Stress Management Your Essential Guide to Coping with ADHD and Childhood Behavioural Problems

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Emergency, crisis and support services. End of life and palliative care services. Hospitals, surgery and procedures. Planning and coordinating healthcare. Pregnancy and birth services. Behavioural disorders in children Share show more. Children Children - Behaviour and learning Parents Parents - Common childhood health concerns Anger and conflict. Some children have extremely difficult and challenging behaviours that are outside the norm for their age. Boys are more likely than girls to suffer from behavioural disorders.

Treatment options include parent management training, cognitive behaviour therapy, medication and treatment for associated problems. All young children can be naughty, defiant and impulsive from time to time, which is perfectly normal. However, some children have extremely difficult and challenging behaviours that are outside the norm for their age.

These three behavioural disorders share some common symptoms, so diagnosis can be difficult and time consuming. A child or adolescent may have two disorders at the same time. Other exacerbating factors can include emotional problems, mood disorders, family difficulties and substance abuse.

Oppositional defiant disorder Around one in ten children under the age of 12 years are thought to have oppositional defiant disorder ODD , with boys outnumbering girls by two to one. Some of the typical behaviours of a child with ODD include: Easily angered, annoyed or irritated Frequent temper tantrums Argues frequently with adults, particularly the most familiar adults in their lives, such as parents Refuses to obey rules Seems to deliberately try to annoy or aggravate others Low self-esteem Low frustration threshold Seeks to blame others for any misfortunes or misdeeds.

Around five per cent of 10 year olds are thought to have CD, with boys outnumbering girls by four to one. Some of the typical behaviours of a child with CD may include: Frequent refusal to obey parents or other authority figures Repeated truancy Tendency to use drugs, including cigarettes and alcohol, at a very early age Lack of empathy for others Being aggressive to animals and other people or showing sadistic behaviours including bullying and physical or sexual abuse Keenness to start physical fights Using weapons in physical fights Frequent lying Criminal behaviour such as stealing, deliberately lighting fires, breaking into houses and vandalism A tendency to run away from home Suicidal tendencies — although these are more rare.

Attention deficit hyperactivity disorder Around two to five per cent of children are thought to have attention deficit hyperactivity disorder ADHD , with boys outnumbering girls by three to one. The characteristics of ADHD can include: Inattention — difficulty concentrating, forgetting instructions, moving from one task to another without completing anything. Overactivity — constant restlessness and fidgeting. Gender — boys are much more likely than girls to suffer from behavioural disorders. It is unclear if the cause is genetic or linked to socialisation experiences.

Temperament — children who are difficult to manage, temperamental or aggressive from an early age are more likely to develop behavioural disorders later in life. Family life — behavioural disorders are more likely in dysfunctional families. For example, a child is at increased risk in families where domestic violence, poverty, poor parenting skills or substance abuse are a problem.

Learning difficulties —problems with reading and writing are often associated with behaviour problems. Intellectual disabilities — children with intellectual disabilities are twice as likely to have behavioural disorders. Brain development — studies have shown that areas of the brain that control attention appear to be less active in children with ADHD. For example, a child who exhibits the delinquent behaviours of CD may also have ADHD, anxiety, depression, and a difficult home life.

Diagnosis methods may include: Diagnosis by a specialist service, which may include a paediatrician, psychologist or child psychiatrist In-depth interviews with the parents, child and teachers Behaviour check lists or standardised questionnaires. Treatment of behavioural disorders in children Untreated children with behavioural disorders may grow up to be dysfunctional adults.

Generally, the earlier the intervention, the better the outcome is likely to be. A large study in the United States, conducted for the National Institute of Mental Health and the Office of School Education Programs, showed that carefully designed medication management and behavioural treatment for ADHD improved all measures of behaviour in school and at home. Treatment is usually multifaceted and depends on the particular disorder and factors contributing to it, but may include: Parental education — for example, teaching parents how to communicate with and manage their children.

Family therapy — the entire family is helped to improve communication and problem-solving skills. Cognitive behavioural therapy — to help the child to control their thoughts and behaviour. Social training — the child is taught important social skills, such as how to have a conversation or play cooperatively with others. Anger management — the child is taught how to recognise the signs of their growing frustration and given a range of coping skills designed to defuse their anger and aggressive behaviour. Relaxation techniques and stress management skills are also taught.

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Comparisons of the baseline scores of the study variables stress, anxiety, depression, and mental health revealed no significant differences among the three groups. However, immediately after, and one month after the completion of the stress management program utilizing cognitive behavioral approach, a statistically significant difference was found among the three groups regarding stress and mental health. The mean score of stress reduced in both intervention and the placebo group, but the mean mental health score improved only in the intervention group.

The results of one-way ANOVA showed that the mean score of stress immediately after the intervention was Also, the mean mental health score was One month after intervention, improvement in the mean mental health score was detected only in the intervention group. The mean anxiety and depression scores were statistically significant in the intervention and the placebo groups.

It is shown in Table 1. Within group comparisons of the variables were performed using one-sample repeated measurement ANOVA in the intervention group. The placebo and the control groups were not changed. The changes in the scores of mental health and depression-anxiety-stress at baseline, immediately after, and one month after the intervention are presented in Table 2. This study was performed using stress management program utilizing cognitive behavioral approach in three experimental, placebo, and control groups. In fact, elimination of the confounding variables and inclusion of a placebo group are important because any change in the experimental group at the end of the intervention can be attributed to the cognitive behavioral stress management intervention.

This study assessed the effect of stress management program using cognitive behavior approach on mental health of the mothers of the children with ADHD. The results of this study showed that cognitive behavioral stress management program in the experimental group led to improvement of mental health immediately and one month after the intervention and reduction of maternal stress immediately after the intervention. Previous studies have been mostly conducted on the relationship between maternal mental health and behavioral problems in the children, stress management training for the parents, and determining the degree of stress, anxiety, and depression in mothers of the ADHD children.

The results obtained in these studies are compatible with those of the present one. Musa and Shafiee conducted a study in Malaysia in order to determine depression, anxiety, and stress levels among the mothers of the ADHD children and their relationships with ADHD symptoms. The results of that study showed that compared to the control group, the mothers of the ADHD children experienced higher levels of stress, anxiety, and depression resulting from external behaviors in the children These results suggest that the mothers of hyperactive children need a comprehensive training to increase their information and awareness about ADHD that can, in turn, create changes in attitude and behavior toward children Also, increase in the parents' information and awareness can reduce the maternal concerns and anxiety and reform the parents' false and dysfunctional beliefs.

The reformation eventually paves the way to promote the mothers mental and social health Although perception and acceptance of the characteristics and behaviors of the children are hard by mothers, they can more easily explain their children's behavior after participation in the training sessions. Consequently, behavior problems in the children are reduced, the children will obey the maternal orders more, and the mothers will feel less under pressure and stress Furthermore, the findings of studies have pointed out that the parents' training programs can be effective in improving the relationship between the parents and their ADHD children.

Up to now, studies have used different training programs to increase the knowledge and awareness of the mothers of hyperactive children.

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The results of their study showed that stress management program helped the parents of hyperactive children as a valuable adjunctive strategy in the overall comprehensive management of ADHD Regarding the effect of training on mental health of mothers of ADHD children, the results of the present study are in agreement with those of the previous ones. Meftagh and colleagues carried out a research on 95 mothers to determine the effectiveness of different treatment methods for children with ADHD on maternal mental health. That study indicated that maternal behavioral training methods and the medications used for these children improved maternal mental health in post-test and follow-up stages Moreover, Parand and colleagues performed a study which aimed to develop a stress management program for mothers of the children with ADHD and determine its effectiveness in their mental health.

The results revealed significant improvement in mental wellbeing of the mothers and diminishing their anxiety and depression The findings of the current study showed a reduction in stress levels in the placebo group immediately and one month after the intervention. The observed reduction might have resulted from participation in the meetings for talking about and expression of feelings. In addition, the loss rate in the placebo group was higher compared to the other two groups since they believed that expressing their feelings would not lead to any improvement.

In the control group, no significant changes were observed regarding mental health and stress, anxiety and depression. This study had some limitations. First of all, the sample size was relatively small because of inclusion of three groups and lack of facilities. Thus, further studies with three groups and larger sample size are required to confirm the results of this study.

Also, the studies are suggested to have follow-up periods of more than 1 month and be repeated over time. The findings of the present study showed the effectiveness of cognitive behavioral stress management intervention in improvement of the mothers' mental health and stress.

Nonetheless, further studies with longer follow-up periods and in the mothers who have more than one ADHD child are suggested to be done in this area. The manuscript has been extracted from the Master dissertation of Ms. Shekufe Zarei Grant No: Also we would like to thank the mothers who took part in this investigation. The authors would like to thank Ms. The authors would like to thank center for development of clinical studies of Namazee Hospital for statistical assistance. National Center for Biotechnology Information , U. Journal List Iran J Pediatr v.

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Published online Jun Author information Article notes Copyright and License information Disclaimer. Received Dec 16; Accepted May This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4. This article has been cited by other articles in PMC. Objectives Therefore, the present study aimed to assess the effect of stress management program using cognitive behavior approach on mental health of the mothers of the children with ADHD.

Results A total of 90 mothers completed the study. Experimental Times a P Value Stress 0. Open in a separate window. Discussion This study was performed using stress management program utilizing cognitive behavioral approach in three experimental, placebo, and control groups. Limitation This study had some limitations. Acknowledgments The manuscript has been extracted from the Master dissertation of Ms. Braz J Med Biol Res. Parent training interventions for attention deficit hyperactivity disorder. Cochrane Database Syst Rev. Diagnostic and Statistical Manual of Mental Disorders.

Sadock B, Sadock V. Lippincott Williams andWillkins; Comparison of parenting stress in mothers of children with attention deficit hyperactivity disorder and mothers of children with normal. Parenting stress among families of children with attention deficit hyperactivity disorder. J Abnorm Child Psychol. Attention-Deficit Hyperactivity Disorder; a handbook for diagnosis and treatment. Comorbid disorders, social and familial adjustment, and subtyping. Parent and Contextual Factors. J Child Fam Stud. Parenting stress and public health: Review of prospective longitudinal studies of children with ADHD: Mental health, educational, and social outcomes.

Curr Atten Disord Rep. J Psychiatr Ass Thailand.