Is ADHD a way of conceptualizing long-term emotional stress and social disadvantage?

Background: The prevalent, neuropsychiatric, deficit perspective on children and youth diagnosed with ADHD prohibits a multidimensional approach where socio-economic status, family stress and relationships within the families are relevant factors to examine. Assessments of ADHD through the use of rating scales and short-term interventions may lead not only to overdiagnosis but also to a reductionistic approach in the psychiatric field. This literature review aims to address research outside the prevailing discourse on ADHD as an organic brain dysfunction and broaden the perspectives on children's behavioral difficulties. Methods: The articles included in this applied, mixed-method, systematic review includes 26 peer-reviewed articles, both English and French, with a search focus on ADHD in children and youth related to Attachment styles and relationships. Results: In the studies reported, researchers approached correlations between ADHD and attachment in different ways, and in most cases, there was a caution to address causality. The role of parents was found to be both buffering and aggravating for the appearance of ADHD. In the French case studies, the diagnosis was conceptualized as a relational phenomenon where the child's behavior was inseparable from family member's suffering. Discussion: This review article illustrates how children's difficulties in terms of ADHD symptoms can be addressed through a paradigm where emotional and cognitive dysregulation is understood through psychosocial factors rather than as a neurological condition. In our view, to avoid an overly reductionistic and medicalized approach to children's behavioral difficulties, it is time to reiterate the value of the biopsychosocial perspective. Conclusion: Professionals and researchers need to acknowledge that becoming diagnosed with ADHD has a strong connection to economic disadvantage, social status, and familial care. The academic discourse of addressing brain dysfunctions might serve the unintended purpose of masking emotional stress and social disadvantage that manifests across generations. A biopsychosocial approach to ADHD including family, emotional history, and socio-economic issues could imply a lesser focus on medical treatment as a first choice.

Exploring Tinnitus-Induced Disablement by Persistent Frustration in Aging Individuals: A Grounded Theory Study.

Background: Qualitative research can help to improve the management of patients, meet their expectations and assist physicians in alleviating their suffering. The perception of moment-to-moment variability in tinnitus annoyance is an emerging field of exploration. This study sought to enlighten variability in tinnitus-induced disablement using a qualitative approach. Methods: Twelve participants (six females, six males, aged 51-79) were recruited via the French Tinnitus Association Journal for participation in recorded semi-structured interviews. Each participant had three interviews lasting 1 h, the sessions being separated one from the other by 2 weeks. Following recommendations of Charmaz (2014), the second and third interviews were aimed at gathering rich data, by enhancing the participants' reflexivity in the circumstances of distress caused by tinnitus. After transcription, the data (n = 36 interviews) were analyzed using the approach to Grounded Theory proposed by Strauss and Corbin (1998). Results: Tinnitus as persistent frustration emerged as being the core category uniting all the other categories of the study. Hence, the core category accounted for the broader scope in participants' experience of chronic tinnitus. It is suggested that tinnitus-induced disablement varied according to the degree of frustration felt by the participants in not being able to achieve their goals. The implications of this were analyzed using the following categories: "Losing body ownership," "Lacking perspectives," and "Persevering through difficulties." Based on these findings, we draw a substantive theory of tinnitus tolerance that promotes an active, disciplined and individualized approach to tinnitus-induced disablement. The model distinguishes pathways from sustained suffering to reduced annoyance (i.e., emerging tolerance). It accounts for difficulties that the participants experienced with a perceived unchanged annoyance over time. Furthermore, this model identifies a set of new attitudes toward oneself and others that tinnitus tolerance would entail. Conclusion: The subjective experience of frustration enlightens tinnitus-induced disablement, offering new perspectives for long-term self-management. Modulation of frustration, rather than moderation of tinnitus interference, is suggested as a new approach to the clinical management of tinnitus-related distress.

Learning from tinnitus patients' narratives--a case study in the psychodynamic approach.

Tinnitus is assumed to be the perception of sound that results exclusively from activity within the nervous system without any external stimulation. Approximately 1-2% of the population regard their tinnitus as a serious threat towards their quality of life. The way the patients describe their suffering varies, sometimes also depending on the interest and insight of the clinician to whom they turn to for help. The lack of insightful narratives of someone who is severely annoyed by the presence of a constant tinnitus sound may lead to limited and biased models of tinnitus suffering. In the present case study the participating patient, a woman aged 70, shared her experience of being victimized by tinnitus with the clinician/researcher during a number of psychotherapeutic sessions. The psychodynamic, narrative approach, made it possible for the client to articulate the unique and specific meaning that she experienced as being part of her suffering. In her words, tinnitus became a tolerable symptom that she managed to work through within psychotherapeutic alliance.

Risk behaviour and noise exposure among adolescents.

Adolescents in Western society often expose themselves to high levels of sound in gyms, rock concerts, discotheques etc. As these behaviours are as threatening to young people's health as more traditional risk behaviours are, our aim in the present study was to analyze the relationship between self-exposure to noise, risk behaviours and risk judgements among 310 Swedish adolescents aged 15-20 (167 men; 143 women). Adolescents' behaviour in different traditional risk situations correlated with behaviour in noisy environments, while judgements about traditional risks correlated with judgements regarding noise exposure. It is an interesting finding that although young women judge risk situations as generally more dangerous than young men do, they nevertheless behave in the same way. We suggest that this difference is a social and cultural phenomenon which underscores the importance of adopting a gender perspective in the analysis of risk factors. Adolescents reporting permanent tinnitus judged loud music as more risky than adolescents with no symptoms and they did not listen to loud music as often as those with occasional tinnitus. Research on hearing prevention for young people needs to acknowledge and make use of theories on risk behaviour, especially due to the existence of a relationship between adolescents' risk-taking in noisy environments and other types of risk-taking. Similarly, theories on risk behaviour should acknowledge noise as a risk factor.

The impact of perceived tinnitus severity on health-related quality of life with aspects of gender.

The Nottingham Health Profile (NHP) has been used to investigate the health profiles in different medical conditions. It has, however, never been applied to tinnitus sufferers. The present study aimed at investigating relationships between the perceived severity of tinnitus, audiometric data, age, gender and non-disease specific health-related quality of life measured with the NHP divided into two sections; NHP I (topics related to health status) and NHP II (health induced problems in daily life). These parameters were statistically analysed to identify predictive factors to the perceived severity of tinnitus, described by the Tinnitus Severity Questionnaire (TSQ). A total of 186 consecutive tinnitus patients (57 females and 129 males) attending an audiological specialist clinic in Sweden were included in the study. The stepwise regression model used explained 37.8 per cent of the variance in the perceived severity of tinnitus, and the significant predictors were: "Emotions", "Sleep", and "Pain", three of the six dimensions of the NHP I. Differences between gender were found in NHP II and age-related differences emerged in NHP I when male and female patients were compared to normal controls.