The different reactions of parents to the discovery that their children had ADD/ADHD has an effect on the primary relationship established between mother and child. This is essential in the later involvement, experience and meaning attribution of the child with respect to all subsequent relationship formation on the child's journey towards his ultimate target, namely self-actualisation. It was felt that psychological intervention could help parents to bond, communicate with and relate to their children without experiencing negative feelings which would enhance parental acceptance. In this study, ten mothers were used to participate in an adapted group Filial Therapy programme. This unique therapy involves parents as the primary agents to resolve child-related problems and to encourage children's healthy psycho-social development. Results were positive. The mothers felt that they had formed better relationship with their children. They were empowered with knowledge and coping mechanisms, such as reflective listening, setting limits and providing choices. For the first time they were enjoying their ADD/ADHD children. / Psychology of Education / M. Ed. (Guidance and Counselling)

The aim of this study is to examine social workers’ experiences of how the ADHD-diagnosis affects their work with children and youths living in foster care and how it affects the individuals and families themselves. The study is built upon five qualitative interviews and the results are analyzed through a theoretical framework that constitutes ADHD as not only the symptoms and the medical disorder but also as a social phenomenon where the disorder is socially constructed by the current society, norms, and knowledge. The study shows that the social workers’ do not rely on the sole ADHD-diagnosis in the understanding and guidance of the children and their foster parents, but rather see the individual needs of each children. The social workers’ experiences shows that the diagnosis can act as a relief and explanation for both children and their foster parents but can also be a stigma. My overall conclusions are that the diagnosis seems to have only minor significance for these social workers’ daily work and is rather more relevant for obtaining medical treatment or extra support in school for the children. / Syftet med den här studien är att undersöka socialsekreterares erfarenheter av hur ADHD hos barn och unga som är familjehemsplacerade påverkar socialsekreterarnas arbete och hur diagnosen påverkar barnen och de unga samt familjehemmen. Studien bygger på fem kvalitativa intervjuer och resultaten är analyserade genom ett teoretiskt ramverk som betraktar ADHD som inte bara symtomen och den medicinska störningen utan också som ett socialt fenomen där diagnosen är socialt konstruerad genom samhället, normer och aktuell kunskap. Studien visar att socialsekreterarna inte förlitar sig enbart på ADHD-diagnosen för att förstå och hjälpa barnen och deras familjehemsföräldrar utan snarare ser varje barns individuella behov. Socialsekreterarnas erfarenheter visar att diagnosen kan ge lättnad och förklaring för både barnet och familjehemsföräldrarna men att den också kan vara stigmatiserande. Mina slutsatser är att diagnosen tycks spela mindre roll för socialsekreterarnas dagliga arbete med barnen utan är mer relevant för att erhålla medicinsk behandling eller för att få extra stöd i skolan.

Summaries in Afrikaans and English / ADHD is a well-known disorder affecting approximately 8% of children in South Africa. Despite years of research and development re the disorder, it seems that parents and teachers sometimes do not have the ability to handle a child with ADHD. Since a lot of the information is contradictory, confusion exists among parents and teachers who act as the support system of the child with ADHD. ADHD is a serious and destructive disorder and can influence the child’s social functioning negatively. Due to continuous failure, the child with ADHD has a low self-esteem. These aspects are the point of reference for the aim of this study, namely the development and implementation of a Gestalt therapeutic intervention plan aimed at the empowerment of the child with ADHD in the middle childhood years, his supporting systems and the evaluation of the impact thereof. The empirical data was gathered by a process of intervention research. A combination of the qualitative and quantitative approach was used. During the use of the qualitative method, a quasi-experimental one-group-pretest-posttest design was utilized. During the qualitative phase, the phenomenological perspective was used. An in-depth literature study was done in respect of ADHD, the theoretic basis of ADHD, the child with ADHD in the middle childhood years and the ADHD from a Gestalt therapeutic perspective. This literature study was the starting point for the development of the comprehensive holistic intervention plan. The intervention plan consists of three programmes: Firstly an empowering program of six sessions aimed at the child in the middle childhood years with ADHD – attention was given to emotional awareness and the dealing with unfinished business. Secondly an empowering programme aimed at the parents consisting of four parental guidance sessions, and thirdly an empowerment programme aimed at the teachers, consisting of two workshops. / AandagTekortHiperaktiwiteitsVersteuring (ATHV) is 'n welbekende versteuring wat ongeveer 8% van SuidAfrikaanse kinders be'invloed. Ten spyte van jarelange navorsing en die verbetering van begrip vir die versteuring, blyk dit dat ouers en onderwysers steeds nie altyd oor die vermoe beskik om 'n kind met A THV te hanteer nie. Aangesien daar baie teenstrydige inligting beskikbaar is, word verwarring geskep by ouers en onderwysers, wat as die kind met A THV se steunstelsels moet dien. A THV is 'n ernstige en verwoestende versteuring en kan die kind se maatskaplike funksionering negatief be'invloed. As gevolg van voortdurende mislukking het die kind met ATHV dikwels 'n lae selfwaarde. Hierdie aspekte het as uitgangspunt gedien vir die doel van die ondersoek, naamlik die ontwikkeling en implementering van 'n Gestaltterapeutiese intervensieplan gerig op die bemagtiging van sowel die kind met A THV in die middelkinderjare, asook sy steunstelsels, en om die impak daarvan te evalueer. Tydens die ondersoek is 'n proses van intervensienavorsing gevolg wat 'n gekombineerde kwalitatiewe en kwantitatiewe navorsingsmetode is. In die benutting van die kwalitatiewe metode is 'n kwasie-eksperimentele een-groep-voortoets-natoetsstrategie benut. By die kwalitatiewe metode is vanuit die fenomenologiese perspektief gewerk. 'n Diepgaande literatuurstudie is gedoen ten opsigte van ATHV, die teoretiese begronding van ATHV, die kind met ATHV in die middelkinderjare en ATHV vanuit 'n Gestaltterapieperspektief. Hierdie literatuurstudie het as basis vir die ontwikkeling van 'n omvattende holistiese intervensieplan gedien. Die intervensieplan bestaan uit drie programme. Eerstens 'n bemagtigingsprogram van ses sessies gerig op die kind met A THV in die middelkinderjare waar die klem geplaas is op emosionele bewuswording en die hantering van onvoltooidhede. Tweedens 'n bemagtigingsprogram gerig op die ouers tydens vier ouerleidingsessies. Derdens 'n bemagtigingsprogram gerig op die onderwysers bestaande uit twee werkwinkels. Gestaltterapie het nie slegs as teoretiese verwysingsraamwerk tydens die ondersoek gedien nie, maar Gestaltterapeutiesemetodes is ook benut tydens die implementering van die intervensieplan. Resultate vanuit die empiriese gegewens dui aan dat die ouers en onderwysers se kennis ten opsigte van ATHV verbeter het, want hulle het hanteringstrategiee aangeleer en begin toepas, en daar was beter begrip tussen die skool en die ouers waarby die kinders gebaat het. Die kinders se selfwaarde is ook verhoog en hulle maatskaplike funksionering het verbeter. / Social Work / D. Diac. (Play Therapy)

The different reactions of parents to the discovery that their children had ADD/ADHD has an effect on the primary relationship established between mother and child. This is essential in the later involvement, experience and meaning attribution of the child with respect to all subsequent relationship formation on the child's journey towards his ultimate target, namely self-actualisation. It was felt that psychological intervention could help parents to bond, communicate with and relate to their children without experiencing negative feelings which would enhance parental acceptance. In this study, ten mothers were used to participate in an adapted group Filial Therapy programme. This unique therapy involves parents as the primary agents to resolve child-related problems and to encourage children's healthy psycho-social development. Results were positive. The mothers felt that they had formed better relationship with their children. They were empowered with knowledge and coping mechanisms, such as reflective listening, setting limits and providing choices. For the first time they were enjoying their ADD/ADHD children. / Psychology of Education / M. Ed. (Guidance and Counselling)

There is a tendency for children who display unacceptable behaviour to be described as having Attention Deficit-Hyperactivity Disorder when the actual reason for the child’s diagnosis may simply be affective factors, another disorder or simply misbehaviour. ADHD is the most commonly diagnosed child disorder affecting 3-5% of all school age children. The aim was to investigate the prevalence of Attention Deficit-Hyperactivity Disorder in a sample of Foundation Phase children at an Inclusive ex Model C Preparatory School in the South Metro, Western Cape, by uncovering the criteria that are used by their teachers to suggest a possible Attention Deficit-Hyperactivity Disorder in a child for a referral to a parent, therapist or professional. This study used a phenomenology design making use of interpretations, meanings and an individual’s opinions regarding the teacher’s criteria, which relate to the diagnosis of ADHD. It required a qualitative analysis with the emphasis on observation, interviews and document analysis. A verbal Interview consisting of questions which were taped and transcribed, as well as an observation, and completion of a Connors Form of the selected children was completed by the teachers. Ten class teachers were interviewed and seven children from Grades one, two and three were observed. A model from Creswell was used, in order to identify the units of meaning relating to the prevalence of ADHD amongst learners in the South Metro District. The findings include lack of understanding of ADHD amongst teachers, subjectivity in the diagnosis of learners with ADHD, factors influencing the diagnosis of ADHD, criteria necessary to identify ADHD and stereotyping differences. / Inclusive Education / M. Ed. (Inclusive Education)

The aim of this study was to create awareness of the emotional needs of children diagnosed with ADHD. In order to reach the aim of this study, an initial literature study was executed to describe ADHD and the emotional needs of children. Semi-structured interviews and two projective techniques were used to conduct the empirical study. Valuable data was also collected from the biographical questionnaires completed by the parents. Based on the data collected and analysed, findings were made which were verified by means of a second literature study. This was followed by conclusions which served as the basis for recommendations that were made in the form of guidelines to the parents, with the aim to make the parents aware of the emotional needs of their children diagnosed with ADHD. These guidelines will be made available to the parents at a seminar that will be held on acceptance of this research. / Social Work / M.Diac. (Play Therapy)

The study proposes an ecosystemic approach as an intervention for attentional difficulties and heightened motor activity, traditionally known as AD/HD. A literature study of AD/HD is presented first as a psycho-educational frame of reference. The focus then shifts to the symtoms of AD/DH to move closer to the possible underlying causes of these symptoms. In doing so, the focus changes from AD/HD as a diagnosis to attentional difficulties and heightened motor activity as presenting symptoms. Attention and motor activity as constructs are investigated in terms of their neuro-anatomical, neuro-chemical and neuro-physiological aspects. Furthermore, neurodevelopment, physiological stress, neurodevelopmental delay, information processing systems, sensory-motor subsystems and integration as constructs are investigated to understand their role in attention and modulation of motor activity. The study of attention and motor activity and their associated neurological factors motivates an alternative, ecosystemic method of intervention. The proposed approach includes an investigation into internal and external biochemical ecosystems such as environmental pollutants, deficiencies of essential nutrients and genetic deficiencies of the immune system. Other aspects such as time, maturation and neurodevelopment are also considered as well as the gentle interplay between these aspects. The therapeutic intervention includes sound therapy, neurodevelopmental movement activities, EEG neurofeedback and nutrition. Experimental research with a sample population of 12 diagnosed grade 4 and 5 AD/HD learners over a 11 week period was conducted. Statistically significant improvements in aspects of attention were noted using 2 standardised instruments and verification through parent interviews in the first and second experimental groups. Statistically significant improvements were noted in aspects of motor activity (a decline in hyperactive behaviour) in the second experimental group with verification from teacher interviews. Additionally, children in the first experimental group improved significantly more than children in the control group with regards to mathematic skills. The second experimental group showed significant improvement with large effect sizes on reading, mathematic skills and spelling. In conclusion, the statistically significant results obtained with the proposed approach motivates implementation, with improvements in attention, motor activity control and academic performance as a prospect. / Psychology of Education / D. Ed.(Psychology of Education)

Attention Deficit Hyperactivity Disorder (ADHD), an intellectual impairment, generally characterised by inattentiveness and impulsivity has become prevalent in South African schools. ADHD learners require support from within the classroom to accommodate their academic and behavioural needs. A quantitative research was undertaken to determine the impact of an educator's knowledge of ADHD on teaching support strategies. An educator's ADHD knowledge is based on their understanding of the diagnosis, causes, symptoms and management of ADHD as well as the effect that ADHD has on a learner's classroom skills. Data was obtained from responses to questionnaires from randomly selected respondents within randomly selected government secondary schools in the Umlazi District of Kwa-Zulu Natal. The data was descriptively analysed to conclude that the level of ADHD knowledge possessed by educators impact on the appropriateness of their teaching strategies. There is a need to impart knowledge regarding learning barriers to educators, to ensure the efficacy of teaching strategies. / Inclusive Education / M. Ed. (Inclusive Education)

The purpose of the study was to examine the relationship between sleep patterns, motor proficiency and commonly co-occurring neurodevelopmental disorders in children, attitude to physical activity, mental health, and age. The study also looked at differences in sleep efficiency, as well as, perceived adequacy in physical activity between typically developing children and children with low motor proficiency. The sample consisted of 127 participants, 6-12 years old living in Perth, Western Australia. 51% participants were considered typically developing and 49% to have low motor proficiency. Motor proficiency, indications of Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder and anxiety/depression, adequacy in, or predilection for physical activity did not show a relationship to sleep efficiency. Significant differences between groups in sleep efficiency or adequacy in physical activity were not found. No interaction effect of neurodevelopmental disorders were identified. Sleep in children with movement impairments caused by neurodevelopmental disorders is an area where continued studies are of great importance. Although no relationship was identified in the current study, previous research has suggested sleep may play an important role for development and optimal everyday functioning. A better understanding of physical and psychological consequences and possible contributing factors of low motor proficiency in childhood is important as the risk of long-term dysfunction in emotional, cognitive and physical areas may be reduced in an optimal environment.

Succédant à une théorisation centrée sur le rôle des déficits des fonctions exécutives, les modèles contemporains du trouble déficit de l'attention / hyperactivité (TDAH) mettent en avant l’hétérogénéité d’une catégorie diagnostique impliquant des déficits neuropsychologiques, voies cérébrales et mécanismes étiopathogéniques multiples. En dépit de cette évolution, la majorité des études d'imagerie cérébrale des corrélats structurels du trouble menées à ce jour ont été conduites au niveau de la catégorie diagnostique, sans spécification supplémentaire. Cette approche comparant en moyenne un groupe de patients avec TDAH à un groupe de sujets sains a donné des résultats très variables d'une étude à l'autre, la comparaison inter-étude étant toutefois rendue difficile par la présence de facteurs confondants, tels que des différences en terme de régions d’intérêt examinées, de comorbidités acceptées chez les patients, de pourcentages de sujets masculins et féminins, de fenêtre d’âge sélectionnée, de méthodologie d'analyse ou encore de pourcentage de patients traités par méthylphénidate. Dans ce doctorat, nous nous sommes appuyés sur la morphométrie voxel-à-voxel pour isoler l’influence sur les volumes de matière grise de deux facteurs d’hétérogénéité intra-catégorielle dans le TDAH : le genre d’une part, et un polymorphisme génétique (Val158Met du gène Catéchol-O-méthyltransferase (COMT)) d’autre part ; ces deux facteurs présentant l’intérêt de moduler le risque associé de développer un trouble de type externalisé. Nous avons également comparé les volumes de matière grise d’enfants avec TDAH ayant reçu un traitement par méthylphénidate, de patients n'ayant jamais été exposé à la médication, et de sujet sains. Ces recherches expérimentales ont été inscrites dans une discussion plus générale de l’hétérogénéité des résultats de la littérature structurelle consacrée au TDAH et des sources neuropsychologiques de cette hétérogénéité. Dans notre étude des effets du genre sur les volumes de matière grise dans le TDAH, nous reportons pour la première fois une interaction entre genre et diagnostic, avec des corrélats structurels du trouble différents chez les garçons et les filles avec TDAH dans des régions de la ligne médiane du cerveau, impliquées à la fois dans la régulation émotionnelle et dans le fonctionnement du mode de réseau par défaut. Nous suggérons que ces différences structurelles pourraient contribuer aux différences de risque associé pour les troubles internalisés et externalisés présentées par les garçons et filles avec TDAH. Dans notre étude explorant l'influence du polymorphisme Val158Met sur les volumes de matière grise, nous mettons en évidence une modulation génétique des corrélats structurels du trouble : les sujets homozygotes pour l'allèle Val158, identifiés dans la littérature comme à risque pour le développement d'un trouble des conduites, présentent des volumes de matière grise supérieurs dans le noyau caudé comparativement aux sujets sains, tandis que les patients avec TDAH porteurs d'un allèle Met158 présentent des volumes de matière grise plus faibles dans le cortex préfrontal inférieur droit, une région cruciale pour les processus de contrôle attentionnel. Enfin, dans notre étude des corrélats structurels de l'exposition au méthylphénidate, nous reportons un effet potentiellement normalisateur du traitement sur les volumes de matière grise de l'insula et du pole temporal, des volumes de matière grise plus faibles chez les patients traités comparativement aux sujets sains dans le gyrus frontal moyen et dans le gyrus précentral, et une association entre volume de matière grise dans le nucleus accumbens gauche et durée d'exposition au méthylphénidate chez les sujets traités. (...) / Previous models of Attention Deficit / Hyperactivity Disorder (ADHD) such as Barkley’s or Brown’s conceptualized ADHD as essentially a developmental impairment of executive function. Against this view, it is now recognized that ADHD is a heterogeneous disorder, involving multiple deficits and multiple neuronal pathways. Despite this current theoretical framework, most structural brain imaging studies in ADHD have compared groups of children with ADHD with typically developing children, without trying to identify subgroups within the diagnostic category. This approach has yielded heterogeneous findings, possibly due to inter-studies variations in the type and number of comorbidities, the percentage of medicated participants included, the number of girls included, and/or methodological and statistical differences. Patients participating in these studies were also often exposed to methylphenidate, and potential medication effects on grey matter volumes are still unclear in certain brain regions such as the frontal lobe, despite a therapeutic action involving the preferential activation of catecholamine neurotransmission within the prefrontal cortex. In this thesis, we used voxel-based morphometry to study the influence of two important risk factors for the development of comorbid conditions in ADHD. The first of these two factors was gender, and the second a genetic polymorphism of the Catechol-O-methyltransferase gene known to put children with ADHD at risk for developing a conduct disorder (Val158Met). We also compared grey matter volumes in children with ADHD exposed to methylphenidate, never-medicated children with ADHD and typically developing children. These experimental studies were part of a more general discussion of ADHD neuropsychological and neurobiological heterogeneity. In our study exploring the influence of gender on the structural correlates of ADHD, we report for the first time a gender-by-diagnosis interaction, with grey matter volume differences in boys and girls with ADHD in midline cortical structures, involved in emotional regulation and part of the default mode network. We propose that these differences may contribute to explain why girls with ADHD more often develop inattentive and internalizing symptoms, whereas externalizing symptoms are predominant in boys with ADHD. In our study investigating the effects of Val158Met in ADHD, we report the first evidence of a COMT-related genetic modulation of ADHD-related grey matter volume alterations. Indeed, children with ADHD at higher risk for developing a conduct disorder (children homozygotes for the Val158 allele) presented increased grey matter volumes in the caudate nucleus when compared with typically developing children, whereas children carrying a Met158 allele presented with decreased grey matter volumes in the right inferior frontal cortex, a region known for its key role in attention. Finally, we measured grey matter volumes in medicated children with ADHD, never-medicated children with ADHD and typically developing children using both whole-brain voxel-based morphometry and automated tracing procedures in chosen regions of interest. We document potential methylphenidate-related grey matter volume normalization and deviation in previously unexplored frontal and temporal regions, and report a positive association between treatment history and grey matter volume in the nucleus accumbens, a key region for reward processing. Our first two experimental studies therefore contribute to a better understanding of the influence of important sources of within-category heterogeneity, while the third helps clarifying the potential confounding effect of medication exposure in previous structural brain imaging studies in ADHD.