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ADHD symptoms as problematic adaptation factors in elementary school children



Previous studies have shown that students with ADHD symptoms also have more problems in all aspects of adaptation. The aim of the research is to check out which ADHD symptoms predict adaptation problems. The three groups of symptoms were examined (hyperactivity, impulsiveness and inattention) with respect to academic adjustment (school success and academic self-efficacy), social adjustment (number of friends, peer acceptance, social self-efficacy) and emotional adjustment (empathy, emotional competence, emotional self- efficacy). 501 primary school students (average age M= 2.72, SD=1.62) from 4th, 6th and 8th grade participated in the study. The following instruments were used: Hyperactivity-Impulsivity-Attention Scale (HIP ; Vulić-Prtorić, 2006), Selfefficacy questionnaire for children, Croatian version (SEQ-C ; Vulić-Prtorić and Sorić, 2006), Emotional competence questionnaire (UEK-45 ; Takšić, 2002), Emotional empathy scale from E- questionnaire (Raboteg-Šarić, 2002) and students also were asked to estimate the feeling of peer acceptance, how many friends they have and to give information about their school success. Obtained results have shown that inattention was a significant predictor of problems in all aspects of adaptation (academic (β=-0.317 ; β=-0.528 ; p<0.001) social (β=-0.269 ; β=-0.430 ; p<0.001) and emotional adjustment (β=-0.225 ; β=- 0.367 ; p<0.01)), impulsiveness was only significant predictor for one aspect of academic adjustment (academic self-efficacy ; β=-0.187, p<0.01), and hyperactivity for one aspect of emotional adjustment (emotional competence ; β=-0.174, p<0.05). Since inattention has proved to be a dominant problem in all types of student adaptation, experts working with children, especially teachers, should make an effort to increase attention and concentration in all students as prevention strategy for adaptation problems.
Faculty of Education, Osijek
UDK: 373.3.091.212:159.952.6
Izvorni znanstveni rad
Primljeno: 26. 2. 2018.
Previous studies have shown that students with ADHD symptoms
are more likely to have problems in all aspects of adaptation.
The aim of this study is to identify ADHD symptoms that predict
maladjustment in the general population of students. Hyper-
activity, impulsiveness and inattention were examined with res-
pect to academic, social and emotional adjustment. Elementary
school students (average age M= 12.72, SD = 1.62) partici-
pated in the study (N= 501). The instruments used were:
Hyperactivity-Impulsivity-Attention Scale, Croatian version of Self-
-efficacy questionnaire for children, Emotional competence
questionnaire, self-assessment of peer acceptance and school
success. Inattention was a significant predictor of problems
in all aspects of adaptation, i.e. academic (β= -0.317;
β= -0.528; p< 0.001), social (β= -0.269; β= -0.430;
p< 0.001) and emotional adjustment (β= -0.225; β= -0.367;
p< 0.01). Impulsiveness was only a significant predictor of
academic self-efficacy (β= -0.187, p< 0.01), whereas hyper-
activity was only significant for emotional competence
(β= -0.174, p< 0.05). Since inattention proved to be a
dominant problem, it is recommended that experts working with
children make an effort to increase attention and concentration
as a prevention strategy for adaptation problems of all students.
Keywords: hyperactivity, impulsiveness, inattention, academic
adjustment, social adjustment, emotional adjustment
Tena Velki, Josip Juraj Strossmayer University of Osijek, Faculty
of Education, Cara Hadrijana 10, 31 000 Osijek, Croatia.
Numerous previous studies have shown that ADHD children
show adaptation problems, primarily academic, social and
emotional difficulties (Bussing, Mason, Bell, Porter, & Garvan,
2010; Bussing et al., 2012; Defoe, Farrington, & Loeber,
2013; Velki & Dudaš, 2016), which make their everyday func-
tioning at home and school harder. Moreover, recent studies
have shown that children suspected of having ADHD, i.e.
children with more salient symptoms of ADHD but not ex-
ceeding the critical value for diagnosis, also show difficulties
in daily functioning. Thus, studies show that children sus-
pected of having ADHD perform lower in all domains of aca-
demic achievement – reading, writing, mother tongue and
math (August, Ostrander, & Bloomquist, 1992; Bussing et al.,
2010; Hong et al., 2014), have more problems with attention
during formal exams and show significantly poorer results on
tests of executive functions (Brown & Casey, 2016; Hong et al.,
2014), drop out of school higher than average, have more psy-
chosocial problems, problems in peer relations and internal-
ized problems (Norén Selinus et al., 2016), have fewer friends,
make poor-quality friendships and earn negative reputation
among peers (Rielly, Craig, & Parker, 2006). Generally speak-
ing, their social functioning has been shown to be less suc-
cessful with more problems in the domain of emotion control
(Gudjonsson, Sigurdsson, Eyjolfsdottir, Smari, & Young, 2009;
Norvilitis, Sun, & Zhang, 2010), poorer behavioral and emo-
tional control (Hong et al., 2014), lower level of empathy
(Groen, den Heijer, Fuermaier, Althaus, & Tucha, 2017), and,
also, they show more internalized and externalized disorders
(Brown & Casey, 2016; Bussing et al., 2010) and generally
greater comorbidity (Cho et al., 2009).
In the case of school-age children symptoms of inatten-
tion have proved to be crucial in predicting academic failure.
Problems with forgotten homework, inability to concentrate
on school assignments, difficulty in copying from blackboard,
truancy, dropping out of school and poor academic self-effi-
cacy altogether lead to poorer school achievement even
though these students may be of average or above average
intellectual abilities (Barkley, 2000; Pagani et al., 2008; Passolt,
2002; Weyandt & DuPaul, 2008; Young, Heptinstall, Sonuga-
-Barke, Chadwick, & Taylor, 2005).
In addition to the symptoms of inattention, the symptoms
of impulsivity proved to be significant for poorer academic
performance, even at college level (Frazier, Youngstrom, Glut-
ting, & Watkins, 2007). Children with more salient symptoms
of impulsivity, especially when combined with aggressive
behavior, show poorer academic achievement, which is the
result of a common neurobiological background, i.e. deficien-
cy of executive functions, short response times to external stim-
uli and unbalanced emotional functioning (Sjöwall & Tho-
rell, 2014).
In a longitudinal study of ADHD girls, the main risk fac-
tor for poor school success was a combination of symptoms of
hyperactivity and inattention (Young et al., 2005). Addition-
ally, the same group displayed a lower degree of self-confi-
dence in decision-making and planning. Another longitudi-
nal study with children aged 12 to 26 years at follow-up con-
firmed that symptoms of hyperactivity and inattention led to
poorer academic achievement and more frequent drop outs
from further education (Galéra, Melchior, Chastang, Bouvard,
& Fombonne, 2009). Additional research showed that children
with more salient symptoms of hyperactivity and inattention
displayed poorer academic and social functioning and less
developed learning skills (Norvilitis et al., 2010; Norwalk, Nor-
vilitis, & MacLean, 2009), poorly developed academic self-ef-
ficacy, weaker results in cognitive and achievement tasks, and
problems in processing information and with executive func-
tions (DuPaul & Langberg, 2015; Todd et al., 2002).
The symptoms of impulsivity have proved to be particu-
larly challenging for social and emotional functioning of chil-
dren since these are most often associated with violent and
aggressive behavior towards peers (McQuade & Hoza, 2015;
Velki & Romstein, 2016). Children that are more impulsive are
prone to interrupt others in conversations, to a reckless and
ignorant behavior during interaction and, also, a lack of re-
cognition of emotions in others, which results in conflicts dur-
ing interaction; in other words, they show deficits in verbal
behavior and communication skills (Corkum, Corbin, & Pike,
2010). As a consequence of this behavior, their peers tend to
exclude impulsive children from play and social activities,
which increases the risk of development of addiction and
depression in later years (Barkley, 2015; Defoe et al., 2013;
Lachenmeier, 2014). Peers prefer to make friends with chil-
dren who are easier to establish a relationship with, or show
a preference for a relationship in which they need to invest
less energy than when dealing with impulsive friends who
are being unpredictable (Bartolac, 2013).
Numerous studies have pointed at age and gender dif-
ferences in ADHD and indicated the disorder as more com-
mon in boys than in girls (Quinn & Wigal, 2004). However,
the number of people diagnosed with ADHD grows with age
whereas gender differences are reduced (Velki, 2012). The study
GOD. 28 (2019), BR. 3,
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of children suspected of ADHD concluded that age had a me-
diating effect in the connection between symptoms of ADHD
and academic achievement. For self-evaluated hyperactivity,
age had a full mediating role, i.e. as the students' age increased,
there was no correlation between self-evaluated hyperactivi-
ty and academic achievement. In addition, age had a partial-
ly mediating role in the connections between self-evaluated
inattention with academic achievement and academic self-
-efficacy, i.e. as the students' age increases, the correlation
between self-evaluated symptoms of inattention and both aca-
demic self-efficacy and academic achievement, becomes
weaker (Velki & Vrdoljak, 2019). The explanation is found in
the fact that ADHD is the most commonly diagnosed when
children start school where they are faced with increased
developmental tasks. This usually leads to the recognition of
hyperactive boys and the most frequently diagnosed sub-
types of ADHD are the combined subtype or predominantly
hyperactive/impulsive subtype (Moldavsky, Groenewald,
Owen, & Sayal, 2012). The second identification period of
ADHD occurs when students move to upper grades of ele-
mentary school, when school requirements get even more
demanding and complex. The predominantly inattentive sub-
type of ADHD is diagnosed more often at this time as prob-
lems with inattention significantly disrupt the daily function-
ing of the child (Biederman et al., 2002; Cantwell, 1996; Ram-
tekkar, Reiersen, Todorov, & Todd, 2010; Rucklidge, 2010).
This subtype of the disorder is more commonly found in girls
(Gershon, 2002).
Previous research has mostly focused on children and
adults who have been diagnosed with ADHD, not on those
showing only some individual salient symptoms (Balázs &
Keresztény, 2013). Children suspected of having ADHD have
more salient symptoms of the disorder, which may present a
problem for their everyday functioning (Velki & Dudaš, 2016),
and, because they lack a diagnosis, they are not involved in
treatment or prevention programs. Furthermore, numerous
studies have shown that manifestation of a particular ADHD
symptom leads to academic, social and / or emotional diffi-
culties (Frazier et al., 2007; Norvilitis et al., 2010; Norwalk et al.,
2009; Weyandt & DuPaul, 2008; Young et al., 2005), although
findings are not always consistent when it comes to the im-
portance of a particular symptom. Therefore, the purpose of
this study was to find out how particular symptoms that are
not at a critical level for making a diagnosis may pose prob-
lems in adaptation of the general population of elementary
school children not diagnosed with ADHD.
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The aim of the study was to identify self-evaluated ADHD
symptoms that are critical as adaptation challenges in the ge-
neral primary school population of students. Three groups of
self-evaluated symptoms were examined (hyperactivity, im-
pulsivity and inattention) with respect to academic adjust-
ment (operationalized as school success and academic self-ef-
ficacy), social adjustment (operationalized as peer acceptance
and social self-efficacy) and emotional adjustment (operation-
alized as emotional competence and emotional self-efficacy).
As previous studies have established age and gender differ-
ences in ADHD, the variables age and gender were kept under
control when the self-evaluated symptoms of ADHD were
tested in general population.
Following the aim of the study, we established three main
H1: Self-evaluated symptom of inattention, in comparison to
hyperactivity and impulsivity, will be a better predictor
of school maladjustment. Students with higher level of
self-evaluated inattention will have lower school success
and lower academic self-efficacy.
H2: Self-evaluated symptom of impulsivity, in comparison to
hyperactivity and inattention, will be a better predictor
of social maladjustment. Students with higher level of
self-evaluated impulsivity will have lower peer acceptance
and lower social self-efficacy.
H3: Self-evaluated symptom of impulsivity, in comparison to
hyperactivity and inattention, will be a better predictor
of emotional maladjustment. Students with higher level
of self-evaluated impulsivity will have lower emotional
competence and lower emotional self-efficacy.
The study included six elementary schools in the regions of
Slavonia and Baranja. The participants were students in grades
4, 6 and 8. The total pool of students invited to participate in
the study was 896. Parental consent was received for 501 stu-
dents (55.92%). There were 254 male and 247 female students.
The age ranged from 10 to 16 years and the average age was
12.72 years (SD= 1.62). In the study, only the self-assessment
measure of symptoms of ADHD was included, and not the
existence of a medical diagnosis, therefore two children with
ADHD diagnosis were excluded from the analysis). Table 1
shows the distribution of students by gender, age and grade.
Grade Gender f%Average age
4 boys 50 48 M= 10.9
girls 54 52 sd = 0.48
total 104 20.8
6 boys 91 49.2 M= 12.25
girls 94 50.8 sd = 0.46
total 185 36.9
8 boys 112 52.6 M= 14.32
girls 100 47.4 sd = 0.49
total 212 42.3
Total boys 254 50.7 M= 12.72
girls 247 49.3 sd = 1.62
total 501 100.0
Hyperactivity – Impulsivity – Attention Scale
(HIP; Vulić-Prtorić, 2006)
The HIP Scale estimates hyperactive and impulsive behavior
and the difficulty with focused attention. It consists of 19
items divided into three subscales: hyperactivity (6 items), im-
pulsivity (4 items) and inattention (9 items). The items are
statements that describe the most common symptoms of hy-
peractivity, impulsivity, and inattention. The structure of the
HIP Scale was based on a classification system used to mea-
sure deficit attention hyperactivity disorder symptoms and for
the purpose of theoretical interpretation of ADHD sympto-
matology. The task of the participant was to decide on the fre-
quency of behaviors they had experienced in the six-month
period prior to the study. Accordingly, each item was marked
following the 5-point scale: 1 = never, 2 = rarely, 3 = sometimes,
4 = often, 5 = very often. The result was obtained by calcu-
lating the arithmetic mean of selected items. The internal con-
sistency for hyperactivity subscale was Cronbach α= 0.86, for
the impulsivity subscale α= 0.80 and for the inattention sub-
scale α= 0.88.
Emotional Competence Questionnaire
(UEK-45; Takšić, 2002)
The Emotional Competence Questionnaire was used for as-
sessing emotional intelligence as a personality trait. UEK-45 is
a short version of the Emotional Intelligence Questionnaire that
was created based on the Mayer and Salovey theory (1997).
The questionnaire consists of three subscales with a total of 45
items. The subscale 'Ability to observe and understand the
emotion' consists of 15 items (e.g. When I see how someone
feels, I usually know what happened to them.); the subscale
'Ability to express and name emotions' consists of 14 items
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Distribution of students
by gender, age and
(e.g. I can almost always describe my feelings and emotions with
words.); and the subscale 'Skills of emotion control and regu-
lation' consists of 16 items (e.g. Even when people around me
are in a bad mood, I can keep a good mood.). The task of the
participants was to make a subjective judgment on a 5-point
scale (1 = 'not at all' to 5 = 'definitely yes') about how strong-
ly the statement refers to them.
Self-Efficacy Questionnaire for Children
(SEQ-C, Vulić-Prtorić & Sorić, 2006)
Self-Efficacy Questionnaire for Children was designed to measure
children's self-efficacy feelings in three domains: academic,
emotional and social. The questionnaire consists of 24 items
that are divided by efficacy domains. The domain of social
self-efficacy (k = 8) refers to assertiveness and perceived ca-
pacity for relationships with peers, the domain of emotional
self-efficacy (k = 8) refers to the ability to face negative emo-
tions, and academic self-efficacy (k = 8) refers to the perceived
ability for coping with school materials, learning and meeting
school expectations. Instructions for the completion of the
questionnaire are short and very clear, and the task of the par-
ticipants is to estimate on the 5-point Likert scale how the
behavior described in the statement relates to them (from 1
meaning 'not at all' to 5 meaning 'very well').The overall result
is obtained by determining the arithmetic mean of relevant
items. Internal consistency in this study was Cronbach α= 0.84
for the academic self-efficacy subscale, α= 0.80 for the social
self-efficacy subscale and α= 0.79 for the emotional self-effi-
cacy subscale.
Demographic information
The participants in the study provided demographic infor-
mation about themselves: their age, gender and grade, Also,
they provided information on their school success (general suc-
cess at the end of the semi-semester and at the end of the last
school year; grade in mathematics at the end of the semi-se-
mester and at the end of the last school year; grade in Cro-
atian language (mother tongue) at the end of the semi-semester
and at the end of the last school year). Internal reliability of
school success was Cronbach α= 0.79. Furthermore, they gave
data about peer acceptance (2 items on 3-point Likert scale).
After consulting with the schools and getting permission to
use the questionnaires, consents from parents were collected.
All children who returned a signed parental consent agreed
to take part in the research voluntarily. The data collection
procedure was conducted in groups and lasted for about 45
GOD. 28 (2019), BR. 3,
STR. 503-522
minutes. It was clearly stated that the participation was ano-
nymous and that there were no (in)correct answers. The import-
ance of providing sincere answers when completing the ques-
tionnaire was emphasized. At the beginning of each ques-
tionnaire, detailed instructions were given to the participants.
If during the data collection procedure it turned out that the
question was somewhat unclear, the researcher provided
additional explanation individually. The participants were al-
lowed to resign from completion of the questionnaires at any
time, but no such cases were recorded.
Data analysis started with examinations related to the de-
scriptive statistics for the variables included in the study (Table
2). The testing of normality of distribution of major research
variables showed no significant deviation from the normal
distribution. Asymmetric indexes did not exceed values greater
than +/- 2.00 and parametric statistics was applied.
Variables N Min Max M SD Skewness Kurtosis
Hyperactivity 501 1.00 5.00 2.28 1.02 0.737 -0.282
Impulsivity 500 1.00 5.00 2.15 0.95 0.851 0.064
Inattention 500 1.00 4.78 2.14 0.89 0.657 -0.462
School success 501 1.67 5.00 4.09 0.80 -0.582 -0.578
Academic self-efficacy 501 1.00 5.00 3.57 0.83 -0.388 -0.046
Peer acceptance 501 1.00 3.00 2.62 0.50 -1.217 0.812
Social self-efficacy 501 1.00 5.00 3.74 0.74 -0.601 0.467
Emotional competence 501 1.76 5.00 3.74 0.54 -0.439 0.463
Emotional self-efficacy 501 1.00 5.00 3.38 0.83 -0.196 -0.311
The possibility of generalization from the data obtained
was examined prior to the main analysis. The prevalence of
children with self-evaluated symptoms of ADHD was exam-
ined. A student was identified as suspected of having ADHD
if his/her self-assessment included four or more of the de-
scribed behaviors (the participant marked four or more items)
which occurred to him/her "often" (represented by '4' on the
scale) or "very often" (represented by '5' on the scale). Accord-
ing to this milder criterion of determination of ADHD sus-
ceptibility (Biedermann, Petty, Evans, Small, & Faraone, 2010;
Fergusson, Boden, & Horwood, 2010), 24.6% of the participants
were identified as suspected of having ADHD. Comparison
of this finding with the existing studies showed that the pre-
valence of ADHD susceptibility ranges from 0.8% to 23.1%
depending on the methodology used (Balázs & Keresztény,
2013). This led us to the conclusion that the sample of chil-
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Descriptive statistics
for measured
dren suspected of having ADHD in this study is representa-
tive of the general population of elementary school children
aged 10-16.
There were no statistically significant age (grade) differ-
ences in self-evaluated ADHD symptoms (hyperactivity
F(2,499) = 0.78, p> 0.01; impulsivity F(2,499) = 3.34, p> 0.01;
inattention F(2,499) = 1.74, p> 0.01). On average, all students
have shown rare self-evaluated symptoms, which is expected
because the study included a general population sample (with-
out ADHD diagnosis), not a clinical one.
Since requirements for regression analysis were met, the
data were analyzed using hierarchical regression analysis. In
step 1, age and gender variables were kept under control, while
ADHD symptoms were introduced as predictors of adapta-
tion difficulties in step 2. Six identical regression analyses were
performed, and only the criteria of adjustment were changed.
Inattention proved to be a significant predictor of all of
the measured adaptation difficulties, impulsivity showed to
be significant only for the prediction of difficulties in acade-
mic self-efficacy, and hyperactivity for the prediction of emo-
tional competence problems. By testing the difference in the
predictor significance (βcoefficients), it was found that inat-
tention was a statistically more significant predictor of aca-
demic self-efficacy than impulsivity (t(996) = 3.95, p< 0.001),
and that inattention was a statistically more significant predictor
of emotional competence than hyperactivity (t(996) = 2.95,
p< 0.001). As the variables of age and gender were kept under
control, ADHD symptoms (hyperactivity, impulsivity and
inattention) as predictors of difficulties in students' adapta-
tion were tested for the effect size. However, the effect size for
social and emotional adjustment is almost insignificant, where-
as a slight to moderate effect size was found for academic
adjustment (Cohen's f2= 0.02 – 0.07; Kolesarić & Tomašić
Humer, 2017).
Average self-evaluated
symptoms of ADHD by
Criteria Academic adjustment Social adjustment Emotional adjustment
School Academic Peer Social Emotional Emotional
success self-efficacy acceptance self-efficacy competence self-efficacy
Predictors ββ β β β β
Age -0.306** -0.168** 0.060 0.016 0.038 -0.055
Gender -0.203** -0.011 0.083 -0.022 -0.012 0.121**
Regression model
R0.372 0.168 0.103 0.027 0.039 0.133
R20.139 0.028 0.011 0.001 0.002 0.018
R2cor 0.135 0.024 0.007 0.000 0.000 0.014
F(2,498) 39.36 7.05 2.66 0.17 0.38 4.32
p< 0.001 < 0.001 > 0.05 > 0.05 > 0.05 < 0.05
Age -0.283** -0.129** 0.076 0.046 0.071 -0.034
Gender -0.186** 0.019 0.094* 0.001 0.015 0.139**
Hyperactivity 0.116 -0.095 0.026 0.155 -0.174* -0.115
Impulsivity 0.038 -0.187** 0.102 0.084 -0.013 0.063
Inattention -0.317** -0.528** -0.269** -0.430** -0.367** -0.225**
Regression model (final solution)
R0.426 0.511 0.214 0.268 0.254 0.309
R20.182 0.261 0.046 0.072 0.065 0.096
CI 0.131-0.232 0.206-0.316 0.016-0.075 0.035-0.108 0.030-0.099 0.055-0.136
R2cor 0.173 0.253 0.036 0.062 0.055 0.086
F(5,495) 21.60 33.85 4.72 7.43 6.78 10.15
p< 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
Cohen's f20.02 0.07 0.002 0.005 0.004 0.008
** p< 0.01; * p< 0.05
Treating age and gender as control variables, the symp-
toms of ADHD (R2) explained the following percentages of
the variance of student adjustment: 23.7 % of the variance in
academic self-efficacy (inattention and impulsivity), 8.2% of
the variance in emotional self-efficacy (inattention), 7.1% of
the variance in social self-efficacy (inattention), 6.5% of the
variance in emotional competence (inattention and hyperac-
tivity), 4.3% of the variance in school success (inattention),
and 3.5% of the variance in peer acceptance (inattention).
In line with the study aim, distinctive ADHD symptoms were
examined in order to determine best predictors of maladjust-
ment in the general population of elementary school chil-
dren. Inattention proved to be the best predictor for all three
types of maladjustment, that is, problems of academic, social
and emotional adjustment. In accordance with the first hy-
pothesis, inattention proved to be the best predictor of school
maladjustment. Students with more salient inattention esti-
Hierarchical regression
analysis results
mated lower academic self-efficacy and poorer school success,
which is consistent with previous research that pointed out in-
attention as the key factor affecting academic failure (Barkley,
2000; Pagani et al., 2008; Passolt, 2002; Weyandt & DuPaul,
2008; Young et al., 2005). The students with attention problems
report that they are unable to follow a lecture and copy from
the blackboard, their thoughts are often disrupted and wan-
der off, they tend to give up even before they begin working
on more complex tasks and perceive themselves as less com-
petent academically (Bussing et al., 2012; Galéra et al., 2009;
Velki, 2012). The combination of inattention and impulsivity
explains most of the variance in academic self-efficacy, as much
as 23.7%, i.e. it is the next significant predictor, which is con-
sistent with some previous studies (Frazier et al., 2007). Further-
more, the students with inattention symptoms and more pro-
nounced symptoms of impulsivity have, generally speaking,
more problems in school, especially so if they are more in-
clined toward aggressive behavior. Studies show that the com-
bination of inattention and impulsivity, which leads to poor
academic success, is actually a consequence of the same neu-
robiological basis, i.e. difficulty in executive functions, short
response time and emotional instability (Sjöwall & Thorell, 2014),
thus providing an explanation for poorer academic self-effi-
cacy, which this combination of symptoms leads to. Along with
learning difficulties, these students have significant problems
in meeting school expectations. By examining the variance ex-
plained (4.3% – 23.7%) and the effect size (Cohen's f2= 0.02 – 0.07)
more closely, it can be concluded that inattention had the great-
est influence on academic maladjustment, which is not sur-
prising given that inattention has proved to be the major risk
factor for poorer school success and lower level of academic
Contrary to the expected, the symptom of inattention was
a statistically significant predictor of emotional maladjustment.
It is interesting to note that inattention alone explained 8.2%
of the variance in emotional self-efficacy, whereas in combi-
nation with hyperactivity, it explained only 6.5% of the vari-
ance in emotional competence. However, the effect size for
both aspects of emotional adjustment was very small. Emo-
tional competence refers to the ability to recognize, regulate,
and respond to emotionally charged situations. Children who
struggle with paying attention have difficulties in recogniz-
ing emotions in others, problems with reading facial expres-
sion and correct emotional coding, less emotional control as
well as problems with focusing on peers during a conversa-
tion (Hong et al., 2014; Kristensen et al., 2014; Sjöwall & Tho-
rell, 2014), all of which lead to additional difficulties in emo-
tional and social functioning. Problems with concentration
GOD. 28 (2019), BR. 3,
STR. 503-522
and focusing on their own emotions as well as with recogniz-
ing emotions in others lead to a reduced ability to face nega-
tive emotions or problems in regulating their negative emo-
tions (Treuting & Hinshaw, 2001). Emotional self-regulation
problems are an additional indicator of poor emotional self- ef-
ficacy (Hampel, Manhal, Roos, & Desman, 2008), which makes
it difficult for these children to manage relationships with their
peers as well as other close persons in their everyday life.
Based on previous studies (Barkley, 2015; Bartolac, 2013;
Defoe et al., 2013; Lachenmeier, 2014) it has been expected
that impulsivity would play an important role in predicting
social maladjustment, i.e. problems in relationships with peers.
However, inattention turned out to be the only significant
predictor of problems in social adjustment. Still, it should be
taken into account that the effect size in this case was almost
insignificant. As previous studies have shown (McQuade &
Hoza, 2015; Velki & Romstein, 2016), a possible explanation
for this finding is that symptoms of impulsivity are significant
in predicting aggressive behavior or peer violence, which was
not included in the scope of the present study. Problems with
following the rules, listening to conversations and engaging
in group activities that significantly disturb peer relationships
are actually a reflection of symptoms of inattention. Neverthe-
less, the difficulties perceived in social self-efficacy are only
explained by inattention in small portion (7.1%). Although
they are not always aware of their own negative social status
(Diener & Milich, 1997), this awareness can develop due to a
high risk of constant negative peer feedback: the problems of
this group of children related to maintaining interest during
joint activities, their increased risk to disrupt or interrupt their
peers, and their inability to concentrate on play and conver-
sation with peers for a continued period of time lead to the
expression of dissatisfaction by their peers. Consequently, their
level of social self-efficacy can decrease, i.e. they become aware
of the difficulties in establishing and maintaining their peer
relationships, which is a very important developmental task
during puberty. Furthermore, inattention explained only a small
percentage of the variance in peer acceptance (3.5%), which is
almost insignificant. A possible explanation can be found in
the existence of negative balance in peer relations, i.e. inatten-
tive children choose peers and like them more often than their
peers who, at the same time, choose them rarely and dislike this
particular group of children (Mrug et al., 2009).
The findings of this study point to the fact that a certain
proportion of children, without a diagnosed disorder, report-
ed having inattention problems, and therefore having diffi-
culties in everyday functioning. In other words, they mostly
have problems in academic, and in some smaller portion in
GOD. 28 (2019), BR. 3,
STR. 503-522
social and emotional adaptation. Subjective experience of the
child's difficulties plays an important role in his/her adapta-
tion. Although children in the general population with more
salient inattention had emerged in this study as children with
the most difficulties in academic adjustment, the social and
emotional functioning of these children was disrupted as well.
Since the study includes the general population of children,
and not those diagnosed with ADHD, prevention should be-
come a part of formal education. A reduced feeling of self-ef-
ficacy, the result of more salient self-evaluated symptoms of
ADHD, has a negative impact on child development. As an
educational institution, the school needs to attend to these
problems: it needs to deal with not only academic difficulties
children may have but also with socio-emotional issues that
may be more important for the student's adaptive function-
ing since they can mediate academic difficulties too. Working
on issues of inattention, increasing concentration, and atten-
tion focus on key aspects in both academic work and relations
with peers, where these problems affect socio-emotional ad-
aptation, will greatly help students in further development
and work. These findings should be implemented in school
prevention programs, especially because of the long-lasting
effect on academic life and personal life of students. In accor-
dance with some previous studies, the main problems with
inattention persist throughout the students' education. In
high school and college, attention deficit has the most nega-
tive influence on academic and social functioning and on
learning habits and learning skills (Norvilitis et al., 2010;
Norwalk et al., 2009; Pagani et al., 2008). For students with
particularly prevalent problems with inattention symptoms,
it was possible to predict academic problems even at the end
of the first year of study (Frazier et al., 2007). In order to pre-
vent these negative influences of attention deficits, primary
schools should incorporate in their curriculum everyday ac-
tivities, i.e. organize class and activities in a way that all stu-
dents could benefit from. First of all, teachers should have
proper education about the symptoms and consequences of
attention deficit while at university. This is important not just
for recognizing the symptoms of inattention, but to learn how
to prevent inattention of students in the classroom. Future
teachers should learn during their studies how to provide a
diversity of activities that would engage different children
(for example using different types of games during regular
classes so that all students could benefit) or how to teach self-
-control of impulses to children (for example, waiting in line
for lunch during break or waiting to be picked to play). Sec-
ondly, proper class organization, without unnecessary dis-
tractions and which enables constant supervision of teachers,
GOD. 28 (2019), BR. 3,
STR. 503-522
could benefit all students. Each student is an individual with
different needs, and only inclusive education can help all stu-
dents use their full potential. For example, some students
react better to visual stimulants (like pictures with classroom
rules) and others to verbal instruction (like students' repeti-
tion out loud of the assignment given by the teacher). Ad-
ditionally, it is important that teachers clearly communicate
classroom rules and behavioral expectations to all students.
Classroom routine helps all children prepare for upcoming
tasks, gives them structure and helps them to develop plan-
ning strategies. Furthermore, educational technology in the
classroom could help with attention problems. All children
generally respond very well to new technologies, which re-
quire a certain degree of attention and concentration but in
an interesting and acceptable way. New technologies, such as
computers, tablets and smartphones, give them immediate
feedback on the task which has great positive impact on their
work. Using educational games, creating cognitive maps in
special applications, writing tasks, and seeking additional in-
formation through modern technologies (which, in contrast
to classical literature, provides video and audio information)
can be an extremely useful tool in day-to-day work with all
children. There are creative and well-designed computer games,
which have characteristics that may help in the development
of certain skills of the child (for example, Tetris is an excep-
tionally good game for the development of logical thinking,
visual representation, and depending on the type of 2D or 3D
rotation, spatial abilities and concentration). Teachers need to
clearly define what type of information or teaching material
they want their students to master, and then ensure that an
adequate application or computer game is used by students
for learning and not only for fun during class (Velki, 2018).
Methodological limitations of the research carried out
should be taken into account in the interpretation of results.
Data pertaining to the variables were gathered solely through
student self-assessment. A subjective assessment of difficul-
ties and problems a child experiences is extremely important
because as the child becomes aware of problems with adap-
tation, regardless of a more objective assessment of the envi-
ronment, it is necessary to work with the child on the prob-
lems detected. However, the importance of self-estimated
symptoms and difficulties for overall adjustment is question-
able. It would be interesting to examine levels of agreement
between students' assessments of symptoms and different as-
pects of adjustment with assessments of their teachers or peers.
Additionally, the study was conducted on a general elemen-
tary school-age population, excluding those diagnosed with
ADHD. Since the aim of the research was to identify difficul-
GOD. 28 (2019), BR. 3,
STR. 503-522
ties that some ADHD symptoms may cause in the general pop-
ulation of students at elementary level, it would be interest-
ing to compare the findings with those about the contribution
of ADHD symptoms in students with an official diagnosis to
difficulties in adapting to the school environment. Further-
more, the response rate of the study's participants was only
55.92%, which allows for the possibility that there are students
with more problems and difficulties who did not participate
in the study due to a missing parental consent. In the future,
a greater response rate of participants and a wider age range
would be beneficial. Also, students with an ADHD diagnosis
should be included in order to compare contributions of par-
ticular ADHD symptoms on all adaptation measures for both
groups of students, those with and without an ADHD diag-
Attention difficulties have been detected as a major problem
in all aspects of student adaptation at elementary-school level.
Academic adjustment of students is mostly hindered by inat-
tention which, in addition, creates problems in social and
emotional adjustment. The students without an ADHD diag-
nosis or attention deficit who reported more inattention diffi-
culties are at risk for developing a number of difficulties in
their everyday functioning. As an educational institution, the
school has a key role in preventing the problem of students'
adaptation and it is crucial that addressing these issues should
start at the very beginning of formal education.
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Samoprocijenjeni simptomi ADHD-a
kao rizični čimbenici prilagodbe
u osnovnoj školi
Fakultet za odgojne i obrazovne znanosti, Osijek
Prijašnja su istraživanja pokazala kako učenici koji pokazuju
simptome ADHD-a ujedno imaju i više problema u svim
aspektima prilagodbe. Cilj je istraživanja provjeriti koji
simptomi ADHD-a predviđaju probleme u prilagodbi opće
populacije učenika. Hiperaktivnost, impulzivnost i nepažanja
ispitane su u odnosu na akademsku, socijalnu i emocionalnu
prilagodbu. U istraživanju je sudjelovao 501 učenik (prosječ-
ne dobi M= 12,72, SD= 1,62). Uzeti su u obzir sljedeći
instrumenti: Skala hiperaktivnosti-impulzivnosti-pažnje,
Upitnik emocionalne kompetentnosti, Upitnik samoefikasno-
sti te samoprocjena osjećaja vršnjačke prihvaćenosti i školski
uspjeh. Nepažnja se pokazala kao značajan prediktor proble-
ma u svim aspektima prilagodbe (akademskoj (β= -0,317;
β= -0,528; p< 0,001), socijalnoj (β= -0,269; β= -0,430;
p< 0,001) i emocionalnoj prilagodbi (β= -0,225;
β= -0,367; p< 0,01)), impulzivnost samo u akademskoj
samoefikasnosti (β= -0,187, p< 0,01), a hiperaktivnost
samo u emocionalnoj kompetentnosti (β= -0,174, p< 0,05).
Budući da se nepažnja pokazala kao dominantan problem,
stručnjaci koji rade s djecom trebaju raditi na jačanju pažnje
i koncentracije kod svih učenika kao na prevenciji za
probleme u prilagodbi.
Ključne riječi: hiperaktivnost, impulzivnost, nepažnja,
akademska prilagodba, socijalna prilagodba, emocionalna
GOD. 28 (2019), BR. 3,
STR. 503-522
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Full-text available
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Studies in children with ADHD suggest impairments in social cognitive functions, whereas studies in adults with ADHD are scarce and inconclusive. The aim of this study was to investigate the relationship between ADHD traits and self-reported social cognitive style in a sample of adults from the general population. For this purpose, a community sample of 685 adults filled out online self-report questionnaires about ADHD symptoms (ADHD Rating Scale, ARS), social cognitive functioning and friendships. The Empathy Quotient (EQ) with the subscales Cognitive Empathy (CE), Emotional Empathy (EE) and Social Skills (SS), and the Systemizing Quotient (SQ) were included for measuring social cognitive style and the Friendship Questionnaire (FQ) for the quality of friendships. Participants who met the DSM-5 criteria on the ARS (‘subclinical ADHD’; n = 56) were compared regarding their social cognitive functioning scores with a control group (n = 56) that was matched for age, sex and student status. With small effect sizes, the subclinical ADHD group showed reduced EE scores on the EQ and a more male social cognitive profile. This result was not influenced by sex or ADHD subtype. This study points to a relationship between traits of ADHD and the emotional aspect of empathy, whereas more complex aspects of empathy were unrelated. These findings should be corroborated in clinical patients with ADHD, employing neuropsychological tests rather than self-report questionnaires.
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Sažetak: Brojna istraživanja potvrdila su povezanost ADHD-a s vršnjačkim nasiljem i agresivnim ponašanjem. Cilj istraživanja bio je provjeriti povezanost različitih samoprocijenjenih simptoma ADHD-a (hiperaktivnost, impulzivnost i nepažnja) s različitim aspektima vršnjačkog nasilja (tjelesno, verbalno i elektroničko) i agresivnim ponašanjem (reaktivna i proaktivna agresija). U istraživanju je sudjelovao 501 učenik 4., 6. i 8. razreda, 50,7% dječaka i 49,3% djevojčica prosječne dobi M=12,72 (sd=1,62). Učenici su tijekom jednog školskog sata ispunili Upitnik o nasilju među školskom djecom (Velki i Kuterovac Jagodić, 2012), Upitnik reaktivno-proaktivne agresije (RPQ; Raine i sur., 2006) i Skalu hiperaktivnosti-impulzivnosti-pažnje (Vulić-Prtorić, 2006). Provedena je korelacijska analiza (Pearsonov koefi cijent korelacije), a značajnost razlika u korelacijama testirana je Fisherovim z testom. Dobivene su statističke značajne povezanosti sve tri mjere vršnjačkog nasilja, verbalno, tjelesno i elektroničko sa sve tri skupine simptoma ADHD-a, impulzivnost, hiperaktivnost, nepažnja (r=0,151-0,411, p<0,01), kao i povezanost svih simptoma ADHD-a s reaktivnom i proaktivnom agresijom (r=0,318-0,486, p<0,01). Razlike u značajnosti korelacija ovisno o simptomu ADHD-a dobivene su za povezanosti s verbalnim vršnjačkim nasiljem i proaktivnom agresijom, gdje je dobivena jača povezanost impulzivnosti i verbalnog vršnjačkog nasilja u odnosu na povezanost s hiperaktivnosti (z=2,20, p<0,05) i u odnosu na povezanost s nepažnjom (z=1,95, p<0,05) te jača povezanost impulzivnosti i proaktivne agresije u odnosu na povezanost s hiperaktivnosti (z=2,42, p<0,05) i u odnosu na povezanost s nepažnjom (z=2,63, p<0,01). Razlike u povezanosti vršnjačkog nasilja i agresivnog ponašanja sa simptomima nepažnje i hiperaktivnosti nije bilo. Rezultati su potvrdili prijašnje nalaze koji govori u prilog o povezanosti ADHD-a s vršnjačkim nasiljem i agresivnim ponašanjem, a posebice da je ta povezanost jača kada se radi o impulzivnosti. Iz navedenog možemo zaključiti da simptomi impulzivnosti predstavljaju rizik za razvoj vršnjačkog nasilja i agresivnog ponašanja, te da bi bilo dobro djecu koja pokazuju simptome impulzivnosti uključiti u prevencijske programe za sprječavanje razvoja vršnjačkog nasilja i agresije. Ključne riječi: agresivnost, vršnjačka interakcija, vršnjačko nasilje, hiperaktivnost, impulzivnost, nepažnja
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The basic goal of this study was to determine if there is a difference between children who, according to their selfevaluation meet the criteria for the diagnosis of one of the three types of attention deficit/hyperactivity disorder (ADHD; predominantly hyperactive-impulsive type, predominantly inattentive type, combined type), and those who are, according to their self-evaluation, suspected of having ADHD (who have 4 or 5 symptoms of ADHD) considering the level and the type of peer violence (verbal, physical, electronic), aggression (proactive, reactive) and peer victimisation (verbal, physical, electronic) in regard to children who do not think that they have ADHD symptoms. The participants were 501 pupils (50.7% boys and 49.3% girls) of fourth, sixth and eighth grades from six elementary schools. Age ranged from 10-16 years and mean age of the pupils was 12.72 years (sd=1.62). The children completed the Reactive-Proactive Aggression Questionnaire (RPQ; Raine et al., 2006.), the Peer Violence Among School Children Questionnaire (UNŠD; Velki, 2012.) and the Hyperactivity-Impulsivity-Attention Scale (HIP; Vulić-Prtorić, 2006.). It has been established that children who, according to their self-evaluation, meet criteria of the disorder and children suspected of developing the disorder exhibit higher levels of aggression and peer violence in regard to children who feel that they do not have symptoms of ADHD, but such children are also victims of peer violence among children. Higher levels of violence and aggression were found in children with combined type and predominantly hyperactive-impulsive type of ADHD. It can be concluded that symptoms of hyperactivity and impulsivity pose a bigger issue for a child than symptoms of inattention, especially when it comes to peer violence and aggressive behaviour among children.
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Objective: To examine the association between different levels of childhood attention deficit hyperactivity disorder (ADHD) symptoms and sex differences in psychosocial outcomes during adolescence. Method: Swedish children (n = 4635) were screened for neuropsychiatric symptoms at age 9 or 12. ADHD symptoms were divided into three levels: screen-negative, screen-intermediate, and screen-positive. At follow-up (age 15), parents and teenagers filled out questionnaires regarding (i) hyperactivity/inattention, (ii) peer problems, (iii) school problems, (iv) internalizing problems, (v) antisocial behaviour, (vi) alcohol misuse, and (vii) drug misuse. All outcomes were controlled for symptoms of diagnostic categories other than ADHD. Results: Increasing levels of ADHD symptoms in childhood were associated with higher proportions of adolescents who displayed negative psychosocial outcomes. More girls than boys reported internalizing problems (all levels) and risky drug use (screen-intermediate and screen-positive only). More boys reported antisocial behaviour at the screen-negative and screen-intermediate levels, but at the screen-positive level, similar proportions of girls and boys displayed antisocial behaviour. Conclusion: The findings support the view that ADHD symptoms, as well as their negative outcomes, are dimensionally distributed in the population and that adolescent girls and boys display different risk profiles. The findings confirm that ADHD symptoms are associated with higher risk of drug misuse in girls.
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This study investigated whether problem behaviors, typically associated with a clinical diagnosis of ADHD, would also be associated with subclinical ADHD symptoms within a non-clinical college sample. These are symptoms characteristic of ADHD, which are insufficient to warrant a DSM-IV diagnosis of ADHD. Self-ratings of behaviors known to be comorbid with ADHD (Oppositional-Defiant Disorder (ODD) behaviors, risk-taking, and Executive-Functioning (EF) problems) were examined as predictors of self-ratings of ADHD symptoms. Measures of ODD symptoms, risk-taking, and EF behavioral problems (related to poor management of time) significantly predicted ADHD symptoms, as measured by Barkley’s ADHD Combined Subscale. These predictors accounted for 26% of the variance. The same measures predicted symptoms of ADHD, Inattentive type, as measured by Barkley’s Inattentiveness (IA) Subscale, and accounted for 30% of the variance. For the Hyperactivity-Impulsivity Subscale (HI), the ODD measure significantly entered the equation, while the other two measures were borderline significant, accounting altogether for 10% of the variance. As hypothesized, the EF measure was the strongest predictor for IA, and the ODD measure was the strongest predictor for HI. In conclusion, problem behaviors comorbid with a formal clinical ADHD diagnosis were found to be significantly associated with subclinical ADHD symptoms within a non-clinical sample of college students, as indicated by the substantial proportion of the variance they accounted for in predicting the Barkley’s’ Combined and Inattentiveness Subscales, and to a lessor extent for the Hyperactivity/Impulsivity Subscale. This indicates that college students with ADHD symptoms may have substantial problems not only with their ADHD symptoms, but also with executive functioning and externalizing behaviors associated with these symptoms.
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The present study examined the association between trait emotional intelligence (TEI) and ADHD symptomatology in samples of 1388 adolescents (ages 14–17 years) and 3313 young adults (ages 18–24 years). Consistent with the notion that difficulties in emotion processing and affect regulation are important features of ADHD, TEI was found to be a moderate to strong predictor in both samples. The TEI dimensions of stress management and adaptability uniquely predicted both hyperactivity–impulsive and inattentive symptomatology for both samples. Implications are discussed in terms of the usefulness of the TEI framework for enhancing understanding of the socio-emotional difficulties associated with ADHD symptoms and for informing interventions and coping strategies.
Problems with self-esteem have proven to be a frequent and central issue for patients with ADHD. The responsible pathogenic mechanisms of ADHD are significantly different from other phenomenologically similar forms of affected self-esteem e.g. classic narcissistic disturbances. The takeover of external judgements and psychodynamic developments are involved as well as specific forms of seemingly logical but false conclusions by the ADHD-patient himself in respect to his worth. Furthermore, the nature and significance of negative hyper-focusing are discussed, including new conceptualisations from a clinical point of view. A number of specific ADHD-mechanisms were detected by integrating neurobiological factors and clinical observations. They are presented in combination with an adaptive model of ADHD, that contributes to the clinical understanding of ADHD-specific problems with self-esteem. Finally, corresponding general conclusions for the treatment of patients with ADHD are drawn.
Background This study investigates the ability of primary school teachers to recognise Attention Deficit/Hyperactivity Disorder (ADHD), and the impact of subtype and child gender on recognition and proposed management. Method Primary school teachers read one of four types of vignette describing the behaviour of a 9-year-old child: either a boy or a girl with inattentive or combined subtype of ADHD. Teachers were asked about their conceptualisation of the child's difficulties and their thoughts about need for specialist referral and other interventions. ResultsOf 496 teachers, 99% identified the presence of a problem. Subtype (combined) of ADHD influenced teachers’ recognition of ADHD and agreement that medication might be helpful. Only 13% of teachers thought that medication might be helpful. Conclusions Results suggest a need for better teacher awareness about inattentive subtype of ADHD.