Dikkat Eksikliği Hiperaktivite Bozukluğu Olan Ergenlerde Bilinçli Farkındalık

Year 2021, Volume: 11 Issue: 1, 76 - 81, 21.01.2021

Nihal Yurteri

https://doi.org/10.33631/duzcesbed.821844

Abstract

Amaç: Bu çalışmanın amacı tedavi almamış Dikkat Eksikliği Hiperaktivite Bozukluğu (DEHB) tanılı ergenlerde bilinçli farkındalıkla ilişkili faktörlerin incelenmesidir.
Gereç ve Yöntemler: 13-18 yaş arasındaki, DEHB tanısı alan ve tedavi almamış olan 30 ergen ve yaş- cinsiyet açısından eşleştirilmiş sağlıklı 30 ergen çalışmaya alınmıştır. Klinik muayene ve “Okul Çağı Çocukları için Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi-Şimdi ve Yaşam Boyu Versiyonu (ÇDGŞG-ŞY)” tanı görüşmesi ile tanılar ve komorbiditeler belirlenmiş ve dışlama kriteri olan olgular çalışmanın dışında tutulmuştur. DEHB belirtilerini değerlendirmek için “Conners DEHB Anababa Dereceleme Ölçeği Kısa Form-CADÖ”, anksiyete belirtilerini değerlendirmek için “Spielberger Durumluk-Sürekli Kaygı Ölçeği- SDKÖ”, depresif belirtileri değerlendirmek için “Çocuklar için Depresyon Ölçeği-ÇDÖ” ve bilinçli farkındalık düzeyini değerlendirmek için “Bilinçli Farkındalık Ölçeği- BİFÖ” kullanılmıştır. İstatistiksel değerlendirmede; normal dağılıma uygunluk koşullarına göre “bağımsız örneklemler t testi” ve “Mann–Whitney U testi”, korelasyon analizlerinde “Spearman korelasyon analizi” kullanılmıştır.
Bulgular: DEHB grubunda kontrol grubuna göre, CADÖ, SDKÖ ve ÇDÖ ölçek skorları istatistiksel anlamlı olarak yüksek (p<0,001), BİFÖ toplam skorları ise istatistiksel olarak anlamlı düşük bulunmuştur (p<0,001). Ayrıca, DEHB grubunda, BİFÖ toplam skorları ile CADÖ, SDKÖ ve ÇDÖ ölçek skorları arasında istatistiksel olarak anlamlı, negatif ve orta etki büyüklüğünde korelasyonlar saptanmıştır.
Sonuç: Çalışmamızda, DEHB tanılı ergenlerde sağlıklı ergenlere göre bilinçli farkındalık düzeylerinin düşük olduğu ve DEHB grubunda DEHB, anksiyete ve depresyon belirtilerinin bilinçli farkındalık düzeyleri ile negatif ilişki gösterdiği bulunmuştur. Bu sonuç; bilinçli farkındalık temelli yaklaşımların etkisinin, ergenlerde DEHB belirtileri ve sıklıkla eşlik eden anksiyete, depresyon belirtileri açısından daha ileri çalışmalar ile araştırılmaya değer olduğunu düşündürmektedir.

Keywords

Dikkat Eksikliği Hiperaktivite Bozukluğu, bilinçli farkındalık, ergenler

Supporting Institution

yok

Project Number

yok

Mindfulness in Adolescents with Attention Deficit Hyperactivity Disorder

Abstract

Aim: The aim of this study is to examine the factors associated with mindfulness in treatment-naive adolescents diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).
Material and Methods: Thirty treatment-naive adolescents with ADHD aged between 13-18 and age-gender matched 30 healthy adolescents were included in the study. Diagnoses and comorbidities were determined through clinical examination based on DSM 5 and the Interview Schedule for “Affective Disorders and Schizophrenia for School-Age Children- Present and Lifetime Version (Kiddie-SADS-PL)”, and cases with exclusion criteria were excluded from the study. “Conners ADHD Parent Rating Scale-revised short form- CPRS-RS” was used to evaluate ADHD symptoms, “Spielberger State-Trait Anxiety Scale- STAI” to evaluate anxiety symptoms, “Child Depression Inventory- CDI” to evaluate depressive symptoms and “Mindful Attention Awareness Scale- MAAS” to evaluate mindfulness. In statistical evaluation, “independent samples t test” and “Mann- Whitney U” test were used according to conformity to normal distribution. “Spearman correlation analysis” was used for correlation analysis.
Results: CPRS, STAI and CDI scale scores were found to be statistically significantly higher (p<0.001) and MAAS total scores were found to be statistically significantly lower (p<0.001) in ADHD group compared to control group. In addition, it was determined that MAAS total scores showed statistically significant, negative and moderate effect size correlations with the scores of CPRS, STAI and CDI scales in ADHD group.
Conclusion: Mindfulness levels were found to be lower in ADHD group compared to control group. Additionally, ADHD, anxiety and depression symptoms showed negative correlations with mindfulness levels in adolescents with ADHD. This result suggests that the effects of mindfulness-based approaches are worth investigating with further studies in terms of ADHD symptoms and frequently comorbid anxiety and depression symptoms in adolescents.

Keywords

attention deficit hyperactivity disorder, mindfulness, adolescents

Project Number

yok

References

• 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). 5th ed. Arlington: American Psychiatric Association; 2013.
• 2. Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015; 56(3): 345-65.
• 3. Faraone SV, Biederman J, Spencer T, Wilens T, Seidman LJ, Mick E, et al. Attention-deficit/ hyperactivity disorder in adults: An overview. Biol Psychiatry. 2000; 48(1): 9-20.
• 4. Spencer TJ, Biederman, Mick E. Attentiondeficit/ hyperactivity disorder: Diagnosis, lifespan, comorbidities, and neurobiology. Journal of Pediatric Psychology. 2007; 32(6): 631-42.
• 5. Reale L, Bartoli B, Cartabia M, Zanetti M, Costantino MA, Canevini MP, et al. Comorbidity prevalence and treatment outcome in children and adolescents with ADHD. European Child & Adolescent Psychiatry. 2017; 26(12): 1443-57.
• 6. Nigg JT. Attention-deficit/hyperactivity disorder and adverse health outcomes. Clin Psychol Rev. 2012; 33(2): 215-28.
• 7. Hinshaw SP, Arnold LE, MTA Cooperative Group. Attention-deficit hyperactivity disorder, multimodal treatment, and longitudinal outcome: Evidence, paradox, and challenge. Wiley Interdiscip Rev Cogn Sci. 2015; 6(1): 39-52.
• 8. Bachmann K, Lam AP, Philipsen A. Mindfulness-based cognitive therapy and the adult ADHD brain: A neuropsychotherapeutic perspective. Frontiers in Psychiatry. 2016; 7: 117. doi: 10.3389/fpsyt.2016.00117.
• 9. Kabat-Zinn J. Mindfulness-based interventions in context: Past, present, and future. Clin Psychol Sci Pract. 2003; 10(2): 144-56.
• 10. Germer CK, Siegel R, Fulton P. Mindfulness and psychonyanaponika therapy. New York: Guilford Press; 2005.
• 11. Bishop SR, Lau M, Shapiro S, Carlson L, Anderson ND, Carmody J, et al. Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice. 2004; 11(3): 230-41.
• 12. Bögel SM, Hoogstad B, van Dun L, Schutter S, Restifo K. Mindfulness training for adolescents with externalizing disorders and their parents. Behav Cogn Psychother. 2008; 36(2): 193-210.
• 13. Semple RJ, Reid EFG, Miller L. Treating anxiety with mindfulness: An open trial of mindfulness training for anxious children. J Cogn Psychother. 2005; 19(4): 379-91.
• 14. Hesslinger B, Tebartz van Elst L, Nyberg E, Dykierek P, Richter H, Berner M, et al. Psychotherapy of attention deficit hyperactivity disorder in adults A pilot study using a structured skills training program. Eur Arch Psychiatry Clin Neurosci. 2002; 252(4): 177-84.
• 15. Hirvikoski T, Waaler E, Alfredsson J, Pihlgren C, Holmström A, Johnson A, et al. Reduced ADHD symptoms in adults with ADHD after structured skills training group: Results from a randomized controlled trial. Behav Res Ther. 2011; 49(3): 175-85.
• 16. Yavuz BG, Yavuz M, Onal A. Examining the factors that are correlated with mindfulness with a focus on attention deficit hyperactivity symptoms. Perspect Psychiatr Care. 2018; 54(4): 596-602.
• 17. Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, et al. Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997; 36(7): 980-8.
• 18. Gökler B, Ünal F, Pehlivantürk B, Çengel-Kültür E, Akdemir D, Taner Y. The reliability and validity of the Turkish version of schedule for affective disorders and schizophrenia-present and lifetime version for school children. Turk J Child Adolesc Ment Health. 2004; 11(3): 109-16.
• 19. Kaufman J, Birmaher B, Axelson D, Pereplitchikova F, Brent D, Ryan N. Schedule for affective disorders and schizophrenia for school-aged children: present and lifetime version (K-SADS-PL) DSM-5 working draft. New Haven: Yale University Child and Adolescent Research and Education; 2016.
• 20. Ünal F, Öktem F, Çetin Çuhadaroğlu F, Çengel Kültür SE, Akdemir D, Foto Özdemir D, et al. Reliability and validity of the schedule for affective disorders and schizophrenia for school-age children-present and lifetime version, DSM-5 November 2016-Turkish Adaptation (K-SADS-PL-DSM-5-T). Turk Psikiyatri Derg. 2019; 30(1): 42-50.
• 21. Conners CK, Sitarenios G, Parker JD, Epstein JN. The revised conners’ parent rating scale (CPRS-R): factor structure, reliability, and criterion validity. J Abnorm Child Psychol. 1998; 26(4): 257-68.
• 22. Kaner Ş, Büyüköztürk Ş, İşeri E. Conners parent rating scale-revised short: Turkish standardization study. Arch Neuropsychiatr. 2013; 50(2): 100-9.
• 23. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual for the state-trait anxiety inventory. Palo Alto: Consulting Psychologists Press; 1983.
• 24. Carey MP, Faulstich ME, Carey TC. Assessment of anxiety in adolescents: Concurrent and factorial validities of the trait anxiety scale of Spielberger's state-trait anxiety inventory for children. Psychological Reports. 1994; 75(1): 331‐8.
• 25. Öner N, Le Compte A. Süreksiz durumluk/Sürekli kaygı envanteri el kitabı. 2. baskı. İstanbul: Boğaziçi Üniversitesi Yayınevi; 1998.
• 26. Kovacs M. Rating scales to assess depression in school- aged children. Acta Paedopsychiatrica: International Journal of Child and Adolescent Psychiatry. 1981; 46(5-6): 305-15.
• 27. Kovacs M. The childrens’ depression inventory (CDI). J Psychopharmacol Bull. 1985; 21(4): 995-8. 28. Öy B. Çocuklar için depresyon ölçeği: Geçerlik ve güvenirlik çalışması. Türk Psikiyatri Derg. 1991; 2(2): 132-6.
• 29. Brown KW, Ryan RM. The benefits of being present: Mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003; 84(4): 822-48.
• 30. Özyeşil Z, Arslan C, Kesici Ş, Deniz ME. Bilinçli farkındalık ölçeğini Türkçeye uyarlama çalışması. Eğitim ve Bilim. 2011; 36(160): 224-35.
• 31. Yavuz M, Çalkan B, Sönmez E, Tetik G, Kadak MT. Ergen yaş grubunda bilinçli farkındalık ölçeğinin psikometrik özelliklerinin incelenmesi. Turk J Child Adolesc Ment Health. 2019; 26(2): 68-74.
• 32. Zylowska L, Ackerman DL, Yang MH, Futrell JL, Horton NL, Hale TS, et al. Mindfulness meditation training in adults and adolescents with ADHD: A feasibility study. J Atten Disord. 2008; 11(6): 737-46.
• 33. Gu Y, Xu G, Zhu Y. A Randomized controlled trial of mindfulness-based cognitive therapy for college students with ADHD. J Atten Disord. 2018; 22(4): 388-99.
• 34. Xue J, Zhang Y, Huang Y. A meta-analytic investigation of the impact of mindfulness-based interventions on ADHD symptoms. Medicine (Baltimore). 2019; 98(23): e15957.
• 35. Deci EL, Ryan RM. Self determination theory: When mind mediates behavior. The Journal of Mind and Behavior. 1980;1(1): 33-43.
• 36. Mitchell JT, McIntyre EM, English JS, Dennis MF, Beckham JC, Kollins SH. A pilot trial of mindfulness meditation training for ADHD in adulthood: Impact on core symptoms, executive functioning, and emotion dysregulation. J Atten Disord. 2017; 21(13): 1105-20.
• 37. Teasdale JD, Segal Z, Williams JM. How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help. Behav Res Ther. 1995; 33(1): 25-39.
• 38. Shapiro SL, Schwartz GE. The role of intention in self-regulate: Toward intentional systemic mindfulness. In: Zeidner M, Pintrich PR, Boekaerts M, editors. Handbook of self regulation. San Diego: Academic Press; 2000. p. 253-73.
• 39. Hölzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U. How does mindfulness meditation work? proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science. 2011; 6(6): 537-59.
• 40. Flook L, Smalley SL, Kitil MJ, Galla BM, Kaiser-Greenland S, Locke J, et al. Effects of Mindful awareness practices on executive functions in elementary school children. Journal of Applied School Psychology. 2010; 26(1): 70-95.
• 41. Zeidan F, Johnson SK, Diamond BJ, David Z, Goolkasian P. Mindfulness meditation improves cognition: Evidence of brief mental training. Consciousness and Cognition. 2010; 19(2): 597-605.
• 42. Cortese S, Kelly C, Chabernaud C, Proal E, Di Martino A, Milham MP, et al. Toward systems neuroscience of ADHD: A meta-analysis of 55 fMRI studies. American Journal of Psychiatry. 2012; 169(10): 1038-55.
• 43. Brewer JA, Worhunsky PD, Gray JR, Tang YY, Weber J, Kober H. Meditation experience is associated with differences in default mode network activity and connectivity. Proc Natl Acad Sci USA. 2011; 108(50): 20254-9.
• 44. Germer CK, Siegel R, Fulton P. Mindfulness and psychonyanaponika therapy. New York: Guilford Press; 2005.
• 45. Felver JC, Tipsord JM, Morris MJ, Racer KH, Dishion TJ. The effects of mindfulness-based intervention on children's attention regulation. J Atten Disord. 2017; 21(10): 872-81.
• 46. Aadil M, Cosme RM, Chernaik J. Mindfulness-based cognitive behavioral therapy as an adjunct treatment of attention deficit hyperactivity disorder in young adults: A literature review. Cureus. 2017; 9(5): e1269. doi: 10.7759/cureus.1269.
• 47. Roemer L, Lee JK, Salters-Pedneault K, Erisman SM, Orsillo SM, Mennin DS. Mindfulness and emotion regulation difficulties in generalized anxiety disorder: Preliminary evidence for independent and overlapping contributions. Behavior Therapy. 2009; 40(2): 142-54.
• 48. Kallapiran K, Koo S, Kirubakaran R, Hancock K. Effectiveness of mindfulness in improving mental health symptoms of children and adolescents: a meta-analysis. Child and Adolescent Mental Health. 2015; 20(4): 182-94.
• 49. Raes F, Griffith JW, Van der Gucht K, Williams JMG. School-based prevention and reduction of depression in adolescents: A cluster-randomized controlled trial of a mindfulness group program. Mindfulness. 2014; 5(5): 477-86.