The assessment and treatment of children with attention deficit hyperactivity disorder (ADHD) tend to be heavily adult centered and disease based. This approach reflects little insight into the subjective life experience of children with ADHD and tends to limit treatment options to pharmacological and behavioral focused interventions. Evidence suggests that, while this approach to treatment can mediate the immediate impact of ADHD symptoms, it does not improve health outcomes. This study addressed this concern by engaging children with ADHD in a developmentally sensitive way to explore what makes their life “really good.” Two broad questions guided the study: (1) What might be learned if children with ADHD were engaged in a developmentally sensitive way? (2) How might the children's own sense of well-being inform clinical practice and/or treatment strategies? This study was based on the understanding that children experience life based on their own perceived view, situation, and social position, separate from the perspective of others.
Twenty children (age 7-11) diagnosed with ADHD participated in this study. One of the co-researchers met each child and his or her parent in a mutually agreed-upon location (e.g., private home, public library, community center). Most of the children -- after being given the option of having his or her parent in or out of the interview room -- chose to have their parent wait outside the room. The seven parents who remained in the room did not interact with the child or researcher during the interview. A draw-and-tell conversation (DTC) approach framed the semi-structured interviews during which each child was asked to draw a picture about a time in their life that was “really good.” They were also asked to tell the researcher about the drawing. The interviews were audio-recorded and then transcribed verbatim. Each child's accompanying parent completed demographic and health-related forms, which included questions about the child's ADHD condition.
A qualitative analysis of the children's drawings and accompanying stories revealed three themes: activity, nature, and connections. Ninety percent of the children described engaging in some form of activity, often outdoors, and with others as a time that was "really good;" 85% referenced nature; and 65% referenced relational connections. While both urban and rural participants referenced nature, this theme was more consistent with the rural children (however given the small number of urban participants, this finding should be interpreted with caution).
According to the researchers, the outdoor and nature-focused themes highlight the restorative effects of nature and reinforce the concept of biophilia (affinity for the natural world). While biophilia may apply to all children, the implications and/or impact of this natural affinity may be especially important for children with ADHD.
The child-granted insights generated through this research indicate that cultivating well-being through activities, nature, and connections should be a focus of intervention for children with ADHD. Examples of non-pharmacological and health promoting interventions include Nature Clubs for Families and Green Schoolyards -- initiatives developed by the Children and Nature Network. Such interventions reflect an important move beyond symptom mitigation to the promotion of life satisfaction for children with ADHD.
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