance, negating previous misconceptions, and incite the need to delve more deeply into the far reaching affects of the disorder. The American Academy of Pediatrics suggests that this is not only debilitating for the children dealing with this disability, but it also affects the quality of life for the parents and subsequently the overall family life (Coghill, et al., 2008).  This paper will seek to define ADHD according to recent studies and review the associated symptoms. Because ADHD in family systems influences certain adaptations in normative processes (Coghill, et al., 2008), this paper will also discuss adaptations and normative processes of families with individuals who deal with ADHD; this will establish a framework for future comparison. Some reference will be given to ADHD parent within families, but for purposes of establishing elementary components of the disorder primary focus will be given to ADHD children within families

As previously noted, ADHD has become one of the most common mental health-related disabilities in the United States.  For many years ADHD was thought to be a mere behavioral disorder with eternalized symptoms. These pronounced symptoms were diagnosed as abnormal developmental behaviors which were gauged by what was considered “normal” developmental behavior according to clinicians (Garro & Yarris, 2009). As studied in children, the external symptoms of ADHD were seen as solely affecting academic performance. There were relatively few noted behaviors and what few were recorded only substantiated the hyperactivity component of the disorder.  In previous years, these roughly included only one basic area, negative interactions with other students and teachers (Kendall, Leo, Perrin, and Hatton, 2005). However, most recent analysis gives considerations that suggest inhibited volition merely plays a role on a much larger stage that affects more than children and adolescents. Garro & Yarris state, “This expansion and growing perception of ADHD as an enduring condition occurred concomitantly with a greater emphasis on ADHD as a ‘neurobiological disorder,’ as contrasted with a ‘behavior’ disorder.” More recent studies have broadened the scope and questioning to not only include these symptomatic behaviors as being a neurobiological disorder but further questioning the disorder as affecting the everyday occupations and interactions within family life as well.

“Questions about the extent to which disordered behavior can be attributable to biological causes are being raised. What impact does this ambiguity have on children with ADHD and their parents, and is this an uncertainty that parents grapple with as part of everyday family life are being evaluated more closely as an influential component needing consideration in diagnoses and treatment” (Garro & Yarris, 2009).

Studies are questioning how families cope with volatile patterns of behavior, the resourcefulness and overall adaptability experienced in family life as well as understanding the affects of these adaptable processes on the individual (Coghil, et al., 2008) (Segal, 1998). Internalized contexts of the disorder are still being evaluated and analyzed and there is still much in terms of research that needs to be done to gain a greater understanding of the root causes and biological processes that underpin the externalized features that are visible through symptomatic behavior.  Nevertheless, the externally displayed symptoms cause enough disruption in normative processes that they justify a more thorough analysis.

Garro & Yarris report that beginning in 1968, the American Psychiatric Association as ascribed in the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II), first labeled ADHD as a “Hyperkinetic reaction of childhood (or adolescence).” The manual further specified that the disorder was “characterized by over activity, restlessness, distractibility and short attention span, especially in young children and conveyed the expectation that the behavior usually diminishes in adolescence.” A definition printed in 2000 omitted the last portion of the printed definition, included the fact that the disorder continued into adulthood, and inserted forgetfulness as a key component of the continuous exhibited symptoms (Garro & Yarris, 2009). Additionally another researcher illustrates a more descriptive explanation associated with symptomatic behavior in ADHD individuals.

“Symptoms are present in varying degrees of intensity and are manifested in difficult behaviors such as aggression, poor rule-regulated behavior and poor delay of gratification, behavioral disinhibition, learning difficulties, poor impulse control, and low motivation. Approximately 70% to 80% of children with ADHD demonstrate continued problems with impulsivity; over activity; restlessness; and behavioral, attentional, and cognitive difficulties through adolescence; the severity of these symptomatic behaviors often extend into early and middle adulthood” (Kendall, 1999).

This information presents the context from which to understand the difficulties families face when coping and adapting to normative family life. It also enables the astute to see through the lens of the family associating with ADHD which gives perspective in understanding the difficulties associated with the disorder.

Normative family processes

In order to understand how families dealing with ADHD might be different from normative families, establishing an understanding of normative processes within family life will establish perspective in order to substantiate the differences between normative family processes and those of ADHD families. Beginning as early as World War II, family life researchers have given greater emphasis to understanding stress and coping amongst American families dealing with catastrophic events and understanding post-traumatic stress.  These events have been observed, analyzed, and recorded to better understand adaptability within families.  However, more recently, daily hassles in family life devoid of catastrophic events, have become the focus to better ascertain how daily living, transitions, and normative change affect adaptability in family processes.

“Examples of hassles include annoying problems such as losing or misplacing things, being stuck in traffic jams, inclement weather, arguments, disappointments, and financial and family concerns. Daily hassles [are] a better predictor of psychological symptoms than [are] major life events, although the two approaches are not unrelated as life events may influence and color the perception and reaction to daily hassles” (Nesteruk & Garrison, 2005).

Such studies as the conducted seek to include variables such as time and energy involvement, positive and negative influences, and family resources, coping, and managing strategies. These variables explicate the essence of normative family life.

In the previously mentioned study conducted by Olena Nesteruk and M. E. Betsy Garrison, they describe normal functioning within a family by depicting the stress associated with daily hassles of life and the resources families utilize to cope and adapt. Using the aforementioned criteria as their model of analysis Nesteruk & Garrison (2005) report: “The findings from this study begin to confirm an intuitive belief about what kinds of stressors tax families; such stressors [being] financial matters, household chores, child care or school-related matters, work duties, and transportation and traffic”.  Using the Family Daily Hassles Inventory (Norem, Garrison, & Malia, 2001) which carries a .77 alpha reliability rating in time and energy involvement and .88 in positive and negative influences, respondents (primarily parents) indicated the intensity to which the daily life of their family is affected by each item’s dimension: time and energy, negative influence, and positive influence. The six possible responses for each dimension are 5 = a great deal, 4=a lot, 3 =moderate, 2 = slight, and 1 =none, or 0 = not applicable. As designed, scores for each dimension of family daily hassles were then summed in three separate variables. Family coping strategies were assessed separately using the Family Coping Strategies Inventory.  This 22-item self-report assessed five aspects of coping: humor, social support, spirituality, outside help, and reframing. The five possible responses were 5 (most of the time), 4 (usually), 3(occasionally), 2 (seldom) or 1 (never). Based on data collected from each family, findings within this study suggest that hassles have a positive impact on daily living and adaptations.

“Both mothers and fathers reported higher-than expected (mathematically) levels of time and energy involvement and positive association with daily hassles and lower-than-expected levels of negative association with daily hassles” (Nesteruk & Garrison, 2005).

Family life with ADHD

            It is beyond the scope of this paper to fully describe the various family types that are affected by the disorder, but merely to express simply that families generally are affected by the disorder and the differences, if any, that are present as compared to normative processes. ADHD families not only deal with normative daily processes, but they also deal with additional stress created by key disruptive behaviors such as inhibited volition which becomes increasingly more difficult at transitory times of the day during daily occupations, especially during mornings, meal times, external environmental occupations, and bed-time (Segal, 2000). Family occupations are those ritualistic processes that are carried out daily at similar times out of necessity such as those previously mentioned. Segal further explains in connection with daily occupations that planning for and scheduling family meals is a primary process for families and can be considered a family occupation. Additionally Segal shares that family occupations include all the tasks related to caring for and raising children and that the biggest proponent for success with families dealing with ADHD children in these key daily tasks as compared to normative families is structure and flexibility that enables children to participate in the daily processes as their personal ability permits.

“Those mothers who reported that their strategies were successful also described that they either changed their own routines or that there was another adult who helped them and the children by constructing occupations and routines of children in conjunction with constructing the occupations and routines of other family members. Fostering an enabling environment as a legitimate and essential aspect of occupational therapy has been shown to be key in connection with the previously stated activities” (Segal, 2000).

Firmin & Phillips (2009) reiterate this finding in similar study replicated in the form after Segal’s ensuring that routine and structure provide the best occupational strategies for lessening the affects of symptomatic behaviors. That being said, because of the high volatility and need for high levels of flexibility and daily adaptability there is a strong correlation between ADHD children and parenting stress. Kendall, Leo, Parrin, & Hattin explain that because of the severe behavioral problems children and adolescents with ADHD exhibit, parents report more negativity in their social life and feel less competent in their parenting abilities (Kendall, Leo, Parrin, & Hattin, 2005).  This often exists because of excessive internal conflict within the family and negative external interactions in their ecological environment which conversely relates to increased maternal distress, increased marital conflict, separation and divorce, less contact with extended family, and fewer positive family experiences compared to families with non-ADHD children despite high levels of involvement, and flexibility these disruptive behaviors can still lead to maladaptive processes. It is important to note that the study drew a positive correlation between maternal reframing of stress-related events due to disruptive behaviors symptomatic of ADHD and less family conflict. However, despite increased stress on parental figures in families with ADHD children additional research supports that effective treatment suggest that interventions will need to continue to involve parents, “In the parent-child relationships dynamic, parents must be the primary agent of change” (Burke, Pardini, & Loeber, 2008).

Sibling interactions play a major role when considering the outcomes of disruptive behaviors as affecting family life. In a study evaluating sibling interactions where one or more children suffer with ADHD, there was strong evidence to suggest that negative sibling interactions contributed to family conflict thereby influencing family processes in family life. Two major themes were reported in a study following 10 families with one or more adolescent siblings in the home: 1) Living with a brother or sister with ADHD may result in a heightened stress level for siblings, with resultant feelings of frustration, annoyance, irritation, anger, or depression and 2) Siblings may experience discord and strained relationships with members of the immediate family, relatives, or friends due to causes they link, directly or indirectly, to the child with ADHD (Doran, 2001).

ADHD family process outcomes

            Adaptive processes in normative families as suggested in recent findings has shown that families positively adapt to daily hassles and that there is positive correlational evidence that supports normative family reframing of daily stressor events. “For family coping strategies, the results indicate that the majority of the families use spirituality, reframing, social support, and humor more frequently than expected” (Nesteruk & Garrison, 2005). When these characteristics were found in family processes, daily hassles were seen as positive outcomes when re-framed. Not unlike normative families, families with ADHD were reported as being successful when occupying these components in daily regimens.

“Research confirmed that parental strategies are salient for successfully rearing children with ADHD. However, our data pointed to two particular strategies, namely, vibrant family involvement and implantation of structure and routines. In particular, families in our sample emphasized the constructs of “routine” and “structure” as being paramount to navigating daily life successfully” (Firmin & Phillips, 2009).

However, due to higher levels of family conflict and volatility in family interactions, families coping with ADHD were found to have higher levels of care-giver and parental stress (Kendall, Leo, Perrin, & Hatton, 2005).  However, outcomes of relationships and familial interactions within ADHD families also suggest greater adaptability in communication and time involvement (Segal, 2000).  This representative data gives the ADHD a promising outlook toward bon-adaptation in family life as compared to normative families. This also suggests that family outcomes within ADHD families can inherently have a high level of resiliency.

Conclusion

            As prevalent as ADHD can be within families, there are many sources that would suggest, as previously noted, that there is a positive outlook for individuals of families who suffer with the disorder and that despite the distressing symptomatic behaviors negatively exhibited in family occupations families retain a certain level of positive adaptations as compared to normative families and processes. 

           Implications would also suggest that greater support in way of family resources could greatly assist families in dealing with the increased care-giver and parental stress involved with carrying out daily occupations. Further studies in conjunction with the collaborative evidence presented herein would aid in the further re-framing for families learning to cope and adapt to processes when dealing with ADHD.

References

Bradley-Klug, K., & Grier, J. (2000). Adolescents and their families: Coping with ADHD. School Psychology Quarterly, 15(4), 480-485.

Burke, J., Pardini, D., Loeber, R. (2008). Reciprocal relationships between parenting behavior and disruptive psychopathology from childhood through adolescence. Abnormal Child Psychology, 36:679-692

Coghill, D., Soutullo, C., d'Aubuisson, C., Preuss, U., Lindback, T., Silverberg, M., et al. (2008). Impact of attention deficit/hyperactivity disorder on the patient and family: Results from a European survey. Child and Adolescent Psychiatry and Mental Health, 2.

Firmin, M., & Phillips, A. (2009). A qualitative study of families and children possessing diagnoses of ADHD. Journal of Family Issues, 30(9), 1155-1174.

Garro, L., & Yarris, K. (2009). “A massive long way”: Interconnecting histories, a “special child,” ADHD, and everyday family life. Culture, Medicine and Psychiatry, 33(4), 559-607.

Hebert, R. S., Schulz, R. (2006). Care giving at the end of life. Journal of Palliative Medicine, 9, 1174-1187

Kendall, J. (1999). Sibling accounts of attention deficit hyperactivity disorder (ADHD). Family Process, 38(1), 117-136.

Kendall, J., Leo, M., Perrin, N., & Hatton, D. (2005). Modeling ADHD Child and Family Relationships. Western Journal of Nursing Research, 27(4), 500-518.

Nesteruk, O., & Garrison, M. (2005). An Exploratory Study of the Relationship Between Family Daily Hassles and Family Coping and Managing Strategies. Family and Consumer Sciences Research Journal, 34(2), 140-152.

Pressman, L., Loo, S., Carpenter, E., Asarnow, J., Lynn, D., McCracken, J., et al. (2006). Relationship of Family Environment and Parental Psychiatric Diagnosis to Impairment in ADHD. Journal of the American Academy of Child & Adolescent Psychiatry, 45(3), 346-354.

Segal, R. (1998). The construction of family occupations: A study of families with children who have attention deficit/hyperactivity disorder. Canadian Journal of Occupational Therapy, 65(5), 286-292

Papers....and Sex Education

I can enjoy a good paper every now and then....it can almost be satisfying...once its done. :S This semester has been the semester of papers unending! Well, I take that back, outside of Technical Writing 400 something, who really cares about the number, something upper division. I shudder as I recall its painfulness. I had a 25 page instructional manual due. It explained better building practices of Building Green. Boring? Oh believe me, it was. For some reason or another, I managed to save my paper to a temporary folder and didnt realize it; I beleive it happened in the shuffle of emailing my professor back and forth seeking help with revision. But two days before it was due, my computer went through its normal process of de-junking my computer files. :O You guessed it! I was right in the middle of typing out my Abstract when POOF, it vanished. I can't even begin to describe my hyperventilation. :S I somehow managed to stay up all night two days straight and somehow managed to get it in on time. I dont know how I pulled an A out of that class. I digress.

Anyway, This semester is a lot of writing, but I find that its intriguing subject matter. I was quite pleased with how it turned out. My assignment was to analyze the arguement in support of Abstinence-based Sex Education in America and suggest the flaws contained within. In addition, I was to develop the best method of Sex Education, using proven research as authority. There were 250 students in the class, only 10 A's were given, and I got one! I share this more out of sheer excitement than out of boasting. I'll share a portion, dont fall asleep, but if you must dont snore:

The debate surrounding sex education curriculum taught in schools has encountered controversy on many levels, the most critical being which content is most appropriate and crucial to incorporate into school curricula. All sides agree that the most important result should more effectively aid the reduction rate of teenage pregnancy and the spread of Sexually Transmitted Diseases (STDs). However, the most important facet of any argument lies in the presentation of reliable and valid conclusions by incorporating the adequate use of research methods. Lack of adherence to standard research protocol weakens and debilitates a claim of its potential validity. “School-Based Health Clinics and Sex Education” is a treatise that defends abstinence-centered sex education in schools. This essay examines three key weaknesses within the arguments of the treatise based on research methodology: correlation studies, statistical data, and exclusion of important in-text citations; it expresses and discusses a formal opinion on the subject of sex education in schools, reinforced by a peer-edited review, “A Multidimensional Approach to Sexual Education”(Mabray & Labrauve, 2002).

....

Although imperfections and “flaws” have been identified in the presentment of research, I have come to understand that an abstinence-oriented foundation to sex education supplemented by need-based comprehensive material would best address the demands to help curtail pregnancy rates, reduce the spread of STDs, and provide adequate, appropriate sexual health information specific to the needs of individual groups of students. An abstinence-oriented foundation to sex education would guide school curricula in presenting the important information by segregating critical and detailed information tailored to student understanding, experience, and background. This would be directed under the scope of understanding the positive, long-lasting effects of abstinence, coupled with the dangers of promiscuity. My ideas have developed two-fold, from my own individual experiences through observation and my religious beliefs that sexual intercourse is intended only between man and wife within marriage (The Family, ¶ 4). Attending a high school where teen pregnancy and dropout rates were high and academic interest, financial income, and parental involvement was low; lead me to observe that each of these variables were involved in sexual education and could only be addressed individually and specifically within the construct of each District or region, and that a generalized federal program could not impact the specific affects aforementioned. My opinion is made valid by “A Multi-Dimensional Approach to Sexual Education”. Mabray & Labrauve (as cited in Carrerra, 1995) indicate, “The actual needs of local students and families must be assessed before a program can be implemented” (p. 8). Suggesting that in order to incorporate a comprehensive scope under the umbrella of Abstinence, many components of the community must be understood.
The study (2002) also states, “While acknowledging that teens should always be encouraged to abstain from sexual intercourse, the focus needs to include the sexually active adolescent [as well]” (as cited in Bean et al., 1998). In addition, factors of income, background, and academic status would be considered,
Those identified with the following at-risk indicators: female, lower-income family, lack of involvement in school, lack of performance in school, and number of previous pregnancies. According to Manlove (1998), school attachment is associated with a lower risk of school-age birth. Almost 60% of pregnant school-age teens drop out between the eighth and twelfth grades. High grades, high test scores, and high post-secondary expectations are associated with a reduced risk of school-age pregnancy (Mabray, 2002, p. 8).
In addition to validating my opinion-based observations, the studies indicated adhere to standard research reporting protocol. It is devoid of supposition-based inferences lacking citation; while each inference made has statistical data reported that explains the variables measured (Mabray & Labrauve 2002).

Well, now that you're all asleep, maybe you can think about what sex education to your children means to you and what you care or dont care about that is taught to your children in the classroom. I thought it was provoking material to analyze. Maybe my commentary will engage your mind and you'll want to know more! If not, glad you stopped and read what I had to say about it at least.

Inactive....

What a whilrlwind life! I fell in love, got engaged, and married. Im finishing up with my degree in December at BYU. Then were off to graduate school somewhere. (We'll start looking sometime during the summer). I am planning on starting up my blog again. So without further adieu, Ryan, the Red-head returns! Stay tuned for the exciting episodes that follow.