The Well-Being in the Children and Adolescents with ADHD: Possible Influencing Factors and How to Improve It

Abstract

In recent years, academics have increasingly emphasized the importance of research into the well-being of children and adolescents. This is because well-being plays an important role in the development of children and adolescents. The literature reports that high levels of well-being facilitate positive functioning in children and adolescents. They contribute to the overall development of the individual and are a key factor in helping children and adolescents to integrate into society. ADHD, the most prevalent neurodevelopmental disorder, affects more than 5% of children and adolescents, and the distress caused by its symptom can seriously undermine the well-being of children and adolescents. Therefore, this chapter discusses this noticeable issue focusing on the following key parts: An understanding of the well-being in children and adolescents, the factors that affect the well-being of children and adolescents with ADHD, and how to improve the well-being of children and adolescents with ADHD.

1. Introduction

Children and adolescents are the future of every country, and their physical and even psychological health is a place where every country attaches great importance. In recent years, scholars around the world have done a lot of research on the mental health of children and adolescents, and they have found that well-being plays an important role in the healthy psychological process of children and adolescents, which can not only help individuals better integrate into society, but also lay a good foundation for the further development of individuals. In the process of studying the mental health of children and adolescents, a large number of scholars have found that mental illness has a huge impact on individual well-being, of which ADHD is one of several common childhood psychiatric disorders.

ADHD is the most common neurodevelopmental disorder, affecting more than 5% of children and adolescents in the world, and the pain caused by its symptoms can seriously damage the well-being of children and adolescents, which in turn affects the process of their integration into society and the process of self-development [1]. This chapter focuses on the following points: sources of well-being in children and adolescents, factors that affect the well-being of individuals with ADHD in children and adolescents, and how to improve the well-being of individuals with ADHD.

2. What is well-being?

Well-being is the experience of health, happiness, and prosperity. It includes having good mental health, high life satisfaction, a sense of meaning or purpose, and the ability to manage stress. More generally, well-being is just feeling well.

Well-being is something sought by just about everyone because it includes so many positive things—feeling happy, healthy, socially connected, and purposeful. Unfortunately, well-being appears to be in decline in ADHD children. Children with ADHD have a marked decrease in happiness, and this status quo in turn affects the symptoms of ADHD [2].

3. Sources of well-being for children and adolescents

Well-being is the best state that a whole individual can present, we often link people’s mood, such as happiness and healthy, with well-being, for children and adolescents, the source of well-being is also relatively simple: 1. school, 2. family. Among them, the school can also be divided into several major blocks: peer relationship, teacher-student relationship, and learning ability. The family aspect is simpler: the degree of harmony of the family. Next, I will analyze them one by one:

1. Peer relationships: In childhood and adolescence, in both Eastern and Western countries, peer relationships are an important part of the individual’s social function, even beyond family relations. In China, in addition to sleep time, a child’s time is about 14 hours, of which the time spent with parents or siblings is generally no more than 6 hours, and half of these 6 hours may be busy, and the time to actually sit down and chat maybe even less. In Western countries, children also communicate more with their peers and with their parents as they grow up, so peer relationships are destined to be an important part of the social function of the individual during this period [3]. The well-being index brought about by good peer relationships is very high, and can even help individuals counteract negative energy from other aspects. For a simple example, the most common problem of individuals in adolescence is rebellion, so most individuals will have discord in family relations, and the peer relationship at this time will play a great role in regulating and helping individuals get out of the haze, at this time, the discord of family relations will have a minimal impact on the social function of individuals, at least in school, there will be no great fluctuations, but on the contrary, peer relationship discord will have the most direct impact on various social functions in school life.

2. Teacher-student relationship: The teacher-student relationship is a dynamic system consisting of different levels of relationships between teaching, psychology, individual, and ethics. Scholars have both macro and micro perspectives on the definition of the teacher-student relationship, under the macro perspective, the teacher-student relationship has two attributes social relationship and natural relationship, and in its social relationship attribute, the teacher-student relationship is a dynamic system composed of different social subsystems. From a micro perspective, the teacher-student relationship is regarded as an educational relationship in school educational activities [4]. The teacher-student relationship also has an indispensable role in the development of children and adolescents, and a good teacher-student relationship brings not only progress in learning to individuals, but also a sense of security, and the basis of well-being is safety. Only in a safe environment can individuals further discover the beauty of social interaction and will have a sense of well-being. In addition, the teacher is also the “guardian” of the student’s mental health, usually, the first to find that the student has psychological problems is the peer or teacher, and the real can help solve the problem is usually the teacher, because for the individual, although the peer can talk about everything, the ability to solve the problem is limited, the family has the ability to solve the problem, but some things of the individual are not willing to share with the family, and the teacher is such an intermediate role, can be trusted, but also has the ability to solve the problem.

3. Learning ability: Children and adolescents inevitably need to face the problem of learning ability, even in Western countries, this aspect is also very important. Naturally, individuals will have more or less problems in this regard during this period, such as declining grades and not keeping up with the average level of the class, then the individual’s emotions will inevitably be affected, and the accumulation of negative emotions will cause a decline in well-being, and further aggravate the learning problem, resulting in a vicious circle. On the contrary, individuals with better grades will be recognized by the teacher’s family and classmates, on the one hand, they will get spiritual rewards, on the other hand, they will also urge themselves to continue to cheer, form a good cycle, and enhance well-being.

4. Family relations: Family relationship is the most important relationship in the family, parents’ occupation, education level, parenting style of children and parents’ own awareness, etc., are directly in this relationship on the child’s future physical and mental development has an important impact, is the core factor in children’s growth. Some studies have pointed out that the construction of parent-child relationships from the perspective of positive psychology requires democratic equality in family parenting methods, sincere and fraternal communication between family members, harmonious nature in the field of family education, and pluralistic wisdom of family education methods [5]. During childhood and adolescence, the love and help that an individual receives at home is a source of well-being, and good family relationships play an integral role in the growth of individuals [6]. There is a clear difference between a child who comes out of a harmonious family and a child who comes out of a chaotic family, and the probability of suffering from mental illness is also different. For children and adolescents, a good family relationship will make children have a strong foundation, will not be humble when getting along with people, and will better integrate into society. On the contrary, the more chaotic family relationships will lead to problems with the child’s personality, either too cowardly or too grumpy, and the defects of the character will cause damage to the individual’s social function in the future.

4. Factors influencing the well-being of individuals with ADHD in children and adolescents

At present, after experiencing COVID-19 worldwide, the psychological disorders of children and adolescents are gradually increasing, and the well-being index is gradually decreasing [7]. It can be seen that mental health diseases have a significant impact on well-being. And there is such a group of children who have been plagued by diseases - attention deficit and hyperactivity disorder (hereinafter referred to as ADHD).

ADHD is a neurodevelopmental disorder, and although the cause of the disease is not very clear, there are generally both family genetic factors and environmental factors. The prevalence of ADHD is generally reported to be 3–5%, and the male-to-female ratio is (4–9):1 [8]. The disease has a huge impact on the well-being of individual children and adolescents, judging from several sources of well-being analyzed above:

1. Peer relationship: ADHD’s individual peer relationship is generally poor, some hyperactive/impulsive individuals often have tantrums due to small things or even hit people when interacting with their peers, such ADHD-based individuals often feel that they have been bullied in school, and the occurrence of adverse events is always blamed on the outside—such as “it’s all his fault” or “I didn’t mean it, they pushed me first,” and similar incidents emerge endlessly. Over time, the surrounding classmates will become more and more reluctant to associate with him, more and more isolated from him, and this will bring more negative cognition to the individual, and his impulsive behavior will only increase [9]. Negative emotions are occasionally suppressed by teachers or parents, but if they slowly accumulate, it will inevitably be a “disaster,” and in China, the control of knives and firearms will make the results less bad, but such individuals appear in the United States and other Western countries, and it is difficult to imagine whether there will be such tragedies as school shootings. In addition, from the perspective of ADHD individuals themselves, the above situation usually occurs for a long time before the diagnosis is confirmed, and after the diagnosis comes another problem—stigmatizing the disease. In general, children and adolescents feel ashamed of mental illness, and this stigma is more obvious in children with ADHD because of the poor peer relationship mentioned above. Because people around him will use him as negative teaching material—“Look, that person is sick, let’s stay away from him”—thus aggravating the above situation.

2. Teacher-student relationship: The teacher-student relationship of individuals with ADHD is also often problematic, with individuals with predominance of attention deficit often experiencing wandering in class, while impulsive behavior of individuals with hyperactivity/impulsivity can cause greater distress to teachers [10]. Such children are often considered by teachers to be deliberately causing trouble before they are diagnosed, so there will inevitably be more conflicts between teachers and students. Some substitute teachers often feel that children’s lack of concentration in their own classes is disrespectful to themselves, so they will always answer questions by name to “recall” the child’s attention, but this way will make the child feel that the teacher is targeting himself, thus aggravating his rebellious psychology, but making the child more reluctant to listen to the class. Another part of the teacher often sees such individual impulsive behavior, will have a very poor impression of the child, so it is difficult to avoid the occasional wrongful child situation, such as ADHD individual and another classmate dispute, resulting in physical conflict, the teacher often feels that it is the problem of the child of the ADHD individual. When such situations increase day by day, the contradictions between teachers and students usually become irreconcilable, and it is not surprising that there is a poor teacher-student relationship, and even more physical conflicts.

3. Learning ability: ADHD individuals in this regard are undoubtedly more seriously impaired; learning is a process of receiving information, digesting information, and accumulating information, once the attention is not concentrated, its first step will appear to ask, such as difficulty concentrating in class, after school home to complete the homework attention cannot be concentrated, will represent its learning ability decline, parents often say that the child learning is particularly difficult. However, learning difficulties often occur gradually, and in general, ADHD individuals have basically no difficulty in learning in grades 1–2, and their grades can be maintained at the upper middle level, or even among the best because the IQ at this time can generally be compensated. After the 3rd grade, the homework gradually increases, the compensatory ability of IQ is insufficient, and the grades gradually decline. Of course, the decline of this grade can also be reversed, and there is a significant relationship between the attention of parents and teachers, teachers or parents strengthen counseling and supervision of learning, and the grades will rise; Conversely, if the teacher pays less attention and the parents are too busy to take care of the time, the grades will decline. And in the learning of ADHD individuals, the more simple the problem, the more prone to error, because ADHD children cannot concentrate, behavior is reckless, without understanding the meaning of the question in a hurry to answer the question, often in mathematical subjects: the front of each volume of the simple calculation, oral arithmetic, judgment, choice, fill in the blanks, etc. almost all lose points, the application of the problem, the solution of the equation can be done correctly. This creates doubts about the attitude of parents and parents—always feeling that the child is not unwilling, but unwilling, which in turn affects their family relationship. Of course, the study of theoretical knowledge of books does not represent all, such children often have the above problems when learning other types of knowledge and skills, such as children who practice the piano will make mistakes in their scores because of lack of concentration, and often miss the teacher’s teachings.

4. Family relationship: The family of an individual with ADHD has a misunderstanding of the child before its diagnosis, the family will generally feel that the child has deliberately made trouble, or deliberately does not go to school well, and the child will feel that the parents do not understand themselves, so the conflict gradually intensifies. Even if the later diagnosis is clear, the rift in the relationship is already difficult to repair [11]. From the perspective of parents, parents will feel that such children are difficult to manage, and children’s behavior often leads to parents being impatient, and gradually lack patience using rough authoritarian and rejecting parenting methods. This parent-child relationship further exacerbates the development of children’s bad behavior forming a vicious circle. Similarly, from the perspective of siblings, they will feel that such brothers (or sisters) make them feel “ashamed,” and even unwilling to mention it in front of classmates and friends, which is also relatively distant for ADHD individuals, and such a relationship will also cause the development of their bad behavior. Therefore, family discord is often triggered by the behavior of individuals ADHD individuals and enters a vicious circle.

The four aspects described above will also have various connections and influences on each other, and these four aspects will be used as four factors to form a new model—the functional progressive disintegration model. In the functional progressive disintegration model, the four nodes of peer relationship, teacher-student relationship, learning ability, and family relationship constitute a closed loop, and there will be interaction between each node. That is, peer relationships can affect both teacher-student relationships, learning abilities, and family relationships, as can the other three. The effect of these four nodes on the well-being of individuals exists at the same time.

Peer relationship is often greatly affected by family relationships, and good and harmonious family relationships often shape confident and sunny children, so that children will be more likely to interact with others and maintain good peer relationships. On the contrary, children with poor family relations will always be unconfident or even have inferiority, lack of security, etc. Such children often appear as two extremes in dealing with peer relationships, one is excessively flattering, such as listening to others to get people’s “care” or “attention”. The other extreme is not to suffer losses at all or take advantage of other people, to make themselves look like not to be trifled with.

For the teacher-student relationship, the learning ability factor and the peer relationship factor have a greater impact on it. Specifically, children with poor learning ability have a teacher-student relationship that is mostly worse than that of children with good learning ability, and children with good peer relationships do not need teachers to bother to manage socially in school, and they are naturally less worried than children with poor peer relationships and often contradictory children. Of course, the learning ability here is not simply measured by academic performance, in China also pays attention to the “moral, intellectual, physical, and aesthetic” comprehensive development. Children with strong learning abilities may not have very good results in some courses, but their efforts and serious attitude are the same as the embodiment of learning ability, and they will still be looked at by teachers, thereby strengthening the relationship between teachers and students.

Generally speaking, compared with the other two factors, the influence of the teacher-student relationship on learning ability is greater, we often hear children say “I don’t like this subject, because I don’t like this substitute teacher,” and a good teacher-student relationship will promote children’s interest in learning and achieve the purpose of enhancing learning ability. Then, on the other hand, a bad teacher-student relationship will lead to a child’s dislike of the teacher linked to the curriculum itself, which will not only cause the performance of this course to decline during the teacher’s teaching, but also more serious child will completely abandon the course, and even cause the performance of other subjects to plummet. Declining grades can hit an individual’s self-confidence, which in turn affects their ability to learn.

Family relations are a relatively independent factor, and the impact of the other three factors on it can be said to be not much different and may be slightly larger in terms of learning ability. The decline in the child’s learning ability will lead to an increase in the anxiety of the parents who are caregivers in the family, and it is inevitable that there will be impatience when dealing with the relationship with the child, which will lead to tension in the family relationship. Of course, family relations are not only related to the child’s learning ability, but also have a lot to do with the social functions of other members of the family, for example, a child who does not have a learning ability problem, if the social function of his family is very bad, the emotional ups and downs are large, then sooner or later it will still cause tension in family relations. In addition, studies have found that individuals with good family relations have not bad teacher-student relationships and peer relationships, which means that parents provide them with more emotional support, making them more willing to accept help from others, so as to obtain a more positive emotional experience and have a higher level of psychological capital [12].

When ADHD individuals encounter negative life events, negative stimuli are generated, functional progressive disintegration models begin to “start,” various factors gradually appear functional damage, each functional damage will lead to other functional damage, and eventually lead to serious damage to individual social functions, such individuals usually appear as irritable personality, incompatible with family, almost no interaction with classmates, and teachers are more like enemies, their grades are naturally a mess, and the well-being index must be negative at this time.

In general, for individuals with ADHD, the root cause of their well-being must lie in their disease, and the impact of the disease on them lies mainly in interpersonal relationships, such as relationships with peers, teachers, and family. Children with ADHD experience tension and constant frustration from an early age in their studies, work, and relationship interactions, and are often criticized and blamed by teachers, parents, siblings, and peers. After a few years, if this criticism and accusation are not diagnosed with ADHD, the child will feel “all my fault,” resulting in negative emotions such as obvious depression, and well-being is gone.

5. How to improve the well-being of individuals with ADHD

As mentioned earlier, the reason why the well-being of individuals with ADHD is low is closely related to the impact of the disease, so the first thing to solve is the treatment of the disease.

1. Medication: Medication is the basis for improving the core symptoms of ADHD. The use of drugs can improve academic performance, and the effect of drug therapy on ADHD is very good, and after taking the drug, attention can be concentrated, the effect of listening to lectures is improved, and academic performance will gradually improve [13]. Close cooperation between doctors, parents, and teachers is required when administering medications. To encourage treatment compliance,doctors should make parents and children aware that ADHD can affect learning, behavior, self-esteem, social skills, and family functioning, then provide parents with information on the causes of ADHD treatment, long-term prognosis, etc. Secondly, on the basis of family members having a comprehensive understanding of these problems, discuss the choice of treatment and side effects with parents, because there are many parents who are very concerned about the side effects of drugs, and most of the reasons for self-withdrawal are worry about side effects [14]. Finally, let parents understand that the education system plays an important role in the treatment and monitoring of children with ADHD, and obtain the cooperation of teachers. Establish a treatment alliance through doctors, parents, and teachers to develop an effective treatment plan.

2. Behavioral therapy: (1) Behavioral reinforcement. It is the result of giving a stimulus immediately after a particular behavior, which makes the behavior more likely to occur in the future or increases the incidence of that behavior; (2) Coupling contract. (a) In the form of a written agreement, in consultation with and with the consent of the child, it is clearly defined the behavior that the child should have and the conjugal result that will be obtained if the behavior occurs or not; (3) Token Law. Use tokens with a certain “value” to reinforce the desired target behavior. Tokens can be paper coupons, chips, little red stars, etc.; (4) Fade. refers to a behavioral treatment that no longer gives any reinforcement after the occurrence of a behavior, thereby reducing the incidence of the behavior or making it not occur; (5) Enhanced pause. Children are left unending for a period of time to inhibit their particular behavior [15].

3. Parent training: It is through scientific and systematic guidance for parents of children with ADHD, so that parents can better manage and guide their children. The most important thing is to guide the parents of the child to adopt a specific strategy to intervene in the child’s bad behavior one by one to achieve the purpose of alleviating or eliminating the bad behavior. The method of parent training is mainly to guide parents to effectively manage these behaviors in children, and to enhance compliance and self-control. When children’s compliance improves, there is also hope for improvement in behaviors that are not targeted. Some of the skills of parent training in managing children’s behavior are not only suitable for children with behavioral problems but also helpful for the education and management of normal children. This method has a good role in promoting the construction of a harmonious family environment.

4. School-based training: Educational interventions for ADHD students are key to improving academic achievement and classroom performance. Classroom learning educational interventions include highly structured instructional design and teacher guidance, environment-based environment creation, and self-management. Instructional design aims to provide ADHD students with a highly structured classroom structure, so that teaching is in line with students’ cognitive structure and thinking characteristics; Teacher guidance mainly provides additional resources for learning and behavior problems in the classroom in the introduction, management, and closure of the curriculum; environment creation adapts the classroom environment to the special needs of ADHD students, reducing distractions and increasing adaptability; self-management is the key to improving students’ ability to control the classroom. Structured instructional design, multifaceted teacher mentoring, diverse environment creation, and self-management enable ADHD students to adapt and actively participate in classroom learning to improve academic performance [16].

5. Cognitive level of ADHD individuals: To solve the child’s stigma of the disease, the following points must be done: 1) Family support. Good family support will give children endless confidence. 2) Do not avoid the disease, or even take the initiative to seek knowledge. When children really understand the disease, they may form the idea that the disease is like a cold, and if I insist on taking medicine, I can be cured. 3) School understanding. Because the group of children and adolescents is more or less classmates, the care of teachers and the understanding of classmates are also very important.

6. Conclusions

Around the world, the mental health of children and adolescents is receiving more and more attention, and child psychology and psychiatry experts are actively exploring various remedies for mental illness and mental illness. Well-being is a positive emotion and perception that also reflects good mental health. With the rebound of the epidemic, the well-being index of children and adolescents has been declining, and this time we have explored the well-being of such a special group of people—ADHD individuals. The well-being of individuals with ADHD is generally lower than that of normal children and adolescents, and the root cause of this phenomenon is inseparable from the disease itself, but the direct cause is inseparable from the environment around them.

Peer relationships, teacher-student relationships, learning abilities, and family relationships are considered to be direct factors affecting their well-being, and ADHD has a great influence on these four factors, and these four factors are also considered to have various connections and influences, thus forming a functional progressive disintegration model. In this model, the four factors are both functional embodiment and influencing factors, with the generation of negative stimuli, the negative cycle begins, the functions disintegrate, and the individual’s social functions gradually decline, eventually leading to serious consequences.

For such individuals, it is necessary to identify as early as possible, intervene as early as possible, and treat as soon as possible. Treatment includes medication and behavioral therapy, and parents should also be trained to know how to get along with their children, enhance their children’s well-being, and improve their social functioning. Schools should also upgrade the relevant curriculum to provide personalized classrooms for these children, so as to improve the functions of children with ADHD and enhance their well-being from several aspects. From the perspective of the affected individual, it is necessary to strive to break the stigma of the disease, not to think too terrible, but also to maintain a considerable degree of attention. Just like we treat the enemy, we despise the enemy strategically and value the enemy tactically.

Conflict of interest

The authors declare no conflict of interest.