Children's behavior: personality, action or diagnosis?

 

Children's behavior:

personality, action or

diagnosis?

A qualitative study of how professionals

interprets and understands children's behavior as signs

on ADHD or exposure to violence

Preface

This is a master's thesis in social work at the Center for Social Work (CESAR), Uppsala

university, written in the spring of 2020.

We would like to thank the people who made this study possible. Above all, we would like to extend a big thank you to everyone

interviewees who took the time and enabled the implementation of the study. We also want to thank

our supervisor Stina Fernqvist, for all the help you contributed during the process, as well as ours

university comrades for the feedback and support you have given us.

Jenny Gudmunds & Michaela Janemon

Title: Children's behavior: personality, action or diagnosis? A qualitative study on

how professionals interpret and understand children's behavior as signs of ADHD or

exposure to violence

Authors: Jenny Gudmunds & Michaela Janemon

Summary

That a child exhibits an extravagant behavior, difficulties in regulating emotions,

Impulsivity and hyperactivity can be due to various things. Among other things, it can be one

indication that a child has ADHD, a diagnosis that is becoming more common, but it can

also be an expression that a child has experienced violence or developed PTSD as a result.

The purpose of the study was to investigate how professionals in social work interpret

and understand children's behavior as a sign of ADHD or exposure to violence and how these

interpretations affect the work. This is because previous research has shown large knowledge gaps

regarding the similarity between these and a risk of malpractice. To investigate this

has conducted seven interviews with social work professionals who meet

children in their daily work. The theoretical framework of the study consisted of social constructivism,

stamp theory and systems theory. The results of the study showed that the professionals

has an accepting approach to children's behavior. The professionals saw the child

behavior as a consequence of the environment rather than the child's own personality.

As a result of this approach, the professionals worked mainly with the relational

aspect and interaction regardless of the problem that caused the behavior. The

there were divided opinions about what is the basis for the increase

the diagnosis, mainly ADHD, but common was that they did not differ on their own

treatment and work significantly based on a diagnosis. The study further problematized

this is because it is important that children with ADHD or PTSD get different

treatment specialized based on the problem but that many children can benefit from that

get a stronger interaction with their parents, positive encouragement and other support like them

professionals worked with regardless of causation.

Keywords: Children's behavior, professional interpretations, ADHD, exposure to violence.

1 INTRODUCTION

Children who are unwell can show it in many different ways and there can be several explanations for it

why children behave the way they do. In the field of social work, professionals come daily

in contact with children who feel unwell for any reason where their interpretations and observations of

children's behavior can be of great importance. According to the Social Services Act (2001: 453), the social services must

provide efforts and support on a democratic and solidary basis so that all children have the opportunity

to grow up in a social and economic security. The social services' area of ​​responsibility is also to intervene

when a child's development and health are endangered. Child and adolescent psychiatry [BUP] is also responsible

for support and treatment for children and young people who are mentally ill (Broberg, Almqvist,

Risholm Motander & Tjus, 2015, pp. 500–501).

Today, more and more children are diagnosed with ADHD [Attention Deficit Hyperactivity Disorder]

(Broberg et al., 2015, p.430). In the social services, the influx of reports of anxiety is also increasing, including

concern for children who are doing badly (National Board of Health and Welfare, 2019). There are great similarities between the symptoms of ADHD

and behavioral signs that a child is exposed to violence (Lundström, 2018, 19 March). There is

also difficulties in determining whether the symptoms that may indicate ADHD have occurred

in a child who has been or witnessed violence before or after the violence (Sanderud, Murphy,

& Elklit, 2016, p.2). ADHD is a diagnosis that falls under the umbrella term neuropsychiatric

disabilities [NPF]. ADHD affects, among other things, a person's attention and

concentration ability and impulse control (Broberg et al., 2015, p.418-419). In the treatment of

ADHD is an initial focus on a pedagogically oriented parental support and an adapted schooling.

If this is not enough, the child can be medicated with central stimulant drugs that have

proved to have an effect on the symptoms (Swedish National Agency for Medical and Social Evaluation [SBU]

In Sweden, studies where children have been asked if they have been exposed to violence have shown that approximately

15-30% of the children have been subjected to violence by their parents at some point and that 3-7% state that they

become so repeatedly or often (Broberg et al., 2015, p.359). When a child is subjected to violence

it is common for the child's development to be disrupted. One of the most common consequences is that of the child

attachment patterns to the parents become disoriented, which among other things means that the child does not

can use the parents as support even though they are physically present. This can have consequences

in the child who may express himself through difficulties in regulating emotions and aggressive behavior

(Broberg et al., 2015, pp.367-368). PTSD [post-traumatic stress disorder] is a diagnosis that can

attributed to a person who has experienced traumatic events in the form of, among other things, exposure to violence.

It is common for children who have been through nasty experiences to show symptoms that match

with PTSD a shorter time after the event, but if these become persistent and affect the child's daily

functioning for over a month after the event, there is a great risk that the experience will affect the child

development. A child's reactions as a result of PTSD may impede the development of the child

which makes it important to pay attention to symptoms that may be signs of a trauma disorder

(Broberg et al., 2015, p.277).

Sometimes there are clear signs that someone is exposed to violence, which gives the environment the opportunity

to discover this. But it's not always that these signs are clear, or so can the signs

exist to stand for something other than what they are first interpreted as. Many of the symptoms of exposure to violence

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may overlap with the symptoms of illness or disability and it is required that people

who work with this have knowledge of violence to increase the probability that the exposure to violence will

discovered (National Board of Health and Welfare, 2014a, p.21).

Problem formulation

There is an interesting aspect to how professionals come into contact with children in their work

interprets and observes certain behaviors as well as what they read into these behaviors. For example

extravagant behavior, impulsivity and difficulty concentrating, which can be both signs that

a child gets sick but also signs of ADHD. Due to this, it can be argued that

There is a knowledge gap around this area and that it can pose a risk of ADHD and

Violence can be mixed up or end up in the shadow of each other, which can be problematic in

several respects. On the one hand, the children can receive the wrong treatment and medication, and on the other hand, it can lead to

the children who are harmed are not noticed or come to professionals who work with children

knowledge when signs they show are interpreted as something else. Children who experience violence are in themselves one

central theme in today's social work, even the risk that children do not receive the right support in time makes this topic

relevant to pay attention. Likewise, the interpretations of professionals and what these interpretations can be

have for consequences a relatively unexplored topic which also justifies the importance of this study.

Purpose and questions

The purpose of this study is to investigate the ways in which professionals in social work interpret

and understands children's behaviors that may be signs of ADHD and violence and how

their work is influenced by these interpretations.

• In what way do adults who work with children interpret different behaviors (for example, acting out?

behavior, difficulty concentrating and impulsivity) in children?

• What explanations do professionals attribute to these behaviors?

• What tools and preconceptions will be central to the work and assessment?

Definitions

Violence: The concept of violence includes many different types of violence. Including physical violence, psychological violence,

sexual abuse, violations, neglect and more (National Board of Health and Welfare, 2016, p. 28). We also have

chose to use the term "children who have experienced violence". Experiencing violence means both to the child

have seen violence but also if the child, for example, has heard violence between his parents. In the former

research often uses the term “child maltreatment”, we have chosen to use in the translation

the concept of "children who get sick".

Disposition

The essay is divided into six different sections. The first introductory section is presented as relevant

background facts as well as purpose and issues that the study intends to investigate. In the second section

previous research in the subject is presented. This is followed by a third section where the research approach

and theoretical framework is described. In the fourth section, we describe our research method. After

follows section five, which is the main part of the essay, where results are presented and analyzed in

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relation to previous research and theory. Finally, in the sixth section, a discussion follows

of the study in its entirety.

2. PREVIOUS RESEARCH

The present section aims to account for the previous research that exists in the subject. From

In the research we have collected, we have divided the content into four headings. The headlines are themed

partly directly based on our questions to give us a basis to be able to answer these in the results and analysis part, but partly also based on themes we have found as recurring in the studies we

reviewed. These are norm-breaking behaviors in childhood, ADHD and exposure to violence, the relationship

and risk of misdiagnosis as well as the role and competence of professionals in ADHD and

exposure to violence. The first three themes address norm-breaking behavior, criteria for diagnoses and

causes and consequences of ADHD and exposure to violence. Then there is limited research on how

professionals interpret children's different behaviors as extravagant behavior,

concentration difficulties and impulsivity, the text is therefore supplemented with a section on the connection

between ADHD and exposure to violence and how the role of professionals and work with children experienced

violence or children with ADHD looks like. Finally, there is a summary and a map

discussion of the research field

Search process

The search process has mainly been based on Uppsala University Library's database. Furthermore, keywords

such as "ADHD", "trauma", "children" and "violence" have been used, as well as keywords such as "professional",

"Children", "observation" and "interpretation". In English, the keywords “child maltreatment” and

"ADHD". Search has also been done through the database PsycINFO and there the keywords were used

"ADHD + PTSD" and "ADHD + PTSD + misdiagnosed" and "maltreatment + ADHD". At

search for supplementary studies used words like "ADHD + gender" and "ADHD + girls"

and also "professionals + children + interpreter". Chain search based on other publications

references have also been implemented. After the search was completed, the hit list was handled by

to limit to peer-reviewed articles to ensure reliable studies. The content

was then supplemented with reports from the National Board of Health and Welfare as the established research can be seen

as deficient on some fronts.

Norm-breaking behavior in childhood

Norm-breaking behavior in children can be both aggression and extravagant behavior but also

when a child violates rules and laws. These behaviors are most common in adolescents in

ages 15-17 years but also occurs in smaller children. Behaviors should be noted in good

time when early norm-breaking behavior tends to persist over a longer period of time. It is common, for example

that adults in crime have shown norm-breaking behavior in early childhood (Andershed &

Andershed, 2005, p.17-20). Many studies have shown that there is a great deal of heredity when it comes to

mainly aggressive but also non-aggressive norm-breaking behavior in children. The risk of having children

develops such behavior can, however, be influenced by both genetic and social factors (Andershed &

Andershed, 2005, pp.66-67). Both children with an ADHD diagnosis and children who have experienced or been exposed

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for violence is at high risk of developing norm-breaking behavior in childhood (Andershed &

Andershed, 2005, pp. 101 and 142).

ADHD and exposure to violence

The onset of ADHD is mainly due to hereditary factors, although psychosocial factors are also

of importance (Nigg, 2012). The diagnosis of ADHD has increased significantly in recent years and is

nowadays a relatively common diagnosis where approximately 2-5% of all school-age children have the diagnosis (Broberg

et al., 2015, p.430). To be diagnosed with ADHD, the symptoms must be severe and lasting

and that they are noticeable in several different parts of everyday life (SBU, 2005, p.15). Simplified can ADHD

is described as a condition with difficulty in regulating its behavior. The symptoms of ADHD

changes over time and depends on age and severity. As children grow and that

the school work's demands for concentration increase, among other things the attention problems become more

noticeable (National Board of Health and Welfare, 2014b, p.13). The diagnosis is three to four times more common than among boys

than girls, indicating that girls may be underdiagnosed. Most likely the reason for this

It is believed that girls show more introverted symptoms such as depression and anxiety while boys

are considered to be more hyperactive and impulsive, which attracts more attention (Broberg et al.,

When diagnosing ADHD, there can be talk of various main symptoms. These different main symptoms

may be hyperactivity, attention deficit disorder or a combination of the two (Broberg et al.,

2015, pp.421-422). The hyperactivity, or overactivity as it is sometimes called, is manifested by

the children move more than others and that they have difficulty being still. Children, or mainly young people, with

ADHD is usually not visibly overactive but is more often expressed in that they easily become restless

and impatient. The attention problem is shown by the children easily losing focus and having

difficult to concentrate. They have difficulty following simple instructions and planning and organizing

their existence. Impulsivity is manifested by children having difficulty controlling their emotions and

hold back their reactions. The impulsivity allows them to expose themselves to dangerous situations when they have

difficult to think long-term (Kadesjö, 2010, p.19-20).

Some signs that children are exposed to physical violence can include poor hygiene, then

language development, poor growth, poor learning ability, difficulties interacting with other children and

contact-seeking behavior towards adults. Additional signs are difficulty concentrating,

overactivity, impulsivity and aggression as well as repetitive behavior. The latter points emphasize

the importance of examining whether the behavior is a consequence of ADHD as the symptoms are similar

(Janson, 2010, pp.25-26). It is possible to see strong connections between crime, PTSD and the general public

behavioral problems during adolescence and depression in adults who have been exposed to physical violence

as a child (Janson, 2010, p.23). About 20% of children who are exposed to violence develop some type of

norm-breaking behavior. In children with norm-breaking behavior, children who have been exposed to or

experienced violence an overrepresented group. One reason for this may be that the children imitate

parents' aggressive actions and ways of resolving conflicts (Andershed & Andershed, 2005,

p.101).

A risk factor for a child to be exposed to physical violence at home is if the child suffers from prolonged

illness or disability. Children belonging to these categories have been exposed about twice as much

often for physical violence in the home compared to children without illness or disability (Janson,

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2010, p.19). Furthermore, Jansson (2010) describes that possible reasons for this may include that

these children may have poorer social networks and therefore fewer people who can detect violence. The

may also be due to the fact that children with, for example, ADHD can be perceived as challenging for the parents

and that parents in these cases may have difficulty understanding that the behavior has with one

disability to do. Children with difficulties in attention and concentration

are particularly vulnerable to corporal punishment (Janson, 2010, p.19). When it comes to health factors can

there is talk of strong physique, cognitive ability and social skills. Something that has a clear connection

with the child's ability to cope with difficult growing up conditions is a safe and lasting relationship with one

affirmative adult (Broberg et al., 2015, p.363).

If a child experiences domestic violence, it can also lead to the child becoming mentally ill. Children who

experienced violence is at higher risk of developing mental illness than children who have not experienced violence (Broberg

et al., 2011, p.9). There are similarities in the consequences if a child is directly exposed to or experiences

violence. The child may develop mental illness such as depression, anxiety, aggression,

difficulty concentrating and hyperactivity. It can also lead to the child getting a disoriented one

connection to the parents and risks developing PTSD and chronic stress (National Board of Health and Welfare,

2016, p.30). When children themselves have been asked about the usual consequences of being exposed to violence, they have

mentioned fear, anxiety, low self-esteem, stigma and insecurity (Buckley, Holt & Whelan, 2007, pp. 301–

304).

The symptoms for children affected by PTSD look different but in many cases some type of

behavior change (Broberg et al., 2015, p.277). Then it is common for children to experience

Scary events react in any way, it may be important to wait about a month for

to see how the symptoms develop before a therapist starts any type of treatment or

investigation of PTSD. In the meantime, however, the child's support should focus on comfort, in general

care and practical support for both the child and the family (Broberg et al., 2015, p.329). One

Some children continue after this time are affected by what happened to them in a way that can be classified as

PTSD. This is characterized by the child involuntarily reliving painful memories from one

traumatic event and can thereby be put in the same fear as when the event occurred

(Broberg et al., 2015, pp.330-331). These experiences can cause physiological reactions in the form of

irritability, restlessness, difficulty concentrating, difficulty relaxing and difficulty

fall asleep. It can also lead to avoidant symptoms.

The child's development is an ongoing process where individual differences, biological conditions, the child's interaction history and its emotional and thought life come into play. In the behavioral analysis, the interaction between the child's environment and its own reactions is investigated. The therapist systematically maps how situational factors, behavioral patterns and the consequences of the child's behavior affect each other. The behavioral analysis thus aims to gather knowledge about how the child is affected by and affects his environment.

After the analysis, the treatment can be carefully planned with regard to the child's uniqueness and to the family and the environment in general. The goal is not only to eliminate problem behaviors and associated suffering, but even more to help the child develop lasting useful skills. The most effective results are achieved when the treatment is focused on both children, family and the environment.

In the 1950s and 1960s, behavioral therapy began to be used more systematically in the treatment of children and families. In the beginning, they worked mostly with developmentally disabled and severely disturbed children and young people, often in institutions. Many of the basic learning psychological principles that were then applied still have bearing capacity - such as gradual approach, model learning and positive reinforcement.

What has come to be known as the behavior-system perspective was formed in the 1970s and 1980s on the basis of well-documented research. The treatment goals and application were expanded and became more general in clinical child psychology, family treatment, health psychology and behavioral pediatrics. The behavior-system perspective meant that the treatment required efforts on many levels, in different environments and with a number of people involved.

During the 1990s, the development has continued, with more detailed analysis methods and an extension of the treatment to include such diverse issues as juvenile delinquency, prevention of mental illness in children, classroom problems and learning difficulties.