Introduction. SPPAHI or also known as Skala Penilaian Perilaku. Anak Hiperaktif is an instrument to evaluate if there is

Transcription

1 Introduction SPPAHI or also known as Skala Penilaian Perilaku Anak Hiperaktif is an instrument to evaluate if there is a possibility of ADHD occurring among children in Indonesia. This instrument is sensitive towards the symptoms of ADHD (Attention Deficit Hyperactivity Disorder) on children in the society even if they are in the clinic or not.sppahi consists of a list of items that has specific psychopathological characteristics of ADHD among children in Indonesia. The items of the instrument was made based on the feedback of parents and teachers, added details from Conners Parent Rating Scale, Conners Teacher Rating Scale, Child Behavior Checklist (CBCL),Edelbrock Children s Attention Problems (CAP),and ADD Comprehensive Teacher Rating Scale (ACTeRS).Hence it was then adjusted according to Indonesian norms and culture so that researchers, teachers, and parents are able to understand the questionnaire. The items on the questionnaire are arranged according to the symptoms that are most frequently and rarely found symptoms among children who have attention deficit/hyperactivity disorder. The diagnosis of ADHD that is made using the

2 Pedoman Pengolongan Dan Diagnosis Gangguan Jiwa Indonesia (III) (PPDGJ III) combined with SPAHHI Questionnaire is hoped to be more accurate when compared to only using the PPDGJ III. However the SPPAHI Questionnaire that is used can only be used to detect the behaviour of children within the age range of 6-13 years old. Further research has to be done for children in the age range of above 13 years old. The research that has to be done should include children from the ages of 3-5, elementary school children (6-13) and teenagers (13-18) from different geographical areas representing in and out of the Java region. The findings of this research will be able to tell us about the prevalence of ADHD. This questionnaire will only aid in the early screening of ADHD. If a diagnosis is to be made, evaluation from a psychiatrist is of the utmost importance. (Saputro D.,2004) Attention Deficit Hyperactivity Disorder is a frequently diagnosed childhood neuropsychiatric disorder associated with a range of cognitive and behavioural impairments and the symptoms can include inattention, hyperactivity and impulsivity (American Psychiatric

3 Association 2000).It is a mental health problem affecting 5-8 % of schooling children in the United States (American Psychiatry Association, 2000). The condition manifests as difficulty in focusing attention, termed attention deficit to the tasks at hand and a display of higher levels of physical activity compared to their normal peers termed hyperactive (Waslick and Greenhill 2004 cit. Abikoff and Gittelman 1985) and also accompanied by impulsive behaviour defined as acting without forethought of the consequences. As these descriptions may apply to most normal children and are considered common, the distinction would be a positive and collective signs of hyperactivity, impulsivity and inattention observed altogether in a child and inconsistent to his stage of development (Wiener and Dulcan 2004). Mental Health professionals use the Diagnostic and Statistical Manual IV TR (DSM IV-TR) to diagnose the condition based on strongly manifesting criteria of the disorder. ADHD is a developmental syndrome whose cardinal signs are inattention, impulsivity, and hyperactivity. The diagnosis of ADHD requires a chronic pattern of such

4 behaviours manifesting before the age of 7 years and causes performance issues in at least 2 settings such as school and home. The key feature of this disorder is inattention whereby they have difficulty in maintaining focus in motivationally related tasks. Children with ADHD are disabled in many ways of daily functioning. In school, they may not comply with simple instructions by the teacher due to their inattention made worse by multicommission commands at higher level of education (Waslick and Greenhill 2004). According to a research done by Lee S.S. et al. 2008, it was found out that ADHD children tend to be poorly-adjusted or adapted in terms of social functioning even after entering adolescence. A child with ADHD has higher chances of being diagnosed with a co-existing psychiatric disorder such as anxiety and mood disorder thus worsening the degree of impairment of the child and the future prognosis. ADHD, per DSM-IV-TR (American Psychiatric Association, 2000),currently encompasses multiple forms of the disorder, including an inattentive form, a fairly rare purely hyperactive form, and a combined type that is the most common form and features

5 both inattention and hyperactivity. Inattention, or the inability to direct and maintain selective attention to motivationally relevant tasks, is a key feature of the disorder. Impulsivity refers to acting rashly without apparently thinking of the consequences, such as blurting out answers in class. Hyperactivity refers specifically to excessive motor activity. The kinds or presentation of ADHD can occur based on the types of symptoms.the first kind is the combined presentation whereby both the criteria of inattention and hyperactivity-impulsivity were present for the past six months. Secondly is the predominantly inattentive presentation where enough symptoms of inattention but not hyperactivity-impulsivity were present for the past six months and lastly is the predominantly hyperactive-impulsive presentation whereby enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months. However since symptoms are subject to change, the presentation may change over time as well. The manifestation of these symptoms will vary depending on the age of the child. Younger children (in the 4 to 6 year range) are known to be little terrors. They run from one part of the room

6 to another, hop on furniture, knock objects off tables, explore the contents of visitors handbags, talk incessantly, run outside without telling their parents where they are going, has difficulty learning to look both ways before crossing the street, lose and break toys, stay up late, wake up early and generally exhaust their parents. When these children enter school and begin the task of learning, the difficulties in focussing attention become more evident. They may miss what the teacher is saying, are unable to complete the assignments, forget menial things such as pencils or books and just blurt out answers to questions without even being asked or even waiting for the questions to be finished. They also may annoy their school playmates by pushing ahead in line, grabbing equipment of the playground or violating the rules of games or are unable to obey commands. These children may fall behind in school work and are unable to compete with their peers and start to lack confidence. Teachers may complain about their behaviour and request that their behaviour be corrected. Other than teachers, children usually spends

7 most of their time with parents. Hence it is important to observe how parents react and handle children with ADHD. Parents may be warm and loving or hostile and rejecting. Each pattern of parental behaviour affects the personality development of children. Rohner s theory which is the Parental acceptance-rejection theory (PARTheory),is known as a theory of socialization which attempts to explain and predict the antecedents, correlations and consequences of parental acceptance and rejection throughout the globe. This theory suggests that each individual has experienced the warmth and affection provided by someone important to him/her, who is called the parent. However this theory also highlights that the parent is not necessarily, the biological or adoptive mother and father. The parent here is referred to as the major caregivers of the child. To understand the parental acceptance and rejection theory we will have to understand the concept of the warmth dimension of parenting. One end of the warmth dimension is about affection and they are expressed with physical, verbal and symbolic gestures between parents and their children. Parental acceptance is marked by

8 warmth, affection, care, comfort, concern, nurturance, support, or simply love that children can experience from their parents and other caregivers.on the other end of the dimension is rejection which refers to the absence or significant withdrawal of these feelings and behaviors, and by the presence of a variety of physically and psychologically hurtful behavior. PARTheory reveals that rejection can be felt by four principal expressions which is (1) cold and unaffectionate, the opposite of being warm and affectionate, (2) hostile and aggressive, (3) indifferent and neglecting, and (4) undifferentiated rejecting. Undifferentiated rejection refers to individuals' beliefs that their parents do not really care about them or love them, even though there may not be clear behavioral indicators that the parents are neglecting, unaffectionate, or aggressive toward them. Aggressive parents are when parents act on feelings of hostility, anger, resentment, or enmity. Hence according to PARTheory, aggression is any behavior where there is the intention of hurting someone, something, or oneself (physically or emotionally). Parents may be physically aggressive and expressing it by hitting, pushing,

9 throwing things, and pinching. They may also be verbally aggressive by cursing, mocking, shouting, saying thoughtless, humiliating, or disparaging things to or about the child and being sarcastic. Additionally, parents may use hurtful, nonverbal symbolic gestures toward their children. Since parental acceptance and rejection is very emotion based it has been viewed and studied from two perspectives which is the phenomenological perspective whereby we assess how the individual feels or it can be studied from the behavioral perspective whereby it is reported and studied by an outside observer. Usually, but not always, the two perspectives lead to similar conclusions. PARTheory research suggests, however, that if the conclusions are very discrepant one should generally trust the information derived from the phenomenological perspective. For an example a child may feel unloved (as in undifferentiated rejection), but observers maybe unable to detect any indicators of parental rejection. Alternatively, observers may report a significant amount of parental aggression or neglect, but the child may not feel rejected. This usually happens in

10 the case of child abuse and neglect. Thus there is only a problematic relation between so-called "objective" reports of abuse, rejection, and neglect on the one hand and children's perceptions of parental acceptancerejection on the other. As Kagan (1978, p. 61) put it, "parental rejection is not a specific set of actions by parents but a belief held by the child." The way the parents behave towards their child has played a part in a child s psychological development. When the child perceives to have been rejected it results in psychological problems ranging from infantile autism to chronic illnesses like schizophrenia (Rohner, 2000).