Attention-deficit hyperactivity disorder (ADHD) is one of the conditions commonly affecting children. Approximately 5% of children are affected by this condition, hence prompting the need to find an approach to addressing the problem among children and adults alike. Various intervention measures have been used in the past, with varying degrees of effectiveness. Pharmacological procedures, as well as psychotherapy-based procedures, have been used in the past. Counseling is one such method that can be used in fostering self-management among children with ADHD. When counseling such patients, there is a need to be keen on the procedures and methods used, which should be aligned with the overall needs of children and the need to achieve positive intervention outcomes. Accordingly, this paper mentions three distinct areas of focus when counseling children with ADHD, including conflict resolution, motivation/self-efficacy, and self-esteem. Counselors have to take children-specific measures in these areas to ensure that outcomes foster academic and normal living development.
Counseling for Children with ADHD
Attention deficit hyperactivity disorder (ADHD) is a disorder characterized by a continuous cycle of inattention and hyperactivity, which results in developmental and normal functioning challenges. The presentations associated with ADHD can be either hyperactivity alone or a combination of both hyperactivity and inattention impulsivity. According to Nizar (2017), children affected by ADHD are often more likely to exhibit hyperactivity than a combination of the two forms of impulsivity. Moreover, it is reported that impulsivity, unfocused motor attention, and inattention are common behaviors for all people. However, individuals with ADHD have more pronounced and more severe symptoms of these aspects. Furthermore, the symptoms are more frequent and inhibit normal academic, social, or professional functioning (Nizar, 2017). Among children, ADHD normally results in interference with classroom management, aggressive behavior that may be unacceptable to peers, and generally antisocial behaviors.
Risk factors for ADHD among children include low birth weight, genetic predisposition, cigarette smoking, drug and alcohol use during pregnancy, brain injuries in childhood, exposure to toxins during pregnancy, and young age exposure to environmental toxins, including high levels of lead. Male children are more susceptible to ADHD than female children. Presently, there is no certain cure for ADHD (Nizar, 2017). However, the condition should be managed to reduce the severity of its symptoms in order to improve general life functioning. Commonly available approaches to ADHD management include pharmacotherapy, education or training, a combination of several treatments, and psychotherapy, among others. It is important to identify the most effective treatment approaches, and this paper explores the effectiveness of counseling as a treatment approach for children with ADHD.
The paper presents a general overview of children counseling as an ADHD intervention. The paper will first give a general description of ADHD, explaining its clinical definition and highlighting its most common causes and symptoms, possible outcomes, and the conventionally used interventions besides counseling (Nigg, 2013). It also gives a description of counseling as an intervention for ADHD and a general overview of the key counseling focus areas during ADHD intervention. Finally, the effectiveness of the intervention is described, followed by a conclusion.
Attention Deficit Hyperactivity Disorder (ADHD)
A study by Nigg (2013) defines ADHD as “a developmental disorder characterized by a pattern of severe inattention–disorganization and/or hyperactivity-impulsivity beyond that observed in individuals at a comparable level of development.” The condition affects more than 5% of children across the world (Nigg, 2013). However, the DSM-V definition of ADHD emphasizes that for the condition to be diagnosed, it has to cause certain impairment in the victim (Wilens &Spencer, 2010). The severity of symptoms is not to be confused with the impairment caused by it. It is, thus, important to consider not only the severity of the symptoms but also the effects they have on the affected individuals. In most cases, the effects can be both psychological and physical, which makes the condition even more difficult to diagnose and treat.
Probable Causes and Symptoms
While there is no clear understanding of the exact causes of ADHD, previous research has shown that the condition may be caused by a combination of physical and environmental factors that result in behavior modification. Wilens and Spencer (2010) also explain the possible links between ADHD and genetics, with the argument that children from families in which the prevalence of ADHD has been observed are more likely to suffer from the condition. Furthermore, various risk factors that support the argument for the combination of environmental, genetic, and social factors as a cause of ADHD have been mentioned. Nigg (2013) mentioned lifestyle factors, such as sleep patterns, obesity, drug and alcohol consumption, and depression, if experienced during pregnancy, may result in ADHD in children. For children, other factors that can cause ADHD include head injuries and exposure to abuse at a young age.
The symptoms of ADHD vary depending on the severity of the condition. One of the most common symptoms is mood variation and anxiety in victims. According to Wilens and Spencer (2010), various anxiety disorder symptoms also manifest in ADHD patients and are most likely to appear as generalized, social panic symptoms. These anxiety and mood disorder symptoms may include irritability, lack of response to any form of structure or structured communication, mood instability, and psychosis. Other symptoms that manifest include distractibility, difficulty in sustaining attention and/or mental effort, restlessness and excessive talking, hyperactive fidgeting, and impulsivity. Additionally, the condition may be characterized by impairment functioning in any of the four environments, including home, school, and work (Thapar et al., 2012). The impaired functioning normally goes on for at least six months.
Possible Outcomes of ADHD
ADHD is often described as a condition that initiates comorbidity due to the potential for numerous symptomatic occurrences that are also associated with other psychological and physical conditions. The most common outcome associated with ADHD is a combination of emotional and cognitive problems, characterized by limitations in executive functioning, including response inhibition, as well as a reduction of working memory and organization skills (Nigg, 2013). The symptoms associated with these problems increase with age as the patients grow and face increasing demands for self-management. It is also associated with issues in mood regulation, such as irritability. Such issues are not commonly cited as symptoms of ADHD but have somewhat obvious implications for interpersonal relationships (Thapar et al., 2012). As such, declining quality and quantity of interpersonal relationships, even among children, is a common outcome associated with ADHD.
Besides the emotional and cognitive outcomes, ADHD is also associated with various physical outcomes. According to Nigg (2013), ADHD is associated with problems in motor skills and motor development, which may result in outcomes such as predisposition to secondary health issues. This is one of the reasons why ADHD is defined as a co morbidity-initiating condition. Further outcomes include academic under-achievements and deficiencies in occupational functioning.
Common Interventions and their Effectiveness
In determining the most appropriate treatment for ADHD, it is required to consider all aspects of an individual’s life, including their daily activities. Various intervention measures have previously been considered for ADHD. Multimodal approaches combine educational, individual, and family therapy for the condition. On the other hand, psychotherapy may be used alone or in combination with various medications for ADHD and comorbid problems (Nizar, 2017). Various forms of pharmacotherapy can also be used, including noradrenergic agents, stimulants, antidepressants, and alpha agonists. The choice of treatment approach is dependent on the severity of the condition and the intention of management. Most pharmacological methods are effective for long-term management and can be used across the patient’s life-span.
Counseling for ADHD
ADHD Counseling Overview
Counseling is part of conventional ADHD treatment approaches. In counseling, the objective is to enhance the patient’s capability to handle the symptoms of the condition, to notice the triggers for the condition, and to address them effectively. De Oliveira and Dias (2018) propose that psychotherapy, particularly cognitive-behavioral therapy approaches, can be used at any developmental stage to help deal with residual symptoms of ADHD. In doing so, there have to be clear directions and goal setting. For children, the parents have to be made aware of the treatment objectives to reduce non-adherence, which is reported to range between 13.2% and 64% (De Oliveira & Dias, 2018). The authors report that lack of knowledge is one of the factors that promote non-adherence. For parents, this is possible due to the probability of denial and low development of ADHD symptoms, which may make parents non-commitant.
Counseling Focus Areas
When working with children as ADHD patients during counseling, various areas have to be considered, based on the outcomes associated with ADHD. These focus areas are discussed by Hamilton and Astramovich (2014). Counseling children can be difficult without parental support and may not achieve the targeted objectives. ADHD is commonly diagnosed in children through observatory assessments conducted by teachers, parents, mental health professionals, or primary physicians. Accordingly, getting the right resources and the right personnel in child counseling is paramount. The three areas, conflict resolution, motivation/self-efficacy, and self-esteem, have to be considered when counseling children with ADHD regardless of the context within which the counseling occurs or the individual carrying out the counseling.
One of the areas that have to be considered in depth during child counseling for ADHD is the aspect of conflict resolution. In most cases, children with ADHD are perceived to be difficult due to their irritability, poor interpersonal skills, and inattention. Instructions have to be repeated severally for them to understand and implement. This can be challenging and detrimental to the interpersonal relationship between the children and their peers, teachers, and even parents. For this reason, counseling and training the children on interpersonal skills is a crucial part of the ADHD intervention that cannot be willed away (Hamilton & Astramovich, 2014). Counselors can use strategies such as peer mediation to help children with ADHD to resolve conflicts constructively. This can be monitored through frequent assessment of the children’s capability to constructively resolve and/or manage conflicts.
Motivation/ Self Efficacy
Besides conflict resolution, children with ADHD also have to be counseled on the concepts of motivation and self-efficacy, and how to differentiate these concepts from the symptoms of the condition. Since ADHD is also characterized by increased activity and aggressiveness, the children ought to recognize where that activity is arising from, a manifestation of the symptoms of the disease, and where it is from personal motivation (Nizar, 2017). Motivation and self-efficacy would be characterized by the ability to finish assigned tasks, perceptions of self-worth, and significant visible efforts to engage in assigned activities, which are contradictory to the behaviors commonly exhibited by children with ADHD (Hamilton & Astramovich, 2014). As such, counselors working with children with ADHD need to come up with techniques for enhancing self-efficacy and motivation among the children; one of the techniques is by helping the children to identify various activities that they can take part in both at home and in school and also assisting then in those activities until they are completed.
According to Hamilton and Astramovich (2014), ADHD is associated with the feeling of peer rejection and even rejection from teachers who may not understand the student behaviors. For this reason, counselors address the need for self-esteem to foster Maslow’s theory that builds on self-esteem. The theory defines self-esteem as a deficiency need, which means that learning becomes more effective only after meeting the need. The children have to understand that they must first value themselves and thus develop feelings of being valued by others. Low self-esteem may be construed to be incompetence, which would result in continual rejection and dejection (Sprich et al., 2015). Counselors working with children with ADHD ought to consider these characteristics using approaches that are self-assuring. To do this effectively, they have to assess through observation, self-defeatist behaviors among the children undergoing counseling and then challenge behavior and thought patterns that foster negative self-perceptions.
Effectiveness of Intervention
Counseling can be effective when initiated earlier on in the management process for ADHD. It has been used over the years with adult populations for behavior management in order to control the symptoms and outcomes of ADHD. However, for child patients, ADHD counseling has to consider several perspectives and be conducted by professionals with experience in handling children. Distinctive measures have to be taken to ensure success, focusing on areas of weaknesses, and addressing some of them before they escalate. When working with older children and adolescents, Sprich et al. (2015) recommend a collaborative approach to counseling, in which the patients also offer their ideas about dealing with certain concerns. The same principle can be applied when working with children.
Counseling for children with ADHD can be an effective approach towards managing the condition. From previous research, it is evident that pharmacological approaches to managing ADHD are more suitable to full life-span management, and can be used effectively for adults. However, the symptoms of ADHD begin during childhood and get more severe with time. It is, therefore, recommended that during childhood, approaches aligned to psychotherapy, such as counseling, should be used to help manage behavior before initiating active learning and ensure sustainable self-management.
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