Attention-deficit/hyperactivity disorder: a systems perspective. A comprehensive qualitative analysis of the literature

Abstract

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurological syndrome resulting in problems with self-regulation. ADHD is characterized by inattention and/or hyperactivity-impulsivity which causes impairment in at least two settings. These characteristics often arise in childhood and were previously thought to diminish during adolescence and disappear by adulthood. However, studies over the past decade indicate that although some symptoms may decrease in severity, ADHD does continue throughout adulthood for many individuals. The impact of this disorder is felt not only by the individuals with ADHD, but also by the various systems in which these individuals live, work, and socialize. In this comprehensive analysis of the literature ADHD is discussed from a systemic perspective. Initially the symptoms and characteristics that define ADHD are reviewed along with other disorders that commonly coexist with ADHD, and what research tells us does and does not cause ADHD and the development of the co-morbid disorders. Prevalence of ADHD and co-morbidity is also reviewed. The term “system” is defined and the various systems presented as related to this topic, from the micro-system of the individual to the macro-system of society at large. As the characteristics of ADHD are exhibited inconsistently according to the age of the individual and the context of the interaction, these are addressed, as appropriate, in the categories of child, adolescent/teen, and adult for each system. The first system discussed is the internal system of the individual in which ADHD resides. This micro-system consists of the biological, intellectual, and psychological components. This is followed by examination of this micro-system of the individual interacting in the family system, both nuclear and extended. The common effects on other family members in the system and the system as a whole are discussed. With understanding of the individual and his/her family with ADHD as a foundation, the view is broadened to other systems in which both the individual and his/her family operate. The discussion includes the reciprocal effects of ADHD and the educational, employment, social/recreational, and legal systems, as well as the influence of interactions between these systems. The presentation of the pervasive impact of ADHD on all systems is followed by analysis of the different treatment options and effectiveness. Included are interventions in the areas of interpersonal relationships within the family, social relationships, leisure/recreation, school, work, and in the legal arena. Since the acceptance and attitude about ADHD are important factors in interaction and treatment effectiveness, these are also investigated throughout. A summary of the analysis of the literature is presented in the second chapter. This is followed by conclusions and a discussion of implications for marriage and family therapists.