Illness-perception in adolescent attention-deficit/hyperactivity disorder: A qualitative study.

Background: Adolescents with attention-deficit/hyperactivity disorder (ADHD) experience aspects of their lives in diverse ways. They often have more energy and creativity which are positive traits of ADHD, while their inability to control their actions in academic or social spheres may cause feelings of inadequacy. Aim: To explore illness-perception, including emotional experiences, in adolescent ADHD. Setting: Using convenience sampling, 12 adolescent participants, eight boys and four girls, diagnosed with ADHD, were included. Participants followed up at Weskoppies Tertiary Psychiatric Hospital's child-and-adolescent outpatient clinic. Methods: This qualitative study used semi-structured question guides to conduct interviews that allowed participants to actively construct their knowledge of their disorder. Maintaining a phenomenological perspective, thematical analysis of data was done. Results: Adolescents' perceptions of their ADHD could be placed into three categories. 'Negative self-perception in ADHD' represented adolescents' descriptions of 'inability' and 'lack of control' over their cognitive processes, behaviour, emotions, and restlessness. Adolescents perceived 'feeling judged by others', amplified self-stigmatisation and discrimination. This antagonistic environment caused conflict between their self-perception and others' perception of them, further intensifying feelings of 'not being normal'. The theme 'self-empowerment strategies', included controlling external stimuli, accepting support from others, and personalised learning strategies. Conclusion: Adolescents with ADHD struggle with cognitive, behavioural, and emotional control, and frequently experience stigmatisation and discrimination. They often learn to rely on self-taught coping strategies. Contribution: This research grants perspective to educators and clinicians on experiences of adolescents with ADHD, and identifies the need to address stigmatisation. It recognises the value of personalisation of coping methods.

Adolescent psychiatric outpatients and their caregivers: Comparing the Strengths and Difficulties Questionnaire.

BACKGROUND: The use of the SDQs as a screening tool to monitor new or ongoing problems in adolescent psychiatric outpatients is needed to improve clinical outcomes. Discrepancies between parent and adolescent reports on the Strengths and Difficulties Questionnaire (SDQ), reflects the degree of emotional and behavioural symptoms. This may affect their ability to work together to reach therapeutic goals. AIM: The level of SDQ (dis)agreements between adolescent-parental self-reports in adolescent psychiatric outpatients was examined. SETTING: Weskoppies Child and Adolescent outpatients. METHODS: This two-group cross-sectional comparative study obtained SDQ responses from 74 psychiatrically diagnosed adolescents and their parents (148 completed SDQ questionnaires). Adolescent outpatients aged between 11 and 18 years following up at the outpatients between July 2017 and November 2017 were included. Adolescent and parent rating scores were compared using a paired sample t-test, and patterns of agreement were measured by using Pearson's correlation coefficient and Cohen's kappa. RESULTS: Parents reported more difficulties than adolescents, although differences were non-significant (p > 0.58). Caregivers and adolescents agreed on the conduct domain and on emotional symptoms (0.21 ≤ kappa ≤ 0.40, p < 0.05). Caregivers and adolescents agreed on the presentation of internalising and externalising disorders (R = 0.48, p < 0.001). CONCLUSIONS: The SDQ confirmed fair agreement between parents and adolescents. Parental perceptions of adolescent behavioural difficulties could influence parent- adolescent relations and communication. Using the SDQ as a screening tool in South Africa, requires further validation for it to be integrated as part of a multi-informant best-practice approach.

A case study of two adolescent-parent pairs describing the association between vagal tone and social-emotional adjustment during a Positive Cognitive Behaviour Therapy Programme.

OBJECTIVE: A case study describing the association between vagal tone and social-emotional adaptation in two distressed adolescent-parent (A-P) pairs during a Positive Cognitive Behaviour Therapy Programme (P-CBTP). METHODS: Two A-P pairs completed a P-CBTP with pre- and post-intervention biosocial-emotional assessments; weekly training sessions over 7 weeks to develop individual strengths, new adaptive cognitions, positive discipline skills, optimism and knowledge on age-appropriate developmental expressions; augmented by moderate physical activity. Resting vagal tone and vagal reactivity were assessed by time-domain measures of vagal activity (RMSSD). RESULTS: Social-emotional adjustment improved in all A-P pairs. Resting vagal tone increased over the intervention period, from low-to-low-normal towards average-for-normal in three subjects. The fourth individual had excessive pre-intervention resting vagal tone that declined in the direction of normal over the intervention period. Vagal reactivity in response to orthostatic stress remained the same pre- to post-intervention. CONCLUSIONS: Changes in resting vagal tone demonstrated improvements in psychological functioning in all four subjects over the period of intervention. Results supported the view of the association between vagal tone and mental health not being an absolute positive relationship, but that low, as well as excessive, vagal tone may be maladaptive. Indications are that the same may apply to vagal reactivity to psychological stress. More studies need to examine the association between resting vagal tone and emotion regulation in A-P relationships during P-CBTP, keeping in mind that a linear relationship cannot summarily be expected in population studies.

Clinical and demographic factors associated with sexual behaviour in children with autism spectrum disorders.

INTRODUCTION: The sexual behaviour and development of children with autism spectrum disorders (ASDs) have been mostly overlooked in research and practice. This study aimed to determine the association between certain clinical and demographic factors found in a sample of children with ASDs, and their reported sexual behaviour (RSB). METHODS: The study was conducted at a school in Gauteng, South Africa, for learners with ASDs. Two questionnaires completed by caregivers/parents enquired about family stability, clinical profile and RSB (if any) in their child. RSB was analysed via three domains: self-care, socio-sexual skills and actual RSB, with additional information from school records. RESULTS: Of the 107 questionnaires distributed, only 31 parents responded and 24 agreed to participate. The 24 (100%) children included 10 pubertal and 14 pre-pubertal children, of which 18 (n = 18) had more stable primary caregiver statuses as well as more stable socioeconomic and family environments. Two of the 14 pre-pubertal children had abnormal self-care, whereas none of the 10 pubertal children had any abnormal self-care. Eight of the 18 children from more stable environments displayed abnormal sexual behaviours. Of the 6 children from less stable environments, two displayed more abnormal socio-sexual skills, whereas 9 of the 18 children from more stable environments displayed more abnormal sexual behaviour. In contrast with the postulated hypothesis that children from less stable socioeconomic and family environments would exhibit more abnormal sexual behaviours, this study did not find any evidence of such a relationship or association. CONCLUSION: ASDs are characterised by deficits in communication and social skills. These may lead to an affected individual struggling to develop appropriate sexual behaviour. If specific risk factors that contribute to the development of abnormal sexual behaviour can be identified, one can try to modify/prevent these where some degree of prevention or alleviation may be possible.

A descriptive study of biological and psychosocial factors associated with body mass index for age, in adolescents attending an outpatient department at Weskoppies Psychiatric Hospital.

OBJECTIVE: To describe biological and psychosocial factors associated with body mass index (BMI) for age in adolescents attending an outpatient department at Weskoppies Psychiatric Hospital. METHODS: A total of 50 adolescents participated in a convenience sampling research study. BMIs were calculated using their weights and heights to distinguish different weight categories based on the 2007 World Health Organization (WHO) growth charts. Based on their BMIs, participants were categorised as underweight, normal body weight, overweight and obese. The association between the BMIs of the biological parents and their adolescent children was investigated using the Fisher's exact test. The data collection included adolescents' demographic information, psychiatric diagnosis, psychiatric medication, nutritional intake, eating habits and the intensity of physical activity such as sports, leisure and sedentary behaviour. SETTING: The study was conducted at Weskoppies Psychiatric Hospital's adolescents outpatient department. RESULTS: Of the participants, 72% were males. Forty-eight per cent of all the adolescents had a normal BMI, mostly of black African descent. When comparing the adolescents' BMI with that of their biological mothers, 50% of those who were obese also had mothers who were mostly obese (53.8%). The Fisher's exact test indicated a statistically significant association between the BMI categories of mothers and those of their adolescent children (Fisher's exact test, p = 0.032). Despite the above association, no significant association could be found regarding their nutritional intake and eating habits. Also, no significant association was found between the adolescents' BMIs and the use of psychotropic medication, as compared with other previous studies. Furthermore, no association could be found between adolescents' BMI categories and the level of intensity of physical activity such as sports and leisure activities or sedentary behaviours. CONCLUSION: This study supports previous findings that a significant association exists between maternal and childhood obesity. The association between BMI and psychotropic medication, nutritional intake and eating habits, and level of physical activity could not be confirmed in our study. The study results were limited by the small sample size and the convenience sampling method. Although this was only a descriptive study, it highlighted the complexity of biological and psychosocial factors involved in weight gain. Further studies are needed to explore the interplay of physical and environmental risk factors for childhood obesity, as well as to ensure early identification and education of patients and their families to prevent development of obesity.

Autonomic correlates at rest and during evoked attention in children with attention-deficit/hyperactivity disorder and effects of methylphenidate.

OBJECTIVE: The aim of this study was to assess autonomic nervous system functioning in children with attention-deficit/hyperactivity disorder (ADHD) and to examine the effects of methylphenidate and focussed attention. METHOD: Children with ADHD (n = 19) were tested while they were stimulant free and during a period in which they were on stimulants. On both occasions, autonomic nervous system functioning was tested at baseline and during focussed attention. Autonomic nervous system functioning of control subjects was also tested at baseline and during focussed attention. Autonomic nervous system activity was determined by means of heart rate variability (HRV) and skin conductivity analyses. Attention was evoked by means of the BioGraph Infiniti biofeedback apparatus. HRV was determined by time domain, frequency domain and Poincaré analysis of RR interval data. Skin conductivity was determined by the BioGraph Infiniti biofeedback apparatus. RESULTS: The main findings of this study were (a) that stimulant-free children with ADHD showed a sympathetic underarousal and parasympathetic overarousal of the sympathovagal balance relative to control subjects; (b) methylphenidate shifted the autonomic balance of children with ADHD towards normal levels; however, a normal autonomic balance was not reached, and (c) stimulant-free children with ADHD exhibited a shift in the sympathovagal balance towards the sympathetic nervous system from baseline to focussed attention; however, methylphenidate appeared to abolish this shift. CONCLUSIONS: Stimulant-free children with ADHD have a parasympathetic dominance of the autonomic balance, relative to control subjects. Methylphenidate attempts to restore the normal autonomic balance in children with ADHD, but inhibits the normal autonomic nervous system response to a cognitive challenge. CLINICAL APPLICATIONS: These results indicate that methylphenidate may have a suppressive effect on the normal stress response. Although this may be of benefit to those who interact with children who suffer from ADHD, the implications for the physiological and psychological well-being of the children themselves are debatable. Further research is needed. LIMITATIONS OF THE STUDY: Only 19 children with ADHD and 18 control subjects were tested. Further studies should include prior testing in order to exclude children with possible co-existing learning disabilities. Cognitive function and emotional responses of children with ADHD were not tested.