theroleofpsychologicalinterventiontoimproveattentionadhdchild ·...

The Role of Psychological Intervention to Improve Attention ADHD Child

Novil Cut NizarMaster of Psychology

University of Muhammadiyah [email protected]

INTRODUCTION

Attention-Deficit/Hyperactivity Disorder (ADHD)is one of the most common behavioral health concernsin children and adolescents, with a prevalence rate of2% to 9% worldwide. Children with ADHD presentwith executive functioning impairments andbehavioral challenges that negatively affect their dailyfunctioning across everyday settings. Thesedifficulties place them at greater risk for sufferingadverse outcomes throughout the life span, includingdisruptions in relationships (with parents, peers, andteachers), academic problems, chronic behavioraldifficulties, and delinquency and substance abuse inadolescence. ADHD is more common in men thanwomen in the general population, with a ratio of about2: 1 in children and 1.6: 1 in adults. Women are morelikely than men to experience innattentive (Curtis,. etal, 2013; APA, 2013). ADHD begins in childhood.The requirement that several symptoms be presentbefeore age 12 years conveys the importance ofsubstantial clinical presentation during childhood.

ADHD in the Bahasa is gangguan pemusatanperhatian dan hiperaktivitas (GPPH) which is difficultto concentrate on the tasks assigned to them. Even ifthey have good motivation, they are harder to do, andeven if they do they spend a lot of energy whencompared to other children. ADHD has symptoms ofattention disorders and concentrations, impulsivityand hyperactivity (Paternotte & Buitelaar, 2010).

Hyperactivity and implusivity symptoms:squirmsin seat, talk excesively, blurts out an answers before aquestion has been completed, etc. Innatenttionsymptoms: doesn’t not seem to listen when spoken todirectly, doesn’t follow through on instructions andfail to finish schoolwork, avoids,

forgetful in daily activities, etc (Gehan & Samiha,2011; Schultz. et. al, 2011; Månsson1. Et. al, 2017).

Children with ADHD have less attention resultingin difficulties when in a social institution such as apublic school when absorbing a lesson at school(Dupaul, Weyandt, O’Dell & Varejo, 2009). Andchildren who have ADHD usually have time toconcentrate that is about 6-10 seconds depending onthe severity.

Research on individuals with ADHD has beenwidely practiced. Researchers are doing more researchon the effect of treatment on individuals with ADHDby performing various approaches either by providingstimulant drugs or with various psychologicaltherapies. Patients diagnosed with ADHD areincreasingly prescribed with drugs such asmethylphenidate (ritalin, concerta), dexafetamine,atomoxetine (strattera), tricyclishe, anatidepresive,nortiplyline, pemoline, or imipramine. Many clinicaltrials have found the core symptoms of hyperactivity,impulsivity, and lack of attention indicate statisticallysignificant cure and better academic achievement,association with family and peers and behavioralproblems, and drugs can even reduce the risk ofsubsequent psychiatric comorbidities .

Other researchers have found that side effectsmean that pharmacological intervention is not alwaysacceptable for parents, children, or even someclinicians. Negative effects such as loss of appetite,weight loss, difficulty falling asleep, trembling, drymouth, nausea, abdominal pain, low energy,irritability, diarrhea, muscle tension, grinding teeth,and rare but important cases of sudden death due topre-existing hidden cardiovascular problems mayprevent continued use of psycho-stimulants (Curtis,2013).

The token-economy system is one of the mostwidespread for managing and measuringdysfunctional behavior. Children’s parents and other

Abstract. Children with ADHD (Attention Deficit Hyperactivity Disorder) have problem with attention that are very difficult tomaintain on a particular task. Children with ADHD have problem when in a social institution such as a public school. Patientsdiagnosed with ADHD are increasingly prescribed with drugs such as methylphenidate (ritalin, concerta), dexafetamine,atomoxetine (strattera), tricyclishe, anatidepresive, nortiplyline, pemoline, or imipramine usage of stimulant medication may resultin side effects such as insomnia, loss of appetite, abdominal pain, headache, anxiety, stress, and nervousness. stimulant medicationworks only short-term and symptoms return once medication is stopped. The purpose of this study was to determine the role ofpsychological interventions that are widely used in ADHD children in increasing their attensiveness. The method used is journalliterature or literature review. And the result is a token economy is a much-conducted intervention and gives significant results tothe increased attention of children with ADHD. Then play therapy is also able to increase attention to ADHD children by combiningwith other therapeutic techniques. While Music and Tone also mmberikan significant results only still lack of researchers to do thisresearch.

Keywords: Pschological Intervention, Attention, ADHD

3rd Asean Conference on Psychology, Counseling and Humanities (AC-PCH 2017)

Copyright © 2018, the Authors. Published by Atlantis Press. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).

Advances in Social Science, Education and Humanities Research, volume 133

113

mailto:[email protected]

caregivers keep a record of daily or weeklyoccurrence of target behaviors initially formulatedtogether with the child or teen. For children withADHD, some researchers have suggested printing outthese predetermined behaviors (rules) on cards.Thistechnique uses as consequence strategy awards ofpoints or tokens for desirable behavior (positivecontingency reinforcement) and may conditionsignificant impairments to display of inappropriatebehaviors such as withdrawal of a previously gainedtoken (response cost). DuPaul et al. reportedefficacious strategies for behavioral interventionsapplicable in the school setting using the tokeneconomy system as a strategy that may lead toimproved behavior for task completion, and foundclinically significant improvements in task-relatedattention as well as productivity and accuracy of workdone in class, especially when combined with the costresponse system (Dupaul, 2011; Reitman, 2011;Andez de la Cruz. et. al, 2017; Hedges. et. al, 2013).

Some studies also indicate that methylphenidatecan ease most of the time deficits and normalize thefunctioning of networks involved in ADHD, yieldingto an improved performance in cognitive tasks. In thissense, we think of music, as an eminently temporaland rhythmic art that displays lively, spontaneous,emotional, and motivational dimensions that couldpossibly be of great help in studying aspects of timeprocessing in children with ADHD. Our studyinvestigated how the perception of time is related tothe modulation of attention, executive, and inhibitorycontrol of impulsive behaviors related to self-regulation, planning, and control of motor actionsthrough sound and music (Career, 2015).

Treatment with behavioral therapy with or withoutmedications leads the children to do well at schooland college and become productive adults.Multimodal behavioral programs integrating playtherapy, exercise, and reward systems usingpsychologists have been shown to help the majority ofchildren with ADHD. Yoga with meditation modifiedfor children was chosen as the physical exercisecomponent. Yoga also needs limited space, noequipment, is easy to learn, and also culturally wellaccepted. There is strong belief but limited evidenceto show that yoga and meditation help focus andattention (Metha., et al, 2012).

Individuals with ADHD are at risk for a variety ofnegative outcomes including poor peer relationships,higher rates of delinquency and substance abuse, lowself-esteem, lower educational attainment, andeducational underachievement (Miller & Lee, 2013).

Based on the above description, the growingtreatment and interventions developed to increaseattention to ADHD children. Therefore, researcherwant to study the role of various interventionprograms through the results of previous research byexperts.

LITERATURE REVIEW

Attention ADHD ChildChildren with ADHD have problems fails to gives

close attention to details. This difficulty is not causedby disturbing external stimuli to maintain attention.Unable to concentrate or make careless mistakes inmany activities, difficulty maintaining attention totasks or play activities, seeming not listening whenspoken to directly, not completing tasks, difficultyorganizing tasks and activities, avoiding, disliking orbeing reluctant to engage in tasks that demandongoing mental endeavor (such as schoolwork orhomework), loss of objects essential to a task oractivity (for example, toys, stationery, schoolwork),disturbed by unrelated stimuli, and forgetfulness indaily activities (Flanagen, 2005; Paternotte & Buitelar,2010 ).

Unlike hyperactive–impulsive or combined typeADHD patients, adults who are primarily inattentiveoften do not report as many behavioral problems athome or at school when they were. Rather, inattentiveadults were likely to have experienced academicproblems and received feedback from teachers notingtheir need for more supervision in completing work,to pay better attention in class, and to develop betterstudy skills. Their grades were likely to suffer fromturning in assignments late, incomplete, or forgettingto turn them in altogether. Because their difficultiesgenerally were internalized and did not lead todisruptive behaviors that would capture the attentionof teachers, these patients’ difficulties often were notidentified until college or later in adulthood. Notsurprisingly, predominantly inattentive symptoms areoften associated with comorbid internalizing disorders,such as anxiety or depression (Ramsay & Rostain,2008).

Psychological InterventionThe results of many studies reveal that

psychological intervention has significant effect onchildren with ADHD. Psychological interventionssuch as token economy and play therapy.

Token economyThis therapy is used to increase attention

organizing tasks and activities because individualswith ADHD often loses things necessary for tasks oractivities (Robert, Alexander & Michalla, 2005).Token economy technique has been widely used foroperant conditioning in children showinginappropriate and disruptive behavior cases presentingbehavioral problems with lack of empathy, guilt, andself-monitoring difficulties (callous – unemotional)may present resistance and even behavioraldeterioration if interventions involve cost of responseor punishment. Interventions that maximize rewardswith positive reinforcers appear to be most effective(Tarbox, Ghezzi, Wilson, 2006).

The token-economy system is one of the mostwidespread for managing and measuringdysfunctional behavior. Children’s parents and othercaregivers keep a record of daily or weekly


114

occurrence of target behaviors initially formulatedtogether with the child or teen .

Content analysis technique consists of three mainstages: (1) pre-analysis – organ-izing materials tosystematize initial ideas, demarcating what will beused, formulating hypotheses and goals, and finallycompiling indicators to be analyzed; (2) exploration ofmaterial – categories are defined by coding andidentifying in recording units for the categorizing andfrequency counts; (3) results are processed forinterpretation (Coelho, et al., 2015).

Combination of Other Therapeutic Techniquesand Playtherapy

Yoga with meditation modified for children waschosen as the physical exercise component. Yoga alsoneeds limitedspace, no equipment, is easy to learn,and also culturally well accepted. There is strongbelief but limited evidence to show that yoga andmeditation help focus and attention. Pilot studiesusing this as family based therapy for ADHD in 8boys have been reported to show promise. Additionaltheoretical basis may be the increase in dopaminerelease in the CNS from yoga. In ADHD, reduceddopamine levels are seen in the CNS, and strategies toregulate these levels are suggested as possibletherapies (Metha., et al, 2012).

When doing play therapy, play time is alsoconsidered because it relates to the development ofattention and ability to learn. Dynamic temporalpatterns, such as the rhythm of speech, can beimportant to learn. In addition, performanceimprovements with exercises involving the transitionfrom reactive to predictive time, so different types oftime need to be done.

Furthermore, the Adventure-based counseling(ABC) technique can make ADHD children completetheir tasks combined with Adlerian play therapy.Adlerian's play therapy focuses on four delinquencygoals: attention, power, revenge, and disability(Portrie-Bethke, Hill & Bethke, 2009).

Music and Sound

ADHD involves cognitive and behavioral aspectswith impairments in many envi-ronments of childrenand their families’ lives. Music, with its playful,spontaneous, affective, motivational, temporal, andrhythmic dimensions can be of great help for studyingthe aspects of time processing in ADHD. In thisarticle, we studied time processing with simple soundsand music in children with ADHD with the hypothesisthat children with ADHD have a differentperformance when compared with children withnormal development in tasks of time estimation andproduction (Carrer, 2015).

The development of psychological interventions forADHD children

1.Token ekonomy

Token economy is an approach that comes frombehavioristik. This therapy has long developed alongwith the development of behavioristic theory itself.Which of these treatments by Skinner (1971) givessignificant results in ADD children or those nowcalled ADHD. There have been many studies that usethis therapy to increase attention to ADHD childrenwhose research conducted by Reitman and othercolleagues title “The influence of a token economyand methylphenidate on attentive and disruptivebehavior during sports with ADHD-diagnosedchildren” which is significant to the behavior ofADHD children.

Tarbox's research, et al (2006) token economy isone example of extrinsic reinforcement that makes aperson do something to achieve that can increaseattention both from the level of tenacity and from thelevel of vigility, the goal is to change the extrinsicmotivation into intrinsic motivation, it is desirable thatthe desired acquisition of behavior can be rewardedfor maintaining new behaviors.

2. Playtherapy

According to research conducted by (Hall,Kaduson, & Schaefer, 2002) for over 60 years, playtherapy has been a trusted treatment in treatingADHD children in clinical practice. One reason forusing play therapy is that it has proven to be a veryeffective approach for children when the abstractreasoning and verbal skills needed to articulate theirfeelings, thoughts, and behaviors have not developedoptimally. This is also supported by previousresearches in the journal psychology (Pykhitna,Balaam, Wood, Pattison, & Oliver, 2011) play therapyresearchers with the title “Designing for attentiondeficit hyperactivity disorder in play therapy: the caseof Magic Land” that play therapy can help childrenwho have difficulty remembering, concentrating andconcentrating on ADHD. Then research conducted by(Ray, 2008) play therapy researchers with the title“Impact of play therapy on parent-child relationshipstress a mental healt training setting” states that playtherapy empirically been validated as an effectiveintervention to mengtasi children's problemsespecially ADHD. In addition, research conducted by(Burtch, 1999) play therapy researcher with the title“The use of play therapy in the private clinicalsetting” states that play therapy is the most possiblemethod to treat and also widely used and accepted inhandling children's problems. child.

And research conducted by (Ray, Bratton, Rhine,& Jones, 2001) play therapy researcher with the title“A meta-analysis of the play therapy outcomeresearch from 1947 to Present” stated that playtherapy gives a large positive effect based on theresults treatment across the population, sex, clinicaland non-clinical populations, the environment and on


115

theoretical thinking. In addition, the positive effects ofplay therapy can be greater if there is a parent fullyinvolved in child care. Some play techniques can beused to deal with ADHD children, playing “towerbuilding” for example can be used to improve focusand concentration. Playing "where my house" forexample can be used to control behavior in roughmotor, so the child can increase the intensity of hisattention more focus on game game given byresearcher.

3. Music and Sound

Russell A. Barkley (Benzon, 2002) argues thatADHD is essentially disoriented in time. This noteexplores the possibility that music, which is welltuned in favor of temporal cognition, may play a rolein improving ADHD. However, given the fact thatADHD does involve problems with temporalcognition, and the music trains one's time ability, theuse of music therapy as a way to correct ADHDshould be investigated. Resercher also recommenddoing an epidemiological study of the relationshipbetween dance and music to interventions in ADHDchildren. Research on music and sound has not beenmuch done because the researchers proved themselvesto have difficulty in finding the literature on thistherapy.

Psychological interventions in ADHD childrenhave long been done. Based on the literature searchthat researchers do by limiting the three therapiesabove are token economy, play therapy and musictherapy and tone.

Therapy for children with ADHD from the1990s to the present is increasingly seeing betterdevelopment. Most research by experts in the 1990sconducted research using only one therapy alone insolving problems in ADHD children such as one ofthe token economy is the most widely performed andgives significant results to the increased attention ofchildren with ADHD. But after the 2000s researchersconducted comparisons or conducted research that ismultimodal such as see the effectiveness of tokeneconomy and CBT, in addition to doing play therapyand Yoga, etc .. so from the results of research intothe literature of researchers showed that increasingprogress in terms of psychological intervention inchildren with ADHD.

Furthermore, among the three therapiesmentioned above, the most widely used by researchersin providing intervention in ADHD children is a tokeneconomy that gives significant results to increase theattention of children with ADHD. In addition, playtherapy is also widely used especially in Indonesiathat matches the culture in Indonesia where playtherapy is done by using traditional games. WhileMusic and Tone itself is still rarely done whichproved a lack of literature that researchers found. AndMusic and sound is associated with cognitive-relatedNeuropsychology in children with ADHD.

METHOD

The method used is journal literature or literaturereview.

CONCLUSION

Based on the above description it can beconcluded that the researchers token economy is amuch intervention done and provide significant resultsto increase attention of children ADHD. Thenplaytherapy is also able to increase attention toADHD children by combining with other therapeutictechniques. While Music and Tone also givesignificant results only still less researchers do thisresearch.

REFERENCE

Andez de la Cruz, Lorena Fern. et. al. (2017). Treatment ofchildren with attention-deficit/hyperactivitydisorder (ADHD) and irritability: results from themultimodal treatment study of children withADHD (MTA). Journal of the american academyof child & adolescent psychiatry.

APA. (2013). Diagnostic and statistical manual of mentaldisorder (Five Edition). Washington, DC:American Psychiatri Association

Burtch, J. J. (1999). The use of play therapy in the privateclinical setting: CounselingMental Health. AResearch Paper of American PsychologicalAssociation (APA)

Carrer, Luiz R.J. (2015). Music and sound in timeprocessing of children with ADHD. JournalUniversidade Federal de São Paulo (UNIFESP),São Paulo, Brazil

Coelho,. et al. (2015). Use of cognitive Behavioral Therapyand Token economy to alleviate DysfunctionalBehavior in children with attention-Deficithyperactivity Disorder. PsychobiologyDepartment, Universidade Federal de São Paulo,São Paulo: Brazil

Curtis, David,. et al. (2013). Family Skills TrainingIntervention for ADHD: Putting the Child BackintoChild Therapy. Journal OMICS PublishingGroup : USA

DuPaul GJ, Weyandt L. L, Janusis GM. (2011). ADHD inthe classroom: effective intervention strategies.

DuPaul, G.J., et al. (2009). College student with ADHD:Current status and future directions. Journal ofAttention Disorder 13, 234-250.

Flanagen, Robb. (2005). ADHD Kids Attention DeficitHyperactivity Disorder. Pustakarya: Jakarta

Gehan, M.A & Samiha, M. (2011). Effect of regular aerobicexercise on behavioral cognitive andpsychological response in patients with attentiondeficit-hyperactive disorder. Life Science. Journal,8 (2). 392-397

Hedges, James H. (2013). Play, attention, and learning: Howdo play and timing shape the development ofattention and influence classroom learning?. Annareport Annals of the new york academy ofsciences

Jackson, N. (2003). A Survey of Music Therapy Methodsand Their Role in the Treatment of EarlyElementary School Children with ADHD. Journalof Music Therapy. Proquest Education Journals:Temple University.


116

Månsson, Annegrete Gohr . et. al (2017). The influence ofparticipation in targetshooting sport for childrenwith inattentive, hyperactive and impulsivesymptoms – A controlled study of best practice.BMC Psychiatry.

Mehta, Segar,. et al. (2012). Peer-Mediated MultimodalIntervention Program for the Treatment ofChildren with ADHD in India: One-YearFollowup. International Scholarly ResearchNetwork Article Clinical Study.

Miller, Faith G & David L. Lee. (2013). Do FunctionalBehavioral Assessments Improve InterventionEffectiveness for Students Diagnosed with ADHD?A Single-Subject Meta-Analysis. SpringerScience Business Media New York.

Paternotte, Arga & Jan Buitelaar. (2010). ADHD (AttentionDeficit Hyperactivity Disorder) gangguanpemusatan perhatian dan hiperaktivitas. PrenadaMedia Group: Jakarta

Paternotte, Arga & Jan Buitelaar. (2010). ADHD (AttentionDeficit Hyperactivity Disorder) gangguanpemusatan perhatian dan hiperaktivitas. PrenadaMedia Group: Jakarta

Pykhitna, O., Balaam, M., Wood, G., Pattison, S., & Oliver,P. (2012). Designing for attention deficithyperactivity disorder in play therapy: the case ofMagic Land. Journal of Internet Psychology

Ramsay J. Rusell & Anthony L Rostain. (2008). CBT forAdult ADHD. Book. Taylor & Francis Group.New York

Ray, C. D. (2008). Impact of play therapy on parent-childrelationship stress a mental healt training setting.British Journal of Guidance & Conselling

Ray, C. D., Bratton, S., Rhine, T., & Jones, L. (2001). Theeffectiveness of play therapy: Responding to thecritics. International Journal of Play therapy.

Reed. D.D & Martens, B.K (2011). Teroral DiscountingPredicts Student Responsiveness To ExchangeDelay In A Classroom Token System. Journal ofapplied behavior analysis.

Reitman D, Hupp SD, O’Callaghan PM, Gulley V, NorthupJ. (2001). The influence of a token economy andmethylphenidate on attentive and disruptivebehavior during sports with ADHD-diagnosedchildren.

Reitman D, Hupp SD, O’Callaghan PM, Gulley V, NorthupJ. (2001). The influence of a token economy andmethylphenidate on attentive and disruptivebehavior during sports with ADHD-diagnosedchildren. Behav Modif .

Schultz, brandon k. et. al. (2011). School-based treatment ofattention deficit/hyperactivity disorder.Psychology in the Schools, Wiley Periodicals, Inc.Ohio university.

Tarbox R, S, Ghezzi. P. M & Wilson G. (2006). The EffectsOf Token Reinforcement On Attending In AYoung Child With Autism. BehavioralIntervention.


117

theroleofpsychologicalinterventiontoimproveattentionadhdchild ·...

Documents