Research Article - (2023) Volume 17, Issue 2
Received: 27-Jan-2023, Manuscript No. iphsj-23-13451; Editor assigned: 30-Jan-2023, Pre QC No. iphsj-23-13451 (PQ); Reviewed: 13-Feb-2023, QC No. iphsj-23-13451; Revised: 20-Feb-2023, Manuscript No. iphsj-23-13451(R); Published: 27-Feb-2023, DOI: 10.36648/1791- 809X.17.2.1000
The paper explores the effect of Attention Deficit Hyperactivity Disorder in children and adolescents who suffer from negative changes in their life due to the loss of a family member or bullying cases. The research to investigate this stance has used qualitative thematic analysis on five case studies that are primarily gathered from a local community. The case studies are of five participants, and each of them was either at home, school or with their family. The research results through a qualitative analysis of interviews have proven that family helps these patients become better-behaved and emotionally stable as they live in a protected environment where all their family members support them. Hence, the researchers have provided qualitative evidence that the familial care environment of ADHD patients, while secluded environments like home and school make the patients feel stressed and uncomfortable.
Attention deficit hyperactivity disorder; Child; Adolescents; Negative life changes; Grief; Loss; Qualitative interviews; Thematic analysis; Ecological systems theory
Attention Deficit Hyperactivity Disorder (ADHD) is a neurological condition that affects an individual's ability to manage their attention and activity levels. It is characterized by inattention and impulsivity, ADHD can lead to decreased academic achievement, impaired relationships, and disordered behavior. Research has found the possible biological causes of ADHD including genetic factors, family dynamics, and environmental exposures . As the scientific understanding of the disorder develops, evidencebased interventions have been developed that emphasize both medical and psychosocial strategies . This current knowledge of ADHD will continue to evolve as research captures new insights into the origin and efficacious treatment of ADHD. Grief or losses are emotions that affect childhood development, and patients who suffer from ADHD have even more delayed symptoms. It is found that it is true that ADHD is a genetic disorder, but the key factors for bringing changes in the actions of people are gene x environmental interactions with the dopamine system. Kanarik et al  explain that along with ADHD, other diseases that coexist in the human body, these diseases include substance use disorder, depression, and obesity. The research found that this interaction is based on genes, gender, changing variants, and specific environmental conditions that can affect the mental health of people. The environmental conditions, in this case, refer to the sadness, grief, and worrisome effects in life that cause a change in dopamine levels. The change in dopamine levels is then interacted with the genes in the body to create alterations that contribute to the pathogenesis of ADHD. To treat this change in the body and reduce the effect of ADHD, drugs are used to act on catecholaminergic neurotransmission that can affect the cortical and subcortical genes. Pliske  found that a range of personal resources could facilitate positive growth in children facing major negative life changes. The researchers discovered promising benefits from engaging in interpersonal relationships and group art/play therapy to help children adaptively process their adverse circumstances instead of becoming overwhelmed by them.
The research aims to establish a relation to this issue and find out about the key aspects associated with symptoms, diagnosis, and treatment of ADHD. The negative life changes leave a deep impact on children as they are sensitive to changes around them such that their development is affected. This concept is known by the researchers, and it is explored as well, which is evident from the literature review. However, the literature lacks in terms of developing a relationship between environmental stressors and ADHD’s impact on childhood development. Therefore, this study aimed at evaluating the attention deficit/hyperactivity disorder (ADHD) that can influence the development of children who are already dealing with major negative life changes, such as experiencing grief or a loss. To address this aim, we generated a research question; what is the complex interplay between environmental stressors and ADHD's impact on childhood development of the patients also hypothesized the following that there is a significantly lesser impact of environmental stressors on the childhood development of patients who are suffering from ADHD and that children with ADHD have a severe impact due to environmental stressors that have harm their life.
The methodology that is used for this research is a thematic analysis design that allowed exploring how different environmental factors interact to shape ADHD patients’ experience and development over time. Also, a theoretical framework of ecological systems theory was used to affirm the findings from an ecological perspective i.e., caring about the environment and the changes associated with it. This research design has been chosen due to its ability to identify and analyse patterns within qualitative data collected from different sites, allowing for a comprehensive exploration of the complex interplay between environmental stressors and ADHD’s impact on childhood development. The research has used ecological systems theory to conduct the research and highlight the ecological factors that act as environmental stressors to affect the life and childhood development of the patients. The thematic analysis approach is an effective way to explore the complex relationships that exist between environmental factors, such as ecological systems theory, and how they interact with a child's experience and development. This method of analysis allows for a detailed exploration of the interplay between various environmental stressors and their impact on childhood ADHD. By utilizing this approach, case studies can be conducted to identify and analyse common themes that emerge from qualitative data collected from various sites. The thematic analysis enables researchers to gain insights into the factors that shape a child's experience over time, such as their access to resources and support, family dynamics, cultural beliefs and values, and school experiences . In this regard, ecological systems theory is a framework to understand the interactions between living and non-living components of an environment. It is a complex, interdisciplinary theory that explains how energies and materials are exchanged among different elements of the system, such as water, air, soil, plants, and animals. Additionally, ecological systems theory offers insight into how disturbances affect these elements in both short- and long-term timeframes. This theory is useful in understanding the dynamics of a wide range of ecosystems, from small-scale gardens to large-scale landscapes. So, using this interdisciplinary framework along with the thematic analysis of case studies proper findings is explicated.
The study is based on a detailed analysis of case studies of 5 children diagnosed with ADHD. The participants for this research will be recruited via a local mental health facility where the children would range from 12 to 15 years of age who can communicate effectively and understand the diagnosis. For this research, ethical considerations must be kept in mind, and for this researchers have informed the participants about the purpose and procedures involved in the research before they give their consent to take part in this particular interview. It is also essential that all data collected is handled sensitively and securely so as not to breach privacy regulations or cause distress for participants – meaning appropriate measures must be put into place for securing participant data throughout the project including encryption protocols where appropriate. Finally, it must also be made clear how findings from the research will be disseminated upon completion so that consent forms explicitly state whether results will remain confidential or if data could potentially end up being shared publicly at some point in the future.
The participants of the research that are sampled appropriately are as follows
Participant 1 is a 14-year-old male adolescent who suffers from ADHD, moderate autism, and anxiety. He was verbal since an early age but has difficulty expressing himself in social settings. His parents reported that he often gets overwhelmed by noise or other stimuli in his environment, leading to frustration and outbursts. Participant 2 is a 12-year-old female suffering from ADHD and ODD. She has been in the care system since she was 9 years old and is currently living with foster parents in a rural community located close to her hometown. Participant 2's primary carer reported that she struggles with regulating her emotions, often resulting in angry outbursts. Participant 3 is a 13-year-old male who is diagnosed with ADHD. He has been on multiple medications since the age of 7, but none have provided satisfactory results. His teachers and parents note that he experiences difficulty concentrating in school, quickly becomes bored and frustrated with tasks, and is easily distracted by external stimuli.
Participant 4 is a 15-year-old ADHD female patient who has been medicated for the condition since age 5. The patient is currently taking a methylphenidate medication but reports no improvement in symptoms. The patient's parents report that the patient often has difficulty focusing and controlling his impulses, leading to disruptive Behaviors in class and at home.
Participant 5 is a 12-year-old male ADHD patient. He began therapy by identifying his main problems like difficulty in concentration and difficulty managing the emotion that was impacting his life. This included difficulty concentrating and managing his emotions, which had caused significant distress in school, with friends, and at home.
To order conduct this study, three primary research sites will be selected: family, school, and home environment. For each site, semi-structured interviews or focus groups with children diagnosed with ADHD are undertaken to collect detailed accounts of their experiences dealing with grief and major life changes while living with ADHD. In addition, parents or guardians of these children may also be interviewed to gather information about their perspectives on the situation as well as any strategies they have used to help their child cope with such difficulties. Furthermore, records from mental health providers or other medical professionals involved in providing care for these children may also be reviewed where available. For this purpose, 5 research participants are recruited where participants 1 and 2 were interviewed at school, participants 3 and 4 were interviewed in a home environment, and participant 5 was interviewed in a family setting. These participants were thoroughly interviewed to find out about the theme that each of them shares along with knowing about the environmental stressors that affect the life of ADHD patients. Once the interview is conducted, then the themes are decided to finalize the results and state the conclusions.
Data Analysis Plan
The data analysis plan was a stepwise process where the first step is to prepare a questionnaire for interviewing the research participants. Then the participants were recruited as well for interviewing and the consent of the participants was gained beforehand. These participants were aware of the research and their parents were notified as well since they have to be a part of this research. The questions that were asked of the research participants are as follows:
1. How do you feel about being diagnosed with ADHD? (To be asked to patients only)
2. How has having ADHD affected your life? (To be asked to patients only)
3. What strategies have you used to manage the symptoms of ADHD? (To be asked to parents and patients both)
4. Have any major negative life changes impacted your ability to cope with ADHD and grief/loss? (To be asked to patients only)
5. In what ways has your environment contributed to your experience of living with ADHD, grief, and loss? (To be asked to parents and patients both). Once these questions are asked, then the answers of each of them are analyzed into themes to know about the environmental stressors and their impact on the life of ADHD patients. Here each question has its significance and each answer is from the firsthand experience of the research subjects.
Answers of Participant 1 and their parents
The answers to each of the research questionnaire questions are stated below respectively.
I. I felt overwhelmed and confused when I was initially diagnosed with ADHD. I told my parents that I often had difficulty expressing myself and communicating effectively in social settings due to being easily overwhelmed by noise or other stimuli.
II. My life was drastically changed after the diagnosis of ADHD. I began to experience difficulties in everyday tasks, such as managing time, focusing on work or activities, and controlling my impulses. My grades at school started to suffer and I found it increasingly hard to maintain friendships due to my inability to read social cues correctly.
III. I have been utilizing a variety of strategies, these strategies include a strict routine and structure in my life, which helps me stay organized and on task. As parents, we have created a "quiet space" for him at home, where he can go to take a break and calm himself down when necessary. He also follows a healthy diet, takes regular exercise, and is engaged in cognitive-behavioral therapy to help with his ADHD symptoms.
IV. I have experienced several major negative life changes that have had a significant impact on my ability to cope with ADHD, grief, and loss. My father passed away suddenly several years ago, and the resulting trauma from such an unexpected event has been difficult for me to process.
V. My environment has contributed a lot as I am at school so I feel the urge to learn and comprehend things better, which sometimes strains me as well. As parents, we try to consult with his teachers and ask them to take care of his emotional needs as he suffered from the loss of his father.
Answers of Participant 2 and their parents
I. Being diagnosed with ADHD can be a difficult experience for any child, especially when I am dealing with grief, loss, and major negative life changes. Initially, I felt overwhelmed and scared as my diagnosis led to feelings of isolation and fear of the unknown.
II. My life has changed a lot as I feel socially incompatible and the community around me made me feel belittled, which shattered my whole personality.
III. To manage the symptoms of ADHD, I have actively been provided with a variety of strategies. Her primary carer works diligently to ensure that she follows through with these strategies. However, there have been times when she has not followed them as expected. As parents of a person with ADHD, it is important to recognize which strategies are effective and how they should be utilized. This includes encouraging the use of positive reinforcement and avoiding negative feedback when possible.
IV. One of the major negative life changes I have faced is the divorce of my parents, which shattered me a lot. I live with my mother now, but the grief of that time still exists.
V. Being at school taught me a lot and my teachers supported me a lot. However, my peers were not supportive, and I have zero to no connection with them.
Answers of Participant 3 and their parents
i. I feel frustrated and overwhelmed by my ADHD diagnosis. It can be difficult to focus on tasks, concentrate in school and adapt to changing situations. I often find myself struggling with daily activities that are normally easy for others because of my ADHD symptoms.
ii. Having ADHD has had a significant impact on my life. It has made it difficult for me to focus on school, pay attention to what’s going on around me, and keep up with tasks that may require sustained effort. I also tend to get easily frustrated when presented with tasks that take too long or seem too hard. I have spent many years trying different medications without much success, which can be discouraging at times.
iii. One of the most common strategies used to manage the symptoms of ADHD is medication. Medication is often prescribed to children with this condition to improve focus, reduce hyperactivity and impulsivity, and help them better regulate their emotions and behavior. However, medications can also have adverse side effects that may be disruptive to a child's development.
iv. I have experienced a great deal of upheaval in the past few years that have harmed his ability to manage his ADHD and cope with grief or loss. My mother was diagnosed with an aggressive form of cancer when I was 10, and despite her valiant efforts to beat the disease, she passed away two years later. This experience affected me a lot, and my life changed a lot after this experience.
v. Since I am at home, my life has been confined to one place, and grief keeps on revolving around my mind. I tried to remain calm, but the memories at home kept on recurring in my mind.
Answers of Participant 4 and their parents
I. I feel extremely agitated due to my disease, and it has affected my life greatly. I want to relieve my anger in any way, and at times it results in aggressive behaviors such as throwing away things.
II. My life since the age of 5 is greatly affected as I had absolutely no social life and was mostly secluded.
III. I have been utilizing a range of strategies to manage my symptoms associated with ADHD. These strategies included cognitive-behavioural therapy, family counselling, and medication management. Cognitive-behavioural therapy teaches the patient skills for managing impulsivity and improving attention, while family counselling offers support for the patient's family along with medication to keep stressors under control.
IV. Her parents report that she has had to deal with multiple negative events in her life, including grief and loss. In particular, when she was 10 years old her maternal grandmother died suddenly from a heart attack, leaving the family reeling from shock and grief. This event changed the dynamics of the family forever, as her grandmother was very close to her.
V. I am mostly at home and staying at this place makes me remember my grandmother every moment. So, my environment has made me self-centred, and I feel very distressed.
Answers of Participant 5 and their parents
i. When I was first diagnosed with ADHD, my initial reaction was one of confusion and worry. I felt overwhelmed by the thought that despite all my efforts, there were still parts of me that I couldn’t control.
ii. ADHD has had a major impact on my life, from the difficulties I have in concentrating and managing my emotions to the distress it has caused in so many aspects of my life. One of the areas that have been particularly impacted is my ability to cope with grief, loss, and major negative life changes.
iii. The most common strategies that are used by me for managing the symptoms of ADHD include developing healthy lifestyle habits such as eating a balanced diet, getting enough sleep, and exercising regularly. Additionally, when I struggle more with the disorder, then I go for relaxation techniques such as yoga, mindfulness meditation, and progressive muscle relaxation.
iv. He has experienced the death of his mother, a major negative event that greatly affected him and his ability to cope. He expressed difficulty coming to terms with her passing, as he felt tremendous guilt and sadness thinking that he could have done more to help her.
v. I live in a family gathering and being in a social setting helped me keep my behavior good as I was never alone.
This research is conducted according to the qualitative framework of ecological systems theory and through the interviews of five case studies that were conducted primarily. However, there are a few limitations of this research, which include a focus on ecological systems theory only and a small sample size that cannot suffice for the general population. Therefore, the research is primary evidence that sadness, grief, and loss of ADHD patients affect their quality of life greatly whereas the changes in the level of quality of life depend on the setting in which the patients live. Thus, the research has proven the importance of familial love for patients of ADHD which suggests that patients should be allowed to live in family settings to cope with the negative changes in their life. These findings are consistent with the findings documented by Stinson et al . Stinson et al  aimed to assess the longitudinal impact of childhood adversity on early adolescent mental health during the COVID-19 pandemic in a cohort from the (Adolescent Brain Cognitive Development) ABCD Study. The combined effect of racial and ethnic factors along with the pandemic has affected the vulnerability of youth to mental stress and cognitive changes. The research results have suggested that greater childhood adversity is a source of increasing negative impact on people during the pandemic
According to Bronfenbrenner's framework and ecological systems theory, different categories of environmental stressors that are dependent on the surroundings of the patients. Applying the thematic analysis to the findings and interview answers of the five participants, it is found that there are three themes i.e., school-based, home-based, and family-based. These are three settings where most of the patients are kept, and these settings create a change in the actions of the patients. It is found that patients who are at school are at risk of peer reaction and this can also be turned into an opportunity through peer connection therapy. However, the patients who are at home felt secluded and had no social life, which made them feel even more anxious. Lastly, patients who lived with a family showed the most positive behavior as they are well supported, and they are tended properly on time with familial love. In this regard, the research factors include ADHD patients, sadness, grief, school, home, and family. These variables are interrelated to find the impact of location and emotion on the patients where it was found that family-based environment along with stress allows ADHD patients to cope with the negative changes in a better way.
Conclusively, ADHD patients should be trained to cope with their sadness in a family environment as they need emotional support to overcome their sadness alongside medication and therapy. It is because school and home settings make these patients feel pressured such that their sadness keeps on elevating and their health condition worsens.
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Citation: Fabian Ilione T , Ogolodom MP (2023) The Effects of Attention Deficit Hyperactivity Disorder on the Development of a Child Dealing with Grief, Loss, and Major Negative Life Changes. Health Sci J. Vol. 17 No. 2: 1000