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ECHEZONA NWANNEKA, H PG/M.Sc./10/57080
CHILD TEMPERAMENT, GENDER AND LEVEL OF EDUCATION AS PREDICTORS OF ATTENTION DEFICIT- HYPERACTIVITY DISORDER AMONG PRIMARY SCHOOL PUPILS
DEPARTMENT OF PSYCHOLOGY
Faculty of SCOIAL SCIENCES
Digitally Signed by: Content manager’s Name Nwamarah Uche DN : CN = Weabmaster’s name O= University of Nigeria, Nsukka OU = Innovation Centre
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CHILD TEMPERAMENT, GENDER AND PARENTAL LEVEL OF EDUCATION AS PREDICTORS OF ATTENTION DEFICIT-HYPERACTIVITY DISORDER AMONG PRIMARY SCHOOL PUPILS
BY
ECHEZONA NWANNEKA, H PG/M.Sc./10/57080
DEPARTMENT OF PSYCHOLOGY
UNIVERSITY OF NIGERIA, NSUKKA
SEPTEMBER, 2013
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CHILD TEMPERAMENT, GENDER, PARENTAL LEVEL OF EDUCATION AS PREDICTORS OF ATTENTION DEFICIT-HYPERACTIVITY DISORDER AMONG PRIMARY SCHOOL PUPILS
A PROJECT SUBMITTED IN PARTIAL FULFILLMENT FOR THE AWARD OF A MASTER OF SCIENCE (M.Sc.) DEGREE IN COUNSELLING PSYCHOLOGY
BY
ECHEZONA NWANNEKA, H PG/M.Sc./10/57080
DEPARTMENT OF PSYCHOLOGY FACULTY OF THE SCOIAL SCIENCES UNIVERSITY OF NIGERIA, NSUKKA
SUPERVISOR: DR. L. O. AMAZUE
SEPTEMBER, 2013
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CERTIFICATION
This is to certify that ECHEZONA NWANNEKA, H a postgraduate student of Department of Psychology, University of Nigeria, Nsukka with registration number PG/M.Sc./10/57080 has satisfactorily completed the requirement for course and research work for the award of Master of Science ( M.Sc .) Degree in Counselling Psychology. The work embodied in this thesis is original and has not been submitted in part or full for any other diploma or degree of this or any other University.
------Dr. L. O. Amazue Prof. P. N. Ibeagha (Supervisor) (Head, Department of Psychology)
------Prof. C. O. T. Ugwu (External Examiner) (Dean, Faculty of the Social Sciences)
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DEDICATION
THIS WORK IS DEDICATED TO THE ALMIGHTY GOD FOR HIS INSPIRATION AND STRENGTH.
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ACKNOWLEDGMENTS
My profound gratitude goes to Dr. L. O. AMAZUE my supervisor for his immeasurable support, patience, encouragement and supervision. My special appreciation also goes to the Head, Department of Psychology, University of Nigeria, Nsukka- Prof. P. N.
Ibeagha, I wish to express my profound gratitude to Rev. Fr. Prof. M. C. Ifeagwazi, Dr.
P. C. Mefoh, Dr. J. E. Eze, Dr. L. I. Ugwu, Dr. I. Onyishi, Dr. Val Eze, Dr. Agbo, Mrs.
Joy Ugwu, Miss N. Obi Miss B. Ome and others including all the non-academic staff of
Psychology Department, University of Nigeria, Nsukka as you all contributed towards the success of this programme.
To my dear, lovely husband Mr. S. C. Echezona whose encouragement and support saw me through. To my lovely children, I owe a very big thank you for your understanding, support and encouragements during the course of the programme. I thank you for the adjustment to the stress this programme may have put you through.
I can not forget to express my heartfelt appreciation to my Mr. V. Odo, Pastor E. C. Obi,
Mr. P. Oranu, Mrs. F. Obi and Mrs. P. Echezona whose ideas and encouragements contributed to the success of this work.
May the good Lord reward you all including those whose names are not mentioned but contributed in one way or the other to the successful completion of this work.
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TABLE OF CONTENTS Title Page i Certification ii Dedication iii Acknowledgments iv Table of Contents v List of Tables vi Abstract vii CHAPTER ONE: INTRODUCTION 1 Statement of the Problem 11
Purpose of Study 12
Operational Definition of Terms 12
CHAPTER TWO: LITERATURE REVIEW
Theoretical Review 14
Empirical Review 22
Summary of Literature Review 32
Hypotheses 34
CHAPTER THREE: METHOD
Participants 35
Instruments 35
Procedure 37
Design/Statistics 37
CHAPTER FOUR: RESULTS 38
CHAPTER FIVE: DISCUSSION 40 8
Implications of the study 42
Limitation of the study 44
Suggestions for further studies 45
Summary and Conclusion 45
REFERENCES 47
APPENDIXES
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LIST OF TABLES
Table 1: Linear regression table showing beta ( β) coefficient and significant levels of temperament, gender and parental level of education as predictors of
ADHD.
Table 2: Correlation and descriptive statistics of temperament, gender and parental level of education as predictors of ADHD
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ABSTRACT
The research investigated child temperament, gender and parental level of education as predictors of attention deficit-hyperactivity disorder among primary school pupils in Nsukka, Nsukka Local Government Area. Five hundred primary school children (210 males and 290 females) participated in the study. The children ages ranged from 6 years to 12years, with mean age of 9 years. Two instruments were used for data collation in the study: Swanson Nolan and Peham (SNAP) Questionnaire and the Sutter-Eyeberg Student Behaviour Inventory. Multiple regression was used for data analysis and the result showed that child temperament significantly predicted ADHD ( β = .44, t = 11.27, P <.001). The result also showed that gender significantly predicted ADHD (β = -.09, t = -2.42, P <.05). The result showed that parental level of education was a significant predictor of ADHD ( β = .08, t = 2.23, P <.05). The findings were discussed with reference to previous studies and the implication and the limitations of the study were highlighted.
CHAPTER ONE 11
INTRODUCTION
Attention deficit-hyperactivity disorder (ADHD) has become a very widespread concern in most societies (Schonwald & Lechner, 2006). It is characterized by symptoms of attention deficiencies, hyperactivity and impulsiveness that appear to be displayed frequently and persistently (Wymbs,
Pelham, Molina & Gnagy, 2008). Various definitions have been put forward to actually conceptualize the term ADHD.
Johnston and Mash (2001) defined ADHD as a chronic, debilitating disorder which may impact upon many aspects of an individual’s life, including academic difficulties and social skill problems. National Institute of Health of
Nigeria (2012) defined ADHD as a mental or neurobehavioural disorder characterized by either significant difficulties of inattention, hyperactivity and impulsiveness or combination of the two.
National Institute of Health of Nigeria (NIH) (2012) further posits that
ADHD is a developmental mental health disorder most common among young children with approximately 3 to 5 percent of children suffering from the disorder. American Psychological Association (APA) (2000) indicates in the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) that ADHD symptoms emerge before seven years of age. More so, NIH (2012) affirmed that
ADHD is seen in a range of situations, inconsistent with the child’s developmental level and causing social or academic impairment. 12
Attention deficit-hyperactivity disorder is characterized by specific constellation of symptoms, functional problems and developmental history that follows predictable patterns. Bellani, Moretti, Perlini and Brambilla, (2011) observed that ADHD children experience delays in speech and language as well as motor development. Persons with ADHD often struggle with low self- esteem, troubled personal relationships and poor performance in school or at work. Dobie
(2012) noted that children with ADHD tend to get distracted from school work rather easily and they often behave disruptively.
Racine, Malnemer, Shevell and Snider (2008) also opined that children with attention deficit hyperactivity disorder suffer major impairment concerning their studies and difficulties in their handwriting which seem to be common. It is a developmental disorder in which certain traits such as impulse control lag in development (Schonwald & Lechner, 2006) and which has been estimated to range from 3 to 5 years. To be diagnosed with ADHD, symptoms must be observed in two different setting for six months or more and to a degree that is greater than other children of the same age.
The symptom categories yield three potential classification of ADHD, predominantly inattentive type (ADHD-PI or ADHA), predominantly hyperactive impulsive type (ADHD-H1 or ADHD-H) and combined type (ADHD-C) if criteria for both subtypes are met (Ramsay & Russell, 2007). Health and Outreach
Publication (2009) identified predominantly inattentive type symptoms to involves, being easily distracted, forgetting or missing details, frequently 13 switching from one activity to another and trouble completing or turning in homework assignments. Predominantly hyperactive-impulsive type, fidget and swim in their seat, talk nonstop, dash around, touching or playing with anything and everything in sight. They do experience trouble sitting still during dinner, in school and story time, constantly in motion and also have difficulty doing quiet tasks or activities. They blurt out inappropriate comments, show their emotions without restrains and act without regard for consequences. They are impatient, that is have difficulty waiting for things they want or waiting their turns in games.
Often children with ADHD suffer from comorbidities and learning problems (Child & Youth Psychiatric Society, 2008). Attention deficit- hyperactivity disorder impacts school-age children and result in lack of focus, restlessness, impulsive acts which impairs their ability to learn properly.
Mannuzza, Klein and Bessler (2006) indicated that children with the disorder are at greater risk for longer term negative outcomes such as lower educational and employment attainment. As adult, children who were diagnosed with ADHD are at increased risk for antisocial personality disorder, substance abuse, mood and anxiety disorders, marital problems, traffic accidents, legal infractions, and frequent job changes (Wilens, Biederman & Spencer, 2002). Youngster with
ADHD are at increased risk of engaging in health threatening behaviours including smoking, risky sexual behaviours including multiple partners and non use of contraceptives (Barkley, 2000). Driving as well posses an additional risk for them as Individuals with ADHD can be easily distracted while driving. As 14 children with ADHD get older, the way the disorder impacts upon them and their families changes (Alessandri, 2006). Assessing the quality of life of the child suffering from ADHD is difficult. Behavioural assessments are usually carried out by parents, teachers, or healthcare professionals, and it can usually only be inferred how the child must feel. It is noted that children with ADHD view their most problematic behaviour as less within their control and more prevalent than children without ADHD (Kaidar, Wiener & Tannock, 2007). Johnston and Mash,
(2006) reviewed the evidence of the effect of having a child with ADHD on family functioning. Johnston and Mash concluded that the presence of a child with ADHD results in increased likelihood of disturbances to family and marital functioning, disrupted parent-child relationships, reduce parenting efficacy and increased levels of parent stress, particularly when ADHD is comorbid with conduct problems. Rapport, Bolden, Kofler, Sarver, Raiker and Alderson (2009) posit that children with ADHD move around a lot as it helps them stay alert to complete challenging tasks.
Attention deficit-hyperactivity disorder is also known to have an enormous impact on the child’s life in terms of accumulation of human capital (Currie &
Stabile, 2006), peer relationships, and low self- esteem (Wehmeier, Schacht &
Barkley, 2010). Moreover, the disorder also seems to influence siblings (Currie &
Stabile, 2006; Fletcher & Wolfe, 2008) and classmates (Aizer, 2009) negatively.
Meanwhile, despite years of research, the likely causes of ADHD are still not fully understood. Evidence to date indicates that there are many factors 15 underlying ADHD, among them is genetic and neurobiological vulnerabilities.
Faraone, Perlis, Doyle, Smoller and Garalnick (2005) posit that inherited gene from our parents are the “blueprints” for who we are and consequent to this is an indication that ADHD often runs in families and can be inherited.
Children with ADHD are also noted to have other illnesses or condition.
For example they may have one or more of the following. Oppositional defiant and conduct disorder; which occur with ADHD at a rate of 50% and 20% respectively (McBurnett & Ptittner, 2009). This in essence is characterized by antisocial behaviours such as stubbornness, aggression, frequent temper tantrums, deceitfulness, lying, or stealing (Krull, 2007).
A child's environment may also contribute to the development of the disorder or worsen the symptoms. Pennington, McGrath, Rosenburg, Barnard,
Smith, Willcutt, Friend, DeFries and Olson (2009) theorized that the environment can play a significant role in modifying how a person’s genetic background is expressed, saying it can either strengthen or weakens it. On that note, Pennington and colleagues (2009) opined that ADHD could be more heritable in a “risky” environment characterized by poverty, parental discord, single parent families and so forth. However, in this study the researcher aims to examine the likely individual variables that may predict ADHD.
Child temperament is one of the individual variables that have been related to ADHD. There is also a potential link between the construct of ADHD and child temperament (Bussing, Gary & Mason, 2003; McIntosh, & Cole-Love, 1996). 16
Goldsmith, Buss and Plomin (1987) posit that children show a great deal of variation in those behavioural dimensions considered to be temperamental for example emotionality activity level, attention/persistence, sociability, and reactivity. Goldsmith and colleagues (1987) also observed that some children do cry easily and intensely whereas others are more easy going; some are highly active and always on the go where others are more sedentary; some attend and persist in tasks for long periods of time where others attention wander quickly. It is these individual differences and the variations in between that are of interest to the researcher to understand why these differences in their temperaments especially as it relate to ADHD.
Thus, temperament as a concept is conceptualized as a behavioural style that individuals consistently exhibit in reaction to their environments (Buss &
Plomin, 1984; Chess & Thomas, 1984; Rothbart & Bates, 1998). It encompasses the affective, activational, and attentional sectors within personality and acts as a screen through which children view and interact with their environment (Foley,
McClowry & Castellanos, 2008). Temperament is evident early in life, relatively stable across time and situations, biologically driven, and genetically linked
(Foley et al., 2008). Two complimentary perspectives of child temperament are particularly relevant when exploring the similarities and differences of the construct with ADHD. From a behavioural perspective, McClowry (1998) defined school-age temperament as inborn dispositions that influence reactions to situations, especially those involving change or stress. 17
McClowry (1995) identified four dimensions of school-age temperament:
Negative reactivity (intensity and frequency with which the child expresses negative affect), task persistence (persistence or attention span), activity (motor behaviour), and approach/withdrawal (initial response to new situations). These four domains, or close equivalents, are supported by other studies of children
(Ahadi & Rothbart, 1994; Presley & Martin, 1994; Sanson, Smart, Prior,
Oberklaid, & Pedlow, 1994). Based on combinations of dimensions, McClowry
(2002) also identified temperament typologies as “high maintenance” temperament profile and self regulation. McClowry (2002) observed that high maintenance children were high in activity and in negative reactivity and low in task persistence and the typology mirrors the symptoms of ADHD.
On the other hand, self-regulation is the ability to accomplish goals by self-moderating emotional, attentional, and behavioural responses to events
(Rothbart et al., 2004). Children who are low in self-regulation demonstrate difficulties in paying attention at school, organizing tasks, making and retaining friends, moderating emotional displays, and controlling impulsive behaviours
(Clark, Prior & Kinsella, 2002; Miller, Gouley, Seifer, Dickstein & Shields 2004;
Murphy, Shepard, Eisenberg & Fabes, 2004; Raver, Blackburn, Bancroft & Torp,
1999). These same behaviours and developmental outcomes are regarded as symptoms of ADHD but can also be viewed as the effects of behaviour at the extreme end of normal child temperament. 18
Indeed, the primary symptom domains of inattentive- disorganized and hyperactive-impulsive behaviours can be related conceptually to key personality and temperament domains. Eisenberg, Fabes, Guthrie, Murphy Maszk, Holmgren and Suh (1996) and Eisenberg, Sadovsky, Spinrad, Fabes, Losoya, Valiente,
Reiser, Cumberland and Shepard (2005) observed two types of controls Reactive
Control and Effortful Control thought to be implicated or do reflect mostly temperament in young children but both temperament and personality In older children. Eisenberg and colleagues (1996, 2005) defined Reactive Control as the relatively automatic modulation of emotion and behaviour and is likely related to
‘bottom up’ incentive response, including both positive incentive approach and negative withdrawal aspects of temperament.
Thus, this trait can be conceptualized as linked to impulsive behaviour problems like hyperactivity-impulsivity or impulsive aspects of conduct- disordered symptoms (Oldehinkel, Hartman, De Winter, Veenstra, & Ormel,
2004; Olson, 2005). Effortful Control is defined as the relatively deliberate modulation of emotional states and ensuing behaviour (Eisenberg et al., 1996;
Olson, 2005). It involves the ability to deliberately focus and shift attention and has been conceptually related to prefrontal cortical circuits and neuropsychological executive functioning (Rothbart & Bates, 1998) which are a major feature of some theories of ADHD (Barkley, 2003). It presents a logical linkage to the inattentive-disorganized symptoms of ADHD. Both Reactive and
Effortful Control describe the relatively reflexive versus deliberate regulation of 19 affect and behaviour (Eisenberg et al., 2005; Nigg, 2000) and are predicted to be differentially related to the inattentive versus hyperactive symptom domains of
ADHD in our dual pathway framework.
Studies indicate that gender as one of the individual variables likely to be related to childhood ADHD (Arnold, 1997). Attention deficit hyperactivity disorder is much more common in boys than in girls and that the number of boys diagnosed with ADHD outnumbers girls by at least 4 to 1. Arnold (1997) also noted that higher ratio of males in clinic samples may be due to selective referral rather than actual incidence. Girls with ADHD compared with boys with ADHD seldom have conduct problems. Girls are more likely to exhibit internalizing symptoms such as aggressive and antisocial behaviour (Warner-Rogers, Taylor,
Taylor, & Sandberg, 2000). Girls with ADHD often differ from boys in terms of lower levels of hyperactivity and lower rates of externalizing behaviours.
Although boys more often have comorbid conduct problems but girls with ADHD and opposition defiant disorder or conduct disorder might have more problems than boys (Carlson, Tamm & Gaub, 1997; Gaub & Carlson, 1997). It has also been suggested that girls with ADHD are less vulnerable to definite in executive functions than boys with ADHD (Seidman, Biederman & Faraone, 2004). Brain imaging study suggests that some of the morphological differences seen in boys with ADHD are also seen in girls with ADHD, although girls with ADHD have different neuropsychological profiles, patterns of comorbidity, severity of core 20 symptoms and impairment in social functioning compared with boys with ADHD
(Castallanos, Giedd & Berquin, 1997).
Current research Wymbs, Pelham, Molina and Gnagy (2008) indicated that parental level of education as well may have important links to ADHD. Wymbs and colleagues (2008) posit that parents with lower levels of education tended to be associated with a more negative parenting style than those who had higher levels of education. It would seem likely that a negative parenting style could adversely impact a child’s ADHD symptoms.
The parents of children with ADHD who have lower levels of education could be parenting in a more negative way because they feel less competent educationally and less empowered. Parents who are more learned and as well feel more proficient educationally tend to feel more empowered to take a stand for their child’s disability (Singh, Curtis, Ellis, Wechsler, Best & Cohen, 1997).
Knowledge is power and obtainable through education. Thus parents who are not as educationally advanced seem to feel less empowered and as a result, lack access to important resources to cope with and appropriately treat or handles their child’s disorder. This suggests that children with ADHD who have parents with lower levels of education are at a disadvantage.
More education tends to mean more money and future prospects while the reverse is the case. This may be an indication that many of the parents who already feel less empowered to speak out or to ask for help in learning how to parent a child with ADHD may also lack the resources to do so. It may however 21 be an indication that children of low parental education are likely to experience much more general disadvantage than those from parent with high educational background. This could also be due to the different bio-psychosocial factors that come along with lower incomes (Cuccaro, Wright, Rownd, Abramson, Waller, &
Fender, 1996). This information could be extremely important in looking at possible treatments and interventions for children with ADHD.
Statement of the problem
Attention deficit hyperactivity disorder is a behavioural disorder that can occur in any family irrespective of race, social status or religion. As a neurobiological /developmental childhood disorder, it has not received the due attention it deserves from the counselling psychologists, teachers and parents.
Literature has it that, ADHD affected up to 3% to 9% of school age population and approximately three times as many boys as girls (APA, 1994; National
Institute of Health, 2000). Children with ADHD are at increased risk including low academic achievement, poor suspension, and expulsion (Barkley, 1997,
2000). Where ADHD persists into adolescence and adulthood it is associated with greater risk for poor peer and family relations, anxiety, depression, aggression, conduct problems, delinquency and early substance experimentation. This study is imperative because more information is needed to better understand ADHD and to give room for appropriate intervention. Studies on ADHD have been predominantly conducted in Europe and American environments and this seems 22 to contribute to low level awareness about ADHD in Nigeria. Thus, the present study specifically sought to provide answers to the following questions.
1. Will child temperament significantly predict ADHD among primary school
children?
2. Will gender significantly predict ADHD among primary school children?
3. Will parental level of education significantly predict ADHD among
primary school children?
Purpose of the Study
The purpose of this study is to find out whether:
1. Child temperament will significantly predict ADHD among primary school
children.
3. Gender will significantly predict ADHD among primary school children.
4. Parental level of education will significantly predict ADHD among
primary school children.
Operational Definition of Terms
Attention deficit hyperactivity disorder refers to as a chronic disorder characterized by inattention, hyperactivity and impulsive behaviour as measured by Swanson Nolan and Pelham (SNAP) Questionnaire (Swanson, 1992).
Child temperament refers to as behavioural styles characterized by affective, activational, and attentional sectors within personality that individuals 23 consistently exhibit in reaction to their environments as measured by the Sutter-
Eyeberg Student Behaviour Inventory (Eyeberg, 1998)
Gender refers to both male and females who participated in the study.
Parental level of education refers to as the educational attainment of parents. In this study parental level of education is categorized into two levels. Parents with
FSLC, SSCE, GCE, OND and NCE are classified as having low parental level of education, while those with HND, B.Sc, M.Sc and Ph.D are classified as having high parental level of education
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CHAPTER TWO
LITERATURE REVIEW
Theoretical Review
In this study, the following theories that helped explain the concept of attention deficit hyperactivity disorder were reviewed:
Medical model of ADHD
Social Constructive Theory of ADHD
Hunter versus Farmer Theory
Social Learning Theory
Low Arousal Theory
Medical Model of ADHD
The theory was propounded by Barkley (1997). Potential causative factors associated with ADHD that have received the most research are biological in nature. That is, they are known to be related to or to have a direct effect on brain development and/or functioning (Barkley, 1997). The theory states that ADHD is as a result of mild brain damage. In addition, Magnetic Resonance Imaging (MRI) scans have show distinct physiological differences in brain regions between
ADHD and control children (Barkely, 1997). Studies have shown that ADHD children differ from children with no psychological disorders on a variety of measures of neurological functioning and cerebral blood flow (Barkley 1996;
Wilens, Beiderman & Spencer, 2002).
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The areas of brain most likely involved in ADHD include the frontal lobes:
The caudate nucleus with the basal ganglia; the corpus callosum, which connects the two lobes of the brain, and the pathway between these structures (Bradley &
Golden, 2001). Each of these brain areas and pathways, play an important role in the development of attention, the regulation of impulses control, and the planning of complex behaviour. Bradley and Golden (2001) posit that children with ADHD are neurologically immature, their brains are slower in developing than are other children’s, and this is why they are unable to maintain attention and control their behaviour at a level that is appropriate for their age. This immaturity hypothesis helps to explain why the symptoms of ADHD decline with age in many children.
A genetic component to ADHD is strongly suggested because ADHD clusters in families (Waldman & Rhee, 2002). For example, in a clinic-referred sample, 34 – 40% of the subjects with ADHD reported a family history of ADHD compared to 8% of controls (Biederman, Wilens & Mick, 2004). Twin studies suggest that concordance for hyperactivity is greater among monozygotic twins than dizygotic twins; for clinically diagnosed hyperactivity in 51% of monozygotic and 33% of dizygotic pairs (Goodman & Stevenson, 1989).
The neurotransmitter that is most consistently implicated in ADHD is dopamine (Dougheity, Donab & Spencer, 1999; Kraus, Dresel & Kraus, 2008).
Although serotonin seems to play a role in aggressive behaviour, it does not appear to influence ADHD (Wilens et al, 2002). Dopamine transporters functions to terminate the action of dopamine in the synapse by facilitating its re-uptake 26 into the presynaptic membrane. The therapeutic efficacy of methylphenidate in the treatment of ADHD has been ascribed to blockage of the dopamine transporters, increasing the availability of dopamine in the synapse (Volkow,
Wang & Wigal, 2009).
Comings, Gade-Andavolu, Gonzales and Mulhelm (2006) studies have tested for an association between attention deficit hyperactivity disorder ADHD and 27 different candidate gene. Moreover, each of these genes appears to account for a relatively small proportion of the variance in ADHD symptoms
(Faraone, Doyle, Mick, & Biederman, 2005) suggesting that none are likely to be necessary or sufficient to cause ADHD.
Pregnancy delivery and infant complications (PDIC’S) have been studied to determine correlate and/or predictors of ADHD. Milberger, Brederman,
Faraone, Chen and Jones (1996) found a positive association between ADHD and
PDIC’S using linear and logistic regression models in their study. In addition, very low birth weight children have been found to have an increased prevalence of in attention and hyperactivity; 23% of very low birth weight children met research diagnostic criteria for ADHD in contrast to 6% of normal birth weight pears (Bottin, Powls, Cooke & Marlow, 1997). Milberger and colleagues (1996) investigated the role of maternal smoking during pregnancy in the etiology of 6-
17 years old boys with ADHD found that 22% of the ADHD children has a maternal history of smoking during pregnancy compared with 8% of the comparison non-ADHD subjects. This finding remained significant after 27 adjustment SES, parental IQ and parental ADHD status. Hill, lowers, and Locke-
Wellman (2000) posit that parental ignorance and exposure to cigarette and alcohol is also associated for the etiology of childhood psychopathology including
ADHD.
Social Construct Theory of ADHD
Social constructionist theories of ADHD reject the dominant medical model that
ADHD has a distinct pathologic and genetic components. The theory was developed by Szasz (2001). Szasz argues that attention deficit hyperactivity disorder is not necessarily a valid medical diagnosis, but rather a social constructed explanation to describe behaviours that are not genuinely pathological, but rather simply don’t meet prescribed social norms. The theory also oppose the pathology as symptoms of ADHD by explaining ADHD as a social construct rather than an objective disorder (Timmis & Begum, 2006).
Timmis and Begum agues that western society creates stress on families which in turn suggest environmental causes for children expressing the symptoms of
ADHD. They also believe that parents who feel they have failed in their parenting responsibilities can use the ADHD label to absolve guilt and blame. A common argument against the medical model of ADHD asserts that while the traits that define ADHD exist and may be measurable, they lie within the spectrum of normal healthy human behaviour and are not dysfunctional. However, by definition, in order to diagnose with a mental disorder, symptoms must be 28 interpreted as causing a person distress/maladaptive. In the Diagnostic and
Statistical Manual (DSM-1V) it requires that “some impairment from the symptoms is present in two or more settings and that there” must be clear evidence of significant impairment in social, school, or work functioning for a diagnosis of ADHD to be made.
Hunter versus Farmer Theory
The theory was developed by Thom-Hartmann (1995). Thom-Hartmann maintained that attention deficit hyperactivity disorder have been with mankind since Adam. Why is it only recently that it has become a problem? He then drew a logical conclusion that ADD and ADHD are as a result of natural adaptive behaviour. This theory originated from a child getting the ADHD diagnosis and the parent thinking “my child does not have a disorder” Thom-Hatmann’s son was diagnosed and that got him to look at ADHD controversy seriously. His conclusion was that ADHD is only a list of symptoms, with no criteria directly connected to any cause or disorder.
According to the theory, humans were nomadic hunter-gatherers for thousands of years, but as people started farming and living settled lives other personality traits, more suitable to a sedentary life, developed. The ADHD person is some one who has retained some of the older hunter-gatherer characteristics.
So-called normal people are the “farmers”. The theory posit that people who leaves a traditional tribal and nomadic lifestyles have no problem of ADD and 29
ADHD but member of the same tribe who leaves in towns had ADHD problems like those in western society.
The people that are covered by this theory have an Attention deficit disorder or Attention deficit hyperactivity disorder personality. They do not have a disorder, but need to find their niche in our modern western society. A part of this adaptation is finding a career that suits their personalities and not, as is so often the case, fit themselves into a career considered a “good career” for the average individual.
An important talent ADHD people have is the ability to hyperfocus.
Hyperfocus is an intense form of mental concentration or visualization that focuses consciousness on something. It is like tunnel vision where the rest of the world is cut off, blocking out potential distractions. It is in this state that the ADD personality’s creative imagination is at work. Hyperfocussing can either be while thinking or while engaged in some activity.
The theory also maintained that people can also rapidly shift their focus and attention. Their minds work in parallel processes so they can hold multiple thoughts. This ability causes problem at school when they are presented with specific tasks to do. They think in a more intuitive way than the school teaches.
They do not do well when told what to think and how to think.
The hunter has to be aware of signs of their prey dangers and make quick decisions. This is a stimulating experience, where impulsivity and hyperactivity, two symptoms of ADHD, are beneficial. For such a child, sitting in a classroom 30 and forced to do some boring or repetitive work, will heighten every distraction from the class room and even from outside. This is the reason for their distractibility.
They also argued that the errors many leading ADHD researchers make is to assume that only one way of thinking or learning is “normal” and a child thinking or learning another way is a “disorder”. There are many learning styles which are personality traits.
Social Learning Theory:
The theory was propounded by Albert Bandura (1977). Bandura states that children learned by observing the behaviour of others and imitating and modeling their behaviour. He also states that behaviour is learned from the environment through the process of observational learning. Children observe the people around them behaving in various ways. This is illustrated during the famous bobo doll experiment (Bandura, Rose & Rose, 1963).
Individuals that are observed are called models. In the society children are surrounded by many influential models, such as parents within the family, characters on children’s TV, friends within their peer group and teachers at school. These models provide examples of masculine and feminine behaviour to observe and imitate. They pay attention and watch others as they behave in a particular way and do imitate them. Immediately as they watch e.g. In a classroom setting when a teacher will be delivering his or her lesson the children 31 will observe the way the teacher speaks, the way he or she moves his eye, body movement.
This is an indication in Bandura’s experiment were children are allowed to observe a film in which an adult ricked, hit and sat on a blow-up bobo doll. As the children were placed in a play room with a bobo doll, they were significantly more aggressive toward the bobo doll than a group of children who had not seen the film. It is through modeling that they learned to be aggressive. Children are more likely to learn and imitate those people they perceive as similar to themselves. It is more likely they should imitate behaviour modeled by people of the same sex. The people around the child will respond to the behaviour it imitates with either reinforcement or punishment. If a child imitates a model’s behaviour and the consequences are rewarding, the child is likely to continue performing the behaviour because his or her behaviour has been reinforced.
Children with attention deficit hyperactivity disorder must always be placed in a setting where other non ADHD children are present, for this will help the ADHD children to initiate the non ADHD children during play time. Also each food behaviour demonstrated from ADHD children must be positively reinforced by a reword so that the child will always perform the same behaviour all the time. The child will also take into account of what happens to other people when deciding whether or not to copy someone’s actions.
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Low Arousal Theory
The theory was developed by Sikstrom and Soderhead (2007). According to the low arousal theory people with ADHD need excessive activity as self-stimulation because of their state of abnormally low arousal. The theory states that those with attention deficit hyperactivity disorder ADHD cannot self-moderate and their attention can be gained by means of environmental stimuli, which in turn results in disruption of attentional capacity and an increase in hyperactive behaviour
(Sikstrom & Soderlund, 2007)
Without enough stimulation coming from the environment, an ADHD child will create it him or herself by walking around, fidgeting, talking. This theory also explains why stimulant medications have high success rates and can induce a calming effect at therapeutic dosages among children with ADHD. It establishes a strong link with scientific data that ADHD is connected to abnormalities with the neurochenical dopastimulation PET scan results in ADHD subjects.
Empirical Review
Empirical review on attention deficit hyperactivity disorder (ADND) in this study will focus on the following areas.
Child temperament and ADHD
Gender and ADHD
Parental level of education and ADHD 33
Child temperament and ADHD
Foley, McClowry and Castellanos (2008) examined empirical and theoretical differences and similarities between attention deficit hyperactivity disorder (ADHD) and child temperament in 32 ADHD children aged 6–11 years, and a comparison group of 23 children with similar socio demographic characteristics. Participants consists of (78.2%) Anglo-American. The sample also included some African-American, Hispanic-American, and Asian-American children. There was no difference in children's ages for the ADHD group
(M=8.59, SD=1.68) versus the comparison group (M=8.87, SD=1.66), t(53)=.60, p=.55. As expected based on national norms, the ADHD group had significantly more males than the comparison group χ2(1, N=55)=5.43, p=.02. Family composition did not differ significantly for the two groups. The parent respondents, all of whom were English speaking, included 53 mothers and 2 fathers, ranging in age from 31 to 52 years, with an average age of 40.38
(SD=4.62) years. Most of the informants (83.6%) were married (n=46), 7.3%were divorced (n=4), 7.3% were separated (n=4) and 1.8% were single, never married
(n=1). Many of the parents (41.8%) were college graduates (n=23), 25.5%held graduate degrees (n=14), 12.7%attended some college or had specialized job training (n=7), 18.2% were high school graduates (n=10), and 1.8% had graduate equivalent degrees (n=1).
Children were assessed for ADHD symptoms (hyperactivity, impulsivity, and inattention) and dimensions of child temperament (negative reactivity, task 34 persistence, activity, attentional focusing, impulsivity, and inhibitory control) using standardized parent reports and interviews. ADHD was assessed with three instruments: The Revised Conners Parent Rating Scale Questionnaire, Short
Form; the ADHD parent interview module from the Diagnostic Interview for
Children; and the Strengths and Weaknesses of ADHD-Symptoms and Normal-
Behaviours Rating Scale. Child temperament was assessed using two tools, the
School-Age Temperament Inventory (SATI) and the Children's Behaviour
Questionnaire (CBQ). Using Pearson product moment correlations, significant correlations, ranging from −.47 to .92, were found between the temperament dimensions and the ADHD symptoms.
Martel and Nigg (2006) sampled 179 children (113 males, 66 females),
(age 6–12 years), who had at least partial data on the relevant trait measures from a larger sample of 267 children in the MSU ADHD study. Ninety two (92) had
ADHD, 52 were Controls, and 35 were borderline or not otherwise specified cases of ADHD. Dispositional trait scores were derived from parent-completed
California Q-sort and the Early Adolescent Temperament Questionnaire. Child
ADHD symptoms were evaluated using maternal structured diagnostic interview and teacher-completed symptom ratings.
Zero-order correlations between parent or teacher ratings of ADHD symptoms and maternal ratings of child traits indicated that all traits were significantly correlated (P < .01) with both ADHD symptom domains. Reactive
Control was related to hyperactivity-impulsivity as rated by both parents and 35 teachers. Negative Emotionality was related to oppositional-defiance. Resiliency was primarily related to inattention-disorganization as rated by both parents and teachers; Effortful Control was related uniquely to inattention in parent but not teacher data. A moderation effect emerged; the relationship between parent-rated
Negative Emotionality and teacher-rated ADHD symptoms was stronger for children with high levels of both Reactive and Effortful Control.
Bussing, Gary and Mason (2003) studied the temperaments of 200 eight- to ten-year old male and female (n=52.5%) children who screened positive on the
Diagnostic Interview Schedule for Children (DISC) for the ADHD-combined subtype based on parent reports. The children who screened positive for ADHD- combined subtype also self-reported low in task orientation and high in activity as measured on the Dimensions of Temperament Survey (DOTS; Lerner, Palermo,
Spiro, & Nesselroade, 1982). Children with the combined subtype ADHD scored significantly higher on the activity level-general dimension (pb.05) and significantly lower on task orientation than did children in the non- ADHD group.
Lemery, Essex, and Smider's (2002), longitudinal study of 451 children examined item overlap between the dimensions of temperament on the Child Behaviour
Questionnaire and Preschool Behaviour Questionnaire and the symptoms of
ADHD on the MacArthur Health and Behaviour Questionnaire (HBQ; Ablow,
Measelle, Kraemer, Harrington, Luby & Smider 1999).
To assess ADHD, the researchers used the behaviour problem composite for Attention Deficit (inattention and impulsivity subscales). When both empirical 36 and conceptual confounded items were removed, moderate associations (.44 to
.59) remained between the temperament dimensions of activity level, attentional focusing and inhibitory control and ADHD symptoms of inattention and impulsivity.
Gender and ADHD
Studies have also shown a significant association between gender and ADHD.
Novik, Hervas, Ralston, Dalsgaard, Pereira and Lorenzo (2006) In their study to examine gender differences for referral patterns, social demographic factors,
ADHD core symptomatology, co-existing health problems, psychosocial functioning and treatment. They sampled 1,478 children: 231 girls (15.7 %) and
1,222 boys (84.3%). The study was a 24-month, naturalistic, longitudinal observational study in 10 European countries of children (aged 6–18 years) with hyperactive/inattentive/impulsive symptoms but no previous diagnosis of ADHD, were analysed by gender. Gender ratios (girl: boy) varied by country, ranging from 1:3 to 1:16. Comparisons showed few gender effects in core ADHD symptomatology and clinical correlates of ADHD. Compared with boys, girls had significantly more parent-rated emotional symptoms and prosocial behaviour and were more likely to be the victim of bullying and less likely to be the bully. Girls and boys had similar levels of co-existing psychiatric and physical health problems, and received the same type of treatment. In Conclusion, they found out that fewer girls than boys are referred for ADHD treatment, but they have a similar pattern of impairment and receive similar treatment. 37
Grevet, Bau, Salgado, Fischer, Kalil, Victor, Garcia, Sousa, Rohde and
Belmonte-de-Abreu (2006) sampled 219 clinically referred adult patients. The interviews followed the DSM–IV criteria, using the K–SADS–E for ADHD and oppositional defiant disorder and SCID–IV for comorbidities. Regression models were used to analyze gender and subtype main effects and interactions in psychiatric outcomes. In the initial sample, 117 patients (53.5%) were of the combined subtype, 88 (40%) were inattentives and 14 (6.5%) hyperactives. There were no significant interactions between gender and subtype in any variable assessed. Men and women did not differ in the relative frequency of each subtype.
Patients of the combined subtype in both genders presented a higher severity and increased rates of conduct and ODD disorders than inattentives. The main effects of gender and subtype in this sample are similar to those previously reported in other countries, suggesting the cross–cultural equivalence of the phenotype. The absence of significant interactions between gender and subtype suggests that, at least in clinical–based samples, DSM–IV adult ADHD subtypes present cross– gender validity.
Neuman, Sitdhiraksa, Reich, Ji-Ted, Joyner, Sun, and Todd (2005) conducted a study on the estimation of prevalence of DSM-IV and latent class-defined
ADHD subtypes in a population-based sample of child and adolescent twins. The goal of their study was to determine the prevalence and age of onset of Diagnostic and Statistical Manual of Mental Disorders (APA, 1994) and latent class-derived attention deficit/hyperactivity disorder ADHD subtypes in a population-based 38 twin sample of boys and girls. Missouri birth records identified families with a twin pair 7 to 18 years of age. Telephone screening interviews for ADHD symptoms were completed for 5007 families. Diagnostic assessments were administered to 564 families with at least one twin meeting screening criteria, plus 183 control families. Prevalence and age of onset for both ADHD nosologies were calculated by sex and zygosity from parent report data. The prevalence of any DSM-IV ADHD was 6.2% overall, 7.4% in boys and 3.9% in girls. The inattentive subtype was most common in boys; the combined subtype was most common in girls. The mean age of onset of symptoms in children with any DSM-
IV ADHD was 3.5 years, with significant differences between boys and girls.
Prevalences of latent class defined ADHD subtypes also varied by sex with the severe inattentive and combined classes more common in boys than girls. The age of onset of symptoms did not differ between boys and girls but were higher than in the DSM-IV subtypes. Findings in this twin sample showed that clinically significant ADHD, defined by either DSM-IV or latent class criterion, has an early age of onset and is more common in boys than girls.
Warner-Rogers, Tayloy, Taylor and Sandberg (2006) indicates that the number of boys diagnosed with ADHD outnumbered girls by at least 4 to 1. He noted that more boys (11%) than girls (4.4%) had an ADHD diagnosis The higher ratio of males in clinic samples may be due to selective referrals, rather than a actual incidence. Furthermore, females are more likely to exhibit internalizing symptoms that involve mood affect and emotion, whereas males usually display 39 more externalizing symptoms such as aggressive and antisocial behaviours.
Warner-Rogers et al (2006) has indicate that referrals initiated from the school environment are more likely to be due to overt or disruptive behaviour, symptoms found more often in males with this disorder.
Dalsgaard, Mortensen, Frydenberg and Thomsen (2002) conducted a study on conduct problems, gender and adult psychiatric outcome of children with attention-deficit hyperactivity disorder with 47 participants. The purpose of their study was to identify predictors for adult psychiatric outcome of children with
ADHD, including gender and comorbidity. Children aged 4-15 years, referred for hyperactivity/inattention and treated with stimulants were included (n=208). The
Psychiatric Case Register provided follow-up data on psychiatric admissions in adulthood until a mean age of 31 years. A total of 47 cases (22.6%) had a psychiatric admission in adulthood. Conduct problems in childhood were predictive (hazard ratio HR=2.3; 95% CI 1.22-4.33). They found out that
Attention-deficit hyperactivity disorder ADHD is a common childhood condition, and is more prevalent in boys. Girls with ADHD with conduct problems had a very high risk of a psychiatric admission in adulthood.
Parental level of education and ADHD
Tillman and Granvald (2014) in their study examined the relationship between parental level of education and symptoms of ADHD in children using four hundred and sixty four (464) participants all residing in Sweden. Participants 40 consist of one hundred and sixty three (163) 9 year-old children all attending regular school classes and three hundred and one (301) parents. Attention deficit- hyperactivity disorder Rating Scale–IV (DuPaul, Power, Anastopoulos, & Reid,
1998) was used to collate data for the study. Parental level of education was reported in a questionnaire using five dimensional approaches: Mandatory school
(9 years or less), 1-2 year vocational training, 2-4 year theoretical education on high school level, shorter post-high school education (not college/university), or college/ university education. Their educational level was generally high with
70% of the mothers and 53% of the fathers having a college or university education. They used multiple linear regression for data analysis. Although the result shows that the levels of ADHD symptoms in the population-based sample were generally low, but there was a pattern of slightly higher ratings in children with parents of lower educational background than parents with higher parental education level. Thus it indicates that parental level of education significantly correlates with symptoms of ADHD in children; children with low parental educational levels depicting high symptoms of ADHD than children of parent with high parental educational level backgrounds.
Matthew, Amori and Bryce (2010) conducted a study in Charlottesville,
Virginia to investigate the relationship between educational level of parents and exhibition of good report for their children with attention-deficit/hyperactivity disorder ADHD. Two hundred and forty eight (248) participants participated in the study. Participants consisted of one hundred and twenty four (124) (62 41 educated parents and 62 non educated parents), and one hundred and twenty four
(124) school children aged 6-10years. The children comprises 85% white, 5%
African American, 2% Asian American, 1% Latino, and 7% constituting children from other races. Parents who participated in the study were drawn from clinics, schools, pediatricians, and from a database of families who had previously participated in research at the university. Using hierarchical multiple regressions the result shows that there were significant differences between educated parents and non educated parents with regards to children with ADHD. The result of their findings indicated that educational level of parents contributes to better functioning of children with ADHD in peer relationship, reduced conflict and disengagement and child’s social skills development.
Zwi, Jones, Thorgaard, York and Dennis (2010) examined 284 participants in other to determine whether parent training interventions (educated parents) are effective in reducing ADHD symptoms and associated problems in children aged between five and eighteen years with a diagnosis of ADHD, compared to controls with no parent training intervention (non educated parents). In their study, data collection was obtained electronically through electronic database by searching the following electronic databases for all the available information: Central (2010,
Issue 3), Medline (1950 to 10 september 2010), Embase (1980 to 2010), Cinahl
(1937 to 2010), Psycinfo (1806 to 2010), Dissertation abstracts international (14
September 2010) and the MetaRegister of controlled trials (14 September 2010).
They also contacted experts in the field to ask for details of unpublished or 42 ongoing research. Randomization approach was used as the selection criteria.
After the data collection and analysis they found five studies involving 284 participants that met the inclusion criteria, all of which compared parent training with de facto treatment as usual. One study included a nondirective parent support group as a second control arm. Four studies targeted children's behaviour problems and one assessed changes in parenting skills. Of the four studies targeting children's behaviour, two focused on behaviour at home and two focused on behaviour at school. The two studies focusing on behaviour at home had different findings: One found no difference between parent training (i.e. parent education) and child performance, skill acquisition and development, whilst the other reported statistically significant results for parent training (parent education) versus child performance, social competence, skill acquisition and development. The two studies of behaviour at school also had different findings:
One study found no difference between groups, whilst the other reported positive results for parent training (parent education) when ADHD was not comorbid with oppositional defiant disorder ODD.
Summary of Literature Review
Attention deficit hyperactivity disorder is a complex and heterogeneous constellation of behaviours which impacts the socialization, cognition and self- perception of the individuals affected by it. Appropriate changes and treatment of
ADHD cannot take place without some overarching conceptions about the nature of the disorder and without consideration of key psychometric, developmental, 43 and theoretical issues (Hinshaw, 1994). In this study there are theories reviewed in order to throw more light on that issue. Medical model of ADHD propounded by Barkley (1997) assert that ADHD is as a result of mild brain damage. Social constructive theory of ADHD by Szasz (2001) on the other hand explain ADHD as a social construct rather than an objective disorder. Hunter versus Farmer
Theory (Thom-Hartmann, 1995) affirmed that ADHD are as a result of natural adaptive behaviour. More so, social learning theory states that behaviour is learned from the environment through the process of observational learning that
ADHD can be learned by what children observe the people around them doing.
Low arousal theory by Sikstrom and Soderhead (2007) also opined that ADHD is due to lack of stimulation coming from the environment. The theory states that those with ADHD cannot self-moderate and their attention can be gained by means of environmental stimuli, which in turn results in disruption of attentional capacity and an increase in hyperactive behaviour.
Empirical studies were also reviewed under three subheadings: Child temperament and attention deficit hyperactivity disorder, Gender and attention deficit hyperactivity disorder, parental level of education and attention deficit hyperactivity disorder. Temperament was significantly indicated to be associated with ADHD Foley, McClowry and Castellanos (2008); Bussing, Gary and Mason
(2003); Martel and Nigg (2006).
Warner-Rogers, Tayloy, Taylor and Sandberg (2006), Novik, Hervas,
Ralston, Dalsgaard, Pereira and Lorenzo (2006), Dalsgaard, Mortensen, 44
Frydenberg and Thomsen (2002), and Neuman, Sitdhiraksa, Reich, Ji-Ted,
Joyner, Sun and Todd (2005) studies indicates that the number of boys diagnosed with ADHD out numbered that of the girls. Whereas study by Grevet, Bau,
Salgado, Fischer, Kalil, Victor, Garcia, Sousa, Rohde and Belmonte-de-Abreu
(2006) reported no gender differences in childhood ADHD. Child temperament was also indicated as a significant predictor of ADHD in children (Tillman &
Granvald , 2014; Matthew, Amori & Bryce, 2010; Zwi, Jones, Thorgaard, York
& Dennis, 2010). Thus, based on the reviewed literature, it was observed that there is a dearth of literature as regards to temperament, gender and parental level of education in African/Nigerian setting. It was indicated that most of the studies done were carried out in America, Europe and Asian continents. In order to fill the gap in knowledge as it relates to African background the researcher decided to use Nigerian sample in the study.
Hypotheses
Following the review of literature, In this study, the under listed hypotheses will be tested.
1. Child temperament will significantly predict ADHD among primary school
children.
2. Gender will significantly predict ADHD among primary school children
3. Parental level of education will significantly predict ADHD among
primary school children 45
CHAPTER THREE
Method
Participants
A total of 500 primary school pupils were randomly selected for the study.
These pupils were drawn from four primary schools in Nsukka Local Government
Area. The schools were: University of Nigeria Staff School Nsukka, Central
School Onuiyi Nsukka, Central School Odenigbo Nsukka and Model Primary
School Nsukka. One hundred and twenty five (125) pupils each were drawn from the selected schools. The pupils were drawn from grade 2 to 6 classes in each of the selected schools. The pupils consisted of both genders with age range between
6 to 12 years.
Instruments
Two instruments were used in this study. The two instruments were; the Swanson
Nolan and Pelham (SNAP) Questionnaire (Swanson, 1992) and the Sutter-
Eyeberg Student Behaviour Inventory (Eyeberg, 1998).
The Swanson Nolan and Pelham (SNAP) Questionnaire
It is a 20 item questionnaire designed to assess ADHD. The SNAP-IV is based on a 0 – 3 rating scale: Not at all = 0, Just a little = 1, Quite a bit = 2, and Very much
= 3. Examples of some the items in the scale include; Often is forgetful in daily activities, often fails to give close attention to details or makes careless mistakes in school work or tasks, often dose not follow through on instruction and fails to finish school work, chores, or duties, often has difficulty awaiting turn and often 46 has difficulty sitting still, being quiet, or inhibiting impulses in the class or at home. Scores on the SNAP-IV are calculated by summing the scores on the items and dividing by the number of items. Swanson Nolan and Pelham (1992) reported a Cronbach’s alpha of .94 and .97 for both parents and teachers rating respectively for the instrument.
A pilot study was conducted to determine the reliability of the 20 items of the SNAP-IV for use in the present study using one hundred and fifty pupils from
Central Primary School Alo-Uno in Nsukka Local Government Area. The result of the study yielded a Cronbach’s alpha of .89.
The Sutter-Eyeberg Student Behaviour Inventory
It is a 36 item questionnaire designed to assess child temperament. It is rated on a
1 – 7 point Likert scale format ranging from 1 = never to 7 = always. Examples of some of the items in the scale were; Acts defiant when asked to do something, Is careless with books and other objects, Makes noise that disturbs others and Has difficulty sharing materials etc.
A pilot study was conducted to determine the reliability of the 36 items of the Sutter-Eyeberg Student Behaviour Inventory for use in the present study using one hundred and fifty pupils from Central Primary School Alo-Uno in Nsukka
Local Government Area. The result of the study yielded a Cronbach’s alpha of
.93. It indicates that the instrument is reliable for use n the present study.
47
Procedure
The researcher first obtained an identification letter from the Head of Department of Psychology University of Nigeria, Nsukka. Thereafter, the researcher also approached the authorities of the selected schools and obtained permission.
Simple random was used as a sampling technique to select the classes that were used for the study. The instrument is a teacher rating scale. To ensure for proper assessment based on the questionnaire the researcher also solicited the consent and assistance of the class teachers selected. Five hundred (500) copies of the questionnaire were issued to the teachers of the selected pupils whom then helped to assessed them based on their ADHD and temperament. The questionnaires were retrieved thereafter from the teachers after rating the pupils.
Design/Statistics
The study was a cross sectional design. Multiple regression analysis was used to analyze the data.
48
CHAPTER FOUR
RESULTS
Table 1: Descriptive statistics and Correlation matrix for child temperament, gender and parental level of education on ADHD
Variable Mean SD 1 2 3 4
1. Temperament 12.33 8.04 1
* 2. Gender 1.42 .49 -.110 1
3. Parental level of Education 1.61 .48 .019 1 .062
* 4. ADHD 22.11 11.26 .453 ** -.110 .091 * 1 A total of 500 participated in the study. Gender 1) (2 = male, 1 = female), Parental level of education 2) FSLC, SSCE, GCE, OND and NCE = Low level of parental education (1), HND, B.SC, M.SC and PhD = High level of parental education (2). ** P < .001 , * P <.05
The correlation result showed that child temperament was significantly and positively related to ADHD (r = .45, P < .001). Child temperament was also indicated to be significant but negatively correlated with gender (r = -.11, p <
.05). The result also indicated a significant but a negative correlation between gender and ADHD (r = -.11, P <.05). More so, Parental level of education was also shown to be significant and positively correlated with ADHD (r =.09, P
<.05).
49
Table 2: Linear regression table showing Beta (β) coefficient and significant levels of temperament, gender and parental level of education as predictors of ADHD
Unstandardized Standardized Coefficients Coefficients
Variables B Std. Error Beta( β) t
Temperament .629 .056 .447 11.276**
Gender -2.036 .904 -.090 -2.420 *
Parental level of Education 2.045 .916 .089 2.233 * a. Dependent Variable: ADHD Note ** P < .001, * P < .05
Table 2 indicated that child temperament significantly predicted ADHD among primary school children ( β = .44, t =11.27, P <.001). It was also shown that gender was a significant predictor of ADHD among primary school children
(β= -.09, t =-2.42, P <.05). The result of the present study showed that parental level of education was equally indicated to be a significant predictors of ADHD among primary school children (β= .08, t = 2.23, P <.05).
50
CHAPTER FIVE
Discussion
The present study investigated child temperament, gender and parental level of education as predictors of attention deficit-hyperactivity disorder among primary school pupils. Three hypotheses were tested in the study. The result of the study shows that child temperament is a significant predictor of ADHD among primary school children (β = .44, t =11.27, P <.001). This implies that a child’s ADHD is related to a child’s temperament. Thus the first hypothesis which states that child temperament will significantly predict ADHD among primary school children was supported. The result is consistent with the findings of Foley, McClowry and Castellanos (2008) who observed significant correlations between child temperament dimensions and the ADHD symptoms. The result agrees with Bussing, Gary and Mason (2003) who found a positive correlation between the temperament dimensions of activity level and ADHD. It is also consistent with the findings of Martel and Nigg (2006). The likely explanation for these might be that temperament and ADHD have similar characteristic profile and children with temperament attributes of such kind if not properly managed/controlled or subjected to predisposing environment could develop
ADHD (Pennington, McGrath, Rosenburg, Barnard, Smith, Willcutt, Friend,
DeFries & Olson, 2009). The result further indicated that child temperament is positively related to ADHD. This suggests that children who are low in self- regulation demonstrate difficulties in paying attention at school, organizing tasks, 51 making and retaining friends, moderating emotional displays, and controlling impulsive behaviours (Clark, Prior & Kinsella, 2002; Miller, Gouley, Seifer,
Dickstein & Shields 2004; Murphy, Shepard, Eisenberg & Fabes, 2004; Raver,
Blackburn, Bancroft & Torp, 1999).
In the same vein, the result also supported the second hypothesis which states that gender will significantly predict ADHD among primary school children. The result shows that gender is a significant predictor of ADHD among primary school children ( β= -.09, t =-2.42, P <.05). It indicates that ADHD are found more in boys than girls. Also the result indicates that the more ADHD increases among male children the more it decreases among female children. The probable explanation could be that ADHD is found to be more common in boys, as they are believed to depict more behavioural problems than girls. More so, recognizing the signs of ADHD in girls prove more difficult as it presents itself differently. Attention deficit hyper activity disorder is more obvious in boys and tends to be recognized very early. The result is consistent with some previous studies (Novik, et al., 2006; Neuman, et al., 2005; Warner-Rogers, et al., 2006;
Dalsgaard, et al., 2002) that found a significant association between gender and childhood ADHD. On the other hand, the result contradicts the study that reported no gender differences in childhood ADHD (Grevet, Bau, Salgado, Fischer, Kalil,
Victor, Garcia, Sousa, Rohde & Belmonte-de-Abreu, 2006).
The third hypothesis was also confirmed as the result supported the third hypothesis that parental level of education will significantly predict ADHD 52 among primary school children. It shows that parental level of education is a significant predictor of ADHD among primary school children (β= .08, t = 2.23, P
<.05). The result indicates that parental level of education is an important determinant of childhood ADHD.
As reviewed in the literature children with ADHD were found to be more of with parents that have low educational level than parents with high educational level. The likely reason could be that the parents with low level of educational background may lack the true knowledge and understanding as regards to issues in childhood ADHD. They may also lack the intellectual abilities, strategies, medical and behavioural approaches to adopt for a child diagnosed with ADHD.
Consequent to that, this may directly or indirectly affect both outcomes and the likelihood of having a child with ADHD. Unlike parents with high level education, they may know the likely techniques, skills, and modifying intervention approaches necessary to adopt based upon how the child is doing.
Equally, more educated parents are more likely to restrict the activities of their children, able to identify and find the right treatment approach. The result is consistent with the findings of Tillman and Granvald (2014) who observed that a significant correlation exits more between parents with low educational level and
ADHD than parents with high educational level and ADHD.
Implications of the findings
The result of the study indicates that child temperament, gender and parental level of education predict ADHD. In essence, these have some 53 implications as it may likely influence the child welfare and the people arround them. In Nigeria, professional care is practically not available for ADHD children in schools and homes. Teachers and parents appear not to have appropriate knowledge, training and skills in handling children with ADHD as well. This calls for an urgent need and application of counselling on children with ADHD as children who are diagnosed with ADHD are prone to: Being aggressive, rejected by peers, have poor conversational skills, have trouble using conversational skills in social situations, become frustrated or angry more easily than other children. In the same vein, they are also prone to exhibit hyperactivity, inattention and impulsivity which may likely promote antisocial behaviours that may also contribute or exacerbate substance use or abuse. Conversely, substance use could worsen the symptoms of ADHD.
On the other hand, ADHD poses substantial economic burden on patients families and third-party payers; significantly affects marriages, spousal relationships, social interactions and health-related quality of life. This is because the families of children with ADHD have to contend with a greater number of behavioural, developmental and educational disturbances which often requires that more time, commitment, logistics and energy be spent.
In order to help them overcome their difficulties and live like normal children counselling seems to have a significant role to play. According to
Stefflre (2004) counselling is a professional service offered by a competent counsellor. Hanh and Maclean (1995) defined counselling as a one-to-one 54 relationship between an individual troubled by problem with which he cannot cope alone and professional workers whose training and experience have qualified him/her to help others reach solutions to various types of personal difficulties. Counselling units should thus, be established in all the primary schools as this will help reduce most of the problems ADHD pupils face in the process of learning. Through the help of counselling psychologist, behaviour modification, cognitive therapy, anger management, social training and family counselling will prove to be more effective as parents, teachers and children learn specific techniques and skills from a therapist, or counselling psychologist experienced in the approach, that will help improve children's behaviour. Parents and teachers more often times can as well use the skills they learned from the counselling psychologist in their daily interactions with their children with
ADHD, resulting in improvement in the children's functioning in the key areas noted above.
Limitations of the study Since the present study focused on temperament, gender and parental level of education as predictors of ADHD among primary school children. There were some of the limitations encountered by the researcher while conducting the study which are worthy to be highlighted. They were as follows:
The sample size was small and it might affect the generalizability of the finding to the wider populations. Time frame is another limitation encountered in this study.
55
Suggestions for further studies Researchers in their subsequent studies should endeavour to use larger sample size in order to improve generalizability and applicability of the findings.
Meanwhile more studies should be conducted using Nigerian sample as it will help to provide clear insight and understanding about ADHD and its interventions among school children in Nigeria. On the other hand, researchers in future should also try to include other variables like, socio economic status, locality and personality types in their study to ascertain their influence on the manifestation of
ADHD.
Summary and Conclusion
The research investigated temperament, gender and parental level of education as predictors of attention deficit-hyperactivity disorder among primary school pupils. A sample of five hundred primary school children from University of Nigeria Staff School Nsukka, Central School Onuiyi Nsukka, Central School
Odenigbo Nsukka and Model Primary School Nsukka participated in the study.
Swanson-Nolan and Pelham (SNAP) Questionnaire and the Sutter-Eyeberg
Student Behaviour Inventory were used to elicit response from participants. Three hypotheses were tested using a cross sectional survey design and multiple regression. The result of the analysis confirmed the three hypotheses that; 1) child temperament will significantly predict ADHD among primary school children (β
= .44, t =11.27, P <.001), 2) gender will significantly predict ADHD among primary school children (β= -.09, t =-2.42, P <.05), and 3) parental level of 56 education will significantly predict ADHD among primary school children
(β= .08, t = 2.23, P <.05).
In conclusion, it is suggested that children diagnosed with ADHD need assistance and guidance from their parents and teachers to reach their full potential and also to excel in both social and academic endeavours. Thus, adequate training is required to help the teachers and parents acquire techniques and skills needed in handling children with ADHD. More so, professional care and counselling should be made available for the ADHD children in schools and homes as this would help them to overcome certain challenges and difficulties and to live like normal children.
57
REFERENCES Ablow, J. C., Measelle, J. R., Kraemer, H. C., Harrington, R., Luby, J., & Smider, N. (1999). The MacArthur three-city outcome study: Evaluating multi- formant measures of young children's symptomatology. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1580−1590.
Ahadi, S. A., & Rothbart, M. K. (1994). Temperament, development and the Big Five. In C. F. Halverson, G. A. Kohnstamm, & R. P. Martin (Eds.). The developing structure of temperament and personality from infancy to adulthood . Hillsdale, New Jersey: Erlbaum.
Aizer, A. (2009). Peer effects, institutions and human capital accumulation: the externalities of ADD. New York: Brown University Press. Alesandri, S. M. (2006). Attention, play and social behaviour in ADHD pre- schoolers. Journal of Abnormal Child Psychology, 20, 289-302. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorder (4 th Ed). Washington, D.C: Author. Amori, Y. M., Allison, J., Christian, C. E., & Haley, F. S. (2010). Parental influence on children with attention deficit/hyperactivity disorder: relationships between parent behaviours and child peer status. Journal of Child Psychology and Psychiatry, 38 (6), 721–736. Arnold, L. E. (1997). Sex differences in ADHD; conference summary. Journal of Abnormal Child Psychology, 24 , 555-569 Bagwell, C. I., Molina, B. S., & Pelham, W. E. (2005). Attention hyperactivity disorder and problems in peer relations: Predictions from childhood to adolescence. Adolescence Psychiatry, 40( 12), 85-95 Bandura, A. (1977). Social learning theory . New Jersey: Prentice-Hail. Bandura, A., Ross, D., & Ross, S. A. (1963). Imitation of film-mediated aggressive models. Journal of Abnormal and Social Psychology, 66 , 3-11.
Barkley, R. (1997). Psychosocial treatments for attention-deficit hyperactivity disorder in children. Clinical Psychiatric, 63 , 36-43.
Barkley, R. A. (1996). Attention deficit hyperactivity in Marsh, E. J., & Berkley, R. A. (Ed). Child Psychopathology . New York: Guilford press.
Barkley, R. A. (2000). Biological etiologies associated with ADHD and the nature of self control . New York: Guilford Press.
58
Barkley, R. A. (2003). Attention-deficit/hyperactivity disorder. In E. J. Mash, & R. A. Barkley (Eds.). Child ADHD and personality/temperament traits Psychopathology, 8 , 75–143.
Baud, P., Perroud, N., & Aubry, J. M. (2011). Bipca disorder and attention deficit hyperactivity disorder in adult: Differential diagnosis or comorbidity in French. Review on Medical issues, 7 (29), 1219-1222.
Bauermeister, J., Shrout, P., Chavez, I., & Padilla, I. (2007). Attention hyperactivity disorder and gender; are risk and sequel of ADHD the same for boys and girls. Journal of Child Psychology and Psychiatry,48(8), 831- 839.
Bellani, M., Moretti, A., Perlini, C., & Brambilla, P. (2011). Language disturbances in ADHD. Epidemiological Psychiatric Science, 20 (4), 311- 315. Biederman, J., Wilens, T. E., Mick, A., & Faraone, S. V. (2004). Dose attention deficit hyperactivity disorder impact the development course of drug and alcohol abuse dependence?. Biopsychiatry 44 (2), 69-73. Botting N., Powls, A., Cooke, R.W., & Marlow, N. (1997). Attention deficit hyperactivity disorders and other psychiatric outcomes in very low birth weight children at 12 years. Journal of Child Psychological Psychiatry , 3, 931-941.
Bradley, J. D. D., & Golden, C. J. (2001). Biological contributions to the presentation and understanding of attention deficit hyperactivity disorder. A review. Clinical Psychology Review, 21, 907-929.
Braun, J., Kahn, R. S., Froehlich, T., & Lonphear, C. (2006). Exposures to environmental toxicants and attention deficit/hyperactivity disorder in U.S. children. Environmental Health Perspectives ,114 (12), 1904-1909.
Burks, H. M., & Steffire, B. (1979). Theories of counselling . New York: McGraw-Hill.
Buss, A. H., & Plomin, R. (1984). Temperament: Early developing personality traits. Hillsdale, New Jersey: Erlbaum.
Bussing, R., Gary, F. A., & Mason, D. M. (2003). Child temperament, ADHD, and caregiver strain: Exploring relationships in an epidemiological sample. Journal of the American Academy of Child & Adolescent Psychiatry, 42 (2), 184−192.
59
Campbell, S. B., & Ewing, L. J. (1990). Follow-up of hard-to-manage preschoolers: Adjustment at age 9 and predictors of continuing symptoms. Journal of Child Psychology and Psychiatry, 31,871–889.
Carlson, C. L., Tamm, L., & Gaub, M. (1997). Gender differences in children with ADH,ODD, and coocurring ADHD/ODD identified in a school population. Adolescents Psychiatry,36 ,1706-1714. Castellanos, F. X., Giedd, J. N., & Berquin, P. C. (1997). Magnetic resource imaging in girls with attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 58, 289-295 Chess, S., & Thomas, A. (1984). Origins and evolution of behavior disorders. New York: Guilford Press.
Child and Youth Psychiatric Society (2008), Reference program for diagnosing and treating children and adolescents with ADHD . Conference Paper.
Clark, C., Prior, M., & Kinsella, G. (2002). The relationship between executive function abilities, adaptive behavior and academic achievement in children with externalizing behavior problems. Journal of Child Psychology and Psychiatry, 43, 785−796.
Cocarom, E. F., Hirsh, D., & Stein, M. A. (2007). Plasma homovanilic acid correlates Inversely with history of learning problems In healthy volunteer and ADHD subjects. Psychiatric Research, 149( 1-3), 297-302. Comings, D. E., Gade. A., R., Gonzales, N., & Muihlman, (2006). Multivariate analysis of associations of 42 genes in ADHD, ODD, and conduct disorder Clinical Genetics, 58, 31-40.
Costello, E. J., Farmer, E. M., Angold, A., Burns, B. J., & Erkanli, A. (1997). Psychiatric disorders among American Indian and white youth in Appalachia: The great smoky mountains study. American Journal of Public Health, 87(5), 827– 832.
Cuccaro, M., Wright, H., Rownd, C., & Abramson, R. (1996). Brief report: Professional perceptions of children with developmental difficulties: The influence of race and socioeconomic status. Journal of Autism and Developmental Disorders , 26 (4), 461-469.
Currie, J., & Stabile, M. (2006). Child mental health and human capital accumulation: The case of ADHD, Journal of Health Economics, 25, 1094-1118.
60
Dalsgaard, S., Mortensen, P. B., Frydenberg, M., & Thomsen, P. H. (2002). conduct problems, gender and adult psychiatric outcome of children with attention-deficit hyperactivity disorder. British Journal of Psychiatry ,181, 416-421.
Dobie, C. (2012). Diagnostic and management of attention-deficit hyperactivity disorder in primary care for school-age children and adolescents. Institute for clinical systems improvement. Retrieved 12 th February 2012.
Dougherty, D., Donab, A., & Spencer, T. (1999). Dopamine transporter density in patients with attention deficit hyperactivity disorder. The Lancet, 354, 2132-2133.
DuPaul, G. J., Power, T. J., Anastopoulos, A. D., & Reid, R. (1998). ADHD rating scale IV: Checklists, norms, and clinical interpretation . New York: Guilford Press.
Eisenberg, N., Fabes, R. A., Guthrie, I. K., Murphy, B. C., Maszk, P., Holmgren, R., & Suh, K. (1996). The relations of regulation and emotionality to problem behavior in elementary school children. Development and Psychopathology, 8 , 141–162.
Eisenberg, N., Sadovsky, A., Spinrad, T. L., Fabes, R. A., Losoya, S. H., Valiente, C., Reiser, M., Cumberland, A., & Shepard, S. A. (2005). The relations of problem behavior status to children’s negative emotionality, effortful control, and impulsivity: Concurrent relations and prediction of change. Developmental Psychology , 41 , 193–211.
Eyberg, S. M. (1998). Revision of the sutter-eyberg students behaviour inventory: teacher ratings of conduct problem behaviour. Educational and Psychological Measurement, 58 , 88-98. Faraone, S. V., Biederman, J., & Mick, E. (2006). The age-dependent decline of attention deficit hyperactivity disorder: A meta-analysis of follow-up studies. Psychological Medicine, 36, 159-165.
Faraone, S. V., Biederman, J., & Spencer T. (2000). Attention- deficit/hyperactivity disorder in adults: An overview. Biological psychiatry, 48 , 9-20.
Faraone, S.V. Perlis, R.H., Doyle, A. B., Smoller, J. W., & Goralnick, J. .J. (2005). Molecular genetics of attention-deficit/hyperactive disorder Biological Psychiatry, 57 , 1313-1323.
61
Faraone, S.V., Biederman, J., & Monuteaex, M. C. (2005) Attention- deficit disorder and conduct disorder in girls: Evidence far fairlicol subtype. Biological Psychiatry, 48, 21-29
Faraone, S.V., Doyle, A. E., Mick. E., & Biederman, J. (2005). Meta-analysis of the association between the 7-repeats allele of the dopamine D4 receptor gene and attention deficit hyperactivity disorder. American Journal of Psychiatry, 148 , 1052-1057 Fletcher, J., & Wolfe, B. (2008). Child mental health and human capital accumulation: The case of ADHD revisited, Journal of Health Economics 27, 794-800.
Foley, M., McClowry, S. G., & Castellanos, F. X. (2008). The relationship between attention deficit hyperactivity disorder and child temperament. USA: New York University.
Gaub, M., & Carlson, C. L. (1997). Gender differences in ADHD: a meta-analysis and critical review. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1036-1045.
Goldman L.S., Genel, M., Bezman, R. J., & Slanetz, P.J. (1998). Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Journal of the American Medical Association , 279, 1100- 1107.
Goldsmith, H. H., Buss, A. H., & Plomin, R. (1987). Roundtable: What is temperament? Four approaches. Child Development, 58, 505-529.
Goodman, R., & Stevenson, J. (1989). A twin study of hyperactivity: The etiological role of genes, family relationships and perinotal adversity. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 691-709
Graetz ,B., Sawyer, M., & Baghurst, P. (2005). Gender differences among children with DSM-IV ADHD in Australia. Journal of American Academic and Child Adolescent Psychiatry,44, 159–168.
Grevet, E. H., Bau, H. D., Salgado, A. I., Fischer, A. G., Kalil, K., Victor, M. M., Garcia, R., Sousa, N. O., Rohde, L. A., & Belmonte-de-Abreu, P. (2006). Lack of gender effects on subtype outcomes in adults with attention– deficit/hyperactivity disorder. Journal European Archives of Psychiatry and Clinical Neuroscience, 256(5), 311-319
62
Hahn, M. T., & Maclean, M. S. (1955). Counselling Psychology . New York, McGraw Hill.
Health & Outreach Publications (2009). Htt://www.nih.gov/health/ publication/ attention-deficit-hyprtswvyibiyy-disorder/complete-index.Shtml. Retrieved 10 th February, 2013.
Heather, A. J., Jeffery, N. E., Stephen, P. H., Elizabeth, B. O., Terry, C. C., Eugene, A., Betsy, H., & Karen, C. W. (2010). Ethnicity as a moderator of treatment effects on parent-child interaction for children with ADHD. Journal of Attention Disorders,13 (6),592-600.
Hill, S. Y., Lowers, L., Locke-Wellman, J., & Shen, S. A. (2000). Maternal smoking and drinking during pregnancy and the risk for child and adolescent psychiatric disorders. Journal of Student Alcohol, 61 , 661- 668.
Hofvander B., Ossowski, D., Lundstrom., & Anckarsater, (2009). Continuity of aggressive antisocial behaviour from childhood to adulthood: The question of phenotype definition, International Journal of Law Psychiatry, 32 (4) 224-234.
Johnston, C. Marsh, E. J (2001). Families of children with attention-deficit hyperactivity disorder: Review and recommendations for future research. Clinical Child Pharmacology and Psychological Review, 4, 183-207.
Johnston, C., & Mash, E. J. (2006). Families of children with ADHD: Review and recommendations for future research. Clinical Child Pharmacology and Psychological Review, 14 , 18-20. Kaidar, I., Wiener, J., & Tannock, R. (2007). The attributions of children with attention deficit hyperactivity disorder for their problem behaviours. Journal of Attention Disorder, 6, 99-109.
Kaylyn, N. K. ((2002 ).Family structure, household income, and mental/behavioural wellness in children with ADHD. Charlotte: University of North Carolina
Keck, P.E., McElroy, S.L., Strakowski, S.M., West, S.A., Sax, K.W., Hawkins, J.M., Bourne, M.L., & Haggard, P. (1998). 12-month outcome of patients with bipolar disorder following hospitalization for a manic or mixed episode. American Journal of Psychiatry,155, 646–652
63
Kessler, R. C., Adler, L., & Barkley, R. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163, 716-723.
Khan, S. A., & Faraone, S. V. (2005). The genetics of attention- deficit/hyperavtivity disorder: A Literature review. Current Psychiatry Reports, 8, 393-397.
Krause, K., Dresel, S., & Krause, J. (2008). Increased straiatal dopamine transporter in adult patients with attention deficit hyperactivity disorder: Effect of methyl phenidate as measure single photon emission computed tomography. Neuroscience and Letters, 285, 107-110
Krull, K. R (2007). Evaluation and diagnosis of attention deficit hyperactivity disorder in children. Cambridge: Cambridge University Press. Lemery, K. S., Essex, M. J., & Smider, N. A. (2002). Revealing the relation between temperament and behavior problem symptoms by eliminating measurement confounding: Expert ratings and factor analyses. Child Development, 73, 867−882.
Mannuzza, S., & Klein, R.G., Bessler, A. (2006). Adult outcome of hyperactive boys. Educational achievement occupational rank and psychiatric status. Archives General Psychiatry, 50 , 565-576. Matthew, D. L., Amori, Y. M., & Bryce D. M. (2010).The Alliance in a friendship coaching intervention for parents of children with ADHD. Charlottesville, VA: University of Virginia.
McBurnett, K., & Pyiffner, L. J. (2009). Treatment of aggressive ADHD in children and adolescents: Conceptualization and treatment of comorbid behaviour disorder’. Postgraduate Medicine, 121(6), 158-165.
McClowry, S. G. (1995). The development of the school-age temperament inventory. Merrill Palmer Quarterly, 41 , 271−285.
McClowry, S. G. (1998). The science and art of using temperament as the basis for intervention. School Psychology Review, 27 , 551−563.
McClowry, S. G. (2002). The temperament profiles of school-age children. Journal of Pediatric Nursing, 17, 3−10.
McIntosh, D. E., & Cole-Love, A. S. (1996). Profile comparisons between ADHD and non-ADHD children on the temperament assessment battery for children. Journal of Psycho educational Assessment, 14, 362−372. 64
Mental Health (2003). Attention-deficit/hyperactivity disorder in school-aged children: Association with maternal mental health and use of health care.
Mick, E., Biederman, J., Faraone, S. V., Sayer, J., & Kieinman, S., (2006). Case control study of attention-deficit hyperactivity disorder and maternal smoking, alcohol use, and drug use during pregnancy: Journal of the American Academy of Child and Adolescent Psychiatry, 41 (4), 378-385.
Milberger, S., Biederman, J., Faraone, S. V., Chen, L., & Jones, J. (1996). Is maternal smoking during pregnancy a risk factor for attention deficit hyperactivity disorder in children? American Journal of Psychiatry,153 , 1138– 1142.
Miller, A. L., Gouley, K. K., Seifer, R., Dickstein, S., & Shields, A. (2004). Emotions and behaviors in the Head Start classroom: Associations among observed dysregulation, social competence, and preschool adjustment. Early Education and Development, 15 , 147−165.
Murphy, B. C., Shepard, S. A., Eisenberg, N., & Fabes, R. A. (2004). Concurrent and across time prediction of young adolescents' social functioning: The role of emotionality and regulation. Social Development, 13 , 57−86.
Nair, J., Elimare, U., Betman, B. D., Nair, S. S., & Lavin, A. (2006). Clinical review: Evidence-badsed diagnosis and treatment of ADHD in children: Mo Medicine, 103 (6), 617-21.
National Institute of Health (2012). Attention deficit-Hyperactivity disorder. Retrieved February 10 th 2013
Neuman, R. J., Sitdhiraksa, N., Reich, W., Ji Ted, H.C., Joyner, C., Sun, L., & Todd, R. D. (2005). Estimation of prevalence of DSM-IV and latent class-defined ADHD subtypes in a population-based sample of child and adolescent twins. Twin Research and Human Genetics, 8, (4), 392-401.
Nigg, J. T. (2000). Oninhibition/disinhibition in developmental psychopathology: Views from cognitive and personality psychology and a working inhibition taxonomy. Psychological Bulletin , 126 , 220–246.
Novik, T. S., Hervas, A., Ralston, S. J., Dalsgaard, S., Pereira, R. R., & Lorenzo, M. J. (2006). Influence of gender on attention- deficit/hyperactivity disorder in Europe. Journal European Child and Adolescent Psychiatry, 15(1), 15-24
65
Oldehinkel, A. J., Hartman, C. A., De-Winter, A. F., Veenstra, R., & Ormel, J. (2004). Temperament profiles associated with internalizing and externalizing problems in preadolescence. Development and Psychopathology , 16 , 421–440.
Olson, S. L. (2005). Developmental foundations of externalizing problems in young children: The role of effortful control. Development and Psychopathology, 17 , 25–45.
Pastor, P. N., & reuben,, C. A. (2008). Diagnosed attention deficit hyperactivity disorder and learning disability. United States: Hyattsville.
Pennington, B., McGrath, L., Rosenberg, J., Barnard, H., Smith, S., & Willcutt, E. (2009). Gene x environment interactions in reading disability and attention deficit/hyperactivity disorder. Developmental Psychology, 45 (1), 77-89. Phillipsen, A. (2006). Differential diagnosis and comorbidity of attention- deficit/hyperactivity disorder (ADHD) and border line personality disorder (BPD) in adults. European Archives of Psychiatry and Clinical Neuroscience, 256, 142-146. Presley, R., & Martin, R. P. (1994). Toward a structure of preschool temperament: Factor structure of the temperament assessment battery for children. Journal of Personality, 62, 415−448.
Ramsay, J. R. (2007). Cognitive behavioural therapy for adult ADHD . Rutledge. Author Rapport, M. D., Bolden, J., Kofler, M. J., Saver, D. E., Raiker, J. S., & Alderson, R. M. (2009). Hyperactivity disorder (ADHD): A ubiquitous core symptom or manifestation of working memory deficit . Journal and Abnormal Child Psychology, 37 (4), 521-534. Raver, C. C., Blackburn, E. K., Bancroft, M., & Torp, M. (1999). Relations between effective emotional self-regulation, attentional control, and low income preschoolers' social competence with peers. Early Education and Development, 10, 333−350.
Rothbart, M. K. (2004). Commentary: Differentiated measures of temperament and multiple pathways to childhood disorders. Journal of Clinical Child and Adolescent Psychology,33 , 82–87.
Rothbart, M. K., & Bates, J.E. (1998). Temperament. In W. Damon (Series ed.) & N. Eisenberg (Eds.). Handbook of child psychology: Social, emotional and personality development. Hoboken, New Jersey: John Wiley & Sons, Inc. 66
Rothbart, M. K., Ellis, L. K., & Posner, M. I. (2004). Temperament and self- regulation. In R. F. Baumeister, & K. D. (Eds.), Handbook of self regulation: Research, theory, and applications (pp. 357−370). New York: Guilford Press.
Rubia, K.. (2011). Cool” Interior frontostriatas dysfunction in attention-deficit /hyperactivity disorder versus “hot” ventromedial orbito frontal-limbic dysfunction in conduct disorder a review. Biological. Psychiatry, 69 (12), 69-87. Sanson, A., Smart, D., Prior, M., Oberklaid, F., & Pedlow, R. (1994). The structure of temperament from three to seven years: Age, sex and socio - demographic influences. Merrill Palmer Quarterly, 40, 233−252.
Schonwald, A. & Lechner, E. (2006). Attention deficit hyperactivity disorder: Complexities and controversies. Pediatric. 18 (2), 189-195. Seidman, I. J., Biederman, J., Faraone, S. V. (2004). A pilot study of neuropsychological function in girls with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 336-373 Shaw, P., Gornick, M., Lerch, J., Addington, A., Seas, J., Greenstein, D., Sharp, W., Evans, A., Giedd, J. N., Castellanos, F. X., & Ropport, J.C. (2005). Polymorphisms of the dopamine D4 receptor, clinical outcome and cerfical structure in attention-deficit/hyperactivity disorder. Archives of Genecology Psychiatry, 5 (63), 540-549. Shreeram, S., Jian-Ping, H., Kalaydjian, A., Brothers, S., & Merikangas, K. R. (2009). Prevalence of enuresis and its association with attention- deficit/hyperactivity disorder among U.S. Children: Results from a nationally representative study. Journal of American Academic Child Adolescence , 48(1), 35–41. Sikstrom, S., & Soderlund, G. (2007). Stimulus dependent dopamine release in attention deficit hyperactivity disorder”. Psychological Review, 114 (4), 1047-1075.
Singh, N., Curtis, W., Ellis, C., Wechsler, H., Best, A., & Cohen, R. (1997). Empowerment status of families whose children have serious emotional disturbance and attention-deficit/hyperactivity disorder. Journal of Emotional and Behavioural Disorders , 5(4), 223-229.
Swanson, J. M. (1992). School-based assessments and interventions for ADHD, Nueroscience Biobehaviour Review, 24 (1), 21-25 67
Szasz, T. S. (2001). Pharmacracy: Medicine and politics in America . New York: Praeger.
Tillman, C., & Granvald, V. (2014). The role of parental education in the relation between ADHD symptoms and executive functions in children. Journal of Attention Disorders, 1-7
Visser, S. N., lessene, C. A., & Perou, R. (2007). National estimates and factor associated with medication treatment for childhood attention deficit hyperactivity disorder . Pediatrics, 119, 99-106.
Volkow, N. D. Wang, G. J., & Wigal, T. L. (2009). Evaluating dopamine reward ptturay in ADHD. Journal of the American Medical Association , 302(10), 1084-1091 .
Waldman, I. D., & Rhee, S. H. (2002). Behavioural and molecular genetic studies. In S. Sandberg (ed.), Hyperactivity and attention disorders of childhood . New York: Cambridge University Press.
Warner-Roger, I. Taylor. A., Taylor, E., & Sandberg, S. (2000). Inattentive behaviour in childhood. Journal of Learning Disabilities, 33, 523- 537.
Wehmeier, P. M., Schacht, A., & Barkley, R. A. (2010). Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life, Journal of Adolescent Health , 46(3), 209-217.
Weiss, G., & Hechtman, I. (1993). Hyperactive children grown up. ADHD in children, adolescents and adults. New York: Guild Ford.
Wilens, T. E., Biederman, J., & Spencer, T. T. (2003). Attention deficit hyperactivity disorder across the lifespan. Annual Review of Medicine, 53, 113-131. Woodward, I., Dowdney, L., & Taylor, E. (1997). Child and family factors influencing the clinical referral of children with hyperactivity” :A research note. Journal of Child Psychology and Psychiatry, 38 (4), 479-485. Wymbs, B., Pelham, W., Molina, B., & Gnagy, E. (2008). Mother and adolescent reports of interparental discord among parents of adolescents with and without attention deficit/ hyperactivity disorder. Journal of Emotional and Behavioural Disorders, 16 (1), 29-41. Wymbs, B., Pelham, W., Molina, B., Gnagy, E., Wilson, T., & Greenhouse, J. (2008). Rate and predictors of divorce among parents of youths with ADHD. Journal of Consulting and Clinical Psychology, 76 (5), 735-744. 68
Zwi, M., Jones, H., Horgaard, C., York, A., & Dennis, J. A. (2010). Parent training interventions for Attention Deficit Hyperactivity Disorder (ADHD)in children aged 5 to 18 years. Charlottesville, VA: University of Virginia.
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APPENDIX A
QUESTIONNAIRE
Department of Psychology, University of Nigeria Nsukka.
Dear Respondents,
I am a postgraduate student of the above addressed department currently conducting a research on attention deficit hyperactivity disorder. Kindly help the researcher by supplying the necessary information receded below. All answers provided will be treated with utmost confidentiality and will be used for research purpose only. Thanks for your cooperation.
Yours faithfully,
Echezona Nwanneka.
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DEMOGRAPHIC DATA
Instructions: Please tick ( √ ) appropriately
1. Age: 6-7yrs…………8-9yrs………..…10-12yrs……………………………. 2. Gender: Male……………Female……………… 3. Parental education (Father): FSLC……,SSCE/GCE…….,OND/NCE………. HND/ B.SC…….M.SC,……PhD………,Others specify……… (Mother): FSLC……., SSCE/GCE……,OND/NCE……,HND/B.Sc……….. M.Sc……., Ph.D…….., Others specify……… 4. Father’s occupation: ………………………………………………………….. 5. Mother’s occupation:………………………………………………………….. SECTION B (The Swanson Nolan and Pelham (SNAP) Questionnaire) For each item, check the column which best describes this child S/N Item Not at Just a Quiet a bit Very all little much 1. Often fails to give close attention to details or makes careless mistakes in school work or tasks 2. Often has difficulty sustaining attention in tasks or pay activities 3. Often does not seem to listen when spoken to directly 4. Often dose not follow through on instruction and fails to finish school work, chores, or duties 5. Often has difficulty organizing tasks and activities 6. Often avoid, dislikes, or reluctantly engages in tasks requiring sustained mental effort 7. Often loses tings necessary for activities (e.g. toys, school assignment, pencils, or books) 8. Often is distracted by extraneous stimuli 9. Often is forgetful in daily activities 10. Often has difficulty maintaining alertness, orienting to requests, or executing directions 11. Often fidgets with hands or feet or squirms in seat 12. Often leaves seat in classroom or in other situations in which remaining seated is expected 13. Often runs about or climbs excessively in situations in which it is inappropriate 14. Often has difficulty playing or engaging in leisure activities quietly engage in leisure activities quietly 15. Often is “on the go” or often acts as if “driven by a motor” 16. Often talks excessively 17. Often blurt out answers before questions have been completed 18. Often has difficulty awaiting turn 19. Often interrupts or intrudes on others (e.g. butts into conversations/games) 20. Often has difficulty sitting still, being quiet, or inhibiting impulses in the class or at home 71
APPENDIX B
RELIABILITY STATISTICS FOR ATTENTION DEFICIT HYPERACTIVITY DISORDER ADHD
Case Processing Summary N % Cases Valid 150 100.0 Excluded 0 .0 a Total 150 100.0 a. Listwise deletion based on all variables in the procedure.
Reliability Statistics Cronbach's Alpha Based on Cronbach's Standardized N of Alpha Items Items .892 .892 20
Item Statistics Mean Std. Deviation N VAR00001 1.4933 150 1.06024 VAR00002 1.4667 150 1.07233 VAR00003 1.4533 150 1.04648 VAR00004 1.5200 150 1.09740 VAR00005 1.3200 150 1.11920 72
VAR00006 1.2533 1.01787 150
VAR00007 1.0133 1.07433 150
VAR00008 1.2867 1.07651 150
VAR00009 1.2867 1.06397 150
VAR00010 1.3200 1.03833 150
VAR00011 .9400 1.13652 150
VAR00012 1.1533 1.19134 150
VAR00013 1.2800 1.18219 150
VAR00014 1.0533 1.09168 150
VAR00015 1.3067 1.19252 150
VAR00016 1.1933 1.14515 150
VAR00017 1.2533 1.14216 150
VAR00018 1.1200 1.08634 150
VAR00019 1.1533 1.07277 150
VAR00020 .9000 1.14546 150
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Item-Total Statistics Scale Corrected Squared Cronbach's Scale Mean if Variance if Item-Total Multiple Alpha if Item Item Deleted Item Deleted Correlation Correlation Deleted VAR00001 23.2733 149.166 .402 .891 .366 VAR00002 23.3000 .556 .606 .886 144.305 VAR00003 23.3133 .480 .582 .888 146.525 VAR00004 23.2467 145.717 .485 .481 .888
VAR00005 23.4467 142.692 .592 .561 .885
VAR00006 23.5133 145.043 .559 .536 .886
VAR00007 23.7533 144.992 .527 .438 .887
VAR00008 23.4800 143.728 .577 .561 .885
VAR00009 23.4800 145.285 .521 .441 .887
VAR00010 23.4467 146.450 .487 .406 .888
VAR00011 23.8267 145.567 .471 .520 .888
VAR00012 23.6133 140.749 .623 .584 .883
VAR00013 23.4867 142.104 .577 .523 .885
VAR00014 23.7133 146.850 .444 .410 .889
VAR00015 23.4600 142.425 .560 .443 .886 74
VAR00016 23.5733 143.266 .554 .477 .886
VAR00017 23.5133 145.983 .453 .452 .889
VAR00018 23.6467 146.686 .453 .502 .889
VAR00019 23.6133 144.803 .535 .600 .886
VAR00020 23.8667 148.022 .375 .417 .891
Scale Statistics Std. N of Mean Variance Deviation Items 24.7667 159.777 12.64031 20
75
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APPENDIX C
RELIABILITY STATISTICS FOR THE SUTTER-EYEBERG STUDENT BEHAVIOUR INVENTORY
Reliability Statistics
Cronbach's Alpha Based on Cronbach's Standardized Alpha Items N of Items
.931 .930 36
Item Statistics
Mean Std. Deviation N
VAR00001 3.4000 1.56728 150
VAR00002 2.8333 1.68059 150
VAR00003 3.7067 2.10957 150
VAR00004 3.4467 1.66099 150
VAR00005 3.5067 1.97551 150
VAR00006 4.0533 1.83839 150
VAR00007 3.4667 1.94096 150
VAR00008 3.5867 1.98716 150
VAR00009 2.6667 1.44085 150
VAR00010 3.0867 1.81691 150
VAR00011 2.8867 1.68107 150
VAR00012 2.4667 1.29359 150
VAR00013 3.1400 1.43789 150
VAR00014 2.2800 1.55058 150
VAR00015 3.6867 2.05670 150
VAR00016 3.3933 2.15162 150
VAR00017 1.7800 1.46947 150
VAR00018 2.6800 1.89779 150
VAR00019 3.7733 1.91829 150
VAR00020 3.0667 1.59558 150
VAR00021 3.2200 1.74121 150 77
VAR00022 3.3267 1.62818 150
VAR00023 2.9533 1.69617 150
VAR00024 3.2933 2.09360 150
VAR00025 2.4000 1.77227 150
VAR00026 3.0400 1.69832 150
VAR00027 3.6133 1.54045 150
VAR00028 3.8933 1.63496 150
VAR00029 3.4867 1.60844 150
VAR00030 3.6467 1.81025 150
VAR00031 4.2200 1.96912 150
VAR00032 4.2933 2.05804 150
VAR00033 4.1600 2.05325 150
VAR00034 4.0467 2.30068 150
VAR00035 3.6067 2.03953 150
VAR00036 3.0867 2.00983 150
Item-Total Statistics
Cronbach's Scale Mean if Scale Variance if Corrected Item- Squared Multiple Alpha if Item Item Deleted Item Deleted Total Correlation Correlation Deleted
VAR00001 115.7933 1157.051 .783 .905 .926
VAR00002 116.3600 1187.359 .456 .836 .929
VAR00003 115.4867 1151.822 .606 .804 .928
VAR00004 115.7467 1169.143 .626 .915 .928
VAR00005 115.6867 1151.680 .652 .902 .927
VAR00006 115.1400 1157.880 .653 .832 .927
VAR00007 115.7267 1150.683 .673 .869 .927
VAR00008 115.6067 1172.213 .491 .771 .929
VAR00009 116.5267 1197.889 .432 .667 .929
VAR00010 116.1067 1192.109 .379 .755 .930
VAR00011 116.3067 1198.684 .357 .717 .930
VAR00012 116.7267 1196.750 .498 .809 .929
VAR00013 116.0533 1195.863 .453 .590 .929 78
VAR00014 116.9133 1212.496 .260 .673 .931
VAR00015 115.5067 1177.205 .436 .886 .930
VAR00016 115.8000 1166.349 .490 .852 .929
VAR00017 117.4133 1228.848 .117 .769 .932
VAR00018 116.5133 1208.426 .235 .665 .932
VAR00019 115.4200 1171.655 .515 .718 .929
VAR00020 116.1267 1196.850 .395 .688 .930
VAR00021 115.9733 1167.167 .612 .797 .928
VAR00022 115.8667 1182.573 .516 .727 .929
VAR00023 116.2400 1174.345 .566 .755 .928
VAR00024 115.9000 1164.292 .520 .782 .929
VAR00025 116.7933 1197.212 .348 .600 .930
VAR00026 116.1533 1172.292 .583 .795 .928
VAR00027 115.5800 1187.346 .502 .696 .929
VAR00028 115.3000 1197.406 .379 .681 .930
VAR00029 115.7067 1191.001 .445 .694 .929
VAR00030 115.5467 1166.813 .590 .843 .928
VAR00031 114.9733 1141.328 .735 .860 .926
VAR00032 114.9000 1147.245 .657 .839 .927
VAR00033 115.0333 1154.838 .602 .806 .928
VAR00034 115.1467 1160.757 .491 .824 .929
VAR00035 115.5867 1173.935 .465 .789 .929
VAR00036 116.1067 1161.425 .566 .847 .928
Scale Statistics
Mean Variance Std. Deviation N of Items
1.1919E2 1.243E3 35.25643 36
79
APPENDIX D
Regression Tables
Descriptive Statistics
Mean Std. Deviation N
ADHD 22.1120 11.26095 500
Temperament 12.3360 8.04067 500
Gender 1.4280 .49528 500
ParentalEducation 1.6100 .48824 500
Correlations
TEM GEN PAEDU ADHD
TEM Pearson Correlation 1 -.042 .019 .453 **
Sig. (2-tailed) .346 .678 .000
N 500 500 500 500
GEN Pearson Correlation -.042 1 .062 -.110 *
Sig. (2-tailed) .346 .168 .014
N 500 500 500 500
PAEDU Pearson Correlation .019 .062 1 .091 *
Sig. (2-tailed) .678 .168 .042
N 500 500 500 500
ADHD Pearson Correlation .453 ** -.110 * .091 * 1
Sig. (2-tailed) .000 .014 .042
N 500 500 500 500
**. Correlation is significant at the 0.01 level (2-tailed).
*. Correlation is significant at the 0.05 level (2-tailed).
80
Variables Entered/Removed b
Variables Variables Model Entered Removed Method
1 Gender, . Enter Temperament a
2 ParentalEducatio . Enter na a. All requested variables entered. b. Dependent Variable: ADHD
ANOVA c
Model Sum of Squares df Mean Square F Sig.
1 Regression 13495.759 2 6747.880 67.368 .000 a
Residual 49781.969 497 100.165
Total 63277.728 499
2 Regression 13991.211 3 4663.737 46.934 .000 b
Residual 49286.517 496 99.368
Total 63277.728 499 a. Predictors: (Constant), Gender, Temperament b. Predictors: (Constant), Gender, Temperament, ParentalEducation c. Dependent Variable: ADHD
Coefficients a
Standardized Unstandardized Coefficients Coefficients
Model B Std. Error Beta t Sig.
1 (Constant) 17.296 1.556 11.118 .000
Temperament .629 .056 .449 11.276 .000
Gender -2.060 .905 -.091 -2.276 .023
2 (Constant) 14.217 2.074 6.853 .000
Temperament .626 .056 .447 11.271 .000
Gender -2.187 .904 -.096 -2.420 .016
ParentalEducation 2.045 .916 .089 2.233 .026 a. Dependent Variable: ADHD 81
Model Summary c
Change Statistics Std. Error Mode R Adjusted R of the R Square F Sig. F l R Square Square Estimate Change Change df1 df2 Change
1 .462 a .213 .210 10.00824 .213 67.368 2 497 .000
2 .470 b .221 .216 9.96835 .008 4.986 1 496 .026 a. Predictors: (Constant), Gender, Temperament b. Predictors: (Constant), Gender, Temperament, ParentalEducation c. Dependent Variable: ADHD